TEN STEPS DR SHRINIWAS KASHALIKAR

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TEN STEPS DR SHRINIWAS KASHALIKAR Powered By Docstoc
					Ten Steps
To Be a Successful Doctor

Dr Shriniwas Kashalikar
M.B.B.S., M.D., D.Sc. [OIUCM],
Fellow of Indian College of Gerontology [Mumbai],
Foreign Faculty Fellow of Basic Medical Sciences; (Medical
University of South Carolina and Educational Commission for
Foreign Medical Graduates) USA
No cure of the part should
   be attempted without
    treatment the whole
   NO attempt should be
  made to treat the body
       without the soul
               *
       All that Heals is
          Medicine
             *
1. Accept, love and respect your patients
   unconditionally: it promotes healing
2. Your patients already have a healer within:
   Invoke him!
3. Educational policy [Including medical
   education] affects the health of millions
   including you and your patients!
4. Take care of yourself!
5 Teach them win-win formula
6. Time Management
7. Be profound and wise, not simple and
   straightforward
8. Discuss with pharmaceuticals the
   perspective global welfare
9. Do not get imposed and do not impose
   yourself.
10. Be a leader and not follower.
1. Accept, love and respect your
patients unconditionally: it
promotes healing
Consider this experience of mine in a clinic. I had
gone to a pathologist with another friend of mine to
collect the blood reports. We were waiting in the
reception. My friend’s face was full of anxiety and his
eyes reflected a strange feeling of helplessness and
suffocation. Being close to him I was aware of the
financial and other stresses he was going through. I
was also aware as to why he was undergoing different
blood tests.

After some time full of tension and pressure the
pathologist called us.

As soon as we entered he turned ferocious and started
scolding my friend, for indulging.
  He was so precipitous and incessant that my
friend could nothing but only listen in shame.
  After the pathologist finished his bombardment
his eyes began to emanate the contempt and pity.
  The pathologist had satisfaction on his face for
having fulfilled what he considered his duty.

  My friend was drowned in self-pity and guilt. He
appeared far sicker now than when he had entered
the lab.

 It was becoming unbearable now.

  Some how I changed the topic, finished the
formalities of payment, thanked the pathologist
and came out.

  My friend said, “I would prefer to die in dignity
than getting harassed here and everywhere. Why
don’t people understand that I am being
suffocated by repeated failures and unending
deceptions. I am not able to cope and hence trying
escape from time to time though with
counterproductive effects. Really, disease is not
killing me. But I am killed every now and then this
leaving death is forcing me into disease and its
sequel the final death.” His eyes filled with tears.

 He headed in the direction of a bar!

 Let us consider another experience.

  I had taken my fried to an orthopedic surgeon.
My friend was in agony, due to severe soft tissue in
inflammation in his leg muscle. After careful
examination and discussion with the patient the
doctor advised the patient about care to be taken.
  I, being aware of the smoking habit of the
patient asked the surgeon if it was essential to quit
smoking.
  To my surprise the surgeon smiled and said,
“Already he is in pain and agony. Considering the
prose and cons, I would not like to deprive the
patient of his small pleasure”
  My friend appeared solaced and in deep sense of
gratitude for the considerate gesture of the doctor.
  After we came out of the clinic, having relieved
by the doctor’s permission to smoke, I was
expecting him to take out and light a cigarette.
  But he did not. On the contrary he gradually
quit smoking altogether.

 Now let us consider yet another experience!

  I had taken my friend to a sex specialist.
  Right in the beginning the sex specialist welcome
us warm greetings. Then after making us
comfortable he just made a remark indicating that
sexual disorders do not signify any kind of
inferiority and or criminal mentality. Thus first
indirectly and then directly suggested to us that we
should accept the given situation unconditionally
[without guilt and lowliness], love it [i.e. not to
despise and resent it] and then respect it [i.e. [
avoid casual approach and take deep interest
involve in careful study and conquer it].
   Then he began to take detailed history and my
friend revealed his heart and all the facts with full
confidence.
   The sex specialist now examined the patient
thoroughly well.
   After examination, the doctor discussed several
issues such as in laws, children, job, wife’s job,
wife’s health status, her perspective or vision of
life, hobbies which apparently appeared to be
unrelated to sexual problem. Then the doctor
wrote in details his prescription and suggested that
the whole family visit his clinic for more complete
benefits and even more, better quality of life.
   Some days later, I met my friend. This time he
was with wife and there was that beautiful broad
smile on their face. Their eyes were sparkling with
happiness and contentment.
   Without me asking them any further, they
ecstatically exclaimed about the wonderful results.
   I requested them to divulge few things if they
could without being embarrassed, so that I could
use that information for benefit of others.
   They said, “The doctor gave us new life. He gave
new vision. He gave new dimension. He
empowered us to express the best within us for the
society and for ourselves. He gave us detailed
knowledge about the realm of instincts and their
role in life. He later elucidated in details the role of
sexual/reproductive instinct, courtship, pregnancy
care, parental instinct, rearing the baby, effects of
our emotions and thoughts on sexual gratification
and how to minimize the damage caused by a
variety of stressors on our happiness [which
heavily depended on our sexual happiness]. He
gave books on stress management and introduced
a stress management expert. As a result apart
from getting sexual fulfillment [by properly
managing the stress] we are conquering blood
pressure, diabetes and many ailments related to
stress. In fact we have started getting results in
terms regaining our youth, vigor and fulfillment in
life!
   Now I was beginning to understand the meaning
of “Accepting unconditionally, loving
unconditionally and respecting unconditionally”!
2. Your patients already have a
healer within: Invoke him!
  Let us go through this letter from my friend. She
is a doctor herself.

  “Dear Dr
  Thank you for your concern about my backache.
  Considering your interests, I would like to
elaborate a little more on it.
  It is true that the backache troubled me a lot.
But since I was having a variety of differential
diagnoses in my mind, I was afraid that I would
have to undergo plethora of investigations and
possibly undergo a major surgery! Hence I was
reluctant to see a doctor.
  But the discomfort went on increasing. Finally I
decided to contact a consultant friend of mine. I
phoned her. After talking few things, I conveyed to
her my problem.
  On phone itself she shouted, “How come you
have waited so much? It is essential to do
ultrasonography urgently. It could be prolapsed
disc. It could be lumbar canal stenosis,
tuberculosis of bone, endometriosis some other
malignancy with secondaries…..”

  I was shocked! Hearing to all this all my fear was
as if endorsed. I felt as if I already entered some
terminal sickness. I was terrified. Chills swept
throughout my spine like electric current. I began
to shiver with fear and started perspiring.
Somehow I finished the phone call. What I was
trying to negate had appeared in front of me with
menacing face! Now what to do? I was trying to
negate all these possibilities because I wanted to
some how avoid hospitalization, investigations and
surgery. Apart from the thought of expenses,
unpleasant atmosphere, doubtful outcome and
above all; suffering! Moreover; I had so many
preoccupations, obligations and responsibilities to
fulfill.
  I repented for having made the phone call! But
there was nothing I could to then! I did not speak
anything to my husband, as I did not want to add
to his stress. I thought, he would be shaken by the
content of our telephonic conversation.
  Somehow I spent that night in extreme anxiety
and next day morning I went to a friend’s place.
This friend of mine; a simple housewife,
immediately reassured me and instantly took me
to her family physician.
  Since she personally accompanied me, I was
feeling greatly relieved. However my anxiety
reflected on my face.
  The doctor took me in the examination room
along with my friend and examined me clinically.
  Then the doctor asked few questions about my
personal, menstrual and family and past
background.
  He seemed quite satisfied with my dietary and
exercise habits.
  Looking at my anxious face with pleasing smile,
he affirmed, “Nothing has to be done”.
  “But what about the pain? Any investigations?
Any internal medicines? Any external
applications?”
  His face reflected supreme confidence. He
repeated with emphasis on every word, “Nothing
is required. Continue your exercises and add some
yoga techniques, which I would teach you. You
would be alright within a week!”
  This was a reverse shock! Decompression!
Relief! Freedom from tons of burden! I breathed a
sigh of huge relief!
  I began to thank the doctor profusely. But the
doctor seemed to be in bliss for what he done
spontaneously and most naturally; and oblivious
to my thanks!
  Within a week I became all right. I contacted my
housewife friend and went back to give the feed
back.
  The doctor received us with smile and then
explained to me that as a result of expectations of
the patients and their relatives, expectations of the
society, quest for glamour and glitter, desire for
power and quick money, fierce competition,
various policies, rules and regulations, demands of
family, financial liabilities, pharmaceutical
propaganda such many factors and most
importantly; their own inability to manage the
stress; the doctors are under enormous stress. He
said, “Doctors are really undergoing enormous
turmoil within! Conceptual chaos and value crisis
is taking toll of them! They are not able to
exercise clinical judgment. Please don’t blame
them!”
  Looking at my friend’s brightened face he
further said, “Your doctor friend has forgotten
your clinical wisdom because of stresses and
strains in life. Hence she gave lop sided weightage
to the differential diagnoses. Hence the fears were
compounded!”
  Waiting for a while the doctor added, “ Stresses
and strains have not only blinded the clinical
acumen of doctors, but their ability to see the
fountain of strength within themselves and their
patients as well! This has made them weak.
Weakness perpetuates weakness! I only can be
complimented for retaining my clinical acumen
and ability to see the healing power within myself
and within you. That is why I asked your friend to
humbly suggest you a traditional way to invoke
and experience the healer within oneself and the
others!”!

  Dear Dr I feel happy to share with you the joy of
relief from not merely backache but regaining my
clinical acumen and healer within myself. Now I
am able to invokve my patients’ healing abilities in
their getting healthier and happier!”
  Thanking you once again,
  Sincerely,
  Dr. Shraddha “

 Dr. Shraddha’s story is self-explanatory.

  However, Dr. Shraddha has not mentioned two
points about her background. I think they will be
of benefit to all of us.
  First point is: Dr. Shraddha was one of the
toppers in her school and college career. She was a
not merely intelligent but a very charming sensible
girl. However in the course of medical training,
she seemed to be getting frustrated. Her curiosity
seemed to be suppressed. Her concern for the
patient seemed to be laughed at rather than
nurtured. Her quest for the happiness of the
patients appeared to be treated as in vein and
utopian. After entering into practice along with
her husband she seemed to be increasingly
disillusioned with medical profession. She had
begun to indulge and some how cope with. But her
melancholy was on the rise. This had begun to get
reflected on her physical health. Gradually she
had started losing weight, graying, wrinkling,
darkening, and getting arthritis and many other
complaints. She had begun to lose confidence and
had become phobic and feeble. In view of these
effects of stress damaging subconsciously, her
backache had been only the tip of the iceberg!
  The second point: The doctor who treated her
effectively had taken care of these points with the
help of Dr. Shraddha’s housewife friend [who is
trained in Total Stress Management and acted as a
support system for Dr. Shraddha]. As a result Dr.
Dr. Shraddha is showing beneficial effects on all
the organs and organ systems and her over all
personality. She is fairer, stronger, confident,
quick and agile. She has started looking younger
and exudes happiness. From academic point of
view Dr. Shraddha has begun to imbibe
perspective of holistic health and holistic medicine.
Her approach has become eclectic. Her patients
get far more options than they were getting earlier.
From professional point of view; her practice has
multiplied.
  In short, her patients, her family and she herself
are all happier and healthier!
 3. Educational policy [Including
medical education] affects the
health of millions including you
and your patients!
   My friend has roaring practice as a pediatrician.
Once I asked the secret of her practice.
   She said, “It is very difficult to pin point to any
particular “secret”, but probably my perspective is
working good for me and my patients.”
   I asked what she meant by that.
   She replied, “In the course of my practice I
started realizing that mastering Nelson’s
pediatrics is not enough! It is important to study
the stress that is playing havoc in the children’s
life. I also began to realize how stress affected my
own personality. So I decided to study the stress,
its dimensions and understand the vast number
factors [not described medical text books]
affecting health. Having appreciated the
importance of these factors; I began to educate the
parents and relatives of my little patients about
dimensions of stress and how to cope with them. I
think it is this understanding that has given
human touch to my interactions with my patients
and that is working well!”
  “Can you give an example of how you educate
your patients’ parents and relatives?”
  “Yes. I gist of what I teach is as follows.”
  “Education is defined in various ways but it can
be safely said to have FOUR domains, which are
as follows.
  The first domain is called AFFECTIVE
DOMAIN. This means the state of mind. In simple
words affective domain relates to how we feel.
Thus when our mind is full of alertness, attention,
enthusiasm, buoyancy, affection, concern, joy,
tolerance, self esteem, mutual respect, mutual
trust, commitment, dedication, confidence, positive
and victorious spirit, we would call it healthy
affective domain. In addition the zeal and
concentration needed in the pursuit of excellence
in intellectual field, tenacity and endurance
required in skillful activities and patience and
commitment essential for “satisfying and socially
beneficial actions” constitute affective domain.
The purpose of education is to nurture this domain
by designing suitable curricula and syllabi.
  The second domain of education is called
PSYCHOMOTOR DOMAIN. This implies ability
to appreciate skills and ability to perform physical
and mental skills, with speed, accuracy, elegance,
ease of performance etc. This may involve
appreciation and performance of skills such as
surgery, playing a musical instrument, playing
basketball or doing carpentry! The purpose of
education is to nurture this domain through
designing suitable curriculums, syllabuses; but
also by providing sufficient practical and
demonstration classes with all the necessary
equipment.
  The third domain is called COGNITIVE
DOMAIN. Cognitive domain incorporates
accurate perspective, contemplation, correct
perception understanding, conceptualization,
analysis and recall of problems, ability to evaluate,
synthesize, correlate and make decisions, make
appropriate policies, plans and expertise in the
management, administration, etc.
  It is clear that all the domains have three
components viz. cognition [Perception], affect
[Feelings] and conation [Response].
  And fourth domain is productive domain!
  Let us consider the traditional system (in India)
in a dispassionate manner and scrutinize the
merits and demerits. It is obvious that we will not
be able to consider all the details of the system as
they varied from time to time and from place to
place. But a general review of the system would
help us to rectify the education system! This can be
done only if we rise above the petty considerations
of religion, region, caste, political power and other
vested interests. This would help us rectify the
present education system.
  Conversely, unless the existing education system
is rectified appropriately subsequent generations
may not be able to develop the four domains of
education adequately and hence won’t be able to
be healthy enough.
   Many of you may argue here that this task
cannot be accomplished by common people, but
can be successfully accomplished only by the
politicians, political advisors, the decision-makers
and the top administrators.
  This argument is partially valid, but not
completely. It has to be appreciated that no
statesman, no political leader, no policy maker and
no administrator can bring about change in an
existing system unless, there is consensus about
these changes in the vast majority of people whose
cooperation in such matters is very vital.
  So let us take at least a cursory look at the
traditional system of education in India.
  The traditional education system in general
ensured that:
  a] Careers were not selected on the basis of
monetary gains,
  b] Careers were not selected arbitrarily on the
basis of idiosyncrasies and whims,
  c] Some lucrative careers could not be sought
after, in preference to the others,
  d] All careers ensured income and production
from early age,
  e] All careers ensured that society was benefited,
  f] All careers ensured security to all the social
groups,
  g] All the careers ensured intimacy and closeness
between young and old in the families.
  h] All careers ensured ethical education and
passage of experience from generation to
generation.
  In my view these were merits.
  But it is probably true but not entirely clear if
  A] The traditional system was marked by
deprivation of scholastic education to many
people,
  B] It was also marked by apparently
unjustifiable distribution of a variety of jobs
amongst different castes.
  C] It did not have the infrastructure for
collective scientific and technological efforts.
  D] It suppressed the talents and individual
aspirations amongst the children and parents from
many castes.
   E] It had an element of arbitrary imposition of
hierarchy and exploitation.
   As the education shifted from homes, home
industries and farms to; nurseries, K.G. schools,
schools, colleges, universities, corporate industries,
research institutions etc.
   Cognitive domain suffered because of:
   a] Huge number of students, in a single class
making following three things almost impossible.
These things are i] individual attention ii] dialogue
iii] discussions,
   b] Lack of adequate salary, accountability,
incentive and economic security to the teachers
taking away the initiative of nurturing cognitive
domain
   c] Increase in alienation with respect to student’s
background and aptitude
   d] Lack of adequate incentive to the students in
the form of creativity, production and earning,
service to the family and service to the nation
[thereby thwarting motivation required for
building up cognitive domain]
  e] Lack of conviction essential in the growth of
cognitive domain in the teachers and students
because of outdated practical and demonstration
classes, lack of interdisciplinary dialogue and in
general the irrelevance of education to the realities
of day to day life in as much as almost predictable
consecutive unemployment at the end! The lack of
conviction could be partly due to lack of
participation by teachers in decision-making,
policy making, development of curricula, syllabi
etc.
  f] Emphasis on recall and hence rote learning
thereby denying free inquiry, reading, questioning
etc. thereby directly thwarting the cognitive
domain
  g]] Too many examinations with irrelevant
parameters or criteria of evaluation [besides being
unfair in many instances] leading to misguided
and in most cases counterproductive efforts thus
adversely affecting the cognitive domain
  h] Competitions where the manipulative skills,
callousness, selfishness are given more respect,
[thereby destroying the enthusiasm of growing in
cognitive domain]
  i] Information explosion affecting cognitive
domain by either causing enormous and
unnecessary burden on memory or inferiority
complex
  j] Pressure of interviews causing constant tension
and sense of inadequacy, right from the tender
age,
  k] Protracted hours of homework in schools
denying the students their legitimate right to enjoy
their childhood [causing hypokinetic stress, denial
of parental rearing] and make them physically,
mentally and intellectually unfit to grow in
cognitive domain
  l] Irrelevant and unnecessary information
loading in lectures in the form of monologue,
leading to suppression of the spontaneity,
originality, interest and enthusiasm so much
required in cognitive development amongst the
students,
  Affective domain suffered due to,
  A] Isolation of the children from their parents
and their domestic environment at an early age
[Making the parents also equally sad]
  B] Lack of warm bonds due to huge number,
  C] Cut throat competition,
  D] Inadequate facilities of sports, trekking,
educational tours, recreation and physical
development etc
  E] Alienation from one’s social environment and
culture
  Psychomotor domain suffered due to
  A] Almost total lack of opportunities to actually
participate in skillful activities such as drawing,
painting, sewing, sculpturing, carpentry, knitting,
weaving, music, agriculture, horticulture, other
handicrafts, various sports, performing arts etc.
  It is important to realize that promotion of
psychomotor domain is evident but in its
caricature form. It has no concrete economic
realistic basis. The activities have no economic
incentive and no productive element.
  The present education system basically and
almost completely prevents a huge section of
society such as teachers, students, clerks, servants,
sweepers and many others such as education
inspectors, etc. from being creative and
productive. In addition it causes colossal loss of
space, electricity, construction cost and so on. In
addition because of the typical emphasis on rote
learning it leads to phenomenal waste of
educational material such as paper, bags, pencils,
ball pens etc.
  Lack of productive element in education not only
causes colossal loss to nation but it also causes
economic loss to children while suppressing and
starving their psychomotor domain! The lack of
productive element and economic incentive is a
single most important cause of
  1] Reduction in the dignity of labor amongst
those who continue to learn, as well as reduction in
the income of the concerned families and the
nation
  2] Lack of education, lack of employment and
starvation or criminalization amongst those who
are forced to drop out because of poverty [Note
that children in villages normally contribute to the
earning of the family].
  3] Inhuman suffering of those dropouts, who
somehow manage to get into cheap labor for
subsistence.
  It has to be appreciated that billions of rupees
are spent on construction, decoration and
maintenance of schools and colleges. Billions more
are spent on payment of millions of teachers and
other staff members engaged in unproductive
exercises. Billions are spent on electricity, and so
called educational material. Billions more are
spent on the exams conducted to test the “capacity
and merit of rote learning”. This way we weaken
the national economy, jeopardize the
developmental activities and force millions of
students to drop out due to economic reasons and
get into the hell of child labor, besides starving and
suppressing the cognitive, affective and
psychomotor domains of millions who are in
schools. In short, present day education system
harnesses [amongst those who continue to learn]
arrogance coupled with lack of confidence leaving
all the domains viz. cognitive, psychomotor and
affective, [including creative and productive skills
and physical health] defective, deficient and
underdeveloped. Further, when this education
fails to give a job, it tends to create vindictive
attitude transforming an individual into a criminal
or develops frustration and transforms an
individual into a mental wreck.
  It must be appreciated that some institutions and
individuals are making illustrious efforts in the
direction of rectifying the education at their level.
  But the mainstream education system has to
ensure that the student must have economic
incentive for what he/she is privileged to make.
Besides, everybody connected with education
directly or indirectly must be involved in
production or service.
  Everyday; approximately
  20 % of the time must be spent in production of
suitable items and service can involve community
projects such plantation, cleanliness etc.
  20 % of the time must be spent in physical
activities such as sports, exercise, trekking, hiking
etc.
  20 % of the time must be spent in personality
development i.e. broadening of perspective
through various means such as invited guest
lectures, seminars, discussions on holistic health,
educational tours and visits to places where the
student gets exposed to rapid developments in the
society such as laboratories, airports, government
offices, share market, farms etc
  20 % of the time must be spent in entertainment
such as playing musical instruments, dance,
painting or anything that makes a student happy
such as mimicry, singing, story telling, drama,
movie etc]
  20 % of the time must be spent on cognitive
domain i.e. study of languages, history, geography,
mathematics etc with utmost emphasis on
interpretation and relevance in day to day life.
Thus typical questions in the examination of
history, languages should be totally done away
with. The subject such as economics, psychology,
civics, philosophy, logic, sociology etc must include
field work and made relevant to the present
society”.
  Finally I conclude by saying, “If we are able to
rectify the education system (not only in India but
all over the world including medical education),
then hypo kinetic stress, stress resulting from rote
learning, undue tension of the examination
success, cancerous growth of copying, corruption
for getting grant, and consequent stress can be
prevented. Indeed, drop outs from school, child
labor, unemployment and corrupt practices affect
our health and cannot be ignored by anyone
aspiring for holistic health i.e. global welfare!”
  I am sure you saw in the above instance; how
you can make the life worthwhile and truly
successful!

 *****
 4. Take care of yourself!
  There is a glaring example of a young doctor!
  He is a physician. He stared practice and by
virtue of his merits started getting good work. His
income started swelling! His market demand also
grew. Pharmaceutical companies started
sponsoring him for conferences. Gifts started
pouring in. His busy practice started keeping him
awake at late nights.
  He started getting hardly any time for his family.
The communication amongst the family members
began to dwindle. Initially his wife and children
complained. But he did not give much importance
to it. He thought it was more important to secure
them by earning more money. Gradually his wife
and children developed distance. They seemed to
stop needing his company. They seemed to; no
more require dialogue with him.
   It was after some years that he sensed this
change. Those dry expressions, those lusterless
eyes and those curt words struck him.
   He realized that something was going wrong
somewhere.
   He went to one of his old teachers. He narrated
these things and sought his advice.
   His teacher carefully listened to his grievances.
In fact the grievances of his family members! He
could see that the strained relationships visibly
disturbed the young doctor. But; what more the
teacher noticed; was deterioration of the physical
health his past student!
   The teacher (himself a doctor; practicing holistic
medicine) had prepared a long questionnaire for
practicing doctors. The questions included detailed
clinical history, personal history, family history,
occupational history and so on. More importantly
it included questions regarding goals, aspirations,
purpose and ambitions in life.
   This young doctor began to think about these
questions! It was not easy to come to any
conclusion, as there were no readymade answers!
  After filling the whole questionnaire, the young
doctor admitted frankly that he was at a loss to
give satisfactory answers to questions such as goal
in life!
  Now the teacher said, “Don’t worry. The
questionnaire is not meant for filling; completely
and correctly. It is meant for making you aware of
hitherto concealed aspects of your personality.
Now that you have made attempt to fill it; let us
discuss further and come to some conclusions.
  After having protracted discussion the young
doctor realized that every one of us has body and
hence physical needs, instincts and instinctual
needs, emotions and emotional needs, intelligence
and intellectual needs and conscience and spiritual
needs!
  These needs give satisfaction in ascending order,
that lasts for longer time and that can be
distributed to larger number of people!
  On this background when he began to evaluate
his professional practice, he realized that he
grossly underestimated his spiritual, intellectual,
emotional, instinctual and even physical needs! He
realized that amongst these various needs he cared
for physical needs to some extent! Market forces,
media hype and illusory financial aspirations to
fulfill phantom physical needs of future were
dragging him! By getting engrossed in the practice
his ego and hence emotions also were gratified to a
certain extent.
  He now decided to give justice to his conscience
with utmost priority. He put the intellectual,
emotional, instinctual and physical needs in that
order.
  He realized that perspective of global welfare
adds new dimension and power to one’s being. He
realized that such perspective is a nurturing nectar
or ambrosia of life! It makes one happy and also
emanates healing happiness!
  He realized that conscientious intellectual
pursuit [and not obsessive one] adds holistic
perspective and hence clinical accuracy and
therapeutic efficiency. Moreover he grasped the
protective importance of intelligence in the quest
of justifying conscience and fulfilling emotional,
instinctual and physical needs!
  Now he had the way to find out what could give
him maximum happiness, that would last for
maximum time and that could be distributed to
maximum people.
  He reorganized his practice on this basis.
  He reaffirmed to himself that he would
consciously get completely committed to the total
welfare of the patient.
  He began to take keen interest in every patient
irrespective his personal likes and dislikes. This
enabled him to develop heart-to-heart
communication with every patient. Every patient
became his friend and family member. This
prompted him for active search for alternative
modalities of treatment, which could suit a
particular individual patient. He started giving
more time to his patients [by not getting obsessed
to see more patients in less time and get more fees].
His clinic became a source of peace and hope for
the patients.
  He stopped working at specific time of the day
[by resisting the temptation to get more money]
thus returning home in time. He began to take
interest in the rearing of the children and the
interests of all the family members. This
development was welcomed by one and all!
  Everyone got reunited with the bond of love and
care. The smiles returned! He realized what he
had missed and how valuable it was!
  The husband and wife once again began to share
optimum time and strengthened each other’s
convictions.
  Lastly, he began regular walk, exercise, yoga,
and swimming and involved his wife and children
in those activities. He paid scrupulous attention to
diet, clothes, environment and such varied factors
that could satisfy physical needs appropriately.

  After few days he met his teacher again.
  He asked the young doctor, “Are you satisfied
with your progress?”
  The young doctor was still hesitant! He was not
sure!
  The teacher smiled and said, “You are on right
track. You here onwards, have to reach the top
decision makers. You have to influence them
beneficially for the welfare of millions through
proper policies and decisions. This would satisfy
your spiritual domain and give you fulfillment.
For this; all of you need to practice and propagate
NMASMARAN”.
  The young doctor prostrated in front of the wise
teacher and returned home.
  Today this young doctor is not only being paid
his fat fees with great respect and gratitude but
doing very well on every front! What is more, he is
beginning to get into the position of opinion
maker!
 5. Teach them win-win formula
  Who is a successful practitioner? One who is
paid more? One who has more crowds? One who
works more?
  You must have seen doctors who are paid more,
but because; one has to pay them. Even as some
patients can easily afford; in most instances
payment is made reluctantly. One may agree that
such doctors are usually sought after because of
their expertise, lack of other options and practical
need. But what about fondness and love?
  Some doctors are very busy. Their clinics are
always crowded. If you look into the reasons, you
may find that they are inexpensive and easily
accessible. Thus here is also compulsion, financial
compulsion. Some times these doctors are “tried”
as first step.
  Some doctors work more. They are dedicated.
They may get genuinely faithful patients, but;
what about their families? What about their own
health? What about the time they should be
spending in academic pursuit?
  I don’t want to blame any of these categories of
doctors.
  But consider this example!
  Here is a neurosurgeon. He is in his clinic at
right time. He is fresh and enthusiastic. His staff
members welcome his arrival with joy and enjoy
his presence. He is confident and modest. He is
dignified and respects the dignity of his patients,
especially lady patients. The patients are
brightened by his reassuring gestures.
  He listens carefully and performs the clinical
examination meticulously. He makes decision that
suits the patients maximally. He is open-minded
and keeps as many options as possible.
  He is methodical and always ready to do any
work at any given moment.
  His staff members are always ready to help him.
They feel privileged to work with him.
  Apart from these qualities, he is extremely open-
minded and ready to learn from even his juniors!
He is always helpful and ready to teach his junior
colleagues.
  He is never seen showing tantrums at the time of
surgery. He does not lose temper. His nurses are
relaxed and alert at the time of surgery. He has
trained them very well.
  Apart from all this; there is no grumbling or
backbiting. He is never heard gossiping. When he
returns home he has all the satisfaction on his face.
  What is most important, everyone feels
victorious with every success of his, be it surgery,
be it guest lecture, be it winning an award, be it
publication of paper!
  You would agree with me, that he/she is a
successful practitioner, whom his/her patients,
colleagues, associates and everyone related to
him/her love. In other words, when people around
you participate in your success or failure; as if it is
their own; then that is success…. rather great
success!
  It is very essential therefore to learn and also to
explain the patients and their relatives, that three
formulas should be shunned!
  The first formula to be discarded is win-lose
formula.
  In this formula if the doctor succeeds, then he
would feel triumphant. He would take all the
credit. The patient’s relatives would prostrate [or
would be expected to prostrate] as “losers”.
  The doctor’s head would be bloated with pride
and arrogance and patients head would droop
down in meekness.
  Now the second formula to be discarded is lose-
win formula.
  Here the doctor loses. He declares his inability to
handle the patient or the doctor’s efforts fail and
the patient succumbs.
  The patient’s relatives having no trust and sense
of cooperation; would develop contempt and
hatred about the doctor as he is loser and patient’s
relatives would get excited aggressive and doctor
would go defensive.
  The third formula that needs to be rejected is
lose-lose formula.
  This is a strange formula where the both, doctor
as well as patient and/or patient’s relative would
act cynically and apathetically. Neither the doctor,
nor the patient/patient’s relatives would aim at
getting well. Together they accept the defeat
without struggle; as if determined to lose!
  Now the fourth formula to be taught and
adopted in every day life is win-win formula.
  In this win-win formula, patient’s recovery is
considered to be the success of the patient,
patient’s relatives as well as the doctor and his
team and all those involved directly and indirectly
including the manufacturers of the drugs! When
the doctor, the patient and the patient’s relatives
work together to win together, they usually win!
Not only they win but also they celebrate it as their
common success!
  The win-win formula is not only important for
becoming successful as a doctor, but it also assures
wellness cycle, in your life and in the life of every
one around you.
  Remember, all other formulas always throw us
in distress cycle. They result from as well as lead to
anxiety, violence, abusiveness, melancholy,
cynicism, and lack of appreciation,
disinterestedness, apathy and distrust in spouse,
child, friend, relatives and destroy one another.
6. Time management: a way to
greater efficiency
  “Three score summers when they are gone, will
appear as one!”
  “Time flies”
  “We listen to people saying, “If I had some time I
would have been able accomplish this!”
  It is indeed extremely important to use time in a
wise way! The wise use of time assures living to
maximum satisfaction!
  Sometimes people are seen asking their more
successful friend about how does he manage so
many things? How does he get time for it?
  They do not realize that everybody has twenty-
four hours of the day! No body gets extra time!
  Consider these points in time management and
judge for yourself if you could extract more
satisfaction and greater success!
  We should be cautious about our time but being
harsh disciplinarian usually brings more pain than
happiness! Being perfectionists also usually brings
more disappointment than satisfaction! Time
management is important but expecting others to
comply with your standards usually leads to
dismay and bitterness. Time is extremely precious.
But getting obsessed by time leads us nowhere. It
can turn you inhuman. It can take away the
humane and warm moments in your life! It can
deprive you of the excitement in life. Another point
about time management is taking the burden
about the future! The thought of “better time
management” in future obsesses us! Avoid it!
  How are you going to judge your success in time
management? Only financial yardsticks should not
evaluate time management!
  When it comes to social interactions, people do
expect us to spend our time for them. It is
important to assert our priorities in such
instances. We must learn to give due value to our
time and alertly protect it from being “stolen”!
  This is especially true if you are sensitive,
vulnerable and malleable!
  The other side of the coin is yearning for others’
company and time! Be particular about not
stealing other’s time as that person may despise
you in future.
  Time management involves keeping
appointments meticulously. Always keep your
appointments as that may involve time of many
individuals [e.g. meetings]
  It is rather preferable to make a habit of asking,
“Am I doing at present, what I prefer most?” Let
the future take its own course! Do not worry!
  One of the most important ways of time
management is to determine the sequence of
priority.
  First find out what is most important for you by
using the formula viz. what gives you maximum
happiness, for maximum time and that can be
distributed to maximum people. After you
determine what is most important for you, give it
top priority. This is called prioritization. After you
prioritize it, assert yourself by actually doing it.
  After you assert it you may like to repeat and
reinforce your satisfaction or you like to revise and
improve upon your performance. According to
this method, you generally succeed in fulfilling the
most important task and never regret for having
forgotten something vitally important.
  Another important point in time management is
using sense of proportion.
  Many of us spend exorbitant time to save small
amount of money. In the quest of getting better
bargain we go from shop to shop. We tend to
forget how valuable time is being wasted in the
process. The sense of proportion has to be
exercised while planning to buy certain
commodities. We tend to get bogged down by our
budgetary provisions and keep postponing
purchasing of certain commodities that would give
us great deal of comfort. It is important to realize
how much time of our life is going waste without
the enjoyment of those commodities. It is
important to make a quick and courageous
decision to purchase commodities, which would
improve the quality of our lives. Another aspect of
sense of proportion is waiting. Many of us tend to
wait for a bus to save money on taxi. We must
realize that we are depriving ourselves of precious
time that we could happily spend with spouse,
children or friends! This sense of proportion also
comes into play when it comes to appointing
housemaid, driver, assistant or other helpers. We
must learn to appreciate how much time we should
be saving to spend in more useful activities rather
than worrying about relatively less precious
money of salaries!
  The other way of time management is using
technology, human resources and other tricks.
  Thus, you can use telephone, SMS, email,
Internet, printed material, compact discs, and
videocassettes for effective communication with
large number of people in small time. Similarly
you can achieve education of large number of
patients in short time. This saves your time
tremendously. Talking to every patient can be
wasteful and can be tiring and irritating for you
and your patients and even their relatives!
  Another way of time management is to delegate
your work to suitable associates. But this requires
that you train your associates properly. Training
includes, inspiring, motivating and involving them
in your mission and also training them in technical
matters. If you are able to do this then your work
force, work output and satisfaction all multiply.
  Yet another trick is to do more than one thing at
a time!
  For example, when you take morning walk,
practice NAMASMARAN i.e. remember the name
of God [if you don’t strongly disbelieve in God]
and simultaneously harmonize abdominal
breathing with your steps.
  When you watch news on T.V., use techniques of
reflexology or acupressure, or do head massage.
Head massage can ensure comfort to your head,
improve your sleep, improve the health your hair
and also get exercise to your hands and shoulders.
  Elderly or diabetic individuals can utilize the
time of T.V. watching by doing foot massage.
  You can perform foot exercises, leg exercise,
knee exercises or practice suitable yogasana also
while watching T.V. One can take food or a cup of
tea as well.
  One can take specific exercises of shoulders, neck
[BRAHMA MUDRA], back while watching T.V.
  One can practice some techniques such as
Bhramari, Kapalbhati, Ashvini Mudra, Bate’s
technique, Anulom Vilom while traveling (and not
driving) in bus, train, plane or car.
  Many of you may be already practicing this
trick. But what is important is now you can
appreciate its importance even more!

  Having discussed this much last for steps can
be simply stated!
  7. Simple and straight forward? No!
profound and wise!
  8. Discuss with pharmaceuticals the
perspective of global welfare, which is a
treasure of lifetime!
  9. Do not get imposed and donot impose
yourself.
  10 Be a leader and not a follower!
  The simple way to begin all this,
       is NAMASMARAN
          Try it and Verify

				
DOCUMENT INFO
Description: Dr. Shriniwas Kashalikar’s holistic, healing, empowering and enlightening interpretation; of the greatest ever treatise; on the principles of rejuvenation, revitalization and victorious blossoming of an individual and the universe; in every possible stressful situation anywhere; viz. Bhagavad Gita!