"TEN STEPS DR SHRINIWAS KASHALIKAR"
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