UDLCO CRH: Cultural differences between doctor patient clinical communication in Eastern vs Western ecosystems

Based on the conversational transcripts spanning 2015 and 2026 around patient autonomy in an Indian healthcare online learning ecosystem, below is the structured IMRAD summary, keywords, and thematic analysis of the legal, ethical, and cultural tensions surrounding patient autonomy.

IMRAD Summary

Introduction

The transition of healthcare from a traditional, localized dynamic into an era governed by digital medicine, ambient data, and modern statutory privacy frameworks introduces friction between clinical benevolence, family-led decision-making, and individual autonomy. This analysis evaluates an ethical dilemma originally debated in 2015: whether a physician should withhold a terminal lung cancer diagnosis from a "happy-go-lucky" patient at the urgent request of his son (who is also a doctor). It contrasts this legacy dilemma with updated 2026 perspectives under contemporary legal shifts, such as India’s Digital Personal Data Protection (DPDP) Act.

Methods

A qualitative, longitudinal analysis was conducted on educational and collaborative transcript datasets involving clinicians, medical students, and bioethics educators. The analysis traces a continuous ethical debate across two distinct eras: September 2015 (focusing on the Medical Council of India [MCI] Code of Ethics Regulations 2002 and Western-centric bioethical conventions) and March–May 2026 (evaluating the issue through modern data governance frameworks, medical student inputs, and cross-cultural ethical parameters).

Results

The findings reveal a decisive shift in how patient disclosure is managed over time:

• The 2015 Consensus: While a few participants defended non-disclosure on compassionate grounds to prevent existential misery, the majority argued that the patient has primacy over his body and a legal right to information under MCI regulations clause 2.3 and 7.14.

• The 2026 Re-evaluation: Modern participants rejected familial "gatekeeping" entirely, noting that hidden diagnoses cause psychological distress and a sense of betrayal. Furthermore, the 2026 regulatory framework explicitly solidifies this view; under the DPDP Act, the patient is legally codified as the sovereign "Data Principal," stripping away the family's power to intervene without explicit consent.

Discussion

The debate illustrates a breakdown of the traditional, paternalistic/familial informational framework in favor of strict legal individualism. While statutory laws like HIPAA in the US or the DPDP Act in India explicitly mandate individual autonomy, they frequently collide with the collectivist, socio-cultural realities of developing nations, where elderly patients often defer medical choices to senior family members. Rather than forcing a blunt Western template onto collectivist societies, the transcripts suggest utilizing compassionate, non-threatening communication models—such as metaphorical clinical explanations (e.g., comparing oncogenesis to ecological degradation)—alongside adaptive, legally sound governance to balance data privacy with cultural ecosystems.

Keywords

• Patient Autonomy

• Bioethics

• East-West Cultural Dichotomy

• Data Principal

• DPDP Act 2023

• Familial Gatekeeping

• Truth Disclosure

Thematic Analysis: East-West Cultural Differences Affecting Patient Autonomy

The transcripts expose a deep-seated tension between Western bioethical individualism and Eastern collectivist family dynamics. This conflict manifests across three distinct thematic dimensions.

1. Individual Autonomy vs. Familial Interdependence (The Dyadic Dynamic)

The foundational Western medical ethics model—codified by frameworks like HIPAA—views the patient as an atomized individual with absolute dominion over their clinical data.

In contrast, the Eastern or Asian clinical ecosystem historically relies on a dyadic or pluralistic framework where the family unit acts as an emotional and decision-making buffer. As highlighted in the transcripts:

• The Western Perspective: The doctor-patient relationship is an exclusive contractual agreement. The son's request to hide the diagnosis is legally irrelevant, and overriding the patient's right to know is viewed as an infringement on bodily integrity.

• The Asian/Collectivist Perspective: It is common for elderly or vulnerable family members to prefer that a senior relative manage severe health information to protect them from existential trauma. Some medical educators note that within this cultural context, shifting the burden of a terminal diagnosis away from the patient is viewed as an act of familial protection and love, rather than a violation of rights.

2. "Compassionate Deception" vs. The Legal Reality of Data Sovereignty

The conversations illustrate how cultural values of benevolence can directly conflict with evolving legislation:

• Benevolent Shielding: The 2015 debate included arguments that revealing a terminal timeline to a blissfully unaware patient is "cruel," equating it to telling a prisoner they are about to be executed. This reflects a traditional Eastern paternalistic approach where maximizing peace of mind in a patient’s final weeks outweighs the cold delivery of absolute truth.

• Legal Individualism (2026): By 2026, modern legislation leaves no room for benevolent deception. Under frameworks like the DPDP Act, the patient is strictly defined as the Data Principal, and the physician is the Data Fiduciary. This legally mandates that the patient owns their health data entirely. Consequently, cultural traditions of family-led shielding are actively overridden by statutory obligations that criminalize the withholding of information from the data owner.

3. Reconciling the Systemic Disconnect

The final transcripts highlight an operational dilemma for modern physicians trained in Western bioethical traditions but practicing within Eastern socio-cultural environments. When an elderly patient culturally expects their family to lead the conversation, but statutory privacy laws demand strict individual confidentiality, the healthcare provider faces a systemic disconnect.

The text suggests that the resolution lies in evolving a hybrid approach: utilizing nuanced communication strategies—such as gradual, metaphorical disclosures—to fulfill the legal requirement of truth-telling without destroying the supportive familial ecosystem that the patient relies upon.

Provide an imrad summary, keywords, thematic analysis focusing on East West cultural differences affecting patient autonomy as brought out in the conversational Transcripts below from 2015 as well as 2026

Conversational learning Transcripts:

[10/03/26, 23:48]hu1: If you could give one tip  to a cancer patient what would it beeeee

[11/03/26, 21:51]hu2: I shall

Answer the question below first:

A doctor’s healthy father suddenly started complaining of weakness, dyspnea and loss of appetite. A chronic smoker for many years, he was diagnosed with pulmonary cancer with few weeks to live. Keeping in mind his father’s happy go lucky nature, total ignorance of health issues and his own sadness for his father, the doctor did not disclose the diagnosis to his father. He asked the treating doctor not to tell his father either. One day the father came for consultation alone and asked the treating doctor point blank- what is wrong with me?

What should the treating doctor do?

a. Tell the entire truth and betray his friend’s trust?

b. Tell a white lie to his patient?

c. Any other choice?

Which is the way you would prefer and why? Can you suggest some other solution and why?

[11/03, 22:54]hu1: Good evening, I think the doctor should have explained the son in the start itself that it won't be right to gatekeep the verdict with the patient , because a reflection that nothing wrong is diagnosed and yet the patient is feeling something very wrong with his body would also be very distressing for the patient , moreover telling about the diagnosis along with a counsellor and providing adequate palliative care would've been a better solution for the patient than gatekeeping it from him and him suddenly not only getting a big 'bad news' but also a feeling of betrayal from his own family member

[12/03, 06:56]hu2: Well done 👏

[12/03, 07:27]hu2 : 

The above question was shared from a 10 year old e-mail sent to a group:

On Mon, Sep 21, 2015 at 10:25 PM, hu3> wrote:

Dear Dr hu2

Please send me your affiliation.

And thank you Dr.hu4 ...for taking my disclosure in the right spirit!😁

On Mon, Sep 21, 2015 at 10:11 PM, hu2> wrote:

Thanks Prof ... and all for this interesting discussion. 

My answer is 'c'

The patient is already aware that there is something wrong and his family is hiding that from him, so keeping him ill informed still may not be the right thing even if it is for a few weeks (again it may be months and is difficult to predict with a lung cancer)?

This query from Dr hu3 (and the previous one) hints at a traditional dyadic informational relationship between son and patient, doctor and son, patient and doctor slowly breaking down to make way for a newer pluralistic informational infrastructure? (more here: http://www.ncbi.nlm.nih.gov/pubmed/26123908). 

In my own practice i believe in a metaphorical approach to communicating with patients who have terminal illnesses (more here: http://annals.org/article.aspx?articleid=715632) and i often ask patients (such as the one under discussion) to look out of my office window and notice the upcoming concrete buildings where previously green forests and river streams reigned (my office actually overlooks a slowly dying Kaliasot forest and river). After that i inform them that this is exactly what is happening inside their body and it is possible that in time all the greenery will be eventually wiped out. 

No one can really predict how soon: weeks, months or years. All of us have this process going on within us and all of us will have to one day come to terms with dealing with the same dilemma and will need to face our imminent departure and provide for our loved ones before that. (more disease metaphors here: offline full text: http://searchworks.stanford.edu/view/7929525). 

best, 

On Mon, Sep 21, 2015 at 8:47 PM, hu5> wrote:

There is something in this case which we ought to keep in mind. That is "he was diagnosed with pulmonary cancer with few weeks to live". This is a very important fact. 

The other important fact is that he is a happy go lucky person "Bindaas" in nature.

Let us decide whether he should live those few weeks happily or in misery thinking about the death every moment of those weeks left for him on this planet?. Even  the animals-in-waiting in slaughter houses are kept in such a place from where the fate of the earlier animal is NOT visible to them.

The clinicians may not agree with me. Though I am a scientist and my researches were related to experimental radiation therapy in animal tumour models, I feel telling the truth to such a person is CRUEL He is not a criminal to be told about his coming death a few week ahead by hanging in advance. 

On Mon, Sep 21, 2015 at 3:33 PM, hu6> wrote:

There is caselaw on the right of the wife to know in cases of AIDS, for instance, but does it extend to all diseases?

On Mon, Sep 21, 2015 at 3:27 PM, hu7> wrote:

Dear Ma'm

It has been already reiterated by most that the father has a right to know about his illness.

I agree totally with that.

The treating doctor can call his friend, the patient's son, explain the dilemma,  and if possible disclose the diagnosis in the son's presence.

But if the son is still not in favor of disclosure, the doctor has to over-rule him and tell the patient, even if it is at the cost of a friendship.

The doctor, since he is a friend may also garner the support of someone else in the patient's family-his wife or other offspring.

In fact, what about the wife?

Shouldn't she know?

regards

On Mon, Sep 21, 2015 at 2:48 PM, hu6> wrote:

The question essentially is, who has a stronger right to one's bodily integrity? One's own self, or one's relatives? And the answer, of course, is the self. Unless the agency is questionable, but even then, the patient has primacy over the relatives, right?

On Mon, Sep 21, 2015 at 2:28 PM, hu8> wrote:

I instinctively seem to agree with hu9-any agreement to treat is between the patient and the doctor-most compassionate and empathetic way to tell him must surely be found –but he needs to be told

Regards

Monday, September 21, 2015 10:29 AM: hu9

 

​I am surprised by the method by which some of the respondents have arrived at their answer, rather than by their answers themselves.

​The query posed is not directed towards eliciting personal opinion on ideal physician behaviour, but rather to delineate the ethical conduct prescribed under the extant rules and regulations, including

Code of Ethics Regulations, 2002

http://www.mciindia.org/RulesandRegulations/CodeofMedicalEthicsRegulations2002.aspx 

prescribed by the MCI on the duties of the Physician. Hence, it may be appropriate to start by identifying the rules/regulations applicable to the fact-situation, and then infer the answer.  I find that the following clauses of the above regulations are applicable: 

1.3.2. If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.

2.3 Prognosis: The physician should neither exaggerate nor minimize the gravity of a patient’s condition. He should ensure himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition as will serve the best interests of the patient and the family.

7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except –

1.    in a court of law under orders of the Presiding Judge;

2.    in circumstances where there is a serious and identified risk to a specific person and / or community; and

3.    notifiable diseases

Therefore, I would say that the doctor has to disclose the true condition of his health to the patient. If he is applying 2.3, he has to personally ensure that such disclosure would not harm the patient. The opinion or recommendation of the patient's son in this matter is irrelevant, just as if the son had not been a doctor himself. 

best,

On Mon, Sep 21, 2015 at 7:31 AM, hu10 wrote:

Bioethical issues in medical practice

A patient’s right to information

A doctor’s healthy father suddenly started complaining of weakness, dyspnea and loss of appetite. A chronic smoker for many years, he was diagnosed with pulmonary cancer with few weeks to live. Keeping in mind his father’s happy go lucky nature, total ignorance of health issues and his own sadness for his father, the doctor did not disclose the diagnosis to his father. He asked the treating doctor not to tell his father either. One day the father came for consultation alone and asked the treating doctor point blank- what is wrong with me?

What should the treating doctor do?

a. Tell the entire truth and betray his friend’s trust?

b. Tell a white lie to his patient?

c. Any other choice?

Which is the way you would prefer and why? Can you suggest some other solution and why?

Do write in with views and your suggestions!

[12/03/26, 15:52] hu1: The forest thing sir😭😭😭

[12/03/26, 16:37]hu2: So once we destroy our forests we will try to build alternate sources for photosynthesis in our concrete jungles?

https://youtu.be/EZbre8l5KBc?si=Xy-dMMLgqB2AVgf-

Cellular receptor depletion in the early stages of oncogenesis is a critical mechanism by which precancerous cells evade detection by the immune system and overcome tumor-suppressive barriers like senescence. This process often involves the downregulation of specific receptors, such as the interferon-gamma receptor, which allows cells to avoid programmed cell death even in the presence of immune cells.

https://www.mdpi.com/2073-4409/10/9/2382

[31/05/26, 14:30]hu11: As per DPDP act, the patient is always the data principal and can do whatever he pleases. The doctor is always the data fiduciary/processor and needs to take consent from the patient.

[31/05/26, 15:49] hu12:

While I was taking AETCOM Class for UG Students in Ethics, I had referred to a published paper ( I would try to share here once I trace it in my records).

The point or context was Ethics & Culture in the USA. 

USA law discourages the doctor from discussing patient health details even with relatives without the patient's consent. 

But it was noted that in the context of the Asian patients, particularly for elder or female patients, the patient want the senior male member of the family take the decision on patient's behalf. In the Asian cultural context it is considered to be perfectly OK.

But now the challenge  & dilemma was for the doctors trained in western systems. 

whether it is ethically correct to discuss the patient's health details with the relatives without the patient's consent?

The HIPPA act in USA & Data Privacy Act in EU have been prevented from the western world's perspective, and are correct.

My question is, considering the socio-cultural plus healthcare systems realities in the developing countries, how we can balance data privacy within the socio-cultural & healthcare eo-system realities.

UDLCO CRH: Why I didn't take up a career in surgery

 Summary

• Introduction: Selecting a medical specialty is a pivotal milestone in a clinician's professional identity. This analysis evaluates conversational and narrative transcripts from two medical practitioners to understand how undergraduate experiences, evolving technological paradigms, and early clinical exposures guide medical students toward or away from specific fields.

• Methods: The text applies qualitative narrative analysis to first-person reflective accounts from two alumni of Indian medical training programs. The analysis focuses on their shifts in perspective regarding Internal Medicine and General Surgery during their clinical terms and internships.

• 
  

• Results: Career choices are shaped by three distinct factors. First, historical context matters: the lack of advanced imaging and interventional therapies in the 1970s made internal medicine feel like an exercise in "control without cure," driving one practitioner toward the immediate, definitive interventions of surgery. Second, a physician's autonomy plays a role: surgery appeals to students who want direct control over the outcome, bypassing the unpredictable nature of patient compliance with long-term medications. Third, early clinical exposure can alter expectations: when a student witnesses a premature surgical recommendation or recognizes the repetitive nature of routine procedures, their interest can shift away from surgery toward more complex medical diagnostics.

• Discussion: Student life acts as a testing ground where clinical experiences interact with a student's personal goals and temperament. For one student, the desire for immediate, definitive cures outweighed the intellectual satisfaction of bedside diagnostics. For the other, witnessing defensive or routine surgical practices pushed them away from the operating room and toward the broader, less repetitive field of medical cognition. This shows that specialty selection is rarely just an objective choice; it is heavily shaped by how early clinical encounters match a student's emerging professional values.

2. Thematic Analysis

The narrative content highlights three core themes that influence how medical students choose their specialties:

┌────────────────────────────────────────────────────────┐
│             SPECIALTY SELECTION IN MED SCHOOL          │
└───────────────────────────┬────────────────────────────┘
                            │
         ┌──────────────────┼──────────────────┐
         ▼                  ▼                  ▼
┌─────────────────┐ ┌────────────────┐ ┌─────────────────┐
│ Curative vs.    │ │ Patient        │ │ Procedural      │
│ Management Bias │ │ Compliance &   │ │ Repetition vs.  │
│ ("Cure vs.      │ │ Locus of       │ │ Cognitive       │
│  Control")      │ │ Control        │ │ Strategy        │
└─────────────────┘ └────────────────┘ └─────────────────┘

1. Curative Intent vs. Long-Term Management ("Cure vs. Control")

A major factor in choosing a specialty is how a student views the final goal of patient care. In the 1970s and 1980s, internal medicine relied heavily on supportive care rather than definitive interventions. As a result, students who prioritized immediate, tangible results often felt unfulfilled by simply managing chronic conditions.

"The realization seeped into me gradually that I wanted to CURE my patients, not merely CONTROL their diseases with drugs..."

Surgery, by contrast, offered clear and decisive resolutions—such as removing an appendix or fixing a fracture—which strongly attracted students who valued definitive outcomes.

2. Patient Compliance and the Doctor's Locus of Control

The transcripts reveal an interesting link between a student's preferred way of working and the specialty they select. Internal medicine requires sharing responsibility with the patient, meaning the success of a treatment plan depends heavily on long-term compliance and regular follow-ups. For some students, this reliance on factors outside their control feels frustrating. Surgery provides a much more direct line of accountability. The surgeon plans the procedure, executes it in a controlled environment, and sees the outcome directly reflect their own technical skill, providing a clearer sense of personal impact.

3. Procedural Repetition vs. Cognitive Novelty

While the direct nature of surgery attracts many students, it can also push others away if they feel it becomes too routine. Witnessing standard procedures performed over and over can make the field feel finite and predictable. Furthermore, seeing a senior physician recommend surgery too quickly or inappropriately can damage a student's enthusiasm for the discipline. Students who lose interest in the repetitive physical aspects of surgery often find themselves drawn back to internal medicine, choosing to focus on diagnostic strategies and medical cognition rather than manual procedures.

3. Socratic Steelman Analysis

Topic A: Surgery as the Ultimate Expression of Definitive Clinical Action

• The Pro-Steelman Argument (Direct and Accountable Intervention):

  Choosing surgery is a logical path for clinicians who believe medicine should deliver direct, definitive results. The surgical model removes the uncertainty of long-term patient compliance by treating the disease as a structural problem that can be physically corrected. When a surgeon removes an obstruction or repairs a damaged organ, the benefit to the patient is immediate and measurable. This approach centers the responsibility on the clinician's technical skill and judgment, making it highly appealing to students who want their training to translate directly into clear, observable cures.

• The Con-Steelman Argument (The Overtreatment and Mechanical Bias Risk):

  An overemphasis on surgical intervention can create a narrow viewpoint where every clinical problem looks like an indication for operation. This "mechanical" approach can lead to reflex choices, such as recommending an appendicectomy for abdominal pain before exploring other possibilities. Focusing too much on anatomical fixes can cause a clinician to overlook the complex, systemic nature of many diseases. It can also turn highly trained professionals into routine technicians, limiting their long-term intellectual growth and missing the subtle variations that a more analytical, medical approach would uncover.

Topic B: Internal Medicine as the True Foundation of Medical Cognition

• The Pro-Steelman Argument (Intellectual Depth and Systemic Care):

  Internal medicine represents the intellectual core of clinical practice, emphasizing deep history-taking and thorough physical examinations over procedural routines. It treats the patient as a complex, interconnected system rather than a collection of isolated surgical targets. The field requires advanced cognitive strategies to solve diagnostic puzzles without relying solely on imaging. Managing chronic diseases through careful adjustment of therapies provides its own deep fulfillment, supporting long-term health and addressing the root lifestyle and metabolic factors that surgery often bypasses.

• 
  

• The Con-Steelman Argument (The Therapeutic Nihilism and Dependency Trap):

  An exclusive focus on diagnostic reasoning can sometimes lead to an unhelpful pattern of making precise diagnoses without being able to offer effective solutions. Identifying the exact location of an injury or illness loses its value if the only available options are basic palliative measures or lifelong medication. This dynamic can turn medicine into an exercise in management rather than resolution, leaving patients dependent on prescriptions and exposed to the risks of poor compliance. For a student driven by the desire to clearly fix a problem, a career spent managing chronic symptoms can feel more like an admission of therapeutic limits than a true cure.

Provide an imrad summary, keywords and thematic analysis of the content below focusing on how medical student's choice of future specialties are driven by their experiences during student life.

[28/05, 20:34] hu1: A story from my book:

[28/05, 20:41] hu1: CURE VERSUS CONTROL: WHY I CHOSE SURGERY OVER MEDICINE

I joined the Armed Forces Medical College (AFMC) on the 15th of July 1973, shortly after my 18th birthday, full of enthusiasm, brimming with energy, and raring to start my medical education. 

Young medical students pass the first 15 months of medical college in the Anatomy dissections halls, cutting up dead bodies soaked in Formalin (known as cadavers), and also in the Physiology and Biochemistry labs. After that, we entered what we called the 4th term, and started visiting the hospital wards to examine patients. One student in the clinical batch of 6-8 students would have to “present” the patient: what he/she had heard and seen, to our teachers, who were all senior doctors of the Armed Forces. The rest of us were free to question the presenter about any important questions that she had missed out on. Such questions were highly encouraged by our teachers. 

I found the whole process of taking a “history” and eliciting physical findings to come to a provisional diagnosis, an extremely fascinating one. The diagnosis had to be arrived at without a single investigation, not even a blood report or an X-ray. These would be done, but to arrive at a correct diagnosis without these was obviously an immensely satisfying experience! 

How did we do it? Can it still be done? Is it possible without a bunch of tests? 

It is possible, and it is being done by senior clinicians, but sadly the emphasis on investigations like Ultrasonography, CT scan and MRI scans has become so common that it has completely displaced the classical routine of a “detailed history and a thorough clinical examination”, which served us so well in the 1970s. We used to listen to the heart sounds and heart “murmurs” very carefully. Murmurs are sounds of turbulence of blood flowing through the four cardiac valves. Each valve could either be narrowed (stenosed) or could be allowing blood to flow back (regurgitation). One could diagnose cardiac valvular diseases by carefully listening to the heart. These days Echocardiography records these sounds, and technicians interpret the sounds. It is also true that investigations like Ultrasonography, CT and MRI scans took a decade or more to reach our shores. In the Armed Forces hospitals where I worked for over 22 years, these investigations were mostly not available. 

While it was undoubtedly satisfying to make a correct diagnosis, I soon realized that there was nothing much we could offer by way of medications or “procedures”. Heart attacks (myocardial infarctions) were treated with Aspirin, injections of Morphine and tablets of Sorbitrate! There was no coronary angiography, so no angioplasty and no stents. All that came decades later! Many patients who had blockage of major vessels simply died! Similarly bleeding stomach ulcers were treated with blood transfusions, antacid gels, and even milk drips given into the stomach by a naso-gastric tube. Obviously, these measures didn’t suceed very often in stopping the bleeding! Treatment of clots in the brain causing a stroke (brain attacks causing loss of movement of a part of the body, loss of speech etc) were treated with anti-coagulants given by mouth or by injection. Today’s technology of “stroke protocols” where it is possible to bust the clot with great accuracy and precision….  were decades away. 

Hence after making an accurate diagnosis which even included the part of the heart or brain that was dying, we could do very little about it in the 1970s an early 1980s!! To put it simply, the patient would survive if the attack was relatively mild, and if he/she had a body constitution which permitted survival. 

I got so interested in Internal Medicine that I started consulting multiple books, above and beyond our standard textbook, and I prepared notes on diseases of the different systems in the body, like Liver Diseases, Neurological diseases etc. I read a lot about how the waves get created in Electrocardiography (ECG) and I taught many of my fellow students about ECGs. I realized that the best way to learn was to teach and be asked questions. So I used to look for interesting cases in Command Hospital, Pune (which was our teaching hospital), and I would read up extensively on that disease. Then I would invite a few of my classmates for an “evening clinic” to that ward, and one of them would “present the case”, and I would be the teacher asking them questions, and they were also free to quiz me. This proved to be a great learning experience for me and them.   

But what has all this to do with surgery? The realization seeped into me gradually that I wanted to CURE my patients, not merely CONTROL their diseases with drugs like anti-hypertensives, oral hypoglycemic agents, Insulin injections, drugs to treat bronchial asthma etc. Patients with such diseases never get cured, the medicines they are prescribed merely keep their diseases under control, that too only if they take their medicines regularly and come for checkups as advised. 

A surgeon could remove an inflamed appendix, fix a fracture with plates and screws, reduce a dislocated joint, excise (take out) cancerous tissues, remove stones from the kidneys or ureters which are causing pain, bleeding etc. Many serious conditions of the intestines and stomach like a perforated ulcer, twisting of the intestines, intestinal obstruction and many more could ONLY be treated with surgery. No medical management existed except to “optimize” the patient’s condition prior to surgery. Management of serious trauma was almost entirely surgical. Badly diseased heart valves could be removed and replaced with artificial valves. The list is endless, and with every day that passes, the scope of surgery only gets wider and wider.

Apart from the curative aspect of surgery, the whole idea of tackling the surgical issue, planning the surgery, and finally DOING it, was very fascinating for me. The idea that what the surgeon did, or didn’t do, and HOW well he did it, would make all the difference, was a novel one. 

In the field of Internal Medicine, the physician made the diagnosis, and advised the medications. However, the efficacy of the treatment depended on various factors like availability of medicines, compliance with treatment, willingness and ability to come for reviews. Thus a “lack of control of the disease” could be due to a variety of reasons beyond the physician’s control, as patient compliance was completely out of control. 

All these factors gently nudged me towards surgery, and not medicine, as my specialty of choice. I was fortunate to score 65% in general surgery in my MBBS exams, and this helped me to get a seat in General Surgery at my alma mater AFMC. The rest, as they, is history, and I did thousands of surgeries in my career, venturing into fields like Obstetrics, Plastic Surgery, Pediatric Surgery, Urology and Orthopedics.

[29/05, 17:59]hu1: Did you read my piece?

[29/05, 17:59]hu2: Reading it!

[29/05, 17:59] hu2 : Very inspiring 🙂👏

[29/05, 17:59]hu1: My book

[29/05, 18:00]hu2: Great 👏

[29/05, 18:09]hu2: I had some interesting stories about why I didn't take surgery after internship although throughout my MBBS I was sure I would be a surgeon!🙂🙏

[29/05, 18:21]hu1: Oh!!

Great

Please share 😁

[29/05, 21:47]hu2: During third year I would see an appendicectomy being done by our house surgeons every day in the casualty OT for months until I was sure I could do it blind folded and couldn't wait to begin internship where we were often given a chance to do it ourselves during those days.

However in my final year of MBBS when my sister suffered from a long term intermittently recurrent pain abdomen and I took her to our professor of surgery he immediately asked for her to get operated for an appendicectomy the very next day even when I was sure that wasn't the diagnosis! 

That's when I felt the discipline of surgery demands that one keeps operating to stay relevant and I also realised that I would get bored of doing the same repetitive activity again and again as surgeries were finite and scope for developing new techniques were limited.

Hence my internship went without my realising that much cherished dream of holding the scalpel cutting open the abdomen and catching bleeders.

I did get to do umpteen cut downs and venesections during general medicine residency but it was something I never particularly enjoyed inspite of reasonably being efficient with it.

Hence my books are all about Medical cognition strategies!