Patients-not just Images

Let them fly away? - No way!

Ravi Ramakantan

Almost a decade ago, to the day, I talked about "Let them fly away"

And now a decade later , situations have urged me to revisit that space and I write an essay on a topic which reflects the antithesis of what I had said at that time.

“One more time, for the thousandth. time, a time” has come for change.

And I see medical teachers being at crossroads about what to do with their "taught"

“Stability is a good thing” - I had said then.. It still is. How can stability become unstable?

But, without change there is no progress.

As physicians, we normally abhor mutations . Mutations in our core, the genes, are the cause of much human suffering - we see them off and on - the effects of a few A-T C-G pairs misbehaving. Often, we feel helpless at the dire consequences of these mutations and wonder :

“What if the genetic code were to be rock stable… so much of cruel human suffering would have been avoided”.

My all-time-hero of the biological sciences - George Wald , the Nobel Laureate, in his “Origin of life” hypothesis has very beautifully and powerfully said “... but for these mutations, we would all still be amebas”

‘Flying away’ can create ripples with widespread effects - though to be sure - only briefly. When change happens, things get complicated – nothing's the same. Routines become non-routine; there is a ‘void’ that needs to be filled. In due course – most times, this will be filled by a new batch of fledglings - in medical education and training - it always be so ; otherwise, we would not be here.

Traditionally, this is what teaching and training has been all about.

You train them, you educate them; give them all that you have and sooner or later , they will all go away to greener pastures.

And there, they will spread the traditions you gave them.

For me this has been the very basis of my having been a ‘teacher’.

There has always been a great sense of joy in seeing my ‘students’ all over and ever so often excelling me.

But, I guess, this is not an universal feeling with teachers. Surely, it takes all types to run this world.

So, it is not surprising that, for some, change is not welcome. The ripples of the void that change inevitably produces at home are seen to be insufferable. Many feel chaos will reign supreme with each working day. Patient care, it is believed, will suffer.

Surely, some of it is true. For a few weeks or months, someone has to do more till ‘the new’ takes over. This has been the tradition in medical education and training. It's become so universal - so routine, - that this is a ‘given’ in any medical education program.

In my own career, I have seen this several scores of time.

And it makes me proud that those that left home, have established themselves in far away lands.

It's so easy not to do all this; it would be so nice to keep your students at school.

Then there is no stress.. the routine has taken over. This is generally considered to be the worst enemy of progress, To paraphrase Wald’s words, “No mutations, no new species”.

Having gone through this cycle of change every so often; having seen seen it transiently affect patient care, having seen how others left behind fill the void with hard work.. more hard work for weeks or months, I know managing change is possible

Besides, I know that there is some joy in one more of yours going away

Unfortunately this ‘utopia’ is not universal.

Most everyone seeks the comfort of routine .. change? No way?

Teachers of today seem to forget that they had once flown away from their homelands .. leaving behind a void that someone filled .. somehow.

In the English language, there is a word called “tragedy”

Perhaps, it was coined to describe such situations.

October 2018

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