It plays a useful role in facilitating access to specialist care and follow up consultations for patients with chronic diseases, living in remote areas or unable to travel. During this pandemic, it has helped patients seek medical care, when hospital visits carried a high risk of infection or disease transmission.

In recent times, several online portals have sprung up, offering basic or specialist consultations, second opinions, and even day care surgery. However, there are limitations to an online consultation. Medicine is a very hands-on discipline. Every little observation, from how the patient walks into the room to a detailed physical examination is necessary to provide optimal care to patients. It is also needed to form the doctor-patient connection and bond.

If you live in a place that has access to medical care, seek the opinion of your family doctor or general physician first. If they refer you to seek specialist opinion, meet them in person. Specialist referrals or second opinions are generally sought for difficult or tricky medical conditions and you are better off meeting them in person. If this is not possible, then seek an online consultation. Follow the guidelines issued by the concerned health authorities in your area during the pandemic.


Length of life lived is not something that we control, but quality of life lived is largely in our hands.

We are born with certain physical attributes and develop health-related conditions during our lifetime which can affect our physical, mental and social well being. How we respond to these conditions and make the best of what we have determine whether we are happy or miserable.

So if someone is diagnosed with Hepatitis B and diabetes, consulting with concerned specialists, taking prescibed medication and regular follow-up will ensure good disease control and minimise complications. Along with that, a healthy lifestyle consisting of eating healthy, regular excercise, adequate sleep, avoiding harmful substances such as alcohol or tobacco, stress management by meditation will go a long way towards ensuring a long and healthy life.


Although laboratories offer a bouquet of tests, there may be quite a few among them that are not necessary. The tests required for health screening depend on the age, presence of disease specific risk factors and population prevalence of diseases among others. Below the age of 25 years, in a generally healthy individual without additional risk factors, routine testing is not required.

Between 25 & 40 years, a basic health screen is usually offered as part of a pre-employment screen and would include a clinical history and physical examination, complete blood count or hemogram, urine routine examination, Blood sugar fasting, chest X-ray, ECG and ultrasound abdomen. Thyroid testing (TSH) and virology (Hepatitis B) are discretionary and depend on the requirements of the employer/individual. If no abnormality is found, repeat testing is recommended every 2–3 years or earlier if new health-related symptoms develop.

Above the age of 40, in addition to the basic tests, screening generally includes lipid profile, liver function tests, kidney function tests, HbA1c (glycosylated hemoglobin), Echocardiogram or TMT (treadmill test). In case of any known disease, specific tests related to the organ/disease are added on. These tests are generally repeated every 1–2 years or earlier if any new health issue is suspected.


There are certain character traits that you may find more commonly among surgeons but it is not possible to predict based on character traits alone whether one is more or less likely to become a surgeon.

As a person from a non-medical background I had no idea of what I wanted to specialize in when I got selected for medical school. I just knew I wanted to be a doctor. Prior exposure to doctors was limited to clinic visits to the pediatrician or physician which is what I thought being a doctor was all about.

During medical training, you are exposed to all specialties from preclinical to paraclinical and clinical. This was the second choice to be made. I liked to be involved in the care of patients and decided that a clinical branch was my path. During the final professional and more so during my internship, I liked my posting in surgical specialties. The characteristics that appealed to me were that they appeared to be confident about themselves and their work made an immediate difference to the lives of their patients. For example, a patient with a cancer was operated on and by the end of a few hours, was cured of her disease. Medical specialties were impressive with their analytical thinking skills, but had to rely on medication to work. By the end of my surgical posting, I was decided that I wanted to specialize in surgery.

Once in surgical residency, the training is intense. Quotes such as a good surgeon should have the eyes of an eagle, fingers of a lady and heart of a lion were repeated by our seniors. We used to eat, sleep and refresh whatever was available, whenever we got the time & wherever we could. Any sign of weakness was looked down upon as being unbecoming of a surgeon. Scrubbing up to join in a surgery was a previlige and no resident takes a break from surgery for eating, sleeping or even using the restroom. A good surgery resident had to be a go getter. No (no time, forgot, not available) was not acceptable for an answer regardless of the difficulty level.

These character traits get ingrained into you over time. Surgical training can last anywhere from 6–8 years. If these qualities attract and appeal to you, then you already have the makings of a surgeon. If not, don’t lose heart, it will be drilled into you during surgical residency, should you happen to choose it.

However, there is a caveat to all this. After all this training is complete and you have become a skilled surgeon, at the end of the day it is not about how skilful or flamboyant you are. The true hallmark of a good surgeon is to be a good human being. The work that we do has to be motivated by a genuine desire to help those in need using the skiils you have aquired. Other considerations (such as name, fame, position, power, money) should never be the focal point of your life. They may come and go. Then you will be truly happy wherever you are and in whatever you do.


Interpreting organ donation refusal is different for living donation and deceased donation.

In living donation, a family member has to decide whether to donate part of their organ to help save the life of their loved one suffering from organ failure. The consideration to donate or not is a personal one motivated by love and sacrifice and countered by fear (of undergoing surgery, experiencing pain, reduction in functional capacity and a very small chance of death). It may also be subject to the pressure of expectations from family and society.

In deceased donation, the decision to donate organs falls on the immediate family since the person whose organs are to be donated is already brain dead. About 30% of families approached for organ donation eventually consent. Some of the reasons for refusal include;

  1. The shock and suddenness of the event. The common reasons for brain death include road traffic accident with head injury or a stroke. The family of a person who was well a short while ago receives completely unexpected life-changing news of their death. They need time to go through the grieving process and reach acceptance. The thoughts and questions going through their minds do not include organ donation. Involvement of a trained grief counselor at an early stage helps the family to come to terms with death and improves consent rates.
  2. Lack of awareness regarding brain death and organ donation. Brain death, though medically and legally recognised as death is a condition with which the public is unfamiliar. When they see their loved one in an ICU, connected to a ventilator that is breathing for them, monitor showing a pulse rate and blood pressure (maintained with medications), it makes it difficult to believe they are irreversibly dead and easier to hope for a miracle that they might come back to life again.
  3. Family members with strong opinions against organ donation. Legally, only the consent of the next of kin is is required. However, family equations in India are complex and various members may weigh in with their opinions. In such situations, strongly negative opinions negatively impact on the decision to donate organs.

Eventually, both living donors and families of deceased donors are quite satisfied with their decision to donate organs. The majority of live donors once recovered from surgery report that their quality of life is excellent or good and that they would choose to donate again if there arose a need. For deceased donors, their loved one has given life to 6 persons who could have otherwise died and they will be remembered and honoured by all the recipients for their lifetimes.


For the immediate and immense gratification that one feels when a patient is cured, it is worth the physical exhaustion.

Medicine is not an exact science. Whether a patient gets cured of their disease or not depends upon several factors. These include the nature and extent of the disease, age and other comorbid conditions. Surgeons use a specific skillset (i.e. surgery) to treat patients. For example, if someone is suffering from a liver cancer and is a suitable candidate for curative surgery, the procedure may take 6 hours but on the 6th day the patient will walk home, completely cured of their disease. Occasionally however, a patient may not recover from their disease and the surgeon experiences a gut wrenching low as well.

Acquiring such a complex skill is not easy. Surgical training is gruelling and can take 6–8 years after completion of medical school. During residency, one learns to go long hours without food, little sleep and be a go getter. We are constantly reminded that it is important to eat, sleep or refresh yourself whatever you get, whenever you get the time and wherever possible. A popular quote in surgery is that a good surgeon should have the eyes of an eagle, legs of a horse, hands of a lady and heart of a lion.

At the end of the day it is never about the surgeon or their skill, it is always about what is best for the patient. If these are the feelings that touch your heart, you can choose to become a surgeon.


When I had to undergo an endoscopy and surgery during my residency, I trusted the doctors taking care of me and diligently followed their instructions and recommendations. My health issues were related to my speciality and I had a reasonable understanding of the disease processes and outcomes of surgery. It helped me accept it and prepare mentally and physically. I had an uneventful procedure and smooth recovery both times.

I have also had close family members undergo surgery for various conditions including cancer. I chose the specialists based on my prior interactions with them and my colleagues recommendations (since they were not from my speciality). Again, I entrusted them and the system with their care and conducted myself as a family member. I listened to them, asked pertinent questions and followed their advice. It has served me well every time and I am thankful to them.

I have wondered if my response would be different if I were to face a more serious condition such as cancer. I feel that I would more likely trust the process and go with my specialist’s opinion and advise. I would however be mindful of the quality of life on treatment rather than longevity alone.


Memories can be capricious. The strongest memories are those that have a strong emotional connect.

One may remember the exhaustion & exhilaration from a physically or technically challenging surgery for days or weeks but the feeling will gradually fade & eventually be relegated to the archives of memory as we move along with our professional and personal lives. We are only reminded of them when we meet those patients again.

The ones that we never really forget, those that keep coming up to the surface time and again are the moments in which we felt absolutely despondent and emotionally drained as we helplessly watched the life of a patient slip away as if it were sand between the fingers, even as we were desperately trying to save them.

All such experiences leave a scar, some more deep than the others. Some may act as a motivation to learn your lesson, pick and dust yourself off, and move forward. Other scars are meant to be carried on your person like a warrior, a consequence of being in the profession. If there are no scars, then you are not doing enough. But at no point must we allow ourselves to be overwhelmed to the point of giving up or become so hardened or numbed that the experiences leave no mark.


Covid-19 reinfection is quite possible and actually reported, although it will not be possible to predict the exact incidence till more data about the virus is available.

Coronavirus family is one among many viruses that cause seasonal flu episodes (cold, cough, sore throat, fever, body ache and fatigue). It comes in waves once or twice a year around the time of change of seasons. It usually starts with the children (from close proximity at school or play), spreads to other children & family members with varying severity. Healthy adults may experience a milder episode while younger children and elderly are vulnerable to severe illness.

There are 2 main factors that determine the frequency and severity of reinfection;

  • Immune status of the person affected
  • Ability of the virus to change its appearance (mutation) and escape immune surveillance mechanisms.

A poorly developed immune system is seen in the very young, elderly, individuals affected by other diseases that impair immune function such as diabetes, kidney or liver failure, cancer, transplanted patients on immunosuppressive medication. This population is vulnerable to severe forms of disease that can be life threatening. They are recommended periodic vaccination to prevent them from developing severe infections.

Once an infection occurs, the immune system defends the body by producing specialized cells that recognize the viral appearance and destroy them. Even after the virus is cleared and infection has resolved, some of the immune cells called memory cells are preserved so that future infections with the same or similar viruses are dealt with swiftly and efficiently. The number of these memory cells are highest after recovery from the infection and decline over time. They protect from reinfection soon after recovery.

Viruses mutate to change their appearance and evade recognition by the immune system. These changes may be small and incremental or significant. This may confer added qualities such as increased infectivity (ability to cause an infection), virulence (ability to spread). Not all mutations are beneficial though. Variants with favorable mutations thrive while others die out. This is the reason reinfection occurs with the same virus family periodically. Vaccines are updated periodically to include the recent changes in viral behaviour and booster doses are recommended in the vulnerable population.


When we talk about cure, we are referring to eliminating the root cause of the disease itself.

Fatty liver is an accompaniment of metabolic syndrome i.e. obesity, diabetes (insulin resistance), hypertension & dyslipidemia (commonly known as hypercholesterolemia). This is brought on by years of unhealthy lifestyle, consuming excess refined & processed food (junk or fast food), lack of adequate exercise & sleep, inability to cope with stress, smoking & alcohol consumption etc.

However, the body has an immense capacity to heal itself and regenerate if only provided the opportunity. Eating the right food in the right quantity at the right time (food as close to its natural state as possible), regular exercise, practising mindfulness and relaxation techniques, avoiding toxins such as alcohol can help undo the damage. This may take time but the effects are more rewarding and lasting than medication.

It is important to know that medicines may form an important part of the treatment along with lifestyle management. Your doctor is the correct person to advise you regarding the need for medication.

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