“ My father jokes that my IQ dropped by 10 points by the time I came out of AIIMS. On the bright side, it just dropped 10, would’ ve dropped much more elsewhere!”
signing the report, he won’ t sign the report. His student would sign the report. In fact, I could sign the report while training under him but he couldn’ t! Life is interesting! You will learn these things. The other thing you learn in medicine, especially when you go outside, is a lot of humility regarding how little you know. So now I don’ t know if I mentioned this to you, I mentioned this to people who talk to me many times. You really know that you are ready for research when you realize that half of what you know is wrong, and you do not know which half. That is the temperament and attitude one must bring into research. The more you are told that this is the way things are, this is how they’ ll respond, and that this is the right treatment; the more you believe that people get better because of the specific treatments you give, as opposed to a lot of it is random response not in your control, the less mentally ready you are for research. To me these things came very simply by … simple observations. You guys must have been taught about Beta blockers in heart failure? In my time, it was a contraindication. Absolute contraindication. So, my year of Harrison’ s’ 89, says beta blockers are absolutely contraindicated in heart failure. By the time I reach America, they become the number one line of therapy. So much change!
Similarly, you must have studied about the contraindication of beta blockers in asthma. Papers are coming now for using beta blockers in asthma as prevention. They are thinking of the very same ideas in asthma too, of desensitization of receptors.
And the other thing is that we should change our perspectives on these things. All of us grew up with lists.‘ n’ causes of xyz, twenty causes of abc. There usually are competitions for listing out more number of causes or factors. A couple of things changed my approach. One, some guy from the US who was along was asked‘ x’ many causes and he pulls out his little digital pad and starts naming the twenty causes!! [ laughs ] For us, unless you memorize it, you cant pull it out. Anybody can pull out the book. But on the other hand, it is a shame that, if when in front of a patient, I’ m not willing to look something up. But then, what’ s preventing you? Nothing should prevent me from typing in a few search words, from consulting someone or something.
The second thing happened when I was in America. It was this old guy, Daniel Musher. I remembered the name after the incident. They had this X-ray with a Bulging fissure and I remarked that this person probably has a pneumococcal pneumonia. And this old man gets up and says,“ I understand that there’ s a pneumonia, but why would you say pneumococcal pneumonia, I mean, on an X-ray?” I said, that, Harrison’ s had this line, and yeah, Indians are the best at this – Bulging fissure sign is seen in dense mucus producing bacterial pneumonia, usually Klebsiella or Pneumococcus. He says,“ That’ s very nice. It won’ t be there next year. I’ m writing that chapter!” [ laughs ].
So, you realize the futility of the whole thing, right? Here you are, spending so many years studying, taking pride for knowing that line from Harrison’ s and it won’ t be there next year! Because he says,“ I’ ve been seeing pneumococcal pneumonia all my life and never saw a bulging fissure in that.” I don’ t agree with this. So, the previous guy thought it was there and the next guy thinks it is not there. I am slogging off my ass, trying to learn these little lines from here and there. This taught me that- you know something when you know the reason for that line. If you only know that Harrison’ s says it, that’ s hardly a reason why. If for example, I knew there was a study with 200 people with bulging fissures, and 60 % turned out to have pneumococcal pneumonia while in the general population only 20 % had