Blissful Life

When you apply skepticism and care in equal amounts, you get bliss.

Year: 2020

  • The Art of Setting Up Success

    What makes a great surgeon? Do they have long fingers? Or steady hands? Or the heart of a lion?

    I think it is the preparation they do right before they make the incision.

    In VMH, I would be assisting various surgeons, especially Dr MR Seetharam in orthopedic surgeries. MRS is very methodical in preparation for a surgery. Every surgery is different. One might require an expensive equipment, or a team of skilled surgeons. The patient might have severe comorbidities that make post-surgical management difficult. The economics might not work out. Functional recovery maybe more important. There are many factors that go into choosing the right kind of surgery for the right kind of patient. MRS will be thinking of all these as soon as becoming aware of someone who has an issue. But that’s not the preparation I’m talking about.

    Inside the operation theater, with the patient and others eagerly waiting, there’s a final and crucial step of preparation that MRS does. The X-rays are put on the viewer where it can be seen from the operating table. Another look is given at the X-ray to review the approach and the location of the fracture fragments. The fractured part is positioned with great attention to allow the views and manipulations that would be required later during the surgery. Extra tables are brought in if so required. The position of each assistant is decided. All the props are set up exactly where they have to be. The C-arm (A C-shaped X-ray machine that can be rotated around the patient during the surgery to see the bones and the implants near real-time) is brought in and out of the field to ensure there are no hurdles. A shoot is made in each position that the part would be during the surgery to be sure there is no obstruction in the C-arm’s view. All the implants and instruments are reviewed to make sure they’re right. The assistants are warmed up on the procedure and the tools that’ll be used. The success of a surgery is decided before the incision is put.

    That last sentence might sound like this speech by Harsha Bhogle. Or the saying “The more you sweat in practice, the less you bleed in battle”. But I am not talking about the years of dedication one puts in before one becomes a fine surgeon.

    I am specifically talking about the setup. Take this example of a setup for arterial blood draw.

    Depends I think. If you’re crammed between the wall and the ICU bed on an obese hypovolemic patient whose diaper you cannot remove completely and you’re drawing the femoral artery with a plastic syringe not meant for it, should be sufficiently difficult.

    — Akshay S Dinesh (@asdofindia) December 31, 2020

    That is a setup for failure. If one compromises on the setup, they would often have to compromise on the result as well.

    * * *

    What I realized as I was writing this is that I tend to compromise a lot. I don’t know whether I do it as a way to challenge myself so that I feel good about myself if I luckily succeed. Or because I’ve not learned how to negotiate better. Or maybe I don’t know what I need. Or maybe I don’t think. Or maybe I think being accommodating is a virtue.

    Perhaps accommodation isn’t a virtue. Perhaps if you don’t ask for the right working conditions, you’re going to end up being ineffective and lowering the standard all over.

    But you’re never going to have all that you need. “You’re going to have to compromise” is the folk wisdom. It’s difficult to imagine having everything I need. That’s a contradiction.

    Perhaps then my core premise is wrong. It is probably not about the setup. Or maybe it’s a bit of everything. Maybe I’m partly right.

    Maybe you can compromise on the setup if you can compensate with your skill (or luck). Or maybe that’s too much strain on you.

    I don’t know. Maybe I’ll have clarity later.

    PS: I was wondering whether to make the latter section “PS”. But maybe that’s the script. It’s a blog, after all.

  • Science is Broken Because Scientists Can’t Think Rationally

    Scihub is being sued in Indian courts by the journal industry. There are some people worried about it. But it is funny how our knowledge system works. Take this tweet for example:

    Scientific publishing sure is rigged & broken. But hoping that the very bandicoots that are getting fat from the status quo will take hints and improve the system is beyond naive. The telling lack of collective resistance from scientists too enables this perverse model to thrive. https://t.co/ye9SuxlYQM

    — M D Madhusudan (@mdmadhusudan) December 24, 2020

    The reason why journals charge exorbitantly and still get away with it is because almost all academicians publish only in those journals. And why do academicians publish in those journals? Here comes the greatest hypocrisy/logical fallacy of academicians.

    They think that publishing in “prestigious” journals bring “prestige”. They even have a way of measuring prestige without making it sound like it’s an emotional thing – impact factor. It is all part of the same logical fallacy – argument from authority. A cognitive bias that makes humans think that “authority” is right.

    The only purpose of journals in the internet age is to exude authority.

    The same purpose of universities.

    If scientists step down from their pedestals and start looking at the world without bringing in their cognitive biases (like every scientist should be doing), there can be a world where knowledge is produced and consumed with lesser hurdles.

    There definitely is a side to this where the omnipresent, omnipotent “system” is oppressing academicians and forcing them to continue with this prestige based publication. After all, scientists are humans who would rather give in to the way the world works than stand up against anything.

  • What to Do with Privilege?

     I have had the privilege to think and write about privilege often. I have written about how privilege affects Indian software industry’s ability to innovate. I have written about why the privileged should think about how they’re part of the problem. I have looked at my privileges visible to me. I also felt guilty/responsbile and came up with a probably stupid idea of distributing my time to help others.

    Today morning I came across two interesting tweets.

    Your achievements reach far beyond your own benefits, they inspire others to excel. Keep rocking.

    — Venkat Subramaniam (@venkat_s) December 22, 2020

    The next tweet requires a bit of context. New York Times had published a very interesting story about pollution in Delhi by following two kids from different backgrounds and measuring their pollution exposure. You should absolutely read the story (the reality) if you haven’t.

    Something about this article is disturbing. Did the girl sign up to be portrayed as this symbol of “privilege” in this piece? To be fair they might have changed names or whatever. But still. Something off I feel.

    — Deepak Varughese, MD (@VarugheseDeepak) December 19, 2020

    This made me think about the book by Michael Sandel that I recently finished reading – The Tyranny of Merit. It is a book about privilege, inequities, affirmative action, and the idea of justice. 

    The book starts with examination of a US college admission corruption scandal. A few rich parents had paid some people to get their kids fake certificates that would make it easier to get college admission. This was seen as highly unfair and corrupt.

    But being born with privilege automatically gives people an edge. I didn’t have to fake any certificate, but I grew up in an environment where I could “earn” those certificates. Conversely, people who have lesser privileges start with a disadvantage.

    Affirmative action steps in there. The idea with affirmative action is to give those who didn’t have the background a chance to succeed. Reserved seats (or diversity quotas) “level” the playing ground.

    But affirmative action comes with lots of problems. See the replies on this tweet, for example.

    No. It’s an attempt towards balancing the scales so that the industry doesn’t remain so biased towards one gender.

    We’ve seen what the industry looks like without such interventions – a male dominated one. So can’t expect nature to just run its course and fix everything. https://t.co/enPEhdIZjI

    — Balasankar “Balu” C (@balasankarc) October 27, 2020

    Affirmative action makes those who do not benefit from affirmative action feel lots of resentment towards those who do benefit from it, especially if the former view themselves as disadvantaged in a way that is not considered as a disadvantage in the affirmative action program. For example, in this case, male candidates from rural/poor background feel that Google hiring female candidates exclusively is unfair.

    Michael Sandel then questions the very idea of merit. Is it possible to have an Utopia where everyone has equal privileges? Imagine a heavy autocracy where everyone is born in the same conditions. What happens when different human beings are born with different cognitive/physical capacities? Isn’t being born with better genes a privilege? Is it okay for people to use that privilege to get ahead of others?

    Affirmative action is an attempt at ensuring equality of opportunity. But no matter how hard we try there are certain opportunities which everyone cannot equally have. At the same time there is a large amount of wealth inequalities that arise. And also a lot of inequalities in terms of esteem. Those who are privileged feel guilty of their success. Those who benefit from affirmative action are shamed that they couldn’t “qualify” without the same.

    I have thought in the past specifically about college admissions. What if everyone could access high quality of education and nobody had to miss out on the opportunity? Then we wouldn’t need reservation and selection. But, we have created an artificial scarcity of seats. Why do we give universities the monopoly over knowledge like that? Why do we have professions like programming which anyone can enter and then professions like law which people are barred from entering?

    It might be my pet peeve that there are regulated professions. But Michael Sandel also calls for dismantling meritocracy and ensuring equality of condition. The book, like the Justice course, makes you think and rethink the idea of justice.

    Coming back to the tweets above. I think that looking at privilege as a shameful thing is useful for nobody. Giving up privileges is a waste of privilege. The right use of privilege, in my opinion, would be to use it for reducing inequities in the world. The rich family that agreed to be part of the NY Times article therefore need to be applauded. And those with privilege need to acknowledge their privileges and work towards making those privileges irrelevant.

  • Lumbar Puncture and HIV

    Lumbar puncture is a fascinating procedure. It is cheap, it can be done in relatively remote places, and it can be learnt easily given access to enough people who need it.

    LP has an incredible role in the management of many complications related to HIV. I’ve heard stories about how there used to be 5 LPs done every day in VMH during the time when HIV was causing rampant destruction in Karnataka and India. When I was there, we would do about 5 in two weeks. Nevertheless, when a colleague asked on Twitter about CSF analysis, I thought I should write down some of the things I believe to know about Lumbar Puncture itself, especially in relation to its use in management of complications of HIV.

    The first many LPs I saw were all done for spinal anesthesia in KR Hospital. Till then all I knew about spinal anaesthesia was a friend’s description of the back ache he had post a “cool” hernia surgery because they had “poked many times for anaesthesia”. I think I hadn’t really thought about it till I was doing my anaesthesia rotation during internship. The first LP I did was also done during the same time – the “pop” and being in the space that you can learn only by doing. (If anyone thinks that all knowledge is codifiable like I do, here is what it feels like. Imagine there is a thick plastic layer laid around a piece of rusk. Imagine your needle piercing through the rusk and then splitting open the plastic layer. Now you are in the space.)

    The first time I saw an LP done for diagnostic reasons was in the medical emergency ward of KR Hospital where a young patient with some sort of neurological condition was being pinned down to the bed by 4 people and the postgraduate resident was dancing with the needle along with the squirming patient. Despite the grotesqueness of the picture, I found it incredible that 20-40 drops of a particular fluid can be so valuable in diagnosis.

    I learned the reasons when I was in VMH. There were many “spot” diagnoses we made using LP:

    1) Perceived high opening pressure in an HIV infected patient with neurologic symptoms – we send for cryptococcal antigen and it is almost certainly positive. (Always use Cryptococcal antigen test. Indian ink looks fancy under the microscope when it is positive, but is not as sensitive)

    2) High lymphocytes and proteins – you can keep your various tuberculosis diagnoses active. But even otherwise, you can’t rule out TB ever.

    3) RBCs and you can suspect sub-arachno… Just admit that you did a traumatic tap.

    But LP was mainly used for ruling out the infections. It is very simple to miss CNS infections in HIV infected patients. For example they will come with vomiting and you will examine their mouth and see oral (and possibly oesophageal) candidiasis written all over it. But rather unknown to you, they might also be having cryptococcal meningitis.

    It might be difficult to treat cryptococcal meningitis because Flucytosine is not something you find easily in India and therefore you are stuck with Fluconazole and Amphotericin B and good luck to you if you plan to give the latter in peripheral venous lines. (I’m not sure if the liposomal variety of Amphotericin B doesn’t cause as much phlebitis). But cryptococcal meningitis is a diagnosis you do not have to miss, if you are doing LP.

    It is a messy thing, but it is a life saving diagnosis. I’ve seen one patient die during the treatment, even though we were doing regular therapeutic lumbar punctures to reduce the intracranial pressure. But I’ve seen almost everyone else survive (including the case where I had to take PEP). I’ve also heard a very inspiring story from Dr Ramakrishna Prasad about a patient whom everyone else had given up on, coming back to life after switching over to the liposomal variety.

    A (thankfully) much rarer thing is HIV CSF escape syndrome. Hearing about this for the first time is when I realized which peak of the Dunning-Kruger effect I was on. You see, the blood brain barrier is a real thing. And not all of the HIV drugs cross this barrier the same way (paradoxic?). And therefore there are patients who can have no virus in their plasma, but if you do a CSF viral load test you will have a real surprise waiting.

    A not so uncommon thing which can be diagnosed through CSF is neurosyphilis. I always have to read the guidelines three times about when to use a VDRL test and how much to rely on it, but this is a test that we used to do as a protocol while doing an LP in HIV infected.

    Things like gadolinium enhanced MRI are becoming more useful than CSF analysis in diagnosis of things like tubercular meningitis. But from what Dr Rahul Abraham once told a group of us about his experience with MSF in Bihar, lumbar puncture will remain with us till the end of the HIV pandemic.

  • Annihilation of Caste

    Jat-Pat Todak Mandal probably wanted to be the #DalitLivesMatter of their time. That’s how they invited Ambedkar to their annual conference in 1936 to deliver a speech. Organization of conferences in that time and today have at least one thing in common – communication gaps. JPTM wanted Ambedkar to talk about abolition of caste. Like many social reformers, they wanted reforms that do not disturb the status quo. Ambedkar’s speech pointed out how caste is strongly intertwined with Hinduism. If one were to agree with Ambedkar, abolishing caste would require shaking the fundamentals of Hinduism. JPTM did not let Ambedkar know that they would rather not speak logic to the Hindu elite who attend their conference. At least, not when they sent the invitation.

    When the organizers saw the print of the speech to be delivered they straightened the record. Either Ambedkar can stay clear of criticizing Hinduism or they will find a way to cancel the speech. Ambedkar had by then printed a few hundred copies of the speech and was neither interested in changing the text nor in speaking at JPTM’s conference. The speech, thence, became the book. Annihilation of Caste.

     

    *  *  *

     

    Reading this book drastically changed the way I look at Indian independence movement and contemporary Indian politics. Very little of that was brought about by the content of Ambedkar’s speech. The speech is a rather predictable compilation of reasons why Hinduism flares up casteism. It is well written and logical. The points Ambedkar put forward can be directly used in debates even today. The politics around the book, though, is eye-opening.

    It is the same politics that made this book slip under my radar. It is why I have never asked the questions “Did Ambedkar really draft the Constitution?” or “What else did Ambedkar write?”. It is the politics of caste.

    Having grown up as an Indian elite, I did not (and do not) know well the politics of caste. To compensate for this elite ignorance, the book is now prefixed by Arundhati Roy’s essay “The Doctor and the Saint”. This essay is the red pill. If you take it you go down the rabbit hole of Indian politics.

    After that it won’t really matter whether you read the speech or not. Yet you will read it. Like you reached an oasis in a large desert you were thrown abruptly into.

  • How Can I Be Useful For You?

    I’ve been thinking about this for a long time. I haven’t still figured out how to execute this. But here’s the idea. I’m very privileged, purely by the accident of birth. There are millions of people less privileged than me in many ways. I think the right use of my privileges would be to help bridge the inequities in our society. And for that, I have to start somewhere. I’m doing various things, but I think I’m not doing all I can.

    Here’s the deal. I’ll list down a list of things that I think I can effectively help others in. I’ll also list down many of my privileges here. If you aren’t as privileged as I am in any one of these, you can feel free to reach out to me on any topic on the first list, and we can work out a way for you to take my time for your own benefit/growth/advantage.

    List of things I can work with you on

    1. Learning medicine, learning basic sciences.
    2. Learning programming, learning GNU/Linux system administration.
    3. Learning to use the internet.
    4. Contributing to free software projects.
    5. Writing essays/articles in English, learning English
    6. Conceptualizing research studies in health, academic writing, and publication.
    7. Public speech.

    I’m going to be a bit selfish and not list down everything that I can actually do for others. I’m sorry for that. But if you think there’s something related to the above but not exactly in the list, we can talk about it.

    List of my privileges you can use to compare

    By listing something down here, I don’t mean to imply that one is better than the other in any way. I just feel certain things have made things easier for me in my life, and I’ve listed those as privileges.

    1. Being male
    2. Being cisgender
    3. Being heterosexual
    4. Being born in a privileged caste
    5. Being born in an economically stable family
    6. Having my parents alive well into my adulthood
    7. Having young parents
    8. Being born to a doctor
    9. Being born to a teacher
    10. Being born to parents who are in government service
    11. Not having to support family
    12. Being the grandchild of three teachers
    13. Being born in a majority religion
    14. Having access to books from early childhood
    15. Having access to internet by 8th standard
    16. Having been to an English medium school
    17. Not having suffered psychological or physical trauma in childhood
    18. Not having physical disabilities
    19. Being tall
    20. Being fair skinned
    21. Having a lean body-nature
    22. Not having congenital or acquired illnesses that require medical care

    This is by no means a complete list. I haven’t added all the privileges that I accrued thanks to the above privileges. So have I not added the privileges that I am not aware of. Anyhow, if you think I am more privileged than you in any way, you should not hesitate to take this deal.

    You can find my contact details here.

     

     Post script: I have thought about how this can be considered virtue signalling. I am open to discuss ways of making this less about me and more about others. I’ve considered the idea of volunteering at NGOs. But I haven’t found a right fit at the moment. Neither is it feasible at the moment due to COVID. Also, I want to somehow be able to scale this idea and figuring out first hand what works and what doesn’t might be useful in that.

  • Why Wikipedia Is Evil

    Don’t get me wrong. I’m a fan of many things about Wikipedia. I have a small number of edits on Wikipedia too. But, I think democratizing knowledge creation is more important than Wikipedia. And that’s why the title.
    I have written with examples about how Wikipedia’s claims about it being “the sum of all human knowledge” is highly misplaced in my old article titled: “Don’t put all your eggs in one Wikipedia“. In that article I also talk about how Wikipedia could become the foundation for building a federated knowledge system. In this post I talk about why it is necessary to decentralize Wikipedia.
    Monopolies are bad
    It is not that there cannot be socially conscious and good natured monopolies. It is that the existence of monopolies in a society is bad. It stifles innovation by restricting it to only the monopoly. It gives great power to the people who control the monopoly. Arbitrary rules can be created by these people and everyone else is forced to follow suit.
    Healthy competition is the cornerstone of capitalism. Monopolies make competition tough. Worse, monopolies make competitors look bad even when they’re better. Monopolies make it look like the reason for the failure of competitors is incompetence whereas a large part of the reason could be the existence of a monopoly.
    Amazon, Uber, China, there are many examples.
    Monopolies don’t announce themselves
    That monopolies are bad is clear to many people. But recognizing monopolies is sometimes hard. A monopoly doesn’t always start out as a monopoly. And there usually isn’t an announcement when someone becomes a monopoly. In fact, monopolies always deny they have monopoly.
    Here is where Wikipedia becomes interesting.
    Wikipedia announces itself as wanting to compile the sum of all human knowledge (and sometimes even claims to be the sum of all human knowledge). I have ranted enough about this in the older post. But the fact that not enough people question this statement by Wikipedia founders and others should make us think: Have we accepted Wikipedia as the sum of all human knowledge?
    If we have, then we have laid the foundation for Wikipedia to become a monopoly. A monopoly over knowledge.
    We may be too late to act too.
    Wikipedia has prominent ranking on search results for many many terms. Often, people read only the Wikipedia result. These people linking back to Wikipedia creates a reinforcing feedback loop. (Of course, the role of Google’s monopoly over search and discovery of knowledge is also to be questioned).
    Because there is so much of knowledge already present in Wikipedia, many people think that what is not present on Wikipedia is not notable enough or is not important enough to know. Paid editing has existed on Wikipedia from a long time and the reason is that it is becoming increasingly impossible to build a brand without building it through Wikipedia also. And why is that so? Because a large number of people use Wikipedia to measure the relative relevance of knowledge. Wikipedia is becoming the trusted bank of knowledge. Wikipedia is gaining monopoly over knowledge.
    Not all of this is Wikipedia’s fault. There are many projects which try to become collaborative editing spots for various niche topics. Radiopaedia, for example tries to become a reference website for radiology. Yet, for many projects Wikipedia is a large competitor because it is the so-called “sum of all human knowledge”. Editors would rather write on Wikipedia than a smaller collaborative project.
    Because we give Wikipedia too much credit. We consider it the reference. We adore it. We are too scared to fork off. We make it a monopoly. Stop doing that.

  • Liberty vs Morality

    Liberty and morality can be seen as counter-balancing forces.
    Liberty applies to individuals.
    Morality is a social construct.
    Liberty is about what one can do.
    Morality is about what one cannot do.
    Liberty assumes each human is a rational being and respects them for that.
    Morality is enforced on humans by authority based on arbitrary consensus.
    Liberty allows a human being to achieve their maximum human potential.
    Morality can potentially prevent individuals from harming other individuals.
    Liberty and morality are not equally acting on everyone, though.
    Morality often sides with the more privileged. Because the authority to enforce morality rests with them too. In turn, liberty also accumulates with the privileged.
    Privilege may never get equally distributed. We must therefore constantly renegotiate the arbitrary rules of morality for the benefit of the less privileged.

  • Public Lives of Doctors?

    Social media has made our private life public. Facebook, Instagram, even WhatsApp (through stories) thrive on users generating engaging content. Often this content is snaps from daily life. A picture is worth a thousand words, yet can be generated in a second. Image centered social media platforms rely on this to keep themselves going.

    What about doctors (and other professionals) on social media? Is it any different for them? Should it be any different?

    This post has been triggered by the #MedBikini hashtag. Here’s one tweet that reveals what happened:

    This journal article considers social media posts where MDs hold alcohol, wear inappropriate attire, and give opinion on controversial social topics as “potentially unprofessional.” How would any of these adversely affect the care we give to patients? 😳 #MedBikini pic.twitter.com/G1iBuqtX8n

    — Ronnie Baticulon (@ronibats) July 24, 2020

    I will not spend a lot of time discussing this particular paper or the twitter response to it. But I will discuss sections from two of the references in this paper.

    A council set up by American Medical Association to address the subject of Professionalism in the Use of Social Media, included this paragraph in their report:

    Though there are some clear-cut lapses in professionalism that can and have been made online by physicians (such as violations of patient privacy or confidentiality, or photos of illegal drug use), there are many more situations that fall into a grey area.  Examples include photographs posted online of an inebriated physician, or sexually suggestive material, or the use of offensive language in a blog.  Any of these actions or behaviors would be considered inappropriate in the hospital, clinic, office, or other setting in which a physician is interacting with patients or other health care professionals in a professional manner.  However, whether physicians must maintain the same standards of conduct in how they present themselves outside the work environment is a more open question.  Physicians certainly have the right to have private lives and relationships in which they can express themselves freely, but they must also be mindful that their patients and the public see them first and foremost as professionals rather than private individuals and view physician conduct through the lens of their expectations about how an esteemed member of the community should behave.  Thus physicians must weigh the potential harms that may arise from presenting anything other than a professional presence on the Internet against the benefits of social interactions online.

    It is this particular paragraph that have been used when creating criteria for “potentially unprofessional” things in papers that followed. One of them has a section like this:

    Within the clearly unprofessional group, binge drinking, sexually suggestive photos, and Health Insurance Portability and Accountability Act violations were the most commonly found variables. Examples of binge drinking included pictures of residents lining up 5 pints of beer in front of 1 dinner plate, doing “keg stands,”and making comments about being drunk or hungover. Examples of sexually suggestive photos included simulated oral sex, female residents in bikinis with hands pointing to their breasts, and a female resident simulating intercourse with a large cannon. Profanity was also encountered, as was a link to a racist cartoon.

    Within the “potentially unprofessional” group, pictures of residents with alcoholic drinks in their hands were the most frequently encountered. There were also several polarizing political and religious comments made by residents, and 2 instances of residents holding a gun while hunting


    We get a better picture (pun intended) here of what these papers are trying to hint. With that in the background let me talk about a couple of things from my professional life that I’ve thought quite a bit about.

    Alcohol

    Alcohol is a controversial topic among doctors (because many doctors consume alcohol). I do not consume alcohol. I actively dissuade people from consuming alcohol. You could call me anti-alcohol. I have certainly been influenced by Dr Dharav Shah’s campaign against alcohol and his argument for why we should create a negative attitude towards alcohol (the way we have towards smoking) is convincing. And I consider it hypocritical for doctors to be consuming alcohol.

    There are plenty of doctors who disagree. Some of them are of the opinion that social drinking is not a problem at all. They want to draw a line between alcoholism and social drinking and want to allow social drinking without it progressing to alcohol dependence.

    There are some doctors who agree that alcohol is indeed dangerous, but do not agree with the idea that it is hypocritical for doctors to be consuming alcohol while asking their patients to abstain. This is a very important argument.

    One part of the argument is that what doctors, as professionals, give out as advice in a professional setting is not applicable to doctors themselves. That I can talk to my patient about the importance of not eating rice excessively while still eating two full biriyanis a day. That professionals need not hold themselves to the standard that they’re prescribing for their clients.

    The other part of the argument is that what doctors do in their private lives should not be dictated by their profession. Superficially it makes sense. But does it stand scrutiny?

    Firstly, does private life stay private? As we noted in the case of social media above, the notion of a private life that is wholly disconnected from public life is Utopian. What happens when something a doctor does in their private life becomes public?

    Secondly, would you apply that logic when what the doctor does in their private life is something that you find morally reprehensible? Say the doctor in their private life engages in adultery, directing pornography, or working for BJP’s IT cell (not that I find all of these morally reprehensible). Would you be comfortable saying “it is their private life?”

    This leads to the other thing that I am constantly thinking about.

    The impression that a doctor “should” make

    How should a doctor appear in front of their patients?

    The trouble starts from the first day of medical school. There is a certain way you’re expected to be dressing. There is a “smart” appearance dictated by the higher-ups in the hierarchy which usually included (for me) shaved face, short hair well combed, clean new aprons, polished shoes, and so on.

    It goes deeper. In “Be the Doctor Each Patient Needs“, Hans Duvefelt tells this:

    “Doctors are performers, not only when we perform procedures, but also when we deliver a diagnosis or some guidance.”


    The point Dr Duvefelt makes is about the therapeutic effect of a doctor-patient relationship. As a doctor, you need your patient to believe in you and in turn your advice. I talked about how this complicates everything about the doctor-patient relationship in my post about consultation fees.

    The gist of the matter is that doctors might have to do things (like shaving their naturally growing beard) to appeal to the completely irrational gut-sense of their patients. Weird argument, right? I don’t like it either.

    I don’t like it that I have to feign confidence in what I’m saying even when the field of medicine is not 100% sure about anything. I don’t like it that the biases that patients make up based on the impression I leave influence their adherence to the treatment regimen I prescribe. But these are how humans think and act.

    This is exactly why people dress well for an interview. Why politicians are careful about how they’re being photographed. Why celebrities have a link with fashion. And why people put their degrees on their Twitter and LinkedIn handle.

    I hate this world.

    Unprofessional

    Last day a patient messaged me. On SMS and on Telegram. My telegram bio includes pictures of me from a long time back and also a link to my telegram channel where I post links to my own blog posts. For some reason I responded to the patient on SMS although it was easier to talk on Telegram. I am not sure what to think about it. But at that moment I was not feeling comfortable with using Telegram to talk to a patient. The reason is that I blog mostly about technology. And multiple times in the past have people assumed I know very little medicine when they find out how much I know about technology. I don’t want my patients to read my blogs.

    That brings us back to professionalism. Professionalism is defined by society’s sense of morality. And that is where bikini pictures appear potentially unprofessional and sexually suggestive images appear clearly unprofessional to some. The #MedBikini hashtag is either about stating that private lives of doctors should not matter to patients or about the idea that bikinis are not immoral, or both.

    I think the entire post has been devoted to the point about whether we should worry about what patients think about us or not.

    The morality of underwear pictures is something that deserves a detailed debate. I end with the following question. Are sexually suggestive images unprofessional? Why?

  • The Connection Between Curiosity and Knowledge

    Last week, 7½ years after Aaron Swartz death, I was thinking about what made Aaron smart. There is this quote:

    “Be curious. Read widely. Try new things. What people call intelligence just boils down to curiosity.”

    Curiosity. It keeps popping up here and there.
    I was read Anand Philip‘s blog today. The “about” page is just three lines:

    Generalist.

    Superpower: Curiosity.

    Probably not a cat

    Can curiosity be a superpower?

    One of the answers was about The Oxford Electric Bell:
    There wasn’t much detail about the bell in the answer. Intuitively I was thinking it could be something like a clock that would require winding every now and then. But I wasn’t sure. So I went to the wikipedia page on it.
    That’s where I learned that it is an actual bell that rings about twice a second and holds “the Guinness World Record as “the world’s most durable battery [delivering] ceaseless tintinnabulation””
    Now there are many things to learn on this page. We might want to see the bell ringing on Youtube. We might want to read about perpetual motion. We might even want to read about the word tintinnabulation.
    Which reminded me of an old friend Akashnil Dutta who according to LinkedIn is now a Member of Technical Staff at OpenAI. It was about 9 years ago in a camp that I met Akashnil where he told me about magnetotactic bacteria. I asked him how he had come across this rather uncommon piece of information.
    He said he would use the “Random Article” feature of wikipedia to find new stuff.
    Curiosity is a super power.
    Read. Notice. Be curious. Question. Read more. Repeat.