00:00:00: ,639 Speaker: Let's start with the second part. 2

00:00:01: ,480 Speaker: Welcome back, Professor Reddy. 3

00:00:03: ,240 Speaker: Thank you. 4

00:00:04: ,879 Speaker: So we're continuing our talk because it's been expansive. 5

00:00:07: ,679 Speaker: And what you've shared in the first part. 6

00:00:10: ,679 Speaker: And now I'd like to talk about 7

00:00:12: ,919 Speaker: innovations in less fortunate 8

00:00:14: ,880 Speaker: areas. 9

00:00:15: ,760 Speaker: You are very passionate about 10

00:00:17: ,600 Speaker: hygiene in endoscopy, expanding 11

00:00:20: ,320 Speaker: your clinics to mobile vehicles 12

00:00:23: ,320 Speaker: and providing medical care in 13

00:00:26: ,199 Speaker: rural areas, and also cascade 14

00:00:29: ,960 Speaker: guidelines. 15

00:00:29: ,759 Speaker: What can we offer as a second or third option where the best ones 16

00:00:35: ,960 Speaker: are not available? 17

00:00:36: ,640 Speaker: So what's your approach here? 18

00:00:38: ,640 Speaker: Yeah, I think this is a very 19

00:00:40: ,340 Speaker: important point, because I think 20

00:00:43: ,039 Speaker: those in the Western world don't 21

00:00:45: ,359 Speaker: realize some of the problems we 22

00:00:47: ,920 Speaker: have, especially with the 23

00:00:48: ,439 Speaker: underprivileged, those who are 24

00:00:50: ,119 Speaker: not having access to medical 25

00:00:52: ,960 Speaker: care. 26

00:00:52: ,399 Speaker: Unless you actually visit these 27

00:00:54: ,960 Speaker: places and see what's happening, 28

00:00:55: ,700 Speaker: you don't realize how pathetic 29

00:00:58: ,539 Speaker: the situation is people are 30

00:01:00: ,340 Speaker: dying of GI bleeds which could 31

00:01:02: ,500 Speaker: be salvaged. 32

00:01:03: ,019 Speaker: Dying of cholangitis because the 33

00:01:05: ,459 Speaker: CBD stones could not be removed 34

00:01:07: ,939 Speaker: because there is no facility 35

00:01:08: ,420 Speaker: there. 36

00:01:09: ,500 Speaker: And of course, cancers which 37

00:01:11: ,700 Speaker: become advanced when you see 38

00:01:12: ,000 Speaker: them again because nobody 39

00:01:15: ,299 Speaker: actually looked in to see in the 40

00:01:16: ,140 Speaker: early stage. 41

00:01:17: ,040 Speaker: So all these things, we realized that how important it is that 42

00:01:21: ,219 Speaker: even if we can't provide what by Western standards is adequate 43

00:01:26: ,620 Speaker: diagnosis and treatment for them, we should do something so 44

00:01:29: ,939 Speaker: that we can help these patients. 45

00:01:30: ,299 Speaker: So this, uh, I realized long back in practice, early when I 46

00:01:35: ,819 Speaker: started seeing many of these people at a very early stage or 47

00:01:38: ,879 Speaker: coming in shock after a bleed when could have been saved in 48

00:01:41: ,739 Speaker: that situation and so on. 49

00:01:43: ,400 Speaker: So what we did was we started making these large vans, which, 50

00:01:48: ,000 Speaker: uh, are equipped with endoscopy, colonoscopy, uh, with 51

00:01:53: ,379 Speaker: ultrasound, basic medications which can be given to them and 52

00:01:57: ,920 Speaker: went into villages. 53

00:01:58: ,159 Speaker: One important thing to remember 54

00:02:00: ,719 Speaker: is that seventy percent of 55

00:02:01: ,540 Speaker: Indian population is still 56

00:02:04: ,519 Speaker: living in areas, villages or 57

00:02:07: ,539 Speaker: rural areas which are or 58

00:02:09: ,919 Speaker: semi-urban areas. 59

00:02:10: ,360 Speaker: They don't have access to any of 60

00:02:13: ,879 Speaker: these type of medical treatment, 61

00:02:14: ,520 Speaker: especially endoscopy. 62

00:02:16: ,039 Speaker: So we made these vans and then 63

00:02:18: ,360 Speaker: these vans go into the villages 64

00:02:20: ,560 Speaker: park there. 65

00:02:21: ,800 Speaker: And then we announced that we have these facilities. 66

00:02:23: ,319 Speaker: So our gastroenterologists 67

00:02:25: ,960 Speaker: initially trainees and then 68

00:02:26: ,240 Speaker: consultants would go first look 69

00:02:29: ,000 Speaker: at the patients, triage them the 70

00:02:31: ,039 Speaker: next day. 71

00:02:32: ,819 Speaker: Those who have potential problems expected cirrhosis, 72

00:02:34: ,840 Speaker: varices, ulcers and so on would be put up for procedures. 73

00:02:38: ,479 Speaker: And then the procedures were done in these vans. 74

00:02:42: ,719 Speaker: And of course, the problem with hygiene and you mentioned this 75

00:02:45: ,139 Speaker: cascade are from where I think that's very important because if 76

00:02:50: ,520 Speaker: you insist on perfect systems then you can't do it. 77

00:02:52: ,280 Speaker: You can't carry washing machines to those areas. 78

00:02:55: ,560 Speaker: Enough water is not there. 79

00:02:56: ,379 Speaker: More important, you require large amount of water if you are 80

00:02:59: ,340 Speaker: using the washing machine. 81

00:03:00: ,680 Speaker: So what we do is like 82

00:03:02: ,979 Speaker: mechanically clean use, 83

00:03:04: ,419 Speaker: sometimes even glutaraldehyde 84

00:03:06: ,819 Speaker: but other agents to for scope 85

00:03:08: ,580 Speaker: hygiene. 86

00:03:09: ,340 Speaker: It may not be perfect, it may not be that you can take out 87

00:03:13: ,460 Speaker: some rare spots, but I think it's good enough because you're 88

00:03:16: ,819 Speaker: saving so many lives. 89

00:03:17: ,379 Speaker: So it's a trade off between saving lives versus perfection. 90

00:03:21: ,840 Speaker: And, uh, I remember telling me 91

00:03:23: ,620 Speaker: once in endoscopy, perfection is 92

00:03:26: ,780 Speaker: not best. 93

00:03:27: ,180 Speaker: Sometimes you have to be a 94

00:03:29: ,740 Speaker: little less perfect to achieve 95

00:03:30: ,259 Speaker: your results. 96

00:03:31: ,900 Speaker: And this is an important area. 97

00:03:32: ,740 Speaker: So we started now going into this, we are done. 98

00:03:36: ,300 Speaker: Maybe now ten million people 99

00:03:39: ,979 Speaker: have been actually looked at in 100

00:03:40: ,379 Speaker: this way. 101

00:03:41: ,379 Speaker: Very large numbers I think is equivalent to population of some 102

00:03:44: ,900 Speaker: countries where you screen them, uh, looked at various things. 103

00:03:47: ,099 Speaker: Of course, Helicobacter also is very common. 104

00:03:50: ,419 Speaker: Sixty seventy percent of 105

00:03:51: ,340 Speaker: population still has 106

00:03:52: ,300 Speaker: Helicobacter. 107

00:03:53: ,819 Speaker: So these are screened early 108

00:03:54: ,199 Speaker: gastric cancers have been 109

00:03:56: ,439 Speaker: catching very early gastric 110

00:03:57: ,199 Speaker: cancer. 111

00:03:58: ,000 Speaker: Treating esophageal varices. 112

00:04:00: ,120 Speaker: Removing polyps which 113

00:04:01: ,159 Speaker: potentially can become 114

00:04:02: ,000 Speaker: malignant. 115

00:04:03: ,199 Speaker: And it's a huge satisfaction for us. 116

00:04:05: ,620 Speaker: And of course all this is done 117

00:04:06: ,960 Speaker: free of cost because it's 118

00:04:07: ,240 Speaker: supported by philanthropy and 119

00:04:09: ,159 Speaker: donors. 120

00:04:10: ,780 Speaker: And so we believe that doing this, we are actually affecting 121

00:04:14: ,639 Speaker: a large population and helping them in this way. 122

00:04:18: ,240 Speaker: So I think this problem hygiene came up sometimes it's very 123

00:04:22: ,439 Speaker: difficult to follow all the standard steps that you have to 124

00:04:25: ,199 Speaker: do to process your scopes. 125

00:04:27: ,160 Speaker: And of course, I think this is acceptable to the society. 126

00:04:31: ,240 Speaker: Yeah, of course I mean, infection or hepatitis versus 127

00:04:36: ,439 Speaker: dying of a variceal bleed is quite an easy choice. 128

00:04:41: ,800 Speaker: Now, if you actually look at data transmission of infections 129

00:04:45: ,139 Speaker: through a regular upper GI and colonoscopy is extremely rare 130

00:04:49: ,680 Speaker: because it shouldn't happen. 131

00:04:50: ,360 Speaker: If it can be zero, it's best. 132

00:04:52: ,439 Speaker: But even if you look at the era 133

00:04:55: ,540 Speaker: before all these hygiene 134

00:04:56: ,459 Speaker: standards came in, they're very 135

00:04:58: ,399 Speaker: scarce reports of hepatitis or 136

00:05:00: ,079 Speaker: salmonella being transmitted 137

00:05:02: ,980 Speaker: very less. 138

00:05:02: ,540 Speaker: But I think the mechanical the 139

00:05:04: ,500 Speaker: cascade system that we follow, 140

00:05:06: ,180 Speaker: the mechanical cleaning is good 141

00:05:08: ,740 Speaker: enough to prevent this very rare 142

00:05:10: ,259 Speaker: resistant spores. 143

00:05:12: ,459 Speaker: We can't clean, but as long as they're not doing procedures 144

00:05:15: ,459 Speaker: like Ercp or us in this type of situation, it's okay. 145

00:05:20: ,939 Speaker: Okay. 146

00:05:20: ,720 Speaker: Just to put it in a context, 147

00:05:22: ,620 Speaker: you're actually serving the 148

00:05:24: ,180 Speaker: population three times of my 149

00:05:27: ,100 Speaker: entire country. 150

00:05:29: ,100 Speaker: So going forward, this is what we can do, what we can accept. 151

00:05:34: ,660 Speaker: And sometimes there are consequences. 152

00:05:36: ,220 Speaker: But what about mistakes? 153

00:05:38: ,420 Speaker: What constitutes for you a true medical mistake? 154

00:05:42: ,980 Speaker: Quite philosophical question. 155

00:05:44: ,220 Speaker: Yeah. 156

00:05:45: ,379 Speaker: Again very important. 157

00:05:46: ,079 Speaker: This is something that I've always been talking to our 158

00:05:49: ,579 Speaker: juniors and students. 159

00:05:51: ,240 Speaker: I think in, in medicine, 160

00:05:53: ,240 Speaker: especially when you are doing 161

00:05:54: ,480 Speaker: procedures, mistakes are bound 162

00:05:56: ,399 Speaker: to occur. 163

00:05:57: ,879 Speaker: We don't call them mistakes. 164

00:05:58: ,040 Speaker: Normally I think the words Peter Cotton and nicely changed them 165

00:06:02: ,399 Speaker: from complications to adverse events that can occur. 166

00:06:05: ,079 Speaker: So when you do a procedure or any procedure, for example, 167

00:06:09: ,040 Speaker: ercp, you can have bleed, you can have pancreatitis in spite 168

00:06:12: ,079 Speaker: of all the precautions. 169

00:06:13: ,800 Speaker: If you do third space you can have bleed or perforation. 170

00:06:15: ,959 Speaker: So first important thing is that even if you do it for true 171

00:06:18: ,879 Speaker: indication with true intentions, with all the skills, you can 172

00:06:22: ,639 Speaker: still get some so-called adverse events during endoscopy. 173

00:06:27: ,680 Speaker: The first important thing is how you can tackle this. 174

00:06:31: ,120 Speaker: You make mistakes, but tackling 175

00:06:33: ,079 Speaker: these mistakes are very 176

00:06:34: ,199 Speaker: important. 177

00:06:35: ,800 Speaker: For example, have you used Indomethacin IV fluids 178

00:06:38: ,040 Speaker: adequately to prevent ercp? 179

00:06:41: ,000 Speaker: If you haven't done that, then it's a mistake. 180

00:06:44: ,560 Speaker: Have you assessed the patient for potential bleed in terms of 181

00:06:47: ,279 Speaker: coagulation and so on. 182

00:06:49: ,120 Speaker: And before doing third space of poem? 183

00:06:51: ,779 Speaker: If you haven't done, then that's a mistake. 184

00:06:53: ,300 Speaker: So I think mistakes and adverse events are different. 185

00:06:57: ,980 Speaker: So whenever an adverse events happen in the in our department 186

00:07:00: ,379 Speaker: every weekend, Saturday, we sit and look at them, see if there's 187

00:07:04: ,680 Speaker: something that we overlooked which could have prevented this 188

00:07:07: ,339 Speaker: adverse event from occurring. 189

00:07:09: ,459 Speaker: If you made a mistake, that 190

00:07:11: ,579 Speaker: means we didn't look at 191

00:07:12: ,540 Speaker: something that could have 192

00:07:13: ,180 Speaker: predicted this adverse events 193

00:07:15: ,939 Speaker: from occurring. 194

00:07:15: ,180 Speaker: In fact, we're just publishing 195

00:07:17: ,639 Speaker: this data on one of the largest 196

00:07:19: ,839 Speaker: adverse events in the endoscopy 197

00:07:21: ,300 Speaker: unit. 198

00:07:22: ,220 Speaker: I think we have to be frank about it. 199

00:07:24: ,500 Speaker: The reason we are publishing this is because we also do the 200

00:07:26: ,180 Speaker: largest number of procedures, uh, in an endoscopy unit in the 201

00:07:30: ,779 Speaker: world, we do almost seven hundred procedures a day. 202

00:07:32: ,100 Speaker: So which means we are bound to have mistakes which are going to 203

00:07:36: ,259 Speaker: be larger number. 204

00:07:37: ,699 Speaker: So we are publishing all the data of adverse events. 205

00:07:39: ,339 Speaker: So we're also going to show that 206

00:07:41: ,980 Speaker: you can actually prevent many of 207

00:07:42: ,819 Speaker: the adverse events if you have 208

00:07:44: ,139 Speaker: followed all the guidelines 209

00:07:46: ,019 Speaker: properly. 210

00:07:47: ,240 Speaker: But sometimes what happens is in 211

00:07:49: ,319 Speaker: lack of adequate equipment can 212

00:07:51: ,000 Speaker: also result. 213

00:07:52: ,839 Speaker: So I used to be very passionate about doing things even if 214

00:07:55: ,879 Speaker: everything are not available. 215

00:07:56: ,879 Speaker: But I'll tell you an example. 216

00:07:57: ,879 Speaker: When I started IRC first in nineteen eighty three, this was 217

00:08:02: ,519 Speaker: eighty three eighty four. 218

00:08:04: ,040 Speaker: At that time we didn't have mechanical lithotripter. 219

00:08:07: ,680 Speaker: I did an endoscopy, a large CBD stone put in the basket, and the 220

00:08:11: ,600 Speaker: basket got caught impacted. 221

00:08:13: ,879 Speaker: I couldn't take it out. 222

00:08:14: ,160 Speaker: I couldn't get the scope out. 223

00:08:16: ,240 Speaker: Everything got impacted. 224

00:08:17: ,560 Speaker: We didn't have mechanical lithotripsy at that time, so I 225

00:08:20: ,319 Speaker: had to send the patient, along with the endoscope in the mouth 226

00:08:23: ,879 Speaker: to the surgeon. 227

00:08:24: ,120 Speaker: At that time, surgeons and 228

00:08:26: ,240 Speaker: endoscopists were not very 229

00:08:27: ,120 Speaker: friendly. 230

00:08:28: ,920 Speaker: The surgeon took a photograph of the patient with endoscope 231

00:08:30: ,399 Speaker: through the mouth, operated, saved the patient. 232

00:08:33: ,840 Speaker: And whenever I'd pass him by the 233

00:08:34: ,840 Speaker: corridor, he showed me this 234

00:08:35: ,220 Speaker: photograph to remind me that you 235

00:08:38: ,120 Speaker: are endoscopy. 236

00:08:39: ,759 Speaker: And be careful. 237

00:08:40: ,679 Speaker: Now, of course, we are very 238

00:08:41: ,919 Speaker: friendly surgeons who wouldn't 239

00:08:42: ,559 Speaker: do that. 240

00:08:43: ,080 Speaker: So I then stopped doing ercp for 241

00:08:47: ,669 Speaker: six months till we got a 242

00:08:48: ,340 Speaker: mechanical lithotriptor. 243

00:08:50: ,379 Speaker: I realized that unless we have a mechanical. 244

00:08:52: ,639 Speaker: Because at that time, mechanical 245

00:08:53: ,740 Speaker: were not available in the 246

00:08:54: ,500 Speaker: market. 247

00:08:55: ,539 Speaker: I talked to Mahendra and then six months later, a commercial 248

00:08:59: ,340 Speaker: one is available. 249

00:09:00: ,299 Speaker: I got that and then we restarted doing again. 250

00:09:03: ,159 Speaker: So this is very important that before you do the procedure, you 251

00:09:07: ,620 Speaker: actually try and cut down your potential chance of a adverse 252

00:09:11: ,139 Speaker: events occurring by being prepared for that. 253

00:09:14: ,240 Speaker: I think all people doing 254

00:09:15: ,139 Speaker: endoscopy should read this book 255

00:09:17: ,899 Speaker: called Complications by Atul 256

00:09:18: ,860 Speaker: Gawande. 257

00:09:19: ,779 Speaker: Atul Gawande is a is a physician in the US, and he was looking at 258

00:09:23: ,059 Speaker: the mistakes made at Harvard and the number of deaths occurring 259

00:09:27: ,460 Speaker: because of hydrogenic problems. 260

00:09:29: ,860 Speaker: And then, of course, he has made 261

00:09:30: ,340 Speaker: this checklist, so-called 262

00:09:32: ,419 Speaker: checklist, which is usually used 263

00:09:34: ,980 Speaker: in airlines, the nine 264

00:09:35: ,700 Speaker: checklists. 265

00:09:36: ,659 Speaker: So now what we've done is in our endoscopy unit we have a 266

00:09:39: ,580 Speaker: checklist nurse who before any interventional procedure goes 267

00:09:43: ,179 Speaker: and checks is there carbon dioxide coming out. 268

00:09:46: ,440 Speaker: Is this hot biopsy forceps working well? 269

00:09:48: ,720 Speaker: Are the terms working adequately? 270

00:09:50: ,879 Speaker: All these things are done. 271

00:09:51: ,039 Speaker: We have made a checklist. 272

00:09:53: ,559 Speaker: And before each procedure there, 273

00:09:54: ,440 Speaker: the nurse checklist nurse ticks 274

00:09:56: ,879 Speaker: off. 275

00:09:56: ,759 Speaker: And we have found that we have actually decreased our mistakes. 276

00:10:00: ,039 Speaker: Once you have this type of procedure. 277

00:10:03: ,639 Speaker: So pre check. 278

00:10:04: ,960 Speaker: Look if all the precautions are being taken. 279

00:10:06: ,080 Speaker: Have a checklist nurse checking 280

00:10:09: ,200 Speaker: out that everything all the 281

00:10:10: ,440 Speaker: instruments everything is in 282

00:10:11: ,759 Speaker: perfect. 283

00:10:11: ,679 Speaker: And if a adverse events occur manage them in a proper way. 284

00:10:15: ,960 Speaker: I think that's the whole philosophy in this area. 285

00:10:17: ,440 Speaker: You also do have the very famous 286

00:10:20: ,980 Speaker: slide of Nike swoosh with saying 287

00:10:23: ,679 Speaker: Ircp. 288

00:10:24: ,600 Speaker: Just don't do it. 289

00:10:26: ,720 Speaker: So I guess the like pre list is also the deciding whether you 290

00:10:32: ,399 Speaker: need that ircp. 291

00:10:34: ,559 Speaker: So before I remember when everybody was so enthusiastic 292

00:10:37: ,759 Speaker: about Ircp, they were diagnostic ircp being done and ircp being 293

00:10:41: ,440 Speaker: done for all sorts of diseases. 294

00:10:43: ,409 Speaker: So I would in fact now I changed the slide a little. 295

00:10:47: ,330 Speaker: I put my face on a Buddha's face. 296

00:10:50: ,610 Speaker: You know, Buddha sat under a 297

00:10:51: ,409 Speaker: tree for enlightenment for forty 298

00:10:53: ,129 Speaker: years. 299

00:10:54: ,250 Speaker: It took me forty years of 300

00:10:56: ,409 Speaker: working on earth to realize now 301

00:10:58: ,769 Speaker: that never to do ercp when it's 302

00:11:00: ,009 Speaker: not indicated. 303

00:11:02: ,690 Speaker: Indication. 304

00:11:02: ,649 Speaker: Indication is very, very important. 305

00:11:04: ,929 Speaker: And this is now a theme in our unit. 306

00:11:07: ,450 Speaker: So if ercp is done without proper indication that endoscopy 307

00:11:12: ,690 Speaker: is not excused. 308

00:11:13: ,970 Speaker: I think this is something we have to insist to our juniors. 309

00:11:16: ,090 Speaker: Also, ercp is an invasive procedure. 310

00:11:20: ,009 Speaker: It has potential complication. 311

00:11:22: ,409 Speaker: Some of these complications can 312

00:11:23: ,649 Speaker: be very devastating and we 313

00:11:25: ,129 Speaker: should not do it unless strongly 314

00:11:27: ,009 Speaker: indicated. 315

00:11:28: ,090 Speaker: Okay, so going back to your juniors and the current clash 316

00:11:33: ,889 Speaker: between generations, the life work balance question. 317

00:11:37: ,370 Speaker: And if you are doing seven hundred endoscopies per day, 318

00:11:41: ,309 Speaker: that must mean that you're working insane hours. 319

00:11:46: ,629 Speaker: And, um, let's say Gen Z is 320

00:11:49: ,669 Speaker: talking more and more about 321

00:11:51: ,309 Speaker: having a life beside the 322

00:11:53: ,789 Speaker: hospital. 323

00:11:53: ,110 Speaker: What's your take on this? 324

00:11:56: ,269 Speaker: Yeah, of course, we have a large 325

00:11:57: ,409 Speaker: number of, uh, endoscopy is also 326

00:11:59: ,950 Speaker: working about thirty at a time, 327

00:12:00: ,830 Speaker: so. 328

00:12:01: ,750 Speaker: But more than that, I think this is a very important question you 329

00:12:04: ,350 Speaker: raised about work life balance. 330

00:12:07: ,649 Speaker: The work life balance is something that Gen Z is now 331

00:12:10: ,769 Speaker: talking about and say five o'clock, they have to go home to 332

00:12:13: ,149 Speaker: spend life with the family. 333

00:12:15: ,909 Speaker: I have no objections to that. 334

00:12:16: ,350 Speaker: But the problem is, for me, it's not work life balance. 335

00:12:22: ,509 Speaker: It's actually work home balance. 336

00:12:24: ,110 Speaker: So when you finish your work, what do you go home? 337

00:12:27: ,750 Speaker: You spend your life with your partner or with your wife or 338

00:12:29: ,070 Speaker: children and so on. 339

00:12:31: ,909 Speaker: So it's home. 340

00:12:31: ,710 Speaker: It's very important for whoever is, uh, getting into this 341

00:12:34: ,269 Speaker: speciality to think whether they can strike a equation between 342

00:12:38: ,830 Speaker: the home and work. 343

00:12:39: ,610 Speaker: Suppose you have a very understanding partner, or your 344

00:12:42: ,690 Speaker: children are well settled. 345

00:12:43: ,850 Speaker: You don't have to spend so much time, which means you can spend 346

00:12:46: ,850 Speaker: more time in your work. 347

00:12:47: ,929 Speaker: So then the work home balance changes a little. 348

00:12:50: ,169 Speaker: If you talk about work, life is a little different. 349

00:12:53: ,250 Speaker: So I always tell people, don't think about work life. 350

00:12:55: ,769 Speaker: Think about work work home balance. 351

00:12:57: ,570 Speaker: So it's the equation you have with your family. 352

00:13:00: ,809 Speaker: The second thing is the term work. 353

00:13:02: ,370 Speaker: Again, I don't like that work so much. 354

00:13:05: ,649 Speaker: Actually it's not work for me. 355

00:13:07: ,690 Speaker: People say, how do you work for eighteen hours? 356

00:13:09: ,610 Speaker: I say, I'm not working. 357

00:13:10: ,169 Speaker: I'm just enjoying my life. 358

00:13:12: ,809 Speaker: So if you enjoy your work, it 359

00:13:13: ,690 Speaker: becomes a series of enjoyments 360

00:13:15: ,210 Speaker: throughout the day or throughout 361

00:13:17: ,850 Speaker: the year. 362

00:13:17: ,169 Speaker: So if you enjoy what you are 363

00:13:19: ,570 Speaker: doing, it's not hard work at 364

00:13:20: ,730 Speaker: all. 365

00:13:20: ,450 Speaker: It's very difficult to hard work. 366

00:13:22: ,970 Speaker: Just enjoy what you are doing and then you can do it for many, 367

00:13:25: ,210 Speaker: many hours together. 368

00:13:27: ,690 Speaker: So when Gen Z comes and tells 369

00:13:28: ,809 Speaker: me, uh, look, I can't work so 370

00:13:30: ,970 Speaker: hard and all I tell, okay, can 371

00:13:32: ,289 Speaker: you spend a lot of time in a 372

00:13:34: ,730 Speaker: cinema? 373

00:13:34: ,289 Speaker: Can you spend a lot of time in a pub? 374

00:13:36: ,370 Speaker: They say, yes, we can do. 375

00:13:37: ,289 Speaker: That's enjoying. 376

00:13:38: ,690 Speaker: Then I said, do the same thing here. 377

00:13:39: ,850 Speaker: Enjoy your work. 378

00:13:40: ,049 Speaker: It becomes like spending time in a pub or spending time in a 379

00:13:44: ,909 Speaker: movie hall, you know? 380

00:13:44: ,669 Speaker: So it's the trick is to enjoy a 381

00:13:46: ,110 Speaker: work to strike a work home 382

00:13:49: ,149 Speaker: balance. 383

00:13:50: ,590 Speaker: Uh, and then only. 384

00:13:51: ,110 Speaker: But in spite of this, if somebody says he's not up to it, 385

00:13:54: ,629 Speaker: I think he should start thinking of changing his profession. 386

00:13:57: ,950 Speaker: Because if you unless you care 387

00:13:59: ,629 Speaker: very strongly for the patient, 388

00:14:01: ,269 Speaker: don't care about the timing 389

00:14:03: ,830 Speaker: part, only then you'll be a good 390

00:14:04: ,970 Speaker: doctor, especially good 391

00:14:05: ,230 Speaker: endoscopists. 392

00:14:07: ,509 Speaker: This is very important. 393

00:14:08: ,750 Speaker: Yeah. 394

00:14:08: ,629 Speaker: There's also the responsibility 395

00:14:10: ,909 Speaker: to the patient because it comes 396

00:14:12: ,950 Speaker: to your technical abilities and 397

00:14:14: ,830 Speaker: you need the volume to reach 398

00:14:16: ,669 Speaker: that. 399

00:14:17: ,950 Speaker: So a patient comes to us with a full trust. 400

00:14:19: ,289 Speaker: Just imagine a patient is coming 401

00:14:22: ,450 Speaker: to you and giving all his 402

00:14:23: ,149 Speaker: organs. 403

00:14:24: ,909 Speaker: No other profession would be trusted so much. 404

00:14:26: ,429 Speaker: You can't. 405

00:14:28: ,429 Speaker: No other profession will. 406

00:14:29: ,629 Speaker: A person going saying, take my body and do whatever it is we 407

00:14:32: ,710 Speaker: want to do with it? 408

00:14:33: ,669 Speaker: This is a medical medicine is only profession to do that. 409

00:14:36: ,590 Speaker: When somebody is coming with so much trust to say, okay, I've 410

00:14:40: ,769 Speaker: done half the endoscopy. 411

00:14:41: ,529 Speaker: Five o'clock. 412

00:14:42: ,049 Speaker: Time is up. 413

00:14:43: ,490 Speaker: I have to go. 414

00:14:43: ,850 Speaker: We'll see. 415

00:14:43: ,049 Speaker: Tomorrow is absolutely wrong. 416

00:14:46: ,730 Speaker: We have to give the trust they give on us. 417

00:14:48: ,490 Speaker: I think it's very important that as doctors, we do what is best 418

00:14:52: ,649 Speaker: that we can do. 419

00:14:54: ,970 Speaker: This is very, very important. 420

00:14:55: ,649 Speaker: We are like, um, you know, priests in a religion. 421

00:14:58: ,009 Speaker: You know, we are high priests of that religion, of medicine. 422

00:15:02: ,730 Speaker: And when they're coming to us with so much stress, we have to 423

00:15:04: ,009 Speaker: be good high priests. 424

00:15:06: ,450 Speaker: Otherwise, it's not doing the right thing. 425

00:15:08: ,570 Speaker: I get your point. 426

00:15:09: ,409 Speaker: But coming to the Gen Z and your 427

00:15:13: ,129 Speaker: mentees that you currently are 428

00:15:16: ,009 Speaker: mentoring, what do you expect 429

00:15:18: ,009 Speaker: from them? 430

00:15:19: ,809 Speaker: What other skills besides 431

00:15:20: ,129 Speaker: clinical and academic are needed 432

00:15:23: ,409 Speaker: in the current medical 433

00:15:24: ,330 Speaker: landscape? 434

00:15:25: ,450 Speaker: Yeah, of course skills is needed. 435

00:15:27: ,970 Speaker: Uh, person has to be up to date in what he is doing. 436

00:15:29: ,289 Speaker: But more important, we talked 437

00:15:31: ,250 Speaker: about this earlier in the 438

00:15:32: ,690 Speaker: episode. 439

00:15:32: ,370 Speaker: One is compassion. 440

00:15:34: ,009 Speaker: I think the compassion doesn't come naturally. 441

00:15:38: ,169 Speaker: This is very important. 442

00:15:39: ,350 Speaker: People say, okay, some people can be compassionate or no. 443

00:15:42: ,669 Speaker: Compassion can also be trained. 444

00:15:44: ,149 Speaker: You can get a training into becoming compassionate. 445

00:15:47: ,990 Speaker: This is important to realize that. 446

00:15:48: ,029 Speaker: You can say, for example, if a very small child comes to me, I 447

00:15:54: ,950 Speaker: think of the child as my grandson or granddaughter, then 448

00:15:56: ,590 Speaker: I become compassionate. 449

00:15:58: ,509 Speaker: When a teenager comes, I think is like my daughter or son, then 450

00:16:01: ,509 Speaker: I become compassionate. 451

00:16:02: ,110 Speaker: So the important thing about 452

00:16:04: ,330 Speaker: compassion is not, uh, no 453

00:16:06: ,070 Speaker: sympathy. 454

00:16:07: ,070 Speaker: It's empathy. 455

00:16:08: ,269 Speaker: Put yourself into the patient body and then think what they 456

00:16:11: ,309 Speaker: think, or the parents think, or what the relatives think. 457

00:16:14: ,470 Speaker: If you start thinking of 458

00:16:15: ,429 Speaker: yourself that way, then you 459

00:16:16: ,389 Speaker: become compassionate. 460

00:16:17: ,990 Speaker: Because I've seen youngsters 461

00:16:18: ,870 Speaker: trying to do procedures which 462

00:16:20: ,549 Speaker: they're not competent, they're 463

00:16:22: ,669 Speaker: trying to do a third space 464

00:16:23: ,269 Speaker: endoscopy. 465

00:16:24: ,990 Speaker: When there's a competent person near them whom they can refer 466

00:16:27: ,830 Speaker: to, they don't do that. 467

00:16:28: ,309 Speaker: They try and do themselves. 468

00:16:30: ,230 Speaker: And just imagine if you are 469

00:16:31: ,110 Speaker: doing it, your own father or 470

00:16:33: ,309 Speaker: mother and then produce the 471

00:16:34: ,110 Speaker: complication. 472

00:16:35: ,070 Speaker: Would that be okay? 473

00:16:36: ,570 Speaker: No. If you have more competent person may not refer to them. 474

00:16:39: ,970 Speaker: You know, just because you get more and more trained. 475

00:16:41: ,129 Speaker: Once you become good, you know 476

00:16:44: ,490 Speaker: that you are very good in that 477

00:16:45: ,970 Speaker: procedure. 478

00:16:45: ,049 Speaker: You can do it. 479

00:16:47: ,210 Speaker: So I think realizing the limitations of what they're 480

00:16:50: ,649 Speaker: doing, being compassionate and trying to develop skills in a 481

00:16:54: ,490 Speaker: particular area, which is the optimum, is very important. 482

00:16:57: ,809 Speaker: So I tell my unless you do this, you won't become good doctors or 483

00:17:01: ,490 Speaker: good human beings. 484

00:17:03: ,809 Speaker: In fact, I also tell them example of long. 485

00:17:06: ,609 Speaker: Back when I starting at CP, I once asked Michelle Kramer, who 486

00:17:11: ,250 Speaker: was at that time known as the father of IRC. 487

00:17:15: ,210 Speaker: So I asked him, what does it 488

00:17:17: ,890 Speaker: take to become a good 489

00:17:18: ,049 Speaker: endoscopist? 490

00:17:20: ,089 Speaker: And Michelle told me a very, you know, very strange answer. 491

00:17:23: ,069 Speaker: He said, Nagy, it's to become a good endoscopist not the skill 492

00:17:27: ,730 Speaker: or it is. 493

00:17:28: ,609 Speaker: If you are a good human being, you become a good Endoscopist I 494

00:17:31: ,450 Speaker: didn't understand it. 495

00:17:32: ,250 Speaker: Then what is good human being? 496

00:17:34: ,789 Speaker: I realize now that this is very, very right. 497

00:17:36: ,990 Speaker: if you're a good human being, you do the right procedure for 498

00:17:39: ,150 Speaker: the right indications. 499

00:17:41: ,190 Speaker: You know your limitations, and you know how to manage people. 500

00:17:44: ,309 Speaker: When something happens, complication happens. 501

00:17:46: ,789 Speaker: So I think this is very important. 502

00:17:47: ,430 Speaker: Now, I realize after forty years what you said is true. 503

00:17:50: ,950 Speaker: To be a good endoscopist be a good human being first. 504

00:17:53: ,029 Speaker: And that's the advice I give to all my mentees. 505

00:17:57: ,789 Speaker: That's that's very important. 506

00:17:58: ,430 Speaker: That's a tall order. 507

00:18:01: ,710 Speaker: The advice of being a good human being. 508

00:18:04: ,750 Speaker: That's lifetime achievement kind of thing. 509

00:18:07: ,190 Speaker: But then I'm curious, because 510

00:18:10: ,869 Speaker: there's also a very different 511

00:18:12: ,190 Speaker: paradigm that to be a good 512

00:18:15: ,049 Speaker: doctor, you kind of have to 513

00:18:17: ,190 Speaker: distance yourself and to be 514

00:18:19: ,470 Speaker: objective. 515

00:18:20: ,349 Speaker: That's very contrarian to what you are teaching yours. 516

00:18:24: ,670 Speaker: Yeah. 517

00:18:24: ,309 Speaker: So no, this is a very important 518

00:18:26: ,230 Speaker: I think you raised a very 519

00:18:27: ,910 Speaker: important point. 520

00:18:27: ,509 Speaker: You're right that if you get emotionally very involved with 521

00:18:31: ,509 Speaker: the patient, sometimes doing procedures become difficult. 522

00:18:34: ,650 Speaker: I've seen this happen in some of the endoscopists. 523

00:18:36: ,970 Speaker: As they age, they become more emotionally involved. 524

00:18:39: ,890 Speaker: They tend to become less aggressive. 525

00:18:41: ,049 Speaker: They make good physicians, but not good therapeutic endoscopy. 526

00:18:47: ,130 Speaker: So it doesn't mean that just 527

00:18:49: ,289 Speaker: because you have an empathy or 528

00:18:50: ,309 Speaker: compassion, you're getting 529

00:18:51: ,730 Speaker: totally involved into the 530

00:18:52: ,170 Speaker: patient. 531

00:18:53: ,569 Speaker: So keeping some distance is very important. 532

00:18:56: ,490 Speaker: But if a complication occurs I 533

00:18:59: ,869 Speaker: advise the endoscopy has become 534

00:19:00: ,930 Speaker: totally involved. 535

00:19:01: ,809 Speaker: You have to become a part of the patient and patient's family. 536

00:19:04: ,769 Speaker: Only then you can manage it very well. 537

00:19:06: ,730 Speaker: So there are two little contradictory. 538

00:19:08: ,690 Speaker: But compassion is very important. 539

00:19:12: ,569 Speaker: Keeping a little distance is 540

00:19:14: ,450 Speaker: important in the sense that you 541

00:19:16: ,210 Speaker: have. 542

00:19:17: ,170 Speaker: You are doing aggressive 543

00:19:18: ,450 Speaker: procedures, especially happens 544

00:19:19: ,049 Speaker: with surgeons. 545

00:19:20: ,529 Speaker: You know, you can't ask a surgeon to operate on his own 546

00:19:23: ,490 Speaker: mother or father. 547

00:19:24: ,769 Speaker: Many of them don't like to do 548

00:19:25: ,250 Speaker: it, so you have to keep a little 549

00:19:27: ,890 Speaker: distance. 550

00:19:27: ,890 Speaker: But compassion is a little different. 551

00:19:29: ,950 Speaker: Having compassion, uh, is very, very important Indeed. 552

00:19:34: ,150 Speaker: Thank you so, so much, professor. 553

00:19:37: ,549 Speaker: And I guess your advice of 554

00:19:39: ,650 Speaker: becoming the best person you can 555

00:19:41: ,769 Speaker: is the conclusion of our talk, 556

00:19:44: ,630 Speaker: and also of your journey through 557

00:19:47: ,950 Speaker: the years. 558

00:19:48: ,349 Speaker: Thank you so, so much. 559

00:19:50: ,569 Speaker: That was, uh, incredible to to 560

00:19:53: ,869 Speaker: hear your thoughts and your 561

00:19:54: ,230 Speaker: insights. 562

00:19:56: ,069 Speaker: And we hope we really hope to see you here again. 563

00:20:00: ,309 Speaker: Thank you professor. 564

00:20:01: ,950 Speaker: Thank you. 565

00:20:01: ,309 Speaker: I think it was fun doing this podcast. 566

00:20:04: ,230 Speaker: I'd like to thank you for doing this. 567

00:20:07: ,589 Speaker: I know we talked a lot out of endoscopy area, but I think 568

00:20:10: ,430 Speaker: sometimes these are also very important, especially for 569

00:20:13: ,509 Speaker: somebody who is going into this area of course. 570

00:20:16: ,789 Speaker: And also we do not talk that 571

00:20:18: ,309 Speaker: much about things like being 572

00:20:20: ,990 Speaker: compassionate. 573

00:20:21: ,869 Speaker: It's more the basics of endoscopy. 574

00:20:24: ,789 Speaker: Thank you professor, and thank 575

00:20:26: ,430 Speaker: you for the audience for tuning 576

00:20:28: ,710 Speaker: in. 577

00:20:28: ,990 Speaker: We hope you enjoyed it and we will see you in another one. 578

00:20:32: ,549 Speaker: Bye.