Top Urologist Dr. C. Mallikarjuna Reveals His Hardest Struggles | SOTS001 Dr Harsha
Author Name:Dr.Harsha Unfiltered
Youtube Channel Url:https://www.youtube.com/@DrHarshaUnfiltered
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Title: Top Urologist Dr. C. Mallikarjuna Reveals His Hardest Struggles | SOTS001 Dr Harsha
Author Name: Dr.Harsha Unfiltered
Description: From a Telugu-medium government school kid to building INU — one of India's leading urology institutions — Dr. C. Mallikarjuna sits down with Dr. Harsha for a brutally honest conversation most success stories leave out. No accolades, no achievements — just the struggles, failures, and hard truths behind 35+ years in urology and surgery.
From carrying his own diathermy machine in a Maruti 800 to freelance across Hyderabad's nursing homes, to building a world-class single-specialty institution from scratch — this is the story behind the surgeon.
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#DrMallikarjuna #Urology #AINU #MedicalPodcast #SurgeonStories #Hyderabad #HealthcareIndia #MedicalJourney #Leadership #Entrepreneurship #Podcast #DrHarsha #UrologySurgeon #IndianDoctors #MedicalEducation #inspiration
0:00 - Introduction & framing the conversation
1:26 - Childhood and family background
2:47 - Telugu-medium schooling, moving schools often
5:20 - Transitioning to English-medium in MBBS
10:17 - MBBS/MS/MCh and facing the real world after training
12:35 - No jobs, no opportunities in 1990 Hyderabad
18:41 - First break: assisting Dr. Saharya
20:09 - The ICMR pool officer job
23:07 - Freelancing years begin
25:33 - 10 years of freelance surgery (1990–2000)
29:27 - Human limitations & surgery as a craft
32:37 - Importance of teamwork over solo practice
34:12 - Leadership, accountability & building a system
36:21 - Complications, threats & patient litigation
39:24 - Managing difficult/suspicious patients
46:47 - Vision, ecosystem & growth of AINU
53:44 - Aging, limitations, wisdom & incremental learning
1:01:38 - Single-specialty teams vs. solo young practitioners
1:07:36 - Personal evolution & influential mentors
1:12:45 - Non-surgical progress & patient-first philosophy
1:16:43 - Reflections on learning challenges & career inceptions
1:24:05 - Establishing AINU & entrepreneurship challenges
1:30:37 - Handling day-to-day surgical complications
1:35:41 - Final personal retrospects
Our Guest
Dr. Mallikarjuna C
Chief Consultant Urologist and Managing Director at Asian Institute of Nephrology and Urology ( AINU Hospitals ) in Hyderabad, brings over 30+ years clinical expertise.
Scars Of The Stalwart Team
Host:- Dr.Bokka Sri Harsha
Director:- Nikhil Awasthi
Cinematographer:- Akhil
Editor:- Akshay Samala
Concept:- Dr.Bokka Sri Harsha
Social Media Manager:- Payal Awasthi
Thumbnail Desiger:- Nidigattu Manikanta Eswar
Location Coordinator:- Chakradhar (Assistant of Dr. Mallikarjuna C)
Shooting Place:-
AINU Hospital, Banjara Hills, Hyderabad
Gear:-
Camera Sony A7 IV
Camera Sony FX30
Lenses Sony 50mm f/1.8
Lenses Sony FE 28–70mm F3.5–5.6 OSS
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Transcript:
(00:00) She came to my OB and she came in a wheelchair and she was abusing me. I didn't realize [singing] what she's [music] alive and she's all right. I was very very agast at that point of time and after that and she started crying. [music] >> You said you were doing some tough cases, difficult cases, challenging cases.
(00:23) In urology, stones and prostate make the burden better. They give you new clients. They give you a bulk of patients. But the challenging cases they give you a kick at the same time a personal satisfaction which few people want to have. What is the cost of that kick? I know is the brainchild of Dr. Malik Kashna. How difficult is it for you or how challenging is it for you to keep your other colleagues and associates as busy as you are? >> As I said my life has gone to three decades now initially which has happened.
(00:50) One was the struggle for existence. in the next 10 years has gone by struggle to excellence. The third thing is going to be is trying to a stage of establishment. Let me talk about someone who is an inspiring character to me because he's also a urologist. He has served as a source of inspiration to more than three generations of urologists in the country.
(01:16) He is well known for his exceptional work in laparoscopy and reconstructive urology. He has been a past president of Urological Society of India at national, zonal and state level. He is so popular in surgical workshops that the halls are all full when he operates. I'm talking about Dr. S. Malikarjuna who is the managing director of AI Inu Hyderabbad and today we are going to dig and dive deep into all those scars which he has on his body and soul because behind that inspiration there's a lot of perspiration as he says and I'm going to talk about all those
(01:53) struggles and hardships which he had endured and which has shaped into what he is today. [sighs] Sir finally we are here and and you have no idea sir how overwhelming this is to me sir >> sir I am from Hyderabad I never had to look beyond Hyderabbad for an inspiration as a urologist and as a surgeon so sir uh I'm not going to talk about your success stories I'm not going to talk about how good a surgeon you are everybody knows it but I want to explore and I want to dig and deep deeply dive into those struggles and hardships which
(02:30) have shaped you into what you are because we all know it's not a bed of roses. Okay. So the questions are going to be brutal. >> So it should be an unseen side of mine. >> Absolutely sir. Absolutely. [gasps] >> Which I need to recollect now [laughter] >> sir. I'm sure they are not forgettable sir. >> No no no they can never be unseen sides.
(02:49) Most of the time the sides are the the success things are mostly forgotten easily but the things which fail you are never to be forgotten. >> Understood sir. And agreed. Agreed. So sir, let me straight away get started. How privileged was your childhood or how difficult was it? >> Well, I don't say that it was difficult.
(03:07) Difficult is not for that days. I think uh I'm not as bad but at the same time I was not really privileged and in fact my father was a junior engineer at the time in uh irrigation and department. So >> basically very honest officer of those days and we were living on the salary of what we used to get. >> Okay.
(03:31) And uh well I for that moment at that point of time probably I'm talking about 60s or 70s of uh 1960s and 1970s I think we are fairly decent enough to have a house or a rent a a house which is given by the government as a quarters and he's able to fund our education into the schools though I read all through my life in my JPI schools or government high schools only all through.
(03:53) >> So you mean to say you are from a Telugu medium background? Yes, of course. Till till 10th class, I was in Telugu medium only. >> And then how difficult was the transition from Telugu medium to English medium? >> Well, the transition was in fact I said my father was too honest. So I know all my 10 classes of 10 uh classes of the first 10 classes I read it in one one place of each.
(04:16) So I I read in my padu I read in Nandal and I read in Kalasti Guntal Sri Salam Hyderabad Rajbon school in the Kali near Rajban. Okay. >> So all these places where I've been roaming around. So I said at that point of time for that moment they are able to fund my education though in a government school. Okay. >> So we are not starving.
(04:37) So that itself is a great boon asset at that point of time. >> Agreed sir. Agreed. Because an an 80-year-old child, he doesn't know what a Rolls-Roy is and what a marine is. >> For him, being able to go to school without the need to think about their financial goals of their parents itself is a privilege. >> That's it.
(04:54) You may not get luxury, but your basic necessities are met with >> fantastic. He doesn't he doesn't know what a 75 rupees shirt means and what an Armani shirt means. >> You are wearing a shirt. >> That's it. >> There are so many people who are not wearing a shirt on the road. >> Fantastic. So, I'll take it as a privileged childhood with not much of a luxury.
(05:11) But yes, you were allowed to study and do nothing else. Fantastic. Okay, sir. So you said you're from Telugu medium background and you went to uh intermediate or 11th or 12th and probably you went into English medium. That's also okay. But medicine is taught in hardcore English and medicine is not taught in any other language. How difficult was MBBS first year? Let's [laughter] talk about anatomy or biochemistry because it's not easy sir even for English medium student.
(05:37) No. Um I differ a little here >> please. >> You see we all look at what is the difficulty we are categorizing as difficulty. Able to read in English. >> Correct. >> Or translate yourself from English to your own mindset. >> Correct. >> And able to write on paper. Correct. >> Am I right? Correct.
(05:56) These are the three aspects what we look at. >> Correct. >> So if you look at these three aspects >> reading it takes a little more effort. >> Okay. Okay. >> So it is not unachievable. You may be taking 10 minutes time if you're reading in your mother tongue like Telugu and you may take 15 minutes time when you start reading it in English over a period of time and shortens over a period of time.
(06:18) So it is only a time constraint. Nothing more than that. So that extra effort is necessary. >> Okay. >> Second thing is going to be understanding it. >> Understanding entirely depends upon the passion at which you are reading into it. >> Yes. If you're really reading with passion irrespective if you without passion [clears throat] without passion even your mother tongue you will not be able to understand with passion you should be able to understand even if it is difficult English itself >> so that's a second point third point is going to be translating it translating
(06:48) is not because of language how much you understood it >> so that is actually the acceptance of the whole transfer of the into a translation so >> the only difference in the whole whole cycle is only that extra effort you try to make yourself to make understanding that English from other term to English that extra 50% of the time which as the time passes by will starts coming down so first thing is extra effort initially which is not necessary later yeah >> number two is going to be having a passion when you are reading which can
(07:21) understand make you understand okay >> having understood you don't put an effort to really translate it >> 100% 100% >> so I think I don't Think there is a big difference in the whole thing except there is initial struggle probably most of the time which I see in my life is most of us who are translating from that not because we cannot put that struggle >> okay >> we are underconfident of our capabilities.
(07:48) So what makes those PE children I feel who come from that English or a translation but coming from one one group of education to the next group of education like English medium to sorry Telugu medium to an English medium is mostly a lack of confidence in them that they can as well compete with the rest of the boys also. >> Agreed sir.
(08:08) >> So if you have that confidence this is not a big deal. >> Okay. I felt differently difference or difficulty in my ability to read for a longer times but there was a problem but anyway your your vocabulary becomes a little limited you have a limited vocabulary in which everything explanation comes you may not use big big big words of English and possibly a limited vocabulary you'll be able to put it back into the public very easily but anyway that is it's not a hindrance anyway a speed breaker only >> got it sir So MBBS from uh Tupati then
(08:45) MSMCH from Chandigar. Okay. You are all set with MCH degree. So did you think the world will welcome me with red carpet or did you not expect those uh struggles once you came out and how difficult was it to enter the real world after your education? >> Thankfully God has been very kind to me in one aspect wherein I never had any breaks during whole my education.
(09:09) I finished my schooling and my intermediate inropati and then got into a medical seat immediately. So SVMC and the end of before I finished my uh my uh house NC I finished my PG entrance for Chandig Chandigar and I got into it and immediately after my house I joined into PGI.
(09:33) Immediately after my MS I got into senior residency in general surgery which is the most coverted post for training purpose. Okay. And uh I I spent some time on that and then joined urology and then till that time it was a it was a smooth transition though without much of expectations. >> I never aimed at something happening this should happen but it went on it went on without with efforts to succeed but at the same time there was no time gap.
(09:59) Most of the time what hinders you at the time is a lag which comes in and which makes you quite depressed that never happened. So till that point of time it was great. Okay. >> I never expected that it will be a bed of roses. And if you look at the the I say I passed out in 1990 as a urologist PG and BGHD and 1990. This is 36 years ago. >> Yeah. Yeah.
(10:20) >> 36 years ago. What was the healthcare industry in in India at that time? Nothing. Basically it was some pure private few nursing homes where visiting consultants were operating and a government hospitals which are there inside the government under the government sector and everybody was having a job in government hospitals.
(10:39) So there was nothing a carpet was never laid out. There was no carpet at all. There's no fabric of a carpet at all there at that point of time. So you realize that you come out but you're not sure what you're going to do. You're still not clear what you want to do. >> That's a fix. Am I right? You see, you cannot you are trained. Okay, fine.
(10:58) I I've been trained in a good institution. Yeah. >> Where I'm capable of doing it. I'm very confident in my abilities because I worked as a sin surgery and I did in a unit one of the one best units at that point of time for urology training. So I'm super confident in my abilities but I don't know what to be done with that abilities on the ground because there's no opportunity for me to do.
(11:22) There's where was the opportunity? There was no opportunity. I I never expected to be a bed of roses at all. Absolutely. Okay. >> But I realized if I can't find anything in the next two years and if I cannot sustain my family within next two years with my requirements >> in which case I'll move to the Middle East have some money at that point of time because by other time my father is retired and as I said he's such a honest man >> and that we are living with the pension money of my father.
(11:48) Oh >> when he and when I came in he it reted in 1988 and I came to Hyderabad in 1990 and I was living with a 5,000 stipend at that point of time in PGH educate. So I thought even if I get 10,000 rupees in Hyderabad at that point of time okay I'm happy enough and I can sustain my family because I don't need my house is there and I don't need to do anything beyond and luxuries need not be there at that point of time.
(12:14) So that was my thought process when I came in. >> Okay. >> But when I came in I didn't find anything. no opportunity at all. I went to in fact I was never interested in the private sector at all. I was so interested in my my basic concept was teaching and explaining the surgical was my core ability at that point of time >> which you are actually doing even now.
(12:32) >> Yes, of course. Now I'm I'm taking my inner inner this thing coming out and I'm trying to satisfy myself in that which I thought of doing at that point of time itself >> on full-time basis >> on full-time basis but I never had that opportunity because my brother who was an engineer he went to US before I finished my MCH and I was forced to say I'll stay with my with [clears throat] my parents and I came back to Hyderabad and I didn't find anything here I went to Nisams asked for a fellowship or small senior residency But they said
(13:03) there is no post. >> So the job scarcity was even there in '90s. >> Job scarcity was nothing now. It was only there at that point of time. The the government sector jobs were limited and they were all filled up already. By that time there were no new jobs coming up. There were no big hospitals. There were only three or four whole big hospitals having a urology department that time. Gandhi and Usmania none else.
(13:23) Nisams. These are the three hospitals only who had urology department at that point of time and all their post whatever are there are full. And they you need to go through the government selection. continue to go through that process. There should be a there should be advertisement and there so many things will happen right I don't know I didn't even apply so I don't even know the actual processes but anyway that was not available to me I went for nisams to get into a senior residency that was not available to me
(13:47) >> so I was left with nothing at that time >> okay >> and then it so happened that my one of my relatives who were getting operated by Dr. Sahara our super senior in PGhand and who was a transplant surgeon at that time. >> Yes. Yes. >> So I went and met him in view of that patient and he said why don't you come and join and assist us.
(14:07) >> Where was Dr. Sahara? >> That was in Mahavir Hospital. >> Yeah. >> So Mahavir hospital that's how I started off and I assisted him. So the first the first salary probably not a salary the surgical fee what I got was 400 rupees >> for a transplant assistance. my assistance for a transplant and I'm very happy for that.
(14:28) I was very happy for that and I told my wife look this is my first earning at least on the on the ground in Hyderabad at that time >> from Dr. Sahara >> from Sahara and I always say I learned a lot from him at that point of time during my stay of six months with him >> but after that so in view of not postpost somebody told me that you can apply for a pool officership which was which was established by ICMR under ICMR Indian council of medical research to get the brain drain which is happening to outside countries. They were asking
(14:54) those people to come back to India. They used to give a pool officership job and then they used to be placed in one of some of the teaching hospitals for that one to two years. still they can establish into another job. >> So a post was created to retain Indians. >> Indians at that time it is still there. I don't know whether it is still there or not.
(15:12) It was there at that time because people after after postgraduation people were going away. >> So they to they wanted to retain the government jobs were not there. So to wanted to gone people who had gone to England or US they wanted to come back. Okay. So there was a some post called pool officer. That means they were working under a department in a teaching hospital and the ICMR used to pay somewhere around 6,000 rupees per pool officer at that point of time per month.
(15:34) >> So just higher than your stipen I'm fine with it. So I I was so happy to get that and I got selected for it and I went back and joined department as a pool officer at that time. >> Okay. >> So it was not a bid of roses but it was struggle for existence. So this indirectly answers my next question which was like how imperative was you to work and make a living so that you can sustain your family.
(16:00) >> It was very much needed. >> I already had a son already by that time who going to a school and it was and my parents are already retired and that's the only thing. So whatever I earned that's the only way to sustain and I realized it very well but anyway that that didn't bother me because I never expected luxuries but everything was unfolding as the time passes by.
(16:20) So I was happy with that. [clears throat] >> Yeah. Yeah. So the moment you stepped out you got into pool officer post and uh you also started doing some freelancing. >> Yeah. That was actually the starting point of things officer post and uh I started working in usmania which exposed me to a great number of clinicians in Usmania at that point of time.
(16:41) So many anesthetists in the departments of anesthesia. >> Okay. >> They used to love my abilities at that time. They used to love my confidence in my subject etc. So they led me to get exposed to every nursing home possible in in Hyderabad at that time. >> Government hospital led you to freelancing. >> That's exactly obviously that was the only thing at that time.
(16:58) There was nobody else. Whoever is practicing outside in city were all practicing or were working in teaching hospitals in the day and the rest of the time it was happening in the night. That's how the evening clinics were there most of the time. So they led me to get exposed to so many people in Hyderabad, doctors, nursing homes, people.
(17:17) So that exposed my name which I was a newcomer to Hyderabad otherwise. So that exposed me to so many people at that point of time that help me to establish myself with my abilities anyway whatever it is. >> Yeah. Yeah. Got it sir. So sir even in the current era where people like me I mean I'm not freelancing anymore.
(17:36) I used to do it in the past. But people like me or younger guys who are freelancing at this point of time, they find nursing homes or the neighbor neighborhood hospitals quite inadequate for for an adequate patient outcome. The work is more or less substandard because of whatever the reason may be the difficulties were much bigger in your days.
(17:55) I believe >> of course >> but but how could you freelance for almost 10 years? because I read in your CV that you freelanced from 1990 to 2000 with the difficulty of uh an inadequate equipment or manpower or people with lesser abilities around you working in a freelance environment is a daunting task. I tell you the other way.
(18:18) >> When you are struggling to exist, >> okay, >> all those things are not seen. They start seeing once you feeling that you're no more struggling. So the difficulties are felt only when you have adequate things. If you are inadequate and struggle to exist, >> okay, >> those are never found as difficulties. They are day-to-day rituals which will get you to succeed in that struggle.
(18:42) >> So the first 10 years it was true. It was so that I was carrying all my equipment including dither including glycine for turs everything my one of three liter bottles. >> Yes. Three liter body in my dicky of my car along with one assistant to assist me. >> Which car you were driving at that time? >> Mari 8 >> 800.
(18:59) >> 800. >> Okay. >> So so I used to carry all those things to every part of Hyderabad to every nursing home. >> Okay. And luckily luckily I could make a good good out good good outcomes to every fair I operated and that least complication rate possibly at that point of time and that made the difference into my practice.
(19:22) So people call started calling me calling me calling me for that moment I tell you uh majority of the times you're looking at two aspects here number one how much struggle was there to move around correct >> okay as I said that that question I answered saying that if you're struggling you don't feel it as a struggle only when you have an adequacy you will not the second point I tell you which drives you more often was your aim why you are struggling >> okay >> are you struggling to make more money >> or are you strugg struggling to get more
(19:52) experience and your your mark into the society. >> Got it. >> If you are trying to make more money, >> okay, >> you become very very rigid in your whole approach into the whole practice. >> Got it. >> But if it is >> I need some patient to operate. I don't care if I get my pay money or not. I don't mind that.
(20:14) I don't mind even I may do it free of cost. But is this patient ready to get operated by me? That was my approach at that time. Am I getting work from morning to evening? Am I able to do two three cases out of which one may pay me? Doesn't matter in the rest of the two can give me whatever money they can have.
(20:31) But I should have an opportunity to operate a person. Okay. >> Which is my passion to do. So if you have that approach, you start enjoying it. >> You have led me into my next question. >> These are the two aspects of the same question I said. One you look at this way, the other way you look at in this fashion. So you have led me to my next question.
(20:52) When you said you are you were ready to operate free of cost. I heard you did your first 100 laparoscopy cases free of cost. Was it a necessity out of learning or curiosity to learn laparoscopy or uh inadequacy of uh the equipment which made you feel that you may open up a laparoscopic case probably more often? What was the reason? Why did you do the first 100 cases of laparoscopic free of cost? You said uh laparoscopic cases you did 100 cases you did free as sir >> well I'll I'll before I answer that part of it we'll come to the previous part of
(21:29) it >> okay >> I what I'm saying is that that part is based on my decision making at that time about laparoscopic cases but what happened previously between 1990 to 1998 I'm talking about where was my sole aim as I said before also was to operate as many patients as possible to get better at your work. >> I to get better at what Mike fulfill my passion.
(21:53) Continue to continue to practice my passion. >> Okay. >> And number two, prove that I am credible enough. >> Okay. >> That was the main thing. Money became the byproduct of my work. >> Agreed sir. >> So I never worked for money rather than I wanted work for which whatever payment was happening was never bothering me at that time.
(22:12) I tell you in satagindi center when Rupal started satagni center I got associated with him with the same patient whom connected with sahara at that time okay >> so raupal saw me and mahavir and said why don't you come and join as a as a urologist in sata kidney center well there was no concept of full-time urology there at [clears throat] the time so he asked me to come and join okay >> concept or the need >> there was actually a need but there were the concept was not there with neither with the consultant nor with the uh owners or anything like that so I used
(22:40) to spend all my day after my pool officership of one and a half years I used to spend all my day in Satya kidney center. So I used to see so many patients every person whoever is walking that was only kidney center at time it was very famous at that time and the significant amount of workload was there. I tell you there were a hospital package for a UR that is a small uritric stone was 3,000 rupees >> 3,000 >> 3,000 that's all you pay that the package one day admission in the general world 3,000 rupees you finish
(23:10) >> and we are talking about an era when there was no argu >> there's no argu >> and concept of health insurance was unknown >> no no that thing so patients Ram Ramopal was very famous from his village people will come with the urotic stone they want to get operated so Ramopupal used to give the patient to me if the patient is having I said about is how much you have if you have 3,500 rupees I'll operate you 3,000 rupees I used to give to the hospital 500 rupees I used to give to the anesthetist and 3,500 I may
(23:36) not get anything but I used to operate so I used to have 13 to 14 cases a day at that point of time being operated but still but still I used to get majority of the times were free or payments were so meager or equal to the anestries or 500 rupees or 1,000 rupees So, so the passion was to do as many cases as possible than making more money.
(24:02) Got it? >> So, money becomes a byproduct of it. So, this was the initial era which gave me a lot of credibility. I'm patient. Even today those patients come now and say tell me you helped us at that point of time. We still remember which makes me very good. But the same time I feel I mean you you felt that I have done great thing to you but you made me establish myself.
(24:23) >> Agree sir. That's that that is one thing which we need to look at. >> Correct sir. >> Then coming to laparoscopy part with the second part you asked me [clears throat] >> in fact you see for as I said again what is your passion to is practicing urological surgery right? >> Yeah. >> So money becomes the byproduct of practicing this passion.
(24:43) >> Okay. >> Okay. Money has to come by byproduct. >> Yeah. >> How do you update yourself? So there is urology was everchanging specialty in the last three decades. You know it very well. >> Yes. Yes. every first 10 years was endurology. I I learned indoorology by moving away and say that you come I'll operate. I don't mind even if you don't.
(25:02) So my endurology got reaching that doorstep step. So so the next step next what happened was my my laparoscopy laparoscopy was evolving and I felt that I was never been trained into laparoscopy. I never had any laparoscopic experience. It's all here or a conference somewhere a remote conference in as which was happening.
(25:20) One laparoscopy surgery case is done. We didn't have so much of YouTube knowledge at that point of time. So everything was >> it did not exist >> to exist. >> So so then I realized that I need to start my laparoscopy at one point somewhere or other. So where do I get it? I'm not in a government sector. I can't experiment with anybody else.
(25:39) So I have my own patience. I had a fair decent practice god saving at that point of time. Okay. >> So I have to experiment with my own patients. >> Okay. I may not do much harm because I have my abilities to convert and clean it up and do a proper end result at any point of time. >> Okay. >> But what I need is I may spend lot of time. I need some equipment.
(26:00) There is a capital expenditure involved. The there is a there is a hospital bill which goes up because I started learning. So that is a basic reason why I I I had to sacrifice all my surgical fees though charged as a surgical fee to the hospital so that I can learn with that extra time being spent on the on the patient.
(26:22) So fortunately with my open surgical skill which I already had for laparoscopy took somewhere around 50 100 cases of learning curve wherein I sacrificed all the surgical fees so that I can complete the case without a botheration that I have to finish this case otherwise the bill become mounting or something like that. >> Fortunately I had a good wrap up with my hospital administration also.
(26:41) So they were very they were clean enough saying that okay we'll cap the bill at this point you can we may not charge. they were enough to allow me to practice in that fashion. So that is basically why I have done it to learn subject. So whenever there is a passion that needs to be fulfilled or upgraded or continue to be lived with or you need to excel in your passion, there is a sacrifice which is involved.
(27:09) >> Got it sir. >> So that sacrifice initial part was money in the endurology again in laparoscopy. I had workload so I had to sacrifice my money so that I can I can learn it on my own workload. >> So this is a this is a way you need to evolve over a period of time. I don't know there is any other way to do it.
(27:28) >> Absolutely. So you said you were ready to forego your professional fee for what you are doing. At the same time how many times did any hospital or how many hospitals did did they ever I mean ever defaulted their payments to you? Did it happen? I'm sure it would have happened. Now I don't think that sort of a situation exists.
(27:48) Sometimes you see there are two three types of things. >> Okay. >> Sometimes one there are so many places where I operated remote place. I never went back again to take money. There was no UPI some cover has to be given to you at that point of time. So there's many hospitals where I haven't taken the money also for my surgical fee.
(28:05) I always had a shy feeling to accept any money. So I used to say bada and I used to come away from the hospital. Okay. Sometimes it was happening, sometimes it was not happening. But it didn't bother me at that time. >> Okay. >> There was some sort of a 20% of the hospitals there was always when I do that way, they try to exploit you at that point of time.
(28:23) So that was always there and I we accept it as a part. But ultimately whether he he exploited me for money but he could not exploit my learning on the patient where I operated. So that is an additional advantage what I had but I know what set of a people is there and how do you behave in future and the majority of the time 60% to 70% of the times I don't see anybody is that sort of a thing we always have a negative feeling about an hospital administration but >> most of the time they also are business people they also run a business they
(28:55) want to make their money they want to lo don't lose their money at any point of time >> so I don't consider them as a villain anywhere like thing but basically we also should understand that they also need to make money for the establishment what they have done. So in this hustle of freelance practice like doing some 10 to 12 15 surgeries a day going to far off places how could you keep up your mental and physical health? Well, mental health was getting rejuvenated as you do the number of the times. physical health
(29:26) well that was only exercise what I had and possibly that was also this running around was making me physically fit and that energy drive was there with me with me because there is something waiting for me there is something waiting for me all the time you're mentally sick or physically sick there's not when nothing is waiting on >> okay >> you always see that you see if you nothing is waiting for you next time next hour you'll get mentally and physically sick and we are not those people having done medicine and
(29:52) [clears throat] gone through that amount of rigorous the 20 years of training and all we can never keep quiet ourselves all sayante that's a Italian saying that sweetness of doing nothing >> that means do nothing and sit down and think about thoughts that's not easy job at all absolutely not and majority of the doctors can't do that also because your thought process is different and your body mind clock is completely different so >> well mental and physical health was not an issue well sometimes I do get disturbed because of inadequate facility
(30:25) somewhere a big issue and I get troubled well that was part of the game and it was happening all through in my life you know when then it happens whenever whenever you become too super confident there is a god who's always say a speed breaker would teach you that come on come back to the ground you can also have problems like that but what what out of all this bargain what affected was my commitment to my family that was a thing which was >> because I was leaving at 6:30 in the morning coming around 10:00 and uh that
(30:53) was One thing which I always regret in my life. If somebody says what you regret in your life, I regret two things. One, one is I could not give much time to my family. >> Okay. >> For struggle they accepted it because at that point of time because it was my struggle to exist. If I can't if I can't they cannot be happy.
(31:12) >> And the kind of work you were doing. >> That's and number two. We don't we didn't have anything to fall back on >> so that I can continue my life without doing anything also. >> Yes. >> So they accepted at that point. But I feel possibly they they have accepted. The second point is I still feel bad about it.
(31:29) I would have been more organized possibly given some time to it. For example, I tell you >> I haven't attended a parent teacher meeting of any of my kids. The only two times both of them I've read in Gitanjali >> Ganjali here in uh the two times I entered into that school was when I took admission to my son in 1990 when I came to Hyderabad.
(31:51) >> Uhhuh. And when uh there was a school day function on somewhere in 15 years later when my daughter was a 12th standard and he was the head girl of the school at that time. So this was the only two times I could enter into the school premises. So I never attended a parentage meeting nor their school days or any functions.
(32:14) So that's a regret what I have all through my life and I've expressed that regret to my children also many times saying that I can't get back. >> Okay. But I'm ready to sacrifice that whatever extra earning what I had to get back that time which I can't bend to get back any further. >> So it comes with a cost. >> It absolutely comes with a cost.
(32:30) >> Okay. So now let me take you I mean let me take the audience to some human side of Dr. Malik Kajja. Was this the reason that you started smoking? No, most of the time at that time the smoking was basically a hero heroism showing when you when you're in first year of MBS that was the most common thing which was there and at that time I started smoking okay >> that's another regret I still feel bad I told you know one of the regrets is I can't sell it but it's too personal so I telling you >> I I I hate myself for smoking in the
(33:02) front seat of the car with my children sitting in the back seat with the window open see so much crying criminal you look now and I feel >> no no no sir no that that's the reason I said it's a human side of Dr. Malikas. >> So I still feel that is a bad thing which I have done. I can't correct it now.
(33:21) I I'm ready to correct it but I can't correct it now. But anyway that was the reason for smoking was nothing reason. There's nothing thing to stress for me but I never because I never had expectation. I'll get stressful when I have an expectation. I am in the baseline. Even one comes it is a advantage for me. Two comes it is a bonus for me. Three comes I'm excited.
(33:37) Four comes I make a party and spend another two there. So this was the life which I led right from beginning. So I was never having an expectation which will allow me or which will give me any different uh uh field. So >> okay >> so smoking was not that smoking was basically school the college heroism shows that's all nothing else.
(33:58) >> So during this journey of freelancing and whatever it was you >> no first I stopped smoking 15 years ago. >> Oh so you're not a smoke. So you're a reformed smoker now. >> No no no 15 20 years now. 20 years now I don't smoke. One more small person question and how bad a smoker you were? How many cigarettes? >> I was very bad.
(34:15) I was 20 to 25 cigarettes a day. >> Wow, >> that's a huge number. >> Huge number. So sir, in this process of >> But one thing you did ask me why did I stop? >> Uh yeah, I must ask you. I I thought >> then see the reason for it was I feeling was a heroism right? >> Yeah. Yeah. >> Then at one point I realized I'm no more a hero. I can't be a hero also.
(34:34) So one one of my very close friend named another chist. I can take his name because he's no more but anyway he is very close to me since the day I since the day I came to Hyderabad he was practicing in centisa and that guy was so fascinated with my way of work and this thing every open case he used to come and assist me for there his own learning and it was needed for me also as a person who can hold my hand to stop because once upon sometimes I become so so fast in this thing he he's one speed breaker which may say go slow go slow
(35:03) >> you were a running horse >> uh he was he was he was putting a some sort of to break onto it. So >> when another and my kids are there, his kids and my kids are in a similar age at the similar uh [clears throat] age group and similar fashions. One day >> one day he had a chest pain and he was admitted into care hospital and he was advised anogram.
(35:24) That was in end of February and March where exams were due. March and April were due. >> Okay. >> So he refused an anagram and came back home and all his all the friends called me up and said Eric go and talk to him. Get an angog. me may delay it or it becomes difficult. >> Okay. >> So I went to his house for a function. We had a movie to go.
(35:42) I thought we'll spend 1 hour. Me myself, my Rama went. We both were sitting on the in the I and my Ramadan was another day was sitting on the terrace of his house in the flats and I was talking to him and saying 100 reasons why you should get an angog. >> Okay. >> 100 reasons to why you should get an anagram. >> Yes. >> He could answer 101 reasons why you should not get it done now.
(36:01) If something is there, their children education will go away. they will not be able to take exam their their whole thing 10th class or 12th class everything is going to happen now and if something deranged here their life is going to be spoiled will come what may happen I'll do it after their exams their entry into the thing >> at that time I I I finished four hours of talking to him >> so he was in fact giving you a reality check >> yes exactly so when I came back when I came back and sat into the car I revised myself saying that what all he said was
(36:30) true to me also at the same point of time >> it hit you very hard It is it hit me and I still remember he was really living in Beum Pit in that fly over what is there in Amorta Mal area. >> Yeah. >> I I I threw the last packet of the cigarettes in my pocket. >> And never smoked later. >> So it not comes to you when it is impact is more when it comes to your own people.
(36:53) >> Got it sir. So during this journey of freelancing you might have started building a team. So how difficult was it for you or for anyone to retain a right team member? >> It's the most you see the most most difficult thing is to retain the talent. >> Okay. >> Talent is see everybody need not be as passionate as you as thought pro thought thoughtful like you in the same bread in the same way of thinking.
(37:19) Okay, >> it may not be possible but >> but luckily for me it happened that people were there possibly I was clear in my concept and possibly um things worked out because they were also learning at that point of time and u it worked out. I I don't say that what is the best things that can happen but I fairly feel at this present juncture what I'm in I feel that I have got the best team I don't I can't dream better than this at all. Got it.
(37:45) >> So there is nothing a limit for it. I if somebody is I always am I am one person who say always say if somebody who's under who's along with me performs more than my expectation or performs better than me I am the happiest man for that. I give all that opportunities to people who stay with me.
(38:04) Everything is open to them and but I judge their possibility their their capabilities before I give that opportunity for them to them to show because people can't there judge their capabilities. They always presume that they are capable about but in fact it may not be true. So if you give a person who is not capable an opportunity to expose himself he may falter and that becomes less confident and that is end of it.
(38:30) So you need to be fair that decent level of confidence that is judged by the other person as a confident man as that you are a confident man and an opportunity at that time will give you the best possible result and that makes you super confident and once you become confident nothing drags you down. >> Yeah. Yeah. It's all about the mindset.
(38:47) >> It's a mindset. So building that mindset needs >> somebody to judge you. >> Okay. So based on my training during my PGA days possibly my attitude and possibly I was able to fairly judge people what are their capabilities and always felt that I should be able to give them >> the opportunity at the right time.
(39:06) >> So if these three qualities are given loyalty commitment and abilities which quality do you think is the most important for a right team member? >> All are needed one [clears throat] doesn't compensate to others. Okay, >> you see try to understand you may have a very loyal person but if he's not committed or very not ability [clears throat] you are unnecessarily carrying extra baggage which >> he becomes a liability >> liability it's extra baggage he may not be a liability you can call it but he becomes an extra
(39:37) >> correct correct >> baggage to you >> but a fellow with a great ability without commitment without commitment is a liability >> yes >> he's a liability >> a man with a great ability without with no loyalty to be get rid of. >> Yeah. >> So all three are needed. Loyalty is needed to a certain extent. Commitment is needed to certain extent and abilities are needed to extent.
(40:04) And all these things are you will you'll become a better person provided you have all three. If you you can never be a great better person if you don't have these three. >> That's the glitch. Finding the right >> always. You see there are 100 fellows who are absolutely abil the abilities are super but you not know all of them why are you knowing only few people >> okay >> they were committed to a cause they were loyal to a place that makes their abilities to grow up and seen very well >> but if it is not your abilities will get
(40:35) you a little amount of superflows into your mind and loyalties and loyalties lack of loyalty and lack of commitment will never allow you to grow at all. Understood sir. Fantastic. So uh from freelance practice to corporate practice the transition happened in 2000s. >> Yes. >> Was it difficult? Was it easy? >> For please take us through that.
(40:58) >> No I I think I think fortunately you see things the I have never made any decisions ahead. All the decisions were taken according to the situation existed there. >> Okay. So I was very happy in satindi center till some point of time wherein I worked for 10 years there and I was a very keen as I said I was a I was very keen on my teaching part of it I want to I want to do >> what was the opportunity to teach >> there was no opportunity that was a frustrating part of it [laughter] that's a frustrating so I was insisting and I
(41:28) was asking Rupal to take a DNB course there I'll employ so he said how can you take DMB courses we cannot pay this that usual usual style of it and I said okay don't worry >> okay >> I'll create department I take people under me I give salary to them apply for a DNB course from this institution I love people having coming here we'll establish a department we'll grow the department in a different style this is I'm talking about 1979 9798 >> okay >> at that period of time Ramopal initially said yes and that made me to get Samasur
(41:58) at that time who was an assistant professor in no more he's no more I'm sorry to say that but he's he was in uh >> he was in Nisams at that time as an assistant so I called Samsuro who is common friend to Anad Chadri and they said come on join join me okay >> we'll create a department >> so he quit his government job and joined you >> uh he quit his government job and joined me but again the the practices become different >> so somebody the the hospital encouraged me why do you want to work with him become an independent consultant and
(42:26) that that fractured my completely fractured my my sincerity towards the whole institution what I had for that last 10 years basically because I was a de facto to uh next to nephrologist after Ramopal though I was a urologist because there was no other nephrologist after Raual even if he's not there in station if there is a snake bite case I used to come sit and start doing a diialysis with my advisor that time and the technicians used to start diialysis so that fractured my confidence into the system at that point of time so that is
(42:59) the time possibly we start looking at come on this this is not a growth pattern here okay >> possibly if I need to grow that the seed has already sewn into me Yeah. >> And I was waiting for an opportunity to happen and unfortunately my mentor who whomsoever I was there with Ramopal passed away in 2000 at the time >> and uh that made me anyway I was baseless at the time.
(43:21) He was the only savior for me in that institution. >> Okay. >> And that made me to look around and say that come on I need to look into something else. >> Okay. >> Wherein I can fulfill both my practice which I already established to have a fair amount of practice in Hyderabad. I was quite I I started my own clinic at that time to get my own patients and I was quite busy quite busy and so and I was sought after in many nursing homes.
(43:44) Still my freelance was going on. So I said okay I >> I heard you were a favorite to almost all the gynecologist in Hyderabad >> that every nursing home at that time >> every nursing home every nursing home >> every urric injury every bladder injury Dr. [laughter] Malik >> well the available people were very less and available is readily available >> and probably you were the guy who was readily available at any point of time >> at any point of time that's that's the only uh only thing no difference basically okay [snorts]
(44:09) >> but uh so that's a time when I thought that I should get into some sort of a corporate style of work wherein people think in a different perspective like a DNB program or where I can fulfill my teaching or everything into that once I groom into that because for existence I have to be in a private hospital to continue practice I have to be in a private hospital but to get into that sort of a teaching mode I need some people to be there around for that only corporate can help me so >> I tried my Apollo they refused there
(44:36) they tried my level best I was there in Apollo Amar and Saiwani for some period of time Apollo Amar I was doing at the time as fair decent workload as good as what they were doing in main hospital so one of my the guy who was in charge of the hospital so his name was he was he was there he was trying to get me into main Apollo to improve the practice is an Apollo.
(44:58) But anyway, there are so many reasons why they never took me to uh main Apollo. >> So at that time, so my my thing is quite open. I need a place where it can be bigger. I can establish a department and I can have a teaching program in near future. This is what my aim was. And at same time, >> so the secondary band came into picture and Sudendar asked me to come over and that was a fair ground I thought and then I went and joined.
(45:22) So it's not that I want to improvise myself or do but the necessity of fulfilling some more inherent passions what I had >> apart from the clinical work you also wanted >> clinical work was anywhere happening. Yeah. >> Yeah. Yeah. Academic work. And did it fulfill your passion to teach? >> Yeah of course I of course I read I I at least started having a department wherein I had some people to work on.
(45:43) Okay. That was so my variety of workload was going on. routine at least routine surgeries were done by other my other colleagues and I was concentrating on much difficult surgeries so that I can be mental mentally to free to perform whether >> I can't be doing a to zed all the time got it >> so at least the cream part of it I can be doing so that fulfilled my technical or practice improvement what was happening because of the department was happening and then they took the DNB program and the DNB people have started
(46:13) off and till now there are so much of DNB program which is happening. Well, that is what at least and uh and then everything started off with with me doing tough cases, more difficult cases. My laparoscopic skill became better. I was called everywhere to teach laparoscopy. So, inherently I'm getting satisfied regarding >> teaching that skill part rather than a scientist part.
(46:35) I'm not a scientist but I'm basically a technician who wants to make things easy for others to practice. So I would say in a very simple way I would I am the I'm the person who teach anatomy because every surgeon knows what to be done later. >> Yes. >> Simply I I I always say that. >> Yeah. So like uh you said you were doing some tough cases, difficult cases, challenging cases.
(46:59) Uh in urology stones and prostate make the bread and butter. uh they give you new clients, they give you a bulk of patients but the challenging cases they give you a kick at the same time a personal satisfaction which few people want to have what is the cost of that kick and how many times did you have to or did you actually feel that I shouldn't have touched this case or this patient would have been rather left untouched >> how many times it happened and what were those moments >> see you're basically a craft master so you Don't expect yourself to be 100%
(47:33) perfect. >> Agreed. >> So we expecting ourselves to be the best all the time is not correct. >> Okay. >> Things may go wrong because of your There are two things which I always say surgical problems happen because of two reasons. One is ignorance of you. >> Okay. >> Or arrogance of you. >> Yeah. >> So both of the things have to be kept in control at some point of time.
(47:55) >> Correct. So at any point of time when we start doing it we always think that it will end result will be great on all the time no problem >> but sometimes it goes wrong. >> Okay >> I understand there are surgical listed complications all the time. >> Yeah. Yeah >> there's no doubt about it but most of the complications happen because you don't know about it or you're arrogant about the situation there.
(48:18) So if you retrospect retrospect you always think that wish this complication should have not happened. I would have been more more uh knowledgeful about it or I would have been into my limitations had it not the complications would have not happened. >> Yeah, >> it's a learning lesson for every surgeon happening all through his life.
(48:37) So I don't think if somebody says I never had that sort of a situation then he has not done any surgery >> or he's bluffing >> he is bluffing. So I always say I can't remember how many cases the how how many cases have you done so that it it taught you something. No, it is always happens daytoday or every time there is outcome might not be the way you expect even the minor outcome also you always feel that duty like I tell you any patient who had some sort of a PCL procedure he develops a fever so you start analyzing why this
(49:09) this guy had a fever was it the pre preoperative urine culture which was an estester you never treated the urine infection or your puncture technique was wrong you traumatized the tissue you perforated the pelvis You extabated the urine, you created more hematoma. So fever is a fever but li the limiting factor.
(49:28) So as a surgeon >> I expect everybody to to backtrack everybody everything has to be a reverse analysis of every situation so that you find an answer. On the day you find an answer you're a happy man tomorrow but if you don't try to do that or you can't find an answer you can have the same situation coming back to you. So you have to find these situations happening in your life.
(49:51) You can't escape it. If if you are escaping means you are not doing any surgeries. >> Got it? >> So this is a common thing. But the retrospect you need to say the actual thing what you need to say is >> you ask me why did I touch this class right? I give you an example which I always remember throughout my life. Okay.
(50:10) Lame name I don't need to tell I can say that name also. 1998 Anapurama. She's a she's a tumor. Mhm. who came with hematururia had a rightal tumor going right into the IVC >> okay >> just at the just below the level of epatic means and you know the private infrastructure how much it was to operate this case at >> 1998 it is during your freelance days >> freelance days I'm in satic India center so this patient came with hematururia >> okay >> so I said you require surgery I'll be operating you >> okay >> fine we didn't have ventilators we didn't have cardiac setups at that point
(50:39) of time but I was confident I should be able to operate >> okay >> so I convinced that I convinced her saying that you get operated you'll become all right. You see that's where I made a mistake. Convinced her see I retrospect why I tell you you'll know you'll understand. >> She said his only son oh he's getting uh married uh let me see after 5 months anyway his marriage is there after 3 months I'll come back after 5 months.
(51:02) No not a stage get operated. >> Correct. >> Fine. I did that surgery on the table. In fact at the time the primitive instrumentation I passed a fogi a fis catheter inside inflate the balloon and withdraw the whole thrombus repaired everything. patient went home on the fourth day or a sixth day. Fantastic. I was so elated.
(51:22) In fact, we went ahead and and had a party because we could do that case that time. Okay. >> It's a big case that time. I require I asked my Krishna is there. Krishna Kumar Kardan was there at that time. He was colleague to me in Mahab. So I asked his help be there in the OT. So he was there in the OT at that point of time. >> Well, we didn't we finished that surgery.
(51:43) One year later, she came to my OP. >> Okay. >> And she came in a wheelchair and she was abusing me. >> Okay. >> She was abusing me. I didn't realize what she's alive and she's all right now. >> I was very very aged at that point of time. And after that and she started crying. >> Okay. >> I said okay you calm down.
(52:04) I asked them to take that take her away and asked the attender who is one of the cousins because she has only one son no husband and all. She said uh she she said the story of it >> and then the story was after the marriage the the son and the daughter were going on honeymoon trip from Mysore to Ki they had an accident and both were killed.
(52:27) >> Okay. >> So I called her and said I asked you to leave me alone on that day. >> Had it not had you left alone I would have not seen this day. Oh, >> you made me alive and I have to suffer all through my life with that thing without anybody living alone in this world. So what have you done here? You thought you done a great thing.
(52:50) You've done a great surgical outcome. >> Okay. >> You've given a great outcome regarding the disease is concerned. But was it the right outcome for her in our wiser way? >> For her. >> For you. >> Not the disease. >> Not the disease. So what teaches you in thing is not disease. What teaches is the human being.
(53:10) So learn from the patient about not about the disease alone but about the rest of the holistic determination around her. >> So that will teach you when so I'll always say after that I changed. I never said I convinced you. >> Okay. >> So I never try to convince anybody. That changed my perspective. It is not you to get convinced convincing the patient to get operated.
(53:32) It is them to get convinced about the disease to get themselves operated upon. Correct? So you give whole information to them ifs and buts betters and bads of what what is the result of this procedure but it is there to get convinced that they need to get operated. When you try to convince this is what may happen. >> So this brings us to the fact that around the disease there is a whole patient.
(53:56) >> There is much more. >> Yeah. And around the patient there is a whole family. >> There's much more. >> So we not treating a disease, we are treating a family. >> I understand this is exactly what I'm trying to say because we we lack that empathy nowadays. We are losing that completely.
(54:14) We don't have you see there in in a fast world if somebody comes and sits in front of you. How many times you know what is he doing? You hardly we don't even ask him. >> You always see that X-ray oh you have a stone you need to get operated. You take it out and see am I right? And so and you are looking at converting or possibly expecting him to answer when he wants to get operated.
(54:32) >> Yes. >> Am I right or wrong? So I tell you an example when somebody comes and says a farmer coming from a from a rural area. He comes there and sits down and says that he has got a stone. >> Okay. >> And he has got a small 2 cm stone inside the pelvis of the kidney. >> He can get operated after 20 days also.
(54:49) But you say that better not you may get infected. You better may get pain. You may be incapacitated to get operated. But if you go into his detail come into issues and say what you do I'm a farmer sir what is the present situation it sir patty as you put it is just for cutting for the next 3 days if I don't cut there is there rain and all it will go away what is that situation if you really understand that situation what will you feel go finish the job and come back right or wrong how much time you are spending that amount of time with the
(55:19) patient for some reason we getting busy sometimes the patient also feels what is this nonsense he's asking around Yes, >> but the actual patient whom we we will not be able to we will not be identify and take this all parameters into picture. >> Yeah. >> Am I right or wrong? So, absolutely. >> This is one thing which we should realize.
(55:37) Possibly we are losing it because of our fasttrack world and the amount of work we are doing it. But possibly somewhere or other we need to get back into that shoes of the patient and understand the patient as a patient. Don't identify him as a disease. Yeah. >> Like these the days where we identify the people with a phone number rather than as a human being.
(55:55) So you also changing. >> Yes. So can you recall any moments where you were badly stuck with a case on table? The patient was bleeding or you're not able to proceed and there's nobody else to bail you out and could you get out of that situation by yourself or you had to abandon the case? Any such case which can recall? >> No.
(56:17) There is nothing like abandoning the case. You need to seek a help. That's all. There's nothing like a bad >> There's nobody to bail you out as well. >> Uh no, you need to come to your conclusion. If you're not if you are not able to come to your conclusion, better don't touch it. >> Exactly. That's the point. You should be prepared for everything.
(56:32) So it is always there. It is always always happens and you should be prepared well if there may be a little delay but you should be able to mentally get prepared to do that and there is always with the present day in a Hyderabad like city there's always people to help you. You are not in a remote corner of the place.
(56:46) If you are in a remote corner, you should be wise enough what you can bail out and what you cannot bail out. >> Correct? >> So one of the rare causes of a problem which nobody can nobody can think about but on a regular basis what you need to think about you should be aware of it and you should be able to have that confidence that you can come out of it.
(57:03) >> Again ignorance and arrogance >> that's it either you are ignorant about the problem or you are arrogant about your capabilities. >> Okay so I'll ask another sort of the same question. How difficult is it to manage the mess or a problem or the inability surgical inability or clinical inability or some administrative inability created by your uh colleagues in your team or in your past past place of work or current place of work? How difficult is it for you to manage? Do you take it as a challenge or do you
(57:32) take it as a nuisance and how often does it happen? >> You see, we are all we are all human beings. We may also create nuisances. So, let's not blame it. You see basically you'll be creating yourself into two things again when you look at and you'll understand whether it was done by ignorance or an arrogance.
(57:47) Arrogance teaches him ignorance makes him wiser. >> Okay. >> Right. So irrespective it's same for us also. Even if I create it at the same time I'll also become careful. So the this is a part of life. I cannot say that it will be difficult but being now at this seniority of my career possibly I do get these situations very often.
(58:08) Yeah. And [clears throat] with full respect to them I don't say that I can see that what would have gone wrong with the full respect to them I say that at least he's cartisan of two things which I say you can't get away with a complication >> yes >> you should know when you can stop >> correct >> and you ask for a help for somebody else so you should know somebody comes it's very common thing somebody attempted a uroscopy for a small stone and suddenly they are not able to pass a urer urtocope into the into the urer and they
(58:35) didn't take out the stone and the patient will say he's very angry that they didn't do the stone removal. I always tell them >> be happy. Be happy that he knew his limitations and restricted himself to his limitation. I appreciate that man who did no more damage than if not good. So that is a basic thing rather than doing a mess trying to attempt and do much more damage it's better to have an a intact system with less amount of damage coming back to your person who can manage it in other way.
(59:07) So you should know your limitations. Nothing nothing like nothing more than that. And it can happen to anybody. I don't consider that it is it is wrong that they cannot do it. That's the reason why they don't know. It can happen with any anyone anyone. Nobody is nobody is protected from this sort of a problem. >> So it boils boils down to the fact that we are all humans.
(59:24) >> Yeah. Absolutely. We are humans. Try to understand. >> You see boss come on. This is a craft. Craft. It's a craft. When you're doing a craft, you require so many other factors to be playing with you playing with you. Why do the people a a fellow who writing a film script goes to Thailand, sits in a beach without anything and writes a film Chris just because he wants some sort of a peace of mind.
(59:48) So thoughts can flow on. Can you have that sort of a thing? You can have you can have a problem sitting in your house. You can have a problem sitting in your hospital. You may have a problem with sitting with your taxation. You may have a problem within sitting with your vehicle or a children or anything irrespective of all these things.
(1:00:05) You're still your output in a given scenario which is given every day in your operation theater has to be the same. >> Yeah, >> it's not possible. There is some element of some element of pressure which happens because of it. As the time passes by, we may get immune with it or get adjusted to it. But there is always a it's always a thing which happens into your mind. So you get tuned to it.
(1:00:28) >> So that's the reason why I always say always say garner those days of individual practitioner who takes all the all the uh credit and all the headaches onto him and try to deliver with all other headaches inside him. >> So you need to have a team of people. So even if somebody is not giving able to give the best output at one point of time the other can chip in and able to get the best outcome out of it.
(1:00:52) So this is where a team work or a team effort plays a big role. >> Multiple brains working together. >> Absolutely. Absolutely. Nobody is nobody is absolutely saint or nobody has got no no tensions and everybody forgets everything. You see there's a there's a logo also times when you enter the airport cabin inside they always say that the same thing.
(1:01:16) Please leave every other thought outside this cabin. When you enter this cabin don't have any other thoughts. All worries outside. It is expected thing to be done but it's not easy. >> Yeah, >> we all humans. >> So if somebody believes that he's an independent practitioner, he's not independent. I believe he's alone. >> He's alone. Simply alone.
(1:01:32) >> Yeah, >> he's alone. >> So were there any incidents or can you recall any of those moments where you were held accountable or you took the accountability for the wrongdoings of your staff or anyone something like vicarious liability and it took a while for you to come out of it. It is all you see basically any problem is a problem.
(1:01:52) >> It's a leader's responsibility. Leader cannot shy away. >> Rest of the matters where went wrong it's internal discussion. >> Okay. >> But the leader has to take the >> So you have to stand in the front. >> Yes. You have to be in the front. >> Okay. >> You have to be in the front and you are the person over a period of time.
(1:02:05) You see basically what happens is it's a it's a ongoing process. >> Okay. >> For first 25 years you are there in the front. >> You after 25 the system comes into the front. >> Okay. Because but you are the system at that point of time. >> Yeah. >> So today I am the system. >> I am the system but I may not be there in front all the time.
(1:02:26) My system is there in front of >> the system that can take care of that. >> My system I created will take care of that. Yes. >> That is what is more important. >> Fantastic s. So as a clinician and as a surgeon in specific uh were there any incidents where you were threatened or you were abused mentally or physically by the patients or their attendants needed? >> It happens.
(1:02:49) It happens >> whenever whenever there is a bad result there does happen. It does happen but I fortunately had very very very few but most of the time I was more perturbed than their abuse. I was more perturbed. Like I tell you one of the rarest scenarios is we did a ESWL somewhere in 1997. >> Okay.
(1:03:09) Like a shock wave therapy for kidney stone >> stone and this guy goes into septic after that. I didn't do anything to Oh >> didn't do anything to me other than he has to goes into septicmia. At that time the only ventilator was there in care noli because they started off at that time I shifted to gear noli and then that care that means at the time it was original care was there and I I in fact >> on the bed I took my equipment passed a stent under under ventilator because I cannot take him to the thing and then after few days take out a stentole on
(1:03:39) the bed ultimately he recovered out of it but differently. >> Mhm. Well, you always get that difference and you situ situations have to be there. You cannot say that he cannot be there humanly you are emotional. How many times you you you scolded your son. It does happen. Your own son you are scolded.
(1:03:56) So things happen. >> Any incences or incidents where you were sued by a patient? Any litigations? >> No. Not >> never. >> Fortunately, >> fortunately not till now. >> Yeah. Got it. >> It can happen. You see it can happen anytime but not >> bigger the doctor bigger the problems that's what I believe >> no no no not not not till now >> and the problems are multiffold >> always there always multifold >> uh sir how difficult or how tough is it to manage a difficult patient what do you mean by difficult patient who is impatient who is always demanding who is
(1:04:28) a troublemonger who is a potential litigant who is always skeptical who always comes or steps into your op with a sense of suspicion rather than faith how do you manage situation >> you see I can't differentiate a fellow who has this or who doesn't have it on the on the face of him. >> Yeah. >> He walks in. >> Yes.
(1:04:47) >> Walks in. He may have >> all these thoughts inside his mind. >> Yes. [clears throat] >> But I'll not be able to differentiate. So I don't make myself keen enough to understand how is this guy. I make myself to be honest with me. >> Okay. I don't care what he is then till I am what I'm talking is the truth and I am honest to my expression >> okay >> it doesn't matter how soever he looks into it >> if I say I I need to take an opinion of my colleague and only come to it I'm not able to come to any conclusion go to go
(1:05:20) to the next room he'll see him we'll discuss and decide it will be honest >> and you don't need to give an opinion immediately on that okay >> if I'm going to give an opinion which I'm very confident with >> I put my word very clearly Okay. >> Explain these are the reasons why you require you know these are the reasons why you need to go through it.
(1:05:38) It is your choice or as I said I'll never try to convince him. I'll give him the information completely completely ifs and buts completely. Having said that like you have operated a patient let us say a a regular stone case after surgery some pain is seen in many patients but they make a scene out of that abusing you or uh questioning your ability saying that I'm still the same what have you done kind of situation uh it's very difficult for a youngster to handle the situations >> I understand >> but but definitely in at your stature
(1:06:10) maybe patients may not be may not dare to talk to you that way but they may talk behind you so what I mean to ask is somebody may not shout at you but they shout at your receptionist. They may shout at your colleague. It is directly or indirectly shouting at you. >> Absolutely. >> How to handle such patients? >> Well, there are some patients and we see unfortunately what happens is um we presume that everybody will have the best outcomes.
(1:06:32) >> Yeah. >> But sometimes there are outcomes which are not expected to the expected expectations right to the not to the expectations in which case >> we have some troubles beyond it. >> Yes. uh that the only way to come out of it is only communication. Nothing more than that. It is only communication. Communication.
(1:06:51) You see >> had you been very honest before your ability to communicate is very easy. >> Correct. >> Though the confidence [clears throat] at which you can communicate is only when you're honest enough. When you're not honest enough, I feel like I do an ESW. They have a stones coming down and blocking the thing and they say that it's paining you.
(1:07:09) I always tell them before there's a 90% chance that all stones will go away. there's a 10% chance that you may require a repeat intervention. >> Yeah, >> this is one thing which you need to say. Yes, >> if there is a residual stone suppose you did a piece I always say there's a residual stone which may not trouble you in case if it comes down into the urator you may have a trouble let's see it but it appears to be passible I may not do it >> so let's communicate and fair enough in our own result I don't think and this will I understand for a individual
(1:07:36) practitioner initially it becomes a very big difficulty like I tell you >> not independent who is alone >> alone the the biggest choice is somebody talking about a big stone and why he had to talk about because somebody else is offering an RA he also has to come into the same thing otherwise he'll not be able to get a chance to that operate that patient fear of missing out fear of missing out and fear of not missing out the technique fear of missing out the patient here that's exactly not so so that is one thing which I possibly need
(1:08:04) to restrict I have come senior enough to restrain myself and my people may respect my feeling but for a for youngster it may be a problem it may be a problem in near future I think we should be clear enough in our own approach and honesty in our approach so that you don't face the situations. >> One very personal question sir >> please >> I know he's a brainchild of Dr.
(1:08:25) Malik Kashna given your presence in this branch this is an extremely busy center even though it's a standalone specialty center I I I don't know if the situation is same in the other branches of uh I know number one number two how difficult is it for you or how challenging is it for you to keep your other colleagues and associates as busy as you are because the ecosystem in a standalone center is pretty much different from a multi specialty like I I work in a multipy if I'm doing x number of cases a month I get some 25 to 30% cases in my
(1:09:00) name some 20 30% patients from marketing some of the patients from cross referrals in a standalone center unless the person is as big as Dr. from Malik Juna or who has got a pretty pretty long career it's very difficult to attract and retain patients because you have the only source of getting the the only source of getting patience is your credibility and the name the existing name in the society how do you see that >> I think um everything [clears throat] starts like this only Asha >> okay >> to start with it's always a individual
(1:09:32) person >> okay >> around which the system is being created >> okay >> it's how robust Robust is a system which makes a future. >> Okay. >> Right. How robust is a system? >> Yeah. >> So where are your values here? >> Mhm. >> Where are your values? Where are your values here? >> Y >> what is your expectation out of those values? >> Mhm.
(1:09:54) >> How you are efficiently taking care of the need of the talent to create that or keep up that values. >> Okay. >> So this is a vicious cycle. This is a cycle which has to be run all the time. It's all the time. It's a continuous process. It is never a static process. It's a dynamic process. >> Yes. >> So the [clears throat] as I said my life has gone into three decades now.
(1:10:17) >> Initially which has happened. One was a struggle for existence. 10 years has gone by struggle for existence. >> And the next 10 years has gone by struggle to excellence. >> Okay. >> Right. I wanted to do laposcopy. I wanted to do big surgeries etc. I have created a team for helping myself to create that aura.
(1:10:35) I can make those things happen. Yes. And I showed it here and there. That is the third thing is going to be is trying to a stage of establishing it. What I have done, I've learned something. I have created something for myself. What am I trying to do? It goes away with me. I may continue to work in a corporate, make my money and that goes away with me.
(1:10:56) So I need to create an ecosystem wherein something can creep on and excel better than what I could achieve in my personal basis. >> Got it sir. So that was a stage of establishment. So this is I know is a brainchild was happening because of that reason. >> Okay. >> So last come is going to be is minus you >> minus minus you.
(1:11:18) >> Yeah. >> You have established the ecosystem and its ecosystem should be so strong that itself nurtures itself continues to keep the values inside and continues to replenish itself with whatever need of the talent is. Okay. >> So you my aim job now is to create that ecosystem. >> Okay. >> Before I possibly retire or something like that. But I may not retire.
(1:11:45) I continue to be a clinician into the place. But I'll not be the major face for it. I still >> I I'll I'll continue to be clinician because that is my passion. I talking to my patient is always my passion. I may not do surgeries because I'll not be the same way like what I was 20 years ago after 80 75 years.
(1:12:02) So I'll continue rest of the people to do it and take care of it. There are always people to do that. You see you don't expect that it is always run by money. It is not necessary. Had it been money people would have not been not been working in institutions taking a salary. Right? So everybody is not calculated by value. There there is something called value.
(1:12:20) There is something called passion regarding the profession. There's something called work culture and number three is satisfaction in the work. Number four is remuneration. all keeps in a place because if you want to want to increase one other will come down automatically. So it's a balancing equation.
(1:12:36) So my aim here afterwards is to keep that balance intact so that not for me for everybody else. >> Fantastic sir. So have you noticed any physical or mental limitations in you as you're aging? >> Of course you should. If you say that I'm same I'm not. I'm not. I'll not. See this see I always realized at this point because I was a better surgeon possibly 10 years ago >> what was the peak >> peak is around 45 to 50 >> 45 to 50 >> 50 55 45 to 55 is a peak time >> okay >> after that you you probably blunted by 1% every year >> okay >> but the same time you're more wiser
(1:13:17) >> so your in wisdom intelligence of wisdom cars increasing but your physical physical ability starts coming down slowly. We realize that at what point so that physical ability has to be supplemented by the people who can supplement that physical ability who do it. At present I restrict my all my things which I'm well versed with that means where I don't need to put too much of strain on my brain to how to work it out.
(1:13:44) It goes on to spinal memory because of my vast experience what I gained. So that I'll continue to do it. anything new very new surgery or a very new thing which has just entered into the market two months ago unless otherwise it's very easy to do I will not venture those things because there's no point me trying to learn it experiment it and then becoming perfect >> rather a youngster will have a lot shorter learn of curving shorter uh curve of learning will be able to excel and get to that point faster than myself >> y >> so I restrain myself to what I've been
(1:14:16) good at all through I don't go to experiment something new which I've decided that I will not my team somebody will take over on it and they will be able to excel it better than myself >> does it also mean you have uh limited yourself to performing surgeries of shorter duration or performing the only only the main part of a longer surgery >> I think that's a part of training like you see in a long surgery whenever in the in a department somebody is there there is there's a sequential growth which happens to anybody they start
(1:14:44) doing some segmentage it's called incremental learning it's methodology. >> So you you'll you incremental learning means you do some part of operation every time. Don't do a whole operation you fail. So you some part of operation you start doing it and that some part of the operation is given to the next person.
(1:15:01) So he'll excel first that and next step of the operation sometime later he'll get it. So this is called incremental learning. So that incremental learning is a very integral part of it actually. In fact, majority of the times our people uh our people start learning it in a wrong way. They claim they're they're given a degree. They come out into the practice and start doing surgeries and start learning out of their mistakes and look into it.
(1:15:26) >> Correct. >> But they are never groomed in this fashion. I I feel the people who are under me for a long period of time will get benefited out of that opportunity. there is what is called an incremental learning wherein I can I can assess their abilities and give that increments of learning process happening towards them at every point of time during this tenure that's what I said nobody expects me you want to be a good surgeon at the end of the day take your own 10 years time to mature yourself don't think that
(1:15:55) you'll be a great surgeon within the three years you may do two three procedures very well okay that doesn't mean that you establish yourself as a great surgeon so that incremental learning over a period of time makes you more perfect So a mature surgeon I always define is a fellow who doesn't need a fall back.
(1:16:12) >> Okay. >> And define fall back here in surgical terms please define >> fall back means three cases later fourth case he'll be able to do a complication and he calls up somebody what need to be done. >> Okay. >> So that is not the occasion. It is not the thing you see. You may do it once in 500 cases you may ask somebody's opinion.
(1:16:29) That's a different thing which you are not able to come. But >> in an incremental learning process over a long period of time somebody would have noticed this complication. You would have experienced that complication. You would have maneuvered that complication. So how to how to avoid that complication? You are mature about and your wisdom and your muscle memory will not allow that complication to happen.
(1:16:46) >> Correct? >> That happens with time. >> Yeah. >> That happens with exposure. That happens with volume. >> So it doesn't happen so fast. >> Okay. >> So it usually will take a long period of time. So this is what I would say that everybody will take some part of the operation at one point of time. The critical point will come only after they able to close up to that right moment and they are able to I feel that they are able to do that and probably I notice them doing it and I see them doing it once or twice then I'll free
(1:17:15) them so that you can do it. Does it mean there is no scope for an independent practice for a youngster coming into the uh society as a practitioner? Because like you said, if it's a methodical training, if it's incremental learning, you must be a part of a team. >> Unfortunately, I would say yes. >> The reason why is you as an independent practitioner, there are two things which you're not getting.
(1:17:40) Number one, >> okay, >> you can't get you can't get the volume. >> Yes, I agreed. See till if you're doing a laparoscopic surgery twice in a month, how can I become an expert? >> Yeah. >> So you are exposed to 10 cases a month. >> You may do one case in a year but your exposure will be ultimately 120 cases. >> Yes. Yes. >> Right. So that cannot be compensated.
(1:18:04) So your learning time is going to be long. >> Okay. >> And the curve is going to be very slow because the number of volume of the cases is going to be very low. Okay. >> And faster the exposure, better the learning. Slower the exposure, poorer the learning. So I would say for um rather I would say yes for your question. Yeah.
(1:18:21) >> Independent individual practitioners uh who are working alone. I would say alone >> alone >> especially with a low volume with a low volume because most of the time low volume in in in a in a city >> are growing in number like anything. So in which case I would say unfortunately yes you might be doing that common procedures because that volume may be supplementing you but uncommon procedures you are still a poorer man to get operated.
(1:18:45) >> Let's go deeper into the same question. How many teams are there currently in hydrobad in any surgical specialty where good quality work is going on and how many teams actually welcome such youngsters to be a part of the team because these are harsh truths sir. No, these are truths but it depends upon what the leader expects and what the person works works for.
(1:19:08) uh the person two things ah two things basically if the denominator is money no team will survive for long >> correct >> so the that's a basic reason why it happens most of the times >> what you see huh how many you see excellence doesn't happen in one year or two years it happens over 10 years I'm telling you now suppose if somebody is achieving excellence it happens only at the end of 10 years that means the team has formed and matured >> okay okay >> right if something happens over 10 years that means it has formed and matured
(1:19:36) >> you see every time this is what happens majority of the times teams do collapse or something it's only for denominator becomes the money >> but as I said there are so many other variables inside it number one is the passion to do good surgeries the passion to sub centralize yourself into your core specialty where you working alone your core may not be even once in once in a month or twice one case in two months so unless with a team you will not have that volume to come up so one is that and number two your another the
(1:20:05) the culture at work and number two and number three is uh how how how stressed you are at work. All these things matter. So many factors are there for a team to sustain for a long period of time. You need to you need to look at it every time. Every time of course one of the factors is also money. Everybody needs extra money.
(1:20:25) There's no doubt about it. >> Definitely. >> But that should not be the only reason why team has to develop. >> Money should be the service. >> One of the part not everything. >> Yeah. Yeah. >> Not everything. >> Fine. So sir, how have you evolved over this 35 years of your experience as a surgeon and as a leader? >> Well my my um surgeon as I said well I would say I'm very happy in my surgical journey.
(1:20:54) Yeah, >> I was trained as a good good open surgeon when I was in residency but I became a good endooologist during my first 10 years. >> Okay. and later good laposcopic surgeon later and the last 10 years into robotics and getting into uh much more than actual conceptualization of urological surgery rather than rather than how I perform for a single case.
(1:21:24) So conceptualization and making it what achieve what makes me much more much more happier today is >> how to make it simpler to the other person. >> Okay. So that concept probably I started feeling it in the last few years last five to seven years and uh especially when the laparoscopic surgery came in. So that is the most enjoying part of it.
(1:21:45) So >> uh so this is a surgical journey. So every decade there is a change and I always expect if you don't have a change at the end of 10 years in the way you approach your your career you'll be monotonous and that kills you your abilities and your zeal to continue. So you need to have something a purpose of life which is defined in a different fashion at every end of 10 years.
(1:22:09) >> Is is it uh out of quest to excel or quest to >> No, there's nothing to I don't I don't I'm not trying to excel here. I'm trying to uh feel myself good. >> Okay. >> I need to feel good. What makes me feeling good? I'm making somebody easier. Somebody comes and says, "Okay, this way of doing it made me much easier. I could finish it.
(1:22:31) " There's no excellence in that for me. So the most satisfying for me is okay some other person's life in their abilities. That is what makes me much more happier. >> This answers the [clears throat] question as a surgeon evolutionary surgeon. Yes. As a leader. >> I never considered as a leader all these days actually but well because of my seniority because of my ownership I became a leader but I still consider everybody as a part of the >> So you are accepted unanimously as a leader.
(1:22:59) I don't know >> some 70 80 urologists in I know are working alongside there are no there are two reasons why it can happen because I I am a majority is take guy into this or the conceptualization happened because of me and I risked myself to start this institution and possibly all those reasons might be the one but I would say as a leadership is a quality is not an authority >> yeah yeah >> it's not an authority >> it's creating leadershing more leadersh under you see you you need to see the progress in them and feel happy then only you'll be a proper
(1:23:34) leader >> I don't be a calling a leader if I achieve something and I post something at the behest of my team members working behind me rather if they can make something better and make themselves better as a leader though I'm sitting in the back I'll be feeling very very happy about it >> 100% 100% >> that is that is what my cult I I developed into it that's what is >> yep sir uh on a personal note would you be happy or would you be sad if a fantastic or a terrific non-surgical alternative comes into the picture for a
(1:24:07) very popular or demanding surgery like let us take the example of bladder removal for bladder cancer it is considered to be one of the >> most difficult surgeries in urology and of late what we're seeing in medical oncology is something which is progressing towards bladder preservation so what is your take on such things where surgical options come down at the cost of our personal satisfaction or a kick which we get as a surgeons but definitely the patients are getting benefited.
(1:24:34) How do you see that? >> I don't think there's I don't I don't think why should we think about it at all. something great happening great to the community it's always a welcome you never see none of the specialties are devoid of any any and if they don't get away from their work at any point of time like it see it's only thing is if you >> in your own journey if you if I doing an open surgery when I was a resident if I don't learn endurology I would have never existed in the first 10 years of my life if I don't learn laparoscopic
(1:25:04) urology I would have not excelled in the next 10 years of life >> if I not done my establishing practice or a system here for it, I could have not excelled in creating what I felt of teaching somebody and making their lives easier by doing the surgeries. So you need to change everywhere. So whether there is a new outcome, there's a new surgery, there may not be a surgery minus away from your list but bucket list but still you need something more to get added and there are so so many more things which you can you can look
(1:25:31) into and possibly can excel on. So medicine healthcare is never going to be obsolete at any point of time like even now in a IT sector like AI is replacing yes it does replace and probably automate some jobs but there are so many jobs which are necessary in the AI itself. So the people have to modify themselves into that in in that.
(1:25:53) So at every decade you cannot be doing the same work for the next 30 years and getting the same amount of money. You need to progress in your profession in your way of work everything too. So it all comes down to the point that patient first. >> Patient first always. You see there's no way you can defeat that way.
(1:26:08) You cannot pro you cannot stop the progress happening. >> Correct sir. >> At this point of time after 35 years is there anything that that makes you unhappy. >> Well I >> apart from the regret that you just >> No, that's okay. That's that's a part of life. That's a part of life. But I don't think uh I don't think I am feeling unhappy at any point of time.
(1:26:30) But the only thing is um I'm unhappy at one level because I wish I wish I was born at this point of time because learning was so easy. >> Yeah, >> learning is so easy for me at that time to do learn laparoscopy I have to travel so long to see one person. >> Okay. >> I used to spend between 11:30 in the night to 1:00 to see a lapi done by Jira in Ashoda.
(1:26:56) >> Okay. >> Just to learn laparoscopy. It was so difficult for and we see that that cassett used to come get that VCR >> to memorize >> we have to memorize play that cassette which is seen on a TV in a small thing VCR >> and learning was so difficult at that time. Yeah, >> I wish I wish I was a little late possibly 10 years before you are way ahead of your time sir.
(1:27:20) You you must ask me sir. We watch your surgeons on YouTube and we try to replicate them. >> I would have I would have shortened my learning curve that's all is very great. I would have what I achieved probably for 5 years or 8 years to learn my laparoscopic skill to perfect. I would not say perfect to achieve a reasonable skill I would say >> I would have done it in two years had it not been.
(1:27:41) So is there anyone perhaps that you envy or that you have no hesitation in saying that you try to copy them or be what what they are? Any person in medical field that you look up to? >> The three people who influenced me in my life regarding a being a urologist and beyond urologist one person was in my formative stages when I was a residency.
(1:28:00) >> Okay, >> that was uh Dr. Yanadan. He was a western professor at that time >> and he's a man who taught me how to be a urologist. What is that urological thinking which is different from a general surge? >> Yeah. >> So my concept of urology was taught by me or embied from him. >> Okay. >> It was pure imbibition from him.
(1:28:24) >> Okay. >> Which taught me that concept of urology. So many people ask me how your concept is different. >> Yeah. So I still rate that or possibly give the credit to him who molded me as a urologist. >> Okay. >> Having done my urology and coming out my basic uh point was to become passionate about teaching or practicing urology but able to teach people or teaching as a part of my my whole domain into the into the whole thing.
(1:28:52) >> Yeah. >> But that [clears throat] was not practical because I was struggling to exist. Yes. Yes, >> but at the same time I found one answer there was been a person by the name Dr. Mahesh desai. >> Okay. >> Who who could even practice? He was also practicing but he could sense that opportunity and create an environment around him to fulfill that passion what he had for that self.
(1:29:15) So he taught me how to practice urology. >> So you went to nad? >> No no no I not been to but I learned from him. I was association with him made me think I can also do in this fashion which I was clueless how to achieve it. I could see from him that it is if you have a will it is still possible. >> Okay. >> And the last thing is uh the man who was a mentor philosopher and guide to me in many aspects and small small issues sometimes is Dr. Nagishi.
(1:29:43) >> Oh >> so Nagi was instrumental in me thinking much beyond urology. >> Okay. >> So you are a urologist. What is beyond urology? So if you define that thinking process came from Nagi. >> Okay. >> So if you look at these three people these are the people who molded my career completely both formatively establishing and maturing myself into >> anyone you envy.
(1:30:12) >> There's none to envy because we know our limitations. We have their abilities. >> Okay. >> Looking back I can say that I wish I could have done better than what I am today. possibly I should have done in that fashion but it's a retrospect >> there is no point thinking on retrospect which gets you some some bad taste in your mouth but nothing more than that you should be happy with what achieved and possibly I'm fine with that of what I achieved and possibly that's what is to me in my life >> yeah so I'll take you back to the
(1:30:41) question which I asked you about I know it needs a lot of courage and guts to establish a standalone center in the era of multispety given the fact that like I said like we discussed the footfall into a standalone specialy center is whole and soul based on the person or the credibility or the popularity of that surgeon.
(1:31:04) So how could you even think of doing something and how could you materializing it? How could you materialize it and execute it so well? >> Coming back to the history part of it. >> Yeah. The biggest disadvantage what I felt in my corporate practice at that point of time when I was in my previous uh before I know was sustaining the department and getting the financials easy at the same times keeping up my values that was a very tough job because >> your absences felt and uh so many other reasons and >> okay >> and urology was a specialty during that
(1:31:39) time possibly I would say 15 years ago or 20 years ago there's so much of evolution So much of investment happening and we are not given that opportunity or or they were not allowing to in they were never allowing that investment to happen into the hospital structure >> and possibly it was finding for me difficult for me to even approach them and to get those equipment necessary.
(1:32:00) Nowadays every hospital is pushing that equipment because they found it is a mandatory thing but they never felt mandatory at that point of time. Everybody was looking at what is the return I get out of the investment etc. >> Agreed. Well, that was a difficult choice for me at that point of time. At that time, Nagi suggested if money is not your basic aim.
(1:32:19) >> You are capable with your whatever goodwill you have created into the society, you are capable of starting an own institution, building an ecosystem around you, >> investing whatever the way you required to do it and creating it profitable also. And he connected me to one or two people who are already a VCs who are investors into AIG.
(1:32:40) So that that idea came up somewhere around 2011 materialized by 2013 and we started this institution in 2013. But at that point of time the basic idea is to build a world-class institution for kidney diseases alone and it should be so good for that this old building itself was big enough at that point of time. Everybody commented me saying that are you going to think about doing this? It looks like it's such a big building.
(1:33:04) Are you sure about you are able to manage it? >> Yeah. But luckily God has been kind. We could we could stitch a good fabric of the team and then we were successful in creating that values and possibly getting that outcomes to the patient. What we believed is you do good work, good outcomes, money becomes the byproduct.
(1:33:25) That was my chairman's saying at that point of time. You just do good work, money automatically comes. Nobody is saying money. We are not asking you to earn money. You do good work, money automatically comes. That was the philosophy with which we started off. But anyway, any business or any entrepreneurship or any enterprise will over a period of time it has got its natural growth that should happen.
(1:33:47) >> Okay. >> Okay. In a urology like speciality, I can't add another five floors and put more beds. It doesn't make any sense because it is of no use. Yeah. >> So that's how when the concept of single specialtity worked out in our favor for the first seven or eight years >> wherein there's a lot of investment which is done into the into the into the equipment we are eyeing that investment ability to serve that extra mile extra better outcomes without spending too much of money in a corporate style and still getting that outcomes here in this
(1:34:21) sort of an institution. I thought it should be replicable in the same fashion. If the same sort of a thought process is there in the people who are going to work in those places >> valuedriven, >> valuedriven and possibly outcomedriven, finance becomes the rest part of it. I never say that you cannot be doing charity everywhere and still run the institution.
(1:34:38) >> Absolutely. >> So that's how the thought process started and we we we uh we expanded our institutions to many other places. But the same principle holds true wherein we always see that people who are keen on creating those values and change the outcomes and better service or better things just not to earn money.
(1:34:57) >> Yeah, >> just not to earn money. Money is mandatory otherwise growth doesn't happen. You can't get a new equipment if you don't earn. So money is mandatory. There is investor who is invested on you expecting money out of it also. But he doesn't want you to do a unscrupulous thing to get into it.
(1:35:12) So we never encourage that sort of an uncruscular activity unindicated unethical practice at any point of time. So do a good job think about the outcome think about the patient first basis and money becomes the byproduct of it. So that is the real that's a necessity at that point of time for me which made me to start I know after nagi advised me >> and later the natural growth took it to whatever stage it is today.
(1:35:37) >> Yes. Yes. Yes. Having said that sir, the kind of quality quality work that you perform in your hospital every single day, you're bound to come across complications. You're bound to come across some uh mishaps. How difficult is it for you in particular and anybody in general to pull up and keep working on a day where a disaster has happened? Number one.
(1:36:01) Number two, how difficult is it to is it for you to redo the same procedure next time? This happens with everyone at every point of time. I don't say that it doesn't happen. But there may be initial if the similar case comes in the next one month, you may have a little inhibition in doing that. >> But over a period of time, forgetting is a part of life.
(1:36:23) If forgetting is not there, you cannot be alive. >> We have chosen a profession which is bound to have >> bound to have this sort of an issues. >> Yes. Yes. that may be related to the patient host disease and the surgeon all process the patient itself the disease process or the surgeon all three together >> stakeholders and disease >> all the the whole these are the three stakeholders basically these are the three stakeholders which can result into that sort of an outcome but that should not dissuade you from doing it in next time because it is once probably first
(1:36:52) second third occasions you are a little cautious >> okay >> but it doesn't change the actual style of your work or the outcome but basically it satisfies you by being cautious that you are making an attempt not to get into that sort of a complication next time. But it is a part of your game. There's no other way.
(1:37:09) >> Yeah. We can't escape. >> We can't escape. We can't escape. >> We must keep doing the same thing. Sir, uh for an athlete, it's an Olympic medal or a world cup. What is it for you? The ultimate achievement or does a doctor have something called an ultimate achievement? Um that's what again we come back to the same same thing.
(1:37:32) What satisfies you? >> Yeah. >> Right. What satisfies you? Okay. >> Somebody asked me you have been doing 35 years you're doing the same job. What else we are doing? Nothing new. Probably the way we do it laparoscopically open surgery to but ultimately what we do inside the for the disease process is almost the same. Nothing has changed.
(1:37:49) But we get a little satisfaction by doing in a new technique >> something new which you have not done in the last 15 years in the new way and you replicate it you feel happy regarding your capability etc. Okay. >> Number two, you get more happy when somebody who is you taught him are able to replicate it and you made his life easier in making this possible.
(1:38:09) That makes you happy. >> Correct. >> Number three, somebody comes and tells you I you made my life easier and he he they say thanks you to you which makes it >> and ultimately which runs you every day to do the same job again is a a a satisfied patient or a patient attender coming back to you and thanking you in spite of you being paid.
(1:38:29) It is that extra effort what they are doing for making you feel good by saying that thanks which keeps you alive and do the same job again tomorrow. >> Happy patients happy doctors. >> Happy doctors not by money alone but by but by inner feeling and emotion >> always sir. I agreed agreed agreed. So sir last question given a chance to revisit your youth or when you were like 40. Okay.
(1:38:56) uh when you're doing very good surgical work is there anything that you would want to change or you hope and or you believe you could have changed to make yourself a better person >> no that is not in 40s in my format years yes actually everybody with my attitude and the way I was trained in open surgery I had an option of taking two interviews after my MS one was in urology another was for surgical oncology in Nadier >> Mhm.
(1:39:26) surgical oncology inad I had an interview. So these are the two interviews I have to attend. >> Okay. >> So at that time as I said we were just living with the strife and nothing more than that. >> Yeah. >> Um I finished my interview in Urology was first and I was declared elected selected already. >> Okay.
(1:39:46) And uh to come to Chennai again I have to take two trains from Chandigar to Chennai for two days or three days and come back again from Chennai to Chandigar at that point of time I felt okay I have I have something in my hand that's enough I don't need to try for it but >> okay >> looking back regarding my personality and my abilities on open surgery at that point of time and my attitude towards surgery I'd have been a better surgical oncologist I feel had it been that I have not done surgical oncology at that point of time.
(1:40:15) >> Sir, let me tell you something. You can complete your your answer. I was in Tata Memorial. Surgical oncology residents in Tata Memorial, they watch your YouTube videos and they operate. I'm not kidding sir. >> I understand. [laughter] >> No, that that is a surgical procedure. What I meant to say is it's based on what you not do it.
(1:40:33) What you see is how your inbuilt attitude is towards Yeah. >> Like my attitude was that exploration I was very good at even during my Jan surgery days. So I thought so probably I may not things have changed now surgical oncology has become laparoscopy we are all doing a lot of urological oncology also so I don't say that so that was the only thing had it been probably good had it been in a surgical oncology no regrets even being a urologist at that point of time I don't really regret but but the reason for selection was I felt
(1:41:05) the urology department was very good in in in PGI >> okay >> I plastic surgery people were asking me to apply but I didn't apply because I was never suited for plastic surgery. >> Urology was very good. So you get impressive. >> What do you mean by never suited for plastic surgery? >> I was never technic mentally not as I said now I'm an extrapetive surgeon.
(1:41:23) I'm not such a sort of a plastic uh aesthetic aesthetic guy of a thing. So so that I never even I didn't even go to the interview though I was I was called for the interview I didn't even go. So urology I went there. Okay. because I was impressed with the urology work at that time being as general surgery resident not because at that time we had very limited procedures some flavor to urology you don't develop in three years yeah >> am I right we all presume that I'm looking at kidney diseases doctor being because I like kidney disease being
(1:41:53) treated no these all we formatively we get those ideas because the way the work culture is there in the department how your bosses were there at that point of time in that department how the teaching is there in the department what sort of a surgery's residence was getting that makes your decision much easier. Yeah.
(1:42:09) >> So for that reason I went into urology actually frankly speaking I was supposed to become a vascular surgeon. >> I finished my urin surgery and then joined vascular surgery. >> You said your SR ship in >> SR ship and vas John surgery and vasular surgery and I was surgery senior resident vasular surgery on call for 24 by7 for the next one and a half years.
(1:42:29) Oh, >> so at that time had my boss skana at that time would have created a created a lecturership in vascular surgery. I would have been retained in vascular surgery at that time. He failed in creating that job. >> Okay. >> As a lecturer in vascular surgery. There was no MCH in vascular surgery at that time. >> Okay.
(1:42:48) >> So it came later after few years in Chennai at that time. So I was akin to be an surgeon. He failed. So I made my decision to go for another super specialization and then join neurology. >> And you would have happily been a vas surgeon. >> Absolutely. Absolutely. Vasel surgery was my passion at that time.
(1:43:05) >> Oh >> even my thesis general surgery thesis was in vas surgery >> sir. I think one podcast is never never never never enough for a guy like you because we I mean I have tried to bring out a lot of scars or miseries or whatever you have gone through but it's a it's a textbook sir and I strongly believe we ourselves uh stand as a role model for ourselves because our life itself teaches us a lot more than what other people can teach you and you as a leader as a urologist in Hyderabad are you are a source of inspiration to many
(1:43:36) many youngsters sir for generations to come And today I'm a changed man with the kind of interview that I have had with you and uh fantastic opportunity. Thanks a lot for your time and uh >> my last dialogue is always there. Always I say >> if somebody is inspiring you there's a lot of perspiration which has gone behind him.
(1:43:54) >> Absolutely sir. [laughter] Absolutely. Can't agree anymore. >> Thank you sir. Thanks a lot for your time sir. >> Wonderful. Very nice talking to you. Thank you sir. All the best. >> Thanks a lot sir. Thank you sir. Bye sir. Heat. [music] [music] [music] Heat.
Author Name:Dr.Harsha Unfiltered
Youtube Channel Url:https://www.youtube.com/@DrHarshaUnfiltered
Youtube Video URL:https://www.youtube.com/watch?v=FR74rwjr9Fs
Title: Top Urologist Dr. C. Mallikarjuna Reveals His Hardest Struggles | SOTS001 Dr Harsha
Author Name: Dr.Harsha Unfiltered
Description: From a Telugu-medium government school kid to building INU — one of India's leading urology institutions — Dr. C. Mallikarjuna sits down with Dr. Harsha for a brutally honest conversation most success stories leave out. No accolades, no achievements — just the struggles, failures, and hard truths behind 35+ years in urology and surgery.
From carrying his own diathermy machine in a Maruti 800 to freelance across Hyderabad's nursing homes, to building a world-class single-specialty institution from scratch — this is the story behind the surgeon.
🔔 Subscribe for more real conversations with India's top medical minds.
#DrMallikarjuna #Urology #AINU #MedicalPodcast #SurgeonStories #Hyderabad #HealthcareIndia #MedicalJourney #Leadership #Entrepreneurship #Podcast #DrHarsha #UrologySurgeon #IndianDoctors #MedicalEducation #inspiration
0:00 - Introduction & framing the conversation
1:26 - Childhood and family background
2:47 - Telugu-medium schooling, moving schools often
5:20 - Transitioning to English-medium in MBBS
10:17 - MBBS/MS/MCh and facing the real world after training
12:35 - No jobs, no opportunities in 1990 Hyderabad
18:41 - First break: assisting Dr. Saharya
20:09 - The ICMR pool officer job
23:07 - Freelancing years begin
25:33 - 10 years of freelance surgery (1990–2000)
29:27 - Human limitations & surgery as a craft
32:37 - Importance of teamwork over solo practice
34:12 - Leadership, accountability & building a system
36:21 - Complications, threats & patient litigation
39:24 - Managing difficult/suspicious patients
46:47 - Vision, ecosystem & growth of AINU
53:44 - Aging, limitations, wisdom & incremental learning
1:01:38 - Single-specialty teams vs. solo young practitioners
1:07:36 - Personal evolution & influential mentors
1:12:45 - Non-surgical progress & patient-first philosophy
1:16:43 - Reflections on learning challenges & career inceptions
1:24:05 - Establishing AINU & entrepreneurship challenges
1:30:37 - Handling day-to-day surgical complications
1:35:41 - Final personal retrospects
Our Guest
Dr. Mallikarjuna C
Chief Consultant Urologist and Managing Director at Asian Institute of Nephrology and Urology ( AINU Hospitals ) in Hyderabad, brings over 30+ years clinical expertise.
Scars Of The Stalwart Team
Host:- Dr.Bokka Sri Harsha
Director:- Nikhil Awasthi
Cinematographer:- Akhil
Editor:- Akshay Samala
Concept:- Dr.Bokka Sri Harsha
Social Media Manager:- Payal Awasthi
Thumbnail Desiger:- Nidigattu Manikanta Eswar
Location Coordinator:- Chakradhar (Assistant of Dr. Mallikarjuna C)
Shooting Place:-
AINU Hospital, Banjara Hills, Hyderabad
Gear:-
Camera Sony A7 IV
Camera Sony FX30
Lenses Sony 50mm f/1.8
Lenses Sony FE 28–70mm F3.5–5.6 OSS
To Know More,
Follow Dr. Harsha Unfiltered On ⤵︎
Instagram@DrHarshaUnfiltered
/ drharshaunfiltered
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Transcript:
(00:00) She came to my OB and she came in a wheelchair and she was abusing me. I didn't realize [singing] what she's [music] alive and she's all right. I was very very agast at that point of time and after that and she started crying. [music] >> You said you were doing some tough cases, difficult cases, challenging cases.
(00:23) In urology, stones and prostate make the burden better. They give you new clients. They give you a bulk of patients. But the challenging cases they give you a kick at the same time a personal satisfaction which few people want to have. What is the cost of that kick? I know is the brainchild of Dr. Malik Kashna. How difficult is it for you or how challenging is it for you to keep your other colleagues and associates as busy as you are? >> As I said my life has gone to three decades now initially which has happened.
(00:50) One was the struggle for existence. in the next 10 years has gone by struggle to excellence. The third thing is going to be is trying to a stage of establishment. Let me talk about someone who is an inspiring character to me because he's also a urologist. He has served as a source of inspiration to more than three generations of urologists in the country.
(01:16) He is well known for his exceptional work in laparoscopy and reconstructive urology. He has been a past president of Urological Society of India at national, zonal and state level. He is so popular in surgical workshops that the halls are all full when he operates. I'm talking about Dr. S. Malikarjuna who is the managing director of AI Inu Hyderabbad and today we are going to dig and dive deep into all those scars which he has on his body and soul because behind that inspiration there's a lot of perspiration as he says and I'm going to talk about all those
(01:53) struggles and hardships which he had endured and which has shaped into what he is today. [sighs] Sir finally we are here and and you have no idea sir how overwhelming this is to me sir >> sir I am from Hyderabad I never had to look beyond Hyderabbad for an inspiration as a urologist and as a surgeon so sir uh I'm not going to talk about your success stories I'm not going to talk about how good a surgeon you are everybody knows it but I want to explore and I want to dig and deep deeply dive into those struggles and hardships which
(02:30) have shaped you into what you are because we all know it's not a bed of roses. Okay. So the questions are going to be brutal. >> So it should be an unseen side of mine. >> Absolutely sir. Absolutely. [gasps] >> Which I need to recollect now [laughter] >> sir. I'm sure they are not forgettable sir. >> No no no they can never be unseen sides.
(02:49) Most of the time the sides are the the success things are mostly forgotten easily but the things which fail you are never to be forgotten. >> Understood sir. And agreed. Agreed. So sir, let me straight away get started. How privileged was your childhood or how difficult was it? >> Well, I don't say that it was difficult.
(03:07) Difficult is not for that days. I think uh I'm not as bad but at the same time I was not really privileged and in fact my father was a junior engineer at the time in uh irrigation and department. So >> basically very honest officer of those days and we were living on the salary of what we used to get. >> Okay.
(03:31) And uh well I for that moment at that point of time probably I'm talking about 60s or 70s of uh 1960s and 1970s I think we are fairly decent enough to have a house or a rent a a house which is given by the government as a quarters and he's able to fund our education into the schools though I read all through my life in my JPI schools or government high schools only all through.
(03:53) >> So you mean to say you are from a Telugu medium background? Yes, of course. Till till 10th class, I was in Telugu medium only. >> And then how difficult was the transition from Telugu medium to English medium? >> Well, the transition was in fact I said my father was too honest. So I know all my 10 classes of 10 uh classes of the first 10 classes I read it in one one place of each.
(04:16) So I I read in my padu I read in Nandal and I read in Kalasti Guntal Sri Salam Hyderabad Rajbon school in the Kali near Rajban. Okay. >> So all these places where I've been roaming around. So I said at that point of time for that moment they are able to fund my education though in a government school. Okay. >> So we are not starving.
(04:37) So that itself is a great boon asset at that point of time. >> Agreed sir. Agreed. Because an an 80-year-old child, he doesn't know what a Rolls-Roy is and what a marine is. >> For him, being able to go to school without the need to think about their financial goals of their parents itself is a privilege. >> That's it.
(04:54) You may not get luxury, but your basic necessities are met with >> fantastic. He doesn't he doesn't know what a 75 rupees shirt means and what an Armani shirt means. >> You are wearing a shirt. >> That's it. >> There are so many people who are not wearing a shirt on the road. >> Fantastic. So, I'll take it as a privileged childhood with not much of a luxury.
(05:11) But yes, you were allowed to study and do nothing else. Fantastic. Okay, sir. So you said you're from Telugu medium background and you went to uh intermediate or 11th or 12th and probably you went into English medium. That's also okay. But medicine is taught in hardcore English and medicine is not taught in any other language. How difficult was MBBS first year? Let's [laughter] talk about anatomy or biochemistry because it's not easy sir even for English medium student.
(05:37) No. Um I differ a little here >> please. >> You see we all look at what is the difficulty we are categorizing as difficulty. Able to read in English. >> Correct. >> Or translate yourself from English to your own mindset. >> Correct. >> And able to write on paper. Correct. >> Am I right? Correct.
(05:56) These are the three aspects what we look at. >> Correct. >> So if you look at these three aspects >> reading it takes a little more effort. >> Okay. Okay. >> So it is not unachievable. You may be taking 10 minutes time if you're reading in your mother tongue like Telugu and you may take 15 minutes time when you start reading it in English over a period of time and shortens over a period of time.
(06:18) So it is only a time constraint. Nothing more than that. So that extra effort is necessary. >> Okay. >> Second thing is going to be understanding it. >> Understanding entirely depends upon the passion at which you are reading into it. >> Yes. If you're really reading with passion irrespective if you without passion [clears throat] without passion even your mother tongue you will not be able to understand with passion you should be able to understand even if it is difficult English itself >> so that's a second point third point is going to be translating it translating
(06:48) is not because of language how much you understood it >> so that is actually the acceptance of the whole transfer of the into a translation so >> the only difference in the whole whole cycle is only that extra effort you try to make yourself to make understanding that English from other term to English that extra 50% of the time which as the time passes by will starts coming down so first thing is extra effort initially which is not necessary later yeah >> number two is going to be having a passion when you are reading which can
(07:21) understand make you understand okay >> having understood you don't put an effort to really translate it >> 100% 100% >> so I think I don't Think there is a big difference in the whole thing except there is initial struggle probably most of the time which I see in my life is most of us who are translating from that not because we cannot put that struggle >> okay >> we are underconfident of our capabilities.
(07:48) So what makes those PE children I feel who come from that English or a translation but coming from one one group of education to the next group of education like English medium to sorry Telugu medium to an English medium is mostly a lack of confidence in them that they can as well compete with the rest of the boys also. >> Agreed sir.
(08:08) >> So if you have that confidence this is not a big deal. >> Okay. I felt differently difference or difficulty in my ability to read for a longer times but there was a problem but anyway your your vocabulary becomes a little limited you have a limited vocabulary in which everything explanation comes you may not use big big big words of English and possibly a limited vocabulary you'll be able to put it back into the public very easily but anyway that is it's not a hindrance anyway a speed breaker only >> got it sir So MBBS from uh Tupati then
(08:45) MSMCH from Chandigar. Okay. You are all set with MCH degree. So did you think the world will welcome me with red carpet or did you not expect those uh struggles once you came out and how difficult was it to enter the real world after your education? >> Thankfully God has been very kind to me in one aspect wherein I never had any breaks during whole my education.
(09:09) I finished my schooling and my intermediate inropati and then got into a medical seat immediately. So SVMC and the end of before I finished my uh my uh house NC I finished my PG entrance for Chandig Chandigar and I got into it and immediately after my house I joined into PGI.
(09:33) Immediately after my MS I got into senior residency in general surgery which is the most coverted post for training purpose. Okay. And uh I I spent some time on that and then joined urology and then till that time it was a it was a smooth transition though without much of expectations. >> I never aimed at something happening this should happen but it went on it went on without with efforts to succeed but at the same time there was no time gap.
(09:59) Most of the time what hinders you at the time is a lag which comes in and which makes you quite depressed that never happened. So till that point of time it was great. Okay. >> I never expected that it will be a bed of roses. And if you look at the the I say I passed out in 1990 as a urologist PG and BGHD and 1990. This is 36 years ago. >> Yeah. Yeah.
(10:20) >> 36 years ago. What was the healthcare industry in in India at that time? Nothing. Basically it was some pure private few nursing homes where visiting consultants were operating and a government hospitals which are there inside the government under the government sector and everybody was having a job in government hospitals.
(10:39) So there was nothing a carpet was never laid out. There was no carpet at all. There's no fabric of a carpet at all there at that point of time. So you realize that you come out but you're not sure what you're going to do. You're still not clear what you want to do. >> That's a fix. Am I right? You see, you cannot you are trained. Okay, fine.
(10:58) I I've been trained in a good institution. Yeah. >> Where I'm capable of doing it. I'm very confident in my abilities because I worked as a sin surgery and I did in a unit one of the one best units at that point of time for urology training. So I'm super confident in my abilities but I don't know what to be done with that abilities on the ground because there's no opportunity for me to do.
(11:22) There's where was the opportunity? There was no opportunity. I I never expected to be a bed of roses at all. Absolutely. Okay. >> But I realized if I can't find anything in the next two years and if I cannot sustain my family within next two years with my requirements >> in which case I'll move to the Middle East have some money at that point of time because by other time my father is retired and as I said he's such a honest man >> and that we are living with the pension money of my father.
(11:48) Oh >> when he and when I came in he it reted in 1988 and I came to Hyderabad in 1990 and I was living with a 5,000 stipend at that point of time in PGH educate. So I thought even if I get 10,000 rupees in Hyderabad at that point of time okay I'm happy enough and I can sustain my family because I don't need my house is there and I don't need to do anything beyond and luxuries need not be there at that point of time.
(12:14) So that was my thought process when I came in. >> Okay. >> But when I came in I didn't find anything. no opportunity at all. I went to in fact I was never interested in the private sector at all. I was so interested in my my basic concept was teaching and explaining the surgical was my core ability at that point of time >> which you are actually doing even now.
(12:32) >> Yes, of course. Now I'm I'm taking my inner inner this thing coming out and I'm trying to satisfy myself in that which I thought of doing at that point of time itself >> on full-time basis >> on full-time basis but I never had that opportunity because my brother who was an engineer he went to US before I finished my MCH and I was forced to say I'll stay with my with [clears throat] my parents and I came back to Hyderabad and I didn't find anything here I went to Nisams asked for a fellowship or small senior residency But they said
(13:03) there is no post. >> So the job scarcity was even there in '90s. >> Job scarcity was nothing now. It was only there at that point of time. The the government sector jobs were limited and they were all filled up already. By that time there were no new jobs coming up. There were no big hospitals. There were only three or four whole big hospitals having a urology department that time. Gandhi and Usmania none else.
(13:23) Nisams. These are the three hospitals only who had urology department at that point of time and all their post whatever are there are full. And they you need to go through the government selection. continue to go through that process. There should be a there should be advertisement and there so many things will happen right I don't know I didn't even apply so I don't even know the actual processes but anyway that was not available to me I went for nisams to get into a senior residency that was not available to me
(13:47) >> so I was left with nothing at that time >> okay >> and then it so happened that my one of my relatives who were getting operated by Dr. Sahara our super senior in PGhand and who was a transplant surgeon at that time. >> Yes. Yes. >> So I went and met him in view of that patient and he said why don't you come and join and assist us.
(14:07) >> Where was Dr. Sahara? >> That was in Mahavir Hospital. >> Yeah. >> So Mahavir hospital that's how I started off and I assisted him. So the first the first salary probably not a salary the surgical fee what I got was 400 rupees >> for a transplant assistance. my assistance for a transplant and I'm very happy for that.
(14:28) I was very happy for that and I told my wife look this is my first earning at least on the on the ground in Hyderabad at that time >> from Dr. Sahara >> from Sahara and I always say I learned a lot from him at that point of time during my stay of six months with him >> but after that so in view of not postpost somebody told me that you can apply for a pool officership which was which was established by ICMR under ICMR Indian council of medical research to get the brain drain which is happening to outside countries. They were asking
(14:54) those people to come back to India. They used to give a pool officership job and then they used to be placed in one of some of the teaching hospitals for that one to two years. still they can establish into another job. >> So a post was created to retain Indians. >> Indians at that time it is still there. I don't know whether it is still there or not.
(15:12) It was there at that time because people after after postgraduation people were going away. >> So they to they wanted to retain the government jobs were not there. So to wanted to gone people who had gone to England or US they wanted to come back. Okay. So there was a some post called pool officer. That means they were working under a department in a teaching hospital and the ICMR used to pay somewhere around 6,000 rupees per pool officer at that point of time per month.
(15:34) >> So just higher than your stipen I'm fine with it. So I I was so happy to get that and I got selected for it and I went back and joined department as a pool officer at that time. >> Okay. >> So it was not a bid of roses but it was struggle for existence. So this indirectly answers my next question which was like how imperative was you to work and make a living so that you can sustain your family.
(16:00) >> It was very much needed. >> I already had a son already by that time who going to a school and it was and my parents are already retired and that's the only thing. So whatever I earned that's the only way to sustain and I realized it very well but anyway that that didn't bother me because I never expected luxuries but everything was unfolding as the time passes by.
(16:20) So I was happy with that. [clears throat] >> Yeah. Yeah. So the moment you stepped out you got into pool officer post and uh you also started doing some freelancing. >> Yeah. That was actually the starting point of things officer post and uh I started working in usmania which exposed me to a great number of clinicians in Usmania at that point of time.
(16:41) So many anesthetists in the departments of anesthesia. >> Okay. >> They used to love my abilities at that time. They used to love my confidence in my subject etc. So they led me to get exposed to every nursing home possible in in Hyderabad at that time. >> Government hospital led you to freelancing. >> That's exactly obviously that was the only thing at that time.
(16:58) There was nobody else. Whoever is practicing outside in city were all practicing or were working in teaching hospitals in the day and the rest of the time it was happening in the night. That's how the evening clinics were there most of the time. So they led me to get exposed to so many people in Hyderabad, doctors, nursing homes, people.
(17:17) So that exposed my name which I was a newcomer to Hyderabad otherwise. So that exposed me to so many people at that point of time that help me to establish myself with my abilities anyway whatever it is. >> Yeah. Yeah. Got it sir. So sir even in the current era where people like me I mean I'm not freelancing anymore.
(17:36) I used to do it in the past. But people like me or younger guys who are freelancing at this point of time, they find nursing homes or the neighbor neighborhood hospitals quite inadequate for for an adequate patient outcome. The work is more or less substandard because of whatever the reason may be the difficulties were much bigger in your days.
(17:55) I believe >> of course >> but but how could you freelance for almost 10 years? because I read in your CV that you freelanced from 1990 to 2000 with the difficulty of uh an inadequate equipment or manpower or people with lesser abilities around you working in a freelance environment is a daunting task. I tell you the other way.
(18:18) >> When you are struggling to exist, >> okay, >> all those things are not seen. They start seeing once you feeling that you're no more struggling. So the difficulties are felt only when you have adequate things. If you are inadequate and struggle to exist, >> okay, >> those are never found as difficulties. They are day-to-day rituals which will get you to succeed in that struggle.
(18:42) >> So the first 10 years it was true. It was so that I was carrying all my equipment including dither including glycine for turs everything my one of three liter bottles. >> Yes. Three liter body in my dicky of my car along with one assistant to assist me. >> Which car you were driving at that time? >> Mari 8 >> 800.
(18:59) >> 800. >> Okay. >> So so I used to carry all those things to every part of Hyderabad to every nursing home. >> Okay. And luckily luckily I could make a good good out good good outcomes to every fair I operated and that least complication rate possibly at that point of time and that made the difference into my practice.
(19:22) So people call started calling me calling me calling me for that moment I tell you uh majority of the times you're looking at two aspects here number one how much struggle was there to move around correct >> okay as I said that that question I answered saying that if you're struggling you don't feel it as a struggle only when you have an adequacy you will not the second point I tell you which drives you more often was your aim why you are struggling >> okay >> are you struggling to make more money >> or are you strugg struggling to get more
(19:52) experience and your your mark into the society. >> Got it. >> If you are trying to make more money, >> okay, >> you become very very rigid in your whole approach into the whole practice. >> Got it. >> But if it is >> I need some patient to operate. I don't care if I get my pay money or not. I don't mind that.
(20:14) I don't mind even I may do it free of cost. But is this patient ready to get operated by me? That was my approach at that time. Am I getting work from morning to evening? Am I able to do two three cases out of which one may pay me? Doesn't matter in the rest of the two can give me whatever money they can have.
(20:31) But I should have an opportunity to operate a person. Okay. >> Which is my passion to do. So if you have that approach, you start enjoying it. >> You have led me into my next question. >> These are the two aspects of the same question I said. One you look at this way, the other way you look at in this fashion. So you have led me to my next question.
(20:52) When you said you are you were ready to operate free of cost. I heard you did your first 100 laparoscopy cases free of cost. Was it a necessity out of learning or curiosity to learn laparoscopy or uh inadequacy of uh the equipment which made you feel that you may open up a laparoscopic case probably more often? What was the reason? Why did you do the first 100 cases of laparoscopic free of cost? You said uh laparoscopic cases you did 100 cases you did free as sir >> well I'll I'll before I answer that part of it we'll come to the previous part of
(21:29) it >> okay >> I what I'm saying is that that part is based on my decision making at that time about laparoscopic cases but what happened previously between 1990 to 1998 I'm talking about where was my sole aim as I said before also was to operate as many patients as possible to get better at your work. >> I to get better at what Mike fulfill my passion.
(21:53) Continue to continue to practice my passion. >> Okay. >> And number two, prove that I am credible enough. >> Okay. >> That was the main thing. Money became the byproduct of my work. >> Agreed sir. >> So I never worked for money rather than I wanted work for which whatever payment was happening was never bothering me at that time.
(22:12) I tell you in satagindi center when Rupal started satagni center I got associated with him with the same patient whom connected with sahara at that time okay >> so raupal saw me and mahavir and said why don't you come and join as a as a urologist in sata kidney center well there was no concept of full-time urology there at [clears throat] the time so he asked me to come and join okay >> concept or the need >> there was actually a need but there were the concept was not there with neither with the consultant nor with the uh owners or anything like that so I used
(22:40) to spend all my day after my pool officership of one and a half years I used to spend all my day in Satya kidney center. So I used to see so many patients every person whoever is walking that was only kidney center at time it was very famous at that time and the significant amount of workload was there. I tell you there were a hospital package for a UR that is a small uritric stone was 3,000 rupees >> 3,000 >> 3,000 that's all you pay that the package one day admission in the general world 3,000 rupees you finish
(23:10) >> and we are talking about an era when there was no argu >> there's no argu >> and concept of health insurance was unknown >> no no that thing so patients Ram Ramopal was very famous from his village people will come with the urotic stone they want to get operated so Ramopupal used to give the patient to me if the patient is having I said about is how much you have if you have 3,500 rupees I'll operate you 3,000 rupees I used to give to the hospital 500 rupees I used to give to the anesthetist and 3,500 I may
(23:36) not get anything but I used to operate so I used to have 13 to 14 cases a day at that point of time being operated but still but still I used to get majority of the times were free or payments were so meager or equal to the anestries or 500 rupees or 1,000 rupees So, so the passion was to do as many cases as possible than making more money.
(24:02) Got it? >> So, money becomes a byproduct of it. So, this was the initial era which gave me a lot of credibility. I'm patient. Even today those patients come now and say tell me you helped us at that point of time. We still remember which makes me very good. But the same time I feel I mean you you felt that I have done great thing to you but you made me establish myself.
(24:23) >> Agree sir. That's that that is one thing which we need to look at. >> Correct sir. >> Then coming to laparoscopy part with the second part you asked me [clears throat] >> in fact you see for as I said again what is your passion to is practicing urological surgery right? >> Yeah. >> So money becomes the byproduct of practicing this passion.
(24:43) >> Okay. >> Okay. Money has to come by byproduct. >> Yeah. >> How do you update yourself? So there is urology was everchanging specialty in the last three decades. You know it very well. >> Yes. Yes. every first 10 years was endurology. I I learned indoorology by moving away and say that you come I'll operate. I don't mind even if you don't.
(25:02) So my endurology got reaching that doorstep step. So so the next step next what happened was my my laparoscopy laparoscopy was evolving and I felt that I was never been trained into laparoscopy. I never had any laparoscopic experience. It's all here or a conference somewhere a remote conference in as which was happening.
(25:20) One laparoscopy surgery case is done. We didn't have so much of YouTube knowledge at that point of time. So everything was >> it did not exist >> to exist. >> So so then I realized that I need to start my laparoscopy at one point somewhere or other. So where do I get it? I'm not in a government sector. I can't experiment with anybody else.
(25:39) So I have my own patience. I had a fair decent practice god saving at that point of time. Okay. >> So I have to experiment with my own patients. >> Okay. I may not do much harm because I have my abilities to convert and clean it up and do a proper end result at any point of time. >> Okay. >> But what I need is I may spend lot of time. I need some equipment.
(26:00) There is a capital expenditure involved. The there is a there is a hospital bill which goes up because I started learning. So that is a basic reason why I I I had to sacrifice all my surgical fees though charged as a surgical fee to the hospital so that I can learn with that extra time being spent on the on the patient.
(26:22) So fortunately with my open surgical skill which I already had for laparoscopy took somewhere around 50 100 cases of learning curve wherein I sacrificed all the surgical fees so that I can complete the case without a botheration that I have to finish this case otherwise the bill become mounting or something like that. >> Fortunately I had a good wrap up with my hospital administration also.
(26:41) So they were very they were clean enough saying that okay we'll cap the bill at this point you can we may not charge. they were enough to allow me to practice in that fashion. So that is basically why I have done it to learn subject. So whenever there is a passion that needs to be fulfilled or upgraded or continue to be lived with or you need to excel in your passion, there is a sacrifice which is involved.
(27:09) >> Got it sir. >> So that sacrifice initial part was money in the endurology again in laparoscopy. I had workload so I had to sacrifice my money so that I can I can learn it on my own workload. >> So this is a this is a way you need to evolve over a period of time. I don't know there is any other way to do it.
(27:28) >> Absolutely. So you said you were ready to forego your professional fee for what you are doing. At the same time how many times did any hospital or how many hospitals did did they ever I mean ever defaulted their payments to you? Did it happen? I'm sure it would have happened. Now I don't think that sort of a situation exists.
(27:48) Sometimes you see there are two three types of things. >> Okay. >> Sometimes one there are so many places where I operated remote place. I never went back again to take money. There was no UPI some cover has to be given to you at that point of time. So there's many hospitals where I haven't taken the money also for my surgical fee.
(28:05) I always had a shy feeling to accept any money. So I used to say bada and I used to come away from the hospital. Okay. Sometimes it was happening, sometimes it was not happening. But it didn't bother me at that time. >> Okay. >> There was some sort of a 20% of the hospitals there was always when I do that way, they try to exploit you at that point of time.
(28:23) So that was always there and I we accept it as a part. But ultimately whether he he exploited me for money but he could not exploit my learning on the patient where I operated. So that is an additional advantage what I had but I know what set of a people is there and how do you behave in future and the majority of the time 60% to 70% of the times I don't see anybody is that sort of a thing we always have a negative feeling about an hospital administration but >> most of the time they also are business people they also run a business they
(28:55) want to make their money they want to lo don't lose their money at any point of time >> so I don't consider them as a villain anywhere like thing but basically we also should understand that they also need to make money for the establishment what they have done. So in this hustle of freelance practice like doing some 10 to 12 15 surgeries a day going to far off places how could you keep up your mental and physical health? Well, mental health was getting rejuvenated as you do the number of the times. physical health
(29:26) well that was only exercise what I had and possibly that was also this running around was making me physically fit and that energy drive was there with me with me because there is something waiting for me there is something waiting for me all the time you're mentally sick or physically sick there's not when nothing is waiting on >> okay >> you always see that you see if you nothing is waiting for you next time next hour you'll get mentally and physically sick and we are not those people having done medicine and
(29:52) [clears throat] gone through that amount of rigorous the 20 years of training and all we can never keep quiet ourselves all sayante that's a Italian saying that sweetness of doing nothing >> that means do nothing and sit down and think about thoughts that's not easy job at all absolutely not and majority of the doctors can't do that also because your thought process is different and your body mind clock is completely different so >> well mental and physical health was not an issue well sometimes I do get disturbed because of inadequate facility
(30:25) somewhere a big issue and I get troubled well that was part of the game and it was happening all through in my life you know when then it happens whenever whenever you become too super confident there is a god who's always say a speed breaker would teach you that come on come back to the ground you can also have problems like that but what what out of all this bargain what affected was my commitment to my family that was a thing which was >> because I was leaving at 6:30 in the morning coming around 10:00 and uh that
(30:53) was One thing which I always regret in my life. If somebody says what you regret in your life, I regret two things. One, one is I could not give much time to my family. >> Okay. >> For struggle they accepted it because at that point of time because it was my struggle to exist. If I can't if I can't they cannot be happy.
(31:12) >> And the kind of work you were doing. >> That's and number two. We don't we didn't have anything to fall back on >> so that I can continue my life without doing anything also. >> Yes. >> So they accepted at that point. But I feel possibly they they have accepted. The second point is I still feel bad about it.
(31:29) I would have been more organized possibly given some time to it. For example, I tell you >> I haven't attended a parent teacher meeting of any of my kids. The only two times both of them I've read in Gitanjali >> Ganjali here in uh the two times I entered into that school was when I took admission to my son in 1990 when I came to Hyderabad.
(31:51) >> Uhhuh. And when uh there was a school day function on somewhere in 15 years later when my daughter was a 12th standard and he was the head girl of the school at that time. So this was the only two times I could enter into the school premises. So I never attended a parentage meeting nor their school days or any functions.
(32:14) So that's a regret what I have all through my life and I've expressed that regret to my children also many times saying that I can't get back. >> Okay. But I'm ready to sacrifice that whatever extra earning what I had to get back that time which I can't bend to get back any further. >> So it comes with a cost. >> It absolutely comes with a cost.
(32:30) >> Okay. So now let me take you I mean let me take the audience to some human side of Dr. Malik Kajja. Was this the reason that you started smoking? No, most of the time at that time the smoking was basically a hero heroism showing when you when you're in first year of MBS that was the most common thing which was there and at that time I started smoking okay >> that's another regret I still feel bad I told you know one of the regrets is I can't sell it but it's too personal so I telling you >> I I I hate myself for smoking in the
(33:02) front seat of the car with my children sitting in the back seat with the window open see so much crying criminal you look now and I feel >> no no no sir no that that's the reason I said it's a human side of Dr. Malikas. >> So I still feel that is a bad thing which I have done. I can't correct it now.
(33:21) I I'm ready to correct it but I can't correct it now. But anyway that was the reason for smoking was nothing reason. There's nothing thing to stress for me but I never because I never had expectation. I'll get stressful when I have an expectation. I am in the baseline. Even one comes it is a advantage for me. Two comes it is a bonus for me. Three comes I'm excited.
(33:37) Four comes I make a party and spend another two there. So this was the life which I led right from beginning. So I was never having an expectation which will allow me or which will give me any different uh uh field. So >> okay >> so smoking was not that smoking was basically school the college heroism shows that's all nothing else.
(33:58) >> So during this journey of freelancing and whatever it was you >> no first I stopped smoking 15 years ago. >> Oh so you're not a smoke. So you're a reformed smoker now. >> No no no 15 20 years now. 20 years now I don't smoke. One more small person question and how bad a smoker you were? How many cigarettes? >> I was very bad.
(34:15) I was 20 to 25 cigarettes a day. >> Wow, >> that's a huge number. >> Huge number. So sir, in this process of >> But one thing you did ask me why did I stop? >> Uh yeah, I must ask you. I I thought >> then see the reason for it was I feeling was a heroism right? >> Yeah. Yeah. >> Then at one point I realized I'm no more a hero. I can't be a hero also.
(34:34) So one one of my very close friend named another chist. I can take his name because he's no more but anyway he is very close to me since the day I since the day I came to Hyderabad he was practicing in centisa and that guy was so fascinated with my way of work and this thing every open case he used to come and assist me for there his own learning and it was needed for me also as a person who can hold my hand to stop because once upon sometimes I become so so fast in this thing he he's one speed breaker which may say go slow go slow
(35:03) >> you were a running horse >> uh he was he was he was putting a some sort of to break onto it. So >> when another and my kids are there, his kids and my kids are in a similar age at the similar uh [clears throat] age group and similar fashions. One day >> one day he had a chest pain and he was admitted into care hospital and he was advised anogram.
(35:24) That was in end of February and March where exams were due. March and April were due. >> Okay. >> So he refused an anagram and came back home and all his all the friends called me up and said Eric go and talk to him. Get an angog. me may delay it or it becomes difficult. >> Okay. >> So I went to his house for a function. We had a movie to go.
(35:42) I thought we'll spend 1 hour. Me myself, my Rama went. We both were sitting on the in the I and my Ramadan was another day was sitting on the terrace of his house in the flats and I was talking to him and saying 100 reasons why you should get an angog. >> Okay. >> 100 reasons to why you should get an anagram. >> Yes. >> He could answer 101 reasons why you should not get it done now.
(36:01) If something is there, their children education will go away. they will not be able to take exam their their whole thing 10th class or 12th class everything is going to happen now and if something deranged here their life is going to be spoiled will come what may happen I'll do it after their exams their entry into the thing >> at that time I I I finished four hours of talking to him >> so he was in fact giving you a reality check >> yes exactly so when I came back when I came back and sat into the car I revised myself saying that what all he said was
(36:30) true to me also at the same point of time >> it hit you very hard It is it hit me and I still remember he was really living in Beum Pit in that fly over what is there in Amorta Mal area. >> Yeah. >> I I I threw the last packet of the cigarettes in my pocket. >> And never smoked later. >> So it not comes to you when it is impact is more when it comes to your own people.
(36:53) >> Got it sir. So during this journey of freelancing you might have started building a team. So how difficult was it for you or for anyone to retain a right team member? >> It's the most you see the most most difficult thing is to retain the talent. >> Okay. >> Talent is see everybody need not be as passionate as you as thought pro thought thoughtful like you in the same bread in the same way of thinking.
(37:19) Okay, >> it may not be possible but >> but luckily for me it happened that people were there possibly I was clear in my concept and possibly um things worked out because they were also learning at that point of time and u it worked out. I I don't say that what is the best things that can happen but I fairly feel at this present juncture what I'm in I feel that I have got the best team I don't I can't dream better than this at all. Got it.
(37:45) >> So there is nothing a limit for it. I if somebody is I always am I am one person who say always say if somebody who's under who's along with me performs more than my expectation or performs better than me I am the happiest man for that. I give all that opportunities to people who stay with me.
(38:04) Everything is open to them and but I judge their possibility their their capabilities before I give that opportunity for them to them to show because people can't there judge their capabilities. They always presume that they are capable about but in fact it may not be true. So if you give a person who is not capable an opportunity to expose himself he may falter and that becomes less confident and that is end of it.
(38:30) So you need to be fair that decent level of confidence that is judged by the other person as a confident man as that you are a confident man and an opportunity at that time will give you the best possible result and that makes you super confident and once you become confident nothing drags you down. >> Yeah. Yeah. It's all about the mindset.
(38:47) >> It's a mindset. So building that mindset needs >> somebody to judge you. >> Okay. So based on my training during my PGA days possibly my attitude and possibly I was able to fairly judge people what are their capabilities and always felt that I should be able to give them >> the opportunity at the right time.
(39:06) >> So if these three qualities are given loyalty commitment and abilities which quality do you think is the most important for a right team member? >> All are needed one [clears throat] doesn't compensate to others. Okay, >> you see try to understand you may have a very loyal person but if he's not committed or very not ability [clears throat] you are unnecessarily carrying extra baggage which >> he becomes a liability >> liability it's extra baggage he may not be a liability you can call it but he becomes an extra
(39:37) >> correct correct >> baggage to you >> but a fellow with a great ability without commitment without commitment is a liability >> yes >> he's a liability >> a man with a great ability without with no loyalty to be get rid of. >> Yeah. >> So all three are needed. Loyalty is needed to a certain extent. Commitment is needed to certain extent and abilities are needed to extent.
(40:04) And all these things are you will you'll become a better person provided you have all three. If you you can never be a great better person if you don't have these three. >> That's the glitch. Finding the right >> always. You see there are 100 fellows who are absolutely abil the abilities are super but you not know all of them why are you knowing only few people >> okay >> they were committed to a cause they were loyal to a place that makes their abilities to grow up and seen very well >> but if it is not your abilities will get
(40:35) you a little amount of superflows into your mind and loyalties and loyalties lack of loyalty and lack of commitment will never allow you to grow at all. Understood sir. Fantastic. So uh from freelance practice to corporate practice the transition happened in 2000s. >> Yes. >> Was it difficult? Was it easy? >> For please take us through that.
(40:58) >> No I I think I think fortunately you see things the I have never made any decisions ahead. All the decisions were taken according to the situation existed there. >> Okay. So I was very happy in satindi center till some point of time wherein I worked for 10 years there and I was a very keen as I said I was a I was very keen on my teaching part of it I want to I want to do >> what was the opportunity to teach >> there was no opportunity that was a frustrating part of it [laughter] that's a frustrating so I was insisting and I
(41:28) was asking Rupal to take a DNB course there I'll employ so he said how can you take DMB courses we cannot pay this that usual usual style of it and I said okay don't worry >> okay >> I'll create department I take people under me I give salary to them apply for a DNB course from this institution I love people having coming here we'll establish a department we'll grow the department in a different style this is I'm talking about 1979 9798 >> okay >> at that period of time Ramopal initially said yes and that made me to get Samasur
(41:58) at that time who was an assistant professor in no more he's no more I'm sorry to say that but he's he was in uh >> he was in Nisams at that time as an assistant so I called Samsuro who is common friend to Anad Chadri and they said come on join join me okay >> we'll create a department >> so he quit his government job and joined you >> uh he quit his government job and joined me but again the the practices become different >> so somebody the the hospital encouraged me why do you want to work with him become an independent consultant and
(42:26) that that fractured my completely fractured my my sincerity towards the whole institution what I had for that last 10 years basically because I was a de facto to uh next to nephrologist after Ramopal though I was a urologist because there was no other nephrologist after Raual even if he's not there in station if there is a snake bite case I used to come sit and start doing a diialysis with my advisor that time and the technicians used to start diialysis so that fractured my confidence into the system at that point of time so that is
(42:59) the time possibly we start looking at come on this this is not a growth pattern here okay >> possibly if I need to grow that the seed has already sewn into me Yeah. >> And I was waiting for an opportunity to happen and unfortunately my mentor who whomsoever I was there with Ramopal passed away in 2000 at the time >> and uh that made me anyway I was baseless at the time.
(43:21) He was the only savior for me in that institution. >> Okay. >> And that made me to look around and say that come on I need to look into something else. >> Okay. >> Wherein I can fulfill both my practice which I already established to have a fair amount of practice in Hyderabad. I was quite I I started my own clinic at that time to get my own patients and I was quite busy quite busy and so and I was sought after in many nursing homes.
(43:44) Still my freelance was going on. So I said okay I >> I heard you were a favorite to almost all the gynecologist in Hyderabad >> that every nursing home at that time >> every nursing home every nursing home >> every urric injury every bladder injury Dr. [laughter] Malik >> well the available people were very less and available is readily available >> and probably you were the guy who was readily available at any point of time >> at any point of time that's that's the only uh only thing no difference basically okay [snorts]
(44:09) >> but uh so that's a time when I thought that I should get into some sort of a corporate style of work wherein people think in a different perspective like a DNB program or where I can fulfill my teaching or everything into that once I groom into that because for existence I have to be in a private hospital to continue practice I have to be in a private hospital but to get into that sort of a teaching mode I need some people to be there around for that only corporate can help me so >> I tried my Apollo they refused there
(44:36) they tried my level best I was there in Apollo Amar and Saiwani for some period of time Apollo Amar I was doing at the time as fair decent workload as good as what they were doing in main hospital so one of my the guy who was in charge of the hospital so his name was he was he was there he was trying to get me into main Apollo to improve the practice is an Apollo.
(44:58) But anyway, there are so many reasons why they never took me to uh main Apollo. >> So at that time, so my my thing is quite open. I need a place where it can be bigger. I can establish a department and I can have a teaching program in near future. This is what my aim was. And at same time, >> so the secondary band came into picture and Sudendar asked me to come over and that was a fair ground I thought and then I went and joined.
(45:22) So it's not that I want to improvise myself or do but the necessity of fulfilling some more inherent passions what I had >> apart from the clinical work you also wanted >> clinical work was anywhere happening. Yeah. >> Yeah. Yeah. Academic work. And did it fulfill your passion to teach? >> Yeah of course I of course I read I I at least started having a department wherein I had some people to work on.
(45:43) Okay. That was so my variety of workload was going on. routine at least routine surgeries were done by other my other colleagues and I was concentrating on much difficult surgeries so that I can be mental mentally to free to perform whether >> I can't be doing a to zed all the time got it >> so at least the cream part of it I can be doing so that fulfilled my technical or practice improvement what was happening because of the department was happening and then they took the DNB program and the DNB people have started
(46:13) off and till now there are so much of DNB program which is happening. Well, that is what at least and uh and then everything started off with with me doing tough cases, more difficult cases. My laparoscopic skill became better. I was called everywhere to teach laparoscopy. So, inherently I'm getting satisfied regarding >> teaching that skill part rather than a scientist part.
(46:35) I'm not a scientist but I'm basically a technician who wants to make things easy for others to practice. So I would say in a very simple way I would I am the I'm the person who teach anatomy because every surgeon knows what to be done later. >> Yes. >> Simply I I I always say that. >> Yeah. So like uh you said you were doing some tough cases, difficult cases, challenging cases.
(46:59) Uh in urology stones and prostate make the bread and butter. uh they give you new clients, they give you a bulk of patients but the challenging cases they give you a kick at the same time a personal satisfaction which few people want to have what is the cost of that kick and how many times did you have to or did you actually feel that I shouldn't have touched this case or this patient would have been rather left untouched >> how many times it happened and what were those moments >> see you're basically a craft master so you Don't expect yourself to be 100%
(47:33) perfect. >> Agreed. >> So we expecting ourselves to be the best all the time is not correct. >> Okay. >> Things may go wrong because of your There are two things which I always say surgical problems happen because of two reasons. One is ignorance of you. >> Okay. >> Or arrogance of you. >> Yeah. >> So both of the things have to be kept in control at some point of time.
(47:55) >> Correct. So at any point of time when we start doing it we always think that it will end result will be great on all the time no problem >> but sometimes it goes wrong. >> Okay >> I understand there are surgical listed complications all the time. >> Yeah. Yeah >> there's no doubt about it but most of the complications happen because you don't know about it or you're arrogant about the situation there.
(48:18) So if you retrospect retrospect you always think that wish this complication should have not happened. I would have been more more uh knowledgeful about it or I would have been into my limitations had it not the complications would have not happened. >> Yeah, >> it's a learning lesson for every surgeon happening all through his life.
(48:37) So I don't think if somebody says I never had that sort of a situation then he has not done any surgery >> or he's bluffing >> he is bluffing. So I always say I can't remember how many cases the how how many cases have you done so that it it taught you something. No, it is always happens daytoday or every time there is outcome might not be the way you expect even the minor outcome also you always feel that duty like I tell you any patient who had some sort of a PCL procedure he develops a fever so you start analyzing why this
(49:09) this guy had a fever was it the pre preoperative urine culture which was an estester you never treated the urine infection or your puncture technique was wrong you traumatized the tissue you perforated the pelvis You extabated the urine, you created more hematoma. So fever is a fever but li the limiting factor.
(49:28) So as a surgeon >> I expect everybody to to backtrack everybody everything has to be a reverse analysis of every situation so that you find an answer. On the day you find an answer you're a happy man tomorrow but if you don't try to do that or you can't find an answer you can have the same situation coming back to you. So you have to find these situations happening in your life.
(49:51) You can't escape it. If if you are escaping means you are not doing any surgeries. >> Got it? >> So this is a common thing. But the retrospect you need to say the actual thing what you need to say is >> you ask me why did I touch this class right? I give you an example which I always remember throughout my life. Okay.
(50:10) Lame name I don't need to tell I can say that name also. 1998 Anapurama. She's a she's a tumor. Mhm. who came with hematururia had a rightal tumor going right into the IVC >> okay >> just at the just below the level of epatic means and you know the private infrastructure how much it was to operate this case at >> 1998 it is during your freelance days >> freelance days I'm in satic India center so this patient came with hematururia >> okay >> so I said you require surgery I'll be operating you >> okay >> fine we didn't have ventilators we didn't have cardiac setups at that point
(50:39) of time but I was confident I should be able to operate >> okay >> so I convinced that I convinced her saying that you get operated you'll become all right. You see that's where I made a mistake. Convinced her see I retrospect why I tell you you'll know you'll understand. >> She said his only son oh he's getting uh married uh let me see after 5 months anyway his marriage is there after 3 months I'll come back after 5 months.
(51:02) No not a stage get operated. >> Correct. >> Fine. I did that surgery on the table. In fact at the time the primitive instrumentation I passed a fogi a fis catheter inside inflate the balloon and withdraw the whole thrombus repaired everything. patient went home on the fourth day or a sixth day. Fantastic. I was so elated.
(51:22) In fact, we went ahead and and had a party because we could do that case that time. Okay. >> It's a big case that time. I require I asked my Krishna is there. Krishna Kumar Kardan was there at that time. He was colleague to me in Mahab. So I asked his help be there in the OT. So he was there in the OT at that point of time. >> Well, we didn't we finished that surgery.
(51:43) One year later, she came to my OP. >> Okay. >> And she came in a wheelchair and she was abusing me. >> Okay. >> She was abusing me. I didn't realize what she's alive and she's all right now. >> I was very very aged at that point of time. And after that and she started crying. >> Okay. >> I said okay you calm down.
(52:04) I asked them to take that take her away and asked the attender who is one of the cousins because she has only one son no husband and all. She said uh she she said the story of it >> and then the story was after the marriage the the son and the daughter were going on honeymoon trip from Mysore to Ki they had an accident and both were killed.
(52:27) >> Okay. >> So I called her and said I asked you to leave me alone on that day. >> Had it not had you left alone I would have not seen this day. Oh, >> you made me alive and I have to suffer all through my life with that thing without anybody living alone in this world. So what have you done here? You thought you done a great thing.
(52:50) You've done a great surgical outcome. >> Okay. >> You've given a great outcome regarding the disease is concerned. But was it the right outcome for her in our wiser way? >> For her. >> For you. >> Not the disease. >> Not the disease. So what teaches you in thing is not disease. What teaches is the human being.
(53:10) So learn from the patient about not about the disease alone but about the rest of the holistic determination around her. >> So that will teach you when so I'll always say after that I changed. I never said I convinced you. >> Okay. >> So I never try to convince anybody. That changed my perspective. It is not you to get convinced convincing the patient to get operated.
(53:32) It is them to get convinced about the disease to get themselves operated upon. Correct? So you give whole information to them ifs and buts betters and bads of what what is the result of this procedure but it is there to get convinced that they need to get operated. When you try to convince this is what may happen. >> So this brings us to the fact that around the disease there is a whole patient.
(53:56) >> There is much more. >> Yeah. And around the patient there is a whole family. >> There's much more. >> So we not treating a disease, we are treating a family. >> I understand this is exactly what I'm trying to say because we we lack that empathy nowadays. We are losing that completely.
(54:14) We don't have you see there in in a fast world if somebody comes and sits in front of you. How many times you know what is he doing? You hardly we don't even ask him. >> You always see that X-ray oh you have a stone you need to get operated. You take it out and see am I right? And so and you are looking at converting or possibly expecting him to answer when he wants to get operated.
(54:32) >> Yes. >> Am I right or wrong? So I tell you an example when somebody comes and says a farmer coming from a from a rural area. He comes there and sits down and says that he has got a stone. >> Okay. >> And he has got a small 2 cm stone inside the pelvis of the kidney. >> He can get operated after 20 days also.
(54:49) But you say that better not you may get infected. You better may get pain. You may be incapacitated to get operated. But if you go into his detail come into issues and say what you do I'm a farmer sir what is the present situation it sir patty as you put it is just for cutting for the next 3 days if I don't cut there is there rain and all it will go away what is that situation if you really understand that situation what will you feel go finish the job and come back right or wrong how much time you are spending that amount of time with the
(55:19) patient for some reason we getting busy sometimes the patient also feels what is this nonsense he's asking around Yes, >> but the actual patient whom we we will not be able to we will not be identify and take this all parameters into picture. >> Yeah. >> Am I right or wrong? So, absolutely. >> This is one thing which we should realize.
(55:37) Possibly we are losing it because of our fasttrack world and the amount of work we are doing it. But possibly somewhere or other we need to get back into that shoes of the patient and understand the patient as a patient. Don't identify him as a disease. Yeah. >> Like these the days where we identify the people with a phone number rather than as a human being.
(55:55) So you also changing. >> Yes. So can you recall any moments where you were badly stuck with a case on table? The patient was bleeding or you're not able to proceed and there's nobody else to bail you out and could you get out of that situation by yourself or you had to abandon the case? Any such case which can recall? >> No.
(56:17) There is nothing like abandoning the case. You need to seek a help. That's all. There's nothing like a bad >> There's nobody to bail you out as well. >> Uh no, you need to come to your conclusion. If you're not if you are not able to come to your conclusion, better don't touch it. >> Exactly. That's the point. You should be prepared for everything.
(56:32) So it is always there. It is always always happens and you should be prepared well if there may be a little delay but you should be able to mentally get prepared to do that and there is always with the present day in a Hyderabad like city there's always people to help you. You are not in a remote corner of the place.
(56:46) If you are in a remote corner, you should be wise enough what you can bail out and what you cannot bail out. >> Correct? >> So one of the rare causes of a problem which nobody can nobody can think about but on a regular basis what you need to think about you should be aware of it and you should be able to have that confidence that you can come out of it.
(57:03) >> Again ignorance and arrogance >> that's it either you are ignorant about the problem or you are arrogant about your capabilities. >> Okay so I'll ask another sort of the same question. How difficult is it to manage the mess or a problem or the inability surgical inability or clinical inability or some administrative inability created by your uh colleagues in your team or in your past past place of work or current place of work? How difficult is it for you to manage? Do you take it as a challenge or do you
(57:32) take it as a nuisance and how often does it happen? >> You see, we are all we are all human beings. We may also create nuisances. So, let's not blame it. You see basically you'll be creating yourself into two things again when you look at and you'll understand whether it was done by ignorance or an arrogance.
(57:47) Arrogance teaches him ignorance makes him wiser. >> Okay. >> Right. So irrespective it's same for us also. Even if I create it at the same time I'll also become careful. So the this is a part of life. I cannot say that it will be difficult but being now at this seniority of my career possibly I do get these situations very often.
(58:08) Yeah. And [clears throat] with full respect to them I don't say that I can see that what would have gone wrong with the full respect to them I say that at least he's cartisan of two things which I say you can't get away with a complication >> yes >> you should know when you can stop >> correct >> and you ask for a help for somebody else so you should know somebody comes it's very common thing somebody attempted a uroscopy for a small stone and suddenly they are not able to pass a urer urtocope into the into the urer and they
(58:35) didn't take out the stone and the patient will say he's very angry that they didn't do the stone removal. I always tell them >> be happy. Be happy that he knew his limitations and restricted himself to his limitation. I appreciate that man who did no more damage than if not good. So that is a basic thing rather than doing a mess trying to attempt and do much more damage it's better to have an a intact system with less amount of damage coming back to your person who can manage it in other way.
(59:07) So you should know your limitations. Nothing nothing like nothing more than that. And it can happen to anybody. I don't consider that it is it is wrong that they cannot do it. That's the reason why they don't know. It can happen with any anyone anyone. Nobody is nobody is protected from this sort of a problem. >> So it boils boils down to the fact that we are all humans.
(59:24) >> Yeah. Absolutely. We are humans. Try to understand. >> You see boss come on. This is a craft. Craft. It's a craft. When you're doing a craft, you require so many other factors to be playing with you playing with you. Why do the people a a fellow who writing a film script goes to Thailand, sits in a beach without anything and writes a film Chris just because he wants some sort of a peace of mind.
(59:48) So thoughts can flow on. Can you have that sort of a thing? You can have you can have a problem sitting in your house. You can have a problem sitting in your hospital. You may have a problem with sitting with your taxation. You may have a problem within sitting with your vehicle or a children or anything irrespective of all these things.
(1:00:05) You're still your output in a given scenario which is given every day in your operation theater has to be the same. >> Yeah, >> it's not possible. There is some element of some element of pressure which happens because of it. As the time passes by, we may get immune with it or get adjusted to it. But there is always a it's always a thing which happens into your mind. So you get tuned to it.
(1:00:28) >> So that's the reason why I always say always say garner those days of individual practitioner who takes all the all the uh credit and all the headaches onto him and try to deliver with all other headaches inside him. >> So you need to have a team of people. So even if somebody is not giving able to give the best output at one point of time the other can chip in and able to get the best outcome out of it.
(1:00:52) So this is where a team work or a team effort plays a big role. >> Multiple brains working together. >> Absolutely. Absolutely. Nobody is nobody is absolutely saint or nobody has got no no tensions and everybody forgets everything. You see there's a there's a logo also times when you enter the airport cabin inside they always say that the same thing.
(1:01:16) Please leave every other thought outside this cabin. When you enter this cabin don't have any other thoughts. All worries outside. It is expected thing to be done but it's not easy. >> Yeah, >> we all humans. >> So if somebody believes that he's an independent practitioner, he's not independent. I believe he's alone. >> He's alone. Simply alone.
(1:01:32) >> Yeah, >> he's alone. >> So were there any incidents or can you recall any of those moments where you were held accountable or you took the accountability for the wrongdoings of your staff or anyone something like vicarious liability and it took a while for you to come out of it. It is all you see basically any problem is a problem.
(1:01:52) >> It's a leader's responsibility. Leader cannot shy away. >> Rest of the matters where went wrong it's internal discussion. >> Okay. >> But the leader has to take the >> So you have to stand in the front. >> Yes. You have to be in the front. >> Okay. >> You have to be in the front and you are the person over a period of time.
(1:02:05) You see basically what happens is it's a it's a ongoing process. >> Okay. >> For first 25 years you are there in the front. >> You after 25 the system comes into the front. >> Okay. Because but you are the system at that point of time. >> Yeah. >> So today I am the system. >> I am the system but I may not be there in front all the time.
(1:02:26) My system is there in front of >> the system that can take care of that. >> My system I created will take care of that. Yes. >> That is what is more important. >> Fantastic s. So as a clinician and as a surgeon in specific uh were there any incidents where you were threatened or you were abused mentally or physically by the patients or their attendants needed? >> It happens.
(1:02:49) It happens >> whenever whenever there is a bad result there does happen. It does happen but I fortunately had very very very few but most of the time I was more perturbed than their abuse. I was more perturbed. Like I tell you one of the rarest scenarios is we did a ESWL somewhere in 1997. >> Okay.
(1:03:09) Like a shock wave therapy for kidney stone >> stone and this guy goes into septic after that. I didn't do anything to Oh >> didn't do anything to me other than he has to goes into septicmia. At that time the only ventilator was there in care noli because they started off at that time I shifted to gear noli and then that care that means at the time it was original care was there and I I in fact >> on the bed I took my equipment passed a stent under under ventilator because I cannot take him to the thing and then after few days take out a stentole on
(1:03:39) the bed ultimately he recovered out of it but differently. >> Mhm. Well, you always get that difference and you situ situations have to be there. You cannot say that he cannot be there humanly you are emotional. How many times you you you scolded your son. It does happen. Your own son you are scolded.
(1:03:56) So things happen. >> Any incences or incidents where you were sued by a patient? Any litigations? >> No. Not >> never. >> Fortunately, >> fortunately not till now. >> Yeah. Got it. >> It can happen. You see it can happen anytime but not >> bigger the doctor bigger the problems that's what I believe >> no no no not not not till now >> and the problems are multiffold >> always there always multifold >> uh sir how difficult or how tough is it to manage a difficult patient what do you mean by difficult patient who is impatient who is always demanding who is
(1:04:28) a troublemonger who is a potential litigant who is always skeptical who always comes or steps into your op with a sense of suspicion rather than faith how do you manage situation >> you see I can't differentiate a fellow who has this or who doesn't have it on the on the face of him. >> Yeah. >> He walks in. >> Yes.
(1:04:47) >> Walks in. He may have >> all these thoughts inside his mind. >> Yes. [clears throat] >> But I'll not be able to differentiate. So I don't make myself keen enough to understand how is this guy. I make myself to be honest with me. >> Okay. I don't care what he is then till I am what I'm talking is the truth and I am honest to my expression >> okay >> it doesn't matter how soever he looks into it >> if I say I I need to take an opinion of my colleague and only come to it I'm not able to come to any conclusion go to go
(1:05:20) to the next room he'll see him we'll discuss and decide it will be honest >> and you don't need to give an opinion immediately on that okay >> if I'm going to give an opinion which I'm very confident with >> I put my word very clearly Okay. >> Explain these are the reasons why you require you know these are the reasons why you need to go through it.
(1:05:38) It is your choice or as I said I'll never try to convince him. I'll give him the information completely completely ifs and buts completely. Having said that like you have operated a patient let us say a a regular stone case after surgery some pain is seen in many patients but they make a scene out of that abusing you or uh questioning your ability saying that I'm still the same what have you done kind of situation uh it's very difficult for a youngster to handle the situations >> I understand >> but but definitely in at your stature
(1:06:10) maybe patients may not be may not dare to talk to you that way but they may talk behind you so what I mean to ask is somebody may not shout at you but they shout at your receptionist. They may shout at your colleague. It is directly or indirectly shouting at you. >> Absolutely. >> How to handle such patients? >> Well, there are some patients and we see unfortunately what happens is um we presume that everybody will have the best outcomes.
(1:06:32) >> Yeah. >> But sometimes there are outcomes which are not expected to the expected expectations right to the not to the expectations in which case >> we have some troubles beyond it. >> Yes. uh that the only way to come out of it is only communication. Nothing more than that. It is only communication. Communication.
(1:06:51) You see >> had you been very honest before your ability to communicate is very easy. >> Correct. >> Though the confidence [clears throat] at which you can communicate is only when you're honest enough. When you're not honest enough, I feel like I do an ESW. They have a stones coming down and blocking the thing and they say that it's paining you.
(1:07:09) I always tell them before there's a 90% chance that all stones will go away. there's a 10% chance that you may require a repeat intervention. >> Yeah, >> this is one thing which you need to say. Yes, >> if there is a residual stone suppose you did a piece I always say there's a residual stone which may not trouble you in case if it comes down into the urator you may have a trouble let's see it but it appears to be passible I may not do it >> so let's communicate and fair enough in our own result I don't think and this will I understand for a individual
(1:07:36) practitioner initially it becomes a very big difficulty like I tell you >> not independent who is alone >> alone the the biggest choice is somebody talking about a big stone and why he had to talk about because somebody else is offering an RA he also has to come into the same thing otherwise he'll not be able to get a chance to that operate that patient fear of missing out fear of missing out and fear of not missing out the technique fear of missing out the patient here that's exactly not so so that is one thing which I possibly need
(1:08:04) to restrict I have come senior enough to restrain myself and my people may respect my feeling but for a for youngster it may be a problem it may be a problem in near future I think we should be clear enough in our own approach and honesty in our approach so that you don't face the situations. >> One very personal question sir >> please >> I know he's a brainchild of Dr.
(1:08:25) Malik Kashna given your presence in this branch this is an extremely busy center even though it's a standalone specialty center I I I don't know if the situation is same in the other branches of uh I know number one number two how difficult is it for you or how challenging is it for you to keep your other colleagues and associates as busy as you are because the ecosystem in a standalone center is pretty much different from a multi specialty like I I work in a multipy if I'm doing x number of cases a month I get some 25 to 30% cases in my
(1:09:00) name some 20 30% patients from marketing some of the patients from cross referrals in a standalone center unless the person is as big as Dr. from Malik Juna or who has got a pretty pretty long career it's very difficult to attract and retain patients because you have the only source of getting the the only source of getting patience is your credibility and the name the existing name in the society how do you see that >> I think um everything [clears throat] starts like this only Asha >> okay >> to start with it's always a individual
(1:09:32) person >> okay >> around which the system is being created >> okay >> it's how robust Robust is a system which makes a future. >> Okay. >> Right. How robust is a system? >> Yeah. >> So where are your values here? >> Mhm. >> Where are your values? Where are your values here? >> Y >> what is your expectation out of those values? >> Mhm.
(1:09:54) >> How you are efficiently taking care of the need of the talent to create that or keep up that values. >> Okay. >> So this is a vicious cycle. This is a cycle which has to be run all the time. It's all the time. It's a continuous process. It is never a static process. It's a dynamic process. >> Yes. >> So the [clears throat] as I said my life has gone into three decades now.
(1:10:17) >> Initially which has happened. One was a struggle for existence. 10 years has gone by struggle for existence. >> And the next 10 years has gone by struggle to excellence. >> Okay. >> Right. I wanted to do laposcopy. I wanted to do big surgeries etc. I have created a team for helping myself to create that aura.
(1:10:35) I can make those things happen. Yes. And I showed it here and there. That is the third thing is going to be is trying to a stage of establishing it. What I have done, I've learned something. I have created something for myself. What am I trying to do? It goes away with me. I may continue to work in a corporate, make my money and that goes away with me.
(1:10:56) So I need to create an ecosystem wherein something can creep on and excel better than what I could achieve in my personal basis. >> Got it sir. So that was a stage of establishment. So this is I know is a brainchild was happening because of that reason. >> Okay. >> So last come is going to be is minus you >> minus minus you.
(1:11:18) >> Yeah. >> You have established the ecosystem and its ecosystem should be so strong that itself nurtures itself continues to keep the values inside and continues to replenish itself with whatever need of the talent is. Okay. >> So you my aim job now is to create that ecosystem. >> Okay. >> Before I possibly retire or something like that. But I may not retire.
(1:11:45) I continue to be a clinician into the place. But I'll not be the major face for it. I still >> I I'll I'll continue to be clinician because that is my passion. I talking to my patient is always my passion. I may not do surgeries because I'll not be the same way like what I was 20 years ago after 80 75 years.
(1:12:02) So I'll continue rest of the people to do it and take care of it. There are always people to do that. You see you don't expect that it is always run by money. It is not necessary. Had it been money people would have not been not been working in institutions taking a salary. Right? So everybody is not calculated by value. There there is something called value.
(1:12:20) There is something called passion regarding the profession. There's something called work culture and number three is satisfaction in the work. Number four is remuneration. all keeps in a place because if you want to want to increase one other will come down automatically. So it's a balancing equation.
(1:12:36) So my aim here afterwards is to keep that balance intact so that not for me for everybody else. >> Fantastic sir. So have you noticed any physical or mental limitations in you as you're aging? >> Of course you should. If you say that I'm same I'm not. I'm not. I'll not. See this see I always realized at this point because I was a better surgeon possibly 10 years ago >> what was the peak >> peak is around 45 to 50 >> 45 to 50 >> 50 55 45 to 55 is a peak time >> okay >> after that you you probably blunted by 1% every year >> okay >> but the same time you're more wiser
(1:13:17) >> so your in wisdom intelligence of wisdom cars increasing but your physical physical ability starts coming down slowly. We realize that at what point so that physical ability has to be supplemented by the people who can supplement that physical ability who do it. At present I restrict my all my things which I'm well versed with that means where I don't need to put too much of strain on my brain to how to work it out.
(1:13:44) It goes on to spinal memory because of my vast experience what I gained. So that I'll continue to do it. anything new very new surgery or a very new thing which has just entered into the market two months ago unless otherwise it's very easy to do I will not venture those things because there's no point me trying to learn it experiment it and then becoming perfect >> rather a youngster will have a lot shorter learn of curving shorter uh curve of learning will be able to excel and get to that point faster than myself >> y >> so I restrain myself to what I've been
(1:14:16) good at all through I don't go to experiment something new which I've decided that I will not my team somebody will take over on it and they will be able to excel it better than myself >> does it also mean you have uh limited yourself to performing surgeries of shorter duration or performing the only only the main part of a longer surgery >> I think that's a part of training like you see in a long surgery whenever in the in a department somebody is there there is there's a sequential growth which happens to anybody they start
(1:14:44) doing some segmentage it's called incremental learning it's methodology. >> So you you'll you incremental learning means you do some part of operation every time. Don't do a whole operation you fail. So you some part of operation you start doing it and that some part of the operation is given to the next person.
(1:15:01) So he'll excel first that and next step of the operation sometime later he'll get it. So this is called incremental learning. So that incremental learning is a very integral part of it actually. In fact, majority of the times our people uh our people start learning it in a wrong way. They claim they're they're given a degree. They come out into the practice and start doing surgeries and start learning out of their mistakes and look into it.
(1:15:26) >> Correct. >> But they are never groomed in this fashion. I I feel the people who are under me for a long period of time will get benefited out of that opportunity. there is what is called an incremental learning wherein I can I can assess their abilities and give that increments of learning process happening towards them at every point of time during this tenure that's what I said nobody expects me you want to be a good surgeon at the end of the day take your own 10 years time to mature yourself don't think that
(1:15:55) you'll be a great surgeon within the three years you may do two three procedures very well okay that doesn't mean that you establish yourself as a great surgeon so that incremental learning over a period of time makes you more perfect So a mature surgeon I always define is a fellow who doesn't need a fall back.
(1:16:12) >> Okay. >> And define fall back here in surgical terms please define >> fall back means three cases later fourth case he'll be able to do a complication and he calls up somebody what need to be done. >> Okay. >> So that is not the occasion. It is not the thing you see. You may do it once in 500 cases you may ask somebody's opinion.
(1:16:29) That's a different thing which you are not able to come. But >> in an incremental learning process over a long period of time somebody would have noticed this complication. You would have experienced that complication. You would have maneuvered that complication. So how to how to avoid that complication? You are mature about and your wisdom and your muscle memory will not allow that complication to happen.
(1:16:46) >> Correct? >> That happens with time. >> Yeah. >> That happens with exposure. That happens with volume. >> So it doesn't happen so fast. >> Okay. >> So it usually will take a long period of time. So this is what I would say that everybody will take some part of the operation at one point of time. The critical point will come only after they able to close up to that right moment and they are able to I feel that they are able to do that and probably I notice them doing it and I see them doing it once or twice then I'll free
(1:17:15) them so that you can do it. Does it mean there is no scope for an independent practice for a youngster coming into the uh society as a practitioner? Because like you said, if it's a methodical training, if it's incremental learning, you must be a part of a team. >> Unfortunately, I would say yes. >> The reason why is you as an independent practitioner, there are two things which you're not getting.
(1:17:40) Number one, >> okay, >> you can't get you can't get the volume. >> Yes, I agreed. See till if you're doing a laparoscopic surgery twice in a month, how can I become an expert? >> Yeah. >> So you are exposed to 10 cases a month. >> You may do one case in a year but your exposure will be ultimately 120 cases. >> Yes. Yes. >> Right. So that cannot be compensated.
(1:18:04) So your learning time is going to be long. >> Okay. >> And the curve is going to be very slow because the number of volume of the cases is going to be very low. Okay. >> And faster the exposure, better the learning. Slower the exposure, poorer the learning. So I would say for um rather I would say yes for your question. Yeah.
(1:18:21) >> Independent individual practitioners uh who are working alone. I would say alone >> alone >> especially with a low volume with a low volume because most of the time low volume in in in a in a city >> are growing in number like anything. So in which case I would say unfortunately yes you might be doing that common procedures because that volume may be supplementing you but uncommon procedures you are still a poorer man to get operated.
(1:18:45) >> Let's go deeper into the same question. How many teams are there currently in hydrobad in any surgical specialty where good quality work is going on and how many teams actually welcome such youngsters to be a part of the team because these are harsh truths sir. No, these are truths but it depends upon what the leader expects and what the person works works for.
(1:19:08) uh the person two things ah two things basically if the denominator is money no team will survive for long >> correct >> so the that's a basic reason why it happens most of the times >> what you see huh how many you see excellence doesn't happen in one year or two years it happens over 10 years I'm telling you now suppose if somebody is achieving excellence it happens only at the end of 10 years that means the team has formed and matured >> okay okay >> right if something happens over 10 years that means it has formed and matured
(1:19:36) >> you see every time this is what happens majority of the times teams do collapse or something it's only for denominator becomes the money >> but as I said there are so many other variables inside it number one is the passion to do good surgeries the passion to sub centralize yourself into your core specialty where you working alone your core may not be even once in once in a month or twice one case in two months so unless with a team you will not have that volume to come up so one is that and number two your another the
(1:20:05) the culture at work and number two and number three is uh how how how stressed you are at work. All these things matter. So many factors are there for a team to sustain for a long period of time. You need to you need to look at it every time. Every time of course one of the factors is also money. Everybody needs extra money.
(1:20:25) There's no doubt about it. >> Definitely. >> But that should not be the only reason why team has to develop. >> Money should be the service. >> One of the part not everything. >> Yeah. Yeah. >> Not everything. >> Fine. So sir, how have you evolved over this 35 years of your experience as a surgeon and as a leader? >> Well my my um surgeon as I said well I would say I'm very happy in my surgical journey.
(1:20:54) Yeah, >> I was trained as a good good open surgeon when I was in residency but I became a good endooologist during my first 10 years. >> Okay. and later good laposcopic surgeon later and the last 10 years into robotics and getting into uh much more than actual conceptualization of urological surgery rather than rather than how I perform for a single case.
(1:21:24) So conceptualization and making it what achieve what makes me much more much more happier today is >> how to make it simpler to the other person. >> Okay. So that concept probably I started feeling it in the last few years last five to seven years and uh especially when the laparoscopic surgery came in. So that is the most enjoying part of it.
(1:21:45) So >> uh so this is a surgical journey. So every decade there is a change and I always expect if you don't have a change at the end of 10 years in the way you approach your your career you'll be monotonous and that kills you your abilities and your zeal to continue. So you need to have something a purpose of life which is defined in a different fashion at every end of 10 years.
(1:22:09) >> Is is it uh out of quest to excel or quest to >> No, there's nothing to I don't I don't I'm not trying to excel here. I'm trying to uh feel myself good. >> Okay. >> I need to feel good. What makes me feeling good? I'm making somebody easier. Somebody comes and says, "Okay, this way of doing it made me much easier. I could finish it.
(1:22:31) " There's no excellence in that for me. So the most satisfying for me is okay some other person's life in their abilities. That is what makes me much more happier. >> This answers the [clears throat] question as a surgeon evolutionary surgeon. Yes. As a leader. >> I never considered as a leader all these days actually but well because of my seniority because of my ownership I became a leader but I still consider everybody as a part of the >> So you are accepted unanimously as a leader.
(1:22:59) I don't know >> some 70 80 urologists in I know are working alongside there are no there are two reasons why it can happen because I I am a majority is take guy into this or the conceptualization happened because of me and I risked myself to start this institution and possibly all those reasons might be the one but I would say as a leadership is a quality is not an authority >> yeah yeah >> it's not an authority >> it's creating leadershing more leadersh under you see you you need to see the progress in them and feel happy then only you'll be a proper
(1:23:34) leader >> I don't be a calling a leader if I achieve something and I post something at the behest of my team members working behind me rather if they can make something better and make themselves better as a leader though I'm sitting in the back I'll be feeling very very happy about it >> 100% 100% >> that is that is what my cult I I developed into it that's what is >> yep sir uh on a personal note would you be happy or would you be sad if a fantastic or a terrific non-surgical alternative comes into the picture for a
(1:24:07) very popular or demanding surgery like let us take the example of bladder removal for bladder cancer it is considered to be one of the >> most difficult surgeries in urology and of late what we're seeing in medical oncology is something which is progressing towards bladder preservation so what is your take on such things where surgical options come down at the cost of our personal satisfaction or a kick which we get as a surgeons but definitely the patients are getting benefited.
(1:24:34) How do you see that? >> I don't think there's I don't I don't think why should we think about it at all. something great happening great to the community it's always a welcome you never see none of the specialties are devoid of any any and if they don't get away from their work at any point of time like it see it's only thing is if you >> in your own journey if you if I doing an open surgery when I was a resident if I don't learn endurology I would have never existed in the first 10 years of my life if I don't learn laparoscopic
(1:25:04) urology I would have not excelled in the next 10 years of life >> if I not done my establishing practice or a system here for it, I could have not excelled in creating what I felt of teaching somebody and making their lives easier by doing the surgeries. So you need to change everywhere. So whether there is a new outcome, there's a new surgery, there may not be a surgery minus away from your list but bucket list but still you need something more to get added and there are so so many more things which you can you can look
(1:25:31) into and possibly can excel on. So medicine healthcare is never going to be obsolete at any point of time like even now in a IT sector like AI is replacing yes it does replace and probably automate some jobs but there are so many jobs which are necessary in the AI itself. So the people have to modify themselves into that in in that.
(1:25:53) So at every decade you cannot be doing the same work for the next 30 years and getting the same amount of money. You need to progress in your profession in your way of work everything too. So it all comes down to the point that patient first. >> Patient first always. You see there's no way you can defeat that way.
(1:26:08) You cannot pro you cannot stop the progress happening. >> Correct sir. >> At this point of time after 35 years is there anything that that makes you unhappy. >> Well I >> apart from the regret that you just >> No, that's okay. That's that's a part of life. That's a part of life. But I don't think uh I don't think I am feeling unhappy at any point of time.
(1:26:30) But the only thing is um I'm unhappy at one level because I wish I wish I was born at this point of time because learning was so easy. >> Yeah, >> learning is so easy for me at that time to do learn laparoscopy I have to travel so long to see one person. >> Okay. >> I used to spend between 11:30 in the night to 1:00 to see a lapi done by Jira in Ashoda.
(1:26:56) >> Okay. >> Just to learn laparoscopy. It was so difficult for and we see that that cassett used to come get that VCR >> to memorize >> we have to memorize play that cassette which is seen on a TV in a small thing VCR >> and learning was so difficult at that time. Yeah, >> I wish I wish I was a little late possibly 10 years before you are way ahead of your time sir.
(1:27:20) You you must ask me sir. We watch your surgeons on YouTube and we try to replicate them. >> I would have I would have shortened my learning curve that's all is very great. I would have what I achieved probably for 5 years or 8 years to learn my laparoscopic skill to perfect. I would not say perfect to achieve a reasonable skill I would say >> I would have done it in two years had it not been.
(1:27:41) So is there anyone perhaps that you envy or that you have no hesitation in saying that you try to copy them or be what what they are? Any person in medical field that you look up to? >> The three people who influenced me in my life regarding a being a urologist and beyond urologist one person was in my formative stages when I was a residency.
(1:28:00) >> Okay, >> that was uh Dr. Yanadan. He was a western professor at that time >> and he's a man who taught me how to be a urologist. What is that urological thinking which is different from a general surge? >> Yeah. >> So my concept of urology was taught by me or embied from him. >> Okay. >> It was pure imbibition from him.
(1:28:24) >> Okay. >> Which taught me that concept of urology. So many people ask me how your concept is different. >> Yeah. So I still rate that or possibly give the credit to him who molded me as a urologist. >> Okay. >> Having done my urology and coming out my basic uh point was to become passionate about teaching or practicing urology but able to teach people or teaching as a part of my my whole domain into the into the whole thing.
(1:28:52) >> Yeah. >> But that [clears throat] was not practical because I was struggling to exist. Yes. Yes, >> but at the same time I found one answer there was been a person by the name Dr. Mahesh desai. >> Okay. >> Who who could even practice? He was also practicing but he could sense that opportunity and create an environment around him to fulfill that passion what he had for that self.
(1:29:15) So he taught me how to practice urology. >> So you went to nad? >> No no no I not been to but I learned from him. I was association with him made me think I can also do in this fashion which I was clueless how to achieve it. I could see from him that it is if you have a will it is still possible. >> Okay. >> And the last thing is uh the man who was a mentor philosopher and guide to me in many aspects and small small issues sometimes is Dr. Nagishi.
(1:29:43) >> Oh >> so Nagi was instrumental in me thinking much beyond urology. >> Okay. >> So you are a urologist. What is beyond urology? So if you define that thinking process came from Nagi. >> Okay. >> So if you look at these three people these are the people who molded my career completely both formatively establishing and maturing myself into >> anyone you envy.
(1:30:12) >> There's none to envy because we know our limitations. We have their abilities. >> Okay. >> Looking back I can say that I wish I could have done better than what I am today. possibly I should have done in that fashion but it's a retrospect >> there is no point thinking on retrospect which gets you some some bad taste in your mouth but nothing more than that you should be happy with what achieved and possibly I'm fine with that of what I achieved and possibly that's what is to me in my life >> yeah so I'll take you back to the
(1:30:41) question which I asked you about I know it needs a lot of courage and guts to establish a standalone center in the era of multispety given the fact that like I said like we discussed the footfall into a standalone specialy center is whole and soul based on the person or the credibility or the popularity of that surgeon.
(1:31:04) So how could you even think of doing something and how could you materializing it? How could you materialize it and execute it so well? >> Coming back to the history part of it. >> Yeah. The biggest disadvantage what I felt in my corporate practice at that point of time when I was in my previous uh before I know was sustaining the department and getting the financials easy at the same times keeping up my values that was a very tough job because >> your absences felt and uh so many other reasons and >> okay >> and urology was a specialty during that
(1:31:39) time possibly I would say 15 years ago or 20 years ago there's so much of evolution So much of investment happening and we are not given that opportunity or or they were not allowing to in they were never allowing that investment to happen into the hospital structure >> and possibly it was finding for me difficult for me to even approach them and to get those equipment necessary.
(1:32:00) Nowadays every hospital is pushing that equipment because they found it is a mandatory thing but they never felt mandatory at that point of time. Everybody was looking at what is the return I get out of the investment etc. >> Agreed. Well, that was a difficult choice for me at that point of time. At that time, Nagi suggested if money is not your basic aim.
(1:32:19) >> You are capable with your whatever goodwill you have created into the society, you are capable of starting an own institution, building an ecosystem around you, >> investing whatever the way you required to do it and creating it profitable also. And he connected me to one or two people who are already a VCs who are investors into AIG.
(1:32:40) So that that idea came up somewhere around 2011 materialized by 2013 and we started this institution in 2013. But at that point of time the basic idea is to build a world-class institution for kidney diseases alone and it should be so good for that this old building itself was big enough at that point of time. Everybody commented me saying that are you going to think about doing this? It looks like it's such a big building.
(1:33:04) Are you sure about you are able to manage it? >> Yeah. But luckily God has been kind. We could we could stitch a good fabric of the team and then we were successful in creating that values and possibly getting that outcomes to the patient. What we believed is you do good work, good outcomes, money becomes the byproduct.
(1:33:25) That was my chairman's saying at that point of time. You just do good work, money automatically comes. Nobody is saying money. We are not asking you to earn money. You do good work, money automatically comes. That was the philosophy with which we started off. But anyway, any business or any entrepreneurship or any enterprise will over a period of time it has got its natural growth that should happen.
(1:33:47) >> Okay. >> Okay. In a urology like speciality, I can't add another five floors and put more beds. It doesn't make any sense because it is of no use. Yeah. >> So that's how when the concept of single specialtity worked out in our favor for the first seven or eight years >> wherein there's a lot of investment which is done into the into the into the equipment we are eyeing that investment ability to serve that extra mile extra better outcomes without spending too much of money in a corporate style and still getting that outcomes here in this
(1:34:21) sort of an institution. I thought it should be replicable in the same fashion. If the same sort of a thought process is there in the people who are going to work in those places >> valuedriven, >> valuedriven and possibly outcomedriven, finance becomes the rest part of it. I never say that you cannot be doing charity everywhere and still run the institution.
(1:34:38) >> Absolutely. >> So that's how the thought process started and we we we uh we expanded our institutions to many other places. But the same principle holds true wherein we always see that people who are keen on creating those values and change the outcomes and better service or better things just not to earn money.
(1:34:57) >> Yeah, >> just not to earn money. Money is mandatory otherwise growth doesn't happen. You can't get a new equipment if you don't earn. So money is mandatory. There is investor who is invested on you expecting money out of it also. But he doesn't want you to do a unscrupulous thing to get into it.
(1:35:12) So we never encourage that sort of an uncruscular activity unindicated unethical practice at any point of time. So do a good job think about the outcome think about the patient first basis and money becomes the byproduct of it. So that is the real that's a necessity at that point of time for me which made me to start I know after nagi advised me >> and later the natural growth took it to whatever stage it is today.
(1:35:37) >> Yes. Yes. Yes. Having said that sir, the kind of quality quality work that you perform in your hospital every single day, you're bound to come across complications. You're bound to come across some uh mishaps. How difficult is it for you in particular and anybody in general to pull up and keep working on a day where a disaster has happened? Number one.
(1:36:01) Number two, how difficult is it to is it for you to redo the same procedure next time? This happens with everyone at every point of time. I don't say that it doesn't happen. But there may be initial if the similar case comes in the next one month, you may have a little inhibition in doing that. >> But over a period of time, forgetting is a part of life.
(1:36:23) If forgetting is not there, you cannot be alive. >> We have chosen a profession which is bound to have >> bound to have this sort of an issues. >> Yes. Yes. that may be related to the patient host disease and the surgeon all process the patient itself the disease process or the surgeon all three together >> stakeholders and disease >> all the the whole these are the three stakeholders basically these are the three stakeholders which can result into that sort of an outcome but that should not dissuade you from doing it in next time because it is once probably first
(1:36:52) second third occasions you are a little cautious >> okay >> but it doesn't change the actual style of your work or the outcome but basically it satisfies you by being cautious that you are making an attempt not to get into that sort of a complication next time. But it is a part of your game. There's no other way.
(1:37:09) >> Yeah. We can't escape. >> We can't escape. We can't escape. >> We must keep doing the same thing. Sir, uh for an athlete, it's an Olympic medal or a world cup. What is it for you? The ultimate achievement or does a doctor have something called an ultimate achievement? Um that's what again we come back to the same same thing.
(1:37:32) What satisfies you? >> Yeah. >> Right. What satisfies you? Okay. >> Somebody asked me you have been doing 35 years you're doing the same job. What else we are doing? Nothing new. Probably the way we do it laparoscopically open surgery to but ultimately what we do inside the for the disease process is almost the same. Nothing has changed.
(1:37:49) But we get a little satisfaction by doing in a new technique >> something new which you have not done in the last 15 years in the new way and you replicate it you feel happy regarding your capability etc. Okay. >> Number two, you get more happy when somebody who is you taught him are able to replicate it and you made his life easier in making this possible.
(1:38:09) That makes you happy. >> Correct. >> Number three, somebody comes and tells you I you made my life easier and he he they say thanks you to you which makes it >> and ultimately which runs you every day to do the same job again is a a a satisfied patient or a patient attender coming back to you and thanking you in spite of you being paid.
(1:38:29) It is that extra effort what they are doing for making you feel good by saying that thanks which keeps you alive and do the same job again tomorrow. >> Happy patients happy doctors. >> Happy doctors not by money alone but by but by inner feeling and emotion >> always sir. I agreed agreed agreed. So sir last question given a chance to revisit your youth or when you were like 40. Okay.
(1:38:56) uh when you're doing very good surgical work is there anything that you would want to change or you hope and or you believe you could have changed to make yourself a better person >> no that is not in 40s in my format years yes actually everybody with my attitude and the way I was trained in open surgery I had an option of taking two interviews after my MS one was in urology another was for surgical oncology in Nadier >> Mhm.
(1:39:26) surgical oncology inad I had an interview. So these are the two interviews I have to attend. >> Okay. >> So at that time as I said we were just living with the strife and nothing more than that. >> Yeah. >> Um I finished my interview in Urology was first and I was declared elected selected already. >> Okay.
(1:39:46) And uh to come to Chennai again I have to take two trains from Chandigar to Chennai for two days or three days and come back again from Chennai to Chandigar at that point of time I felt okay I have I have something in my hand that's enough I don't need to try for it but >> okay >> looking back regarding my personality and my abilities on open surgery at that point of time and my attitude towards surgery I'd have been a better surgical oncologist I feel had it been that I have not done surgical oncology at that point of time.
(1:40:15) >> Sir, let me tell you something. You can complete your your answer. I was in Tata Memorial. Surgical oncology residents in Tata Memorial, they watch your YouTube videos and they operate. I'm not kidding sir. >> I understand. [laughter] >> No, that that is a surgical procedure. What I meant to say is it's based on what you not do it.
(1:40:33) What you see is how your inbuilt attitude is towards Yeah. >> Like my attitude was that exploration I was very good at even during my Jan surgery days. So I thought so probably I may not things have changed now surgical oncology has become laparoscopy we are all doing a lot of urological oncology also so I don't say that so that was the only thing had it been probably good had it been in a surgical oncology no regrets even being a urologist at that point of time I don't really regret but but the reason for selection was I felt
(1:41:05) the urology department was very good in in in PGI >> okay >> I plastic surgery people were asking me to apply but I didn't apply because I was never suited for plastic surgery. >> Urology was very good. So you get impressive. >> What do you mean by never suited for plastic surgery? >> I was never technic mentally not as I said now I'm an extrapetive surgeon.
(1:41:23) I'm not such a sort of a plastic uh aesthetic aesthetic guy of a thing. So so that I never even I didn't even go to the interview though I was I was called for the interview I didn't even go. So urology I went there. Okay. because I was impressed with the urology work at that time being as general surgery resident not because at that time we had very limited procedures some flavor to urology you don't develop in three years yeah >> am I right we all presume that I'm looking at kidney diseases doctor being because I like kidney disease being
(1:41:53) treated no these all we formatively we get those ideas because the way the work culture is there in the department how your bosses were there at that point of time in that department how the teaching is there in the department what sort of a surgery's residence was getting that makes your decision much easier. Yeah.
(1:42:09) >> So for that reason I went into urology actually frankly speaking I was supposed to become a vascular surgeon. >> I finished my urin surgery and then joined vascular surgery. >> You said your SR ship in >> SR ship and vas John surgery and vasular surgery and I was surgery senior resident vasular surgery on call for 24 by7 for the next one and a half years.
(1:42:29) Oh, >> so at that time had my boss skana at that time would have created a created a lecturership in vascular surgery. I would have been retained in vascular surgery at that time. He failed in creating that job. >> Okay. >> As a lecturer in vascular surgery. There was no MCH in vascular surgery at that time. >> Okay.
(1:42:48) >> So it came later after few years in Chennai at that time. So I was akin to be an surgeon. He failed. So I made my decision to go for another super specialization and then join neurology. >> And you would have happily been a vas surgeon. >> Absolutely. Absolutely. Vasel surgery was my passion at that time.
(1:43:05) >> Oh >> even my thesis general surgery thesis was in vas surgery >> sir. I think one podcast is never never never never enough for a guy like you because we I mean I have tried to bring out a lot of scars or miseries or whatever you have gone through but it's a it's a textbook sir and I strongly believe we ourselves uh stand as a role model for ourselves because our life itself teaches us a lot more than what other people can teach you and you as a leader as a urologist in Hyderabad are you are a source of inspiration to many
(1:43:36) many youngsters sir for generations to come And today I'm a changed man with the kind of interview that I have had with you and uh fantastic opportunity. Thanks a lot for your time and uh >> my last dialogue is always there. Always I say >> if somebody is inspiring you there's a lot of perspiration which has gone behind him.
(1:43:54) >> Absolutely sir. [laughter] Absolutely. Can't agree anymore. >> Thank you sir. Thanks a lot for your time sir. >> Wonderful. Very nice talking to you. Thank you sir. All the best. >> Thanks a lot sir. Thank you sir. Bye sir. Heat. [music] [music] [music] Heat.
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