While it is natural to feel confident and rewarded at the success in treating a patient with a demanding and serious illness, it is important to not become conceited and maintain a humility because there are equal chances of a treatment failing and a physician making a mistake, said Dr. Anil Nanda.
Nanda, MD and MPH, has been the Chair of the Department of Neurosurgery at Rutgers, New Jersey, and a member of the RWJ Barnabas Health Medical Group. He was speaking on Punditry and Poignancy in Healthcare at a recent conference. Organized in Puttaparthi, the district headquarters of Sri Sathya Sai Institute of Higher Medical Sciences in Andhra Pradesh, the global conference on Sri Sathya Sai Ideal Healthcare marked the hundredth birth anniversary of Sri Sathya Sai Baba.
Emphasizing Punditry as expertise in a particular medical field, and Poignancy as a mix of feelings of humility, sympathy and sadness, Nanda said striking a balance between the two while focusing on patient care is an imperative for medical professionals.
Recalling he attended a summer course at the age of fourteen in Brindaban with Sathya Sai Baba, Nanda acknowledged his gratitude to the Baba for giving his life a direction.
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Beginning his talk with listing roots of modern medicine in ancient Indian and Greek practices, Nanda referred to the legendary story of Shiva cutting off Ganesh’s head and of Zeus’s headache being cured by opening his skull. Going to hospital was considered having only a fifty percent chance of survival a hundred years ago. Today, that has turned around, he said.
Coming to the title of his talk, Nanda said it was easy to become arrogant in the realm of medicine, with physicians boasting about numerous procedures performed by them or publishing many academic papers. “I think physicians and medical professions have this sense of toxic doubtlessness sometimes. I’m right, this is the only way to do it, there’s no other way to do it. An important thing to remember that punditry can be dangerous,” Nanda said.
Nanda stressed the need for humility in the midst of confidence. Punditry in medicine often arises from overconfidence and hasty generalization, leading to a toxic form of doubtlessness, he said. It is crucial that we remain aware of how dangerous this can be, he said, and added, “Punditry works sometimes, and sometimes it doesn’t and I think we have to look at our own skill set.”
Pointing out historical incidents of medical punditry, Nanda listed customs during the Roman period, the Middle Ages, and the 19th century, and of treatments like lobotomy surgeries for women, and treatments for George Washington and King Charles as examples of punditry. These historical events were evidence of not all medical practices being effective and of punditry gone wrong, he said.
Quoting Osler’s famous statement that humanity’s three great enemies are fever, famine, and war, Nanda said parallels in literature, such as Apollo’s arrows raining down on the Greeks in the Iliad resonate with the challenges faced in medicine today.
Giving an example of punditry, Nanda reminded the audience of the lockdowns during the Covid-19 which were enforced to save lives but which also created economic and educational setbacks. It is time to consider if lockdowns were justified, or if that decision was erroneous, he said.
If punditry of lockdowns was questionable, there were examples of positive punditry such as use of rose water discovered by Andrew Pare, Joseph Lister’s advocacy for carbolic acid, Florence Nightingale’s data visualization techniques like pie charts, advances made by Marie Curie and Harvey Cushing, Nanda said, adding even once common medical procedures get rejected with time.
A sense of accomplishment after performing a complicated procedure successfully is natural, Nanda said. “As I reflect on my own experiences, such as successfully operating on a large skull base meningioma, I find a sense of accomplishment. Yet, I am reminded of the importance of humility,” Nanda said.
However, medical field requires continuous learning and self-evaluation, Nanda said. Punditry can have its merits alongside its pitfalls, and confidence and humility both are essential for medical professionals, he said. Striking a balance between patient safety and informed medical practices is of utmost importance, he stated.
Medical professionals often come face to face with situations that test resolve and understanding of patient care. Illustrating this with an example of his performing a procedure for spinal cord tumor, Nanda said he removed the tumor after a long and strenuous operation, but the patient was not able to move legs. “For those of us in medicine—whether as nurses or physicians—such complications are often accompanied by sleepless nights spent questioning our choices and capabilities,” he said. The particular case turned out positive after a few days when the patient began to walk, he added.
But not every case ends well. Nanda here spoke of a case involving patients treated for trigeminal neuralgia receiving tenfold dose of radiation, resulting in devastating consequences. “Such events remind us of the profound responsibility we bear as healthcare providers,” he said.
Looking at such cases, it is highly desirable and necessary to have open communication in the operating room, Nanda said. Hierarchies should not prevent anyone—nurses and surgeons alike—from voicing concerns that could avert critical mistakes, Nanda said. “If you think something wrong is happening, you have to speak out because you may prevent a fatal mistake. And therein lies the balance between poignancy and punditry,” Nanda said.
He then spoke about his book on implications of medical errors and the moral imperatives faced by physicians. Nanda went on to reemphasize the importance of learning. We must ask ourselves how we can improve processes and prevent mistakes, rather than placing blame on those involved, he said.
“I think our moral dilemma as physicians is how we address mistakes, how we look back at the root cause analysis and say what could we have done differently? Do not accuse berate and criticize. Instead say how could we do this differently? How can we make a difference?” Nanda said.
Nanda said a balance can be struck between the poignancy that arises from human error and the punditry that often accompanies public discourse on medical failures. “Ultimately, it is our duty to continually question ourselves: How can we do things differently? What steps can we take to make a positive impact on our patients?” Nanda stated. He said such reflections were guiding lights to finding purpose and a path forward in healthcare.