Detangle with Dr. Chetan Pradhan

For those who don't know , you tell us a little bit about your scope of workplace .

So by trauma I mean I deal with all sorts of accidents , injuries , falls and various problems with the musculoskeletal system . So I'm an orthopedic surgeon to begin with , specializing in trauma surgery . That is what I do the whole day and sometimes the whole night .

So when I joined BJ Medical College , my first stint into the operation theater in Sassoon Hospital was an eye-opener for me , because that was the day when it was clear to me that I would be a surgeon , and that is what was interesting as far as the career was concerned .

But then , later on , when I did my internship , that was the time when I had to see a lot of orthopedic patients and that is how I started liking more and more orthopedics and I decided that , orthopedics being a specialty in itself , instead of doing general surgical work I would go into orthopedics . Therefore I joinedopedics as my post-graduate course .

I passed my MS , my residency was at Sancheti hospital and there was a lot of trauma in those days that Sancheti was treating it still is . But then I went to Mumbai and worked with Dr DD Tanna , who is considered like the god of trauma in the country as of now . So through him I got really interested in trauma .

The most important advantage of being in trauma is that it is never , ever boring to do trauma surgery . It usually encompasses everything from head to toe . So each and every case is different , each and every patient is different , and there's a lot of variety in your work , so you don't ever get bored of doing the same surgery again and again .

And that is how I started liking trauma . I developed more and more expertise in it and I came to do only that .

So tell us about your experience with the emotional trauma that comes along with the physical one yeah , I think that's a beautiful question , because trauma is not just physical it is more mental , to not only the victim but also the family , true , so so it will involve the entire family , not just that patient .

Basically , the person who is on the hospital bed is traumatized physically as well as mentally , so he is primarily repressed . We deal with a lot of depression on a daily basis .

Very often , as soon as you declare to the patient that you've undergone an accident , you have broken a few bones here and there , the first thing , that first thought that comes to his mind is probably that's the end of his world and he'll never be the same again .

And that is exactly the emotion which he conveys to his family and the family also starts thinking on those terms . Especially if it's a child , especially if it's a girl , unmarried girl , then the family starts getting more and more depressed .

And that is where my role comes in , or the role of a psychologist comes in , that the first thing that we need to tell that today , in today's world world , today's era of modern technology and high-tech orthopedics , it's not the end of the world . Most of the trauma victims can make a normal again . So depression is the first sentiment .

Despair or , you know , all hopes move on at us . That is second emotion that we deal with on a daily basis .

So he's mentally prepared for it . He's ready , he knows that this is something which I need to do to get rid of my pain , so he is totally prepared for it . In trauma it is exactly the opposite . He is totally unprepared , so his mental capabilities do not come to terms with that injury or the treatment immediately .

He takes a long time and some people take really long time to accept , first of of all , that this is what has happened , this is what will be required to be done , and God forbid if they really end up with significant disability . Then you know , there's a lot of depression that sets in , sometimes pathological , or sometimes they even become suicidal .

So I have seen number of patients who are very , very positive you know , there are certain communities , I would say who would , or patients who blindly trust you . They'll say I know I have broken a leg . Do whatever you want to do . Whatever you do , I'm going to walk in a few days . So they begin with a very positive outlook .

Though the injury is the same , your outlook matters the most in terms of recovery . Exactly opposite are those patients who keep crying from day one . They do not understand that they can become normal again and they take almost double the time for recovery as compared to those who would be positive from day one . They recover in half the time .

Their wounds heal in half the time . Their bones heal faster . Those who keep crying end up with complications , delayed healing both the wounds as well as the bones , and something goes wrong with them . Basically , there is a huge amount of delay and that is purely because of the mental outlook .

So I would definitely agree with you that mental outlook does play a big role in recovery and you see the whole physical ramification .

Fortunately , I have had very good teachers , very good mentors who guided me and made me what I am today . But , to name a few hurdles , most of them are personal ones .

I found very little time for my own hobbies or myself , I probably could not give enough time to my family , my child , my son and before I realized that he grew up and now I feel probably I could have given him some more time . So there's a lot of sacrifice that you need to do on your personal front being in this line .

Second thing is you need to be really updated . So , for example , what I learned as a resident is now in the museums . So the technology changes a lot . There is a lot of advancement in the science almost on a daily basis , so need to keep upgrading , updating .

You need to be studying very hard almost on a daily basis because you need to know in order to give it back to your patients . So those were the hurdles the third thing

was . Trauma in those days was done by each and every orthopedic surgeon . So to portray trauma as a super speciality was really very hard . Everybody used to ask me what different are you doing ? Everybody is doing . But then my mentor , dr Sanchity , told me no , trauma is a speciality . You do that well and you will be a good trauma surgeon .

In fact , let me tell you that trauma is one of the most intricate and difficult surgeries in orthopedics because every case is different . There's no set protocol , there are no SOPs . You open up and you decide on table what to do , what is the best for the patient .

So it took me quite a while , almost more than 20 years , to develop this specialty and to make it as a super speciality in orthopedics Fabulous , unlike the West , where it already was . A super speciality in orthopedics Fabulous , unlike the West , where it already was a super speciality , True .

So today I can confidently tell my patients that don't worry , you are not going to lose your limb or life and I can , with my expertise , my science , take care of you to an extent that you can go back to your work Right , so this aspect has changed Emotionally speaking ? yes , it does affect you .

It does take a toll on your mental health a lot , because whole day you are just hearing negativity . You are dealing with only the negative vibes . You are hearing pain everywhere around you and therefore it tends to make you kind of negative yourself . So I used to meditate , I used to . Your outlets are your friends , your family .

You tend to spend quality time with them and get out of it . But then over the years these emotions start becoming a little blood , to be honest with you . So now today I'm not really festered or bothered by looking at a grotesque wound or a bad , a bad patient . I need to . I've told myself that I don't need to think , I don't need to be emotional .

If I have to help that person , I have to keep my emotions away and I need to concentrate on how best I can apply my knowledge . So there is nothing emotional about it . It's all about protocols and it's all about science right .

But then you know , once you reach there , that your being there is going to make a huge difference in his life . And then you know that perhaps he might die in the next half an hour . And then , of course , it's a teamwork , it's not just me , the whole team gets on .

And a few months later , when he walks back into your clinic without even realizing how he was , when he walks back into your clinic without even realizing how he was when he came , he or she , that gives you a different high , let me tell you . It gives you a completely different high than any substance on this earth can give me .

And that has been my motivation . I am sure it is the motivation for any surgeon , any doctor , for that point .

Today we see even the girls getting drunk , getting high , and it's not just alcohol , let me tell you .

Substance abuse is rampant Smoking , weed or joints or everything is going beyond control in our young population and every single day or night , to be specific , we see accidents because of that , ghastly accidents , injuries that can actually ruin their lives at a very tender age and at that time they probably do not realize the gravity of the situation .

And when they do realize that she or she will never be the same again , it really hits them very , very hard . They are not able to mentally cope with it . They get suicidal tendencies , the family is distraught and everything goes for a toss , and this is completely avoided .

Unfortunately , it is very much on the rise and it is very , very common amongst college girls and boys .

So those traditional teaching that we had in our days is still very , very valid , because people do not say , people see only the social side of it , people do not see the this negative side of it which we do .

So when you see uh , boys and girls from very good families , educated families , uh , so-called high class families , indulge in all this , get into real bad accidents and injuries , you feel really bad that this shouldn't have happened to this boy or this girl true , doc .

They get it right away and even before I can counsel him about the management , he knows what is to be done . But typically any fracture or any problem has multiple solutions . So I have to first of all take into account all those solutions before I even speak to him . I have to give him all those choices .

Not all of them would be pertinent in his scenario and because of this tendency , there is a growing disbelief or mistrust , which affects the doctor-patient relationship . Somebody who doesn't indulge in that , for example , a village farmer who may not have access to this .

If I tell him , okay , you have a broken bone , I'll fix it , he'll believe me , he'll be happy about it , he will be positive about it and he will get out of it within no time . But this I am not against taking multiple opinions . That is the right of every patient , but it need not be all the time on social media .

Every piece of knowledge on the internet need not be always accurate , and there is a huge role of the treating doctor to correlate that piece of information with the physical state of the patient lying in front of it . So it's not .

I mean , unfortunately , the era of Google experts , medical experts is on the rise , but then not everything given on Google may be applicable in your scenario .

First of all , let me tell you there is a very shift in the perception of the patients in terms of the treatment that they get .

That may be because of the rising costs or you know , the plush posh hospitals that they see around , but then there is an unfortunate expectation that in whatever condition your patient is brought in , he should walk out absolutely brand new . So this is not . This is a human body .

This is not a car which is damaged which you know comes out of a body shop looking brand new . So the patients , their relatives , have to understand that medical science has limitations . Every doctor prides his level best to get his patient to do well . There is , I don't know , any single doctor who would purposefully harm his patient . It's not possible .

So the expectations from the patient's point of view are rising that he has to become non . If those are not met or if something goes south , for example , if the patient dies , then he may in spite of having gone down because of medical reasons or natural reasons , the blame game starts . The blame is like he died because the doctor was negligent .

Now , this need not always be true , but this is what is happening . So if I start telling the relatives that your patient is critical and he may die , there are mopsies , there are adverse reactions , there are very negative connotations to all this .

Instead of trying to understand what I am trying to say or what the doctor is giving you , the details about the reactions have become very different . The reaction , first reaction , is why , then ? What are you doing ? Why can't you cure it ? I am . The other round is that there is probably a lack of communication also .

So if the communication channel is good , it is very clear , very honest , then this can be avoided . So right from the beginning .

If there is a healthy communication between the patient , the relatives and the doctor that this is how it is , then understanding becomes much better , these untoward incidences are avoided and the doctor patient relationship also remains on a better note . But unfortunately this is not happening now and it's getting the .

The sanctity of this relation is threatened on a daily basis .

Okay . So my resident will sit next to me when I'm declaring death to a relative or bad news to any relative , and he'll observe me and he'll absorb that and he'll do the same .

Unfortunately , there is an urgent need for psychologists like you to go and teach us , teach all the young doctors , as to how to do proper counseling , and this not only involves declaring death but all sorts of counseling , you know . Right .

So if there is a way of , or a scientific way of , telling the family that , okay , your patient has been involved in a serious accident , then we would always welcome .

One of the first things that doctors say to their patient when they're very relieved to see there is nothing organically wrong with them words , nothing is just stress . Now that is the first line every medical professional needs to unlearn . You cannot say it Even if a patient has see from a doctor's perspective . You know that .

Okay , thank God it's not a tumor , thank God it's not a spinal issue and the backache is because of your work stress . So your relief is coming out as demeaning or not validating the patient . What the patient hears is it's nothing , when it's actually something , yeah . So somebody said oh , the pain is in your head .

And the patient said but I also am in my head , right , so I'm living with the pain . So that's where I mean things can start no , but I mean you are right there .

litigations nowadays oh yes yes so I see this from both sides .

On the other hand , I've also seen patients who've had symptoms which the doctor could not diagnose in time , said okay , this is stress . They oversold anxiety . It turned out to be something purely organic .

Your clinical exposure tells you that this has to be something , and not just psychological .

This is happening very , very frequently and at a very alarming rate . So what has changed ? The residency has almost remained the same . The workload was always the same , the facilities were always the same . Nothing has changed . But the perception that I am being tortured or I can't bear this , I can't come out of this , is changing .

So I feel that in the residency phase itself there has to be some counseling , psychological counseling , which must be done to the residents Because they are unable to bear the stress of even medical training , which is very . I see a lot of young residents and doctors get into alcohol abuse , sometimes even substance abuse . Smoking is rampant .

If you see their parties , everybody talks about doctors' parties going and that's because they are dreaming for stress relief . Right . But one must learn to deal with the stress , because stress is an inherent part of our profession .

By good means , scientific means like , say , meditating , hobbies , reading and going to a counsellor if need be , and that is a change I see happening . So I see quite a few of my colleagues resort to psychological counselling if they are under stress . They are more open about it , they talk more openly about it , we amongst ourselves to definitely discuss .

And then one thing leads to another . Somebody says okay , you go and meet this person , he'll help you .

What happened when I was 16 years old and later on during college life was that you study your heart out . You get into medical college and then into your profession and work was always the worship . But today , if I see the younger generation today , I think they are far more smarter than what I was at 16 years .

They know how to balance their work and life very nicely . So that is what I would like to change .

I love the sound of these books , so I would not hesitate to give your number at the end of that list so that I can go and ask for him .

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I'm talking of doctors only , not the general population , because they need to be trained very early part of their career . And the second thing is getting rid of this substance abuse issues in the younger population , because I'm sure it's going to blow out of control in no time . And there was a movie called urta panjab , oh yes , and it's not just panjab .

I see it happening everywhere , absolutely . So these are the two things which you need to address on an emergency basis . So please do something about it . How do , if I have to ask you a question , how do you declare demo ?

For example , if you are declaring death to a family which is more than three people present and you know that they have each other for support , it's always best to give the details , announce the news and walk away so that they have that little time to be with each other .

But if somebody is all alone let's say it's a couple one has just passed away , the other one is alone . Stay with the person . It's okay to step out of the doctor's shoes at that moment and be just a human being present with them till somebody else walks in . So these are simple ways of reading a room . See how that person is reacting .

Are they having a fainting spell ? Are they taking it ? Well , offer whatever little support you can . It could be a glass of water . But again , read the room . If there is somebody else to bring them the water , step away , because that professional line is a very thin one . So every doctor has to know how is the person reacting to the news ?

You will break the news in a formal , objective way . What happens after that is very important . How long you stay in the room is very important . So this is what doctors should learn .

tend to get a lot of nightmares . That's a medical phenomenon , yes , and there is medical treatment adequately to deal with it , which primarily involves sedating them so they sleep without any drinking , but still they do get it . How do you advise a psychologist's approach to deal with addiction ?

Now , post-traumatic stress disorder can happen irrespective of somebody else dying in the accident or surviving . Medication is the first step , always the first step , but therapy has to be started soon after . Unless the patient understands what is happening , they will not be able to get over it , because ptsd presents itself in very physical ways .

You have a racing heart , you suddenly have night terrors , like you said , blood pressure will rise . So people will feel that something physically is continuously going wrong with them . Unless they come to terms with the fact that , okay , this is happening , but this has an emotional origin , they can't deal with it right .

So you need to have a psychologist involved . The minute you identify ptsd as a surgeon , you need to step away . What people do is they try to step in and they try to do what is not their job . You're not trained in psychotherapy . As a surgeon , you're not supposed to know psychotherapy .

So the best thing is identify and get somebody else involved so that they can deal with it in the right way .

But , doc , this has been a phenomenal conversation . I mean I think we've covered everything from your younger years to the younger years of the doctors practicing today . We have covered so many important topics like declaring death to substance abuse .

I mean what we see as substance abuse is something affecting a whole generation , but to see it practically breaking bones or practically causing trauma which people may not recover from . I think this perspective needs to come out . People need to understand that it could be them on the wrong side of the scalpel very soon .

So thank you so much for taking the time and thank you so much for sharing all this .