Counting Down to 90 - Week 1571 - Raison D'Etre
Whether you are a radiologist or a non-radiology doctor or a non-doctor, ask yourself today. What is my raison d’etre, with the understanding that purpose is not a static concept, but something that evolves and changes along with us.
The Concept Explained
Bhavin Jankharia
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I first talked about Raison D”Etre, French for “Reason for Being” in my Presidential Address at the Indian Radiology Annual Conference in 2014. I said
Our only raison-d’etre is to answer the question why! Why is the patient here. What is their problem. What is the question to be answered. What is the query the referring doctor has.
The sentence “please correlate clinically” is perhaps the worst line in radiology practice, because it sends a message to the referring doctor that we are not physicians and we are not part of the patient’s management team, but are turfing the onus of the diagnosis onto them. Yes when we lack certain clinical data, we can word the report to reflect that, for e.g. in a patient with ground-glass attenuation, we can say that “this is most likely suggestive of hypersensitivity pneumonitis, provided the patient is not immunocompromised or an ever-smoker or in failure”, because we were unable to get the appropriate history. But to write, “ground glass attenuation seen, ?hypersensitivity pneumonitis, please correlate clinically”, betrays a sense of not wanting to be involved.
I went onto say then that this is the reason why teleradiology practiced as a means of just reading scans without being part of a patient management team is rubbish. Over the years I have believed and still believe that while AI can replace some image-readers, it will not replace radiologists who are clinicians and keep trying to answer the question, “why”.
I addressed this earlier in the week with a piece titled, “Why LLMs Will Render Many Radiologists and their Reports Irrelevant”
Bhavin Jankharia
I again addressed raison d’etre in a chapter of a book I was once contemplating titled “Death of Doctors”. This eventually morphed into atmasvasth.com, but the aborted book was all about doctors and their behavior.
Sometime after 2014, I was gifted a book, A Hundred Lamps, edited and compiled by Dr. Yatish Aggarwal, a practicing radiologist. The book is a compilation of seven Hindi short stories about doctors and medicine, written by famous, gifted Indian language writers like Phanishwarnath Renu, Munshi Premchand, Nirmal Verma, Uday Prakash and others, superbly translated into English by different translators. Virtually all the writers are left leaning socialists who use the doctors as protagonists in their stories to clearly enunciate the overall impression that people have of what the profession should be, is and has become these days, ending with their understanding of how doctors should conduct themselves in society. Each story is worth a careful read, especially by doctors.”
Yatish Agarwal
A doctor’s aim is to prevent pain and suffering and if they occur, to alleviate them. It is how the practice of medicine began. Whether it was shamans or witch-doctors or ancient systems like Ayurveda and Chinese medicine, the accent was always on preventing disease, promoting a healthy lifestyle and if disease occurred, to diagnosis it, treat it and reduce pain and suffering as much as possible.
Donald Seldin, a physician from UT Southwestern in Dallas drew a sharp distinction between society’s larger objectives — of “a state of complete physical, mental and social well-being” for humankind — and the role of doctors, which he defined more narrowly as “the relief of pain, the prevention of disability and the postponement of death.” This should be the raison d’etre, the reason to be of every doctor in particular and healthcare in general. The tragedy of course is that even if doctors understand this, the people around them in the so-called healthcare industry have no clue.”
“In July 2019, while conducting a teaching session on Thoracic Radiology in Anand, Gujarat, Deepak, the head of department of Radiology of the Pramukhswami Medical College in Karamsad asked me to give some advice to the radiology residents. I could then think of just one thing. “Wake up every morning and ask yourself…which one life am I going to change today for the better? Even as a radiologist, if we make this our daily mission, we will ensure that whatever we do will be in the interest of the patient and geared towards saving lives and preventing harm.””
My raison d’etre had gone from “answering the question why”, to “which one life am I going to change for the better today” in about 5 years, perhaps mirroring my own evolution as a physician and person.
It is not just doctors. Everyone needs a raison d’etre, a purpose in life. I addressed this issue in Dec 2023 in my atmasvasth blog in my piece titled “The Retirement Conundrum - Managing the Remaining 1500 Weeks”, which I guess was a precursor to this entire project of Counting Down to 90.
This is perhaps the most important issue after financial independence and stability. When you get up in the morning, you need to figure out how to make a difference that day. One of the advantages of being a doctor is that in your late 50s and 60s and perhaps even through your 70s, you are still relevant and make a difference every day to someone’s life. The same is likely true of lawyers, accountants, teachers and other professionals. But those of you who have to retire from jobs or from businesses either because of statutory reasons or the law of the land, have to figure out what to do for the rest of the 1500 weeks left.
While you can take up hobbies and do things you were never able to do before, you also need to figure out how to be and stay relevant. Volunteering is one way of doing this, while taking up another job is another way.
Bhavin Jankharia
So whether you are a radiologist or a non-radiology doctor or a non-doctor, ask yourself today. What is my raison d’etre, with the understanding that purpose is not a static concept, but something that evolves and changes along with us.
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