Reality of General Surgery & MBBS Life: Honest Insights from Dr. Ravindra Kumar Diwan

Reality of General Surgery & MBBS Life explores the honest, unfiltered journey of becoming a doctor through the insights of Dr. Ravindra Kumar Diwan, a veteran surgeon and pioneer of thoracic surgery in India. Drawing from over three decades in medicine, this blog looks beyond textbooks and ranks to examine entrance exam pressures, the true MBBS experience, challenges within surgical training, and the mindset required to choose a medical speciality. It offers aspiring doctors a realistic, experience-driven perspective on medicine, surgery, and what it truly means to serve patients with skill and integrity.

Medical Entrance Preparation: Then vs. Now

Dr. Diwan provides a comparative perspective on the medical entrance examination process.

The MBBS Experience: Rigor and Enjoyment

Dr. Diwan recounts his MBBS journey at Maulana Azad Medical College (MAMC), New Delhi. The initial phase was disconcerting due to the vast curriculum, leading to a feeling of being "thrown into a pond." It took several months to adjust to the academic rigor. However, after this initial adjustment, the 5.5-year journey became highly enjoyable, balancing intense studying with social activities and student politics. Examination pressure was significant leading up to the three professional ("prof") exams, but motivated students maintained a good pass percentage of around 70-80%.

The State of Surgical Training in India

The discussion addresses a declining interest in General Surgery among top-ranking medical graduates over the last 10-15 years.

Identified Problems:

1. Perception: Surgery is perceived as a long and difficult career path to establish oneself.

2. Lack of Focus: Residents often delay specialization decisions after initial training.

3. Work Environment: Surgical residencies are frequently described as "toxic."

Proposed Solutions:

• Early Career Focus: Residents should decide early whether to pursue General Surgery (a super-specialty in itself) or a sub-specialty. This ensures a focused and efficient training path.

• Improving the Work Environment: The atmosphere for surgical residents must become less toxic and more humane.

On the "Toxic" Culture in Surgical Residencies

Dr. Diwan explains the origins and modern persistence of the high-pressure environment in surgery.

Historical Context (Why it started):

In early specialties like cardiac surgery (1980s), postoperative care was primitive. Patients required constant, second-by-second monitoring by residents. Any negligence could directly result in the patient's death. This intense pressure from senior surgeons aimed to ensure patient survival and achieve the best possible results in a high-stakes environment lacking modern support systems like advanced ICUs.

Modern Persistence (Why it continues):

1. Human Nature: An inherent tendency to exercise power and control.

2. Systemic Failures: A shortage of personnel, particularly in government institutions, overworks residents, breeding stress.

3. Legacy Mindset: The belief that the next generation must endure the same hardships is "neither necessary nor desirable." This cycle must be broken.

The Way Forward:

Senior surgeons must foster a humane, stimulating, and growing atmosphere. Considering a proper work-life balance for residents, whose training period (ages ~24-32) is a critical part of their personal lives, is essential.

Choosing a Medical Specialty: Passion Over Lifestyle

Dr. Diwan advises on selecting a medical branch. While acknowledging his bias, he asserts there is nothing more rewarding than being a surgeon. The satisfaction from problem-solving, overcoming challenges, and positive patient outcomes is immense. Surgery also develops leadership potential.

A student should not choose a branch because it appears to be "lighter" or offers a better work-life balance. The primary motivation must be a genuine attraction to the branch for its own potential and subject matter. Ultimately, a better work-life balance should be inculcated in every possible branch of medicine, rather than being a reason to select one branch over another.

The Role and Necessity of Super-specialization

Dr. Diwan clarifies the debate surrounding super-specialization. The goal is not the "super-specialty" tag itself, but having a clear focus early in one's career. Developing a high level of skill in a specific, focused area (e.g., foot surgery) can attract a global patient base. Super-specialization is not mandatory. However, whether one remains a general surgeon or pursues a sub-specialty, the crucial element for success is to decide early and develop a dedicated focus to stay updated with the latest trends.

An Overview of Thoracic Surgery

Dr. Diwan emphasizes the scope, need, and current state of thoracic surgery in India. Thoracic surgeons manage two major causes of mortality: lung cancer and tuberculosis (TB). India faces a critical scarcity, with an estimated under 100 practicing thoracic surgeons for 1.4 billion people and only about 7 M.Ch. training seats annually. This presents immense scope for the specialty's growth.

The scope of thoracic surgery can be remembered by the ("Three Ts" of the chest: 1. **T**B (Tuberculosis), 2. **T**umors, 3. **T**rauma).

Philosophy on Healthcare and Institutional Development

Dr. Diwan shares the guiding philosophy behind developing a state-of-the-art thoracic surgery department at NITRD, including acquiring a surgical robot. His core principle was that poor patients and those unable to pay should not receive substandard care.

Every patient deserves the highest expertise and technology. He justified advanced technology, like robotic surgery, by emphasizing its role in training the next generation of surgeons and keeping the national institution at the forefront of medical advancement. This vision secured necessary funding.

Final Message to Aspiring Doctors and Surgeons

Dr. Diwan concludes with a powerful message:

1. A Noble Choice: Becoming a doctor or surgeon is a commendable choice, despite economic pressures.

2. Be a Compassionate Human Being First: This is the foremost quality the world needs from doctors.

3. Be Consistent and Disciplined: These are keys to long-term success.

4. Uphold Your Integrity: Never bow to any authority if it is unjust. Work towards your goal, and success will follow.