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SICOT e-Newsletter

Issue No. 66 - March 2014

Editorial by S. Rajasekaran - SICOT Treasurer

Snakes and Ladders in Professional Excellence

This is a talk that was delivered in Agra during IOACON 2013 as the "Kini Memorial Oration", which is by the Immediate Past President of the Indian Orthopaedic Association.

While growing up, many of us would have enjoyed playing the game of snakes and ladders. It is a simple board game, where rolling of the dice moves you along a path that has ladders letting you move up quickly and also snakes waiting to pull you down, sometimes dragging you all the way to the start. But there is a larger picture to decipher. Indian philosophy draws a parallel to our journey towards salvation and excellence in life where virtues are ladders that push us to greater heights while snakes are vices that pull us down. In the original game, the prominent squares of virtues were faith, reliability, generosity, knowledge, asceticism, etc., while the squares of vices were disobedience, vanity, vulgarity, theft, greed, lust, etc. Thus the game was actually a simple way to teach morals in life.

Our quest for professional excellence is similar. While thousands of medical professionals start their career with the dream of professional excellence, the numbers, unfortunately, thin out at the top. The snakes distract and charm people away from their goals while the ladders of virtue seem less enticing to climb. This is reflected in the success and failure of several professionals in the medical field.

Upmost, the two important ladders for any skilled specialist will be professional competence and excellent surgical skills. These are essential to catapult anyone beyond competition and make him stand out amongst the crowd. While professional competence is important in any job, it is more so in surgery, as at the receiving end of the scalpel is a patient who is a husband, mother, wife, son or father to someone else and on whose good health an entire family depends on. It is vital that we avoid medical mistakes which still hover on us as one of the important causes of death in patients entering hospitals. Building a culture of safety in your work pattern is again a strong ladder that can propel you up in the path of success.

Dedicated training with a great mentor is an important ladder that can provide experience and build a strong foundation that no technology or gadget can provide. It is wise not to just rely on technology and remember the adage 'A fool with a new tool is still a fool'. Avoiding cutting-edge technologies and new devices that have no safety record but great potential for media advertisement is crucial. My mentor, Prof T.K. Shanmugasundaram, used to tell us, 'If you want to be a cutting-edge surgeon, stay with the times. But your patient may suffer often. But if you want to be a safe surgeon, be five years behind the times'.

As we progress in the career, one has to understand that no success transpires overnight. 'Impatience for success' is a tricky snake that can cause wise people to do many foolish things. Mr Narayanamurthy of Infosys, on being asked how they became an overnight success, replied: 'By working hard for 25 years'. Impatience can draw a surgeon towards unwanted procedures, loose indications, unethical work practices and dicey financial partnerships. It is important to understand the difference between leap frogging towards success and professional shortcuts as the former is the result of knowledge and hard work and the latter is the result of temptation to easy success. Low goals, easy contentment and the tendency to settle for less when more is possible are a few other snakes in the mid-professional career which swallow most of the professionals.

Rather than looking at performance alone, one must also look at the 'performance gap' - that appalling space that divides what we are doing and what we are capable of. Frequently there is a huge gap. One has to strive for the ladders of high aims and hard work at every stage of one's career. No achievement is possible without a high dream. Steve Jobs did not aim for just another improved phone on the market but that his 'products must put a ding in the universe' and the rest is history. However, it is hard work that makes a dream a possibility. The former President of India, A.P.J. Abdul Kalam, rightly mentioned: 'Dreams are not what you see in sleep; they are which don’t let you sleep'. 'Passion for work', 'purpose' and attitude can fuel hard work in the right direction.

With success comes a few vices of 'celebrating success too early'; 'succumbing to early slow down' and 'distractions'. One also has to overcome the snake of 'professional fatigue', which happens due to monotony of work. Individuals and institutions need to reinvent themselves and do new things at least every five years. Remember Steve Jobs question: 'When was the last time that you did something for the first time?'.

The next important ladder is the habit of 'keeping the main thing in life as the main thing'. Losing focus and getting distracted by other businesses and ventures can derail a young surgeon from professional excellence. Money should be the byproduct of professional achievements and not the main quest. Sachin Tendulkar, Indian cricketer, was an example of the singleness of purpose when, after 20 years of cricket history, he said: 'I only think of playing good cricket, nothing else. The hunger for runs is the same today as when I started'. Similar commitment was echoed in the words of Joe DiMaggio, the NY Yankees striker: 'I cannot relax in any game. There is always some kid who may be seeing me for the first time, I owe him my best'. People with such attitude and commitments have never been stood second to anyone.

The last and important ladder is the process of transformation of an individual to an institution and building an excellent team. The need for a committed team is echoed in the Chinese proverb, 'if you want to walk fast, walk alone; if you want to walk far, walk together'. The power of a committed team and the collective wisdom of a group are incomparable to even the best of an individual.

Lastly, from the beginning to the end of the career, there are a few pillars that provide strength, support and fuel growth. They are the love and support from the family, good friends, and probably also religion and faith. No professional career can be without its ups and downs. It is the strength of the family, the support of true friends and advice from colleagues that will help one to sail to the top. They are the true lifeboats in one’s professional career.
The full talk is available on YouTube with the keywords - Dr S Rajasekaran, Snakes and Ladders and Kini Memorial Oration.