Interview with Dr. Arunava Dhar

Dr. Dhar trained in medicine and pediatrics in India. He then moved to the UK and completed his senior clinical fellowship in Neonatology from Cambridge University Hospital NHS Foundation Trust and CCT ( Certificate of Completion of Training ) in general pediatrics with a Special interest in Neonatology from East of England Deanery. Now, he works as a consultant pediatrician and neonatologist in the NHS. He has co-founded MedicToUK and a multiple award-winning project called LocANTS.

How long have you been a doctor for?

I graduated in the year 2000, so it has been 24 years.

How long was your residency?

I am partially trained in India. The residency over there was for 3 years and then I came to the UK. In the UK, as I had done partial training in India, I didn't need to start training in the UK from the beginning - which was 8 years of paediatric training. I'm a paediatrician and on top of that, my specialty is neonatal intensive care so I was an intern and resident for 4 years. All together, it was a mixture of east and west residency of 7 years, 3 years back home and 4 years here.

What would you say you like the most about your job as a doctor / as a paediatrician?

What I would say is the job satisfaction. From what you learn in your medical school and from when you are in the hospital, you can see two things: number one is when the babies and kids get well, they themselves respond in the way that you wish to see. The second is the celestial happiness that you see in the parents’ faces. When they come, normally we see them in a state of real stress because every kid is precious to their parents. I have worked in the neonatal intensive and paediatric intensive care unit so I have seen really sick patients, sick babies and sick kids, they are just hanging on the road between life and death. So when you can change the outcome, then you can see a real happiness on the face of the parents. There is also a beautiful interaction with the kids, you can see how far they have come since the beginning of the process.

What do you find the most challenging about being a doctor?

First of all I would say that it is not a challenge but you have to accept the fact that you have to be hard working. There is no shortcut to becoming a good doctor the reason being is: first of all, you have to read if you do not read in your early days then you will have to read later on - there is no escape route without reading, without acquiring the knowledge you can't get to a point where you can treat the patients in a confident way, whatever stream it is. 

The second thing is experience in the practical sense: if it is like some hands-on skill related to your stream, say for example for the surgical specialty you will need to learn it. Even for the medical specialties, there are procedures we have to learn. Neonatal care becomes very hands-on, for example when achieving central access, so you need to learn those skills to perform well in a really stressful situation. There is no chance of experimentation when you become a doctor whom the patients rely on. You will always work under stress because it's a question of human life, there is no second chance. I would say that you have to mould yourself, you have to reorient your life in a way that gives priority to the patients. In the early days of your career, it will be through knowledge, by acquiring skills and knowledge from the seniors. Later on in your career you have to think in a way that you can support your patient in the best possible way. There will be, there must be some conflicts with your priorities in life with your profession so you have to have a good balance. I would say that is the challenge that you have to handle throughout your career if you want to be a good doctor.

Since you've experienced both the UK and India's healthcare system, have you noticed any difference in the two systems?

Yes, I would say there are lots of differences and I learned from both the systems. I definitely learned a lot from India to work under a certain pressure caused by the population density and the resource allocation in my country back home. For example, I had to see a large number of patients within a specific time period. In places like India, you have to be very fast, skilful in terms of the ability to manage patients, and you have to go through stressful situations where you have to apply your knowledge straightaway without having time to think too much. That is the way I learned to be confident and experienced. 

But when I came to the UK, I learned 2 other things that I would say are very important. I learned how to communicate, how to speak with the parents. When you are treating a patient, as a doctor you tend to think that you only have to treat the patient, but it's not like that. You have to communicate what you are doing to the parents: how you are going to treat the patient, how far you are expecting them to be well, and what the timeline will be. It's the whole family's concern. It's not only treating the sickness, it’s how you're handling and informing the families. In the neonatal unit nowadays we engage parents in discussions and we also allow them to feed the patients, they can participate in the early developmental care even if the patients are very unwell.

The second thing is evidence based medicine. In the East, we have as I said a very strong and bold knowledge base but still, there are some barriers. Some seniors may think that because they are seniors, they know a lot and they are always right. However when I came to the UK, I've seen that even senior doctors in prestigious institutes like at Cambridge, where a lot of my training in the UK was, they know that they have good knowledge, but there is always a lot to know further. There are a lot of people working in different places of the globe, writing up their findings. This is called evidence based medicine as it is using treatment based on evidence, and I have found that that is what is best for the patients.

I would say that I learned from both places but as complementary learning so if someone is trained in the eastern part of the globe and then comes to the western part of the globe, that would make them complete. That is my personal opinion.

When applying to university, what made you decide to do medicine?

For me, when I decided, in India the rule over there was that if you are scoring good marks in your schools then you will be automatically going towards two streams. At that time it was medicine and engineering so that way between these two, I chose medicine. As I said from the beginning, I was thinking of job satisfaction, I wanted to love my job so that I could stick to my choice, otherwise what would have happened was that my job would just be a mode of earning. I'm not criticising but between those two, I thought that medicine would give me the opportunity to reflect on learning whatever I learned during my student days. I also find another satisfaction when I see that someone is doing well after seven days of journey treating acutely, or in a clinic over the period of six months or a year, knowing that you have done something that has given a good outcome for a patient.

Why did you decide to become a paediatrician?

I found that you can not only cure a baby or a kid, but you also cure a whole family. That was one of the inspirations for me to come to paediatrics. If you can help children or babies that are very unwell, then what will happen is the whole family will experience happiness. I also always enjoy when I see my patients become well and before they go, they share some nice words and it's a really nice thing. I love kids and so I love treating them as well.

Could you tell me more about the projects you have co-founded?

Before coming to the project, I need to mention a little bit of background. So while I was doing my training in England, one of my mentors told me that I should think about developing my skills. So I entered one of the business schools here, the Cambridge Judge Business School to learn tools and language of management. With that knowledge, I would say a new domain opened in front of my eyes and from there I made a team with a friend who is a consultant at Google. We started thinking about different innovations which are related to healthcare delivery and healthcare education. 

One of my projects is MedicToUK. It was at the time of Covid, the lockdown period. Everything was closed, only the hospitals were running. One day I was coming home from the hospital driving back and naturally, the only car on the whole street was mine. Suddenly, the fact that all exams were closed came to mind. So then I called my friend from the car about the idea I had in mind, something to do with a virtual learning system for clinical students. I started with paediatrics, the MRCPCH, which is the clinical membership exam for paediatrics and we thought that we could start coaching students for the clinical part of the MRCPCH exam. After a few months of starting, the Royal College itself, launched the clinical exam virtually (without having patients), and at the time we became the pioneers of that concept. We were really fortunate that we got different advice and suggestions from the Royal College. We broke the boundaries because with that system, we could train people who were not within the UK. 

Covid is over now, but we are still continuing that initiative but at the same time, we started what we call the hybrid model. So one day, we are teaching that way, where you don't need the patient, and the next day, we are in the hospital with a real patient and we teach the specific clinical examination skills. I'm trying to take it towards the other part of the globe. I've started talking to people in India, Malaysia, even my friends in Singapore, Dubai.

Find out more about Dr. Dhar’s second project LocANTS:

LocANTS

MedicToUK

Is there anything you wish you would've known at my age or do you have any advice for people in my situation?

I would not say advice, I think of anybody who wants to become a doctor as my future colleagues because that's the way I like to think. The only thing is that there is no shortcut of hardship, if you want to choose to become a doctor, you will definitely get job satisfaction throughout your life. I can vouch for that, but make sure that it is what you really want. If it is not what you want, then you will end up having lots of dissatisfaction if you come to the speciality. If you love to have job satisfaction, if you want to make some changes in your job through your knowledge, through your skills that you develop throughout your career, then it’s the place you should be. There is no shortcut, that much I can tell you.