The Culture of Excellence
I spent a week at the All India Institute of Medical Sciences (AIIMS), New Delhi. My cardiac situation needed an evaluation and thanks to my long-standing friendship with Dr M. Srinivas, Director, AIIMS, it was done. I am back in Hyderabad and sharing some nice memories of the Institute and the people who work there.
First and foremost, AIIMS is a center of excellence in Medical Science. Though I am an engineer, thanks to Dr APJ Abdul Kalam’s initiative in the 1990s to develop civilian spinoffs of Defence Technology, I got involved with doctors and medical technology rather intensively. We could develop a coronary stent by developing a special steel alloy in India.
This success was rewarded with a DRDO Award in 1997 given by Prime Minister Atal Bihari Vajpayee. More than the award, standing before the most handsome man I had ever met in my life was the biggest prize. Considering it my fountainhead in the organization, I resigned from DRDO thereafter and established Care Foundation with which I am still associated. We pioneered telemedicine using satellite even before broadband over the phone arrived and established the telemedicine link between Black Lion Hospital in Addis Ababa and Hyderabad in 2003 as part of the Pan-Africa e-Network sponsored by the Government of India.
Medicine has undergone a transformation in the last 20 years. The best in world healthcare is now available in India and many foreigners, including patients from Europe, come to India to get major operations done here at much lower costs and with great service. For a while, modern medicine was a rich-people affair but then, in the last few years, the Government went in for a system overhaul.
Medical colleges are being established with the goal of every major district of India having one. Today, there are 22 AIIMS and more than 65,000 post-graduation seats in medical education in 2023, which is more than double the number ten years ago. AIIMS Delhi is ranked the best medical college in India. Private sector hospitals have also flourished but they cater mostly to the rich and the affluent.
My problem is related to the heart. Atherosclerosis, narrowing of heart blood vessels due to cholesterol deposits, runs in my family. My father died when he was 49. My younger brother when he was 60. In 2004, when I was exactly my father’s age, I survived a cardiac arrest, for at the time of the mishap, I was already in the hospital, “working” there, and received immediate resuscitation. I had a bypass surgery.
Twelve years later, the bypass also got occluded. The atherosclerosis had spread over other vessels. In 2017, one nearly blocked artery was opened by rotablation, and with two stents the passage of blood was restored. Over the next five years, the disease has further progressed and blocked all three arteries in a diffused fashion. This time at AIIMS, a team of doctors under Prof. Rajiv Narang, evaluated my heart through various tests, including nuclear imaging, and fine-tuned my prescription. Dr Mohsin Raj Mantoo, a cardiologist hailing from Kashmir, visited me twice daily.
The week I spent at AIIMS has brought me in touch with a new reality – the culture of excellence. Though the hospital is overflowing with patients and there is no place to even walk in the corridors, the staff performs without losing their heads in a manner that exemplifies the stithpragya state that the Bhagavad Gita talks about. They do not succumb to high work pressure compounded by demanding patients and are steadfast in their work. All machines are the best of the line, fully functional, and manned by well-trained staff. There are 7 Echocardiography rooms and 5 Cath labs working like a factory – patients taken in, served, and replaced by new patients, almost immediately. There is no discrimination by status and no breaking the queue. No touts or agents, and the fairness of the system is appreciated by the crowd, who reciprocate with patience and courtesy.
The doctors trained at AIIMS as part of their post-graduate education, go out to work in other hospitals in the country, are amongst the best in their fields. The culture of super-specialty is evident in the way they go deep into their specialization and cross-exchange with their colleagues of other specialties. There are no arguments but healthy exchanges. The guru-shishya culture is evident and the seniors are well-respected, while juniors are well-trained. The nursing and technical staff are especially proficient, and I found them equipped with both professional and soft skills. Though there is paperwork, all data flows seamlessly across the hospital.
But the most impressive of what I saw was the use of mobile phones with free data, by the patients and their attendants. While waiting for their turns, they indulge in watching videos, with ear plugs. The security guard in the private ward, where I had a room, was using the mobile phone to prepare for his competitive exam, taking tutorials and using a slate to do the calculations.
Hot food is available at Rs. 20/- for a meal portion and a cup of tea or coffee costs Rs. 5/-. Expansive options are not given so that instead of the majority poor watching rich people enjoying better servings, rich people consume what the poor eat, for a change. There are well-kept pharmacy outlets, and one need not go out to buy medicines.
The truth, I realized from all this is that medicine is all about management. Whatever your malady – blood pressure, diabetes, narrowing of blood vessels, death of cells in the kidneys or liver, or wherever, and cancers – what doctors can do is to “manage”. There is no cure as such. However, as nanotechnology advances, this era of “managing” is ripe for a conclusion and in the next ten years, we will see some “cures.”
I was truly inspired by reading the theme of AIIMS – शरीरमाद्यं खलु धर्मसाधन, the body is the primary instrument to do right things – prominently written on the logo and displayed at every apron. Then, the two snakes around a rod are not the caduceus for healing but the lotus blooming at the top-end of the rod makes it the Sushumna Nadi, and the snakes are the Ida and Pingala Nadi crossing each other and reaching the Sahasrara Chakra – the lotus of 1000 petals, considered as the abode of cosmic consciousness.
A country becomes great due to its people and institutions. India is the most populous country in the world and its multitudes of poor, about a billion people, need medical assistance, affordable medicines, and proper food. The government of India, which is elected by these people is duty-bound to take care of them in the real sense of the word. AIIMS is a shining example of this great tradition and I wish that India has 47 AIIIMS by 2047 and that the medical insurance cover of Rs. 5 lakhs provided by the Pradhan Mantri Jan Arogya Scheme be increased to Rs. 10 lakhs right away.
After I was discharged, Dr Srinivas sent me off with a plant and a memento. It is easy to create good institutions by the well-intent government, but they only become great due to the people who work there. AIIMS is a marvelous example of New India – a great civilization ushering in a new era of prosperity and progress. Mr. Phamdom Lasti Singh, from Manipur, who was recuperating after his cardiac bypass surgery in the room adjacent to mine, felt the same way.
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Exceptional insight into a center of excellence in medical sciences, Prof Tiwariji !
Your message on making good institutions great serves as guideline to excel !!
Dear Sir, Hope you are feeling fit now!
Yes, AIIMS Delhi is a great institution in terms of medicine and treatment. It was my dream institution when I was preparing for the medical entrance test but could not make it as God had a different plan for me. Institutions like AIIMS and PGI Chandigarh provide world-class treatment at very reasonable cost and a great help to poor people in India. Millions of people get treated every year and cured.
Living in Sydney, when I compare the health care system of Australia with India, I feel India is best in terms of accessibility and affordability of treatment. Here in Australia there is infrastructure there is a long waiting queue for any type of surgical treatment and also the cost is very high, almost unaffordable for a common earning person. Consultation fees of GP is 10 times more than a SUPERSPECIALIST’s fee in India. Getting sick is a very big risk and cause of financial loss here, nobody wants to be sick therefore you will find people of age more than 70 yrs running every day to keep them healthy. In India, you can find easily a good doctor’s appointment near your house but here it’s a minimum of 2 days waiting, sometimes months for any eye or cardiac specialist.
India has a great future in health care and has capable minds in medicine and the right place to spend your retirement with family and the best medical care around you. I am also coming back to spend my retirement life, maybe after 20 years, or, even earlier. Warm Regards,
Nice to read your positive blog about AIIMS. We met Dr. M. Srinivas in Hyderabad several times from the Care Foundation side. He did a commendable job in mobilizing healthcare during COVID-19 times. He is a man of mission, and I am sure that he will make AIIMS, one of the best hospitals in the world.
I am sure it would not miss his keen eye that Artificial intelligence (AI) is rapidly transforming the healthcare industry in India, bringing unprecedented tools for diagnosis, treatment, and patient care. This area is too important to be left to the market forces.
AI expenditure in India is expected to reach $12 billion by 2025 and add $1 trillion to India’s economy by 2035, as per a World Economic Forum report. The AI in Healthcare Market is projected to grow from $15 Billion in 2023 to over $100 Billion by 2028. Look forward to AIIMS taking a lead in this important area.
Respected Sir, your blog about AIIMS has come like a fresh breeze. We are living in a very negative atmosphere. People habitually bash our institutions as if the private sector is doing a great service. The horror stories coming from corporate hospitals are never discussed but waiting time in government hospitals is always lamented. You have described the entire situation putting things in the right perspective.
I endorse every word you have written about AIIMS. Green philosopher Seneca famously said, “People pay the doctor for his trouble; for his kindness, they still remain in his debt.“ Thanks to Dr M Srinivas, Dr Rajiv Narang, Dr Mohsin, and the entire team for looking after you from all of us. Due to your immense faith in telemedicine, few years back you facilitated my meeting with Dr Srinivas when he was head of ESIC Hyderabad, to discuss implementation of Telemedicine technology . I was amazed to see his devotion and hard work for the better facilities to patients and making ESIC Hyderabad a world class facility.
You have sent a word not to be disturbed and that denied me a chance to visit you. Hope to see you soon and wish you very very healthy life.
Dear Sir, Thank you for a nice blog. I thought that it was impossible for the poor to get into AIIMS Delhi because Delhi houses complete whos who of Indian politics. I am quite happy to know that all are treated so well. Definitely, it must be the Centre of Excellence. The best of the brains get the admission and service will automatically be of that standard. Diabetes management is an issue, which needs attention. The non-invasive method is the most welcome method. During my discussion with one of the dialectologists at Hyderabad, I was told that one of the doctors at Nizam’s Institute has come out with a saliva-based test and the results are comparable. But the medical lobby is so strong that they would have killed the idea right there. The other could be the sustained release of insulin. This can go as long as one week or 15 days. This will also give a lot of relief to the patients who otherwise take 3 to 4 pricks a day. I am sure Indian Doctors have the ability and will to come out with wonderful solutions but the powerful lobbies have to be kept at bay for the larger good of the public. But I am sure, in spite of all these odds, solutions will emerge and people will benefit. Thank you once again, sir.
Sir, I wish AIIMS would take the lead in non-invasive blood sugar monitoring and end the era of pricking every time one must monitor the sugar levels. As the days of samples going to the lab are now over and prick-based invasive blood glucose detection technology is mainstream, convenient, and practical, starting the day with pricking in the morning, to know fasting blood sugar is unpleasant; it is time to go non-invasive. There are hand-held devices that send a laser through the finger and measure sugar in the blood by measuring the reflected frequency. What if I know my blood sugar level by holding a device and decide to skip the meal if it is already high, or eat something quickly if it is very low? I understand the resistance from the market forces, but an indomitable soul Dr M Srinivas can bring this change. Wish you a speedy recovery and championing this idea.
Dear Prof, Couldn’t be said better. The culture of excellence manifested in the team at AIIMS and rubbing across geographies. This blog is one I could pin on the notice boards of most of our healthcare establishments in my country. While we have a long way to go in uplifting our medical infrastructure, there is always an opportunity for practitioners to create an impact by selfless giving and proper management of whatever little there is, without fear or favor. No one interreacts with you and remains the same. Great that you are feeling better and whishing you many more years of quality life.
Sir, I have been coming to AIIMS as an attendee to my known patients for many years and have seen it from every aspect. There is no doubt that handling this magnitude of patient load, and the great VIP community in Delhi, who are always the most demanding, and even arrogant, is an impossible task without a robust system in place and people following that willingly.
The persona and energy of Dr. M. Srinivas are indeed divine. I am sure he will ensure the implementation of an ambitious Master Plan for the AIIMS rollout well in time. That would surely make AIIMS from the best In India to one of the best few hospitals in the world.
Great to read your blog on AIIMS. I have visited Dr. Srinivas, and he is indeed a great leader and of course an accomplished surgeon. As a nation, India is indeed blessed with great souls, who despite all the problems, our country has been having, in every phase of time, made the system work and the people served. Get well soon Sir. Your visit to Surat is long overdue.
Dear Sir, reading your blog made me feel like I was sitting in your class in 2008 when I was doing my MBA in Healthcare and Hospital Management. Later I did my doctorate and took up an academic career.
Undoubtedly culture of excellence is a truth. Since its inception, AIIMS Delhi has become an outstanding educational, research, and patient-care center. Institutions like the PGIMER Chandigarh, SGPGIMS, Lucknow, JIPMER, Pondicherry, and many other medical/allied sciences institutes and universities, have replicated AIIMS culture, and now serve as an excellent benchmark for all the other hospitals in the country.
We teach hospital management about patient care metrics, educational indices, rating scales, research (quality as well as quantity), number of research publications, foreign collaborations, complaints against HODs lying with the institutes, and infighting instances on record. Published papers, institutional records, and other materials should be accessed for the same – supplemented by qualitative research following the best methodologies. In whichever way, I analyze it. AIIMS is the best.
Get well soon Sir and keep writing.
Any article on your blog is always inspiring and motivates us in the right direction.
Doing research and helping people without succumbing to personal health problems is a true warrior mentality.
Thank you for reminding us about taking care of one’s health and how important is to have an efficient health system backing our needs.
The dimension of your thinking is what surprises me the most. Though I’ve spent only an hour or so with you, that one hour changed the way I see life now.
Thank you Sir for sharing your journey, and hope you are feeling better now.
Reading this blog, reminded me of our previous conversation we had about health conditions and how effective management is crucial. AIIMS is renowned for its outstanding education and patient care. I hope your visit to AIIMS was beneficial sir.
While it is encouraging, that AIIMS services are noteworthy, India still has a long way to go in providing quality, affordable healthcare services to all its citizens, essentially making healthcare a fundamental right.
Thanks so much Arunji for the story. Very interesting to learn the beautiful and impactful work done by AIIMS touching so many lives positively. Clearly last few years have seen decent rise in quality and efforts of governmental institutions. Covid vaccination program was another such shining example. And may this continue for good.
Also, hope you are doing better now. Best wishes!
Thanks from all of us are due to the AIIMS, the doctors, the equipment, the facilities, the government that funds and maintains it. Above all praise in the best form is due to the one character that stands out in what you had so explicitly described…. ‘dedication’ to serve selflessly …. government institute it is, we know their pay is far below the so-called ‘five-star’ hospitals.
My pranaams to that one character that has stood out …that of ‘dedication’. ISRO and its Scientists have also proved it, just a week back.
Sarve janah sukhinaa…..
Great story Arun ji. Thank you. I am happy you are back to normal.
Thank you for sharing the insights on your health, glad to know that you are under good care and of course the bright side of institutions like AIIMS, built by the hard work and dedication of people in it.
I never knew you went to AIIMS, New Delhi a week before. Feelings shared by you alongside your views on progress made on Medical Treatment is the real experience. When I was working in Delhi, sometimes went to AIIMS for consultation. Rightly said by you, it is at a different level than all other Medical Institutes must endeavor to reach. All Institutions are ultimately built by the people who work there. The words of appreciation in your write-up will boost their morale further to do more. Best Wishes for your Good Health.
Health care is a right, not a privilege. Your blog is an inspirational description of the way health care should be. I am glad your stay at AIIMS was pleasant and productive. India is a leader in many areas, including the production of generic medicines. It is a delightful irony that you have been able to benefit from the coronary stent that you developed!
Dear Prof
A beautiful story of excellence based on your own condition. Thank you!
Very happy to note that you got excellent care and that you are in a stable state. Best wishes!
Great dear. You are really great and brave. God bless.