As a practitioner of urology over the last about four decades, do you find that an increasing number of youth need surgical intervention? Your perspective on the trends in the field.

The modern youth are not even aware of the normal anatomy of their private parts. The prepuce or foreskin has to be retracted and washed with water (not soap) during bath. This is not practised for very many years. As a result, the smegma gets calcified and infection sets in making the foreskin unretractable or painful. Now a circumcision is advised.

Next is the undescended testis. Many of them are not aware that two testes have to be present in the scrotal sac. One may get retained intra-abdominally. This is cryptorchidism; and if neglected this can make detection in that testis of diseases (like cancer) difficult.

One other problem is of the ambiguous genitalia. The youth does not know whether ‘he’ is a boy or girl. The parents have reared their child as a boy and at probably 15-17 years it has been found he does not possess the essential male organs. He may have female predominance and his gender assessment has to be done and may need surgery also. These are a few instances.

How healthy is the urology care in rural India? What are the missing links in the delivery of rural healthcare (from the urology perspective)?

Urological problems are so many that they can be screened by the doctor in the primary health centre and advised to seek urological expertise in hospitals. The urological diagnostic lab or team cannot come to a rural setting all the time. All the equipments to diagnose cannot be moved everywhere. If surgery is necessary, again a battery of equipment along with technical personnel will have to be relocated.

Periodic educative camps and medicine distribution have not proved entirely successful. There have been instances when rural people, who had not been informed about the cost and importance of expensive tablets, were found to allow their children play with the same as if they were marbles (because of the various colours)!

Do we have the right insurance ‘products’ in the form of appropriate policies for patients?

I am sorry to say “no”. Insurance companies have products developed by non-medical people or their own doctors who are obedient servants to their companies. The facilities offered to the patient are printed in such minute form that it is cumbersome for the patient to read them first and then to understand the implied meaning. Insurance policies are good for sudden unnatural deaths. That the insurance company determines which hospital, days of hospital stay, etc., is of no medical relevance.

In your view, what can be the best practices relating to urology care that we can adopt from across the globe?

Within the few minutes the urologist spends checking the patient, he must instil confidence in the patient, come to a working diagnosis, order tests and convince the patient that he is in safe hands. Surgery must not be thrust upon the patient even if it is mandatory to alleviate the patient’s symptoms.

On the flipside, the patient armed with all knowledge (sometimes half-baked) from the urologist and the Internet goes ‘doctor shopping’ to confirm that his new-found knowledge is true or not. The patient sometimes misses the competent surgeon and ends up in the hands of the doctor who is going to open a Pandora’s Box of complications; suffering and litigation follows, eventually.

On the research happening in your field.

Research is a continuous process in urology. But still an inert catheter is not available to be kept inside our body sans complications. Though research is good, it is not financially helpful for the ‘worker’ in our county. Genuine research is time consuming and expensive. Who is to foot the bill? Research and innovation is the need of the hour. Which urologist will give up practice and do research?

Research done by non-urologist and introduced into the practice is like telling the patient that this drug will melt your prostate, dissolve all stones within your body without surgery. Patient believes this and confronts the urologist for a prescription of such a nonexistent drug instead of surgery which is the gold standard in many conditions.

The urologist ‘tries’ the new drug on the patient and publishes ‘exemplary’ results. The marketing goes on even after the urologist has moved on to another drug. Research is not like an apple falling on Newton’s head, which was discovery. Research has to find out how and why that apple fell down at that particular time.

Your views on the state of medical education in the country.

Medical education has picked up well now. Earlier the student would get a medical degree by any and many methods and also reaped the harvest of blunders when he became a consultant. Now the postgraduate is a married man with two children to support, where is the time to do research or go into the subject and understand. Gradual awareness is dawning nowadays that only hard work during their postgraduate days will be of moral support in practice.

Nowadays good teachers are a rarity. The so-called professors now are there by virtue of their ‘seniority’ or there are intelligent teachers who have time to read only foreign literature and grind it into the minds of the students, as we do not have genuine statistics of our own.

The postgraduate examines an Indian patient and prescribes a drug recommended by a foreigner (doctor). Today’s postgraduate is better than his teachers in many aspects, who can impart only practical experience but not theory.

In what ways do you suggest there can be betterment in the healthcare delivery provided by the Government?

Government is doing its level best to deliver good healthcare. But what can they do for a hospital which can handle 2,000 patients when 3,000-4,000 come for treatment. This is not like distributing sundal — when the crowd is more give less.

Healthcare cannot be compromised. The disease will not respond. The patient is not satisfied. In a country that ‘boasts’ of population explosion, family planning cannot be implemented successfully and it is unpalatable. People question the Government on their rights and do not wish to be asked about their contribution to society. For everything they want compensation.

National health insurance is the only answer. We ape the West in all aspects but have not taken a leaf out of their book in this aspect that has been practised there for years. No man is poor in India, he feigns poverty. Every service must have a fee, no freebies. Each citizen must be made to contribute to the healthcare he demands.

What was the motivation for you to become an urologist?

The motivation to become a urologist was my teacher, Prof. A. Venugopal. He started urology as a specialty from general surgery, first in the country at Government General Hospital (GH), Chennai. Higher specialty course (MCh) for urology was first started here in GH and the first Indian to adorn that degree was none other than Prof. C. Chinnaswami, who is a legend in urology today. The kind words of these two personalities, the training they imparted, the opportunities and the responsibilities given to me were the motivation. I just followed them like a lamb.