Holding hands by sharing experiences

Dr. Pankaj Singhai, MD in Palliative Medicine
(2014-2017)

Dr Pankaj Singhai is the In-charge of the Department of Palliative Medicine at Sri Aurobindo Institute of Medical Sciences, Indore. Dr Singhai is a past recipient of the Bruce David Gold Medal. He has also received grants from the International Association of Hospice and Palliative care (IAHPC), the Multi national Association for Supportive Care in Cancer (MASCC) and the TMC Research and Administrative Council (TRAC) Mumbai. Dr Singhai is also a national faculty of Indian Association of Palliative care.

What was your motivation to join MD in Palliative Medicine?

Honestly speaking, I didn’t have much idea about Palliative Medicine as a speciality until I appeared for the NEET PG counselling. I wanted to go for a clinical branch but I came to know about MD Palliative Medicine during the counselling period. My first meeting with Dr Naveen Salins gave me an insight to the future of this field. Palliative Medicine has a robust curriculum which includes vast clinical exposure in various fields of medicine which includes Critical Care, Neurology, Oncology, Nephrology, and Pain Medicine, and involves care delivery using a more humanistic approach to heal a patient with extensive suffering. The opportunities to learn from the best teachers in Palliative Medicine and being able to work in an Institute of Excellence were the other motivating factors which made me choose this field. 

Can you tell us about your journey in palliative medicine till date?

Sure, I joined the MD Palliative Medicine program at Tata Memorial Hospital, Mumbai in 2014. In contrast to all the other MD programs, I had a very supportive environment. Excellent academics, supportive faculty and seniors, a family of volunteers/ counsellors made my residency period very graceful. I had opportunities to attend international conferences, work alongside the pioneers in palliative medicine from across the country and beyond, and teach palliative medicine at national level. Immediately after completing my senior residency, I received several offers from the Government sector, the corporate sector and from private institutes. I decided to join the Manipal Academy of Higher Education, Udupi, as Assistant Professor, under the leadership of Dr Salins. We began the Department of Palliative Medicine there. While there, I also had the opportunity to work in Non-Cancer Palliative Medicine and particularly in Renal Palliative Care and ICU Palliative Care. We were the first private medical college in India to begin offering the MD Palliative Medicine course in India. I am now currently working as an Assistant Professor at Sri Aurobindo University, Indore, and am involved in developing palliative care services in Central India.

Were your expectations met and why so? And if not, why so?

In this short career till date, this field has helped me to evolve both personally and professionally. I learnt the art of communicating effectively, treating patients with empathy, leading multidisciplinary teams and ways of engaging with government and non-government organisations. This field provides me with good clinical work exposure, opportunities for international research and collaborations, opportunities to have publications and also become a reviewer for high impact journals, and undertake administrative roles in various capacities. The most satisfying among all for me is that, my team I are able to provide relief for our patients and their caregivers during one of their toughest times in their lives. I must say that I got much more than what I expected.

What is your perspective on the relevance and its future of specializing in palliative medicine in India?

Palliative Medicine in India is still developing. Newer sub specialities of Palliative Medicine like ICU Palliative care, Neuro Palliative care, Palliative care in organ failure, Geriatric Palliative care, Rehabilitations etc. has emerged in this decade. The National Medical Council has also identified Palliative Medicine as separate speciality and included it in the UG and PG program through competency based medical education. Almost all renowned medical colleges are now developing this speciality. Good corporate hospitals are also sourcing palliative care specialists to ensure the provisioning of good quality care and satisfaction for their patients. 

Who according to you should opt for pursuing Palliative Medicine as a speciality?

I strongly feel that not everyone can enjoy working in this specialty. This field requires a lot of patience, empathy, resilience and self-care. Physicians here can get affected due to witnessing huge amounts of suffering and the high death rates among our patients. Most Doctors in this field work for Institutes, while the scope in private practice/ clinics has not yet evolved much yet; the sources of income are therefore limited. As patient referral is based on the primary physicians, you need to develop good relations with your referring physicians. A lot also depends on institutional policies on palliative care. The community in general is not much aware about the concepts of Palliative care. Your colleagues may perceive you as counsellor or doctor for dying patients. Physicians in this field will definitely face these challenges while working in Palliative Medicine. However, for someone who feels a patients’ distress, loves to accepts challenges and is willing to work with a team, palliative medicine is a good career option. Dr Bruera in his book¹ wrote “Some physicians, while impressed with developments in the management of diseases, are more interested in the person who suffers from those diseases. How much physical, emotional and financial suffering are they experiencing? How can the physician alleviate this suffering? How can the physician support the patient’s significant others who are also suffering? Palliative care is probably the best career choice for these physicians.”

(1) “Some notes physicians contemplating a career in palliative and person-centred care” book by Dr Eduardo Bruera, MD Anderson Cancer Center, University of Texas, USA.

Dr. Nandan Choudhary, MD in Palliative Medicine
(2016-2019)

Dr Nandan is currently a Consultant, Palliative Medicine, Shija Hospital and Research Institute, Imphal.

What was your motivation to join MD in Palliative Medicine?

Truly speaking, I did not have any idea about this speciality until I saw it during the AIIMS counselling. The availability of this program at AIIMS New Delhi, caught my attention and I wanted to explore this new speciality. My friends and family also encouraged me to join this ‘new’ course. I still vividly remember the day I met Dr Sushma Bhatnagar. She not only inspired me in that very first meeting but also mentioned everything related to this specialty so perfectly. I then knew that I was in the right place and was very much motivated. 

Can you tell us about your journey in palliative medicine till date?

My journey in Palliative Medicine has been wonderful so far. I feel very blessed to have been trained by expert faculty from AIIMS, New Delhi. The knowledge I gained during my time there made me gain confidence in handling palliative patients. The faculty at AIIMS constantly motivated me to take part in Academics and Research, which gave me an edge over the residents from other specialties. I was lucky to have also been trained in various disciplines and in home care, which I now recognize in my current practice to be one of my most impressive learnings, as most of my patients require home based care. My work in palliative medicine, gives me a lot of satisfaction as I have the opportunity to care for patient who have complex symptoms.

Were your expectations met and why so? And if not, why so?

Palliative Medicine is a newer speciality and one can therefore expect some challenges that needs to be overcome. I always thought that it would be difficult to find a job that matched my requirements. I have however been lucky in this space as I had a smooth transition and was also able to start a Department of Palliative Medicine at my institute. I feel very satisfied when I see an improvement in the quality of life of my patients, who I have cared for.

What is your perspective on the relevance and its future of specializing in palliative medicine in India?

There is definitely increased demand for Palliative Medicine across India, as per my observations. Nearly every big institution is now looking to employ a Palliative Medicine Specialist for their institution, due to the increasing number of patients who are suffering and in need to such services. Having said that, I also feel that training in Palliative Medicine needs to further escalated as the number of seats allotted for specialist palliative medicine training in the country is currently insufficient to cater to the needs of our patients from across India. 

Who according to you should opt for pursuing Palliative Medicine as a speciality?

As per my opinion, any doctor with an intention of caring for chronically ill patients should enrol for this course. Contrary to the belief that palliative medicine is not entirely a clinical branch, in reality this field is purely a clinical branch, which provides training to care for patients holistically, and in different setups such as in Out-patient departments, In-patient wards, in home care settings, and also by way of hospital consultations.

Dr. Jyothsna Kuriakose, MD in Palliative Medicine
(2018-2021)

Dr Jyothsna is currently an Assistant Professor, Department of Palliative Medicine, Christian Medical College, Vellore, Tamil Nadu. She completed her MD in Palliative Medicine in 2021.

What was your motivation to join MD in Palliative Medicine?

Medicine has always intrigued me with its intricate art of diagnosis and the ever evolving treatment paradigms, which enables mankind to win over insatiable illnesses to live longer and better. However, somewhere between the lines of the voluminous textbooks, I sensed that in our conquest of the diseases, the ‘whole person’ experiencing the illness was being forgotten. That’s when I stumbled upon palliative medicine as a speciality.

My first encounter with this field was a three-day rotation as a part of the community medicine posting during my internship. That’s when I got a ‘glimpse’ of the blindingly intense suffering people with serious illnesses experience. I felt that working towards alleviating their suffering would be a rewarding experience. Needless to say, three years of training as a resident in palliative medicine has geared me to not only treat the sufferings which are associated with illnesses, but has also helped me master the art of treating the person within each patient.

Can you tell us about your journey in Palliative Medicine till date?

I joined the MD Palliative Medicine program at Tata Memorial Hospital, Mumbai in 2018. My initial days were tumultuous with the fears and uncertainties of having joined a new branch, having to deal with people caught in abysmal suffering, facing death, getting involved in serious illness conversations and also seized by stares from the corridors and wards as if you were “a death doctor”!!! However, an excellent academic cadre, ever-supportive mentors, seniors and colleagues working with teamwork as their credo and invigorating research opportunities helped me tide through the roller-coaster of residency with grit and grace. During my senior residency, I was privileged to organize a few workshops and was honoured to work as a national faculty in the field; one of the perks of being in a new branch! Currently, I am working as an Assistant Professor at Christian Medical College, Vellore and am involved in various academic, research and clinical activities in the field at a national level.

Were your expectations met and why so? and if not, why so?

Newer ramifications in medicine often spring up with it, the promises of opportunities and calls for pioneers to steer the branch forward through uncharted waters. Parented by excellent clinicians, opportunities were plethoric in this field: be it academic, clinical, or research. There were vast areas unexplored, mysteries yet to be solved and above all, there was the looming need to develop an evidence base in research in palliative medicine that is tailored to the needs of our own countrymen, as the very essence of the subject is the ‘person’.  Parallelly, a wave of sensitization had formed in the country and there was a spike in the demand for specialist palliative medicine physicians. This meant that we could easily procure jobs at teaching  hospitals and oncology centres immediately after finishing post-graduation, a boon that is seldom seen with other general specialities.

What is your perspective on the relevance of specializing in Palliative Medicine in India?

Article 21 of Indian constitution includes both the right to live with dignity and the right to die with dignity. India has consistently occupied rear positions in the global quality of death and dying index, and is only now leapfrogging its way forward in the last few decades. A uniform access to quality palliative care services is pivotal in ensuring dignity while experiencing an illness and dignity in death. The current national statistics paint a grim picture of this with only 4% of Indians having access to palliative care services. The need of the hour therefore is a well-trained and dedicated workforce who can strive to bring this service to every nook and corner of the country so that one day we can dream of provisioning a dignified life and death to every Indian who is faced with a serious illness. Additionally, most of the existing interventions in the field are built on research which is solely dependent on people from the developed world. The onus is on us, the younger palliative medicine specialists, to build a robust evidence base that is tailored to the needs of our fellow countrymen who have a unique and diverse sociocultural background when compared to the rest of the world.

What according to you is the future for palliative medicine specialists in India?

Today, palliative medicine plays a profound role in the care of most of the chronic life limiting illnesses. The need is so much so that experts in the field are envisioning the metamorphosis of the specialty into various sub-specialties such as oncology palliative care, neuro-palliative care, renal palliative care, cardiovascular palliative care, respiratory palliative care and so on. Within the field of oncology itself, we are witnessing the emergence of models of care which encompass both survivorship and palliative care. Increased recognition to the field has allowed for a basic training in palliative medicine in the current undergraduate MBBS curriculum. Given the rate and rhythm at which the field is evolving and expanding each day, the future seems to hold many vistas for those wishing to be the stewards in this arena.

Dr. Kikato V Chishi, MD in Palliative Medicine
(2019-2022)

Dr Kikato is currently a Senior Resident at the Homi Babha Cancer Hospital and Research Centre,Vizag.

What was your motivation to join MD in Palliative Medicine?

Before pursuing MD in palliative medicine, I was working as a medical officer in one of the cancer hospitals in my State, Nagaland. While there, I was exposed to numerous cancer patients. This bothered me as I was witness to many painful situations in their journey, particularly to those advanced cancer patients who suffered helplessly without the presence of a  trained palliative care physician to satisfactorily manage their distressing physical symptoms. On one instance, I  encountered a situation where a physician gave no option to a suffering and advanced cancer patient, but to leave for home with no hope and to suffer their final moments at their home, amidst all the painful experience. Then one day, I was introduced to palliative care in one of the CME’s and it immediately caught my attention. The fact that is dealt with these suffering patients and helped make a difference to them was my primary motivation to choose this subject. This is how I ventured into palliative care.

Can you tell us about your journey in Palliative Medicine till date?

My journey in the field of palliative medicine has given me a package of unexpected satisfaction. As a physician, the primary factor for us is about disease directed treatment and other clinical subjects. However, in palliative care I derive so much joy due to the holistic approach of palliative medicine. My journey till date has shown me how residents are provided with peculiar experiences of not only treating OPD and IPD patients but also care for patients at  their homes and in hospices, which eventually broadens all aspects of knowledge and exposure in this field. The home care experience gave me another level of job satisfaction as a physician, since I got to experience the delight of being there for my patients who could not come to the hospital for treatment. Providing home care for these patients and their distressed family members/caregivers brings me so much peace knowing that our efforts can bring so much comfort and solace to these individuals who are not only suffering physically but also psycho-socially and spiritually. The ability to provide holistic care to a patient and the entire family to me, is something remarkable and extraordinary.

Were your expectations met and why so? and if not, why so?

During my earlier years of learning I experienced mixed emotions as I felt that some expectations are met while others were not met. Now however my job satisfaction is definitely as expected, as I am quite satisfied with how I am progressing in this field and how this subject has broadened the understanding of my patients as a whole. As a physician however, certain expectations are yet to be met, as this is an emerging subject where opportunities are relatively less when compared to other subjects. The limitations in oppurtunties I refer to include: the limited availability of services across the country which restricts our choice to work in preferred areas, the reduced awareness or acceptance of Pallaitive care services, the limited opportunities in corporate hospitals, and the challenges in setting up one’s own clinic.

What is your perspective on the relevance of specializing in Palliative Medicine in India?

The incidence and prevelance of cancer patients is rapidly increasing in India. With increased awareness and understanding of this subject, its significance, its impact in improving the quality of life of those in need of such services, I feel that there is scope for tremendous opportunities in the country.

Who according to you should opt for pursuing Palliative Medicine as a speciality?

Palliative medicine is a unique subject in comparison to others and it is therefore very important to be exposed to this field prior to joining this specialization. I feel that this course is relevant for those individuals who are brave to walk the journey with those patients who are suffering from life-limiting conditions. It is therefore imperative for individuals to be aware of the following before pursuing palliative medicine as a specialty: ability to keep an open mind, be ethical, be compassionate and have the willingness to work even when it is inconvenient.

Dr. Prathibha Jha, DNB in Palliative Medicine
(2021-Ongoing)

Dr Pratibha is a second year DNB student at the Sir Ganga Ram Hospital (SGRH), New Delhi. Her hobbies include Cooking, Mediation and Yoga.

What was your motivation to join DNB in Palliative Medicine?

The biggest motivator which pushed me to join DNB in palliative medicine was the perfect alignment of my thoughts to the ethos of palliative care. My school of thought revolves around the concept of life and the quality of life, which is what palliative care is all about. I realized that in palliative medicine, I have the opportunity to play an active role in improving a person’s quality of life, holistically. This entails not only effective symptom control but also involves providing meaningful psychological and spiritual support, which I believe truly allows someone to be themselves at a difficult time.

Can you tell us about your journey in Palliative Medicine till date?

During my journey here, I realized that the faculty at my institute are recognized to be some of the best in the country, for palliative care. Despite the Department still being in its nascent days, I feel that we have a huge potential to be a differentiator. Being a student of the first batch at SGRH, I have the dual advantage of learning to overcome several challenges while I also have innumerable opportunities to accelerate my learning in palliative medicine.

Were your expectations met and why so? and if not, why so?

I have just begun this journey and I have a lot to explore and experience. My endeavor is to give myself enough chance to achieve my expectations. As of now, I am happy with what I have been seeing and doing.

What is your perspective on the relevance of specializing in Palliative Medicine in India?

India is a vast country with a huge population. Improvements in medical technology and facilities are definitely improving the standard of life of our patients. Despite this, improving a patient’s quality of life, holistically, is still a big challenge. Considering these factors, specializing in palliative medicine will have a huge relevance. This specialization will provide DNB trainees like me, a wide exposure to different social-medico conditions; an experience which is priceless as it immensely broadens our perspective.

What according to you is the future for palliative medicine specialists in India?

I feel that palliative medicine as a field in India is currently largely untapped, and that the future will present a lot of potential. To tap into and harness this huge potential I feel that we must first work towards improving our infrastructure (no. of trained professionals, palliative care beds, no. of hospices etc.). We must also actively engage in advocating with the Government of India to increase spending on health care, design and implement end of life care policies, work towards improving the availability of narcotics, improve the community’s awareness about palliative care and its philosophy, network with the handful of palliative medicine specialists currently available in India etc. I also feel that there is scope for palliative medicine specialists to venture beyond urban areas and deliver care at grassroot levels. My opinion therefore is that there is a huge opportunity for palliative care trained professionals in the country.

Dr. Arjun M Pillai, DNB in Palliative Medicine
(2022-Ongoing)

Dr Arjun is a second year DNB student at the MNJ Institute of Oncology and Regional Cancer Center, Hyderabad.

What was your motivation to join DNB in Palliative Medicine?

Before joining the DNB programme, I had the good fortune of working in palliative care with Pallium India (which in itself was a fortuitous event) for almost 2years. Those 2 years were a huge learning experience for me and it changed my perspective regarding healthcare and the role of healthcare professionals. I enjoyed this experience a lot and it was also helped by the good support team that I had. So, when an opportunity arose for me to pursue DNB in Palliative Medicine, I decided to follow my heart.

Can you tell us about your journey in Palliative Medicine till date?

Exciting. Eventful. Enlightening.

Were your expectations met and why so? and if not, why so?

My prior experience in palliative care was limited to adults. But after joining the DNB program, this experience has given me a different insight into the role of palliative care. I learnt about the role of Pediatric Palliative Care, and role of palliative care especially for non-cancer conditions. I was able to understand the various models of delivering palliative care, the role of the primary oncology team and the coordination needed between the different disciplines of the oncology team to provide better care and improve the quality of life of our patients.

I have also been fortunate enough to be part of a good palliative care team here.

What is your perspective on the relevance of specializing in Palliative Medicine in India?

Palliative Medicine is still considered to be an upcoming specialty and a growing branch. Even though there has been a vast advancement and growth in this field, the need for palliative care and access to essential pain medications is still limited in our country. As Palliative Medicine specialists, we have a huge role to play in addressing this need and in working towards closing the gap for effective delivery of palliative care services.

What according to you is the future for palliative medicine specialists in India?

Healthcare providers are now aware of palliative care and its role and importance in providing comprehensive care to patients. I sense that there is a growing interest in palliative medicine in our country and that the future for palliative medicine therefore appears to be bright. This positive trend shows that there are ample opportunities to work in the field, both in India and also abroad.