A few weeks ago, I met with a prestigious orthopedic surgeon who practices in Rajkot, India. He has studied all over the world, including the UK, the USA, and South Korea. He is a teacher and a continuous academic, constantly striving to improve his knowledge about his field. I was very happy and honored to conduct this interview with Dr. Ketan Shah of Prabhukrupa Hospital.
I really wanted to examine his thoughts on the differences between Western and Eastern medicine, but before we dove into that, I was able to learn more about Dr. Shah’s life. I hope you enjoy reading this interview as much as I enjoyed talking with him!
Where did you go to school?
I did my undergrad from Karamsad, which is in Gujarat, and then I did my masters in orthopedics, so that is called MS, so masters in orthopedic surgery from the same medical school. Then I did my superspecialization, which is the diploma of national boards, so I became a diplomat in the field of orthopedics, which I did it from Pune.
I took my fellowship from different places across the globe for my knee replacement, so that I precisely did from 2000 to somewhere around 2003 – 2005, wherein primarily I got myself trained in Germany, where I was for a very long time. That was a long term fellowship, I stayed there for about a year or so.
I did some short-term fellowships across Singapore and then again back in 2006 I went to Australia, wherein I did my fellowship and training for revision knee replacements. (Revision knee replacements are when a previous knee replacement fails, so a doctor goes in to try to fix the botched replacement).
Why did you become a doctor?
I always wanted to be a doctor, I don’t know why, but I think that’s what my parents say, that the first thing that I started saying was that I want to become a doctor. I don’t know, but there should be some influence as far as the family was concerned, because you know both my parents are doctors and my grandfather was a doctor, grandfather on both sides, my paternal grandfather and my maternal grandfather, both of them were doctors. Maybe that would have had some influence over me, but I’m not very sure.
Right from day one, I wanted to be a doctor gradually as I started growing up and started visiting my parents’ hospital and the discussions that used to happen back home. You get a chance to save somebody’s life and more than that, you start getting a chance to make some difference to somebody’s family. Things like that made me all the more inclined towards taking that (step). After I did my undergrad, I did my first residence in General Surgery. One of my teachers showed me the brighter side of orthopedics and I precisely came to orthopedics because one of the points was that they come crippled and they go back home walking. So that was so very satisfying overall, that you make a huge difference in somebody’s life.
(For example), we used to have a lot of poly-trauma patients, road traffic accidents and stuff like that.
They would have many fractures and things like that. You know, if they are not well fixed, their entire life would get ruined. Somebody who is 20 years old, and if they have some fracture and then it is left out with a deformity, they are crippled for the rest of their life.
So orthopedics was a satisfying kind of a field wherein you feel that completeness of giving a good quality life. Then when the time came to select some subspecialty, I selected joint replacements. Again, precisely because joint pain, so as to say arthritis, is typically a crippling kind of a disease and it is going to affect a geriatric population. So, you know, here we start seeing a lot of people suffering from arthritis being neglected because they can’t walk, they are not self-sufficient, they are not self-reliant. So gradually over a period of time, they have to be dependent on somebody and that is so very traumatic. Putting yourself into four walls, you know. So that was again one of the points why I started doing joint replacements. The aim was to make them independent, give them a good quality of life, so, if not anything, they are self-sufficient. (They aren’t) dependent for the silliest of the things on somebody else.
So that was probably why practically I chose medical school.
Thank you! You have already answered this question somewhat, but … What is your branch of medicine and what does it entail?
My parent branch is orthopedics and my subspecialization is called arthroplasty, which is the medical terminology for joint replacements. So, I deal with joint problems, which essentially would require joint replacements.
You said you enjoyed orthopedics because patients come crippled and go back walking. Is there anything you want to add?
No, as I said, maybe that sense of gratification that you can make a small difference in somebody’s life.
Many times, saving somebody’s life is so very satisfying, but at the same time, every coin has two sides. So at times we see things going the other way around as well. And you know, those situations coming to somebody else’s life is beyond anybody’s scope of control. Making an effort to bring them out from it is something which we can do, and that is, like I said, truly satisfying.
So that’s one of the things which I’d always liked is that it is still a greatly noble kind of a (position).
People give us that dharaja, dharaja is status, status of somebody like, you know, godly kind, which I don’t really feel that and truly believe that we don’t deserve it. Doing all these joint replacements for all these long years, and recently, we studied our own data, we are now coming close to somewhere around 10,000 odd surgeries. So there’s a big number. So gradually, you know, you start to think that you take away nature’s joints, we take it off and then we fit in a part there. And at the end of the day, it has to match God’s joints. You know, we don’t have God, but we have to do it properly. So we can’t get the dharaja of God, but from the point of view of function, work and all that, we have to match to those standards of what has been eternally gifted to us. So there are a lot of challenges as well.
How would you consider your practices different from Western practices, if at all?
Yes, definitely there is a lot of difference and I would rate practice in this part of the world, especially if not anything else, practice as of now in India, any day better than any place across the globe. I visit the US very frequently. I am on their editorial board at HSS, Hospital for Special Surgery. But I would feel, any day, we are absolute on the scales of excellence, we are probably 10 on 10.
I don’t say that somebody is 7 on 10. But why I would say we are 10 on 10 is the exposure.
The amount of cases that we are subjected to in this big country, this big population, is probably triple.
(I will paraphrase the next part to aid in understanding and speed).
When I was in the US last month, I talked to a doctor about a new type of surgery they were trying in the US. He had only done it 2-3 times, and he had a long list of materials needed, and the surgery took a long time. I looked at the list and told him that I could do 10 surgeries with the items on the list. I’d done the surgery many times before, in less time, with less resources.
(The anecdote ends here.)
In India, patients come to us when they are on their last legs of life. When I was studying, the number of patients that we would see in a day was around 150 patients. For them, that was a month of work. I would see a difference as far as the clinical judgment is concerned, the surgical skills are concerned. I would surely undoubtedly say that we are far superior. As far as the technology is concerned, as far as the infrastructure is concerned, as far as the inventory is concerned, undoubtedly they are superior. That part of the world is far ahead in the amount of operation kits, the hospital infrastructure, the inventory so as to say, the instruments and equipment and all that stuff.
Would you say that in surgical skill, India is superior because there is so much exposure?
Absolutely, I would say. Because we are exposed from day one to the amount of cases, the variety of cases, and I would always feel that the limitations of resources made us powerful. Before you are entering your OR, before you are entering your operation theater, you know that you have limited resources. It is not going to be like, in the middle of the surgery if I ask for this kind of instrument, I am not going to get it.
So, before I start the case, I know that I have to finish this case with this many implants, inventory, so on and so forth.
I travel a lot in the territory to do cases. Now, the only time that I would come to know how the patient is doing is when I have already reached, say for example, Gondal or for example, Wankaner, wherein the patient would be taken to the operation theater.
So, you are going back there and that’s the first time that you are going to see that patient and back in your heart, you will feel, oh my God, what is this? He needs so much done, and I don’t have the instruments I need. So, from there, I need to deliver a world class result. With limited resources, you know that you have to play with only these three things and that’s it. So, maybe that over a period of time sharpens your skills.
A final point is people down here are forgiving. So, that is again one of the points why we clinically started getting a lot better. I have been traveling to the US for the last 10 years and I have been to almost all the big names and big centers across the US. Those people, I don’t know, are always afraid of getting sued. You know the people here are very forgiving, they forgive us. That made us good at the end of the day. Maybe we can take it both ways, but then obviously it is a blessing that people are forgiving here.
If something goes wrong, or some complications happen, people would come and say to us that you gave it your best and it is our fate. Which never happens in the US. It’s like you know anything that they want to do, any extra step that they feel that it is necessary, they will not do it. Going anything beyond their destined route is just not possible. Here, we have a lot of luxury to change our decisions, make calls mid-operation, and we don’t have to inform anybody. There, if you have to change your plan in between the surgery, you have to take so many approvals.