LOFTY AIIMS
A place that encourages you to think, challenges you to take on new problems and celebrates success
Ijoined the All India Institute of Medical Sciences or AIIMS as an undergraduate student in the summer of 1981. Having studied in the already rather competitive environment of a Delhi school—the first thing that hit me was that nearly everyone in a class of 50 students at AIIMS was a school “topper”! It really could not have got more intense than that—and I think that one of the key ingredients in making AIIMS an outstanding academic environment is some exceptionally smart kids spurring each other in their individual pursuits of professional excellence. While each of these students may have had a different approach in the way they set about preparing for a future as a healthcare professional—the common theme was their commitment to the cause and their ability to work exceptionally hard. AIIMS has a semester system for undergraduate education, with mid and end semester examinations, and end-posting clinical assessments being an integral part of a
continuing assessment process. Hence, there never was a time to take the foot off the accelerator, and the process of education continued unabated without any “down time” for knowledge or skill acquisition. This relentless work ethic got ingrained into our DNA—and I think has helped all of us become good doctors. When there is a sick individual you have to care for, you do not have the luxury of taking your eye off the ball; it is only your enduring commitment and unwavering focus that serve you and your patient well.
Needless to say, we were mentored by some real stars in the medical firmament. Several of our faculty were not only well regarded in the country, but were also internationally renowned, having contributed significantly to medical literature. It is always inspiring to find contributions from your teachers in the medical textbooks you are being taught from. These were people who had, with their exceptional clinical skills, identified problems, evaluated the factors contributing to their evolution and provided therapeutic solutions. In a recent exhibition we organised on the occasion of the
AIIMS Diamond Jubilee, we put together examples of the seminal contributions of the AIIMS faculty over the previous 60 years. A perusal of these exhibits made it evident that several of India’s key clinical and public health programmes stemmed from technical contributions from AIIMS—a matter of immense pride for all of us. This approach to the functioning of a medical institution has been passed down the generations—and is one of our core values.
Making the transition from a trainee doctor to a faculty member at AIIMS, I carried these core values along with me. The first thing one realises is that we are faced with a vast body of medical literature, and it is impossible to know everything! In the interest of our patients, it is imperative to challenge existing dogma, read and critically analyse current literature, and seek advice and guidance from those who are more skilled and experienced in specific domains! There is no shame in accepting one’s limitations—and work towards acquiring fresh knowledge to be put in use for the care of your patients. I believe that I have never held back in seeking and accepting advice from others—seniors, peers and even trainees—as long as it was logical, rational and backed by evidence. This is necessary for the incremental growth of a professional—and once I again believe that AIIMS has enabled and supported me as a faculty member to follow this path of maturing into a more seasoned healthcare professional.
The AIIMS trinity—patient care, education and research—has been the bulwark on which the institutional foundation is established. Each contributes to the development of the other— patient care is never dealt with in isolation. We learn from our experience in managing each patient to improve the care of subsequent patients. Clinical and public health observations on many occasion trigger a line of questioning which evolves into contextually relevant research—not merely to understand the contributors to disease, but also to find solutions for the problem—at individual and societal levels. The opportunity to interact with colleagues across disciplines, and utilise their skill sets and competencies to help address complex problems is once again a part of the AIIMS ethos. We understand that while individual brilliance is important, the cumulative consultative competence of a team combining their efforts to work towards a common goal is often what makes all the difference. The institution encourages you to think, challenges you to take on new problems and celebrates your success.
MY PLEA IS TO IMPLEMENT STRATEGIES FOR REFERRAL LINKAGES BETWEEN PRIMARY, SECONDARY AND TERTIARY HEALTHCARE FACILITIES TO BEST ALIGN PATIENT NEEDS WITH AVAILABLE HEALTH INFRASTRUCTURE IN GOVERNMENT FACILITIES
The public perception about AIIMS is driven by its contribution to patient care. Sometimes we forget that this excellence in patient care is combined with our track record in education and biomedical research. The very fact that this article is being written is because of our standing as India’s top institution for medical education. Independent bibliometric analysis has unequivocally demonstrated that AIIMS is India’s top institution for biomedical research. And a third set of “league tables” ranks us as the best institution for patient care. It is difficult enough to be at the top of the tables in one domain, but to do so, and that too consistently ever since these league tables were established, across all measured domains, is a sign of institutional strength and a testimony to the effort put in by several generations of faculty, students, researchers and staff. I think this multi-dimensional role for AIIMS needs more acknowledgement and recognition and also the necessary support—administrative and financial—to bolster its place as an institution of national importance and a beacon of hope for the millions of economically disadvantaged ailing individuals who throng its portals in the unflinching belief and hope that this is the place where they receive succour and a resolution of their medical problems. Hence, we need to make every effort to not only enhance patient care facilities in the narrow sense, but also strengthen resources for both education and research—because, together, these facets weave a complex thread to make the tapestry of patient care strong and scientifically appropriate.
As I close this piece, a personal observation about the way forward. I have seen over the years the immense pressures faced by all in their efforts to deliver their responsibilities—may it be patient care, teaching or research. The quantum of time and effort demanded by our patient care service clearly impinges on our ability to teach and research. But, even more importantly, there is to some extent a mismatch between the spectrum of patients attending AIIMS for treatment and the available skill set and infrastructure. To explain this further, at least the government health system has been designed to be multi-tiered—with primary, secondary and tertiary care institutions. AIIMS, by all definitions, was created as a referral tertiary care institution. However, a not insignificant proportion of patients attending the outpatient facilities at AIIMS suffer from ailments which can be easily and appropriately managed by colleagues in secondary care institutions. This also means that several individuals with more complex problems, which cannot be managed elsewhere due either to the limited availability of such facilities or the attendant costs in private health care institutions, are not being able to access the facilities at AIIMS. My plea would be to look at strategies to implement the referral linkages between primary, secondary and tertiary healthcare facilities such that we best align patient requirements with available health infrastructure in government healthcare facilities. This will help streamline patient care and also enable those with more complex health problems obtain the necessary treatment from tertiary care institutions such as AIIMS.
The AIIMS I have grown with is exemplified by three Es: Erudition (in medical knowledge and research), Excellence (in patient care and public health) and Empathy (for the ailing individual). I hope that we sustain our efforts in this regard and continue relentlessly on this wonderful journey called AIIMS.