Interview With Award-winning Author Dr Ranjana Srivastava

Dr. Ranjana Srivastava is a medical oncologist and an award-winning author. She has authored four books, stirring strong emotions from her readers with her poignant style of writing. She won the Human Rights Literature Prize for her book Dying for a Chat: The Communication Breakdown Between Doctors and Patients and was shortlisted for the NSW Premier’s Literary Prize for Tell Me The Truth: Conversations with my Patients about Life and Death. Her latest book So It’s Cancer, Now What? The Expert’s Guide to What You Need to Know provides a useful guide to dealing with cancer. A successful doctor based in Australia, Dr Ranjana writes about the emotional aspect of healthcare like the trauma of a refugee widowed mother who has been diagnosed with cancer and two very young children to care for. Her articles enjoy wide readership and she has written for The Guardian, Time, The Week, The New England Journal of Medicine and The Lancet. Dr Ranjana writes extensively about doctor-patient relationship and the art of Medicine.

She won the Cancer Council Victoria Arts Award for outstanding writing for her story ’Ode to a Patient’ in 2008 and Nossal Global Health Prize for writing in 2012.

A truly Global citizen, having studied in India, The United States, The United Kingdom and Australia, Dr Ranjana has the ideal balance of East and West. She won the Fulbright scholarship that took her from Bihar, where she grew up, to The University of Chicago, United States. She lives in Australia with her husband and three young children.

Here are excerpts of the interview with Dr Ranjana with Medindia.

Q). Have your patients influenced your writings and if so please give us a couple of examples?

I think it’s impossible to work as a clinician and not be deeply influenced by one’s patients. My first book, Tell me The Truth, is a collection of encounters from the bedside. My patients have impacted me in many ways: they have prompted me to keep learning the science of medicine but also to finesse the art. Patients want a doctor who is well-informed and whose knowledge they can trust, but also somebody they can trust with their thoughts, aspirations and fears.

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Q) Very little is said or written about personal stress and grief of doctors who are constantly in challenging clinical situation. How do you handle this personally and do you have any suggestions for your colleagues?

I think we all need to recognise the burden that doctors experience in caring for the chronically unwell, sick and dying. This is a stressful situation but like other skills in medicine, doctors can learn ways to find equanimity and perspective. Ultimately, medicine is a wonderful and rewarding vocation and it’s a privilege to be let into the lives of patients.

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I find catharsis in writing and also in maintaining relationships with a range of people, inside and outside of medicine. I am proud to still be in contact with some of my friends from primary school in Bihar - I met one this week and our children played together!

Many of my patients have advanced cancer and will die within a year or two of seeing me. It is always difficult to disclose the poor prognosis but patients have a right to know their prognosis and plan for their future. There is growing evidence that most patients are unaware of their prognosis, which leads them to seek aggressive, futile and highly expensive care towards the end of life.

The conversation about prognosis and mortality is always difficult and one that patients and oncologists would rather not have to deal with but the truth is that we have to.

Over the past decade I have experimented with different ways of disclosing information, made mistakes and learnt from my mistakes. But many patients are very grateful to know the truth because it helps them prepare for the future - and then, I am reminded of the vital importance of honest and empathetic conversations that tell the truth but still give people hope that they will not be abandoned.

Q) Doctors generally have very little time these days and the art of conversation with the patients is slowly dying? Your book ‘Dying for a Chat’ is on this subject, could you please tell us about the book and how the medical profession can overcome this challenge?

Dying for a Chat is about taking the time to talk to patients so we can ascertain their hopes and aspirations. Without agreeing on the goals of care, doctors can keep treating patients without meaningful gain. This small book discusses the unfortunate journey of one elderly patient and how her prolonged death could have been avoided through better conversations with her and those she loved.

To deal with this challenge, doctors need to consider such conversations an integral part of medical care and prepare for them with the same skill and knowledge that they would when performing a procedure. I try to keep in mind to treat the patient as I’d like to be treated myself.

Q) In your book ‘After Cancer: A Guide to Living Well’ you have elaborated about survivorship template for cancer patients, please tell us more about it?

Survival rates in cancer are rising - 2/3 of patients diagnosed with cancer today will be alive in 5 years.

Many cancer patients feel lost once they have finished treatment because they suddenly have less contact with their providers.

Patients suffer physical and emotional consequences that are not well recognised or adequately addressed - as a result, the trauma of a cancer diagnosis can last long after the cancer is said to have gone. After Cancer is a guide to help patients navigate the important aftermath of cancer treatment.

Q) You were educated in many countries including India, the United Kingdom, the United States and Australia, how has this influenced your life and shaped you as a person and as a writer?

I am grateful to have benefited from being a global citizen although to be honest, I didn’t really like moving so much when I was a child because I had to leave my friends behind.

But all the moves made me more resilient, more appreciative of difference, discrimination and also a wide world of opportunity. I now have friends and colleagues all over the world and my life feels enriched with perspective.

Q)You are a mother, wife, writer and a doctor how do you multi-task and do time management?

I am genuinely grateful to be in all these roles and I try to fulfil them to the best of my ability so that I don’t look back in too much regret.

Motherhood comes with endless guilt, regardless of what other things one does. A long time ago someone told me about the ’good enough’ mother - as in, I didn’t have to be perfect, just ’good enough’ because the kids would survive and probably do well if I didn’t obsess over every detail. This is probably true for many other things in life.

In my career, I obviously try to be the most complete doctor I can be but I recognize that I cannot know everything and never hesitate to seek advice - if it helps my patient, I am all for saying I need help.

As a writer and in the media, I seek to present myself with integrity. I ask myself two questions: will I be able to hold my head high in front of my colleagues and will my actions hurt my patients? If I am satisfied with these two answers, it seems safe to proceed.

I am not one to give advice to other women because I think we instinctively do what works for our circumstances. We do ourselves a disservice by always comparing our achievements and feeling like we come up short.

All of us present an edited version of ourselves to the public - and I don’t want anyone to think that I accomplish things single-handedly. I have a supportive husband, involved parents, good friends, healthy children and generally kind circumstances. Sure, hard work plays a role in any success but as I have grown older I have learnt to acknowledge the role of luck.

Q) Have you had ‘Eureka moments’ in your life and if so please tell us about them?

I think that my Fulbright year spent doing an ethics fellowship at the University of Chicago was a transformative year in my life. I spent a year unable to practice medicine with an Australian license but able to observe the interactions between other doctors and their patients, which in turn gave me food for thought as to what kind of doctor I’d like to be.

This is harder to think about when you are immersed in the job. That year I met doctor-writers who strengthened my resolve to write a book, something I had dreamt about for a long time. I was sceptical about my Fulbright year at the time but it took a decade to realise its enormous impact. Now, I am back in Chicago as a visiting faculty, teaching a course on the art of medicine.

I think the other momentous event in my life has been becoming a parent, something that has broadened my horizons and deepened my empathy. I think I am a better doctor and a more considered person for it although I would hasten to add that it is possible to be both without having children. But for me, children have added an unexpected dimension, for which I am grateful.

Q) Do you have links with India and would you like to work or do a sabbatical in India at some stage in your life if given an opportunity?

I have fond and strong connections with India. I have volunteered in India and would very much like to make a larger contribution. I hope to do this at the end of the year when I come to deliver a talk on the role of humanity in medicine.

About Dr Ranjana Srivastava - http://www.ranjanasrivastava.com/

Books Written by Dr Ranjana Srivastava - https://www.penguin.com.au/contributors/6347/dr-ranjana-srivastava

Source-Medindia