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
‘Medical Oncologist and award winning author Dr Ranjana Srivastava talks about her books, writing and coming to India.’
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
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
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
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
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
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
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
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
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