[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I'm very excited to be speaking to Mr. Kavyansh Bhan. I will clarify here that he goes by Mr. because he is training in the United Kingdom, and in the United Kingdom, when you're a surgeon, you're actually titled Mr. or Ms. rather than Dr. So you actually lose that title of doctor as you advance, interestingly. So anyway, Dr. / Mr. Kavyansh Bahn is training in Orthopaedic Surgery at Bart's Hospital in London. He recently wrote a review article on the relationship of emotional intelligence and good medical practice, and that's why he's on today. I will put a link to that article in the show notes. Welcome to Kavy.
[00:00:44] Kavy Bhan: Thank you very much. It's actually a pleasure to be on this.
[00:00:47] Christine Ko: Thank you. Would you share a personal anecdote?
[00:00:51] Kavy Bhan: I had thought that I would tell you why we go from doctors to misters. Once you advance, you actually drop the title doctor and you become a mister. The reason of doing that is because almost 3- 400 years ago, doctors were only physicians. All the surgeons were actually people who did not have a medical degree. They used to train under barbers and under a royal college guild, and they never had formal education. It was more of an apprenticeship, and they were always people from a non medical background. Over time, these surgeons realized that all this while they have been degraded by being called misters, they will use it as a badge of honor. And now everyone wants, as soon as they become a member of the Royal College, as soon as they become an advanced trainee in the surgery, they just drop the title doctor.
[00:01:40] Christine Ko: Interesting. Can you talk about how you came to study emotional intelligence and the practice of medicine?
[00:01:47] Kavy Bhan: Yes. So it was also quite a journey, actually. When we were in medical school or when we were during our clinical rotations, I have felt that some people just connect with patients in a much better way as compared to the others. And this is something that led me to think that there must be a quantifiable way, or there must be something that is setting people apart. And that's when I started Googling, stumbled upon emotional intelligence. You say like a thousand times a day, Oh yes, this guy's intelligent. Oh yes. The emotional aspect is playing a role. But you never actually connect them together. You never connect the dots and you always think of them as separate entities, whereas emotional intelligence actually affects each aspect of your life as well as your personal life.
[00:02:36] Christine Ko: Okay. And so you started that once you had moved to the UK? Yes.
[00:02:41] Kavy Bhan: Only a few months after we moved to the UK, and before the cases would start, you have to go and speak with the patient, make sure everything is okay. Consent over here in the UK, it's a two way process. You sit down with the patient, you're telling everything to the patient, and the patient can actually question you. It sounds like a very normal thing for people who are practicing in the West, but probably someone who's coming from other countries in Southeast Asia or South Asia, it's not very common for the patients to ask; the patients very rarely question you. You just go there and you tell them this is the surgery you need. Very rarely there's a two way conversation. When I have these two way conversations, it always gets me thinking, Oh, is the patient going to ask me this? Oh, can the patient actually think about all this? And it's this feeling that you develop over time that you need to actually train yourself to keep yourself in the patient's position and then understand as to what they are going to say, what questions they might have, what questions they might ask.
[00:03:42] Christine Ko: Yeah, I agree with you. I feel like I also, much later than you, started to understand that the patient, when they first get a diagnosis of skin cancer, might be really shocked and upset. And after having, a thousand plus conversations like, you have a skin cancer, I should be able to predict how a patient might react, what their questions might be, etc. Every patient's different, but for the patient, it's a completely new experience. Instead of being callous to it, I realized I can say, okay, this is a new experience because this is the patient. This is a different patient than every single one before, and then channel all of those prior experiences to try to make that experience of hearing this news the best possible for that patient. I realized that I can do that instead of just being like, yeah, you have a skin cancer.
[00:04:32] Kavy Bhan: Exactly. Like with a fracture. I still remember in my initial days of residency, I would be like, Oh, the patient must be in so much pain. Oh, the patient has such a swollen leg, but with time, it was just like, Oh yeah, this will improve with time. Don't worry about it. But if you put yourself as a patient, it's very hard to not worry about it.
[00:04:52] Christine Ko: Yes, exactly. Can you give an example of how you apply emotional intelligence as a skill in your work life or daily life?
[00:05:01] Kavy Bhan: Yes. Basically the literature recognizes two distinct definitions of emotional intelligence. There's one group of researchers who believe that it is an inherent quality within an individual's character. And the other goes by thinking that it's actually an ability and a skill that one can train and that one can improve with time. As a skill, emotional intelligence is something that will require extensive training, not only of you, but I believe within the medical curriculum, so that it is something which is not only left for the doctor or the clinician to train themselves on their own, but something that needs guidance, something that needs an input from people who have a knowledge about it.
[00:05:52] So as a skill, you need to understand that many times you will be in situations wherein you need to understand when to approach a patient with the serious news or when to approach a patient with something to calm him down. There will be many instances like when you're breaking bad news to the patient and you just do not know the exact moment when you need to tell him that. So many patients will be anxious; so many patients will be with a flat face They won't have any expression whatsoever. And that's the most worrying bit because you cannot read what a patient is going through. With those kind of emotions, it becomes very difficult. So what I have learned, or what I have found throughout my practice is, you need to understand what the patient is going through and then time breaking the news with his emotions. You cannot break news to a patient who has just walked in, who seems very happy, who's oblivious to whatever is going on.
[00:06:51] You need to comfort him, make him sit down, spend those extra five minutes with him, discuss what he knows about the situation, what he's aware about the situation, what are the potential complications, et cetera, et cetera. And then actually give him the information.
[00:07:07] Christine Ko: Yeah. Yes. That's very wise. It's hard, though, because time is the limiting factor, right? To be able to really take that time and feel that you have that time to take. Do you have tips on how to do that?
[00:07:25] Kavy Bhan: That is something even I'm navigating myself. The problem is... Nowadays, we are so constrained by time. I'm not aware about most of the other countries, but in the NHS, you probably have a five minute window for a follow up patient. And most of the patients who need longer discussions are not the patients on the first visit. They are the ones who are following up. They are the ones who want to follow up with the results. They are the ones who have been under your care for a long time, waiting investigations and all of those things. So the actual art, what I have found is that after the initial two to three minutes with the patient, they become much more comfortable speaking with you. And that is probably the time when you want to lay bare anything that you want to inform the patient about. The main thing is, as soon as the patient comes through the door, the first thing to say is, okay, we are here to catch up on your reports. I have read your reports. This is this is probably not the way to do it.
[00:08:23] Christine Ko: Yes. It's like a little bit of small talk. I don't like small talk. I don't think I'm good at it.
[00:08:29] Kavy Bhan: But I think it makes a big difference.
[00:08:31] Christine Ko: Yes, it makes a big difference. I agree with that. Have you had healthcare interactions that are good or bad that have taught you?
[00:08:39] Kavy Bhan: Yes, actually, I have had interactions with patients which have actually shaped the way I conduct my consultations now. So what I have changed is when I was a more junior trainee I used to be more focused on the clinical aspect of the consultation. I would start looking at the patient's note. Mrs. B, 53 year old, she has a right hip fracture. My consultation would be, Everything is okay. X ray looks good. Send home. My consultation wouldn't be that it's Mrs. A who is a 53 year old lady who works as a chemist or who works as a barista. And she has been struggling with this.
[00:09:20] So that is something which I have now changed quite a bit. So always what I do is when patients come in, have small talk, make them sit down, and actually show them their X rays, their progress and be, what do you think about it? So do you think it's improving? What is your reaction or how are your feelings about this? Because on the X rays, everything looks good, but many times patients are not happy. And that aspect is completely missed if you do not take the time out to speak with the patient. I see most of the total knee replacements, the patients are not happy if the surgeons have not spoken with them long enough. And there is actually published research which shows that if the orthopedic surgeon has not engaged with the patient long enough, their outcomes or the patient reported outcome measures might actually be worse off.
[00:10:14] Christine Ko: Yes. What you just said is really important. Patients want time, and for some reason there's a positive outcome associated with that time. What do you think is essential for everyone in health care to know about emotional intelligence after you've written this nice article?
[00:10:34] Kavy Bhan: Emotional intelligence of every person can actually make or break them. So the idea of motivation -an individual being motivated to develop emotional intelligence as a skill. It's something which takes time, and it is something which needs a lot of training. The main thing is self awareness, that is, a doctor should always be aware of his own limitations. He should always be aware about what he knows, what he does not. It's not only about the clinical acumen and the clinical knowledge, but it is about your own self awareness. The other thing is the team effort. You might be very good in total knee replacements, but there's always that point where you need some help. Medicine is not just a one man show. The feeling or the thinking of, I know it all, should never be there, especially in orthopedics, it should not be there. It's a multidisciplinary thing. Everyone should be aware of their limitations, when to call the boss in, when a patient can be referred to a certain speciality.
[00:11:40] Christine Ko: Do you have any final thoughts?
[00:11:42] Kavy Bhan: The key component of a clinician's daily practice will involve multiple aspects that are heavily affected by emotional intelligence. Like I said, the teamwork, the communication, both with patients, with colleagues, building that trust with patients and the overall clinical performance of an individual clinician, all of this is affected by emotional intelligence.
[00:12:05] So as a clinician, you need to recognize that emotional intelligence impacts all of these key domains of your practice, and you need to take steps basically to be self aware, to be able to read up on all of this, to train yourself and help yourself to become a better clinician.
[00:12:26] Christine Ko: Yes. Thank you. Thank you so much.
[00:12:29] Kavy Bhan: Thank you. Thank you so much.
