Be Bold! Life and Lessons from my Grandfather 

My Grandfather, K.R. Chandrasekhar (whom I, like many of South Indian descent, called Tata, meaning Grandfather, pronounced ‘Tha Tha”)  was born a few years after World War 1 in July of 1922, in what was at that time part of British India.  World War 1 saw many things happen in India from the early independence movement as well as many as 1.5 million Indians being drafted and 75,000 giving the ultimate sacrifice with their lives defending the British Empire against the Central Powers. Understanding the time that he was born, is instrumental in getting an idea of what India was like then. From his humble roots in a little village, about 40 miles north east of the present day town of Bengaluru (aka Bangalore) of the then Kingdom of Mysore, to his days in insurance sales from the 1950s  onwards around the country, his was a life of hard work and sacrifice that he never let me forget. He went to different people’s houses to eat every other day and had a tough life until he was a young teen. Getting the ability to study, changed his life. A good education has been ingrained in every Indian parent’s life from as long as I can remember. That’s how, from close to poverty, he went to St. Joseph’s College in Bangalore and married my Grandmother in 1942. My Mother was born soon after in 1944 and another son, born later that decade, sadly passed away due to a medical error by the late 1940s.

My Grandparents went on to have 2 other children; two sons, my uncles in the early 1950s and that was his family after that. The story of how Tata ended up going into accounting versus engineering is an interesting one.

It was late 1930s and he was cycling down a road in Bangalore called JC Road on his way to pay his college fees to go to engineering school as it was the last day to pay. In the distance, a car was driving towards him. Thinking the driver would avoid him as he got closer, Tata continued cycling. He then realized that the driver (an Englishman who it later turned out was the Commissioner of Police who was drunk after an afternoon of heavy drinking) was swerving left and right and hit and ran over Tata. My Grandfather told me he remembered the wheels of the  car on either side of him as he went down and his bicycle getting crushed. The driver, realizing what had just occurred, stopped, got down and proceeded to get Tata into the car and rushed him to Victoria Hospital; where he paid his hospital bill in advance and left the scene (not wanting to be around due to his position). There my Grandfather lay for 3 days unconscious. On the 4th day he opened his eyes and his brother, who had walked from their village north east of Bangalore was sitting in front of him and said “We were wondering where you were. I searched everywhere and someone said that you had been admitted here so I came. Looks like you are ok, so I’m off!” and he left to go back to their village.

My Grandparents and their young family in the 1950s

In any case, Tata was now in a dilemma. Colleges had closed payment of fees for engineering and he was at risk of missing a year when someone told him that there was still a college in the next kingdom that was available and they had not closed admissions or payment. The only problem was that it wasn’t in Engineering, but a Bachelor of Arts in Economics. My Grandfather thought “Well, one degree is as good as another!” and off he went to start his Bachelor of Arts degree instead of an engineering degree!

From there, he came to Bangalore after one term and ended up getting a seat at St. Joseph’s College. After completing his Bachelor’s of  Arts in Economics, he was interviewed by the local commander of the British garrison to be an auditor for their Bangalore region during WW2; the Commandant didn’t need a person with a degree even though Tata had one “As long as you understand book keeping, that’s all I need”. Landing the job, he then set out to audit the some of the billions of pound that India sent in war material and treasure to the British homeland and the war effort to defend and fight against Hitler and the Nazis (he also mentioned that because he was able to go on the base, people would ask him to get them whiskey and brandy as it was subsidized for the military and he could come back with cases of liquor to share with relatives and friends, something he told me with amusement some years ago).

After World War 2 ended and his work with the military was complete, he briefly got into the restaurant business, but at that time, caste and community played a big role in Indian life as he was chided for being a “brahmin” starting in the restaurant business and that too with the education that he had received, was apparently supposed to do more with his life than just being a ‘lowly’ restauranteur. Unhappy with the criticism of his entrepreneurial pursuits, he left that business in the late 40s and was able to go into life insurance sales with the then Oriental Insurance.  This was his calling and he was as passionate about his job (as I think I am for my work in healthcare) and spoke endlessly about it years after his retirement.

The coolest Uncles a boy could have

In the late 1950s, my Grandfather enrolled my uncles in a boarding school around the ages of 7 or 8. (I speculate) Tata did not want their lives to be disrupted whenever he had a new assignment (though he lived 15 to 20 minutes away from them the first few years they were there) and was posted to a new position. My surviving Uncle shared with me that it felt like being put in jail by my Grandfather, but he’s gone on to be a senior executive of a few companies and I credit Tata for giving him a good foundation for much of his success and harnessing his natural talents, even though my Uncle may think otherwise ( after his undergraduate degree, Tata told him that he had called his accountant friend in Bangalore and my uncle will go work for him as an article clerk in his accounting practice; saying no to my Grandfather was not an option).

My parents soon after their they got married

I find it interesting that Tata kept my Mother with him and not in boarding school like his other two children, two sons to live a very disciplined, boarding school life also gives us insight into the sacrifice of not having his two boys with him by his side during their formative years, especially since he had already lost one son in his life by then. Later in life, he relied on his youngest son more than anyone else after losing his older son to kidney disease in the early 2000s.

My parents were married in the late 1960s. Both of my sets of grandparents knew each other and as was the custom, it was an arranged marriage within our community; a “Ashtagrama”  or “8 villages” community. One of the biggest responsibilities for fathers of daughters in those days was to make sure that he got them married into good families. Both of my grandparents were of good reputation and it was in this light that my mother’s father was able to fulfill one of his life’s obligations. My Uncles were married in quick succession some 8 years later.

Tata and I

He retired as the Divisional Manager for the Southern Region of the Life Insurance Corporation of India in 1985. After my own father passed away when I was a teenager, my Grandfather took us in 1987. Two years after he had retired, he had to take on a new set of responsibilities of his daughter and her two children who had never lived in India, didn’t know the language and customs and were emotionally disconnected from the loss of their well set lives overseas.

He had a never give up attitude. He instilled in me a sense of loyalty to family, reminded me that he came from poverty and he had worked hard to get to where he was. He gave my mother the confidence she needed to get through life without her husband and gave us all inspiration with his stories of the 1920s, 1930s and much of the 20th Century (one story he narrated was about how he was chased by a monkey in the temple town of Tirupathi in the 1920s. When I asked him how he was able to remember an event from the 1920s, his reply was simply; “If you were chased by a monkey, you’d never forget!”)

Persistence and the ability to endure was a hallmark he had. Having lost a child (a son) at a young age of 1 or 2 in the late 1940s, a son in law 31 years ago and then another son a decade ago, many would have grieved and wallowed in their plight. Not my Grandfather. Having faced difficulties throughout his life (he nearly drowned in a well, fallen out from trees numerous times at a very young age and could have left this world on a number of occasions in his youth) his continuous attitude of “Be Bold!” was something that I have continued to carry with me when I need it the most.

In June of 2016, my Grandfather suffered a heart attack and was an inpatient on a ventilator for 21 days in Bangalore. At some point, he could not stay on the ventilator indefinitely and his physicians said that when they took it out and he had trouble breathing, he would need a tracheotomy . After consulting with my family, the doctors were ready to perform the surgery the moment they removed the ventilator. My Grandfather, not one to go that easily and having practiced yoga for 70 years of his life, immediately started the “pranayama” breathing techniques in yoga that he had been practicing most of his life. He slowly began breathing on his own. The doctors were amazed at his endurance and at that age! No medicines, no technology. It was all him! He came home a few days after and when he got on the phone with me, he excitedly exclaimed to me”94, NOT OUT!” At the age of 94, he was still around as my Tata!

He was disciplined with all of his accounting and remembered his bank account numbers until the very end of his life (I’m lucky if I remember what happened yesterday!) The way he kept all of his documents was an amazement to all and he was a excellent document manager.

Prior to leaving to the United States for graduate school for my MBA in the mid 1990s, I had to go and ask my future father in law for my girlfriend’s (now wife’s) hand in marriage. I remember being with my Grandfather before I drove across town and sensing my nervousness he came up to me and said ” Be Bold!” Two words he would speak often to all of us.

While this blog post details his life more than anything else and departs from my discussion of healthcare, as an amateur historian and a grandson to an amazing man such as my Grandfather, I felt it both a privilege and duty of mine to share some of his story with my family, friends and readers of my blog. Hopefully you enjoyed reading this snippet of his life story as much as I have had in writing it.

My Grandfather was 3 months and two weeks shy of his 95th birthday and 6 weeks shy of his 75th wedding anniversary when he breathed his last during the early hours of March 27th, 2017. After a, many would say, full life of 4 children, 6 grandchildren and 6 great-grandchildren, he finally left us. Even in death, Tata wanted to make a difference. Ever the practical man he was and not one to go by convention or tradition, his was the first I’ve ever heard of a person in my family donating his body to science, something that he had apparently wanted to do since 1980, but wrote as his last wishes in December of 2015. Making a lasting impact on medical students to learn from him even a year after he left this world. That’s why I loved him so much. My Grandfather, K.R. Chandrasekhar was simply put, the best of all of us.

 

 

Omaha, Omaha, Yay Putin?

As always, the opinions expressed here are mine and nobody else’s. 

What a wild ride this year has been so far. As my son and I watched the Broncos -Panthers game, it dawned on me that I’ll never hear the famous words from the just retired Peyton Manning anymore. The young next generation QB on the Broncos team though didn’t do too badly though and seemed to keep his cool as he faced the Panthers and end up getting the better of them in the end. Flipping to the wacky Presidential election we’re going through, apparently Vladimir Putin is the new standard of excellence in leadership. 
I always look at our nation’s Declaration of Independence and focus on the words “We the people ” in the Constitution therafter, in the 18th century, those were indeed revolutionary words to even think about,  let alone write as a declaration. 

In our world we need to think ever more about empathy and healthcare as never before. Working at Healthcare Providers for some time now, I see the need for a better more efficient and effective way to care for people and believe truly that a combination of collaborative project management, appropriate resource allocation and technology that enhances patient care and safety has the ability to transform patient care in a positive way. 

I’ve also seen of late, the return of racist elements I’m society that were previously kept at bay which disappoints me greatly. 

Stay focused on the real substance of the world, the care and empathy that we all should have to better understand the human connection that makes us live a more harmonious existence. 

If you’re reading this blog post, just look around you and realize all of the good that is in your life and appreciate the ability to be able to give more of yourself for causes such as better patient care through information technology. 

Go get ’em!

Laughter: Healthcare’s Best Medicine – Behavioral Health and the loss of an Icon

LaughterSome months ago, I wrote about the role of happiness in our lives and the role it plays. Robin Williams played an important role for over 30 years in making the world a happier place. Sadly, he did not feel that he found that himself with his untimely passing last week, which shocked the world.

The role of mental health has taken a huge step into the limelight due to his passing. The closest I got to that was when I worked at a Neurology Clinic some years ago and saw the important work that was being done there by an interesting (pink haired) head of department who was an extremely empathetic person.

The disease, often stigmatized, has now been thrust front and center into a world that may not be ready for it, but we need to be. The need for behavioral health services are grave, from school shootings to celebrity suicides. The “Great Recession” also brought forth many losses, especially for people who lost their homes, their retirement savings and their former occupations and had to start from scratch.  A recent article (in US News – Health) after Mr. William’s death, said that according to WHO estimates, about 350 million people worldwide suffer from depression, which is a staggering number, and I suspect, rising. With the number of veterans coming back from two wars over the last dozen years and the toll it has taken on themselves, the atrocities that they have seen on the battlefield and the loss of a “normal” family life, the need for mental health facilities in our nation has been greater than it has ever been. The need for access and infrastructure for these facilities, trained mental health care providers and the appropriate infrastructure and support mechanisms for follow up or continuous access (do I see a role for mHealth in this?) and continuity of care for patients who travel across geographies make our role as healthcare IT professionals even more important than ever before.

For healthcare providers and individuals engaged in projects to re-mediate applications covering the behavioral health ecosystem, the American Psychiatric Association, in 2013, updated the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (aka DSM-5) which will impact clinical diagnosis, billing, contracts, compliance and more in the psychiatric world in terms of treatment recommendations as it is often determined by their DSM classifications. The need for up to date systems, continuity of care and relevant policies and protocols cannot come soon enough. Sadly, we have seen the effects of a system that hasn’t saved enough of our fellow Americans. All lives are precious and the loss of even one to the effects of depression is a sad event.

So, I ask you, after reading this, to find an old video of Robin Williams in one of his indelible roles; whether as a seemingly helpful Scottish Nanny to his children, an animated Genie from a lamp or, in his break out role as the lovable, yet quirky alien from Ork, watch it and remember an icon has passed and we are all the better for him being a part of our lives for as long as he was.

Thank you Robin Williams for the joy you gave us. You will be missed.

Physicians are people too…right?

When it comes to working with physicians,  we’ve seen their involvement in this healthcare technology world at opposite ends of the spectrum.

The younger,  more technologically savvier physicians who have been used to technology from the early 80s to now, seem to somewhat adapt to using EMRs. They are characterized by their comfort with all things digital and their disdain for a paper process and being eco-friendly. While this isn’t always the case, this is mostly attributed to younger, 45/50 and under physicians.

The older,  more experienced physicians who have been around practicing for 3 decades or more have generally been extremely resistant to the current change and have at times,  even retired rather than continue to use EMRs on the grounds that it takes away from their focus on the patient, which can make for an good debate. I’ve also heard that some of the older physicians don’t feel like they need to be “engaged with their patients” as “the way they have been practicing medicine all these years is fine”. Millennial physicians,  early to mid 30s take to technology as if they were born with it. As digital natives,  they have the ability to be the most productive and efficient when it comes to EMR usage.

Also, their has been a divide when it comes to adoption by small and large practices. Smaller practices have had to think about how they can deal with the process of purchasing EMR capabilities and this has not always been easy. During a project in California, we studied how we can get pediatricians to refer patients to the hospital I was working at and how to make sure the referral process was smooth for them; whether it was directly from their PC and their own EMR system or if they needed to login to a portal with their credentials and how it would then go to the correct clinic at the specialty pediatric facility I was working at the time.

For anyone in the care delivery IT arena, this is old news, but really needed to be said. The question is whether if the digital divide has an impact on the quality of your care and if this trend continues, will we lose our senior, experienced physicians to Meaningful Use?

According to an article out by USA Today (dated 6/30/2014), the United States is expected to need 52,000 more primary care physicians by the year 2025 based on research by the Robert Graham Center and funding for teaching hospitals expires in the latter part of 2015. Due to the Affordable Care Act, the need for family physicians to 8000. As a nation, we cannot afford to lose these experienced physicians at a juncture when more physicians are required than ever before.

Thought Leadership – Empathy’s involvement in Patient Engagement

 

Earlier this year, I had introduced you to “lifestyle philosopher” and Oxford University Professor, Roman Krznaric and his work on empathy’s role in our world today. He has released a new animation which is an amazing video that is part of this post. Hopefully, it is as insightful for you as it was for me. I interviewed Roman on some of his thoughts about empathy and it’s role in healthcare as well as other areas that were relevant to our world today. Here, below is that interview.

Roman, thanks for your time to answer some of my questions. How did you get involved with the concept of empathy?
I used to be an academic teaching and researching political science. But about a dozen years ago I had an intellectual awakening when I came to realize that societies and politics didn’t simply change through new laws, institutions and policies but through changes in the way people treated each other at the individual level, especially through empathy. I define empathy as the art of stepping imaginatively into the shoes of another person, understanding the feelings and perspectives, and using that understanding to guide your actions. It’s a fundamental skill that almost all of us have, but we rarely fulfill our empathic potential, or work hard enough to harness the power of empathy to create social transformation. 
How do you think that empathy can help healthcare, both there in Britain and here in the US, where healthcare is a very politically charged topic?
It’s interesting to me that the origins of public healthcare in Britain can be traced back to an important empathic shift during the Second World War. Over a million children were evacuated from big cities to rural foster homes to escape the German bombs. And one of the unintended results was that relatively well-off rural folk suddenly had relatively poor city children thrust into their homes, and they could see the extremes of urban poverty with their own eyes: it was a moment of empathic understanding and awakening. There was huge public outcry and the government took immediate action, improving public health care for children, giving free meals in schools, vitamin supplements and other health care. This mass meeting of strangers was, in effect, the beginnings of the British welfare state – and it happened right in the middle of the war when resources were extremely scarce. There is a lesson here: that empathy sensitizes us to health care inequalities, and can spur social and political action to alleviate it.
Of course, healthcare reform is a very politically charged topic in the US, since it is so closely associated with the Obama administration. It was also Obama who started talking about America’s ’empathy deficit’ in the lead up to the 2008 Presidential Election. The American right then started critiquing the concept of empathy because of its links to Obama. Despite all this political complexity, I think empathy remains essential to the issue of healthcare. Why? The historical evidence points to the fact that empathy opens the door of our moral concern for neglected or marginalized social groups, and laws, rights and public policy wedge that door open, helping to universalize that moral concern. Healthcare, like other key areas of public policy, is one where we should be shining the light of empathy, trying to understand how different parts of society experience the public health system (or lack of it), and equally how they are impacted by the structure of private health care. It is only through empathising that we gather enough evidence, from enough points of views of different citizens, to design truly effective and socially just health care systems. Otherwise good healthcare becomes the privilege of a few, rather than the right of the many. 
The US is undergoing a sort of renaissance in healthcare information and technology. What do you see as the role of empathy in this area (more usage of smartphones, tablets and laptops vs. human interaction)?
 
One way to think about this issue is to look at the new wave of ’empathy skills training’ for doctors that has become popular in the last few years. Doctors are often criticized for being too clinical and emotionally detached from their patients. In 2010, doctors at a Boston hospital took part in an empathy skills program in which they were advised to pay greater attention to the changing expressions on their patients’ faces (for instance whether they showed anger, contempt, fear or sadness), to take note of voice modulations, and to make simple changes such as facing the patient rather than their computer screens during a consultation. After just three one-hour training sessions, doctors who went through the program showed vastly improved empathy levels. Their patients said these doctors made them feel more at ease, showed greater care and compassion towards them, and had a better understanding of their concerns. The doctors too could see the benefits. After spending a day putting the program’s methods into practice, one hospital doctor reported that while it was initially difficult to empathize with the patient while simultaneously making her diagnosis, eventually it ‘became fun’ and embodied the kind of personal interaction that had initially drawn her into medicine.
Now, what does this tell us? It would seem to suggest that it is person-to-person interaction that patients are after more than anything, and that this is the key to bringing more empathy into the sphere of healthcare. All the technology in the world doesn’t substitute for having a real human being treat you, look you in the eye, and hear your personal story.
 
That might make me sound pessimistic about the possible role that technology might play in empathic healthcare. Yet I also believe that if we get smart about using technology, it can help bring about an empathy revolution in healthcare. OK, almost everyone would rather have the doctor look at them rather than at their computer screen during a consultation. Yet just imagine if basic video technologies like Skype became a standard way for your doctor to visit you in your home to give post-treatment or post-operation check ups and advice. We need to learn to bring a little more intimacy into the way we use technology, especially social networks.
 
Do you foresee any upcoming empathy deficits?
 
The evidence is pretty clear that the US in a period of long-term empathy decline. A well-known study (Scientific American, December 23rd, 2010) revealed that US empathy levels are down nearly 50% in the last 40 years, with the steepest decline occurring in the past decade. So the empathy deficit is growing. At the same time we see rising levels of narcissism – around 1 in 10 Americans now exhibit narcissistic personality traits. There is also growing evidence that social networking technologies are exacerbating narcissism and contributing to empathy decline. There is a question about whether these trends are going to continue. I’m glad to say that there is a growing movement trying to address these problems by teaching empathy in schools. The most effective program, called Roots of Empathy, began in Canada and has now reached over half a million children worldwide.
 
Will we see more of these animations in the future? I think it is a great tool to get your message  across in a simple, entertaining and informative way.
My animation about empathy, The Power of Outrospection (produced by the Royal Society of the Arts in London) makes the case that empathy can be a powerful tool for social change. It’s fascinating how popular the animation form has become – this particular one has had over half a million views – and is evidence of the shift towards visual learning. I think we need to tap into our multiple intelligences when communicating ideas. For some people books are the most powerful, for others it will be animations, blogs or going to talk with a real live human being! Personally I plan to pursue all these communication routes in the future, including the animations – luckily for the world someone else does the drawing, since my drawing skills are in need of serious work!
Thanks for your time on this interview. Hopefully we see a much more empathetic world as we move forward in the 21st Century.
RomanKrznaricRoman Krznaric, PhD, is a writer on empathy and social change based in the UK. His latest book is Empathy: A Handbook for Revolution (to be published in the US by Penguin in November 2014). He advizes organizations including Oxfam and the United Nations on using empathy as a tool for social transformation and public policy. He is a founding faculty member of The School of Life, and founder of the world’s first digital Empathy Library. Website: www.romankrznaric.com Twitter: @romankrznaric