Jasbina Ahluwalia interviews Dr. Rajeev Fernando.
A few of the topics Dr. Rajeev Fernando addresses in this interview are:
- (13:49) CHIRAJ is a Charity for Women’s Empowerment
- (15:28) How did COVID Start in China?
- (18:58) Why are Masks Important to Prevent COVID-19?
- (24:13) What Parts of the World are Infectious Disease Doctors Most Concerned about Regarding COVID as Winter Approaches?
- (25:57) What Areas in the US are Infectious Disease Doctors Most Concerned about Regarding COVID as Winter Approaches?
- (28:13) How are COVID Practices and Attitudes Different from an Infectious Disease Doctor’s Perspective in Texas and New York?
- (31:43) How does the Will to Live Affect Survival Rates in COVID?
- (34:40) Favorite Patient Battling COVID Survivor Story from Infectious Disease Doctor
- (37:38) Why are Female Doctors more Prone to Physician Burnout?
- (41:18) How should Physicians Choose a Medical Specialty?
- (43:32) Self-care Tips for Physicians Battling COVID from Infectious Disease Doctor
- (47:41) Predictions about Telemedicine for Physicians from an Infectious Disease Physician
- (53:56) An Indian Male Physician’s Perspective on why more Female Physicians than Male Physicians Prefer Physician Spouses
- (01:07:31) Why does an Indian Male Physician think lots of Relationships Happen in the Hospital?
- (01:09:10) How can you get Free Masks for COVID from Anywhere in the World if you Can’t Afford Them?
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CHIRAJ is a Charity for Women’s Empowerment
Jasbina:
(13:49) I’m very excited to welcome to today’s show, Dr. Rajeev Fernando. Dr. Fernando has been recognized as one of “America’s Top Doctors in New York” for the specialty of Infectious Disease since 2014. He formally works with Doctors Without Borders and runs a charity on behalf of his parents called CHIRAJ, the goal of which is women’s empowerment. CHIRAJ has responded to the pandemic by donating masks globally via it’s impactful #MaskUpEarth campaign. It’s a pleasure to have you, Dr. Fernando. Welcome.
Dr. Rajeev Fernando:
(14:23) Thank you so much for having me, Jasbina. And that was a very generous introduction, probably something I don’t deserve, but thank you very much for having me.
Jasbina:
(14:32) It’s a pleasure to have you. And let’s start with, tell us about CHIRAJ. Which initiative has it spearheaded throughout the years? Women’s empowerment is a lofty goal and I’d love to hear some of the different initiatives.
Dr. Rajeev Fernando:
(14:47) Sure. CHIRAJ is, like you mentioned before, the name comes from my parents, Chitra and Raj. So it’s called CHIRAJ. Essentially, it’s an organization I founded myself. So I’m the CEO, I’m also the person who sends out the mail, things like that. It’s really a one-man project, which has now evolved to three. But it’s a project, it’s self-funded, I do a lot of overtime to keep the project going. And, like you said, it’s really to empower women around the world. And that’s what my focus is.
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How did COVID Start in China?
Jasbina:
(15:28) Wonderful. Well, let’s switch gears to the pandemic. And I understand that you went to China, January 2019. Actually, if I think back to January 2019, my gosh, like night and day from the world today. And so, that was before the pandemic really took off, actually, before we realized what it was going to become. And so I’d love to hear you tell us about that.
What was it like being on the ground in China in January?
Dr. Rajeev Fernando:
(15:56) As an infectious disease doctor, of course, we’re all nerds. We read a lot to see what’s going on. But what I usually like to do is really, I read a lot but I also like to go down to the ground myself and investigate and give my own thoughts to what I think is really going on over here. Of course, I feel a picture is worth 1000 words. So when I heard about this outbreak that was happening end of December, I realized that something big was going to happen in January. So I decided to go down.
This respiratory illness, which is really coming from a wet market, for our listeners to define what a wet market is, is really a market which has animals, which are things like bats, civet cats, all kinds of mixes. And the interesting thing is, all these animals are put into one cage. So you’re seeing bats, snakes, civet cats all together. And this actually poses a unique opportunity for genetic information to be really transferred between all the animals.
And what happens really over here is, say for example, COVID-19, or Ebola they live in complete harmony with bats. I mean, bats don’t get sick. They have it. They live in harmony. They both live off of each other.
But what happens is, when this spills over into a human being, that’s the problem. The human gets really, really sick. And that’s what really happens over here. So I had a feeling this is going to be bad and that’s why I went down.
The focus of me going down to go down and investigate is really twofold. One is for myself, to understand the pandemic more. And secondly, is to really give information to the public at a first-hand basis, say, “Yes, I’m seeing this. These are my concerns. And that’s what I think is coming out to the future.”
So I went down. I was pretty convinced. It was a little scary, because the WHO had tweeted let’s say January 14, I think, where they said there’s no human-to-human transmission. My findings were different, and I did say there was going to be human-to-human transmission. It is a little scary to go up against the WHO. They’re huge giant in the world, but I had to give my personal opinion. And I really felt that there was going to be human-to-human transmission to keep all of us safe around the world to say, “Hey, this is what’s coming.”
And I started wearing masks immediately. I think one of the things that the United States might have missed a trick or so is we didn’t endorse wearing masks early in the pandemic, and that could have caused a lot of spread of COVID-19 at the time.
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Why are Masks Important to Prevent COVID-19?
Jasbina:
(18:58) Fascinating. So tell me, as an infectious disease doc, why are masks so important in prevention? Can you talk about that?
Dr. Rajeev Fernando:
(19:08) Absolutely. Let me take it back to countries like Japan, for example. It is considered impolite if you have a cough or upper respiratory tract illness, if you are coming to work without a mask, it’s considered inappropriate or disrespectful to people, merely the fact that if you’ve having a cough. It doesn’t matter if it’s COVID-19, or common flu or common cold. If you have a cough, you should be wearing a mask.
It’s pretty simple, pretty straightforward. And that really is a culture because it really prevents infection spreading, and this is going back decades and decades in a lot of parts of Asia. So we do know it protects against respiratory viruses. And now for sure really, like I said, initially, we missed a trick or two. We should have recommended universal mask wearing initially.
But clearly, to me, why I chose a Mask Up Earth campaign was because I realized how important wearing masks are to save lives. I wanted to do something as an infectious disease doctor beyond my charity towards empowering women.
I asked myself, what can I do as an ID physician? Yeah, everyone’s masking, saying wear masks, wear masks. But beyond that, I said, “I’ve got to do something. What about people who can’t afford a mask? Or what part of the country you in? Or do you live in the jungle like the indigenous population in the Amazon? I mean, what if you can’t get a mask?” And that’s how I formed this Mask Up campaign because it’s really … Personally it saves lives. You wear a mask, you protect yourself, and you protect others. It’s pretty simple. Wearing a mask saves lives.
Jasbina:
(20:55) Wow. Huge impact, and really, with a lot of forethought. Thinking in a global perspective of, okay, it’s one thing to get a mask, like you said, in certain areas, and others it takes a lot of resourcefulness and creativity. Tell me, are there any other best practices from overseas that you think Americans or America’s Health Care System would be wise to adopt, given what you’ve seen on the ground in different places?
Dr. Rajeev Fernando:
(21:24) Absolutely. There are many countries that have endorsed or embraced a universal mask wearing. That’s very important. And that’s really one of the … unfortunately, I hate to use the phrase politics. But there might be some other factors that are involved in certain people not wearing masks and things like that. For example, in Indonesia, if you’re caught not wearing a mask, you are responsible for burying the patient with COVID-19 just because you have not been wearing a mask.
Parts of India you’re caned if you don’t wear a mask. There are very severe punitive charges, especially like Italy, also the mayor was on the streets. They charge people thousands of dollars if you’re found not to wear a mask.
So around the world, there are a lot of punitive changes, and they’ve just embraced universal mask wearing and that’s something I feel the United States should be doing as well. I’m not sure about the punitive approach, but certainly, endorsing a universal mask wearing in the States with this coming season I think is very important.
Jasbina:
(22:39) Thank you. I’m processing everything you’re saying. And I’m thinking, as you said, the upcoming season. And clearly the Mask Up campaign is impactful. With the upcoming fall/winter, do you anticipate masks being in short supply? And if so, I know that at times that PPE was limited, people were making their own masks. Are you foreseeing that could be a possibility again in, let’s say in the US come fall/winter, as winter approaches really, we’re already in fall.
Dr. Rajeev Fernando:
(23:16) Yeah, absolutely that could certainly be a problem. But I think most people understand. And you do have the disposable mask, which you wear for a day, the surgical masks which are sold in your convenience store, and a lot of people are actually making masks at home. So it’s really … I really doubt there will be a huge deficiency like what we had, a deficiency of PPE and ventilators.
I think people are understanding this, and really, it comes down to the fact that you just make one at home. There are clear instructions that the CDC has put out, there many websites, which show you the right way to wear a mask. I don’t feel American will be in a problem where we just won’t be able to access a mask. It’s mostly the foreign countries, of course, that I’m very concerned about.
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What Parts of the World are Infectious Disease Doctors Most Concerned about Regarding COVID as Winter Approaches?
Jasbina:
(24:13) What areas of the world are you most concerned about as winter approaches in the Northern Hemisphere?
Dr. Rajeev Fernando:
(24:20) Great question, Jasbina. We are going to have a lot of cases in Europe and the US. If I were to take two things out of the equation, I’d probably say Asia will have less cases. And Africa won’t have that many cases. If I were to take out a couple of continents just off the bat.
I think the United States and the North America is going to have a lot of cases. We still really haven’t come to terms with universal masks and lockdowns, things like that, which they’ve done exceptionally well in Asia.
For example, you can’t travel to places like Thailand, Malaysia. People are dying to go because in my opinion, I think Thailand has some of the best beaches in the world, really. But they are thinking ahead. Tourism is very, very big in Thailand. It’s one of the most visited countries on the planet. But they’re taking a hit with their economy. But they’re saying, “You know what? I don’t care about the economy. We are going to keep this country shut, period.”
They don’t want any sort of foreigners or anything like that. So I mean, they’re taking it very seriously. And many Asian countries follow the same thing. Like I said, everybody knows to wear masks, everybody social distances, and everyone uses hand hygiene. So Asia may be a little less at risk. But the high-risk places I think, are in North America. And we’re already starting to see cases in Europe as well bouncing back.
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What Areas in the US are Infectious Disease Doctors Most Concerned about Regarding COVID as Winter Approaches?
Jasbina:
(25:57) Which areas of the US are you most concerned about, especially as winter approaches?
Dr. Rajeev Fernando:
(26:03) That’s a really, really good question. So we have two situations, where we have one situation, which is what we call a peak and valley situation. The other is what’s called a second wave.
So the second wave happens when some of the states have really hit their baseline. They’ve crushed the curve, and they return to an absolute baseline. And those are the people, once the cases are back to a baseline, those are the places that would be called a second wave. So all of a sudden, you start seeing jumping in cases, let’s say in New York now. That’s what’s called a second wave, because now we’re starting to see cases happen all over, all over again. And that’s a second wave.
Now, however, remember, the country still has about 40,000 or anywhere from 30 to 40,000 infections a day. So that is not touched it. Those states don’t have a baseline. They’re still really, really high. Those numbers are unacceptable. So those are what we call peaks and plateaus, really. It’s going to go up and down.
But it’s really hard to say, for me just off the bat, I think places, states where there’s high crowding, New York in particular, California, lots of crowding. The winter is going to be bringing a lot of people staying at home. So once again, there’s more crowding and things like that. We are going to get a lot of cases, because now schools are … Unfortunately, this is pretty straight up. It’s directly proportional. As states open, the more businesses open, the more schools open, you’re just going to have more and more cases. I’m absolutely convinced to that.
Wherever you’re having surging in cases, it’s really more and more businesses are opening up, schools are opening up. So that’s a tough situation. But the highly crowded states and more colder states, I would think, just off the bat, would be a higher risk for getting severe disease.
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How are COVID Practices and Attitudes Different from an Infectious Disease Doctor’s Perspective in Texas and New York?
Jasbina:
(28:13) And that is really interesting dovetailing with New York. So what’s fascinating is, you work in New York and Texas, so two states. One, New York, the crowding a bit more, everyone on that island. And then Texas more expansive yet, tell us about any regional differences and attitudes even just because those are the two states that you work, attitudes and practices. What have you seen in terms of that? Like two different flavors, right?
Dr. Rajeev Fernando:
(28:45) Yeah. Great, great question. And I have to unfortunately, get a touch political over here. Texas is a state which-
Jasbina:
(28:55) You’re welcome. No editing needed on this podcast. Yeah, absolutely.
Dr. Rajeev Fernando:
(29:05) No, I just generally don’t like putting in my political beliefs. There are a lot of people over here that just don’t wear masks. It’s political, unfortunately. And while in New York, it’s completely different. I mean, walking out of the house without a mask, you’re frowned upon on the streets. So that’s one of the big things I see over here.
And I feel like a lot of poorer faces like when we’re practicing at the border here in Texas. And just people are just … New York, of course, is a mixed population. But around these certain areas of the border, it’s completely a Hispanic population. People tell me this, either I die from COVID-19 or I die from starvation. And a lot of people tell me “I’d rather … I don’t want to die from starvation. I have to go to work, and that’s very simple.” So these areas over here everybody’s going to work.
Now, compared to New York City where you have a lot of wealthier people or Caucasian people where they say, “Well, you want to lockdown, that’s fine with me. I’ll work from home.” So they don’t have those situations where they have to go out and put themselves at risk. Even in New York, all the cases I saw that really … Most of the cases that were really severe, were people who had to go to work, ignored the lockdown, they had to go work to put food on the table. So this is what we saw in New York.
And really, I feel there are more Caucasian people over there who had the option of just staying at home and working from home. That’s one of the big factors.
Much, much poorer people here in Southern Texas, much more, like I said, about 95% Hispanic people. These are also people who have never seen a doctor in their life. Young people in their 30s, 40s and they don’t know they have diabetes. They don’t know they have heart disease. They don’t realize obesity is a factor. And bang, they come into the hospital like all of us say, “Well, what are the risk factors?” And it’s right there. High blood pressure, diabetes, high cholesterol.
For us, it’s right there. We get these blood tests within minutes. And we identify the risk factors, and we know that they’re at higher risk for getting severe disease. But these people unfortunately didn’t know that. So that’s a big difference, honestly. It’s really, race doesn’t matter in this situation.
Jasbina:
(31:35) Clearly, it’s economic.
Dr. Rajeev Fernando:
(31:36) Absolutely.
Jasbina:
(31:36) It’s definitely economic forces here.
Dr. Rajeev Fernando:
(31:40) Definitely.
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How does the Will to Live Affect Survival Rates in COVID?
Jasbina:
(31:43) Let’s switch gears. Tell us about a fascinating phenomenon that connects the patient’s will to live with actual survival. Can you tell us about that?
Dr. Rajeev Fernando:
(31:57) That’s a great question. Yeah, that’s a great question. And, unfortunately, science has been able to prove this, but it’s certainly something doctors see on the bedside, and we correlate with clinical improvement. And it’s a lot of times people are really facing death. It’s right in their face. And I hold their hand, I talk to them, I tell them, I encourage them, “Listen, your family’s batting for you. I’m batting for you. You got to push yourself.”
And really, you don’t have an explanation. When the patient wants to fight, a lot of times, we have better outcomes. Like I said, there’s no medicine behind it. There’s no science behind it. But really, the patient has got to be willing to fight. And as a physician, I always give that encouraging every day.
So like, I’ll say, “Hey, you were able to stand for a minute yesterday without getting short of breath. But now you’re standing for two minutes. That’s awesome. Look, you’re moving in the right direction. We got to do this. We got to do this. Keep pushing.” Small baby steps, which I’m not going to say, “You’re in a ventilator today. You’re going to be off of it tomorrow.” I am always realistic. But small, small baby steps and just I say keep fighting.
Standing up, standing up for a minute yesterday and standing up for two minutes today without going short of breath is an accomplishment for me. And that’s what we like to reinforce with the patients. And because a lot of times the patient’s also on this. The doctors tell them, “Listen, we can beat this”, they lose hope as well.
So we have to constantly reinforce to do this, and that really is a big factor. The other thing I feel also is a heavily involved family. When the family calls multiple times a day. And remember these are very challenging times because patients’ families can’t actually come in to see the patient.
So imagine how hard that is for both the patient who’s just looking at four walls the whole day missing his or her family. And the family really worried because all they hear from a doctor is an update and say, “Hey, your father’s not doing well. Or he’s really hanging or clinging for his life.”
I mean, I can’t even imagine hearing that about my dad and just not being able to go into the hospital and see him. I mean, it’s so hard.
So I really think it’s three people together. Healthcare professionals, patients’ families, and, of course, patients. So we really have to keep reinforcing. I really think there are better outcomes when this happens.
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Favorite Patient Battling COVID Survivor Story from Infectious Disease Doctor
Jasbina:
(34:40) Well, to inspire everyone, can you show us one of your favorite patient survivor stories in the pandemic?
Dr. Rajeev Fernando:
(34:44) Yes. There’s so many, so many success stories. But probably one of the best ones I recall is a 33-year-old gentleman, Hispanic race and it was one of the first cases I’ve actually seen where this patient, 31-years-old actually had a stroke because of COVID-19. And I must admit, the first time when he came in, I was like, I just asked myself, “Well, he’s got to have some clotting disorder. Why is he coming in with 31?” And then I realized very quickly that, yes COVID-19 causes clotting abnormalities, and he had a stroke because the COVID.
Sure enough, we tested him, and he did come up positive for COVID. And he was, I mean, all of a sudden, he couldn’t talk. His whole left side was weak. He couldn’t talk. I mean, he was really bed bound. And can you imagine, he couldn’t even use his iPhone, and he was just … I mean, a young person like that, we take for granted, but he wasn’t able to use social media, had slurry speech, so he couldn’t talk to anyone. He was so out. He was so depressed really. And these are the kinds of patients we spend a lot of time with.
And every day we would walk them more and more and speech therapy and physical therapy. He didn’t get it the first few days. And unfortunately, this is probably going to overlap with our last discussion about reinforcing. And for a 31-year-old guy to suddenly not be able to walk, talk, access basic social media, is one of those same reinforcement things. He started walking. After about three weeks of intensive physical therapy, I didn’t even see when he left, he was going to a rehab facility.
But about three weeks later, he called me and … A lot of people, the younger people, I just introduced myself as Rajeev. And I said, “Hey, I’m Rajeev. I’m your infectious disease physician.” And I like people to call me in a first name. Even with colleagues at the hospital, or students or trainees under me, I always just say, “Hey, just call me Rajeev. We’re all on the same team to get our patients better. And that’s it.” I don’t want this, you don’t need, Oh, Dr. Fernando. I just think a more collegial level.
And so, particularly with some people, I’m like, “Hey, how are you feeling? Are you feeling better today?” And he’s like, “Hey, Rajeev. I feel a lot better.” And it was moving that way. And three weeks later, he called me and said he was walking around and he’s able to use social media. And I was so happy. He sent us some cookies to the hospital which is directly responsible for my six-pound weight gain.
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Why are Female Doctors more Prone to Physician Burnout?
Jasbina:
(37:38) Oh, wow. Inspiring. Wow. Rajeev it’s loud and clear. You clearly love your chosen work. Tell me, what are your top tips to share with fellow physicians of all levels. For med students all the way up to attendings and people in private practice who might be worried or facing burnout, especially during the pandemic, but even apart from the pandemic, just burn out in the field?
What are some tips? What an inspiring success story. Unfortunately, there are others who haven’t quite made it. How do you avoid burnout? How do you still keep that love and passion for your chosen work? Can you share for our listeners who are in the field in health care?
Dr. Rajeev Fernando:
(38:37) Of course, of course. Firstly, I don’t think there are people who haven’t quite made it, and I feel certain people are more prone to physician burnout. Unfortunately, our female physicians are more prone to physician burnout.
Jasbina:
(38:54) Interesting. Tell us about that.
Dr. Rajeev Fernando:
(38:57) Yeah. Let me start at the very top with female physicians. There’s still a lot of sexism and female physicians make less money. They’re actually asked to make their own decisions a lot of times. They’re not supported at a higher … it’s very, very painful to see this. Especially, I grew up with my younger sister who’s … she was an inspiration to me, and I’d still say my kid sister was one of my role models, because she was just so determined. And she works very high up, very well-trained.
There’s something in India called Indian Institute of Technology, which is really the best school in the country, one of the best in the world. And my sister was, I think four or five, and someone said IIT is the best school in India. And she said, “I’m going there.” She didn’t even know what engineering was.
Yeah, it was always in my family early on. Oh, that’s Rajeev. That’s Cathy the smart one and that’s Rajeev the funny one…it took a while to get over that.
But so growing up with two very smart and powerful sisters, I still feel … I’m very upset to see that this situation still persists with female physicians. They go through so much more. We have to understand they bring up children, they go into labor, they bring up children. They have so much, so much more responsibility. And the industry is only pushing them down further. They’re not supporting them enough. And we really need to support our female physicians much better.
Jasbina:
(40:44) Interesting. Okay, very helpful. Tell me, what in terms of female, male physicians facing burnout, what is helpful from mental hygiene to combat that burnout?
Dr. Rajeev Fernando:
(41:03) Sure, sure. I’m sorry, I failed to mention our original question to me about avoiding burnout in general.
Jasbina:
(41:14) That’s okay.
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How should Physicians Choose a Medical Specialty?
Dr. Rajeev Fernando:
(41:18) I really think the most important thing to do is really wholeheartedly love your job. Unfortunately, I feel there are a lot of physicians who choose careers where they say, “Well, this is where I make the most money” and things like that. You may have a few thousand dollars more at the end of the first three, four, five, six years. But if you really don’t love what you do, you’re setting yourself up for disaster, mental fatigue.
Like for me, I’m the first physician who gets to the hospital on Monday morning, and I’m there bright and early ready to go. And a lot of people say “Why are you so happy on a Monday morning? Did you get a lot of coffee or a triple shot of espresso?” For me, it’s really just loving what I do. And it’s loving the challenge, loving every minute of it. And that’s really what keeps me going. It’s was very hard, and probably will be hard tackling the pandemic. But really, if you love your job, I think it’s very easy.
For example, I really get upset, or I hate the term when someone says, “Oh, you’re a hero health care.” I said, “no, I’m not.” We’re here. These are our patients. We do this every single day. And we’re not heroes just because we treat COVID-19 patients, we’re not. Nothing has really changed. Of course, we have our good days, we have our bad days, and sometimes at work I tell my students and residents, I said, “That was such an easy day. I shouldn’t be paid for today.” I mean, I really shouldn’t.
But that’s one end of the spectrum where we have our easy days, but we aren’t going to have our tough, complex, challenging days as well. And I don’t think that makes you a superhero any different at all. So really loving your job and loving yourself, I think is very important to get you very far in your career. Because if you’re not, then it just becomes a part of the day. “Hey, I had a rough day today. But let’s keep going.” But if you don’t love what you do, that’s going to be a really big problem, unfortunately.
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Self-care Tips for Physicians Battling COVID from Infectious Disease Doctor
Jasbina:
(43:32) Okay, so loving what you do. And you mentioned loving yourself. So it makes me think of self-care, maybe mental hygiene. Tell me some tips for physicians, for health care professionals in general to maintain that level of mental hygiene or self-care, so that they really can also care for others.
Dr. Rajeev Fernando:
(43:59) Sure, absolutely.
- One of the most important things I feel for people in this field really, is to get proper sleep. But probably is the number one important factor I feel. You have long days, things of that, but really, you need to shut your brain off at some point and really getting your at least six hours of sleep, of course, and perfect days we get longer. But your six hours of sleep is very, very important, and make sure you get that because you’re working long hours, long days, and getting your sleep is simply the most important thing, and that’s what really keeps me fresh. Because if we’re working and working non-stop, we work nonstop days, but make sure you get that six hours of sleep. That’s really the single most important thing I think for physicians in the field to get that sleep.
Now, a lot of physicians including myself for a long period of time is, we have our experiences that we have on the day it goes in, we take it along with this into our sleep. And that’s actually something was called COVID Dreams actually, or lockdown dreams for people, the general public, where they’re more vivid, they’re more challenging, just uncomfortable situations when you sleep at night. And we had that for a while, but you really have to try to relax. I think there are a couple of apps.
- I like to drive by the beach whenever I have time to just get some waves just in my head, listening to those sounds. Make sure you listen to some relaxing music, things like that before you go to bed, shut your cell phone down. Please, please, please, it’s a very … and I’m guilty as well. I’m trying to get a follow-up everything, COVID all over the world, and this patient, and that patient. But I really encourage physicians to really shut their phone down because you’re only more productive the following day for your patients and you do more justice for your patients as long as you- you have to take some time off to relax. That’s what’s one of the things that’s going to enhance physician burnout.
- Healthy eating is really important. Make sure you get lots of fruits and vegetables, very important and relaxation. I feel even after work, granted, we can take those long vacations anymore. I haven’t taken a vacation in such a long time. But I really think trying to do something fun at the end of the day. Focus on that.
- Do something you like, whatever you like, whatever you like. You want to look up at the stars, you want to do something fun, there’s still so many good things you can do beyond going out to bars and indoor events, just do something for yourself. Online shopping, that helps me, actually. I love my Louis Vuitton online shopping, sorry to say that. But do something fun that you really, really like to do, and that’s important.
- I’ll top of this question with exercise, you really don’t have to go to the gym to feel accomplished for the day. But really, walking about half an hour a day really improves the blood flow to your brain carrying more and more oxygen to your brain. And that’s very helpful as well.
So these are some of the pearls I would recommend for healthcare workers and really, in general to people who are all over the world who are going through this. You don’t have to be a physician to embrace this, but these are pretty good tips, I feel that helped me and have helped a lot of colleagues and friends of mine.
Jasbina:
(47:38) Ah, thank you for those golden nuggets.
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Predictions about Telemedicine for Physicians from an Infectious Disease Physician
Jasbina:
(47:41) Tell me, speaking of those training, and to the medical profession. I know that you work with students, you’re in academic medicine it sounds like as well. So any predictions regarding medicine in the future, whether it’s prospects for specialties, whether it’s telemedicine for medical school listeners, and people training who are really, sticking through, like you said, finding something they love, finding something they love being so important. What predictions and tips might you have?
Dr. Rajeev Fernando:
(48:23) Sure. I’d love to. Yeah, absolutely. For example, infectious diseases is one of the lowest paying specialties in medicine in this country. So once again, it’s a clear example of going into something you really feel passionate about and what you love. And I think in medical school, I’m pretty sure by next year we’ll have a lot more people applying for infectious disease, because for me, it’s really like a mystery, walking up to work every day and try to figure things out. And really, the television show “House” is really based on infectious disease guy.
So a lot of people ask me and say, “Well, Mr. Fernando, are you gonna drill a brain in this hole?” I say, “No, no, no, no, that’s fiction. We’re not going to be doing that. Let’s start conservatively with an MRI of the brain and we’ll make some decisions.” But yeah, that’s based on that. So it’s an infectious disease doctor trying to figure out mysteries and puzzles.
So like I said, don’t worry about the money. It’s a stable field. I don’t think people are going to get really rich or anything like that the way things are right now. But you’ll be okay. You’ll still be able to have a house, good lifestyle, things like that. So really follow your dreams and what you like.
With regards to telemedicine, I really think it’s the future of medicine. They’re going to be, especially, this whole pandemic has enlightened people where they just don’t want to leave their house. They don’t want to … Hospitals and offices can be viewed as potential sites of infection, or could I go to the doctor’s office and get COVID-19? Or go to a hospital?
So even people who are having chest pain or heart attack, they just didn’t want to go to the hospital. They said, “I have chest pain. I could have a little heart attack, but I don’t want to go to the hospital and pick up COVID-19.” So this is really been a game changer. And that’s why I think telemedicine is really here to stay, and it’s really, really going to get big in the future.
People have the convenience of talking from their own homes. Even a physician, they can just work from home. It’s something that we’ve never had before, save that travel time, maybe an hour to the hospital, an hour back, so you have extra time to work with.
And I really think it’s the future medicine. Even critical care, I think in a few years, it can really be managed on the phone, over zoom call and things like that. So stay tuned for this because it’s really, really going to become big in the years to follow. Absolutely convinced of that.
Jasbina:
(51:05) That’s interesting. So that lends itself to another question, an impromptu question from me. And that is this, that given your belief that telemedicine will, this is just the beginning, that it will continue to grow and grow and even encompass critical care and those areas that one thinks are less amenable to telemedicine.
Do you think that also opens up then, and this actually touches on what we spoke of before with respect to medical students and specialties and all, opens up medicine to more of a global playing field? In that, if someone can … you know how some people might say, “Okay, I can get medicines from the US, or I can get medicines from another country, name it. India, Mexico, what have you, at a fraction of the cost.
Do you think that also opens up medical services in that sense to, “Okay, I can have a highly trained physician in the US, but there’s also highly trained physician in, name the country, whatever. And so, instead of calling the number here, I can call the number there.” Do you think that is something for the future as well, in terms of making medicine more of a global practice?
Dr. Rajeev Fernando:
(52:29) Yeah, that’s a really excellent question. I don’t think too many people have touched upon that situation. But that is a really excellent question.
And really, to put that in perspective, I do a lot of international consults as well around the world. I’ve done some for South Korea, I’ve done some for England, and couple of other places in Asia and India as well. So yeah, whether you’re doing a Zoom call within the States or really across the planet, it really doesn’t make a difference. So I think, this is very nice point that you bring up, and I really think it will go across the world.
Health care for US MDs are very highly respected around the world. And it may come to a day where they say, “Hey, let me get a consultation from one of the American physicians.” So that certainly would really be very valuable. Or I can get a consult from someone in Brazil and say, “Hey, listen, what do you think about this case?” And I’ve always maintained that there should be like a global approach to fighting this pandemic, which I really haven’t seen happen. But these new telemedicines or Zoom calls are really going to change medicine forever.
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An Indian Male Physician’s Perspective on why more Female Physicians than Male Physicians Prefer Physician Spouses
Jasbina:
(53:56) Interesting. Tell me, okay, so I’m going to switch gears to the personal front for a minute. And I noticed that we’ve looked with lots of female and male physicians over the years, and ranging from medical students to attendings, private practitioners, people beginning practice, people at the top of their game. And I’ve had the privilege of speaking in various physician conferences about relationships, dating over the years.
I’ve noticed the general pattern that I’m hoping you might share your perspective on, just as a male physician, and now as I learned that has female sisters as well. But as a male physician, why do you think, I’ve noticed something interesting, and I would love your candid, your own impressions of this. Why do you think more female physician than male physicians prefer life partners who share their same profession?
So you’ve got more women who are saying, “Oh, I’m in medicine. I prefer a man who’s in medicine too.” Versus you don’t have as many male physicians saying, “Well, I’m in medicine and I’d like my partner to be in medicine as well.” I’m just curious, and this off the cuff. What would you surmise? What would you guess just based on being in the profession?
Dr. Rajeev Fernando:
(55:17) That is a very good question. And I think, like we had mentioned before, female physicians, there’s a lot of sexism. They go through a lot of very different situations from others, but there’s a lot of sexism that arises. And in my opinion, or my data review actually says, there’s about a 30% to 35% decrease in pay salary also for female physicians. And like I mentioned, female physicians are often asked back for themselves, to get themselves ahead.
I really think that their work obviously stands up for themselves. They’re amazing at what they do. But they have these compromising factors. It’s really, unfortunately brings them down. And I think in that situation, they really look to someone of a similar background in the same field to say, to bridge things together. And I feel some of these factors are really, what we just discussed right now, these factors actually all the more encourage female physicians to be with male physicians so that they understand what the female physician is going through.
Now for example with me, it’s all about equality, but I’m smart enough to recognize that female physicians make up to 30% less than male physicians. Leadership positions are less. I really think, and it really comes down to the personality of the male physician as well. Are they able to put themselves in the shoes of a female physician to understand what they’re going through? And the other thing, which really makes me nauseous is, a lot of patients also, they look at a female physician and say, “Oh, you’re my nurse for the day.” or, “You’re this or that.” And it’s so hard for people to even say, “Oh, my physician is female.”
I mean, these are really real-life problems that I see every day in my practice. So that’s why I think they really look upon male physicians. And as long as the male physician is very understanding, loving and caring, they’re able to see that female physicians are compromised at their work, and I think that’s one of the reasons female physicians like to be with male physicians.
Jasbina:
(57:40) That’s interesting. Why do you think lesser male physicians are seeking to be female physicians? I know I’m putting you on the spot here, but I’m just curious.
Dr. Rajeev Fernando:
(57:50) Don’t worry about it. Don’t worry about it. One of my shows when I was a talk show host in India was, we used to call it Red Hot Madrasa Night. So putting it like this, it was a midnight show, actually. So people would call in for love advice.
Jasbina:
(58:08) Interesting, okay. That’s another show I’ll have to have you on for. That’s interesting.
Dr. Rajeev Fernando:
(58:13) Of course, of course. You know what’s so interesting, I unfortunately feel there are a lot of men out there, who they can’t handle the power woman. And this is what I’ve noticed. Like for me if I see a power woman, it’s like, “Hey, great. Let’s hold hands. Let’s move forward together and let’s do this. It’s quite straightforward.
But there are a lot of male divisions, and once again, as we just discussed a couple of minutes ago, a lot of males don’t want to do that. They just look at someone as a threat to say, “Oh, my God. She has a higher position than me. She’s doing this, she’s doing that.” And a lot of males may be intimidated by female physicians. That’s what I feel, just off the bat. If you were to, the way you pose these questions, and I think a lot of male physicians may be feeling this inside. That’s one of the things.
And I also think some people, some males say, “Well, you know what? I’m going through this very hectic lifestyle. I try to be with someone who doesn’t have this kind of a lifestyle. So those are some of the things that I really think is why male physicians… just it could be some sort of a complex, which is certainly possible.
And the other thing, which is like, “Oh, the woman is better than me” and all this nonsense, which shouldn’t be existing. And the other is sometimes male physician say, “You know what… I’m doing this on my own. I’ve seen enough. I don’t want my wife to be in the same boat as well. We’re going to be bringing up kids together. And if she has a crazy life, and I have a crazy schedule, how’s it going to work?” And I think these are some of the reasons I feel this way.
Jasbina:
(01:00:00) Interesting. Let me ask you a question, do you seeing more male nurses entering the profession of nursing or no? Is that happening or not? In terms of traditionally, nursing has been female. You are seeing more male nurses? Yeah, that is happening?
Dr. Rajeev Fernando:
(01:00:16) Absolutely. Yeah, yeah, lots more. I mean, the whole tradition, of course, we had Florence Nightingale bring things out. I can tell you the number of male nurses I know where they conclusively say, “I don’t want to be a doctor.” And people actually ask these nurses and they said, “Why didn’t you do medical school because you’re a guy?” And the answer is very common, where they say, “I prefer bedside patient care to be with the patient every minute.” Unlike doctors aren’t. We round, we leave. But many nurses say, “I just want to be by the patient’s bedside all day long.”
And so, that is one of the reasons I feel there are many, many more male nurses entering the field right now.
Jasbina:
(01:01:00) Well, then let me ask you this question, now that more male nurses, and females are entering the field at a higher rate, I believe too, in terms of physicians. There are more male nurses and more female physicians entering the profession. And this is just because you are on the ground, you are seeing the dynamics all the way from med students all the way to fellow attendings. Do you think female physicians and male nurses… what do you think of that partnering that way? I mean, what do you say? Off the cuff, what are your thoughts on that?
I mean, lots of pros and cons, I’m sure. But tell me, do you think that’s something because you seem very forward-thinking in terms of telemedicine, in terms of looking in China in January 2019 and saying, “Nope, this is going to get bad.” So you seem to have those predictions that are pretty interesting and amazing. So what do you think of this, the female physicians and the male nurses?
Do you think that’s something that in the future, the way in the past as a lot of people thought female nurses and now physicians, have partnered?
Dr. Rajeev Fernando:
(01:02:22) Yeah, absolutely. For me love knows no barriers. You can’t control who you fall in love with, whether you’re a male doctor and a female nurse or a female physician, and a male nurse. It really knows no boundaries. I mean, I do foresee that. I’m going to, this may be … Sorry to sound a little-
Jasbina:
(01:02:40) No editing! Remember Rajeev, there’s no editing.
Dr. Rajeev Fernando:
(01:02:43) Yeah, yeah, yeah. No, none at all. The thing is, unfortunately, honestly, over the last few years, and I regret to say this. I don’t want to put an arrow in our romance conversation right now. But there are a lot of sexual harassment cases which have come about.
Jasbina:
(01:03:00) Sure, absolutely. Me Too movements and…
Dr. Rajeev Fernando:
(01:03:05) Exactly, and I think that’s completely appropriate. But now there are a lot of clauses when you sign a contract at the hospital. Say, for example, I have to do a sexual harassment course every day, every year…not every day. That’ll be insane.
Jasbina:
(01:03:15) Every day, wow. Rajeev, that’s daily. Just kidding!
Dr. Rajeev Fernando:
(01:03:22) No. Every year we have to do that. And just off the bat, it’s a clear cut – you shouldn’t be doing this, which is,as a supervisor, you shouldn’t be asking someone out. If you ask someone out who is below your position, that can be viewed as harassment. The person below can say, “Well, I didn’t want to go on to this person. But I was scared that she’s ahead of me, that she would fire me and things like that.” And that’s applicable for male physicians and female nurses and vice versa. Either way, yeah.
I love Cupid, but this is a situation, which is real right now. And people have to be really, really cautious about, if you’re a supervisory role, you really have to be cautious about who you’re asking out. And it’s very sad. I mean, like I said, love knows no barriers. But this is a legitimate thing that hospitals all over the country are asking for. So it’s kind of put a dent in that situation.
But I don’t know, I’ve always been a forward thinker. And one thing, which I think could be used in the future is just writing an email with some consent to say, “I know this person. I’m interested in this person, and this is completely consensual.” Thinking ahead. I don’t think it’s been employed so far, but I think as long as you have some sort of thing, which says, “Hey, yeah, it’s in writing. You know about this, and this is completely consensual.” And if it’s in writing, I mean, that’s something which I think should in the future, because it’s really sad to breakup love, because of these few cases of sexual harassment. I don’t know the exact numbers, of course it’s happening out there. But love happens all the time, every corner, every day, every minute. And I think this might be a way out.
And this is obviously not data driven or anything of that. But thinking ahead, you really love someone and you want to be with someone, in order to mitigate this possibility of administration coming down on you, things like that. I think this might be a reasonable approach for the future.
Jasbina:
(01:05:29) Okay, and that’s very interesting, and it’s a great insight with respect to the whole MeToo movement, and how that, and just in general sexual harassment, which has been there for quite a while. The whole pot, in terms of the dynamics, of female-male dynamics, so that kind of thing. I’m just curious.
Putting aside sexual harassment and the power that any potential, like supervisory issues there. Anything there with just the idea of the different fields, and males who happen to be a nurse and a female who happens to be a doctor? Do you see anything coming in the way of that? Or…do you know what I’m saying? As a male physician, right? Definitely as a male physician. I’m just curious.
Dr. Rajeev Fernando:
(01:06:39) Yeah, I think everything is okay. But unfortunately, really, when you work in these bigger places, the administration probably takes a very aggressive role. And I’m going to be honest with you, to all our listeners also. It’s a beautiful feeling to be in love.
But I really want people to really be cognizant of this policy. The last thing you want is you’ve been in training for 20 years and you’ve been working for 20 years to get to where you are. And one of these things can backfire on you and it’s all over.
Jasbina:
(01:07:09) Yeah, with something like that, right. No, no, one has to be very careful about that. Right. I was more thinking it doesn’t even have to be in the same workplace. Just the concept. It doesn’t even have to be in the workplace, it could be two different. But just didn’t even have to work in the same institution. I just meant the whole concept of that profession and that profession.
Dr. Rajeev Fernando:
(01:07:29) Oh, I think it’s beautiful.
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Why does an Indian Male Physician think lots of Relationships Happen in the Hospital?
Jasbina:
(01:07:31) Yeah, forget the same industry, the same institution. I want to put that aside, and just the idea of, because there’s different personality types. And they’re different … And nowadays, you have families where it’s sometimes the dads more hands-on with the kids, sometimes the moms are. So that whole idea in terms of that. Okay, interesting. Anything more on that?
Dr. Rajeev Fernando:
(01:08:03) Oh, no, I think it’s a beautiful thing, and really, if once again, a lot of relationships are happening in the hospital because you we’re all in the hospital the whole day. And you see someone attractive, you share good collegiality, you manage patients together, it really bonds relationships. I have wonderful relationships in the hospital, it’s just, we all get along so nicely, and it’s really like coming home, honestly. Honestly, when I come to work, I’m the happiest.
And so, I certainly think it’s … As long as all of that is satisfied, those criteria are satisfied, I think it’s a beautiful idea. And like you said, many, many more nurses, male nurses on the field, I don’t know whether Meet the Fockers, the Ben Stiller movie where he was a nurse, I’m not sure if that influenced those changes or anything like that. But being a male nurse is really amazing, and I’ve met some brilliant, brilliant male nurses in my career.
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How can you get Free Masks for COVID from Anywhere in the World if you Can’t Afford Them?
Jasbina:
(01:09:10) Thank you. Insightful on many different levels, so diverse. And I’m wondering if you’d like to share your charity’s, CHIRAJ’S, website with our listeners so they can take a look at some of the great initiatives you’ve been involved in.
Dr. Rajeev Fernando:
(01:09:29) Absolutely. So it’s CHIRAJ. It really tells us, tells everyone about the different places we go. I advise listeners not to look for the donate button. It’s really a self-funded charity by myself. So please don’t look for a donate sign there. Just your support is important to me. Spread the word.
Jasbina:
(01:09:55) Spread the word. Okay. Everyone can help by spreading the word.
Dr. Rajeev Fernando:
(01:10:01) Yeah, spread the word.
Jasbina:
(01:10:01) Okay, great.
Dr. Rajeev Fernando:
(01:10:02) Listeners can email me or go to the website and drop the question or anything. And I’ll send out free masks for them or wherever they are as long as they don’t have any, or the community needs some, just drop us a line. And like I said, we’re actually just sending stuff to Russia also right now, actually. We’re all human beings and we shouldn’t be thinking about Cold Wars and this and that, and espionage. It’s really coming down to saving lives.
So it really doesn’t matter which part of Earth you’re in. We send masks. We’re probably going to do some, we’re in China as well. We’re starting to get some contacts there. So it doesn’t matter about these global superpower things and all that. Human beings are human beings. And wherever we can send our masks, it’s very helpful. So thank you all for your support.
Jasbina:
(01:10:53) How inspiring? And thank you. Thank you, Rajeev. I really appreciate your sharing your valuable insights and generosity with us.
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