Dr Surendra Mohan Tuli is a renowned orthopaedist with over four decades of experience. He is former director of the Institute of Medical Sciences, Banaras Hindu University (IMS BHU). Currently, he is practising as a consultant orthopaedic surgeon at Vidyasagar Institute of Mental Health, Neuro and Allied Sciences (VIMHANS) in New Delhi.
For his success, Dr Tuli gives credit to his mentor, Late Dr Doraiswamy, who was also the first professor of orthopaedics at AIIMS, from whom Dr Tuli learnt physiology and philosophy of orthopaedics, whereas he learnt the operative techniques from Dr Balu Sankaran in Delhi.
In an exclusive interview with India Medical Times, Dr S M Tuli elucidates on developments that have taken place in orthopaedics over the decades.
Could you please highlight on your journey of being an expert orthopaedic surgeon?
I did my medical studies from Amritsar Medical College in late 1950s before I moved to Safdarjung Hospital’s Department of Orthopaedics in Delhi to practise orthopaedics surgery. There I assisted late Dr Doraiswamy for seven years. He taught me: “Medicine is like Mathematics as the same patient can be treated via several different methods. Whenever a person is in therapeutic dilemma, perceive the patient to be as of your own child and as part of your own family and you will end up giving utmost ethical care to him or her.”
After seven years, I moved to Banaras Hindu University (BHU), Varanasi and thereafter I kept on moving from one institution to another, whenever a new department (of orthopaedics) was to be established at some new institution. This way, I considered myself fortunate to have been designated professor at the age of 32. It turned out to be a great learning experience for me as I realised the state of real India, i.e. the citizens’ need for literacy and good nutrition, which could not be possible sitting in Delhi.
While practising in Varanasi for almost 23 years, we developed a technique of giving best treatment to tuberculosis (TB) patients, based on which I wrote a book on Bone and Joint TB, called ‘Tuberculosis of the Skeletal System’. The book’s 5th edition has been published, covering the developments that have taken place in medicine, investigations, facilities etc.
We also established a bone bank with moderate facilities, which is called Allogeneic Bone Bank Facility, in Varanasi, at UCMS (University College of Medical Sciences) Shahdara in Delhi; and at VIMHANS. In 1980s, I served as the director of Institute of Medical Sciences at BHU for three years before being transferred to UCMS, Shahdara to establish the department of orthopaedics from scratch. I got retired in 1995 and since then I have been working at VIMHANS in Delhi.
My second book ‘Practical Orthopaedics’ was written under the influence of Banaras. I had realised that 70% of our population reside in tier II & tier III cities, who are treated by another group of 70% surgeons. Hence, the book focuses on what these orthopaedic surgeons should treat and how to give a good orthopaedic treatment to patients. The book also talks about orthopaedics that can be safely practised by general orthopaedic surgeons within moderate facilities under certain conditions. The mentorship of Dr Doraiswamy induced me to do experimental work in orthopaedics. We also worked on congenital bone defects.
What changes have you seen in medical science or in your profession over the years?
Over the years, we as orthopaedic surgeons learnt how to control infection because antibiotics were not available and we realised the need of sterility while treating and operating the patients. We are doing many operations today that we could never think of earlier. In the metropolitan cities, the technical expertise of Indian orthopaedic surgeon is not less than experts working around the world.
Earlier when there was an infection, we were permitting that joint to undergo fusion with lots of wounds, but today, if there is an infection, we aim at healing it with a range of useful range of motions. It is a big development. Think of a knee joint, if it was infected we would fuse it with no movement and it becomes like a stick. But today, movements are maintained. And if a patient is not able to gain sufficient movements without surgery, surgeries are available where we can do a total hip joint replacement and knee joint replacement. These are two major joints where the whole mobility of the body is permitted or dependent. They can be today confidently converted into mobile, stable and long lasting joints.
In India, we have been able to eradicate diseases like polio, small pox and tetanus with the cooperation of mothers in the family.
Do you believe that medicine in India has evolved for better? How the orthopaedic surgery and treatment have evolved over the years? What changes do you foresee happening in this field?
I think the operations that were earlier not possible, such as hip joints, knee joints and spine surgeries, have now become possible. In terms of technology, we have reached the peak but we are looking for biological advancements. During the last 60 years, only two biological advancements have taken place in orthopaedics, one has been Ilizarov technique to be able to produce bone by creating a tension on the bone and then create tissue bone. This way, a short bone can be lengthened. The other major improvement has been in bone grafts.
What change in trend or pattern in behaviour do you observe in today’s medical practitioners as compared to the times when you practised?
Earlier, public used to respect a medical practitioner and showed blind faith on him. He used to be considered godly, but with the pressure of times, society has changed and now everybody is running after money, including the practitioners. I have nothing against people earning by ethical means but not in criminal and unethical manners.
What’s your take on the healthcare industry becoming more in the hands of corporates or administrators, i.e. having money making approach than serving the patients, specially the kind of fault cases that we get to hear in mass media or social media?
Private hospitals have been established and are successful because the government has not been able to provide adequate services to its people. If a common man could get equally good service at a government hospital, it would make a huge difference.
How do you wish to see the healthcare industry or the field of medicine in near future?
In future, we are looking towards to be able to replace a joint surface by a joint surface. Today, it is being done with the help of metal. Similarly, we replace bone loss with metals on a large number of occasions. How about producing bone or a nerve, repair a damaged spinal cord, loss of limb or any kind of paralysis. I think three or four things will happen in future but it will depend on the efforts of our new generation.
What’s your view on limb lengthening surgery, for which an orthopaedic surgeon’s license was suspended recently? Do you agree with the view that it’s just like another cosmetic surgery?
I feel that we should focus more time on functional treatment rather than cosmetic treatment.
What vision do you have for the healthcare or medical industry in India?
I know the government has done a lot but no change can happen instantly. One cannot get a first class faculty overnight; it takes years to build it.
Would you like to give any suggestion, idea or tips to young medical practitioners or students? What should today’s generation do to feel more inspired towards serving the society?
I generally tell young practitioners that orthopaedics is a huge subject. You should become a general orthopaedic surgeon as it sets the base of the pyramid. If your base is broad, you can be a super specialist in one or more subjects. No orthopaedic surgeon can do everything but as a general orthopaedic surgeon, one should be able to treat orthopaedic injuries, dislocations, accidents, which creates situations like emergency.
Also, if you are ethical, there is no dearth of work; and even if you stay ethical, there is enough money to look after your needs or your family’s needs.
by Priyanka V Gupta