By 2003, Evidence-Based Medicine had begun to take root in Sevagram, and much of that credit belonged to my collaboration with Madhukar Pai. But Madhu, as always, thought one step ahead.<\/p>\n\n\n\n
\u201cYou have to go to McMaster,\u201d he said. \u201cThat\u2019s where it all began.\u201d<\/p>\n\n\n\n
McMaster University in Hamilton, Canada, was the birthplace of this movement. It was where Gordon Guyatt\u2014who coined the term \u201cEvidence-Based Medicine\u201d\u2014taught and trained people to question their own certainty. Madhu had attended a workshop there and returned with a new kind of confidence: not the loud kind, but the quiet confidence of someone who knows how to check the facts. He wanted me to feel that shift too.<\/p>\n\n\n\n
***<\/strong><\/p>\n\n\n On April 10, 2003, I wrote to the President of the Kasturba Health Society. I had been accepted for a workshop titled How to Teach Evidence-Based Clinical Practice<\/em>, scheduled from June 22 to 27. The organisers had waived the tuition fee\u2014$2,700\u2014which felt like a small miracle. But travel was still expensive. I worked out the cost of the round trip\u2014Sevagram to Mumbai, then London, Toronto, and back\u2014at around \u20b965,000, a serious amount in those days.<\/p>\n\n\n\n I also added a second reason for the trip. Dr. Mike Galvin had invited me to stop in the UK on my way back and speak in Leeds and London about MGIMS\u2014our work, our rural focus, our stubborn belief that good medicine is possible even in a village. I hoped it might open doors for exchange programmes.<\/p>\n\n\n\n To my relief, the Society agreed to fund half the cost. For the remaining amount, Mr. Dhirubhai Mehta arranged \u20b930,000 from a private trust in Mumbai. That settled the only question that mattered.<\/p>\n\n\n\n I booked an Air Canada ticket.<\/p>\n\n\n\n It would be my first international flight.<\/p>\n\n\n\n ***<\/strong><\/p>\n\n\n I left India with a suitcase of clothes and a head full of nervousness. My itinerary looked simple on paper: Mumbai to London Heathrow, a 90-minute layover, then onward to Toronto.<\/p>\n\n\n\n Heathrow, however, was not an airport. It was a small universe.<\/p>\n\n\n\n I landed, looked around, and immediately felt out of place. Everything was enormous\u2014corridors that never ended, signboards that seemed to multiply, people walking as if they were late for something important. I did what a small-town traveller does when he wants to appear calm and \u201cinternational\u201d: I slowed down. I wandered past duty-free shops. I tried not to look rushed.<\/p>\n\n\n\n I didn\u2019t realise that in aviation, a 90-minute layover is not a relaxed stroll. It is a test.<\/p>\n\n\n\n When I finally reached the transfer desk for the Toronto flight, the staff member looked at my ticket and shook her head.<\/p>\n\n\n\n \u201cSir, your flight has already departed.\u201d<\/p>\n\n\n\n For a second, I couldn\u2019t even respond. The sentence landed like a slap. I was alone in London. I had limited foreign currency. My luggage\u2014most likely\u2014was already flying to Canada without me. I stood there feeling ridiculous and helpless, like a child who has lost his mother in a crowded market.<\/p>\n\n\n\n Then I did the only thing left. I walked back to the airline desk and pleaded.<\/p>\n\n\n\n \u201cI\u2019m a doctor from rural India,\u201d I said. \u201cI\u2019m going to learn how to treat patients better. I don\u2019t have money for a new ticket. Please help me.\u201d<\/p>\n\n\n\n The woman behind the counter studied my face for a moment. Then she softened. She typed quickly, printed a boarding pass, and handed it to me.<\/p>\n\n\n\n \u201cThere\u2019s a seat on the next flight,\u201d she said. \u201cIt leaves in an hour. Run.\u201d<\/p>\n\n\n\n I ran.<\/p>\n\n\n\n I reached the gate breathless and humbled, with a new rule stamped into my mind: never treat a transit lounge like a picnic spot.<\/p>\n\n\n\n ***<\/strong><\/p>\n\n\n By the time I landed in Toronto, the panic had drained out of me. And then I saw a familiar face.<\/p>\n\n\n\n Dr. Nafisa Kapadiya, an MGIMS alumna, was waiting at the airport. She had graduated from Sevagram, done her MD in Radiology at Tata Memorial Hospital, and was now settled in Toronto. Despite my delay, she and her husband had waited patiently.<\/p>\n\n\n\n \u201cWelcome to Canada, Sir,\u201d she said, smiling.<\/p>\n\n\n\n That one sentence brought me back to earth. That evening, sitting in their warm home, we spoke about Sevagram\u2014teachers, wards, old friends, and the strange way a small rural institute stays inside you even when you move continents. MGIMS alumni carry that bond quietly. You recognise it instantly.<\/p>\n\n\n\n I stayed with them for a night. The next day, I travelled to Hamilton and checked into the university hostel.<\/p>\n\n\n\n ***<\/strong><\/p>\n\n\n The McMaster workshop felt nothing like the conferences I was used to in India. There were no long speeches and no ceremonial lectures. It was serious work from the first hour.<\/p>\n\n\n\n The programme was led by giants\u2014Dr. Deborah Cook and Dr. Gordon Guyatt. There were around ninety participants, mostly from North America. I was one of the few from a developing country, and for the first day or two, I felt that difference keenly.<\/p>\n\n\n\n We were divided into small groups by specialty\u2014eight participants, two tutors, and one person who surprised me the most: a librarian.<\/p>\n\n\n\n At MGIMS, librarians were caretakers of shelves. At McMaster, the librarian sat with the clinical group like a key team member. She taught us how to search PubMed and Cochrane properly, how to frame a clinical question, how to separate a good paper from a confident paper.<\/p>\n\n\n\n That was a new idea for me: that finding the right answer is a skill, not an accident.<\/p>\n\n\n\n ***<\/strong><\/p>\n\n\n A large part of the teaching happened through role-play. It sounded childish when I first heard it. It turned out to be brilliant.<\/p>\n\n\n\n One person played the senior consultant\u2014confident, experienced, and allergic to new evidence. Another played the eager junior doctor trying to introduce a guideline without insulting the boss. We acted out the conversations we all know too well, the ones that happen in wards and ICUs when \u201cexperience\u201d and \u201cevidence\u201d collide.<\/p>\n\n\n\n McMaster taught me something I wish we taught residents early: being right is not enough. You have to communicate without bruising egos.<\/p>\n\n\n\n Before applying any new research, we were trained to ask three questions:<\/p>\n\n\n\n Is the study valid? For five days, from morning to evening, we lived inside those questions. We argued over P-values. We dissected confidence intervals. We learned to say, without shame, \u201cI don\u2019t know.\u201d<\/p>\n\n\n\n By the end, I understood what Madhu meant. I wasn\u2019t returning with just notes and handouts.<\/p>\n\n\n\n I was returning with a new operating system in my head.<\/p>\n","protected":false},"excerpt":{"rendered":"The letter that opened the door<\/strong><\/h4>\n\n\n
Heathrow, and a small disaster<\/strong><\/h4>\n\n\n
A Sevagram welcome in Toronto<\/strong><\/h4>\n\n\n
The workshop that rewired my thinking<\/strong><\/h4>\n\n\n
Role-play, resistance, and real life<\/strong><\/h4>\n\n\n
What are the results?
Will it help my patient?<\/p>\n\n\n\n