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Avenia. Hello, Mister Girl. How are you? Can you hear me? I can hear you can hear me. Ok. Yes, I get you. Thank you. Uh, we're just waiting for a few more people to join. It's no problems, no problems. I just wasn't sure how this system works because I've not used this before. Yeah. How are you? You? Ok. I'm ok. Yes, I'm good. I'm good. Right. So will other people be on camera as well or they will just be uh, you, you will be able to see everyone or not? Um, no. So it just be us on camera. But um, the there's a chat box. So people are more than welcome to. I see any questions. Ok, good. So how many have you done this so far? Uh, we've done one, ric surgery. Ok. Um, so we had a consultant from gosh who came and I have, I think another four lined up. Great in different specialties. Yeah, pediatric surgery. Yeah. Interesting. I mean, what, what kind of surgeon was, uh, the other consult, like pediatric, any particular subspeciality, uh, general pediatrics. So, yes, interest in gastro. And so you're doing mainly just surgical branches, is that right? Yes. Ok. Um, so the, we've got British Indian Medical Association, but there's a surgical wing of that. So I'm part of that committee because I have an interest in surgery. Right. Um, and so I think this is a really good way for me and everyone else to kind of get a flavor of the different specialties that are out there. There's no other branch like ophthalmology. So, yeah. No. Well, also I think we don't get that much exposure to ophthalmology and these more niche specialties in medical school. Really a shame because, you know, you guys come like for two days because I get medical students, I sometimes don't even get to talk to them there in the clinic and then I tell them that look come to theater sometimes. So some, some will come to theater and that's usually quite interesting from what to university to come to theater uh as in, as in what students do you? Oh, GST t you know, like uh GGT guys and Kings Medical School. Yeah, those medical students come to the clinics. Um I think we have a few people here so I think we can start if that's ok. Yeah, of course, totally. Yeah. Yeah. Um So hi everyone. Thank you so much for joining. Um as you know, we're running a surgical specialty series where you guys get a flavor of um different specialties, but also with doctors who are in different stages of their training. Um So today we'd like to welcome Mrs who's an ophthalmic consultant surgeon at ST Thomas Hospital, uh Mister Gold. Thank you so much for joining us. My pleasure. Totally my pleasure. Um So I guess to start off the conversation, could you tell us about your journey um from graduating medical school to where you are at the moment? Yeah, of course. So, so I was with your uncle in uh medical school. So we, he, he's with sa and I'm sa as well. So we were on the same like dissection table and uh you know, and various things. So, so after the internship, um we have to do so this is all in India. So we have to do a competitive exam to get into master's. Um So I think about 10 10% people get through that. And so then I chose ophthalmology uh mainly because I had interest actually as a medical student. Uh we had a resident who was like 67 years senior to me and he was a friend through other people from school. So he, when he was on call, I will go and be on call with him and he will teach me one chapter of Parsons every time he was on call. So that's how we will complete the whole book uh during his residency like, you know, all that year and then when he's seeing some patients in the night or, you know, doing some suturing or examining fundus, then he will take me with him and you know, so that really made me really interested. And then I got uh a medal in ophthalmology in, in, in medical school. Um So those were like kind of for me inspiring things uh in medical school itself. And I liked uh that in ophthalmology, you have uh clinical surgical medical ophthalmology, you have charity work, you have research, you have community work. So you know, all, all those things that and you can go in, in a balance of either of those in the mix. So after that, I did my internship from Indore and then post graduation from Surat in Gujarat, which is a three years uh master's program for Master of Surgery and mainly there, you know, you will do cataracts, you know, but not lots of camps as well. Uh And then we did um so me and my wife was in medical school with me and school as well. We did a pla exams uh which is the, you know, to, to come to UK uh part one, part two, part three. So during that period, between 99 to 2000, when we were coming to the UK, I did about uh 15 exams in 18 months in that period. Uh including like, you know, when we started like part one Fr CS, part two Fr CS, part one F RC of part two, part three and of course driving test part one and two. So they were like all lined up FRC of part one. So like all these like 123, MS Master of Surgery, part one part two and then diploma at National Board that was also part one, part two. So like that, there were like 15 exams, uh I did in that period. And so we came to UK, June 2000 and then, uh we did part two lab and then we had to apply for Observer Ship. So by, by chance really that I was just with a friend and he said, his father in law is having surgery tomorrow in a hospital, private hospital. So II said, could you be there? I had just done my part one FRC of at the time. So I said, yeah, sure. If it helps you, I'll, I'll go there. And so I was there and the surgeon said, yeah, sure. Do you want to come in theater? He just asked me to come in theater with him. And then the next thing he asked me is to scrub with him and you know, hold the lens while doing the VR surgery, which is the operation that he was going to do for the first patient. Uh not, not this friend's father in law at the time, but uh so I was assisting him and then he said, would you like to stay over, you know, do the whole list with me? And I said, that's fine. So we got chatting and then during lunch break, he asked me, what do you want to do next? And I said, I'm applying for Observer. So he said, would you care to come to King's College Hospital? You know, that's where I am based. So I said, oh, that would be amazing. So he gave me Observer that day. And then as I was doing the observer, the clinical director gave me a job because they needed it, you know, somebody to take over as an. And um so it was just like by luck, it happened that I got the post there in Kings for three months. And then the main post came up uh like a rotation, two-year rotation. So I got that and then post between Birmingham uh and, and London. And then five years of that training during that training itself, I got to do a fellowship in uh glaucoma within that five years. Then I did a Coronal fellowship at Mofield and then another glaucoma fellowship at fields for 1.5 years, a total of three years of fellowship. And then I got consultant post at Thomas's. Yeah, after that. So for me, it was part luck. But in general, what I found uh most and I tell this to my residents as well that what do you find most useful is actually two things turn up on time for your, you know, whatever you're doing when you're early you see the consultant, you see what's happening and you know, when you get to ask questions and always, you know, finish what you're doing. You know, let's say you take up a patient just because your shift is ending. It doesn't mean that you know, that patient's journey is finished, even you shift may have finished but keep a track the next day or ask what happened because that's how you learn. You know, once you see a patient and in each case teaches you more than any books or anything. So those two things really, really help, you know, sorting out the patient and being on time. I think if you have to do thing two things or get two things from me, those are the two important things which help you in every stage. And so luckily for each stage of my career, you know, the consultant that I was working with made a phone call without me asking them for the next post. So, so, you know, you apply and then they ask you where you're going and then they say, oh, then they make a phone call for you. So they like you and it happens, you know, it's not like there's something unethical or anything. I'm not asking them. They, they want to make a phone call for me. So like a reference do you mean? Yeah. Yeah. Yeah. They will make a phone call and say look uh you know, uh like, so sometimes ii do that for my registers. If I like some, you know, some people and if I know the people so like, say I was operating with professor. So he, he was my consultant at Murphy. He's a professor of ophthalmology and the most dedicated person and the most hardworking person I have ever seen things in glaucoma that I've learned is from professor. Uh So he, so he we were operating and then he, he asked me so, so when is your interview? I said, oh, it's on next week. So he said, do you mind uh doing a favor to me? I said, yeah, please. So he said, can you give me a list of people who are on the panel? Because it will be, it will take me more time to find out. So I said, yeah, no, of course I can. So I just gave him the list and then uh he never told me anything but he called everybody on the panel to say that look. Uh So it's something like you know, which and you, you don't even know that he's, he's done that, you know, until people tell you that oh pro called me or called me or whatever. So, so these things happen in the background. But the reason why they call you is because they like you that you sought out a patient and that you take responsibility for your patients. It's not because you know, anything more like I never got to do any dedicated research during my training, like a two year MD or, or any phd or anything like that. So when I was interviewed for my consultant post, there were, there was a phd, there was MD, you know, all these people were there in the interview as well, uh who, who were being interviewed. But, you know, probably because everybody, you know, had a positive feedback about me, you know, that's why they, so people are looking to work with somebody and, and also it's not about academic degrees when you know, you appoint a consultant. Yes, that's important. But it's about uh what, what do you, what can you do? What can you bring to the hospital? What can you do for patient care? So I think we've been lucky in a lot of things and me and my wife both work at ST thomas'. She's a pediatric clinical neurophysiologist at Evelina. So, yeah, so, so that's our journey or that's my journey into ophthalmology in the UK. It sounds like. So obviously, you, you know, you said, you know, come on time and take care of the patient. So you had your own kind of um interest in ophthalmology, but it sounds like um a big part of your journey was also having the right mentors um and guiding you. So, do you have any advice on how we, as you know, medical students who want to pursue surgery can find mentors who would do that for us. Yeah. So like, like my, my first teacher, I regard as that resident who taught me in medical school. When I was doing my residency in, in Surat, there was uh Doctor Barra Patel who taught me ophthalmology and he's a friend, you know, he, he, he was um and he's become a friend over the years. And then when I came to the UK, I considered uh professor Penco as a great mentor for me. So even now, I think what will prove thing, you know, for this patient, like you know, or deal with this patient in this situation. And Professor Keith Barton, professor and Professor Paul Foster. So these are three main people who influenced my career and I learned the most and they are all three are top in there, you know, fields. Uh So prof is the he's now sir, so he's knighted. Um And uh you know, Keith Barton is uh lead glaucoma surgeon in the country. Paul Foster is the god of angle closure in the whole world. You know, the definition of angle closure is what he gave. So his definition in 2000 is now the definition for angle closure in the whole world is adapted. So, so I got to learn from these people. And, and so II think the key thing is the fellowship where you do your fellowship from. That's a very, very important thing. Medicine doesn't matter like you know which medical school you are in, it's not which general curriculum is the same, you know, and then you do your residency, it's fine. You know, you rotate in different subspecialties and different hospitals. That's also very similar overall. But where you do your fellowship from and your subspeciality or super speciality, that's where. And so I did three fellowship, not just one because I felt so when I went for my next fellowship, like the interview uh at MS uh Keith Barton asked me, so you already done all the things that where you are coming from even learned as a consultant. No, when he was a fellow. So I was, I was working at ST Thomas as a fellow, my consultant. So about him, Keith was saying he never did as many surgeries as you've already done. So why are you coming for another fellowship? So I told him that, look, I want to be in a situation where I can do if a surgery fails what to do next. So, you know, you should be comfortable dealing with all complications, everything that you know, related to that. So you have to be really super specialized in your field to feel comfortable in your job. So that so very few patients, I've had to refer in the last 1314 years as a consultant to other consultants. You know, sometimes they're a medical professionals and they want another opinion or I want them to because, you know, it's a, it's a colleague doctor or somebody or a young patient, it's a 1520 year old that, you know, has a complex condition. I just want to make sure and you know that they are getting or if the patient asks for a second opinion, I will always encourage them. And that a that's actually a very good thing because then, you know, you ask them for another opinion if they are not agreeing with your plan of management. Because the last thing you want is because my field is glaucoma. So, you know, you, you lose sight, you don't have symptoms till very late. And when you have symptoms, it's already 90% damage to the optic nerve and visual fields and it's already late. So, so in the last six months, let's say I've had patients from uh four or five from Nigeria, Tanzania, Barbados, Antigua, Portugal, Canada, USA, India, you know, for coming for specialist surgery uh to and these are some of these patients are people who have been told that nothing can be done for you in the world, you know, like it's too late and uh because II have interest in advanced glaucoma management. So, you know, we are able to still offer them surgery or treatment to save whatever is the remaining. So I'll give you one example of when I was a sho in sit cup. Uh this guy came as a patient, you know, I was examining him and he was uh no light in one eye, no light in one eye. So NPL NPL, that was his vision. And uh he asked me, doctor, will I go blind? No, I had no idea what to say to him because he's already blind completely in one eye. The other eye is only perception of light. So you can only see light is on or off. He can't even see the hand moving. He can't count fingers, there is no charge, you know. So he's blind by many defi all definitions and many times he's blind. So I couldn't uh I couldn't think of what to say to him. So my consultant, this is 20 years ago, 23 years ago. So my consultant who was in the next cubicle heard that question and he came and he said, look Mr So and so if you control your pressure, well, there is no reason why you should lose your sight. So for that patient, that remaining light was very important because that means that they can see where the window is, where the door is. And they can still navigate in the room based on that because they have a plan in the head of the layout of the room. So for that patient and that taught me a lot as a as a show that at whatever stage of the disease you are, there's still something to be done to try and save that because it's important to the patient. So that was really inspiring. So even now, like, you know, I saw king of a country and he's got very poor vision, you know, blind in one eye and just seeing hand in the other eye. That was the only patient so far. Actually, one of the few patients that I've ever refused surgery because I know his pressure is controlled at the moment and he won't get more vision. But even last year, he could see 2 m, ok, something could have been done at that stage, then he would have retained his sight. So I have other patients who are just hand movements, they can only see hand moving, but like one patient is there who tells me if I can just maintain this, I can, I know when my wife is there or my Children have come, I can feel them, I can feel their face. I know where they are. You know, I know where the room is, where the light is. So for him, that's very important. So every two years, three years, when his pressure goes up, I do a surgery or a laser for him to reduce his pressure and he's maintained that sight for the last nine years. So that way, you know, at least whatever we can do for even the advanced stage of glaucoma important for the patients. So, so that kind of, you know, inspires me to carry on and, and my grandfather lost sight in one in one eye. With glaucoma and then he had surgery in the other eye which maintained his sight to the end. So, you know, it kind of uh has a um resonance to me that yes, something can be done that patients should be able to see until the end of their life. That is my aim. And now we plan not just for 7585 but 100 years of age because people are living longer. So you got to try and plan things. So even at 89 it's not enough that you, you give up on a patient. Yeah, there's actually quite a few things that you've said that I was just so interesting. So having that patient focused approach, um and you know, trying to help someone regardless of what stage their disease is, which I think is so great. Um You mentioned, um you know, glaucoma being your um interest, I think I read that cataracts is also your interest. Correct? No particular reason that those two are so important or so interesting to you. Yeah. So, um so when you are a ophthalmology resident, you have to make a decision like just like any other branch like you know, which superspecialty you want to go through. So all of us do cataracts. So that's like kind of common to all of plasmic surgeons in the UK. At least they all got to do a certain number of patients uh surgery to qualify as an ophthalmologist in the UK, it's minimum 300 but mostly people do an average 5 to 800 cataracts as a resident, uh, or at least 500. Yeah. Uh, so 300 is minimum to q to qualify. So we do get good amount of surgery during your residency or your, your, uh, run through training, um, in cataract. And then in the last year you decide, uh, one of the other superspecialty where you want to do oculoplastics or rein or medical retina squat, um you know, cornea glaucoma. Uh So there's so many, you know, pediatrics, pediatric ophthalmology. So there's so many subspecialties and or Superspecialty in ophthalmology. So I got to do a uh Glaucoma fellowship first within my training because the post had become available and I got to do a fellowship within as a, as a resident rather than my fellowship here. And then I did the corneal fellowship which is more anterior segment and then I came back to. So I had an exposure to both and then I liked glaucoma more. So I came back to do Superspecialist uh fellowship in Glaucoma. So that's how, you know, I decided. So what I tend to do and this is a useful tip for uh people who are trying to make a decision. So you write all the subspecialties, all the choices in front of you. And then I take off what I can't do at all. So I can't do this. I can't do this, then your left say out of 10, about maybe four that you can do, then you write, OK, I may be able to do this or, or you know, and these are my two. So you choose about, let's say two down to two or three. And then you see what you know, works out for you, availability and, and you know, so like, II was interested in cornea and then this glaucoma fellowship came along. So I did glaucoma and that's part of the anterior segment. So the posterior segment of the eye is the retina retina. So I'm like more anterior segment surgeon. So I can deal with the front of the eye and the other people will deal with the back of the eye in cataract. Everybody has to do. So, I'm, I'm trained in cornea, I'm trained in glaucoma and cataract. So, so that gives you a comprehensive front of the eye surgery experience. But now I don't do corneal surgery because that itself is a very super, super specialized branch. But having done a fellowship, you have understanding of what is involved and you know, because many of the patients are common, so you have a already understanding of this. So, so that's a useful tip that you write down and then you say what you can do and then you get and then you talk to other people you talk to and go and observe people and then see then what you like more and then make a decision. Yeah. And I think that's applicable to kind of every aspect of still making. Yes. Absolutely. Yeah. Um a question that I asked our previous speaker as well. Um So as medical students, we're asked to kind of look at a consultant and what their life is like because that is what we're going to spend the majority of our life like as well. I think training is a very small portion of that. So what is your day to day life or my life is very happy. So, so yeah, you know, II feel very content with my life and uh I feel very happy. II probably don't want to change anything in my life. You know, I'm very happy where I am, what I do, you know, with family life with my professional life. So I been part of international trials, you know, these are like groundbreaking trials which have actually changed the uh the practice in the world. So we got, you know, opportunity to do be part of those trials. So for me, my c so I have like four clinics, a laser session, a theater session, uh 1.5 days of private practice and a private uh surgery session like that. So, so my, so all my Thursdays like admin research um uh virtual reviews. So, so my Mondays are my busiest clinic days. Monday morning and afternoon clinic. Um Tuesday morning is lasers, Tuesday afternoon is operations Wednesday morning is clinic Wednesday afternoon is private work. Thursday is this research virtual reviews Fridays, all private as well. So like there is a good balance between, you know, uh So, so ophthalmology does give you this uh uh opportunity for uh you know, not just treating in the NHS, but a lot of uh so we get a lot of private patients come from all over the world really uh or they are referred. So I, so like, so sometimes I do surgeries on Saturday as well. Like like this month I had six overseas patients where I couldn't fit them in. So then oo overseas in like out of station from Bristol Coventry, Kent or Nigeria Tanzania. So I had to create a new list for them to operate on them. So, so that's so that's rare. But then once you operate on them Saturday, then I have to go and see them on Sunday as well to make sure they're ok. So that's rare. But mostly my weekends are free. There's one in uh two months, I'm on call on the week or three months on call on the weekend and uh one on call in the weekdays uh uh every two weeks or so. So it's not too bad. So, and that's from home. You're not in the hospital. So usually the registrars or the fellows there are on call and they will uh usually not call you. Uh they know, you know, it's not that can be managed. Most things can be managed the next day, but let's say something comes like a penetrating injury to the eye or, um, you know, that's usually what you need to go in for. Otherwise most things can be managed the next day. Ok. Um, you've, you've already talked to us about some, you know, some of your patients, but is there a particular case or surgery that really kind of sticks out to you as being the most memorable? Yeah. So, you know, this is a, so for me, a lot of patients are memorable patients and some of the most frightening ones are when you're operating on. Uh and unfortunately, many of my patients are single eye only eye patients. So when they have only one eye and the other eye is completely blind and this eye also has, let's say 1% vision left. So I'll show you visual field of one of my patients who I've just seen this week. He's come from abroad. Um I just decided that's his visual field. OK. So that's uh that's his only, the eye is blind and this is the 10 degree field. So this is this part of the vision. We are looking at 10 degrees. So this is about 40 degrees, this is about 70 you know, 50 degrees. So we are looking at 10 degrees out of the 10 degrees, you can only see this two degrees. So the rest of everything is already gone. So it's like tunnel vision and that two very small amount I have worse patients at that as well. So when you do surgery on these patients, then sometimes you wake up in the night or are used to a lot, you know, like thinking of whether they will see the next day because, you know, it's a, their whole life depends on that. Right. Because imagine you have surgery and then you can't see the next day. So, so far that hasn't happened in 14 years that you know, patient can't see at all. Um So I have blinded about and I was counting this thing the other day to a patient who, who is the top, um who is like a, a very a VIP person and he was very scared about surgery. Uh So he's been waiting and he's seen everybody in the world like, you know, America U UK, lots of professors and then he decided that I should do his surgery. So he was asking me every time one hour I will spend with him, you know, in consultation to try and because he was not making a decision, I said, look wherever you have surgery, you need surgery, it's not like you have with me. But so the the question he was asking me is why is your plan? This and the other professors recommending this? And the third professor is recommending this and the fourth professor recommending this. So I had to tell him that look, the professor you are mentioning to me, he refers all his patients to me for the last 10 years. I've done all his patients. That one, the other things you are referring to. There's only three surgeons in the world. I know who do this surgery, which is combined two in America, two in Japan. And you can only I do this kind of mind surgery for patients with such advanced glaucoma. So again, it's not comparable that, you know, because you, you won't get that opinion to do the surgery. And thirdly when patients have such bad glaucoma, when they are nearly blind, we don't put them in trials. So in randomized trials, you exclude certain patients. So let's say somebody has very advanced glaucoma, they endstage glaucoma, then you won't put them in a trial. So, so I can't give you a trial figure. But I can tell you my experience of, you know, last eight years, I've told him in the paper that, you know, we have uh accumulated the patients and everything, uh 60 patients, uh similar situations. So what the results are and all. So, so sometimes these kind of things become very challenging to you because it's not the surgery. Are you? OK, Vinicia, do you know if other people are still there or, or disappeared? I think uh Vinicia is having some problems with that. So uh if, if somebody is still logged in and you can hear me or see me? Oh yeah. Ok. So I think will join us again. So we're just saying that there are, uh, there are, there are obviously challenging patients sometimes rather than uh you know, challenging surgery. And I'll give you an example of a challenging patient where she was referred to me from another hospital. And uh she had surgery in the other hospital already. And then, uh she, once I failed, the surgery failed. And then she was referred to us for managing that eye. So she came in, I said, look, you do need surgery. Your pressure was 30 spent an hour in my NHS clinic. And then she said, no, I want to think about it. So I called her again a few weeks later, it's still another hour. So I spent nearly 34 times um consultations with like, are you, are you ok when you can hear me? Yeah, I'm so sorry. That was my wifi. No, no, no worries. Yeah. So I was just telling about a challenging patient who came from another hospital. Uh one eye had surgery already, the other eye had surgery. Then the one eye surgery failed and then she was referred to us. So I told her you do need surgery. Pressure was 30 then she refused. So we did this for about two months, three months, she was completely refusing. So I said, look, I'm I'm having to discharge you now from my care because I can't see you going blind in my care. So I can't look after you because you're not following what I'm recommending to you. So then she agreed for surgeries. Now on the day of the surgery, her pressure was 28 rather than 33. She said, oh, doctor, look, my pressure is so good. I don't need surgery. I said, look, you need single digit pressures of 8 to 10. Your pressure is still three times higher than what it should be. So she agreed for surgery, her pressure, this is 34 years on, in fact, before the pandemic. So this is nearly 56 years ago. So pressure is now eight or nine in that eye and the other eye is already very good in single digits as well. But because she waited for surgery for those two or three months, she lost another 10% or whatever of of her vision, which was remaining. So now she only has like 5% or 3% vision remaining in her eye. So every time now she comes to the clinic, she first cries that I can't see. My vision is foggy. That's the first thing. So the first five minutes we just do this. And then I said, look, I'm really sorry, I can't bring back what that made me realize is sometimes you have to be even more forceful this thing about patient choice and you know, all this thing is sometimes not applicable. To some of these branches because, you know, if you give a patient choice, nobody wants surgery or nobody wants, you know, invasive surgery in that sense. But then, you know, what are the consequences for this patient? And there's no other way I could have explained to her. No, II remember the similar situation in uh Philadelphia where I was observing, um, this professor, uh who is actually uh the top most glaucoma surgeon there. And uh he, he had a patient with him and, and she refused surgery. No, he had a big go at him. He's called uh spa uh John Space. So, so George Spa, so he's, he's he, he, he is like, you know, one of the dos of uh um glaucoma surgery. So he, he actually had a total breakdown and he actually went at her shouting at her and just going on and on and on. I was scared, I'm like, how is this consultant doing this uh you know, to a patient because that's what you know, II II was like really uh taken aback when he like completely shouting at her and you don't understand this and this is what's going to happen. And he's actually originally from Germany. So, you know, he has this German way of explaining and that's what I had understood. So I now I call it spas way of explaining uh for surgery. And that actually is sometimes very effective because sometimes patients just don't understand what are the consequences? And now I can remember two patients that I, you know, followed space of surgery in clinic, shouting at them and, and one was already a deaf patient and, and you know, dumb patient as well. So she has got congenital rubella so she can't speak, she can't hear and her pressure was 50 she would have been blind as well and she refused surgery. So I had to literally go at her and then she agreed and you know, and then she did well from both eye surgeries, obviously, these are not lifelong, you still need to monitor them, they can still have problems afterwards. But if I don't treat a pressure of 50 it will be blind in like a few months. So or, or a few weeks depending on what the damage they already have. So sometimes it's challenging in that sense where it's so and it's not always, um like, you know, patient choice and all these things are good words, but they don't sometimes work in this situation and you have to be really forceful. A a and, and force them to have surgery. So, so yes, so there are so my life is full of such patients. I can write stories for, you know, hours and hours. But yeah, so, so, so that's just an example of it's not just about managing the disease but managing patient expectations. So, on that point, let me tell you one very good question to ask because I asked this to this recent VIP uh who told me II said to him, what is this? Is that worrying you about your surgery or your condition? So that's a really good icebreaking question to ask, what is it that worries the patient for any branch? You know, you say, what is it that worries you the most because then you can address it directly. Yeah, I learned this thing from Bangor because he would ask this question is what is it that worries you or concerns you. So he told me that look, people where I am don't know that I can't see because I'm able to manage because he still has his central vision. So I'm worried that if I lose that, then people, you know, I won't be able to function. He's still doing his job. He's, he's a high profile person. No, people don't realize that he can't see because he still has the central vision. He can still do everything that he needs to do. But that's actually only by definition, he's blind, but he can still manage everything. So he's worried that he will lose that sight. So I had to recount all those four or five patients who have ever lost sight under my care in one eye and tell him, tell him exactly what happened with each patient and what would have happened if we hadn't done surgery and like infection or you know, like bleeding severe bleeding for like an anesthetic injection or so, whatever I have to actually tell him about every patient. So that took about 1.5 hours to just explain that chances of losing sight is not uh like sarcoma is one in 300 to 500 his risk of blindness is 100% with time. That's what is happening already. So, so sometimes, you know, so the good question to ask is for anything is what worries you about you. So then the patient opens up and they become relaxed. They think you're thinking about them, not just about you telling them what to do. So that's actually a very good question to ask. Yeah. Um No, that sounds great. And you know, it sounds like with your job, it's not just the clinical part that can be challenging but the communication with patients, I think that's what every doctor. Yeah, patients, I suppose. Yeah. Um my next question is um I've had the ophthalmology or getting into it is quite competitive. People say that it's this perfect balance between medicine and surgery, which is nice for people who can't really decide between medicine and surgery. So what do you think we can do? So we as medical student. So I think we have some foundation doctors here too to make our application more competitive for ophthalmology. Yeah. So um so, so there is a slight difference there because I didn't do medical school here. So I'm not like, you know, in that kind of um the normal pathway in that sense, but I'll give you some pointers as to what can be done. So taste a week is a good one. So we get application of medical students all the time. They come spend like just, just now a girl came from Singapore. She's just finishing this week. So she's a medical student there and she has just come to observe, we have the observer from um um when uh from from South America at the moment who has come, but he's a consultant or a Dean Ophthalmology there, he's come to learn certain uh you know, things. So I know fellows are, most of them are overseas as well or UK So what I find is observing, you know, and, and then you say you can say in your interview or application, I went to observe this and this is what inspired me or this is what I learned and that's individual like, you know, what works for you then doing a small project like, you know, by audit, even a small audit of uh like say, you know, a clinical experience of a patient or, or, or interviewing some patients in the clinic, obviously in, in conjunction with the clinic, uh writing a or doing a survey regarding, you know, so you have to be obviously part of a unit where you can ask, what can I do to, you know, and just be after them. The one thing which I would like to say this thing and my wife also tells me the same, just don't get put off by one. Somebody not replying to you once. Ok. So that's a really important tip as well because we do get lots of emails, lots of, you know, from everywhere. Um not just UK but around the world. So we can't accommodate everyone. Ok? So you have to show something different that you know, so like somebody will ask you again and again, like one girl who is actually um school student and it was one of our neighbors, they turned up on my doorstep saying, can you help her because she really wants to do this medicine and can she come in, you know, like a work experience with you? So sometimes you just have to be uh you know, like just, just don't worry about the consequences and just take a bold step. Like the things which work effectively if you think about is if you want to get your thing done. A clark won't help you as much as the, the head of the organization will be able to help you. Like one signature, one word will be enough. So don't be scared of approaching the highest person in that field or highest, you know, because that can open a lot of doors. So, so don't worry about what will they say or what and just write to them again. Or third time it doesn't cost you anything, doesn't they, they won't, you know, fob you off or they might say, look, they will just refuse you. Right. That's fine. So, like my, when my wife was applying for just observers, uh I posted about 200 applications for her. You know how I told you I got like, because I was a attending surgery and the consultant gave me the observer ship there. And then, but like that for her, I posted 200 application, no, sorry, 200 application was to get her first of post applications. And then, you know, first and then first interview, she didn't get the post but it doesn't stop her or, or you from applying, you keep applying and then people will respond. That's one go and do a test a week in, in the department and then look for some projects, a small article or something, you know, along with them like Sushma had a very good medical student and the he audited all their patient journey or, you know, like something within that you can do to demonstrate that, you know, you are interested in the field. And would you say that it needs to be specific in ophthalmology? So if you are doing ophthalmology, you know, if you're applying for ophthalmology application, then it may obviously will be helpful. But any, any audit, any publication and also uh part one as a foundation here. If you do your part one F RC, part one, you know, which people can do, I believe without doing ophthalmology. Then that shows that you're committed to ophthalmology. I see. And you know, you're already on path to uh yeah, and then getting a placement as a foundation if it is allowed in your or related field or, or just going in observing theater, doing a camp uh overseas and doing a um you know, observer overseas where you are allowed to observe, you know, help in the camps or, or some, some voluntary project like that. Uh charity work. So, so there are lots of camps happen all over the world. Um And if you are in, if you're already in ophthalmology or, or then you can learn surgery overseas as well, charitable hospitals or, or contribute. So those things show that your commitment to ophthalmology a and, and there are always volunteering like so there are camps happening but you can't do something as an ophthalmologist. But as a doctor, you can do screening, you can do registration, you can do lots of things. There are so many. Uh uh So yeah, so you're saying somebody should be asking how can we expect you to get involved with research to help with the portfolios? Yeah. So like I was saying, so if you write to and, and then arrange a meeting, writing is one thing but then actually asking an appointment to meet even for five minutes to the research leads of the departments. So every ophthalmology department will have a research lead. OK, so you go and meet the research lead and then they will usually have something or the other which they can, you know, say, OK, can you do this particular audit or do this research or do this? So I can give you a small project because they have different ideas which you know, keep coming to them too. So like doing something like that or even I would say interviewing, let's say, you know, one clinic and asking what patient experience or, or doing some audit on waiting times or just something that can help the unit uh think differently. So you look at, you know, what are the various audit projects going on? You, you can also look at what are the unanswered research questions for each field and then just help in just a very small part of that as to what are the unmet needs, you know, so let's say patient uh you know, blindness or Children appointments or, you know, not getting through. And if you just do a small thing that helps to make that process better by giving some data as to, you know, this is what I found in my telephone interview of 100 patients or whatever, you know, you always have to register these audits and take permission and everything. So those are simple things one can or, or, or if you're part of uh you know, if you do a case report or, you know, any such things, it's definitely helpful. That sounds really good. And actually you mentioned camps. That's not something I've heard about before, but that's really something for like, even when I was a medical student. Uh in fact, I organized that camp myself. Uh So four of us, including, you know, now my wife and another, he's a professor now in um in Medway and the other, she's a consultant in, in Lincoln. So we were in medical school. And so I II did a survey first along with them of a slum in India just to see how many Children were not immunized when they should have already had immunization. So just a slum we took and then we went home, you know, take registration of all the people who have not had immunization, what immunization they had not had. And then from our pediatric department, we brought the immunization kit into that slum and immunized uh the people who had not had the immunization. And then we also gave them other health advice, iron tablets, contraceptives advice, you know, like general things which you can do in that situation. So, and that was a three month project. So one was a visit to survey, one was a visit to give them the first immunization and then a second immunization. So it just becomes like a full project where you have helped maybe 203 100 you know, people uh get health care and also put them in touch with that. What, what they can do next if they have other problems. So something like that, you just have to think about, you know, camps in that way as well. What volunteering you can do, get help with volunteering or organizations. Um you know, like, like like India, there is rotary, there is Lions Club, they do lots of these camps and camps are happening all over the world. In, in that way there are people in, you know, in, in UK who are involved with charities that ta take doctors to like Tanzania to Nepal to, you know, so just even if you have to self fund your ticket, that's still worth it, you know, to go and you can also have a holiday there, you know, while you are there, you can, you know, have time for yourself to a holiday and then do some voluntary work. So that kind of thing can really put you apart from somebody who has not had any exposure at all. Just attending one camp in a different country with a voluntary organization can put your application in, it shows your commitment to this subspeciality and you can talk about that in the interview, not just your application, your experience and what inspired you what you felt. Yeah, that itself is actually quite inspiring because I think as students, we get so caught up in the building up portfolio and doing everything kind of tick box that actually doing community work and charity is so much more important, so much more valuable. Absolutely. Um Something else I wanted to ask you, you mentioned um about your research and I read that you do these international Multicentre trials. Yeah. Um I wanted to know a bit more about that. So how that started? What motivated you? Yeah. So when I was a fellow at Moorfields, um I was part of some trials which are going on as a fellow, you know, like I used to go to Bedford. So my, my time in field used to be like quite challenging. So one morning I'll be in city road in, in S and I'll go to branches like 1618 branches around London as well or, or, or not as many, but definitely now with community centers, they have that many actually and even abroad in Dubai and everywhere. So I used to go mo morning moves and afternoon, I'll go to S or to barking and then Tuesday morning somewhere and then Tuesday morning, I would go to Bedford and then afternoon, a itching group which is like two hours away. And so I used to have a cab, take me from Bedford to Itching group 45 minutes journey in the cab. And that was a research project that was I was part of. And then when I was at movies, they were doing these trials called PVT Trial Tube versus Trabeculectomy. Study, it was an international randomized trial. So you just learn clinically, like you recruit patients there, you, you, you sign up patients who consent them. And so that, and then when the P TVT trial was launched as the next stage. So then I, you know, approached the investigators. So it was only three of us from the UK, then who were part of the trial, one from uh MS and Thomas and Queen Mary Cup like that. So I was part of the trial. So we actually recruited the highest number of patients in the trial from UK. Half of the patients came from although they were uh 17 centers or something like or 13 centers. So 17 consultants, but we gave them the highest number of patients while I was doing that trial. Then another trial came up called eagle trial, early lens extraction in glaucoma. So that was published in Lancet in 2016 and that has changed the management of angle closure all around the world. Oh wow. So now for angle closure, glaucoma patients with high pressure, we take out the lens if they are over 50 years of age rather than doing glaucoma surgery first. So the lens plays a big role in causing angle closure, glaucoma and the incidence of blindness in angle flu glaucoma much higher than open angle. So the 11 out of four people uh in the world are blind with angle pressure, glaucoma as as compared to one out of 10 and open angle glaucoma. It's a more blinding disease, but just taking out the lens gives them better vision takes care of their glaucoma and 60% of the patients afterwards didn't even need a drop to control the pressure just by lens operation. So like my patients now were 1012, 13 years, I can still see these patients. Many of them are not on drops at all, we can discharge them even at the early stage. So that was again because I wrote to the uh investigator who was there in, in, in um in Aberdeen at the time saying look, this is my experience, this is my CB and as a young consultant, I want to be involved in this trial. So then he, you know, he, he allowed me to be part of the trial. So like that sometimes you just have to, you know, be proactive. Then I became part of another trial called tags treatment of advanced glaucoma. So that was a UK wide trial. So I was investigated for that. Then we've done, done a few trials now within our center as well as Thomas and regional trials. So these are mostly clinical trials. I'm not a lab based, you know, like researchers, it's more like clinical what works for the patient in real life. And so yeah, like that, that sounds really great. Um I just wanted to let everyone know that if they have questions, you're more than welcome to put it on the chart. Um And um mister go, another thing I read was that you're quite active in teaching as well, so you run courses. Yeah. So uh it's like all consultants are, you know, involved with teaching uh in, in a way. So it's part of our life. So, yeah, so we were that course, like actually stopped doing that course now. So they used to do a Trabeculectomy wet lab because now there are lots of devices in the market. So, so this is something also I want to tell you as a young um medical like, you know, uh training um a lot of things that you see and read or are are, are industry driven. OK? So a lot of trial work, a lot of these things. So again, and that doesn't necessarily represent real world because many of the trials don't get published. Many of the devices that come into the market are propagated by medical device companies and industry. So, so I try to take care. So I have no financial interest in any companies that way I don't take or I have not had any funding from any of these companies to. So I will say as it is like, you know, if, if it revise doesn't work, I don't have to hesitate. And I will say, look, this doesn't work in my hands, at least you know, it it may work in somebody else's hands. But it doesn't work in my hands. So it's a lot of things in glaucoma we are now seeing is a push towards new medical devices. So as we are very lucky with uh with uh with our uh research lead, Professor Lim, he's a Prosor of glaucoma. So we get lots of uh all the new devices come through because we have a aqueous dynamics lab, the only one in the, in the whole of the country and probably Europe and a few in America. So we get all these devices to study them to see whether they work or not. So we are able to use them in our patients, offer them as part of trial and then study them. And then so what I find is that you have to be very careful. And so the reason why I came to this answer is because so the company has now stopped doing that wet lab because they have their own uh device that they want to market, which doesn't mean that the other surgery is required. So that's why they stopped doing that uh surgery um wet lab. But yeah, so uh you know, we do whatever and we also uh my colleague, Miss runs a laser course. And so people come from all o all over the country to learn that as well. So yeah, so wherever we get chance, we have medical students, research fellows, fellows, clinical fellows. And uh so yeah, so we, we get optometrists work with us in the clinics. Nurses are there. Ortho are there. So there's a multidisciplinary team. So, so that's a, you know, an important part of uh any job. Um I II think I would probably want to be a bit more involved. Uh But at the moment I think, uh there's so much competing, you know, uh priorities on your time that um it's not always possible to do everything. Yeah. Um Does anyone else have any other questions that they would like to ask mister go? Just do it. Um We've talked a lot about your like a lot of things that you do clinically. Um anything outside of medicine that you're passionate about. Yeah. So uh again, I would say time takes a little bit of this thing. But uh so II play badminton on the weekends, so we used to play two hours on Saturday and Sunday. So now it's only Sundays uh two hours. So that's something I really enjoy and look forward to, but that also has its own downside. So I had a back injury um last year and then just last month I had a bad, you know, moving short and then my muscle went into back. So, so that has its own and, you know, our job is mostly sitting and seeing patients doing surgery for hours together. So there's a lot of strain on the back. So that's definitely has a uh impact. So that's something I enjoy I love traveling and I love enjoying time with my family. So we have two girls. So one is in Cambridge. She's doing history in Cambridge. She's in P and uh the other one in school. So we love watching together, Grey's Anatomy. I don't know whether you guys anatomy and sometimes, you know, I look at these things and I, she was telling me yesterday, both my daughters, oh, I saw daddy crying. So, you know, like you, sometimes those are emotional scenes that there with patients or something and you do feel quite emotional. And so yeah, so it's uh so II uh I just spend time with my family and we love to travel uh wherever you get a chance. So try and do like a three weeks somewhere. We can drive around that country, explore different places in the country like that. Once, you know, every year or two, we want to do that one big trip as well so that it's not just small trip, but you enjoy the whole country rather than just uh one place. So go around driving and then you enjoy that place a bit more in depth rather than just the main sites. Yeah. Thank you. Thank you so much. Um I don't think we have any more questions coming in the chart. What do you guys? So anybody who is interested in ophthalmology out of the people who attended, anybody already was thinking and uh you know, they, they feel that something that inspires them in general or as an option. Mhm. Currently, um, I know there's one person here who's in foundation here maybe. And he's definitely considering ophthalmology. Good. That's great too. Oh, yes. Yeah, just applied and had my, oh, so quite a few people are. Yeah. Now, I must say it's really, uh, for me it's, uh, you know, fascinating field and, and, you know, every day because sight is such an important thing. Like, you know, like yesterday, I give you just one example, yesterday I woke up at 2 a.m. in the morning and I couldn't sleep because one of my friend's father is having surgery and this is only eye or very, very advanced glaucoma and day before he was in theater and he refused surgery, he got panicky and, you know, started hyperventilating and they had to cancel the surgery. I had a 40 50 minute chat with him, you know, the day before to say that, look how it's important what I see in patients when they go blind and then you can't reverse it and you can't go to the toilet and you can't even look after. You just can't see the food dependent for everything. And then thankfully yesterday, he did have the surgery in both eyes at the same time because he had the best place to have surgery because he can't travel here. So he's having in, in India where he lives. So I was just so relieved that he had surgery and I was very emotional because, you know, when somebody goes blind in both eyes, that's a really hard thing for not just themselves, the whole family. And, you know, to look after a person who is completely blind is, is a big challenge as compared to, you know, having at least some vision. So for, for me, it's a very rewarding branch that, you know, you, you and, and the other thing is when you do cataracts. So when I do surgery on Friday, I call them on Saturday and the kind of come and say, you know, I can't believe it what I'm seeing, you know, my life has changed and some of them are disappointed but they say I can see my wrinkles on the face. I can, you feel like in a good way. Yeah, what have you done? I can see all my wrinkles now and this and that. So it's a really, you know, uh I had this couple on is 98 year old and 96. Her husband brought the wife and she was sitting like at this distance and I asked her, what can you see? She said I, yeah, I can see you doctor but she could see me. But the husband is saying no, no, don't listen to her. She has cataract, she's falling over. So I did her surgery and then they came, you know, a type four concern with her dementia and the next time they came, the husband is saying mister go, you've created a real problem for me. I said, what have I done? No, she can see everything she's telling me there is dust on the floor, get the hoover, do this, do that. The garden is admiring the bird, you know, like in a positive way. He was so happy that, you know, she had surgery at 96 because actually her engagement with people around her has improved because she can see more. So her dementia in a way is less pronounced because she can engage with uh everything she, you know, she so she can interact, she can see things around her. Yeah. So, so it was really, really and then we did her other eye as well and it was very, very happy that both of them coming together, holding their hand 9896 they come to my clinic, they have no Children, no family and, and they are caring for each other in a way. And, and the only thing she was asking me in theater is am I going to see my husband? Can you take me there? Can you take me there? I want to go back. That's all she was saying all throughout, you know, before the surgery. So it was really, so, so this this kind of uh rewarding experiences you have every day, literally, every day you give us, you know, operation every week and then patients come and tell you how well it is, how wonderful it is. So it's really rewarding. That sounds really great. That sounds really wonderful. Um Thank you so much for talking to us. Absolutely wonderful. Um And also such a breath of fresh air, having someone so passionate about what they do. Um you know, whatever you do, you have to enjoy your work. Otherwise, you know, it's, it can be, medicine can be very hard, it can be very, you know, especially in this stage when all the friends, you know, you will see they be like, like vice president of a company or they are earning money or they are top well, they are lawyers earning 100 and 50 grand or, and then you say, oh my God, I'm going to start at the basic level or like, you know, foundation F one and then my salary is going to be there. But it doesn't matter. Honestly, I'm telling you all of you guys, you know what you do in your life afterwards is so much more rewarding and they actually will give up their jobs and they become um uh it could burnt out at 4850 because they just don't enjoy their job anymore. Then they want to become a teacher or a volunteer. Whereas your job is never boring. You know, you are always doing new things, you're always meeting new people, always interacting with them and always doing something which helps people anyway. So your job is never boring if you enjoy what you're doing. So, we really don't think about this thing at all that, you know, that people are doing this, just think about 1015, 20 years down the line and for the rest of your life, for the next 4050 years, it's a very, very, uh, you know, rewarding branch. So don't get disheartened if you need the long hours and the exams and this and that, that's all the face which you know is, is, is worth uh eventually. That's how I feel. Great. Thank you. Thank you so much. That was so great. Um If nobody has any more questions, I think we'll end the session. Great. Thank you so much. And you know, by all means, if you ever want to come and observe in the data or whatever, you're more than welcome. Does that sounds great. Oh, who is current's dad? I'm just trying to understand. Oh Mo Mo Mo son. Uh He told me that your son, his son is in, I is the right girl, your son. Yeah. Yeah, I think uh he told me. Yes. Yes. Yes. So is uh yeah, a colleague consultant here. Great. All right, all the best. All of you and I hope uh uh you get positivity and you know. Yeah, just keep doing what you're doing and be positive in life. That's the main thing. OK. Thank you so much. Yeah, lovely. Talking to you. Thank you. Thank you. Bye.