As a doctor who quit due to burn out and severe depression and anxiety, this message resonates almost too much for me. I quit my fellowship training before finishing it because it's not something that's worth dying for. When you feel pushed against the wall more and more with increasing duties and stress, at some point you either get squished flat or you quit- jump out and take a breather. I know my patients need me. It doesn't matter if the system is designed so that everything's evidence based- that it shouldn't matter if some other colleague took my spot. My patients know me by name, their family knows me by name... not every doctor is the same, just like how not every tool in the tool box is the same.I miss them, and they're the reason why I even bothered hanging on for so long. It sucks, but when it comes down to it, a dead doctor can't help patients. But honestly? The problem is on a systemic level. Everyone's concerned about doctor burn out and the lack of medical staff, but no one wants to reduce efficiency or prolong waiting time. I honestly think a better approach is just to give medical students and juniors a realistic expectation at what's going to be waiting for them in medical school, residency, and fellowship. Wellness sounds all good and fancy on paper, but can they really implement it effectively? I have my doubts.

@IWorfare

Жыл бұрын

the biggest problem is that the brain functions on a law that "good cannot exist without bad". this means anytime you experience good, you will experience bad ( mental pain such as depression, anxiety, anger, etc) to cancel out the good. we need to break this law with brain implants cause humans arent happy and are suffering no matter which job you pick. even video gamers suffer with mental pain.

@ntebemosai

Жыл бұрын

I also feel like quitting, but I don't know what else I will do.

@IWorfare

Жыл бұрын

@@ntebemosai we need more doctors to use deep brain stimulation on people for depression. depression isnt just going to go away on its own. its gonna keep coming back no matter which career you choose. death isnt the answer cause you will just be reincarnated

Dr. Ellison brings up many great points about the mental health of physicians and burn out rates. I believe that there is an ethical dilemma here of asking doctor’s to “do no harm,” but there is harm being done against physicians every day. Most physicians are overworked and tired from long hour days. A great point Dr. Ellison brings up is that physician burn out begins in medical school. As a second-year medical student, I completely concur with this statement. I take an exam almost every week, where I need to study, on average, twelve hours per day. This amount of studying and dedication has taken a toll on me to say the least. I have gained around fifty pounds since starting medical school, and I have also been chronically anxious and stressed about exams. Moreover, I also have many friends who have failed out of medical school, have taken a leave of absence for the sake of their mental health, and even must repeat the year since failing too many courses. In my opinion, this system of academic rigor causes a ton of harm towards students because not only do we have to make sure we do not fail any courses, but we must also keep our mental health under control enough to maintain our grades and avoid burn out. However, this begs the question: how can we fix the system to allow for physicians not to be burned out? I believe that it starts with allowing physicians to work less hours, especially during residency. In addition, he brought up another great point in healthcare, which is a feeling of detachment. Physician’s start to lose their passion for the practice of medicine and seeing patient’s from being overwhelmed. Physician’s need to be perfect, have everything under control, and cannot put the needs of themselves and their families before their patients. Even now as a medical student, I moved away from San Diego, CA, where I lived with my parents for twenty-five years. Now that I live in Utah and must study long hours, as well as attending labs, I cannot make time to talk to my friends or family. I barely talk to my mother, father, and brother. When my brother told me about his new job, I congratulated him, but I felt detached from him and what is going on in his life. This is hard on anyone; however, to become a physician, these are the kinds of sacrifices we must make. The only issue is we do not want our physicians to make the ultimate sacrifice and lose their life. As a society, there needs to be more time and resources allocated towards the mental and physical health of their physicians before it is too late.

This is so important for everyone to hear - I dropped out of medical school because I was losing my humanity. Very little support, lots of shaming, and lots of pain. Suicides, depression, drug use, and mistreatment were prevalent. Speak out!

@Bee-tj8gc

2 жыл бұрын

250,000 people die from medical error a year. I hope the end HIPPA, malpractice insurance, and start making doctors wear body cameras. just like police

@Bible33AD

2 жыл бұрын

@@Bee-tj8gc what makes u think doctors are the ones responsible for the medical errors? Doctors have no voice in the US. There are many hands in medicine. The public have no idea. Some hospitals insist docs enter all orders in the computer even during sleep hours throughout the night and go to work in the morning. If a doc is on call for a week that's so many patients endangered by dangerous policies due to sleep deprived docs. U wud be sleep deprived too if you were forced to work like this and imagine the consequences. There are numerous other dangerous situations not created by docs

@Bee-tj8gc

2 жыл бұрын

@@Bible33AD police work 12 hours shifts and most of the time are called to work holidays, major sporting events and big concerts. Society has recently held cops to a hire standard, making them wear body cams. Any profession involving the business of life and death should be held to hi standard and closely recorded

@widadm1389

2 жыл бұрын

@@Bee-tj8gc have u even watched the video?

@Bee-tj8gc

2 жыл бұрын

@@Bible33AD doctors use medical scribes to enter data in computers you don't know what your talking about.

Dr. Ed Ellison makes an excellent point about the ethical oath’s doctors take before they practice medicine. He brings up the topic about do no harm which is nonmaleficence. In the medical field we almost always attribute this do no harm ethical principle to only our patients. I can admit I did this until just now. Dr. Ed Ellison talks about how this principle applies to much more than just our patients. It applies to our colleagues and most importantly ourselves. This idea is not taught in medical school and is rarely talked about and why we are seeing such a high suicide rate among doctors. We need to take care of our doctors so they can save lives. I believe there is a disconnect between the doctors who need help and are not getting it because the help they need is much different than the help they offer their patients. Many times it is not physical help they need but a spiritual/mental help. Doctors are often so used to treating physical ailments they do not recognize their own mental health as being a problem. Dr. Ed Ellison talks about the idea of being resilient and I think this is what many doctors fall back on. This idea of just keep going no matter what. There is a way to be resilient in a healthy way and ways that we are seeing in the healthcare field that are not.

This was a fantastic talk by Dr. Ed Ellison surrounding the ethical dilemma of burnout in physicians. He highlights the discrepancy of learning the principle of non-maleficence, or “do no harm”, in medical school and the strain this often places on the physician. He started off by describing many of the qualities of healthcare professionals - dedication, high attention to detail, empathy, and the ability to put the needs of others first. He described how these qualities are part of what makes excellent physicians; however, he also described that these same qualities can be detrimental to the mental health of a physician, in a broken healthcare system. He then proceeded to describe how doctors are devoted professionals who don’t give up until they do. Depression and anxiety can creep in when a person is chronically overworked, chronically sacrificing their health and personal life, and chronically being meticulously graded on their performance. Many doctors will push these feelings aside to continue to put patients first and try to perform to the level of expectation placed on them; however, over time, they develop burnout. A shocking statistic that Dr. Ellison shared was that the suicide rate for physicians is higher than that of combat veterans. Male and female physicians have a 40% and 130% higher risk of suicide when compared with the average population. The current medical system is beating down doctors and ultimately violating non-maleficence within its own ranks. It is doing direct harm to the mental, emotional, and physical well-being of physicians. The unfortunate truth is that this mistreatment starts at the beginning of training. Dr. Ellison described how all stages of training promote an environment where the needs of the trainee are secondary to the training. Medical training is incredibly rigorous, and the health of the trainee is often sacrificed in the process. Basic needs such as sleep, nutrition, exercise, social relationships, and accessing healthcare are all compromised due to being chronically overworked. But the violation of non-maleficence does not end at the physician. A burnt-out physician is less empathetic and can become disengaged. This severely detracts from quality patient care and ultimately violates non-maleficence by doing harm to the patient. While not intentional, a disengaged physician has less ability to be empathetic towards their patients. A sleep-deprived physician is more likely to make mistakes. The list of collateral detriments that the patient experiences from this broken system is extensive. A major issue I see in the medical field right now is the focus of the issue. There is a high level of resistance to promoting the health of physicians. Organizations will offer additional resources and training to try to help their physicians better accommodate the environment. However, the issue is often not the trainee. The issue is often the system itself. I could not agree more with Dr. Ellison that to promote non-maleficence to patients, we need to promote non-maleficence among our own healthcare ranks and that begins with recognizing and protecting the humanity of our physicians.

The sort of behavior around burnout Dr. Ellison talks about is rampant in today’s medical field, and I’m so grateful for this video calling attention to it. Burnout is real, and I’ve seen it a lot in my short career in medicine. I used to work in an ER, and it was easy to see my peers becoming numb to the horrible things we would see. Even now as a student, I feel the effects of burnout in my own life. Things that used to be interesting to me in my studies, have become closer akin to chores. What’s worse is the constant nagging feeling that I can do more. Regardless of if I’ve literally studied for 16 hours in a day, I can always do more flash cards, or listen to another podcast, or review another lecture. The study of medicine is so vast, sometimes it feels infinite. All that to say, I really appreciate this video and the things Dr. Ellison suggests to help fight burnout. My best exams have been the ones where I’ve leaned on my peers in study groups and made sure to take time to exercise and spend time with my wife. Sometimes I feel bad taking time to do other things, but I remember that if I’m not in a good place mentally, my future patients won’t be getting the best version of the physician that I can be. The only way to truly “do no harm” is to make sure that we, as physicians, are mentally, emotionally, and physically able to do so.

Thanks could not have said it better, consultant psychiatrist for 31 years.

Thank you! There is a great need to validate that those people have right to feel exhausted. They are not for society to drain dry. Physycians, nurses, paramedics, lab workers... They are people and they deserve compassion.

@CheyenneHeka-uo5tn

Ай бұрын

This is an amazing and so important!

To all the doctors out there who are suffering from a sense of not being good enough, not being appreciated for the incredible job that they are doing, getting beaten up due to the ignorance and illiteracy of the mass population, the guilt when trying to put their own needs before others; please take care of your mental health. If it doesn’t feel right, there’s no shame in choosing what is right for you and leaving what isn’t. You should come first always.

My brother Dr. Stephen Ranji commited suicide on Feb 25,2022 He was a great doctor.. I love him 4000

@charminglife6150

2 жыл бұрын

Sending love to you.

@SUSANRANJI

2 жыл бұрын

My brother Dr. Stephen RANJI commited suicide on Feb 25, 2022 He loved children, he was an exceptionally talented person I love him 4000

I’m a nurse practitioner in Canada, this is exactly how I have been feeling. I’ve tried to reach out and ask for help and have only met resistance. Shape up or ship out was essentially what I was told. Trying to find my place.

@dantheal4416

4 жыл бұрын

I hope you get the support you need and if you can't find it within the profession find it from a counsellor. Good luck

@autoimmunewarriorqueen7130

2 жыл бұрын

Reach out to other community professionals. You are not alone and maybe you can open a care clinic that doesn’t overbook patients, practices real individualized care and staffs mental health providers for both patients and staff. These kind of clinics are possible and we need ppl like you and other established providers to bring ethical care for everyone into reality.

Thank you Dr. Ellison. Teaching doctors to heal themselves is more important now more than ever.

I am a compassionate, courteous, respectful person, of course, and with an injury I suffered 7 years ago I was all that with the 24 doctors I consulted. And what was their response? I believe they saw me as someone they could get through the consult very rapidly with and with minimal offering of assessment or intelligent treatment, easy to manipulate. I was shocked, never been treated like that before by any other category of professional or any other human being. Three of the 24 I saw were truly good souls and helpful. A compassionate think outside of the box primary care doctor friend of mine just retired from the profession enraged at colleagues for their lack of curiosity in problem solving for patients, telling patients so commonly that their problems were in their heads instead of admitting they didn’t know the answers for those patients, and not being up to date with latest developments in their specialties. He felt another problem is that patients overly divinize and act subservient to doctors. Yes, I understand these doctors have complex challenges, but how many do really from the beginning have an interest in humans rather than money or prestige? How about totally reworking how they are taught in medical school? How about training and then screening for social and psychological skills, and delegate to research only those grading poorly in those areas? Also, protest medical corporations who treat their doctors and all staff so inhumanly, seemingly a common problem. I met a doctor from Denmark doing a fellowship in the U.S.. He could not imagine working in the American system, again which does not allow the doctors to be human or train them to treat their patients as humans.

I finished 2 hours, after clinic hours, at a clinic I don’t own, trying to find an intervention for a dangerous psychiatric crisis of SI and acted on HI ... in elementary children ... whom I’d already referred to Psych and sent to Pedi Hospital ER, from which they were punted back; to then be confronted with the managerial reality that such practices lose money. I was not insulted by this because I know it’s true. Appointments are scheduled for every 10 minutes (less than 10 min therefore for triage/SOAP/discharge).

Dr. Ellison hits on a major point that has become such an important topic and concern to focus on for physicians, residents and medical students - burnout. I think that this idea has become even more important to focus on as when Dr. Ellison gave this talk nobody knew that the COVID pandemic was going to occur and we have seen the lasting mental effects that it has had on patients, physicians, nurses, residents, medical students and all sorts of medical professionals. It has become even more imperative that physicians and medical professionals focus on taking care of themselves as well as their patients. I really appreciate the point that Dr. Ellison mentions about how physicians go into medicine to “do no harm” and provide “benefit” to their patients. However, what often gets overlooked and forgotten about is physicians need to focus on themselves as well because they are also humans and should be “doing no harm” to themselves. In order for physicians to be able to provide the continued empathetic and passionate care they strive to give their patients when they first enter medical school they have to realize that their own well-being is just as important if not more important. Once a physician starts suffering from burn out their ability to provide top notch medical care for their patients deteriorates, which results in them unfortunately breaking the fundamental oath of “do no harm” to our patients. As a current medical student I have seen and experienced the burn out associated with medicine and how medical professionals seek to help others but suffer from the issue of never taking care of themselves or seeking medical attention for themselves because they feel like they are not allowed to also seek help. Although it is not perfect by any means, I have seen a major shift in teaching and resources provided from my medical school to help students approach, coup and deal with mental stressors or burdens. I am by no means saying it is perfect, but the intent is there and it needs to continue to improve. Before medical school my goal in becoming a physician was focused on helping improve the lives of others because it brings me so much joy, this has not changed; however, I have come to realize throughout my first two didactic years how important taking time for myself and focusing on myself is to my overall success and ability to become an amazing physician. Dr. Ellison really covered an amazing topic and sheds light on the importance of saving the lives of those working to save lives. All in all, not only is it imperative that physicians do not harm to their patients but also it is vital that they do no harm to themselves.

Perfect timing! Thank you Dr. Ellison for an eloquent talk offering realistic picture and solution.

Well said, Ed, such an important issue for all of us. I still remember the day I got my medical school acceptance letter from Northwestern. It was one of the proudest days of my life, and I wish we can all think back to how each one of us must have felt on that day. SCPMG is leading the way with your leadership.Thanks for all you do.San B.

Way to light the wick of an idea, Dr. Ellison! Such an important, powerful message to share. And love that you've shared something we can do to help remedy this. Thank you!

Absolutely love this ted talk! He is so well spoken! And so compassionate

Very well organized talk that drives home the point for the all the stakeholders. Thank you Dr. Ellison.

You nailed it Ed! Such an important issue.

Brain injured veterans are like this very much. Thanks for exposing this truth

Thank you. My dad was a physician and I loved him so much and I also really appreciate my family doctor so maybe the next time I see him I will tell him that and maybe I will tell him that not do I appreciate him but I have no doubt that his other patients feel the same and I hope he is looking after himself.

Dr. Ellison’s discussion five years ago regarding one of the most significant issues facing the U.S. healthcare system still rings true, now more than ever after the COVID pandemic. I feel the philosophy that is repeatedly ingrained into physicians of always placing patients first and never showing weakness has ultimately led to many physicians’ downfall of mental, physical, and emotional health. The current administrative duties/burden within the current healthcare system placed upon physicians doesn’t help their situation and eventually, this toll on physicians’ health begins to affect patients. As Dr. Ellison stated, physicians are instructed and taught to do no harm, the very definition of the medical ethics principle of non-maleficence. However, I agree wholeheartedly with Dr. Ellison that if physicians are continually trained without any instruction to focus on their own wellness, their current and future patients’ health outcomes will continue to suffer. Physicians will become overwhelmed, make medical errors and patients will suffer maleficence, no matter how diligently physicians attempted to avoid those errors. I agree with Dr. Ellison that physicians should “put their own oxygen masks on first,” or in a more general sense, happy, satisfied physicians will lead to happy, satisfied patients. If reform can be made starting with medical schools and hopefully progressing to rotations and residency programs, future physicians can further uphold the medical ethics principle they were mandated to do from the beginning, which again states, do no harm or uphold/maintain the principle of non-maleficence.

Dr. Ellison explained that while being a doctor is noble calling, there can be a darker side that is often left unsaid. The medical world is being strained as doctors who are not saying anything about burn out syndrome, a mental and physical condition that is a result from chronic workplace stress where a person can feel totally depleted from energy, feel cynicism related to their joy, and suffer many symptions of major depression disorder. Dr. Ellison explained that the qualities that make doctors great doctors often lead to misery for that person as this job requires so much giving and with little return or rejuvenation. It is often true that perfectionists make great physicians which is a great trait but often can lead to isolation in their personal life and limit them to want to ask for help from others when they need to. This isolation, lack of exercise, constant shoving of emotions, fear of failing and dissappointing others or failing their patients leads to disengagement, detachment, and depression in their personal life. If we are going to change it, we need to change the culture of the medical field even if that means going against the grain of what the culture originally has been. It is important that physicians are taught that they need to keep up on their nutrition, exercise, mental health, and put their wellness on the top of their list even above others so that they can ultimately be the best doctors they can be. I think it is essential that we end this epidemic of burn out and depression amongst doctors who are people too. I will start be reaffirming my humanity as I fulfill my first noble calling of saving my own life before I start to try to save others lives.

Thank you for a powerful presentation and for making a difference in our world.

How do we expect our physicians to help the community when they are unable to take care of themselves? There are tremendous amounts of expectations, pressures, and the need to be perfect, that it creates burnout, suicide, and poor mental health. I agree with him that doctors are people too, and we need better resources and support for our physicians. As a medical student, I agree with him that it starts right from the beginning which is medical school. My peers and I started out school with excitement, but by the end of our second year, all I see around me is burnout. It is so crazy to me the amount of information that is expected from us, and it is true that many students do not ask for help. I think that is one of the biggest problems, which is the inability to set aside one’s ego, and ask for help. People are afraid to ask for help, but how are you expected to ever learn if you don’t ask for help? I am a proponent of asking for help especially seeking mental health resources when I feel myself headed towards an emotional state, but many of my peers who have greater troubles than me, refuse to seek help. It is the ideology of perfectionism, and I think that by being a perfectionist, it will eventually lead to the violation of nonmalificence which is to do no harm. How can ensure that someone does no harm if they never ask for help, constructive feedback, or critiques on how to improve oneself? By hiding our flaws and mistakes, it absolutely does more harm than good. By lack of sleep and depriving our body of nutrients, we are doing more harm to our patients by not showing up with our best versions of ourselves, not leading by example, and not mentally sharp to provide the proper care. I wish this was emphasized more in school, because in order to fix the problem of physician burnout, we must look and help shape better practices amongst medical students.

Thank you for bringing this topic to light and provide insights!

Truly inspiring talk. We need to help the doctors and care professionals.

Its a number of small things that pile up; one step would be, could you get people to quit demeaning us by calling us “providers??” We’re physicians and it is wrong for the “suits” to take that away from us.

@historypandas3457

2 жыл бұрын

me, me, me, it's always about your ego start focusing on what really matters which means in your job - the patients

As physicians continue to get more and more depleted and exhausted from having to take on so many roles as well as having shortages across the country, how can we ensure that we shift this paradigm into something completely different and make sure that physicians get the rest that they need, and the opportunity to have as much self-care as they give to others? Physician burnout is extremely complex and includes a multitude of factors, including depersonalization, emotional toll caused by patient care, as well as reduced quality of care. Due to these many factors, it is hard to pinpoint what the steps forward should look like, but we do know that it needs to be multidimensional. With the current system that is in place, it is extremely difficult to know what the right answer is to prevent physician burnout. One thing that should be considered is the fact that governmental entities have not approved enough residency spots for physicians to be able to get matched and work in their perspective fields. Due to this, the physician shortage continues to grow larger and larger, without any solution in sight. We cannot solve physician burnout if we do not solve the issues that are larger than what we can control. Although there was an increase in residency slots this year, it is nowhere near where it should be. There should be growing concern of physician and other healthcare professional burn out, because if we do not figure this out as a society, more and more people will be impacted and sick and continue to be sick. How can we help those who help us in a way that is beneficial for society and prevents us from getting worse?

You mentioned the importance of addressing stigma surrounding mental health in healthcare settings. What specific steps or initiatives do you believe institutions and medical organizations can take to effectively combat this stigma?

I was not prepared for him to mention Kaiser Permanente

i dont have a job yet i feel stressed out and have bad depression, anxiety, OCD, and anger. the issue isnt the job. the problem is with our own brains. we need brain implant chips badly if we are ever gonna solve this problem. otherwise the stress wont just go away on its own. we have to send electricity to the region of brain that can help increase focus, energy, happiness and get rid of the mental pain from depression. i saw that there are brain implants have are in trial but havent heard any news on them. i also hear tms is working in some people but the science doesnt the science doesnt make sense. i believe fixing depression would require some sort of pacemaker device to deliver electricity to certain parts of the brain to prevent ruminating thoughts from getting strong.

Clinic Reimbursement? dwindles almost as fast as he Rx med prices rise. The Psych intake guy remarked that the insurance of the two patients won’t even pay the psych hospital Unless the patients were ‘in the act’ of attempting suicide or homicide at the time of admission! And yet, our Medical training produced attitudes of: “...I know I am sick, but that’s not an excuse to miss work - unless I’m actively vomiting...” We had fellow residents work while hooked to IV poles for rehydration or broken ribs or just-casted fractures. We traded stories re: staying up more hrs for a bigger crisis than the next guy. We wore our self-sacrificing sufferings in the face of duty to our patients and each other like a badge of honor. More Paperwork, more patients, less pay, Less Time, more treatment interference, and still the same nutrition-poor, overworked, under slept, self-sacrificial lifestyle. And No confidants? No Wonder!

You get the GIST, what a subtle pun

what need doctor is more vacations and better hospitals with better tools .... i dont forgive imperfection for doctor .....

🦋

Good news.. Now we have Ai to reduce Physician burnout

Hey that’s not Colin Baker

🙏💜😗

Laughter yoga and medical marijuana help some help some people greatly

£43 for doctors letter what racket are doc running

Sorry Doc's, no sympathy here. You've turned over your profession to government, insurance co's, pharma and with commercial medical groups, euphemisms. The last time I visited my "primary care provider" [sic] he spent the beginning of our "encounter" by staring at his laptop computer screen. I said to him; "I'm right here, not in there". He re[lied he was "checking my insurance", I responded that his receptionist had already done so. He said my "history" was in the computer. I said but "I'm right here in front of you, I saw you last month, that's my history, so far". Finally, after a waste of 10 minutes with the computer, he asked me; "How do you feel?". I said that "my microchip feels defective". The doctor typed that into his laptop before he realized my answer was facetious. With the above named detrimental influences in the medical profession you doctors have already taken a bite of the "Apple" and there's no going back to the Garden of Eden and the respected, "Family Doctor". You're all "providers" now and we patients are noting more than "clients". To expect respect and consideration in such a context is to expect too much. Physician, heal thyself.

Farmers save even more lives every day.

@ericorr3461

4 жыл бұрын

Farmers are not the subject of this conversation.

@guestguest4023

4 жыл бұрын

@@ericorr3461 why bring up the phrase "saving lives"? Don't we all save lives? For example, mechanics save lives because if ambulance breaks down, they have to fix it, etc.

@UnironicallyToast

3 жыл бұрын

guest guest that’s amazing. Can I watch a ted ed about farmers and engineer? What sort of issues are they having? I’m curious. Surely you brought them up because there are important issues you want to discuss, not just to invalidate and get triggered over a title, right?

@ths6036

3 жыл бұрын

Definite Amen to Farmers... essential! and yet also taken for granted & lacking societal support; their unceasing efforts unappreciated; their struggles, heartaches and disasters unrecognized.

@Bible33AD

2 жыл бұрын

@@guestguest4023 You're being deliberately dismissive. Very revealing...

I want nothing to do with medical doctors. Not now, not tomorrow, not ever.

@dantheal4416

4 жыл бұрын

Maybe one day you will need a doctor and if you do I hope you will appreciate the help you get. You probably have a good reason for feeling the way you do but there are a lot of dedicated physicians out there.

@LT-cy3uj

4 жыл бұрын

Best way to have nothing to do with medical doctors- never fall sick. Not now, not tomorrow, not ever.

2935. my name my number my cure hippocratically. & 2651 times me= Alok waiting my paediatric my mom mother UshaVirna 23 29 39Pandey kind is KK 🔥 × 5

@virnamisra1657

2 жыл бұрын

& the above subject matter connection

Connect { Samsung my 2 legal sons photo.. .. connect facts here with LSE London lecture & my Navy Navi Bombay near IIT Bombay selected bungalow sea facing. &. Reorganize through USA University & send envelope with papers through registered post. Near PO RK puram. Janakpuri New Delhi 58. C/C KK. The Pandey House