In my last place of work, junior doctors were advised not to assist me in their work. I was never made aware of the reasons for this antagonism. Perhaps I had issues with their lack of experience or expertise, or both. My concerns about a lack of respect, despite being a faculty member, were also drowned out by the loud din of a shared knowledge of my future goals.

This only represented the very least of my troubles. A constant rejection at multiple interviews where I was supposed to be the most qualified candidate represented another reality. It seemed that an apparition was to be constructed prior to every interview and my responses were to be recorded. That recorder, which continues to act as a disgraceful perversion, remains certain of my lack of success.

Statements like the following were encountered and duly recorded –

Voice raised to an audible pitch – Strike 1 – “We would like to control the work that you do, in our sister institute, from our main nodal centre”

Strike 2 – “Dr “A”, you were not particularly good with nurses”.

Pause. Then silence, as if their response was to be recorded.

Then the sound of someone pulling a chair from a distance or speaking over my head (the accompaniments of complete and absolute authority).

Similar to the manner in which every mail concerning an individual’s name was to be turned into a voice in a non-existent space around your ears.

A shared knowledge of knowing manipulation and the rot setting in the system.

Conveniently, these had been forgotten at the time of bestowing me with a degree.

But what had changed from the time that I had left that organisation?

What had the ambition of being competent turned me into? A pariah!! The fact that I remembered most of my patients was definitely a deal-breaker.

Was I to be blamed for seeking my own definition of specialised palliation?

Coming back to the interviews, there was also the question of publications and abstracts.

Abstracts which had previously counted as publications (for the purpose of appearing in an examination), were now in danger of being relegated to the dustbin.

Were these even legitimate research, the panels seemed to be asking ?

My hard work agreed that they were, but the furtive glances, the silences and the dis-ease in acknowledging them, spoke of a completely different story.
A difference in opinion which had punctuated every nuance in my work was suddenly in danger of being overlooked and conveniently forgotten. Stern message (in all CAPS) – Institutional accountability for the lack of beds was not to be sought.

After timely addition of a list of foreign conferences and my ticking all the boxes – a delicate charade was played out. Interview – no or minimal subject based questions – no effort to wriggle out a response from someone who was feeling insulted and suffered from a trust deficit with the system – termination of interview.

There was also the question of getting back to me (Dr “A”, we will get back to you soon), which never culminated into anything meaningful or honest. Dishonesty is a powerful tool of those in power, or at least those whose existence seems to be enveloped by it. 

In fact, I was made aware by a junior later that he had been propositioned by the same team for this position, and his refusal was highlighted as a badge worthy of seniority.

There were other interviews too, where yours truly who had dared to seek an year-long training at an organization with a ward for inpatient admissions was to be relegated to a non-specialist role by an individual who had been instrumental in misrepresenting career options available to postgraduates earlier. After expressing agreement with the fact that paediatric palliative care fellowships were more suited to paediatricians, not only was I being told that I was not fit for a fellowship, but my training up until that time was being challenged.

Wait, there was more to follow. The fact that I would have liked to pursue training in Internal medicine was used against me by the individual who was supposed to represent the last word in everything that began with a “P” and ended in an “N”. No, one is not talking about palliation here. Despite being forewarned that my mails were not at all welcome, I had communicated my misgivings about a lack of foundational training in Internal Medicine to this very important person.

This calculated charade also led to the begrudging realisation that personal mail exchanges were liable to be weaponised and used at critical junctures to discredit one’s capability. A figure who was assumed to be the seat of all authority, but precious little expertise, was to declare the most experienced candidate, the third-placed candidate on a list of exactly three candidates and utilise the imaginary computer created around me to enter the result.

Wait, there were more interviews to follow; one, where proclamations about requiring a minimum of ten years to get an institute stacked with infrastructure but marred by resignations were to be made. In the middle, I also got to hear statements like, “A particular institute needs you more” or “Your departure will be a potential loss” by those willingly playing their self-determined roles to the “T”. Statements which tried to bury the ignominy and unpleasantness of rejection within conveniently emotive slogans.

Then there was a charade of sceptics, people from other specialities, who had gotten their foot inside the door, were now willing to assert their authority.

Question 1 – How are you going to set up a palliative care department, and everything that you said was to be met with a vacant stare?

I am running an independent OPD – vacant stare lasting 5 secs.

I am admitting patients under my care – duration of vacant stare doubles.

Q2 (from another legend of an interviewer) – What are the legislations and the guidelines governing end-of-life care provision in India?

Response – I am aware of the supreme court judgement in the Aruna Shanbaug case and the ___society guidelines (no response, more vacant stares, dumbfounded, almost deafening silence).

Then a discussion with the director regarding one’s approach to care, which ends in a false promise, which yours truly shares with all those around him, only for it to be another stab in the back.

Wait, there’s one more interview, where you will be insulted prior to entering the director’s chambers – Are you even eligible for this position?

I believe that my facial expressions exemplified the fact that I had been forced to be mentally absent for exactly 99.9999 per cent of my exalted tenure. Well, ideologically, I had been absent 100 per cent of the time.

Despite the piling up of rejections, I had continued to view things differently and refused to be driven by a self-important juggernaut which defined palliation with the hurriedness of a cyclone, only to miss the forest for the ideological trees that it wished to plant, in impressionable minds.

And also there was a very intellectual question on high-frequency nasal oxygen, which the interviewer (all stoic and apparently well-intentioned), after the just correct amount of acting and faux seriousness, had plotted to come up with. And this was not someone who, like yours truly, had been part of the patient’s experience; it was someone who had done his reading prior to the interview, which possibly justified his presence as a specialist. A resourceful mention of the MABEL study did not get me the position; it just got me closer to the realisation about how this panel, mired in the dubious grandiose idea of enforced civility, was far removed from the patient’s experience, how a circus had to be perpetuated in order to justify the propagation of institutional affiliation over merit.

And believe you me, there was more to come; the fact that a portal run by a neurosurgeon was to be made the centrepiece of all discussion was unexpected, and reflected the pre-determined nature of the interview to a certain degree of accuracy.

I believe the most important reason for their continued rejection was my insistence on positioning methadone as a reserve drug when their final authority on all matters had justified its distribution without proper monitoring because the stock was going to expire. A specialist sitting in front of them and reminding these self-anointed pioneers about his allegiance to UK-based guidance, proved like an unwelcome blip in their radar.

I was able to decipher their loopy thought process: a dying patient did not have relevant medical issues, methadone was not to be considered a reserve drug, every rapid opioid titration was to go on for 24-48 hours (for patients who had mastered the art of arriving screaming and howling to the OPD in PAIN). Why this spectacle did not repeat itself in the two years of my manning an independent unit in a hospital, with a similar footfall, supposed to be in terminal decline, remains a mystery. Why I was forced to take a stand on not supporting the creation of new postgraduate seats without a commensurate increase in committed teachers was becoming clearer to me.

Also for future aspirants, it might be important to remember that terming the NDPS Act as “barbaric” in front of a panel which expects you to rattle off the provisions, without clearly understanding or critiquing them, might be considered a deal breaker. The results, which remained positively negative, conveyed only a full-throated rejection of an ideological stance that advocated for the inclusion of Internal medicine teaching as central to the practice of palliative medicine.

They all seemed to be saying the same thing – we know that you want to work in a better system and our system is perhaps not that. That your responses demonstrate your lack of belief in a propaganda-driven religulous version of palliation, and that seems to be your biggest strength, oops fault.

There might be those who might be tempted to enquire why I subjected myself to this humiliation and disgust; however, these attempts represented the firm beliefs of an idealist, who wished to seek accountability on behalf of the poor, underprivileged patient and their families. Today his thought process stands exposed.

Multiple Institutions might have been successful in proving their implacable authority in front of a postgraduate specialist seeking direction and forever willing to question his own credentials. The amplified, politically correct and administratively astute message being broadcast to the community on the whole was that while they were willing to bestow a degree upon an outlier antagonist, they would never be willing to provide a credible position to someone who harboured aspirations to work in a foreign country.

In retrospect, a stated desire to work in a foreign country could also have been reason enough for a rejection. The manner in which your future ambitions are exposed in front of the entire panel and proclamations are made about a jingoistic breed of throat-clearing (ahem ahem) hyper nationalism says a lot about the political environment that has been cultivated within institutional narratives and allowed to govern the shared conscience of healthcare professionals comprising interview panels across the breadth of this country. The same country, where the leading organization while willing to stamp their authority on a flawed selection process (the brand name of an organization gets your foot in the door), but opting to the maintain a complete silence on standards of healthcare provision (in the same setting).

Where the appeals of a contractual faculty citing absence of ICU facilities is lost amidst the machinations of a lacklustre system and the wails of numerous dying patients (who are left with no options for escalation) are silenced (into coercive death). This narrative strikes pre-emptively, at the very foundation of the Hippocratic oath and changes everything into a populist, person-centred narrative where an individual, who is unaffiliated with the behemoth, remains in permanent danger of being thrown OUT.

I have often decried why there are no parallels between interviews held for the NHS, where intensive preparation and resources remain available, and organisations in this country. After being through the process, and looking at the undocumented manner in which merit is being determined, I have come to understand its flaws. I remember proposing a solution which involved an entrance examination, matched to the standards of the SCE examination; however, despite more than five years having passed, the scenario remains wanting (and any shred of accountability remains conspicuous by its absence).

I have often wondered to myself, was it the individual or the organisation that was on the panel? After a sustained amount of tenure, can one really separate the individual from the organisation? At what point does personal ambition trump moral uprightness, turning professionals into perpetrators of gruesome, ideological violence? How does being embedded within a farcical narrative take away all semblance of humanity and innate goodness?

How does one counter the duality of this narrative of opposites – the yin, throbbing with venomous antagonism during interviews, with the yang, a veiled impostor ever so eager to manufacture an imaginary apparition, willing to participate in every activity of yours, becoming a part of every experience (reading, writing and the unmentionables!!).

There had been multiple facets to the identity of this construct: the silent watcher, the hesitant but persistent listener and the speaker who preferred to speak in aphorisms and euphemism through the voice of another. That they had been threatening to do damage was known, but they had remained, up until now, mostly in control. Then the weight of these unexplained, unexpected decisions started accumulating, threatening to take advantage of the individual, who in his feverish idealism might have trusted this construct.

Which emotional adage or rational explanation does one take recourse to when one’s back is up against the wall and the watchers, listeners and the genteel speakers start verbalising, in sombre, indignant tones, trying to outwit, outmanoeuvre, mostly out of turn and manufacture an illicit construct.

A vicious unending silence, followed by a staged attempt at negotiation. The persistent whirring of a fan followed by the realisation of the increasing weight of one’s own breath.

Disarm. Negotiate. Outmanoeuvre. Attack. Repeat.

A specific algorithmic pattern. Disarmingly simple. Unsurmountable.

Is that how the seeds of burnout are sown? An ambition extinguished, an epiphany murdered.

Is this what pre-empts a lifelong dependence on spirituality, in the name of coping with an unmitigated onslaught on a mind made vulnerable by doubt?

I told myself once that I was going to embellish my experiences of engaging with this system, with humour and irreverence. Today, like the interview panel which promised to get back, I renege on this promise.

Cite as

Arora, R. D. (2026). Mindful critique (MC11) – Perspectives on the challenges encountered during interviews – revisiting reality and documenting harsh truths. Zenodo. https://doi.org/10.5281/zenodo.21993743

Disclaimer
Every attempt has been made to safeguard the identity of institutional behemoths referred to in this vignette, and any untoward circumstances arising out of this reflective exercise are completely unintended on the part of the author. The author does not intend to cause any harm to another individual’s or organisation’s reputation and has tried his level best to ensure that identities are protected. This exercise attempts to engage in truth telling about the system that a healthcare professional is expected to inhabit (without offering any resistance) and tries to raise serious questions about existing practices related to recruitment that might endanger long-term learning and ethical clinical practice.

Palliative medicine is a relatively young subspecialty whose intellectual and clinical boundaries continue to evolve. In the absence of definitive texts to address contemporary questions, artificial intelligence tools, primarily Claude (Anthropic), have been employed to challenge assumptions, support deeper conceptual exploration, and improve clarity of expression. They do not replace critical scholarship, clinical experience, or editorial judgment. Final responsibility for all interpretations, factual accuracy, originality of synthesis, and the quality of the published material rests entirely with the Founder and Editor.