Ranjana Srivastava

A geriatric oncology patient with early cancer initially insists on surgery, but a conversation about his daily routines and fear of losing independence reveals that avoiding treatment better aligns with his priorities. The case illustrates how shared decision-making requires doctors to explain individualized risks, acknowledge that refusing treatment is a valid choice, and communicate in terms patients understand. The piece argues that time constraints, knowledge gaps and generic consent procedures undermine meaningful choice, and recommends practical patient and clinician decision-making tools from Australia and the NHS.

An oncologist describes telling a dying cancer patient’s family that he likely has weeks rather than months to live, while his young grandson remains at the bedside. The experience prompts reflection on whether adults overprotect children and young people from illness, ageing and death, leaving them without the emotional tools to cope later. Srivastava argues that carefully including young people in end-of-life experiences can foster courage, empathy and preparedness, while also acknowledging the emotional burden placed on medical staff who increasingly act as surrogate family for isolated patients.

Doctors often delay conversations about death, dying and future care with incurably ill patients, even though these discussions help align treatment with patients’ goals and prepare families for deterioration. A study found that prompting clinicians increased documented serious-illness conversations from 22% to 28%, rising to 32% when both clinicians and patients were prompted, while prompting patients alone had no effect. Despite barriers including limited training, time pressures and burnout, Srivastava argues that healthcare systems should make these conversations routine and document them clearly so patients receive appropriate care, including in emergencies.

The closure of three Cohealth GP clinics in Melbourne was attributed to inadequate funding, but an expert inquiry found that poor practice oversight, high corporate costs, weak governance and management’s failure to heed clinicians were more significant causes of sustained losses. The closures affected more than 12,000 vulnerable patients, while the board lacked a credible plan to protect their access to care. Cohealth accepted recommendations to strengthen governance, leadership and communication. The experience is presented as a warning that healthcare performance depends not only on funding but also on responsive management, clinical involvement, transparency and integrity.

Australian oncologist Ranjana Srivastava argues that doctors should not dismiss wellness influencers despite the serious harm caused by unqualified health advice on platforms such as Instagram and TikTok. Patients are abandoning nutritious foods, adopting ineffective diets and pursuing dangerous claims such as ivermectin as a cancer cure. Research cited in the column suggests that qualified medical professionals make up only a small share of prominent wellness influencers, while life coaches, product sellers and people relying on personal experience dominate the space. Declining trust in doctors and widespread difficulty distinguishing fact from fiction have allowed this influence to grow. Srivastava calls for doctors and medical institutions to engage patients empathetically, explain evidence without outrage, support credible communicators and provide accessible health information in settings such as multilingual waiting-room posters.

A doctor recounts how a general practitioner recognized that a diabetic patient’s rapid heart rate was caused by hunger, then personally took him to buy groceries and provided a meal. The experience prompts reflection on whether doctors should act beyond conventional clinical duties and whether practical kindness can be offered consistently. While acknowledging legitimate criticism of the medical profession, the author argues that everyday empathy and altruism remain essential, under-recognized aspects of healthcare.

Older adults taking multiple medications can face serious risks, particularly when they become frail, cognitively impaired or terminally ill. Ranjana Srivastava argues that deprescribing—a structured, supervised process for stopping medicines that are no longer beneficial—should become a routine part of care. She highlights the scale and cost of medication-related harm in Australia, criticizes fragmented communication among GPs and specialists, and urges patients to ask why each medication is needed, what would happen if it were stopped and how discontinuation can be managed safely. New Australian guidelines and pharmacist-led medication management reviews could help reduce unnecessary prescriptions and improve quality of life.

Australian hospitals are trapped in a cycle in which long waits leave patients sicker, require longer admissions and further reduce capacity. The problem is worsened by bed shortages, delayed rehabilitation and aged-care placement, inadequate mental-health services, workforce attrition and the loss of experienced staff whose mentoring and discretionary effort once helped care systems function. Similar post-Covid pressures affect other wealthy countries, suggesting that increased funding alone will not solve the productivity and access crisis. Srivastava argues for stronger community-based care, expanded aged care, accessible rehabilitation and psychological services, and greater emphasis on prevention and healthcare education.

Oncologist Ranjana Srivastava argues that doctors should stop presenting themselves as having complete certainty. Drawing on difficult conversations with cancer patients, she explains that medical data can support informed estimates but cannot predict every individual outcome. Acknowledging uncertainty, when paired with honesty, continued support and a commitment to find answers, can strengthen rather than undermine patients’ trust. Medical education should teach this approach explicitly instead of encouraging qualified doctors to maintain a misleading appearance of omniscience.

There is no reliable “everything” blood test or total-body scan proven to save healthy people from cancer. Grail’s Galleri test, which detects circulating cancer DNA and was studied in a 142,000-person NHS trial, failed to meet its primary endpoint of reducing stage 3 and 4 cancer diagnoses, despite the company emphasizing other positive findings. The results highlight the difference between detecting more cancers and improving survival, since some detected tumors may never become life-threatening while follow-up procedures can cause significant harm. Until stronger evidence emerges, cancer-risk reduction should focus on limiting processed foods and alcohol, avoiding smoking, and exercising regularly.

Ranjana Srivastava reflects on a long-term cancer patient she experienced as a “heart-sink” patient and examines research finding that doctors label roughly one in six patients difficult. Personality disorders, depression, anxiety and chronic pain are commonly associated with these judgments, while physician inexperience, low empathy, burnout and poor job satisfaction also contribute. The article argues that patients’ dissatisfaction can reflect genuine failures in care, particularly when chronic pain is dismissed because tests are normal. Better access to mental-health, allied-health and social-work services, along with mandatory communication training, is needed so doctors address difficult medical problems without redefining patients as difficult people.

On her daughter’s 18th birthday, oncologist Ranjana Srivastava argues that caring for ageing parents must not automatically become women’s responsibility. Drawing on her experience treating older patients, she describes how daughters and other female relatives typically organise appointments, provide emotional support and manage medical information, while sons are more likely to defer to sisters. Although women account for seven in 10 primary carers and provide billions of hours of unpaid care, this work carries substantial physical, emotional and financial costs. Srivastava urges her sons to share housework and caring duties so her daughter can balance responsibility with her own life, and hopes gender stereotypes will weaken by the time she needs her children’s support.

After a terminally ill patient unexpectedly survives a near-fatal episode, physician Ranjana Srivastava describes the guilt, doubt and anxiety that she and her team experience but never formally discuss. She argues that this silence can develop into vicarious trauma, harming both healthcare providers and patients. Hospitals may offer limited wellbeing sessions, but she says they need sustained, specialized and context-aware psychological support, including professional debriefing, to address the cumulative effects of emotionally intense medical work and reduce burnout.

Australia’s palliative-care system is failing many people with predictable deaths, particularly those with dementia, frailty and organ failure, as well as many cancer patients. Specialist care often begins only days before death, while unplanned hospital admissions remain common despite patients’ stated preferences for quality-of-life care. Earlier palliative intervention could improve symptom management, help families make informed decisions about care settings, reduce distress and potentially lower healthcare costs. The article calls for better funding, awareness and advocacy so palliative care is available across illnesses and integrated earlier into treatment.

At the funeral of an Indian-Australian community leader, oncologist Ranjana Srivastava reflects on the impact of a life devoted to cultural preservation, public service and helping others. Although she knew him only through occasional encounters, his warmth and ability to make people feel valued profoundly affected her. The funeral also prompts her to consider mortality, distraction and the difficulty of being present. She resolves that she and others should make patients and people around them feel seen through everyday actions, so their lives will have fulfilled their purpose when they are no longer needed.

Ranjana Srivastava reflects humorously on her cavoodle Odie’s shifting patterns of affection as he turns five. Although Odie stays close to Srivastava and enjoys attention from the family, he shows particular favoritism toward her eldest son and his bed, even when the son is away. The family speculates about whether this preference reflects walks, gentleness, past experiences or canine intelligence, while accepting that the mystery is part of the pleasure of living with a dog.

Australian pharmaceutical companies paid 6,504 doctors more than AU$33 million between 2019 and 2022 through consultancy fees, advisory boards, sponsorships and related benefits. Research consistently associates such payments with increased prescribing of the paying company’s drugs, branded medicines and higher costs, including prescriptions for unsuitable patients. The author argues that disclosure and self-regulation are inadequate because doctors may underestimate the influence of gifts and financial relationships, and calls for stronger independent oversight to protect patients and taxpayer-funded healthcare.

Surgeons’ technical expertise should be matched by empathy, clear communication and attention to patients’ quality-of-life goals. Patients often disclose different priorities to oncologists or general practitioners than to surgeons, which can lead to significantly different treatment choices. Shared decision-making, decision aids, multidisciplinary care and nuanced discussions of prognosis help patients make informed choices. The experience of an 87-year-old cancer patient illustrates the value of understanding personal goals: after discussing her priorities, a surgeon cancelled a major operation that she felt was not in her best interest. Surgical training should therefore place greater emphasis on communication and bedside manner.

Fraudulent scientific publishing is expanding rapidly through paper mills, brokers and predatory journals, with artificial intelligence making bogus papers easier to produce. A Northwestern University study estimates that at least 400,000 papers published from 2000 to 2022 are suspect and identifies cancer research as particularly vulnerable. Patients who search online may mistake polished misinformation for evidence, leading some to reject effective cancer treatment in favor of unproven remedies and ultimately requiring more intensive, costly care. Better research funding, stronger publisher oversight and greater public awareness are needed, while patients should continue researching but assess the reliability of their sources carefully.

Ranjana Srivastava describes abandoning close supervision of her children’s homework, devices, study routines and sleep in favor of trust, clear expectations and an open-door policy. She argues that the hands-off approach has increased her children’s independence, intrinsic motivation and academic responsibility while improving their grades and reducing family conflict. The approach may not suit every child, particularly students facing disadvantage who need substantial support, but her friend’s advice—to keep quiet while remaining available—offers a practical model for parents coping with exam anxiety.