John Keats left medicine for poetry, but not before he had walked the wards of Guy’s Hospital in London as a student and qualified, in the summer of 1816, to practise as an apothecary. Late in his short writing life, probably toward the end of 1819, he wrote eight lines that were found among his papers and printed only long after his death:
This living hand, now warm and capable Of earnest grasping, would, if it were cold And in the icy silence of the tomb, So haunt thy days and chill thy dreaming nights That thou would wish thine own heart dry of blood So in my veins red life might stream again, And thou be conscience-calm’d—see here it is— I hold it towards you.
Critics have argued about whom the lines address and what they are for, and the argument need not be settled here. What matters to me is the contrast the poem is built on, between a hand that is warm and capable and the same hand cold in the tomb, and the gesture with which it ends. The speaker does not take anything. He holds his hand out. The reader may take it or not.
A medical education passes through that contrast in reverse order. The student first learns the body cold, in the dissecting room, where nothing is refused and nothing is felt, and where an earlier essay on this site has tried to say what the student owes. Then, some time later, he is brought to a bed on which a living person lies, and asked to examine him. This essay is about that second meeting, and about the difference between knowing medicine and touching another person. The knowledge is the same knowledge; the anatomy has not changed. What has changed is that the body is now warm, capable of earnest grasping, capable of flinching, of asking what is being done, and of saying no.
I will not describe a particular first patient. It would be easy to supply one, and the story would almost write itself, but the first person a student examines is, of all patients, the one with the least reason to become an anecdote. That person lent his body to someone else’s education, usually without much benefit to himself, and the least that can be done in return is to leave him undescribed. What can be described is the situation, which every medical student enters and which, I have come to think, contains most of medical ethics in miniature.
Warm and Capable #
The dissecting room teaches a kind of looking that the living will never permit again: complete, unhurried, uninterrupted, with every layer available and no one to consult. The ward teaches the opposite. The living body can be seen only in part, only with permission, and only for as long as the permission lasts. It is clothed, and has to be uncovered piece by piece. It breathes and moves, so that the structures the student traced on the dead are now in motion, felt rather than seen, shifting under the fingers with each breath. It is sensitive, so that the pressure that would have revealed an edge in the cadaver may now cause pain. And it is inhabited, so that every act of examination is also an act toward someone, who notices it, interprets it and remembers it.
That last fact is the real difference between knowing medicine and touching another person, and it is easy to underestimate because it is so obvious. The knowledge a student brings to his first examination is knowledge about bodies in general: where the liver’s edge should be, what the normal breath sounds are, how the pulses are found. The person on the bed is not a body in general. He has a name, a history, a reason for being in that hospital that has nothing to do with the student, and a view, which may be very clear or may be unspoken, about being examined by a stranger. The student’s knowledge arrives at the bedside as a possession. It can only be used there as a kind of request.
Keats’s hand, warm and capable of earnest grasping, is a reminder that the patient’s body is not passive. It grasps back. It holds its own position, resists or yields, makes its own small judgments about the person touching it. A patient who has been examined many times can usually tell within seconds whether the hands on him are confident or frightened, attentive or distracted, and he will adjust what he allows accordingly. The first examination is therefore not a performance on an object. It is an encounter between two people, one of whom has much more to lose.
A Second Permission #
A patient who agrees to be treated has agreed to something, and the companion essay on the physical examination describes how that agreement must be renewed, step by step, as an examination proceeds. A student asks for something different. He is not, in most cases, the person responsible for the patient’s care. His examination may add nothing to it; the diagnosis has usually been made, or will be made, by others. What he asks for is permission to learn: to use this person’s body and time and patience for the sake of his own education, and for the sake of patients he will treat years later, whom this patient will never meet. It is a second permission, distinct from the first, and it cannot be assumed from the first.
Bedside teaching as a formal method is old. It is commonly traced to the Dutch physician Herman Boerhaave, who in the early eighteenth century took his students at Leiden into a small hospital ward of a dozen beds, six for men and six for women, and taught medicine at the bedside; his pupils carried the method across Europe. The patients in those beds were, as in most hospitals of the time, the poor. The history of the teaching hospital explains why the distinction between care and teaching was so long ignored. Michel Foucault, in The Birth of the Clinic (1963), described the arrangement that took shape in the hospitals of late eighteenth-century and revolutionary France as a kind of contract. The poor received care in hospital at the public’s expense, and in return their bodies and their illnesses became available to the clinical gaze, as objects of observation and teaching. The knowledge so produced went on to benefit those who could pay physicians privately. Foucault’s account can be contested in its details and still be right about the structure. Teaching has often been conducted on those who had least power to refuse it, and the bargain was rarely stated aloud.
The structure has not vanished. In India, as in many countries, students have long learned at the bedsides of charitable and public hospitals, where people receive care at little or no cost. The point is a general one, and uncomfortable enough as such. The people on whom students learn have very often been the people who receive care at low cost, and the arrangement need not be exploitative, but it becomes so if it is silent. Consent is what turns a structural bargain into a personal agreement: an arrangement between this student and this patient, in which the patient knows what he is being asked and is free to refuse.
Would patients refuse, if asked? The evidence suggests that many are glad to help. In a Swedish study published in 2008, 495 patients in general practice who had consulted a fifth-year medical student before seeing their own doctor were surveyed afterward. Ninety-two per cent were satisfied with the consultation; their reasons included personal benefit and altruism; and almost all were prepared to consult with a student again, though in about a third of cases only depending on the nature of their complaint. Emotional problems and intimate examinations made patients more reluctant. The patients also described their own role in the student’s education, as people who help a learner develop, as experts on their own condition, and as part of the real context in which medicine is learned. The finding is encouraging, and it should not be misread. A general willingness to help students is a disposition. Consent is an answer to a particular question, asked by a particular person, about a particular act. The first does not license skipping the second.
Saying “Student” #
To patients in a hospital, almost anyone in a white coat is a doctor. Another essay on this site describes how the title arrives before the degree, offered by strangers who have no way of knowing whom they are addressing. For a student at his first bedside, that misunderstanding is a temptation. If the patient believes the young person in front of him is a doctor, he is more likely to agree to an examination, less likely to ask questions, and more likely to treat the student’s hesitation as thoroughness. The student, for his part, would like to be competent, and the patient’s assumption lets him feel that he is. Correcting it costs something: a moment of exposure, a possible refusal, the admission, at the very start, that he is learning.
The correction is still owed, and the reason is simple. Consent given to a doctor is not consent given to a student. A patient who allows an examination because he believes it is part of his care, by someone responsible for it, has agreed to something other than what is happening. However kindly the student behaves afterward, the permission was obtained under a misunderstanding about who was asking.
Imagine, as a purely hypothetical illustration, what the sentence a student owes might sound like at a bedside. It would give his name and say plainly that he is a medical student. It would name the team or the doctor responsible for the patient’s care, so that the patient knows the student is not that person. It would say what he would like to do, in ordinary words: listen to the chest, feel the abdomen, look at the hands. It would say why: that it is for his learning. And it would say, before the patient has to ask, that the patient may decline, and that declining will make no difference at all to his care. None of this is elaborate, and all of it is easy to omit when the ward is busy, the teacher is waiting and the patient seems agreeable.
Punjabi courtesy contains a word that fits this moment. ਇਜਾਜ਼ਤ (ijāzat) is permission, the leave one asks before entering a room or doing something in another’s presence. It is also, in ordinary politeness, the word a visitor uses when he wishes to go: to ask for ijāzat at the end of a visit is to ask leave to depart, as though even leaving required the host’s consent. The double use is a small lesson in itself. Permission frames an encounter at both ends. The student who asks leave to begin an examination should also, in some fashion, ask leave to end it, with thanks, and with a word about what will happen next.
The oldest Indian address to a medical student, in the Charaka Samhita, which the essay on the first day of medical school reads more fully, instructs the physician to enter a patient’s house in the company of someone known to the household, whose entry is permitted. The instruction recognises that a stranger has no standing of his own in another person’s private space. He borrows it from someone who has it. A student on a ward is in exactly that position. His standing at the bedside is borrowed from the clinician responsible for the patient, and the honest way to use borrowed standing is to say whose it is.
How a Patient Says No #
Permission that cannot be refused is not permission, and the hardest practical problem of consent at a teaching bedside is not asking but hearing the answer. Patients rarely refuse in so many words. In a hospital, and especially in a crowded public or charitable ward, the person in the bed is sick, dependent, often far from home, and surrounded by people who appear to control what happens to him. A refusal can feel like a risk to his care, however often he is told it is not. So reluctance tends to come out sideways: a pause before the answer, a glance toward a relative, a hand that stays where it is, a question about how long it will take, an assent so quiet that it is almost a sigh.
Punjabi offers a clear example of how assent and agreement can come apart. ਜੀ (jī), the particle of respect, is also one of the commonest ways of saying yes, and ਹਾਂ ਜੀ (hāṅ jī) can mean anything from glad agreement to “I have heard you, and I am not going to argue.” ਠੀਕ ਹੈ (ṭhīk hai), it’s fine, is said as often to close an awkward moment as to approve of anything. A patient addressing a young person in a white coat whom he takes for a doctor will very often answer in exactly these words, and the words are not lies. They are courtesy, deference, and a wish not to cause trouble. They are not, by themselves, consent.
The setting multiplies the difficulty. A teaching round often arrives at a bed in a group: a teacher and several students, standing, while the patient lies down. A patient asked in front of that group whether the students may examine him is being asked to refuse a crowd, in public, in the presence of the person responsible for his care. Very few people will. If the question is to mean anything, it has to be asked before the group gathers, by someone the patient can refuse without witnesses, and in a form that makes the no as easy to say as the yes: offered first rather than last, with an explicit statement that it changes nothing.
The student’s part is to learn to listen for reluctance with the same care he will later bring to a chest. A hesitation is a finding. A patient who agrees but holds himself rigid, who flinches before he has been touched, who keeps asking what is going to happen, is saying something, and the right response is to stop, to ask again, and to be visibly content with whatever answer comes. A student who treats every jī as final has learned the form of consent without its substance.
Noli Me Tangere #
Noli me tangere: touch me not. The words come from the Gospel of John, where the risen Jesus says them to Mary Magdalene in the garden; the King James Version renders them simply, “Touch me not.” Painters have returned to the scene for centuries, a hand reaching and a figure drawing back. Medicine, too, once borrowed the phrase. Noli me tangere was an old name for certain malignant ulcers, so called, the usual explanation runs, because handling or meddling with them made them worse.
The physician and novelist José Rizal took the phrase as the title of his novel of 1887, written while he was continuing his medical studies in Europe; Rizal was an eye doctor, and is now honoured as the national hero of the Philippines. In the English translation published by Charles Derbyshire in 1912, the translator’s note explains that the title suggests the pathological term, and Rizal’s own dedication to his country begins with it: “Recorded in the history of human sufferings is a cancer of so malignant a character that the least touch irritates it and awakens in it the sharpest pains.” A few lines later, describing what the book will do, Rizal promises to “raise a part of the veil that covers the evil.”
The three senses of the phrase, the Gospel’s, the pathologist’s and the novelist’s, fit together into something a student at his first bedside needs to understand. First, the right to say touch me not belongs to every patient, and the student’s education has no claim against it. A refusal is not an obstacle to be managed; it is an answer to be accepted. Second, touch can harm. Some conditions are made worse by handling, and some patients are made worse by being handled repeatedly. A patient with a striking physical sign may be examined in a teaching hospital by student after student, each of whom needs to feel it once, and for the patient the twentieth examination of a tender abdomen is not twenty times as educational. It is twenty times as painful. Third, the physician’s task is often to uncover, and Rizal’s phrasing is exact about the limit: a part of the veil. The examination lifts what it needs and covers the rest, and the companion essay on the physical examination describes the courtesies of sheet and gown that make this practical.
Why Each Step #
Students learn the physical examination as a sequence, and the sequence is old and sensible: look first, then feel, then tap, then listen, region by region, in an order that a teacher can check and a student can remember. For the first examinations of a student’s life, the sequence is the curriculum. Completeness is the point. The student examines everything because he does not yet know what can safely be left out, and because the only way to learn the normal is to examine a great many people who are mostly normal.
From the patient’s side, the same examination looks very different. A nervous stranger performs a long series of manoeuvres, many of them apparently unrelated to the reason the patient is in hospital, with a slowness and repetition that may seem either thorough or alarming. Why is he pressing there, when the trouble is here? Why is he listening so long? Has he found something? A senior physician’s examination is usually shorter and more selective, because it is driven by a question: the clinician knows what he is looking for and why. The student’s is driven by a list.
The gap can be bridged only by explanation, and the explanation does not need to be technical. It needs to translate the curriculum’s purpose into the patient’s terms. That the student is going to listen to the back of the chest and then the front, and why. That he is going to press on the abdomen, and the patient should say at once if anything hurts. That the length of the examination reflects the student’s learning, not anything found. This is not a script, and the examination itself should be learned at the bedside under supervision, not from an essay. The principle is simply that the hands should never arrive before the words. A patient who knows what is about to happen, and why, is being examined with his participation. A patient who does not is being examined in spite of it.
There is a further benefit, which students tend to discover only later. Explaining each step forces the student to know why he is doing it. A sequence memorised as a list becomes, when it has to be explained to the person undergoing it, a sequence of questions: what am I looking for here, and what would it mean if I found it? The patient’s right to an explanation turns out to be one of the best teachers a student has.
What a Student May Not Say #
At some point in the first examinations a patient will ask the student a question. Is it serious? What did you hear? Will I be all right? The question is natural; the student has just listened to his heart for a long time with a grave face. And it is one of the hardest moments in a medical education, because every instinct of kindness and every wish to seem useful pushes the student toward an answer he is not entitled to give.
The distinction he has to hold is between a finding and an interpretation. A student may notice something: a sound, a swelling, a change in colour. What it means, whether it matters, and what should be done about it belong to the clinician responsible for the patient, who knows the history, the tests and the plan. A reassurance from a student, however gentle, is a statement about the patient’s health made by someone with neither the knowledge nor the standing to make it. If it is wrong, it can mislead. If it is right, it is right by luck. Either way, it substitutes the student’s wish to comfort for the patient’s need to know.
The honest answer is less satisfying and more respectful. That the student is learning, and is not the person who can answer that question properly. That the question is a good one. That he will make sure the doctor caring for the patient hears it. And then he must actually make sure, because a patient’s question carried away from the bedside and forgotten is a small betrayal. Keats’s word for the living hand was capable, and capability is what the first examinations begin to build. Authority is something else. It comes with responsibility, and on the first day at the bedside the student has none.
The habits formed in these early encounters matter more than they seem to. A study of 401 students at five medical schools in Philadelphia, published in 2003, asked how important it was that a patient be told in advance if a student was going to perform a pelvic examination on her while she was anaesthetised. Students who had completed their obstetrics and gynaecology clerkship rated that consent as significantly less important than students who had not. The authors’ conclusion was that clerkship directors should ensure that students perform examinations only after patients have given explicit consent. The finding is about a particular, intimate kind of examination, in one country, at one time. Its general lesson is that the conviction a student brings to his first bedside, that permission matters, is not self-sustaining. Clinical training can erode it, quietly, by example, and the erosion is easiest to begin precisely when the student is new, uncertain, and watching what his seniors do.
The Case for Teaching #
All this insistence on asking has a cost, and the people who bear it deserve a hearing. Every patient wants to be treated by a doctor who has examined many people before him. No patient particularly wants to be among the many. If enough patients declined, students would graduate having felt too few abdomens and heard too few murmurs, and the patients of the next generation would pay for the scruples of this one. It can be argued, on this basis, that people who benefit from a system of trained physicians have some obligation to help train them: that being examined by a supervised student is a modest contribution to a common good from which everyone draws, as jury service or vaccination is. On that view, an endless emphasis on refusal risks teaching patients that participation is an imposition, when it is closer to a civic gift.
I think the argument is partly right, and that it changes the tone of the request more than its substance. Teaching is a common good, and patients who help students are contributing to it; the Swedish patients who described their own role in those terms understood this better than an anxious student does. A student who approaches every patient as a potential victim of his education will ask badly, with an apology in place of an invitation. The request can be made with confidence, as an offer to take part in something worthwhile.
But an obligation of that kind, if it exists, belongs to a whole society, and it cannot fairly be collected at the bedside of whoever happens to be lying in the charitable ward. If there is a duty to help train doctors, it falls on the wealthy patient in a private room as much as on the poor one in a general ward, and a system that asks only the second is not distributing a civic duty but levying it on those least able to refuse. Nor can a general duty to participate become a duty to submit to any particular examination. Citizens may owe jury service; no one owes a particular cross-examination. The obligation, at most, is to be asked, and to consider the request in good faith. The answer remains the patient’s.
There is also a practical reply. Patients who are asked well are often glad to help, as the Swedish study suggests, and the surest way to keep that willingness is to treat every patient who helps in a way that leaves him glad he did. Pressure, even the soft pressure of an unasked question, spends a resource it cannot replace, which is the goodwill of the next patient.
Feedback Away from the Bed #
A student examining his first patients needs correction, and much of it can only be given by a teacher who watched him do it. The question is where. The tradition of bedside teaching includes a long and not always admirable habit of instruction in front of the patient: the student questioned at the foot of the bed, his errors exposed, the patient’s findings discussed in terms the patient can half understand and fully overhear. The patient, in that arrangement, becomes the audience for a lesson that is not about him, and sometimes the material for the student’s embarrassment.
The better rule is that the bedside belongs to the patient, and the corridor belongs to the lesson. What needs to be said at the bed is what concerns the patient: what is being done, what was found, what happens next, and thanks. The correction of a student’s technique, the discussion of what a sign might mean, the teacher’s account of what the student missed, all belong outside, where the student can be wrong without an audience and the patient is spared a seminar on his own body. Some teaching can and should happen at the bedside, with the patient’s agreement and often with his participation; the Swedish patients who saw themselves as experts on their own condition were right, and a patient who has lived with an illness for years may have more to teach about it than any textbook. But the participation has to be invited, not assumed, and the student’s failures are not part of the patient’s care.
Supervision is often described as something the teacher gives the student, and it is that. It is also, and first, something the institution owes the patient. The supervisor is the person who makes sure that the patient was asked, and asked properly; that what the student found is checked by someone competent to check it; that a patient’s question carried away from the bed reaches the clinician responsible; and that the patient is not examined more often than his illness and his patience can bear. A student examining without supervision is not merely missing a lesson. He is touching someone on behalf of an institution that has not yet vouched for him.
The same principle applies in reverse. A patient’s discomfort, his refusal, his embarrassment, his tears, are not material for the student’s education, though they may teach the student a great deal. They are the patient’s, and the student who has witnessed them owes them the same discretion he owes to anything else he learned at that bed.
Keeping the Curtain #
In a crowded ward, the curtain around a bed is often the only privacy a patient has, and it is not much: a cloth on a rail, drawn or not drawn, through which voices pass freely. Punjabi uses the same word for that curtain and for something much larger. ਪਰਦਾ (pardā) is a curtain, a veil, a screen. To keep someone’s ਪਰਦਾ, ਪਰਦਾ ਰੱਖਣਾ, is to protect that person’s dignity by keeping what one knows of them covered: not exposing a secret, not repeating a weakness, not letting another’s private trouble become public talk. A related phrase, ਲਾਜ ਰੱਖਣੀ, to keep someone’s honour, appears in prayers as well as in ordinary speech, as a request that one’s shame be covered and one’s dignity preserved.
A student who has examined a patient has drawn back a curtain, and the phrase says what he owes afterward. He has seen a body that was uncovered for his learning and heard things that were said to him because of the coat he was wearing. Students talk about their days; they talk over tea, in hostels, at home. Most of that talk is harmless, and some of it is how they learn to bear what they see. But the patient who was examined has a right not to become a story, and certainly not a story that could identify him. The curtain now has a modern rent in it that earlier generations of students did not face. Almost every student carries a camera. A striking rash, an unusual swelling, a scan on a screen, a chart left open: each can be photographed in a second, shared in a minute, and kept indefinitely, and the impulse to do so is usually innocent, a wish to remember or to learn or to ask a friend. But a photograph of a patient’s body is a drawing back of the curtain that outlasts the examination and travels beyond the ward, and no general willingness to help students covers it. If an image is truly needed for teaching, it needs its own permission, asked separately, with the patient told where it will go and who will see it. Otherwise it should not exist.
The Charaka Samhita‘s instruction that the affairs of the patient’s house are not to be repeated outside is one of the oldest statements of that right in Indian medicine, and it was addressed, in the first instance, to students.
The same reasoning governs what a memoir may tell. A remembered patient, in an essay written decades later, would be a person who agreed to help a student learn and did not agree to appear in that student’s memoir. Even with details changed, the story would draw back a curtain that the patient never asked to have drawn. The first patients of a medical education belong, finally, to themselves. They gave something that cannot be returned, and the only adequate acknowledgment is to have learned from it and to keep it covered.
I Hold It Towards You #
Keats’s poem ends with a gesture and an offer: “see here it is— / I hold it towards you.” Read from the patient’s side of the bed, the line describes what every patient does who allows a student to examine him. He holds out his hand, his wrist for the pulse, his back for the stethoscope, his abdomen for the student’s uncertain fingers. He holds it out; it is not taken. And what is held out can be withdrawn.
That is the difference between knowing medicine and touching another person, and it does not diminish with experience. Knowledge is a possession. A student acquires it in lecture halls and dissecting rooms and from heavy books, and once acquired it is his to keep. Touch is not a possession. Every examination, the first and the ten-thousandth, is something a patient lends, for a time, on terms he is entitled to set. The first patient a student examines teaches him this whether or not he notices, because it is the first time his knowledge has needed someone else’s permission to become anything at all.
Everything a physician later knows with his hands was learned that way, on loan. The anatomy came from the dead, who could not refuse. The examination came from the living, who could have, and did not. A career that remembers the second fact will practise differently from one that forgets it, not because it is more sentimental about patients but because it is more accurate about where its own competence came from. The living hand was warm and capable. It was held toward the student, and he was allowed to take it.
Evidence and Editorial Note #
Documented findings. Public biography relied on: MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, 1997–2002; family physician. John Keats, “This living hand,” text from Wikisource; his training at Guy’s Hospital and qualification as an apothecary in 1816, the usual dating of the fragment to late 1819, and its posthumous publication: standard reference knowledge. The Gospel of John 20:17 in the King James Version: standard reference text. José Rizal, The Social Cancer: A Complete English Version of Noli Me Tangere, translated by Charles Derbyshire (1912), Project Gutenberg eBook 6737: the dedication “To My Fatherland” (both quotations) and the translator’s note on the title’s pathological sense, the Gospel source and Rizal’s medical studies in Paris and Germany. Michel Foucault, The Birth of the Clinic (1963), paraphrased; the older use of noli me tangere for ulcers aggravated by handling; Rizal’s practice as an ophthalmologist; and the classical sequence of the examination: standard reference knowledge. A.-C. Haffling and A. Håkansson, “Patients consulting with students in general practice,” Medical Teacher 2008;30:622–9 (abstract). P. A. Ubel, C. Jepson and A. Silver-Isenstadt, “Don’t ask, don’t tell,” American Journal of Obstetrics and Gynecology 2003;188:575–9 (abstract). Charaka Samhita, Vimana Sthana 8.13, English translation at Charak Samhita Online. The Punjabi senses of ਇਜਾਜ਼ਤ, ਜੀ, ਹਾਂ ਜੀ, ਠੀਕ ਹੈ, ਪਰਦਾ, ਪਰਦਾ ਰੱਖਣਾ and ਲਾਜ ਰੱਖਣੀ, and Herman Boerhaave’s bedside teaching at Leiden in a ward of twelve beds: standard reference knowledge. Vendor representations. None.
Recollection and tradition. No first patient, ward, teacher, supervisor, examination, question or feeling from the author’s training is described; the essay explains why it does not. The bedside introduction in the section “Saying ‘Student’” is a hypothetical illustration, introduced as such, and describes no real encounter. Nothing is asserted about what patients at any particular hospital were or were not told.
Analysis and forecast. The reading of Keats’s fragment from the patient’s side, the distinction between consent to care and consent to teaching, the application of Foucault’s account to charitable teaching hospitals generally, the reading of noli me tangere in three senses, the account of how reluctance is expressed and why consent asked before a group is less free, the weighing of a possible duty to take part in teaching, the limits placed on what a student may say, the rule that correction belongs away from the bed, and the account of ਪਰਦਾ as a duty of discretion are the author’s interpretation and ethical preference as of November 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.