Monthly Archives: June 2015

The only way towards a solution: A 13 point charter for Doctors

The only way towards a solution:
A 13 point charter for Doctors
Happy Doctor’s Day!
© Dr. Rajas Deshpande

1. If we want to survive without being exploited and improve healthcare, we must forget all our differences and unite for this cause. We must be able to overcome all personal differences to realize what great strength we are. This is the only solution for ourselves and our dear patients!

2. We must form specialty-wise groups of doctors in each city / state and elect a steering committee that will decide the regional regulations. The charging system for consults, procedures and investigations according to “gradation” of hospitals (facilities, location, quality of advanced care, nursing) etc. should be devised by these regional steering committees alone. State committees should elect a National Medical Steering Committee.

3. The specialty groups in each town must include all consultants from that specialty, and decide the correct fees for consultation, procedures, intensive care, emergency availability and surgeries based upon seniority, qualifications, skill, time, complications and other factors intrinsic to that specialty. This schedule must be binding upon all the small and big hospitals in that region, insurance companies and private practitioners. Sharing fees must be the doctor’s prerogative.

4. There should be no free cases, except those below poverty line and in emergency. Doctors should get tax benefits for every free patient (CGHS /CSMA/ ECHS or BPL in India) treated by them, as per the regional schedule. There should be a regional coordinator for all the Free beds in private hospitals, which are often misused by rich officials. Every consultant must see free patients one day in a month by appointment.

5. Govt. must provide all cost of prescribed medicines, surgeries, equipment, medicines and manpower for the treatment of free patients. This should happen real time, as sometimes the dues are not paid to hospitals by govt. for decades. All existing dues should be settled immediately, so hospitals can provide better care. In patients who cannot afford costly treatments / medicines / surgeries, the funds allotted to the local representative (MLA / MP) may be used by priority. Also allow the pharmaceuticals to pay for the poor patients upon request by the treating doctor.

6. Every hospital must provide free available treatment for all the consultants working for that hospital and their families. All doctors should be collectively insured against: illness, disability, death, accident, loss of job, medicolegal cases and violence induced damage (mental and physical). This must be done at state / national level. The medical insurance companies which earn billions by eating from the doctor’s plates must insure them against all these calamities. Also the corporates and other healthcare giants should be answerable to the regional committees.

7. Any medicolegal case / negligence issues must first be presented to these committees, which will refer it to the national committee, whose decision will be recommended to the courts of law. The current compensation system based upon inequality of “value of life” should be eradicated. All patients are equal, and the compensation value of every life must be the same. If one expects “Indian rates of Treatment”, one must accept “Indian rates of Compensation”. In cases of patients treated free, the govt. should pay the compensation to the patient, otherwise no private doctor will want to treat free patients and invite more legal liability (the misuse of medicolegal cases by the poor and political is an emergency in waiting for future generation doctors). Patients should also have an option of committing complete faith in the doctor and signing a “No Legal Liability” bond, which will make it easier for the doctor to do his best for the patient, unaffected by legal fears. Also, any interference in patient care including intimidation, threats etc. must be punishable by law.

8. Doctors must collectively develop a national medical research funding by compulsory contribution, and start advanced centers for research which are not imprisoned by the lack of initiatives , funding, or intellect. This should be autonomous and purely merit based, with no interference from govt. or anyone else. We should also find practical solutions to accessibility and excellent rural healthcare system. Only we can, govt. never will.

9. There should be revamping of medical education: MBBS in four years, internship, one year bond of rural service, then PG, SuperPG, Fellowship and then practice. This is long enough. All other bonds must be cancelled. Payment structures of all Medical officers, Teachers should be compatible with highest in the govt: IAS / IPS, as these doctors deal with life and death everyday, saving millions. PG exams must be conducted on time, and court interference must be avoided, the decisions of National committees must be final. This will save millions of youth-years of generations of doctors. PG seats should increase every year, there must be unified national payment strategy for PGs. They must also get free food, hostel and internet, and compulsory 8 hours daily sleep time.

10. Doctors must also introspect and improve wherever they are really lacking in the social eye: proper compassionate communication, dignified behavior (avoid this talk of the town when someone overdrinks especially in conferences). We must also start “Positive Connection” strategies with patients, and limit / improve upon the existing crisis of faithlessness by encouraging and rewarding trust. There should be doctor-patient coordination committees in every town to facilitate this.

11. A unified “Paperwork and SOP” National committee of doctors must make such paperwork available on the internet for all doctors to use. The laws governing hospitals must be freed from the innumerable “NonMedico” interferences, red-tapism, corruption etc. roadblocks and must be common all over India.

12. Violence against doctors/ hospital staff must be severely punished. All govt. hospital deans must request 24/7 casualty police.

13. All practicing doctors must receive a compulsory paid vacation at least one month in a year to de-stress, and if the govt. or their own hospital cannot pay for it, let other parties willing to pay be discussed without objections or paranoid suspicions. All said and done, it is extremely stressful to be a doctor. Yearly paid vacation is only human.

This is a sweet dream. But what’s life without a dream? Don’t we wish each other sweet dreams? I mean it this time. Let us work to wake up in this dream. We are a great force, let us overcome our differences and become the Great Doctors who ably carry the Nation’s healthcare like Pros, not slaves.

This seems to be the only way. Happy Doctor’s Day
© Dr. Rajas Deshpande

Lifehacks for the Doctor

Lifehacks for the Doctor
With interview of a renowned Cardiologist.
© Dr. Rajas Deshpande

Lifehack:
a strategy or technique adopted in order to manage one’s time and daily activities in a more efficient way.

Are you talented, hardworking, hurried, bitter, artificial, irritable, insecure, obsessive, egoistic, money-minded, dissatisfied and longing for a better life? Yes? Then you must be a successful Doctor!

While medical practice is of paramount and sacred importance, the duties as a spouse and parent are absolute too, there is no replacement for you there (Well, in most cases!). If your “Kick” of being completely swept away by the needs of your practice and competition drowns your own personality and the requirements of your family, you may be a overindulging doctor who is a terrible parent or spouse. Only your family will carry you in their arms few years from now, no one else. Rethink how you treat them today.
Are you really earning “For Them” or for your own super-ego, for overcoming the ever widening valley which converts every luxury into a necessity you must have? The justified feeling that “If I have learnt so much and am so talented, work so hard, I must earn real good”. Has money / affluence become your self-assessment criteria? If so, you may be no different than an attention seeking, beautiful, very very attractive but dumb individual. You trade health, family and life for money.

Calm agility of mind and body are hallmarks of a doctor, and too many tasks, irritability, bitterness, insecurity and lack of satisfaction are making this impossible.

Let us identify how we can reduce stress and improve the quality of life. The only life we have.
1. Separate work and family cellphones. Switch off the work phone outside work hours, except on emergency day. Provide all your patients with casualty / emergency contacts, and only your assistant should be able to reach you on your personal number.
2. Hire and train assistants when feasible, they may assist you with secondary/ nonclinical tasks, paperwork etc.
3. Take a big picture look at your day / time correlation, you will be surprised:
Work (8-10 hours),
Commuting (1 hour),
Sleep (7 hours),
Kids (1 hour) till they are 18.
Spouse (dedicated 1 hour: you married for togetherness all life, right?),
Communication / emails / Internet (1 hour), and
‘Self’ time (1 hour)
Total = 20-22 hours.

You will still have 2-4 hours left for cooking / housekeeping / etc. (to be done by both if both are working). If we expect the society to be modern, we must also give up the traditional “wife at home however educated or smart” and “husband rules” attitude. Family is equal responsibilities to be shared with mutual agreement.

If only one partner is working, it is easier to arrange schedules. If both are working, one may prefer non-clinical / paraclinical duties till kids can take care of themselves. Singles are anyways happier till a certain age!

It is extremely essential to disconnect from the work to be completely with your kids / spouse. Strictly avoid talking about workplace at home, especially do not take your stress to bed.
Switching off cellphone at night is a big step in the evolution of a Doctor’s peace of mind.

You can practice far better with a calm and healthy mind. Hence the necessity of good sleep and self time.

4: Find an activity that makes you feel calm and happy. Don’t need to explain this to anyone, don’t need to feel guilty, this is therapeutic. This must be done alone for an hour everyday , with all communications switched off. Some suggestions:
Music: Listening, Composing, Singing, Learning
Writing, Reading, Painting
Gardening, Watering plants (magically calming effect).
Swimming, Cycling, Dancing, Gymming, Yoga
Long walks / drives if good, uncrowded roads nearby.

One of my senior colleagues Dr. Jagdish Hiremath (Director of the Ruby Hall CathLab) is one of the busiest and renowned Cardiologists in the town, and never skips a smile when a colleague crosses him. Always appears at peace with himself and others. I asked him how he manages such a stressful life of a successful interventional cardiologist. As we talked, I realised his answers are worth what every doctor must think about:

Dr. JSH: “I prefer to be in the present 100%, whether with patient or otherwise. I concentrate upon the task in front of me and blank out all else, so I can do justice to that task. When I am with a patient or in cathlab, my cellphones are diverted to my assistants or receptionist, and I am not disturbed. This helps me, and the patient also feels happy about it. My assistants filter out unnecessary calls and pass on the genuine ones to me as a message, I call and talk to them on my way home”.

Me: “Newcomers, especially superspecialists, face the dilemma: that cut-practice or referral practice is the only way they can start, as no one offers any salary till you have a good patient-base. It is almost impossible for the beginners to start in a decent place without submitting to the existing pay structures”.

Dr. JSH: “Yes that is a shortcoming in our system. But then, the concepts of ethics, morals are quite twisted in medicine today. We must never compromise in doing the best for the patient. But then, others should not decide or dictate how the medical charging systems work: neither insurance people, nor media, community or anyone else. Because they never understand / acknowledge the importance of talent and skill”.

Yes, I thought: who else will allow other professions/ government, society or insurance companies to decide the value of their services? Will they allow others to dictate how they use / share their charges? It is only the doctors who have allowed this, and it is high time everyone else shuts up about this and doctors redefine the charging structures.

Me: “Sir, medical education has become “Earning PG” oriented. MBBS doctors do not get good teachers, and are not clinically well groomed. They are smarter and have better net-knowledge, but not good clinicians. They have become “MCQ Doctors”.

Dr. JSH: “I have always said that MBBS should be ‘the making of a doctor’, and not only stepping stone for PG. We need better institutes, better teaching. A doctor must grow as a human being lifelong, and it must start at this level. Even the PGs are exploited too much. Their teachers should understand that they are no more traditional ‘students’ in college, they are grown up married doctors with families, and must be treated like employees rather than servants”.

Feeling a sense of having learnt something invaluable, I thanked him and left.

There’s this “Becoming a Man (or Woman)” of every Doctor: when they start treating independently and confidently. Then comes the phase of an “All Out” effort to increase practice: extreme self neglect and hardwork, running from one hospital to another. Then one day they wake up to the reality.

All the stories of Morals and Ethics taught and expected of a Doctor are like the things that parents tell their kids not to do, while doing these themselves.

The Indian Doctor’s Enlightenment (approximate latency 5-7 years in practice) comes packed in bitterness and depression towards the very society he / she serves. They realise that the society has lost trust and respect towards us, even the recognition of the extreme education and hardwork doctors have to perpetually live in. An educated patient expects global standard healthcare at Indian rates. The uneducated look upon the doctor as a bandit.

So if you have become the typical successful doctor “Hurried, bitter, artificial, irritable, insecure, obsessive, egoistic, money-minded, dissatisfied and longing for a better life”, it is time for a reboot. No medical bodies stand by or defend doctors. So we must learn and try to sort out this mess ourselves.

For life is change, and wisdom lies in the wish for a better life.
It is high time Doctors learn to take care of themselves.
Wishing all Doctors best of health and a beautiful, rewarding life of success and satisfaction.

© Dr. Rajas Deshpande
(This is Part II of “Delusions, Doc?)

Special Thanks
Dr. Jagdish Hiremath,
Director Cathlab Ruby Hall Clinic

Delusion, Doc? Part-I

Delusion, Doc? Part-I
© Dr. Rajas Deshpande
This post is primarily meant for doctors.

For one moment, stand naked and shed the language public likes. Be yourself as a “non-doctor” person. Right, the one under the shower.
Not enough time for self, peace, family, health, food, sleep, happiness, hobbies or even introspection. No stress free days. Continuous social and media criticism. Highest moral and ethical conduct expected under scrutiny, even the most criminal and immoral can deride you publicly.
Do you want this to be the schedule all the rest of your life?
Doc, are you living your life then?

The dream has materialised. Became doctor, served people, most patients happy, some unhappy. Some earned a lot, some didn’t. Some achieved personal / social goals. Some made mistakes, some suffered unfortunate violence. Some are beginning with new hopes and vigour, confused still confident of better futures.

Some fortunate and vocal got awards, fame, medals. Some fell for the hypocrisy of having to tell everyone how rewarding and pious their career was. Thousands of stories. Some genuine.

Some questions and material answers:
What is the ultimate aim of a doctor?
Serve as many patients as possible, earn money and fame, stay free of problems, and be respected for all this. Be the best in one’s field. If possible, achieve something great. (What?.. Oh! Haven’t had time to think about that yet.).

What was the last stress-free phase of life?
School. After that, only merit, hardwork, compromises and stress. Medical stress is worst, dealing with uncertainty of life itself. One may choose to accept, mature, ignore, meditate and come to terms with some situation, but never have “Peace” of mind in true sense. Absence of irritation is not peace of mind.

How is your family life?
Compromised. No peaceful, happy togetherness. A torn relationship especially if both are doctors. Worst if a surgeon. More irritability, more self neglect, less “love making” time, disturbed nights due to serious patients and other endless calls: a practice essential.

As a parent: Guilt, Shame and Tears. So much want to spend time with kids, watch them grow up. But mostly irritable and completely tired while with them. Sunday is the peak fatigue day for doctors, paralysed with the past week and outstation visits, or plans of the oncoming one. Kids find you happy and energetic only rarely. We catch up with their childhood years later in photo albums!

Personal life?

Food: not always in time, irregular, cold if home-cooked. Cannot afford / even plan healthy eating time wise.
Romance: What’s that? Oh Ok! Yes yes we imagine that
sometimes among the bleeding, crying, whining and violence.
Sleep: Shut Up! Just please SHUT UP!
Exercise: Only what the running around in and between hospitals, stairs.
Social: Hardly a weekend with friends. If hoteling or travelling, accused of being bribed by pharma. At any other social event, grabbed by opportunists who will discuss their health problems, especially bowel habits (during buffet) with you. Or ask you references of a cheap but very good doctor who will treat without investigations or surgery.
In a beautiful Santoor concert, my next-seater described her Tinnitus for a good 20 minutes, entirely spoiling my favourite Raag Shivaranjani!

Time for parents: Rare. Most doctors cannot even accompany / attend their own parents in illness properly.

If you are away from work, someone else is waiting to take your place. Patients cannot wait.

Work satisfaction:
Private practitioners: Moderate income, huge risk and stress, long work hours if charges are competitive. Surgeons earn better, but have higher stress. Physicians have to see more patients for decent income. Good work satisfaction.

Corporate/ Nursing Home practitioners: Moderate income. Most corporates using “divide and rule” policy to encourage competition for earning more. Most doctors have to continually increase revenue. If you are not making good profits for the hospital you work at, there’s someone else in line with better ideas.Hospitals must make profits. So most specialists must work at different hospitals for a decent income. Not everyone can afford to open hospital with all facilities. Low-Moderate satisfaction.

Govt. servants: I am yet to meet a genuinely happy govt. doctor. (Exceptions: those whose transfers / promotions or some other “special requests” are pending). Right from Resident Doctors to Professors, even Deans, are paid pittance, their only satisfaction being : atleast this is better than the earlier generations. Too many non-medical paperwork ‘dumped’ tasks by govt. Low-Moderate satisfaction.

There are some claims:
“I am happy because I don’t care what happens once I am out of my clinic”. Difficult if one is really involved in their patients.
“It is my choice to be in this much stress”. I wonder how happy their families are with this attitude.
Two classes say: “I enjoy serving the poor for free and am proud to be in this profession. I live for this”. Typically a MSS (Medal Seeker Syndrome). Will write separately soon about this.
Class ‘A’: Have it alls. Please explain your merc or beamer sir.
Class ‘B’: Dying for recognition, attention, praise etc. Explain your outcomes sir.

Are you happy with the perpetually unstable state of affairs that has become lifestyle for this profession now? Anyone can make any rules and you must follow them, all specialties must obey what semi literates and non specialists dictate.

The “High” of actually saving lives, curing diseases, easing suffering can never be understood by anyone else, but we too never understand the addiction part of it. We must work, or we are afraid people will die. There is no compensation for being a good doctor, you are at par always by law with anyone with a similar degree.

There are few seekers of perfection, of “doing the best for most”. They are villains in the public eye, for earning more, for being in a hurry, not explaining themselves to the system and general public. They do a lot but never get the deserved “social” accolades, which are typically reserved for the A class mediocre hypocrites.

All in all, the “Doctor”, under the delusion of respect and recognition, is subjecting him/her self to extreme stress, social and media criticism, health and legal risks, and most importantly, a life of a slave to their own delusion.

You income stops, your reputation dies the day you stop practice. Many retired Indian doctors of yesterday, who served the society without thinking of money and who are unfortunate to be alive today, live in a miserable poverty. None of the “Ethics and Morals” lecturing idiots ever cares what happens to them

Like times, we must change or die..

In Part II let us see some of the solutions.

(c) Dr. Rajas Deshpande

The Curse of Real Heroes

The Curse of Real Heroes
© Dr. Rajas Deshpande

Two boys, 15 and 18, wheeled in their mom, a spinal case who can’t walk. They had lost their father guarding the Indian Border. They care for their mom in turns.
Both want to join the army asap.
“How much do we pay?” ask the elder, proud son after the consult.
“I should pay you with my blood, son!” I wanted to say.
But I didn’t want to weaken in front of those bravehearts.
“It is my pleasant duty, dear, you don’t have to pay” I told him.
“But this is a private hospital.. we can pay. We paid elsewhere we went. We want the best care for our mom”.
“That I promise, and this is in honor of what your Father did for all of us”. This made them smile proudly, albeit with a wet twinkle in all eight eyes.

“I was a Black Cat Commando, Sir. I served as a bodyguard to PM Mrs. Indira Gandhi, Sir” said this huge, intimidating gentleman, now a sufferer of Parkinsonism. What an irony, that the one known for speed, strength and accuracy is forced to a life of the opposite! He guarded our PM once! He has to go to apply for some medical concession today.

“I loved this beautiful girl” said the 75 year old Punjabi gentleman pointing at his 72 year old wife, “but her father said I was a nobody, so he didn’t allow us to marry. Then I won an enemy tank, sent him my picture with it. Then he agreed. I fought three wars for India, Sir. But I still cannot dare to fight her, Sir.” You cannot compete Punjabi humor. He is also applying since last one year to get an accommodation with elevator facility, as he is on third floor, and has to be lifted up by wife and an assistant as he can’t climb.

He has roamed some hospitals, in search of relief from a recent illness. Admitted at many places, lost a lot of money in this process. He feels it is “abuse of the system” to claim any concession, as the military hospitals provide adequate healthcare. Naturally, not all patients can be happy with a “fixed” doctor. They do not have a choice, and if they go to a private hospital, they must pay.

Young stroke at 32, from Pimpri-Chinchwad. Fighting terrorists in Jammu Kashmir this moment. After recovery from stroke, joined back in anti terror squad in Assam within four months.

It is a huge, sticking-out red shame that the very people who endanger their lives for their country without a second thought, who stand in the line of genuine fire, have to live a life of “requesting, begging and applying” for favors for basic living: accommodation, transport, food, medicines and even healthcare of choice, while blatant corruption by many erodes the nation’s treasuries.

We live happily at the cost of their risking lives, complacent with garlanding their memorials twice a year.

Even the policemen hurt, injured on duty, and those who suffer heart attacks, strokes and other health problems due to an excessively stressful life who have to stand in line to get memos and recommendation favors from clerical staff to get healthcare concessions. Whatever their level of corruption, it is pathetic to see traffic police at most polluted junctions standing for entire day, literally “giving away” their life.

All healthcare at ANY center of their choice must be made free for those in the Indian Military, and policemen who are injured while on duty. Most doctors and private hospitals will agree with this, if the other affording “free” class is brought to the account book : the rich and affording litany of various political leaders, their whole personal staff, ministers and their staff, influential rich, and many undeserving govt. officials who take immense advantage of the system for self, family and relatives. These number in millions.
There will be some among the military, police who may try to take advantage, who may ill-behave, but that can be dealt with if a common healthfile is maintained for each one, for the doctors to remark so, and deny further care in that case.

In honor generations of soldiers who have taken upon themselves to protect a country which will deny them even the basic care in the hour of their own need. I know most doctors ensure best care for these Heroes, but we must make it officially so.
© Dr. Rajas Deshpande

Food, Sex, Addictions and Privacy: Seriously!

Food, Sex, Addictions and Privacy: Seriously!
© Dr. Rajas Deshpande

An old man of 82 was admitted in London ON once with stroke during his “regular” morning lovemaking with his contemporary wife. An accurate history and onset time is necessary so we can use a clot buster injection within 4 hours of onset. He qualified and eventually recovered too.

I was amazed at the calm, expressionless responses but courteous attitude with which everyone in the staff treated him there, the couple was never embarrassed by any of the staff or doctors. Upon discharge, the patient asked Dr. H, an authority in the world of stroke, with a cute wink if he could continue his “Morning routine”.

A smiling and about twenty years younger Dr. H replied he could, so long as he took the prescribed medicines, and joked with a return wink that he (Dr. H) envied the patient, making the patient smile!

A twenty two year old unmarried female student came for suspected Multiple Sclerosis once. “I smoke grass (marijuana) for recreation, doc. I also take oral contraceptives often. Does this affect my illness?”. Both her parents sat there without any change of expression, and did not interfere at all with any part of the consult. I couldn’t help remembering the contrast panic and beating up by parents in some of my Indian college mates I knew, whose only fault was stealing a cigarette from their Father’s pack! Also the whole-family-humiliation-screw meeting in which the traditional family-nerds irritatingly shine!

In India, people seldom relate correct history for the shame attached to it. I have witnessed some very embarrassing moments, when doctors (especially junior) openly, loudly ask sexual / urinary history or addiction details to the awkward patient, while their colleagues exchange blushed, meaningful and pregnant glances. This is an obvious turn-off, and whether it is sex, sphincters, alcohol or smoking, no patient likes “Open Questioning” about this without adequate privacy. Then too, people talk only if respectful dignity is offered by the doctor. One must ensure such privacy, but never miss to address this issue out of shame or embarrassment. A history of STD or HIV risk must be asked where important, with relevant but properly formed questions, without a condescending tone. Many doctors half the age of patients actually humiliate the patient in a hope to make him / her quit alcohol / tobacco / smoking. Such patients are irreversibly hurt by open humiliation, and this should best be left to professional / experienced counselors.

This is also why many patients (especially the older, less educated, depressed) who have had heart attacks, spinal cord problems, accidents, strokes etc. hesitate to ask a “Loud Doctor in Hurry” about physical relations and addictions. Some refrain from normal life out of unnecessary fear, which may contribute to their depression. If the patient feels embarrassed or awkward, it is the doctor’s job to reassure and address these issues. A pre-discharge counselling meeting is essential. Fortunately the younger and educated generations even in India are now quite open and frankly ask their doubts without feeling “unnecessarily” guilty.

Actually, every patient, rich or poor, deserves privacy for any health discussion. It is a sick scene to see patients in a queue in most govt. / municipal hospitals having to openly answer such questions in absence of proper space. Overworked and authorityless doctors are helpless here.
My internship days.
A civil surgeon (administrative post) took what we call “Babaji Rounds”: smiling, hand-waving rounds just to ‘show’ the patients that “I am the boss”, talking sweet to every patient and firing everyone among staff. Administrative rounds like these are medically useless, but some depressed patients feel good, and some good administrators correct the service deficiencies.

One thin built religious leader was admitted with acute shutdown/ failure of kidneys. No urine output. Blood pressure very high, we struggled to control it. When the CS came to his bed, the worried wife asked: “Sir, what should I give him to eat?
The CS beamed a big angelic laugh, patted on the back of patient and said aloud “Anything he wants.. icecream, fruit juices, milkshakes..”.
“Samosa?” asked the lady..
“Yes sure”, said the CS and told the patient: “Eat more if you want to get better soon”.
The patient touched his feet and said “You are like God Doctorsaab, my illness is half better just by seeing you”.

That diet would have killed that patient, had not our fuming medicine professor (after a caste based solid expletive for the CS) asked me to rush back and stop the excited wife from feeding all that to the patient!

The CS didn’t even know the condition, diagnosis, or other details. He never wrote anything on paper (Capital or Small in verbal instructions??), but could have severely damaged patient’s health, just by his careless advice under pretension of knowing what he didn’t.

Point:
Many unqualified people / quacks/ and some qualified doctors too advise via verbal instructions trivially. Patients blindly follow these instructions. Right from “Shudh Desi Ghee (Clarified Butter)” to herbals!
This is equally or far more dangerous than bad handwriting of a good doctor.

Advice about food, exercise, sex, work, posture, sleep, physiotherapy and lifestyle are all parts of the consult, equally important as the medicines. A good doctor’s routine will include this advice for every patient. Patients should also consult a specialist for their illness at least once in the initial stage, so he / she can plan out long term holistic plan and the regular general / family practitioner can follow it up.

Some patients take advantage and ask the same things repeatedly. In a busy clinic, a personalised printed advice can be given. In a crowded OPD, as in charity and govt. hospitals, a “general instructions for a disease” booklet will go a long way, or special group counselling can be advised.

Things are changing. Many newer generation doctors are making good friends with patients especially from their own age groups. Fortunately, even the youngest doctors still do not use colloquial phrases like “Aish Karo” (Enjoy to the hilt), otherwise some perfectionist patients may really follow it to the core!

Because “Chalte- Chalte” / hurried advice, however trivial, may prove dangerous.

© Dr. Rajas Deshpande

Fraudopathy: The Pre-Forgiven Mass Murders

Fraudopathy: The Pre-Forgiven Mass Murders© Dr. Rajas Deshpande
Seven year old kid. Multiple types of fits / convulsions every day since years, short and long lasting. 

We know every fit further damages brain. 

Rich but illiterate parents. 

Many Neurologists have advised similar treatments, but parents have no patience to build up (titrate) the dose, which may take weeks/ months. 

In search of “immediate” relief, the child is taken to many “Paths” at a time. 

I asked the parents to bring all medicines that this kid was being given.
Turns out that the seven year old is being given 27 tablet/ syrup doses each day!

Only two are allopathic meds prescribed by an epilepsy specialist, remaining are from three other pathies and few herbals a local “Sadhubaba” suggested.
Except the allopathic anti epileptic meds, there were no names on any medicines, these were dispensed “privately” by some doctors (different Pathies), quacks, and others, without any record / prescription. Parents had no clue what these were, the mom identified them with different bright coloured coatings the tablets had (believe me, there was a rainbow in that medicine box).
We are so easily swept away with blasting news of colours and lead and mercury in famous food products, and heroic, blind panicked actions especially against the “unprotected and non bribing” clients! 
Those with right connections can mix the earth with the sky and get away with it!
I respect the genuine Ayurvedic practitioners, (they are usually extremely humble and don’t treat their skill as business, themselves following a certain disciplined lifestyle) and some others who know their science well and are qualified. But the huge crop of “FASTFOOD MEDICINE” practitioners who gain backdoor entry in the allopathic system play havoc with public health, because the in-depth knowledge of drugs and human body (via extremely tough University exams and interviews) and an experience of years cannot be replaced with a six months / 1 year crash course.
In a country with same medical council and health departments, while one pathy is expected to follow prescription formalities to perfection, writing in caps and generics, other pathies are excused altogether. These pre-forgiven “Doctors” sell anything as “personal secret formula” medicines for huge costs, decline to reveal its content, and seldom give a written prescription. The public so damn impressed by idiotic allegations against the “real” allopaths completely ignores the millions of “powders” “bottled pills” which pack anything from steroids, lead, mercury, arsenic, gold, iron, sedatives, narcotics, plant poisons, and even plain calcium carbonate. These are sold at higher costs than even imported medicines, cause huge healthcare burden via kidney and liver failures, heart, stomach and lung disease, brain swellings etc.. 
The colours used to coat such medicines may contain unhealthy chemicals. But then there are no investigations of such “nameless” medicines, sold openly to millions, without even prescription when directly dispensed by the “doctor”.
There actually are sellers of “Personal Secret Formula” medicines for everything from Neurological problems, Heart diseases to Obesity remedies in almost all major cities. They advertise openly, and there are long queues of the educated and rich in the doors of such, a glaring fact in the face of all critics of genuinely qualified doctors. These secret formulas often contain mixtures of established Allopathic medicines, steroids and herbals. 
But the whole system is concentrating upon screwing the “Scientific hence Costly” Allopaths.
Are there any “Medicolegal” cases known against quacks, other Pathies? Obviously not, because the “side effects” like kidney failure or liver failure” will happen after weeks, months or years, there’s no proof, the failure of results is just “badluck” and there’s always the allopath to blame for everything that finally goes wrong healthwise! 
Allopathic medicines have many side effects too, some are dangerous. I repeat, not all allopaths are saints. But we have proven protocols and a scientific methodology. So have the genuine Ayurvedic practitioners, and some other established ways. This article only highlights the risks in taking “nameless” medicines.
“No prescription Nameless medicine” is a big question mark that needs answers.
© Dr. Rajas Deshpande
Please share in the interest of our beloved patients.

The Tortured Beloved

The Tortured Beloved
© Dr. Rajas Deshpande

“I want to kill my father, Doc. Is there any way?” said the polished lady.

Used to a life full of shocks, cruelty and in general many negative shades of human behaviour, we learn to mask emotions to avoid turning off the patient /relative from telling us the whole truth.
This was a googly, and I made a conscious effort to retain my composure.

Thirty-something, very posh and from a high class cultured family, this lady was one of those who automatically garner respect of people around them. What she said didn’t fit in with the mental image she had impregnated upon my mind. Could she be one of the “PSY” cases?

“I live with two daughters aged 9 and 14. My mom passed away 10 years ago. My husband stays away as he cannot tolerate my father. My father was a military officer, retired with many honours. About 5 years ago he started forgetting things. We took him to many doctors all over India, they said he had dementia. Two-three years ago he started abusing in the worst filthy and obscene language we never thought he could use. He also started getting naked anywhere, and doesn’t care if myself, daughters or neighbours are around. He passes urine deliberately when in public and around us. He also makes attempts to sexually abuse us all, and tried more than once to grope the maids, who then left. We had a hard time when a maid filed a police complaint. I could not dump him as no one else can look after him. So I nursed him at home, and my husband who could not tolerate this daily abuse left us to stay in another state.” She started sobbing. All I could offer was a few tissues and a coffee.
I waited for her to speak again.

“I am sorry”, she said in a wet, guilty, embarrassed and one of the most pained voices I have heard. “I love my father as much as I love my husband. I could not dump my father. But then I cannot let my daughters go through this every day. They are terrified and have started behaving strange. We took him to many psychiatrists, and they gave medicines which kept him calm, but he developed too many side effects and could not move out of bed. Now he refuses to take any medicines and if we force him, he gets violent.” Again amongst sobs, she showed me her blue-black swollen shoulder.
“I have to tie him up to his bed and lock his room at night, but he keeps shouting. Our neighbours have started asking us to either dump him or move out of the society. The old age homes do not accept such patients.”
“I am a personality development counsellor, but my work is suffering now, I have lost my smile. I have lost my life. I cannot die, I have two kids to grow up. So I want my father to die. Is there any legal / medical way to kill him?” and then a volcano of unvoiced pain of years wailed out through her throat. She kept her head on the table and cried.

It was unprofessional, but I had to get up and pretend to wash hands just to be able to wipe tears in my own eyes.

Fronto-temporal Dementia, a cousin of Alzheimer’s dementia is a condition in which along with progressive memory loss, there is abnormal behaviour, delusions, sexual inappropriateness etc. It happens due to degeneration in some parts of brain. Progressive for about five-12 years, till patient develops some fatal complication.

This was not totally new. I remember many patients who are tied up at home, beaten up cruelly by their family, and left to die due to this kind of behaviour. This tragic management is also commonly meted out to many psychiatry patients who are burnt, injured with sharps, shackled and tied to beds / trees, kept with head under running water and even poisoned / sedated with herbal or even allopathic medicines to ensure safety of those around them.
Few years ago, one family of bodybuilders (all five brothers in land business) admitted their father with the complaint “he burnt himself with hot water in bathroom”. There were many bruises too. “He fell at home.” They told. When the sons left, the servant told the resident doc: “They (patient’s sons) threw boiling water upon his genitals after tying and beating him, because he tried to touch his eldest daughter in law”. This patient had severe parkinsonian features too, so was not able to move much due to stiffness. They had beaten him up and burnt him in that condition!

The lady in front of me regained her calm in few minutes. I explained her what many Neurologists and Psychiatrists may have earlier told her many times, about such being the nature of this disease. However, we have many safer medicines to control psychosis now. I wrote her a prescription and promised her that I will try and locate a “Care center” for such patients with this severe level of psychosis. There were none in that city. The next option was to hire a male servant and rent a small single room apartment with attached toilet nearby where she could shift her father. Sedatives (sleep medicines) at night were required.
Her husband shifted back. The family appeared to gradually recover from the mad-bad days.

As much as we need the doctors to explain the family about such illnesses, we also need to educate the society about such conditions, and care homes for these patients. Inhuman beating up, tying down, injuring, poisoning etc. humiliating fates by one’s own children is probably the worst that can happen to a human being.

When the lady came to visit with her daughters few months later, her cute daughters wished me mannerfully. We all grown-ups avoided the topic of “Sick Grandpa”. However, the 9 year old, while leaving, boldly asked her mom’s permission to ask me a question.

Then, looking straight in my eyes, the kid asked me “Doc, why did God do this to my Grandpa? Is it possible to cure him? We used to enjoy so much together, I was his dearest. It is ok if he hurts me, I want him back”.

I cursed my stunned wits. “He will get better soon, dear” I lied to the cutie.

© Dr. Rajas Deshpande

WHEN NOT TO DO YOGA

WHEN NOT TO DO YOGA
INTERNATIONAL YOGA DAY UPDATE:
© Dr. Rajas Deshpande

Even as an Allopathy practitioner, I respect Yoga immensely, and owe much to it: my father insisted that I spend the sunrise hour performing Yoga throughout my school years, and later Mr. Mohandas at the “Kaivalyadham” on Marine Drive Mumbai polished some of my concepts.

However, Yoga is not always safe for all.
Here are some diseases which may worsen / flare up with Yoga, and certain conditions where the “Posturing” / “Aasanas” can lead to complications. Please talk to a well trained / qualified Yoga expert before adopting any routine Yoga schedules. Do not learn Yoga from “partially trained / unqualified” or “Student” practitioners.

The following medical conditions may worsen with Pranayama or other breathing exercises:
Vertigo
Epilepsy
Tinnitus
Bleeding in the Brain especially due to Aneurysms, Tumor
High pressure of CSF (Hydrocephalus) in the skull / brain
Psychiatric Diseases like Mania
Cardiac Failure / Severe Heart Disease
Certain muscle Diseases like Myasthenia / Myopathy
Middle ear disease
Tendency towards aspiration of food in certain degenerative brain diseases
Adverse effects of some medicines may be exaggerated (giddiness, vertigo, tinnitus, blurred vision etc.)

Patients with following diseases must consult an allopathic specialist also before starting a Yoga schedule:
All conditions mentioned above
Uncontrolled or severe blood pressure
Heart Disease, especially valvular and hypertrophic, untreated
Severe anemia
Decompensated Liver or Kidney Disease (Highly abnormal tests)
Diseases of the Spine, Nerves, Bones or Muscles
Infections, especially in Brain and Chest
Brittle bones / fracture tendency / myeloma / deficiency states
Bleeding and Clotting disorders
Ataxia / Balance Disorders
Some types of Parkinsonism where balance and / or swallow are affected.
© Dr. Rajas Deshpande

Sheershasana (Headstand) is extremely dangerous in patients with high blood pressure, aneurysms and other blood vessel related diseases of the brain, as the high pressure due to gravity may cause bleeding in the brain. If you have recurrent headaches, get a proper medical check up before embarking upon Yoga lifestyle.

The following patients must also especially avoid Sheershasana (Headstand)

Migraines / Severe Headaches / Sinusitis
Gastrointestinal Reflux Disease / severe Acidity
Patients who have had recent stenting in the blood vessels of neck or brain.
Cervical disc disease / Spinal diseases (some)
Bleeding in the eyes / retina.

Pregnant women and elderly must take special precautions while performing Yoga. All children must be supervised.

Yoga is an extremely useful lifestyle that helps achieve and maintain good health and longevity for most.
We must learn to use it wisely.

The list of contraindications above may not include all conditions in which Yoga must be avoided. Please talk to your Yoga Master and Physician both before starting Yoga.

Happy Yoga Day! Wishing best health and long life to all!!

© Dr. Rajas Deshpande