Monthly Archives: October 2015

Did you plan your murders and suicide at 17?

Did you plan your murders and suicide at 17?
© Dr. Rajas Deshpande

What were you doing when you were 17?
I know not all questions can be answered fully and truly. But some truth applies to all at this age. At 17, we are full of dreams of a good, respectable and if possible luxurious life. And of course of true love.
Well, what options do we have at 17 for such a rich and respectable life?
If you google-search top grossing Indian careers, you will find management, IT, Chartered Accountants, Law, Data management, Sports, Entertainment, Politics and Medicine. Which option would you choose out of these, if you are intelligent and hardworking?
A 9-5 work life with family time and regular food and sleep and holidays, with healthy, alive people around you, or one with no sleep, highest stress, no family life, always being surrounded by illness, crying and death, lifelong exposure to deadly diseases, having to study every day of your life, lifelong competition and struggle, unsure when some patient or mob or press will end your life or career?

No teenager thinks “I will become a corrupt doctor carelessly treating patients to earn all the money I can by prescribing wrong, unnecessary tests and risking my life with deadly diseases just to earn the title of a doctor, and enjoy harming and killing many many patients all my life, long after my classmates have retired..”.
There is far more money and often more respect in many other professions. Illiterate politicians at age 30 roam in Red-beacon cars, Finance, IT and management professionals at age 30 flaunt Beamers and Mercs, while most Superspecialist Doctors aged 45 drive scooters / small cars in India. Why will a talented, hardworking teenager choose at 17 to spoil his / her life by becoming a doctor? This is not for the mildly intelligent to understand.

Where does the “doctor” class come from? Usually academic, poor, middle class families, rarely from rich class. Which parent will teach their children to do bad to ill patients to earn more money? Do you teach your children at age 17 to “loot” sick people?

The govt. failed to provide enough medical colleges and doctors, allowed private colleges, and decided who will start these colleges and what fees they will charge, the courts agreed to this. How is today’s doctor guilty of this? If paying high fees for the desire to become a doctor and serve sick people and later earning enough to repay that fees is a crime, why not ban all private medical colleges and send all patients to govt. hospitals compulsorily? There always will be those who take advantage of any system where money is generated, how come all doctors are blamed?
© Dr. Rajas Deshpande

The govt. made service compulsory after graduation, made bonds, doctors complied in most cases. Those who didn’t, paid fine. After that, they do not remain “PUBLIC SERVANTS”. They become private practitioners, whose service comes under a “consumer law”, thereby the court has decided it is a business. You have govt. hospitals in every small town now. Why don’t you go there and get the cheapest treatment, with usually no tests (because they are not even available!)? No one will force you for extra money or tests or wrong treatment there. That system, where there is absolute guarantee of no “CUT PRACTICE” and referral fees, will never deny service to anyone. Most doctors there are excellent too.

No. You want premium service, best available medical facilities. You want sweet words and better guarantees. You want highly qualified superspecialists in ultramodern A/c buildings with state-of-the-art machines and tests and operation theatres and stents and medicines and catheters attended 24/7 by teams of all experts under one roof, with the best trained nursing staff. Above all you want the freedom to blame and sue someone for everything that may go wrong. “Science is so advanced, doctor, can’t you do something?” you often ask, “My cousin in USA got this same problem, they lifted him up with a helicopter and he was discharged in a week”. You forget one part of the picture entirely: the insurance premium your cousin paid, the treatment charges levied, and the doctor’s fees in those cases. Above all, you didn’t enquire how many poor / compassion / politico/ VIP / govt. servant free patients that doctor in USA sees all his life.
© Dr. Rajas Deshpande

You want the “USA class” service at “Indian” rates. You want the cheapest treatments by world-class doctors, with the ability to sue for crores. If medical tests are unnecessary, ask the govt. to ban them, or go to the people who can treat you without those tests. Ask the fulminant (google this word, my friend) anti-doctor media for the best options from the various quacks they advertise daily. If medicines / instruments / stents / catheters are costly, please ask govt. to only sell cheaper brands and use them. Why doesn’t the govt. ban all foreign medicines? Have guts to go to the doctor and say in writing “Use only Indian and cheapest medicines, catheters, instruments and procedures, I will accept the outcomes as long as the doctor is technically correct”.

No doctor will force tests or medicine. Choosing the doctor, tests and medicines are all your rights and privileges. Own the responsibility of what you do. If you think the doctor was wrong, do file a complaint with authorities, and follow the legal procedure. If you were wrong, face defamation. Just don’t pretend to be lone saints in a world full of criminals.

About the loose talk that our own brethren / doctors unleash upon social media about “most doctors being corrupt”, I think the medical councils and associations must seriously deal with such defamation of our profession. If someone has an issue with medical corruption or malpractice as a doctor, they must go to their specialty association or medical council, not general or social media, as this is just misleading the public. API / IMA must start filing defamation suits if any media plays judge in medical cases before the courts of law have convicted the doctor.

How does one choose a doctor for oneself? Cheapest or Best? How did the doctor you chose become famous / best? Never by only a degree. Of all the rich careers, the richness of a doctor is the costliest, having to toil the hardest over many years to attain that success, with no support from the society, govt. or media. Corruption may make some doctors rich, but never famous.

Let the govt. publish a book of standard tests and treatment of every medical condition and have every doctor follow it, irrespective of the outcome. Alternatively, have faith in the doctor’s education and opinion.

All malpractices in all fields must go: Political, Social, Government, Educational, Public works, Religious, Media, Entertainment Industry, Judiciary, Police and ofcourse medical.

For all those who missed the Indian medical train, enjoy your journey without jealousy! Believe me, you are lucky to not be a doctor in India. For us, the meaning of “Happy Diwali” ended for life when we entered medical college. This Diwali, put on your new clothes, pack some sweets and visit any casualty near you to know what being a doctor means. Then dare to blame an entire profession.
© Dr. Rajas Deshpande

Never Go To Any Doctor

Never Go To Any Doctor

(c) Dr. Rajas Deshpande

“All doctors are thieves. They spend crores to get the degrees and then squeeze patients all their life to earn, doing unnecessary tests, prescribing costly medicines and doing unnecessary surgeries and plasties. I know. I have many doctor friends who tell me when they are drunk”: Arrogant, khadi, Gold, Perfume, Rolex, Gutkha. Add political party of choice. His breathless wife was advised some tests by some other Doctor, and he was complaining about it.

“Sorry Sir, I cannot take this case” said the Doctor now seeing the case, and wrote upon the paper: “Hostile patient / relative”.

The doctor has till now endured too much deceit and pain out of “presumed innocent” population’s baseless allegations uplifted by media. He will easily give up any possible earning from such cases which drain his blood and his reputation.

This is becoming common now.

Let us take off the Holy Apron for a few moments and sit across the table for some school-grade naked logic.
If all doctors are bad, well, don’t ever go to a doctor or hospital. If all doctors are not bad, stop generalizing.

If you think tests advised by the doctor are unnecessary, either don’t do the tests or go to another doctor. You cannot change or challenge the hard-earned wisdom of a qualified doctor. You cannot force a doctor to treat without his/her comfort of knowledge about the patient’s condition (for which tests are required).

(c) Dr. Rajas Deshpande

Have courage to decline tests, admission, surgery and medical treatment on your own, and also to own that responsibility, for yourself or your dependents. Write freely upon the doctor’s note that you do not believe his / her opinion, want another, and that you decline the tests and medicines. That way nothing is hidden. Stop bickering and backbiting a profession that is by and large coping up with the country’s health burden.
Change the doctor, don’t expect a busy specialist to pleasure-massage your medical knowledge.
If you want old age sweet talking doctors, please do not expect new age technology / medicines / surgeries to be involved, neither new age results which are far better. Illness, Disability and Death were gracefully accepted as “Ill-Fate / Destiny” in old age, doctors were not blamed for any of these. Continue that tradition. If you want don’t want completely “professional” attitude from a doctor, please write to the Judiciary which has termed the patient a “Consumer”. Doctors will also make human mistakes, declare your acceptance and write a note that you will not sue the doctor for any mistake. If you want the freedom to sue for gorgeous compensation amounts, you must sacrifice the wish to have “emotionally connected, involved” doctors who try all that they can for their patients. Highly scientific, legal and professional will also be costlier by definition.

Nothing has ever gone cheaper in the world, stop expecting that medical care will. Doctors have to spend a lot upon education (they do not decide the fees for medical colleges, and it is not their fault to want to become a doctor), and they will of course have to earn atleast what they spend upon their education. Who will become a doctor with a wish to be bankrupt?. From onions to your children’s fees to your current phone, things have become costly by the day, why will the doctor not have to earn more?

To accuse that all doctors earn by wrong means is as idiotic and unfair as blaming an entire religion or gender.

© Dr. Rajas Deshpande

Insurance companies and most corporates are out to earn profit, they do not care about you or the outcome. It is only the doctor whose effort and wish are always oriented towards a good outcome for each patient. No doctor enjoys a bad outcome. His/her own reputation is on the line with the outcome, he / she will never risk that. This is also the reason why doctors have become extremely sensitive to hostile / legal-oriented patients / relatives and either avoid them or make them go through all legal (sometimes unnecessary) formalities to keep a proof of everything, should things go wrong. It is not possible to be compassionate and sympathetic towards someone who is looking at you with suspicion, treating all your motives as malignant, and bargaining every penny they can to get the cheapest test and treatment options. One idiotic comment, one threat or one word of suspicion said to the treating doctor starts the process of converting a good-natured doctor into a consumer-service medical professional who maintains a distance. A little good natured talk may quickly translate into legal traps, so most doctors now take precautions not to indulge beyond “strictly necessary” communication with most patients.
We live in India, corruption is the baseline in most spheres. This goes for some doctors, some hospitals and some investigation centers (pathology, radiology etc.). There is no denying that. Not all pathology labs use standard protocols, not all radiology centers do proper studies. Not all doctors make profitless / correct decisions. So if your doctor tells you to visit a particular lab or specialist, it is not because of financial gains always. One has to justify patient’s faith and advise the best. It is not possible / ethical to speak ill about others, so doctors just go by the preferences which they have by experience of years realized suit their wisdom and ethics.

Take the example of a singer. He/she has to have the musicians of choice, who suit their own thinking, style and sense of singing. You cannot force a violinist or guitarist or drummer of your choice upon the Maestro / singer. It will then become a discordant concert. If the Maestro / singer is responsible for the concert, he / she will need the freedom to choose his / her fellow musicians / assistants / music specialists.
Life is far more complicated than music, and medical decisions are often complicated beyond the understanding of google-graduates. The wise will know to have faith in the doctor they choose and benefit from it. The suspicious and oversmarts will keep on doing themselves / dependents harm by spoiling the whole process.
The only thing more important for a doctor than the patient is his / her own reputation. If you are a risk to that, the doctor may refrain from wholeheartedly trying to do best for you. He will do what is legally correct, which may save the doc, but not always do good to the patient.

Like some idol who you have idolized since childhood shoving you away in his / her bad mood in the one lifetime moment you meet them, young doctors who were always taught in all medical schools to “Love” their patients beyond themselves suddenly come across violent, accusative, paranoid patients and relatives, and almost never recover from that grievous mental trauma.

How much for an eye? How much for a limb? How much to hear your beloved talk again? How much to see your loved one coming out alive from the operation theater? How much to see them smile again? How much for a life?
Choose the cheapest options, google everything, hire a lawyer and find out. Why go to a Doctor at all?

© Dr. Rajas Deshpande

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The Lawless Side of Medicine

The Lawless Side of Medicine
© Dr. Rajas Deshpande

A well educated businessman driving in his car with his family had an accident. He had some bleeding wounds, but was fully conscious and alert after the accident. A few young college-going students stopped to help, picked him up, hailed an autorickshaw and took him to the hospital. The patient’s wife and child followed in another.The junior surgical and orthopedic residents examined the patient, stitched his bleeding wounds and started medicines. The wardboys and other staff carried the patient to the CT scanner, and shifted him to the casualty after the scan. Patient’s wife accompanied him throughout. When the senior surgeon came over and asked the details of his prior health status, the patient requested privacy and revealed that he had recently been diagnosed with HIV infection, and was taking some traditional medicine for that. Atleast 4 College students, the autorickshaw driver, and 2 wardboys had been exposed to direct contact with his blood by then. The treating doctors had their gloves on, but not the complete gear expected to be worn while treating such patients. He himself or his wife had not cared to tell helping hands to protect themselves.
There are many blood-borne diseases, some fatal and some dangerous. While the courts merrily write orders about help to the victim (which is must), no one cares about the risk to the helper’s life while executing such help. No court has ever ordered the government to make Universal precaution gear mandatory in hospitals, especially govt hospitals where thousands of budding doctors, nurses, wardboys, techs are exposed to blood contact daily, without knowing the infective status of the patient. No court has ever ordered the govt to implement precautionary measures to avoid accidents, drunk driving, or emergency roadside assistance. People can drink, drive reckless, cause accidents, govt can do away with wrong licencing, zero roadside assistance, but everyone including the press will pounce upon the treating doctor for a bad outcome! No court ever questioned the authority which issued licence to a driver involved in traffic accidents!

Another. A lady of 60 brought to the casualty unconscious, with drunk “mob” led by her son. The son tells that she never had any health problem till that evening, when she had convulsions. They demand immediate admission in ICU and treatment, and declare that they have no money. The hospital obliges and admits her as a free patient as an emergency as per court rules. Next morning the recovered lady revealed: that she had had convulsions till few years ago, was advised regular medicine, but stopped it many months ago. She was also an alcohol addict and had taken alcohol on the prior night. On the day of convulsion, her husband had had a big showdown with her. Upon questioning the same son next day, he replied to the junior doc: “I never said she didn’t have any health problem, and you never asked if she was addicted to alcohol”. They also didn’t have the BPL card they claimed they had.

Fortunately she went home all well, but one shivers at the idea of what would have ensued had she not improved. Probably another cruelly beaten up doctor and voluptuous bad press against the medical fraternity in general.

It is the responsibility of the doctor to be good, perfect and true in everything he / she does. But if the whole action / decision making of this doctor is based upon what the patient tells, any lying / hiding of information by the patient is then likely to impair the outcome. To presume that all patients always tell the truth is a joke. Many hide addictions. Many hide stigma-illnesses like Tuberculosis, Epilepsy etc. Many hide that they were beaten up by a family member. Many do not tell their drunk status during accident (some traffic accident deaths for which the casualty doctors are so often beaten up by relatives may likely be related to the patient being drunk).

The most dangerous patients are those who have themselves or because of family pressure neglected the disease until the time it has reached a critical level, often beyond cure. When something happens to such patients in the hospital, our society is quite impressed with only an innocent sentence: “The patient was completely alright till admission”.

Some patients do not tell that they missed medicines. Some do not follow precautions. Some take additional herbal / traditional / quackery-born medicines along with the standard treatment, without revealing it. The entire responsibility of outcome in every case in any hospital is pinned down upon the treating doctor.

While compassion and the art of “extracting” the correct details are essential for every doctor, it is not mandatory for the patient to tell the complete truth. In this medicolegal age in a mostly illiterate, superstitious society, it is essential to educate people about telling the truth and taking precautions while helping others.

If you have an open wound / cut / injury over your own skin, please refrain from touching a bleeding patient. Avoid blood contact of any person unless you are in a position to save life by taking that risk. It is wise to keep a box of gloves in your car / four wheeler, or carry a pair in your purse / office bag for such an emergency.

While it is expected that every doctor, irrespective of how busy he / she is, writes detailed notes and prescriptions in capital letters for every patient, there is no responsibility assigned to the patient. If the patient is a consumer and the doctor liable for even tiny mistakes or unfavourable outcome, then the clinical-legal responsibility of patients must also be defined. It must be mandatory for every patient to write the details of their health, prior conditions, all medicines, etc. in legible handwriting and sign it with witness to submit to the doctor / hospital, before treatment is begun.

Many patients, educated or not, know this responsibility and carefully, truly detail the doc about everything asked for. They also mostly respect the outcomes. They usually do not blame others / doctor for either their illness or addiction-complications.

However, there is a surge now a days in “blame it all upon the medic or the hospital”. It is high time some wise judges recognize these issues before deliberating a judgement.

Till then, the Indian Medical Profession is at the mercy of press-interpretation.

© Dr. Rajas Deshpande
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