Monthly Archives: August 2016

The Purpose

The Purpose
(c) Dr. Rajas Deshpande
“Shut up, Papa! You are a man too, you too stare at women” Tiya retorted at her father.He was a senior scientist in his late fifties, now beyond embarrassment.
Her mother, a banker, didn’t react. They had learnt a very hard way that the best way to deal with their beloved daughter was to shut up and bear.
“That’s not the way to speak to your father in front of others” I tried to stop her.
“F*** my father. I don’t care about him. Let’s talk about what you can do for me” she said.
Slim, fair, chiselled body. Hard set face of a model. Minimally dressed. Dark black scary eyes with thickset kohl outlines. Dark purple lips. Hair cut short with golden spikes, one pink. Many piercings: ear, nose, tongue and bellybutton. Tattooed on the neck and one visible shoulder, exposed hand and leg. Tattoos mostly knives, swords, blades, bullets and revolvers.
One disturbing tattoo of a hanging gallows just below the neck.(c) Dr. Rajas Deshpande
At the age of 26, Tiya has now had over 20 suicidal attempts, three of them serious enough to make her comatose, spending weeks in ICUs. Somewhere in between she had convulsions and was found to have a brain tumor, operated, recovered, the tumor was not cancerous. She missed her epilepsy medicines often. She has been through many street drug addictions, but fortunately did not need rehab, as she came out herself from that world.
She is not depressed. She is brilliant and never minces her words, speaking exactly what she thinks.
She is also a karate black belt, and has her own art and crafts store online. She also works for some child and animal care NGOs. Her parents grew her up outside India, in a country with semi-western culture. (c) Dr. Rajas Deshpande
“I don’t find much meaning in what is happening in this world. Most people are s***. I can’t stand them” she continued.
“Can I speak to the doctor for a moment?” asked her mother with love. Tiya gestured her with her left hand to go on.
“Doctor, Tiya often drinks a lot. Last week she picked up a fight with some goon at a nightspot in Mumbai, and we had a hard time bribing people not to register a case”.
“So why don’t you let me die peacefully? Why the F*** do you take me to the hospital everytime? That B****** was staring at my *****. I showed him what that costs”.
Her father wanted to interrupt her, but decided to not embarrass himself again.
Exasperated but dogged, her mother continued “Tiya has eight cats and three stray dogs at home. We have come to accept her lifestyle. Her sister stays upstairs, tired of her mood swings and fights, rarely she speaks well with her. You saw how she speaks with us”.
I asked Tiya if she had any reasons to behave so.
“They never knew how to raise kids. They just knew …….”
I interrupted “Can we please stick to sane language for a few minutes? Do speak whatever you want, but there’s no need to abuse anyone else”.
She remained silent for a long time.
“Doc, they knew when I was growing up that I was a trouble child. But they were confused. They didn’t know what to do. They wanted everyone to think that they are ultramodern and advanced. They didn’t question or stop me. I was given unrestrained freedom. I had first sex at fifteen. Then many boyfriends. Aborted once. My father and mother smoked and drank at home, so I smoked and had alcohol in my own home. My father only came and tried to talk me out of it, instead of being firm. Who will listen to philosophy when hooked on?”(c) Dr. Rajas Deshpande
“That’s past. Now that you have grown up, what do you think is troubling you? Now why cannot you take control of your life?” I asked.
“Because I have sudden rush of fears. I cannot describe the restlessness within my heart. I feel like a hundred demons are simultaneously shouting to control me. I sometimes feel that I cannot endure it, then I try to kill myself. At other times I cannot see my parents suffering so much because of me, and then again I try to kill myself. They don’t even let me die. Then I think this is harrassment. My anger piles up”.
Her physical examination did not reveal much, except scars on the neck and the wrist. Mental status examination yielded normal results. I heard some new words that make people blush.
The presumption that every child will grow up into a good adult citizen automatically is a myth, Without any controls, inhibitions, discipline and on some justified occasions physical punishment, a child is more likely never to realise the importance of respecting and treating others well. Misconstrued concepts of freedom,are producing mannerless, arrogant children, and the helpless parents keep on saying “Now a days all children are arrogant and self centered” not even realising the damage that they inflict upon their own children!
In a world where adults seldom know themselves, the kids are being left to understand themselves!(c) Dr. Rajas Deshpande
Tiya had realised early in life that a bad language and behavior gets her more attention, especially male attention. She used it well.
“I have been to psychiatrists, neurologists, counsellors everyone. Nothing works. I am fed up of medicines” she raised her pitch “what’s the F****** use of it all? Everyone dies”.
A few changes in her anticonvulsants (some epilepsy medicines cause / worsen psychosis) stabilised her mood swings. Anxiolytics calmed her down. A counsellor friend started working upon her. In a few weeks, Tiya became near normal, with only minimal spurts of anger.
One night at about three AM, I received a series of whatsapp messages: that she was planning to finally die. She had written that she had already consumed ten tablets of some medicine, and was continuing to eat more. I asked her for her address, tried calling her. She had switched off her cell.
Somehow I remembered that her father had emailed me once. That email had his cell number. I called him, properly panicking myself.
“I am out of town, Doc, with my wife and other daughter. I will call police immediately and give my address” he said.
“Give me the address too, I will send an ambulance with a doctor” I shouted. He messaged me the address.
She is now on a ventilator. There has been significant damage to her brain due to low oxygen levels. Her parents sit outside the ICU by rotation. I cannot bear to see their faces, but must talk to them everyday.
One midnight, as I walked to my car, her father joined me and we chatted.(c) Dr. Rajas Deshpande
“Doc I am a meek man. I never punished my kids, nor allowed my wife to discipline them too much. Now I think I was wrong, but my parents were just like this. still I never misused my freedom. Do you think I was wrong?”.
I did not have the answer to his question. “I sympathise with your situation” I told him. I was truly amazed at his patience.
“I am a firm believer in God, Doc. I believe that whatever happens is for good. I believe that God gave us this child because he knew we could do all this for her. If she is alive, it is another chance God has given me to love her, to show what I can do for her”.
Driving home that night, I looked at the orange glow of street lights that was enhanced by a twinkling drizzle. In that moment I realised what a great thought the unfortunate father had passed on to me:
That if I am alive, this is one more chance for me as a doctor to save lives, to ease suffering and to bring back life from the clutches of death. One more chance to show my love for life: not only my own, but of all those who reached me. That divine purpose is inddeed my duty!
(c) Dr. Rajas Deshpande

The Last Wish

The Last Wish
© Dr. Rajas Deshpande

“What is the biggest problem with you right now?”
I asked Mr. Jason.

This was Mr. Jason’s last consult with a Neurologist. At the age of 45, he knew he had only a few weeks’ life left. His wife was all composure, but the sad pressure bottled in her heart was clearly seen in her eyes, the weak effort she made to smile only worsening the suffering on her face.

He was smiling. With shaking hands, Jason grabbed the control stick of his motorised wheelchair, and positioned himself well. He turned left, and from a straw that was attached to the back of his wheelchair, he sucked some water in hasty sips. In slow, haphazard and jerky movements of neck and eyes, he looked at his wife sitting on his other side, then turned his head to me. He appeared to be thinking.

“The biggest problem I think right now is the amount of money spent on wars. So many million children remain hungry, illiterate and unclothed, still billions of dollars are wasted in wars”..

For one moment I thought he was mentally slipping. Another moment I thought he misunderstood the question. Then, as a tear slowly formed in his eye and started to roll down upon his still smiling face, he answered the question in my mind: “You are from India, right Doc? I read from your mythology that all humanity is one, single soul. .. My body will go now, so will my illness.. My only worry is for those who remain after me. I am used to pain, but not defeat. I wanted to work for deprived children. I have donated much of what I have for the underprivileged children.” © Dr. Rajas Deshpande

Then, ignoring the tears he could not wipe as his hands could not reach his face, he added “I came today only to say thank you. You doctors do such a wonderful job upon earth! You listen to all worries, suffering every day of your life. Death and tears are your daily company. How horrifically this must affect you all! You save lives, you take away suffering, but you give away your own life in doing so. I just wanted to say thank you to every doctor who has treated me”.

I held his shaking hand, now violently shaking because he had become emotional. As I choked upon words, I realised his wife was crying too.
“My wife will write to you later. God Bless You. Goodbye.” he said.

In this set up from a Western University, patients of terminal neurological conditions were brought in, aware that it was their last consult with the specialist, and hereafter they shall only receive general care from their GP. They came prepared with a list of questions, sometimes certain legal documents that they wanted the specialist to sign. Some patients were beyond awareness, their relatives completed the formalities for them. © Dr. Rajas Deshpande
They were often required to obtain signatures about mental fitness from the Neurologist, while finalising their will. This sometimes included the wishes about the details of their last rites: the space in the cemetery, the quality, type, size of and the engraving upon their own tombstone, and other details.

In an ironical way it was a severer punishment for the doctor and relative, for they would endure this memory longer.

A young boy of 26 who knew he would die in a few months came over once to obtain signatures on his will. He had requested to not spend anything or even mark his place of burial, donating all his belongings to a charity. “I want the world to forget me. I want to forget this life myself”. He explained, “There are better things than me for the world to remember”.

How difficult it is to overcome oneself? How difficult is it to think for others above oneself, at least at par with oneself? Spending years after years in Me, Mine, Myself, we waste away such a brilliant chance to extend happiness to so many others who desperately need it, in the form of love, affection, food, respect and other basics of life! © Dr. Rajas Deshpande

Competition, enmity and bitterness in our rat race of earning more, being above others and accumulating more than we need has become a routine. Truly blessed are those who are not addicted to accumulation, those who realise that nothing lasts beyond their last breath!

My boss Dr. GR repeated almost every day: “Rjaas, there’s nothing more stupid than dying with too much money in your bank. It passes on the wrong culture to the next generation”. Of course the money-wise world around him was scared of his attitude, which they thought was ‘impractical’. Coming from India, where almost all major saints advised against accumulation, I respected him deeply for his maturity.

After a few weeks, I received a note sent by Mr. Jason’s wife:

“Jason left us quietly in his sleep three days ago. I have decided to continue his work. I am leaving next week for the aid of children in war torn middle east. Jason felt that the only proof of humanity in someone was their caring for others. He so much wanted to visit India, he often said it is a land of saints. I hope I will fulfil his dream one day and visit India. If so, we will meet. Thank you for caring for us”.

© Dr. Rajas Deshpande

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The Lonely Rainbow

The Lonely Rainbow
© Dr. Rajas Deshpande

“Do you find anything abnormal in my body, Doctor?” she asked in a calm voice politely, the fullness of veins upon her forehead betrayed her hidden anxiety.

“No”, I said, “Your physical neurological examination is completely normal. You do have a fast heart rate, maybe because you are anxious today”. I did not mention the many sharp horizontal scars on her wrists: a tell-tale sign of past suicidal attempts.
At 24, she was suffering from headaches, lack of sleep and episodes of sudden fearfulness, palpitations and sweating. Heart workup was normal prior.© Dr. Rajas Deshpande
“What about my mental status?” she asked. Before the physical we had performed a mental status examination, which was normal too. I told her so.

“So you think I am mad?” she asked. The calm in her voice was scary. I noticed the reddening of tiny blood vessels in the white of her eyes, under the shine of an extra layer of wetness.
(Funny, this liberty we take to call ourselves mad many times, but fight like wet hens when someone else claims that!).
“I do not think you are any more or less madder than most people I meet” I tried to lighten her mood, “but I need to ask you few more personal details if you allow”. She sipped water from her water bottle and paused. I noticed the unusual painted design on her water bottle: a combination of geometric shapes, overlapping in different shades.

“I think you have some stress. Do you want to talk about it?” I explored cautiously.
“It is difficult to explain, Doc. I don’t get along with most people. I don’t hate or dislike anyone, but I feel most people don’t understand me, so it is better to stay away”. Just as I prepared to tell her that this was a very common feeling, she spoke: “May I ask you a few questions, Doc?”
Reluctant, but I had to solve the issue and find an answer to what was happening. If I played curt she would never open up.© Dr. Rajas Deshpande
“Go ahead” I said, hiding reluctance.

“Doc, have you faced a lot of suffering and pain in the past?” she asked.
That was easy. I replied “Very few will answer a ‘NO’ to that question. Most people like to think that their suffering, struggle and pain is unique. I think so too sometimes”.
She started fluently “But it has made you a different person than you are. You love to laugh but are hiding behind a stranger’s mask. You fear losing people, so you keep them at a distance. Maybe because you had a very bad experience with some. You dislike the noise of plastic bags, and you love white colour. You have an upright ego and do not like criticism. You are extremely sensitive and emotional, but feel ashamed to let anyone see that. You will die but not compromise”.
I had to interrupt.
“Thanks, but I am the doctor and you are the patient. Your analysis of my nature is not solicited. Please talk about your own stress” I shifted my face to defence mode.
“One last question, Doc. Are you stressed? Please answer me honestly even if you are angry at me.” she asked.
“Yes, I am, like most sensitive doctors who get too involved with their medical practice” I answered honestly.

“That is my problem, Doc. I am very sensitive and care for people’s feelings. I feel bad when someone feels bad. I cannot ignore the pain of the animal served as food. I cannot be strong enough to neglect others. I am gifted this sensitivity by God, but everyone makes me feel guilty about it, as if it is a crime to be sensitive. I am a professional artist, and my art sells very well in India and abroad: paintings, designs and other objects. My husband is brilliant and on a big job, but he has no interests beyond financial well being and exhibiting it. He looks down upon me as if I was mentally challenged by being so sensitive” she choked, and had another sip of water.
“My hubby says it is a huge disability to be sensitive in today’s world. Everyone must think materialistically to survive. People openly mock those who are sensitive and selfless. “.
“I involved myself in love relationships twice during college, but was hurt to find how easily the word “love” misleads. I was so ashamed of myself, that I tried suicide whenever someone close deceived me. Then I stopped interacting with people and was lost in my art. It helped me survive: not as money but as oxygen”.

“I see and feel beautiful things that most people don’t. I recognise qualities among others that they are themselves unaware of. But the moment I start mixing with others, I realise that my world is different: I cannot find anything interesting in discussions about money, clothes, food, job, traffic, politics, gossips, relationships, TV or such usual topics and the meaningless conversations that follow.”© Dr. Rajas Deshpande

“Now a days nobody talks about the beauty of life and art and the different ways human nature can be palpated, how we can evolve to make transparently innocent relationships, and in general, things that do not get money, sex or pleasures of the five senses. Creativity is extinct, except in gadgetry. People do not think anymore, they only react or expect”.

I had felt it coming: another case of a colourful rainbow in a black and white world!

The diagnosis was not mentioned anywhere in the medical textbooks. We doctors are trained only to assess only the known and averaged, scientifically studied.
She, like few others, was a case of extraordinary (and hence abnormal) genius, who perceived the world far more beautiful than most people can even imagine. She knew meanings of things that many don’t know even exist. In a world where normalcy is the average of intellectual and cultural-social evolution, she was an outstanding “mad” by being far superior!© Dr. Rajas Deshpande
The supra-normal are left out to be mocked, trialled, punished and often abused via discrimination. Some surrender and become slaves to public expectations, performing popular mental stunts. Some, unable to step down, kill themselves. Some come to light eons after their death. Some fight all their life against the very people who they want to uplift.

“You are perfectly normal” I told her. “You cannot adjust with people because you are different. I am no judge but I think you are far superior. This is a common story of many artists, thinkers and geniuses. You should be able to invest all your attention towards your art, and neglect people’s interpretation or analysis of what you do. At least after few years, people will grow up to what you are. Like the language of intellect and kindness, you will find few who understand you.”

“The only fault about your thinking, that is stressing you, is the wish to be accepted and appreciated by others. It is like expecting the night to sing praises of the rainbow. It won’t, because it cannot see one!”.© Dr. Rajas Deshpande

I gave her medicines to deal with anxiety for a short while.
She returned in a few days. Her radiant brilliance brightened the aura around her beautiful face.
“I made this for you” she gave me a water bottle. “I noticed the other day that you liked the painting on my water bottle, so I made this for you”.

On one side of that water bottle, there was a rainbow, on the other, there was a beautiful moon on the background of a dark blue nightsky.

“I felt bad about the night..”.she said. “it cannot see the rainbow.. so I gave it the moonlight”
© Dr. Rajas Deshpande

A Prayer For My India

A Prayer For My India
© Dr. Rajas Deshpande

From the hypocritical mindset that “I should look only at the positive things around me and ignore all that is negative”, that is like saying “Only my brother’s room is on fire, I can still keep on idiotically smiling and act only when this fire reaches my own room”,

From people who have brought great religious and social events down to roadside vulgar drunken dancing and loud shows of might, from the leaders who ingratiate themselves with superiors and masses at the cost of dignity,

From intellectual thinkers lap-dancing for the rich and powerful by wordplay and linguistic trickery, from the voodoo of political religious misuse that affects even the biggest brains, from a society that is being officially turned into a slob mob that is aroused only by hunger, sex , glamour and money,

From the powers that arrest the life-saving qualified doctors at the drop of a hat and send them to police custody for suspicion, presumption and spite, just as celebrities and politicians who kill in front of witnesses are politically and judicially protected using all the resources that power grants,

From the Testosterone Tongues of Flaccid Bodies in a political system that talk of change but troll, block, imprison, manhandle and kill anyone who dares to challenge their wrongdoings, where men in power flaunt bodyguards while women are abused everyday, where laws and rules are used to blackmail rather than protect, © Dr. Rajas Deshpande

From a judiciary which is fast losing its reputation, struggling for its own identity and independence, from the judges who act selectively and partially and then blame it upon the system’s limitations, judges who suo moto initiate actions only against the weak,

From the laws made by the chosen few who never knew the people they made those laws for, the laws that were made over 60 and in some cases 100 years ago that hinder normal interaction than protect it, from a system which uses the legal options just like mafia weapons to threaten, intimidate and harass those who challenge the system or bring good, ©Dr. Rajas Deshpande

From the mindlessly idiotic enormous paperwork at every stage in every office that wastes time, resources, money, paper and ink in a country whose leaders appeal it to turn green and modern, and invite the progressed world to witness how backward, how traffic-senseless and mannerless is our population, even the educated, who find it mandatory to bestow blows and abuses at the slightest provocation upon the roads,

From the millions who cannot raise their voice against the hundreds of rapes, brutalities, hunger deaths, epidemics or corruption in our own country because they are engaged in criticising and trolling neighbouring countries, proving one religion superior to another,© Dr. Rajas Deshpande

From the filmstars who go to the lowest levels of vulgarity and female skin depiction in the name of entertainment, and promote violence on screen as a routine reaction, confirming that this is a lawless country where goondaism coupled with male chauvinism is a heroic choice in life, where the entertainment industry is fast turning into a mental porn-industry catering to the whims and fancies of mobs,

From the fears that shut up ever good man and woman who loves this country, from the lethargy of the press and media to remove their bejewelled blindfolds and see the naked truth for once, From those in high chairs of power and policing who see the wrong but do not speak or act against it for the fear of losing their chair, © Dr. Rajas Deshpande

From doctors soaked in greed for money and fame, conducting fake or plagiarised research, from the competition and ego amongst doctors which prevents them to come together, from a tendency to take advantage of patients, and from the mindless permissions of “anyone practice anything in medicine” for political gains,

From a culture of self-obsessed, me-cultured, comfort-addicted men and women who are mostly proudly training their children to leave their own country, from a society that has started to forget the sacrifices made by the likes of Mahatma Gandhi, Bhagat Singh, Maulana Azad, Netaji Bose, Lokmanya Tilak, Veer Savarkar and Sarojini Naidu (and many others),

From mothers and fathers who cannot find enough time to raise happy children, seeking excuses in the name of careers and necessities, From teachers who seek pleasure in material gains and marking rather than bringing up fearless generations, from schooling that teaches everything except humanity,

Lord Almighty, please grant me freedom. Lord Almighty, please save my nation.

I am not free of some of the faults mentioned above. But I get tearful every single time I hear the song “Saare Jahan Se Achcha Hindostan Hamara” or even the National anthem.

The only way I can stand up to this great feeling of calling myself an INDIAN is by accepting the struggle, punishments, hardships and poverty that is inevitable when I try to bring in some good changes in my very beloved India.

This is my own personal small freedom struggle for my great nation, India.
© Dr. Rajas Deshpande

The Divine Eye

PBMAHVDEH

The Divine Eye
© Dr. Rajas Deshpande

What does a child of 15 years do if his vision is completely and permanently lost?
He goes to the best place in the world to learn about care and rehabilitation of the blind, returns to India, and starts a society to help the blind: “Puna Blind Men’s Association”(PBMA).

But that was 60 years ago.

Now, it has grown. A 250 bedded eye hospital, one of the largest in India, with over 40 doctors, offering the best world-class eye treatment and surgeries. Poor patients are treated / operated completely free, paying patients are charged very low, and there also is a facility of “Premium Services” for those who want to pay. Over 60-70% of the work is free. Patients are picked up and dropped back free by hospital’s vehicles. Many hands of God donate handsomely to this set up, knowing its good work.

Their Technical Training Institute works to train and rehabilitate the blind from working age group. Their old age home houses over 50 blind women, all looked after well.

Their international collaborations attract foreign doctors for training / fellowships. They conduct postgraduate training courses and research , and have many international publications to their credit. They offer services in almost all subspecialties in ophthalmology, like paediatric ophthalmology.

“The PBMA’s H. V. Desai Eye Hospital” in Mohammadwadi, Hadapsar, Pune is a glorious example of what human wish can achieve, how a single man’s dream can extend the dimensions of humanity. Too good to be true, but true indeed, and standing proud!

Padmashree Mr. Niranjan Pandya is the vision behind this institute. Col. Dr. Madan Deshpande is the Chief Medical Officer / Leader. Mr. Nitin Desai is the Chairman. The Medical Directors, Dr. Rahul Deshpande and Dr. Dole were justifiably proud when they told me the story of this great hospital.

Today, I was very fortunate to interact with the doctors there, who had me over to speak about “Multiple Sclerosis and Optic Neuritis”. Thank you, Mr. Vinayak Bhandarkar and Mr. Venkatesh Madake for introducing me to this hospital.

I feel proud to have spoken in this institute that harbours the very essence of true humanity!

May this spread and may millions continue to benefit forever!

© Dr. Rajas Deshpande

Essentials Of Being A Smart Doctor

“Essentials Of Being A Smart Doctor”FB_IMG_1470417314264
Guest Lecture at National Undergraduate Students Conference ‘RESPIRARE’ at the
BJ Medical College
August 3 in B. J. Medical College
© Dr. Rajas Deshpande

My dear friends,
If you are sitting in this hall today, you have already proven that you are smarter human beings, but that alone is not enough for becoming a smart doctor. However intelligent or smart anyone else may be in the outside world, your ability to save their life, help them in illness gives you an upper hand, hence the perpetual tag “Doctor sahab” bestowed upon you by the world. To be able to gracefully deserve that tag is a difficult task.
Like success, riches and many other achievements in the world, medical smartness too is not an accident. One has to earn it with a great effort.
There are really smart and good doctors, and there are also those who pretend so. Most patients can tell the difference. So if you plan to be a really smart doctor, you will have to imbibe the essential qualities in your very subconscious, so they become your basic self, a part of your personality. You will have to force yourself to change certain habits, traits of your behaviour and thinking, and allow the inception of newer, better methods within your being. I am very happy that I can speak this to you at this budding stage, while you still have ample time to modify the DNAs of your medical smartness. Once you accept to change for better, never go back or compromise. © Dr. Rajas Deshpande
Let us consider a small question: What quality is universally liked in a human being by almost everyone, including their enemy?
Genius?
Looks? Money?
Muscle power? Political Connections?
No.
Compassion. Kindness.
It is irresistible. Even when a patient has come to you with a prejudice or suspicion, the first thing that will change his / her attitude is your kind words, your compassionate attitude. It is not very easy to be kind and compassionate to everyone, especially the ill-behaved. This is where you will need to train yourself to be smart: by avoiding use of bad words, not raising your voice and not being aggressive. Keep your words to a minimum, and do not use negative, accusing words. Do not speak arrogantly with the relatives. You don’t know when things may take a bad turn.
However, the first few steps that you take to be kind to the patient will get you the biggest reward that this field has to offer: your patient’s trust, and if you care for it, it is usually lifelong. © Dr. Rajas Deshpande
When the patients come in, they are not willingly entering the hospital in most cases, but out of desperation. They are scared, angry and often extremely worried that something bad will turn up as their diagnosis. Add to this the resentment caused by having to be questioned and touched by a total stranger, whom they have to tell private information. This has already made them jittery.
A smart doctor understands this mental state of the patient completely, and makes the best effort to ease out the patient by welcoming them, wishing them, and initiating a genuinely friendly chat. Such simple sentences like “Good Morning, How are you?”, “Hope you are not very tired”, “I am sorry that you had to wait” reassure the patient that they are dealing with a nice human being, and put them at ease.
Whether the patient comes from rich or poor, educated or illiterate background, the doctor must have utmost respect for their privacy and dignity. Asking private questions, undressing and examination should never embarrass the patient. Standing up and wishing the patient while they enter and leave your room makes the patient feel respected, and adds flair to your smartness. © Dr. Rajas Deshpande

FB_IMG_1470417305344
How should a doctor dress?
It is common to see few doctors, both junior and senior, wearing short sleeves and open collars, sometimes even low rise jeans, trying to show off their physique. One can only imagine what kind of reaction they will generate if things go wrong.
There have been many scientific studies about this. If you yourself want to be treated, you will never prefer a shabby looking, ungroomed, unclean person with a stink. You will want someone who looks healthy and positive to make health choices for you. The patient always wants to see a neat, clean and reassuring doctor. Your demeanour should not be frivolous: unnecessary excessive laughing, smiling, joking, bad language are not welcome to be used in front of a worried patient. © Dr. Rajas Deshpande

It is wise to dress up as good as one can, without too much show and fashion. A very richly dressed doctor in a suit may turn off an already nervous patient from lower socioeconomic classes. The best attire is formal, simple, clean and ironed clothes which cover you well, apron, shoes, and no jewellery. Fortunately, tattoos and piercings have not yet much entered this field. One must avoid religious clues, and refrain from religious and political talk while practicing as an allopath.
A smart doctor cannot forget that our field deals with people from different socio-economic strata. He / she should be able to irradiate the feeling of being a trustworthy person and invoke positive, peaceful feelings in those who come to see him / her.
Personal hygiene is an indicator of a doctor’s smartness, and such simple things as hand-washing after every case, using sanitizers, wearing gloves etc. speak a lot about a doctor’s dedication towards good health. Best clinical practices must be learnt and complied with voluntarily by everyone who wants to be a smart doctor. © Dr. Rajas Deshpande
Humility, manners and etiquette
A Spanish TV anchor who follows up with me for Multiple Sclerosis told me once: that many patients travelling to India complain about the doctors being very good clinically, but worst in manners. “I was amazed that you actually offered me a glass of water when I was crying during my first consult” she said. Such simple manners affect the patients so much!
Many doctors, as they ascend the merit scales in this profession, develop a complex that they are unbeatably smart. They end up becoming ego-balls disliked by almost everyone, because of their high handedness. A smart doctor will never let that happen to himself / herself. There are far more smarter people than most doctors in almost every other field, even some illiterates are sometimes smarter than the most literate. One must never shed humility, whatever one’s achievements. We often see students smarter than teachers, juniors smarter than seniors and we all know what happens in those cases. The best policy is to never presume oneself better than the other. A smart doctor always knows his manners and etiquettes very well. © Dr. Rajas Deshpande
Language and communication:
“What do you mean by dizziness?” my teacher asked a tired female patient once.
“Oh I feel abnormal noise in my ears” she replied. Dizziness, in patient’s language, may mean anything from imbalance, blackout, vertigo, to heavy-headedness or blurring of vision. It is always wise to dig into what they actually mean. A knowledge of regional language often helps resolve misunderstandings. Similarly, the patient may also misunderstand the words that a doctor uses.
A smart doctor will learn to communicate so as to make the patients from different streams understand exactly what is being conveyed. We do not always have too much time, hence it is necessary to develop the skill of using minimum words. One must use simple words, and know the colloquial alternatives (e.g. use “Heart” instead of “Cardiac”, use “Brain infection” instead of “Encephalitis” etc.). If the patient does not understand, one must encourage him / her to ask questions. Use pictures if necessary. Many patients / relatives do not stick to time or subject, often asking irrelevant questions based upon their googling, but a smart doctor must be able to steer them on to the right path with a smile and a gentle reminder of time limitation.
The most difficult part of being a doctor is conveying the bad news. There is no good way, one has to be very careful and diligent. On one hand one must offer sympathy and readiness to help further, while on the other hand, one must also be aware of aggressive, impulsive and shocked reactions, making sure not to risk one’s safety.
While conveying the bad news, surgical risk or complications, a doctor must have the patient / relatives sit down, have witnesses around, and speak compassionately but confidently, offering all possible help to ease out their suffering. A hesitant doctor invokes suspicion even if correct. However, an overconfident liar will invite more trouble, so be careful that you speak what is the exact truth. That never fails in long run. © Dr. Rajas Deshpande
Professional Smartness
Friends, as you become more and more specialised, you will unfortunately face rivalry and jealousy. Doctors are the most ingenious professionals in their ability of pulling legs or sabotaging careers, and you may sometimes be facing your own teachers in such situations. A smart doctor will never compromise his / her own grace or the dignity of our noble profession. Fight all that you must, and I will stand by you if you are correct, but always use the best language, think about and mention the best things about your competitor, and always keep the door for direct discussion open. Refrain from allegations, cheap comments, mockery and defamation. If you feel that a colleague is wrong in some clinical decision, please reach out to them and talk, before you discuss it with others. Everyone usually has a reason for their decisions, one must respect it. If your reaching out is unwelcome, then alone mention on paper what you think about the case. A smart professional will have no friends or enemies, no senior or juniors, but only colleagues. Immediate reporting of any adverse clinical events to the authorities, and correct documentation are essential. © Dr. Rajas Deshpande
Medico legal Smartness
We live in a country with too much poverty and illiteracy. If there is a chance that a doctor’s mistake can be proven, there is every chance that the relatives will drag that doctor into the courts of law, demanding millions in compensation.
In these days of exponential medico legal cases, where patients, relatives, authorities and even some colleagues are usually unforgiving if you commit a mistake, real smartness is to document everything perfectly. Just as an example, a young patient of mine recently had a stroke, without any known risk factor. Upon repeated questioning, he reported that he was taking some unknown herbal medicine since three months, in a mixture of some oils, to improve memory. One must mention every such detail on the paper, including poor known history, delayed admission and alternative treatments. Every interaction with the patient and relatives must be recorded on paper. Recording the date, time and your name and designation at the beginning of every note is an indication of you basic smartness. A proper written consent must be obtained for every procedure, however trivial. Information about dangerous medicine being given to the patient / relative should be recorded, a consent for the same signed by the relatives. © Dr. Rajas Deshpande
Academic Smartness
I do not know if I am enough qualified to talk about this, because I was often beaten up by my primary school teachers for not doing my home work and some other curiosities which I cannot mention here.
A doctor is expected to be on top of the pyramid of scientific advances, and there is nothing more pathetic than a doctor who quotes medical knowledge from decades ago. While we respect the past, we cannot disrespect what every standard medical textbook mentions on its first page: Medicine is an ever-changing science. A smart doctor, therefore, will still study on a daily basis even after achieving the highest degrees, and keep himself / herself updated with the most recent medical knowledge relevant to his / her field. Studying on a daily basis, I feel, is the most important basic quality every smart doctor must inculcate. One must register on smart medical sites like up-to-date, emedicine or many others, to stay updated about one’s medical interests. Yours is a lucky generation, having all information at your fingertips, thanks to your smartphones. Check drug interactions every time you use new medicines. Cross check your differential diagnoses. © Dr. Rajas Deshpande
Digital Smartness
Everyone is semi-addicted to their smartphones. However, they are also a great hindrance to the super-essential concentration required of a smart doctor while interacting with patients or making medical decisions. Smartphones can be wisely used to record data and expedite certain protocols, accessing information etc., but they should be switched off while with a patient. It is very humiliating and irritating for a patient when the doctor is occupied with a cellphone during a consult.
Social Smartness
There is a competition now among some doctors to post everything they do on the social media. A colleague of mine recently posted a video of a huge tumor that she removed from the abdomen of a patient. She is now under an enquiry for compromising patient privacy. One must refrain from posting any information that discloses patient’s identity on the social media.
Most of you google your crush, actor or actress you like, don’t you? Well, some of you will honestly agree.
Patients are as curious and inquisitive as you are, and may google you. So please refrain from posting undignified pictures / matter / vulgar jokes, etc. and pictures while drinking / smoking, hugging etc. on social media. Also refrain from posting stuff that maligns your own profession or colleagues. You can improve things from within, not by publicising them.
A smart doctor will learn over time to refrain from giving out personal number to the patients / relatives, as this may lead to many disadvantages later, including unwanted calls, messages, advertisements and other misuse.
While patronising should be avoided completely, (“You are my brother, sister, mother, father etc.), in some cases it may reassure a frightened patient, hence it may only rarely be used. © Dr. Rajas Deshpande
It is not at all uncommon for a doctor or a patient to get a crush upon the other. In case you sense a love interest blossoming within your patient or yourself, immediately rethink about your life’s choices and refrain from any further progress in that direction, as this could turn disastrous for your career. Do not encourage meaningless chats, messaging or personal comments when dealing with patients. An allegation of molestation, sexual harassment or mal-intention can ruin you.
Most doctors feel proud of their excess hard work, and often mention that they work without proper food or sleep for days together. While this is really commendable, it is also a granted feature of this career. One must learn not to milk a pardon for one’s ill behaviour or mistakes by quoting excess work. A mistake is a mistake and the best policy about a medical mistake is being completely honest about it. © Dr. Rajas Deshpande
Moral Smartness
My recently published book, “The Doctor Gene” ends with the words “A good doctor is the best a human being can be”.
You belong to a community that practices the highest of morals not just because the society expects it, but because you have voluntarily sworn to. You have chosen this career yourself. Right from now, please imbibe the best of morals and truthful attitudes in your blood. Believe me, every human being has the hidden sense to perceive a genuinely good person, make sure that your patients get this feeling about you. © Dr. Rajas Deshpande
Serenity Smartness
One important art in medicine is almost on the verge of extinction: that of immense concentration. What with the hustle-bustle and digital exposure that every medico must work with, we are fast losing the ability to switch off the world and concentrate, think or meditate. These things bring the serenity, so essential an ingredient of medical smartness. Learn to find time, preferably on a daily basis, to be with yourself, and sort out the tangles in your mind before they strangulate you.
Higher education
I get atleast one question everyday from some or other medical student on my facebook page:
Which branch is best? What PG should I do?
You will eventually realise what you like. You may seek opinions, but not decisions from others. Be smart enough to identify what you want and respect your own inclinations. Keep a list of alternative options, as PG seats are limited. Don’t waste too much time in pursuing a particular branch, there are so many advances happening that every PG branch offers you good futures if you are dedicated enough. There are umpteen examples on the other side: doctors who got their desired specialties but never did anything significant after that, other than customary routine. © Dr. Rajas Deshpande
De-stressing
I am sure that in this very hall, there are beautiful dancers, painters, far better authors than myself, speakers, and artists of infinite ability. I think I should also say some potential models. But you will give up all that art and beauty within yourself, lost in the heavy duty career of being a doctor.
One absolute essential for every medico is a sure-shot de-stressing mechanism. We are all destined to face suffering, poverty, struggle, pain and death on a daily basis, and this takes a toll upon our minds. We tend to grow mentally old very soon. Many think that alcohol or smoking is a respite, but this is ridiculously stupid. A smart doctor knows to find his / her escape in arts, literature, family, travel and other hobbies. It is extremely essential to de-stress as your performance may be affected if you accumulate stress for long. © Dr. Rajas Deshpande
What do patients want?
The best compliment for a doctor is a happy patient, and the best feeling in the world is knowing that your efforts saved a life.
A smart doctor is the one who has the reputation of making the correct diagnosis in majority of cases. A smart doctor is the one who invokes trust in a patient by being genuinely honest and compassionate. A smart doctor is the one, most of whose patients are happy, not only because their health issues are well attended, but also because they met a caring, well behaved human being.
Never think about money or anything else when consulting a patient. Think of every case as an exam case, get the most correct history, do the best clinical examination and give the patient the best treatment options. You will make enough happy money with such practice, if you are smart enough to understand what that means. © Dr. Rajas Deshpande
Dear friends, one thing about smartness which I learnt early in my medical career is that a senior doctor should not give very long lectures, and should end up his speech before time.
I have written many more things about the essentials of being a truly good doctor, and the glorious traditions of our noble, almost divine profession, in my book “The Doctor Gene’. If you did not get a copy outside, please email thedoctorgene@gmail.com to get your copy.
I am sure that you will all be very successful doctors, and I will be very happy if my words today help you deal with your medical life smartly. I thank you for patiently listening to me today.

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Love to you all and I wish you all the best, always!
© Dr. Rajas Deshpande
03.08.2016
Thank you, Mr. Yashodhan Morye and BJMC UG Student’s Council