Monthly Archives: February 2017

“If I don’t set an example, who will?”

photo-23-02-17-18-56-00“If I don’t set an example, who will?”
© Dr. Rajas Deshpande
One fine late morning, a phone call woke me up. “Hullo?” I used the trained professional cautious voice that does not encourage further conversation, hoping to not let go of the sleep stage.
“Good Morning. I am Rashmi Shukla, Commissioner of police, Pune. May I speak to Dr. Rajas Deshpande?” the lady on the other side said.
My heart missed one middleclass heartbeat and performed five higher class somersaults. Sleep ran away like a signal jumping two wheeler pursued by a traffic cop.
“Yes mam, speaking” I sat up in bed.
“I want to show my aunt to you. When can I get an appointment for her?”
This was unusual.
Usually most bigwigs just walk in without any warning and want to be seen immediately. Some soft-threaten an appointment via their secretary. Some come with the hospital owners, some hassle the boss to get the doctor rush for them whenever they want. There even are netas and officers (not only police) who ask doctors to “hurry up” with the patient in the chamber and see them first. If you make them wait, your boss usually would remind you many unpleasant things in chaste English.
So, about this call, I felt very respectful.
“Anytime you want mam. What time is convenient for you?”
“You say doctor, you people are always so busy. I will arrange my schedule accordingly”.
“4 PM today?” I asked
“Ok. We will be there” she said.
At sharp 4 she came with her aunt and waited patiently for their turn. Inside the chamber she behaved like a common citizen, and politely narrated the details of her aunt. She listened to the instructions and prescription details, and asked a few questions. She made me laugh with some puns too. Then she thanked me and left. We kept on reading about many new initiatives and improvements she implemented in Pune.
When she followed up today, again with similar polite call for appointment and then a punctual visit, I told her how admirable and respectable her politeness and etiquette was, and how rare it has become among the highly placed.
She smiled: “Doc, If I don’t set an example, who will?”.
Huge Respect, Commissioner!
May all police and government officers be like you!
Then when I requested her permission to write this and also for a a pic, she said “If you don’t smile in the photo, I am going to have you arrested immediately”.
Thank you, Mrs. Rashmi Shuklaji, Commissioner of Police, Pune, for making a common doctor like me feel great again about my choice of this profession!
© Dr. Rajas Deshpande

The Lawful Massacres

The Lawful Massacres
© Dr. Rajas Deshpande

“Doctor, my brother has kidney failure, he is awaiting a kidney transplant. but the waiting list is too long, he has very less time and his health is fluctuating. We cannot afford to treat him out of India. We can pay some money if any donor is ready to donate a kidney. Please save his life, doctor, I will be your slave all my life.. What can we do?” the elder brother was begging and crying at the same time. His 28 years old highly educated younger brother is his only blood relation alive. The elder brother himself has renal compromise at an early stage.

“I am sorry. Indian Law does not allow us any other options”. I felt ashamed of what was happening. I wanted to add “Unless you are in power, unless you are stinking rich and have heavy pulls through many corridors, unless our society so eloquent about criticizing doctor’s intentions learns to come forward to donate organs, you are doomed to a long wait for any transplant”.
In fact, you are more likely to be the one among the three that die every day in India while awaiting an organ transplant. That is over a thousand human deaths every year. More like a massacre.

Because the law is always correct, it saves money, it saves against corruption, and it saves against a few wrong practices. This sacrifice of a thousand lives a year is just a small price to pay!

We are so very much against the word ‘corruption’ and the projected legal correctness of any system, that like the blinded goddess of justice, we refuse to see beyond what is the literal meaning of the law. Whether it is correct, whether it is causing more harm than benefit, and whether it discriminates (usually the rich and the powerful from poor) is something we are not allowed to think. Nor the judiciary probably. © Dr. Rajas Deshpande

Whether it is the action against some great kidney transplant surgeons that made them quit the profession and stop all transplant work, whether it is the “Kidney Racket” headlines on TV channels or in newspapers, the medical profession is already presumed guilty, and everyone seems to derive a pervert pleasure from doctor bashing, some even from within the profession. Yes there are unsuccessful, fame seeking doctors who are jealous of doctors who earn more and have a good name in their field, and most bitter losers like to point out only the bad side of the monumental achievements of such successful doctors: that the transplant teams in India have saved millions of lives of the rich and poor alike by developing transplant surgeries and performing them in a resourceless, supportless, poor country ridden with corruption is a deliberately hidden fact.

There of course are corrupt doctors as in every other profession, but one cannot blindly close all hotels because some didn’t serve good food!

Most of our society looks upon any medical money transaction over three hundred rupees (for anything) as corruption. In a country teeming with people who prefer to eat and drink an unhealthy excess and die early (while many die of malnutrition), for a country where there have to be laws for wearing a helmet, many take it upon themselves to criticise other professions without thinking.

We need many lacs of organ donors for the many dying patients awaiting transplants. We see extremely few organ donors. The only interpretation: “I don’t want to donate organs, I don’t want to help save lives, I will only criticise those who are trying to save lives by closely watching where they cross the law line, and then bash, arrest, defame, try and punish them. © Dr. Rajas Deshpande

The government must seriously reconsider the laws about organ transplant. There must be a freedom to at least donate a kidney for someone one knows, and if the recipient wants to compensate for it, it must be allowed. This can all be documented and supervised by a legal team so as to avoid forceful / illegal sale of human organs. One can also consider the possibility of a rich recipient compulsorily paying for a poor recipients’ transplant surgery, if he / she is allowed to legally ‘buy’ a kidney. That way two lives will be saved. If I sound Utopian, so was everyone who thought that the world deserves to be a better place.

The legal correctness of each transplant should be mandatorily okayed by a judge, and if something is legally wrong, it is that judge who should face the consequences. This is because doctors/ other transplant professionals cannot always interpret all laws correctly, and innocent mistakes are then blown up / misinterpreted as deliberate attempts to kill patients. © Dr. Rajas Deshpande

While the rich and powerful get their kidneys and livers fast and safe in and out of India through the similar rackets that have thrown innocent doctors into jails, it is the poor who are left to die awaiting a transplant: because the government set ups have limited facilities and resources, and the private set ups have to do it at a higher cost to safeguard innovation, technology, investment and skilled personnel. But the only highlighted aspect is the money earned by the hospital or the doctor, not the immense effort and saving of hundreds of lives. Ask hundreds of poor patients whom the transplant teams have saved, whether their doctors worked for money.

Those who choose to differ with this opinion are welcome, provided they answer this question: If your brother, son, daughter or you yourself are awaiting an organ transplant under the approaching shadow of death at a young age (God Forbid), will you choose to be legally correct and prefer to die or explore all options including illegal to survive?

As a doctor, it is very difficult to say “As per law, you must wait even if you die”.

© Dr. Rajas Deshpande

PS: These are the sincere feelings of a doctor’s soul tortured by the plight of those awaiting death thanks to the legal tangles and social apathy about organ donation. I do not support any illegal practices, but I do not also presume that all laws are perfectly correct. There is a lot of scope for improvement, and each waiting day costs us three preventable deaths. Jai Hind.

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A Medical Lesson That Still Hurts

A Medical Lesson That Still Hurts
© Dr. Rajas Deshpande

“Can’t you see I am with a patient? We can talk later. Or may be tomorrow” snapped my lecturer at Pallavi.

Pallavi was 26, had epilepsy herself, but used to sit in our OPD to help other epilepsy patients. She came from her home by local train, travelling over two hours, and went back after OPD to attend her father. She was on many medicines to control her fits and depression, still used to have frequent fits. An epilepsy surgery was not possible, my professor and lecturer who were her caretakers had explored almost every avenue for her. Some unfortunate patients do not respond well.

Obviously she could not get a job and sitting at home worsened her depression. She was quite good looking and kind. However, her father was bedridden with a paralysis attack, and had many problems, even bedsores. That stress made Pallavi cranky and always worried. With no source of income, she was dependent upon help from the staff at our municipal hospital. As she was too proud to accept money without working, my professor had eased her ego by requesting her to help other patients: OPD paperwork, forms, getting medicines, patient education and restrictions etc.

She would either consult us resident doctors or our teachers if there was anything wrong with her or her father. Sometimes her anxiety was too much to deal with, she often asked repeated questions. Some epilepsy and psychiatry patients have worst symptoms around menses, and even get combative.
Most government and corporation hospitals have a never ending line of patients. In that rush it became impossible to answer her repeated questions patiently, and someone or other usually had to either snap at her or prescribe her an anxiolytic. Sometimes being too kind or available results in more attention seeking.

“See if Pallavi is OK” my lecturer told me after a few minutes.

Sulking, Pallavi had gone to the pantry near OPD and sat alone. During our tea break myself and my colleague Dr. Sachin went there too. My thesis / dissertation submission was in final stages, where everything about it seems so pointless and meaningless. I had to submit it within two weeks. © Dr. Rajas Deshpande

“Tea, Pallavi?” we asked her as she sat in the corner.
“No, Doctor. I’ve had it. Thank you” she said. We drank our tea in an invaluable silence.

She suddenly said: “Doctor, my father has started continuously calling me names. He uses very bad language. My headache becomes unbearable when he starts shouting.” She became tearful.
While having tea, I wrote her prescriptions for herself and her father too.
“Doctor, I want to talk” she said, “I need to sort out things in my life” she said.
“Pallavi, the OPD is still heavy, we will talk after lunch, ok?” I replied. It was 3 PM already. We finished tea and returned to the OPD.

A few minutes later, I heard her crying in my teacher’s cabin. “You must learn to be patient” my teacher was trying to pacify her while attending other patients who kept angrily rushing in, demanding their own time. © Dr. Rajas Deshpande

Pallavi got a call from home and left the OPD before it was over.
I went straight to the printer after OPD for the final corrections of my dissertation.

That evening we got the news that Pallavi had fallen off a local train, killing herself. No one knew if it was a suicide.

I have never been able to overcome that till now. What if I would have spent few more minutes, talked her in kinder words, pacified her better?

I learnt one of the most important and precious lessons that every doctor learns eventually: There’s no afterwards. Answer the patient in front of you NOW. Never deny time to one in genuine trouble. A minute of a doctor’s patience can save lives.

This became clearer later, this is true about everyone, not only doctors or patients; no one ever knows which one is the last meeting between any two. Now I make sure to only part with a proper goodbye, a smile and no bad feelings: apologise if I am wrong, forgive if the other one is. Some say that feels too formal, some think it is a way to impress others, or being excessively unnecessarily mannerful. But I know what I mean. There are no guarantees in life: about myself at least. Every goodbye is potentially final.

Patients never seem to stop. Everyone is in their own hurry, tired, pissed off . The doctor is the common point of venting problems, frustrations and also anger. Most doctors acquire the saintly art of not losing patience, raising voice in the worst of situations, but it is at the cost of being inhuman to themselves. To spend 12-16 hours every day (18-20 in case of resident doctors) among the angry, suffering and accusative without losing patience is not a joke. This is one reason why patients see irate/ less interactive doctors commonly and misinterpret it as “ego / pride / snobbishness” etc.

That said, since that incidence in our OPD, I do not refuse any question from any patient in front of me. I do not end the consultation unless I have answered their last question or the patient starts taking advantage by asking repeat or unnecessary questios.

Pallavi, I feel very sorry.
Patient First, Patience Highest, Always, for Every Doctor.
Thank you for the lesson.

© Dr. Rajas Deshpande

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Wrong Doctor, Wrong Punishments

Wrong doctor, Wrong Punishments
© Dr. Rajas Deshpande

“There are many wrong things going on in our profession, and I insist that you must write about them too. Working at a tertiary care center, I see many patients wrongly investigated and treated” my senior professor said on phone last week.
I did not argue. He was correct. He is one of the most brilliant and dedicated superspecialists I know, and I consider myself fortunate that I studied and worked under him. I just explained to him that my page was dedicated to highlight the good side of this profession, as there are umpteen critics but rare sources that speak about the good.
“But we must evolve. It is known that we are humans and there will be mistakes. Many patients die due to medical mistakes too. If we are open about the mistakes, even the law takes a lenient view. Most of the hospitals stand by the doctor if the mistake is honestly reported in time. Many patients understand that too” he said. © Dr. Rajas Deshpande

I disagreed with him then, but as I worship his acumen, I decided to meditate about this.

Yes there undoubtedly are cases we see almost every day, wrongly investigated and treated. Underqualified, wrongly qualified and even unqualified doctors treat patients according to the best of their knowledge, but unfortunately intention alone is not enough to treat a patient correctly. Political support ensures the safety and proliferation of such practices. Although we all know the basic managements, the patient is not then offered the best.

That apart, sometimes, treatable illnesses are missed just because some general practitioners/ paraclinical practitioners/ crossover practitioners who think they know everything never take a second opinion of an expert in the respective field. Many a times though, it is the patients who choose to stay with the least charging practitioner, never knowing their treatable conditions are worsening all the time that they think they are saving money. The practice of obtaining a second opinion is quite healthy and must be encouraged at all levels, although there are some patients dissatisfied with even the twentieth opinion.

Hospitals without the requisite expertise (qualified experts or technology) to treat certain category of patients and conditions often freely admit any patient and treat based upon incompletes skill and resources (under the legal protection of emergency treatment clause). So long as it is cheap, the patient seldom questions treatment. Once they are referred to the higher center, the trust level sinks as bills increase. © Dr. Rajas Deshpande

This often results in a treatable condition worsening to a stage of untreatable emergency. All the anger against this is usually borne by the last doctor / hospital treating the patient and trying to help in their most difficult situation.The non availability of enough staff at many government-run set-ups is never questioned.

Let us consider that a doctor or a hospital has committed a mistake, and the hospital wants to honestly report it to the patient and apologise, then to legally compensate the patient.
It will be wild daydreaming if anyone thinks that our society is presently mature to handle this.

In India, a doctor is presumed guilty of almost every death or failure of improvement in patient’s health. Even a patient who has abused his / her body, not followed any healthcare instructions (smoking, drinking, diet, exercise, reducing work and stress etc., not taking medicines as advised and self treatment) still thinks he is qualified enough to blame the entire medical profession for his / her failing health.
Relatives who have never bothered to know if the patient took his / her meals or medicine in time, procrastinate taking the patient for timely check-ups suddenly become “google qualified lawyers against healthcare system” once something goes wrong. © Dr. Rajas Deshpande

Blatant advertisements of “complete health check up” including hundreds of unnecessary tests are seen everywhere, and the word “concession or free” is probably the sexiest lure in healthcare industry today. Here, the patients or relatives do not mind their blood being drawn, being exposed to unnecessary radiation, or being charged for unnecessary tests just because it is all cheap / concessional. There are umpteen examples where the patient google searches about symptoms, gets the blood tests, MRI and many other unnecessary tests, and then visits a qualified specialist.

Only the qualified doctor advising the necessary tests is labelled an unholy, profitmaking business.

Suppose the doctor declares his / her mistake. Who guarantees that it will be investigated in secrecy, only legally tried by a qualified team of medically updated judges, and if at all the doctor is guilty, then the legal punishment alone will be implemented, guarding the security and the reputation of such a doctor? In a country where the media as well as judiciary is often tainted, how safe is it for a doctor to honestly admit his / her mistake? © Dr. Rajas Deshpande

In a single day, the media will bring down the entire practice of alleged doctors and a reputation hard earned over decades . The mobs with different lawless communities will vandalise their hospitals. The police is unable to always stand by truth, given the influences that gag and tie them. The judiciary will come in later at a time when the doctor’s life will be scarred and damaged beyond repair. Not everyone among the doctors is expected to have a shameless mind structure to go on despite disrepute. Corporate hospitals very easily disown doctors if their reputation is threatened.

Just as there cannot be any compensation of a lost life, there also is no compensation for a doctor’s lost reputation. A doctor’s reputation is his professional life. So long as the society does not offer protection from mobs, media and wrongful allegations in expectation of free / cheap but accurate scientific healthcare, the doctor will never feel safe enough to come out with his / her mistake.

A trial with ensured privacy and security, guarded information to the media in correct format accepted by the court, and very strict guidelines about proceedings in such cases will alone help doctors come out in open about their own mistakes, and also against the malpractices in their own profession.

Till then, we are all at the mercy of the maturity of our politicians, media and society.
© Dr. Rajas Deshpande

Goodbye, Doctor

Goodbye, Doctor
© Dr. Rajas Deshpande

“Screw this satisfaction. Dump this happiness. Can you try to understand that I am fed up of both?” said Dr. Sahil. He was one of the busiest and most respected specialist in our town.

Surprised at a superspecialist doctor friend speaking this, still impressed by his ability to identify and speak the truth about himself. I let him go on.

“There’s no guilt. There’s no regret. I have done my best since school. Topped everything. I did not feel the extra effort: I finished graduation, PG and Super PG by merit alone, that too without having to make a great effort. I have practiced over 15 years now. I did some research, but don’t enjoy the kind of research that goes on in Clinical medicine now. I have practiced with all my heart, and all my time. Now I don’t want to. Repetition kills me, and I cannot see anything but that now”. He paused.

We shared the best bond between two humans: mutual respect with no curtains. Either of us didn’t feel the necessity to modify speech for political correctness or covering up naked feelings.

I replied: “I understand. But we always thought that we need to save lives, give back to the society. So many will benefit with your genius”. I realized just as I spoke, there was something hollow about that. Or did he just uncover a mirror in me?

Sahil was as calm as a meditating saint. “I don’t feel so. Nobody’s saving lives. We use scientific knowledge to try and treat the medical conditions we see, try to comfort the suffering with our kindness, and earn our bread under the continuous threat of something going terribly wrong. I have studied for fifteen years, and served the society back for more than that.”

We sipped our coffee in silence for some time. Hans Zimmer’s ‘Discombobulate’ was playing at that time in my chamber. Coincidences are too much sometimes. That heavenly symphony of all disconcerted instruments played by the expert musicians is one of the best things in human history I think (link below).

He smiled at the music. “I did not promise anyone to spend an entire lifetime doing what I don’t want to do anymore. I respect the gratitude I received, although it was rarely pure and sustained. I am sure many better than me will replace me and continue to treat patients who need care. I have never felt respected or accepted in the society, it was always with the caveat of ‘not all doctors are good’ that the people who I served looked at me, not the other way round.“

He became serious. “I don’t want now to work hard all day and night, be serious all the time, and step up my already busy schedule to reprove my abilities again and again. I am fed up of having to prove my worth and abilities to those who I do good to. When almost every illiterate as well as the educated questions my intentions, I don’t think anyone deserves an explanation. Half my time is spent now explaining the patient what is good for them, why they must do the tests and take the medicines, how I cannot predict all side effects or complications and be held responsible for them. I became a doctor to treat people, not to cover up for their suspicious ignorance with my knowledge and time”.

Somewhere deep, I understood him. But the ego of a doctor: that we have “accepted” the responsibility to serve prodded me to argue with him. I said so.© Dr. Rajas Deshpande

“Who are we serving, Rajas?” He asked. “Society? Government? People? To what end? Where do you see this service either recognized, rewarded, acknowledged or reciprocated?. Then again, where does it all end? The line of unaffording poor is unending, the complaints of affording are mounting, and I seldom get a peaceful night’s sleep, inspite of a clear conscience. I will retire without enriching my own life”.

I remembered my favourite author Richard Bach’s view: “The simplest questions in life are also the most difficult ones to answer”.

My lawyer friend, Advocate Shrirang Choudhary, had time and again pulled me out of civil hospital Nanded. I had this habit of ‘living’ inside the hospital, beyong the 12 hours duty. I would just go home to take a bath and one time meal, then return and stay to assist every consultant I could: there was such a sense of fulfillment in learning!

Shrirang would pull me out, we went to the riverbanks and he ensured that we talked for a few hours anything except medical world. “You will kill yourself if you spend all your life in the obvious negativity that is the milieu of any hospital. There’s more to life than being a good doctor. Treat yourself to the immense beauty life has to offer. You have only one lifetime, and limited active years”.

I realized how much I had wanted to pursue a career in poetry, music, philosophy and adventure. It was with such ease and passion that I had given up all of it, proud that I will be saving lives. Now after 15 years of practice I saw another valid viewpoint.

“You get used to the satisfaction and happiness, the challenges and the victories in healthcare. I can understand that some may enjoy the repetition of the same for umpteen years: in fact an entire lifetime. But can you please also understand that to me it feels like an artist who paints only one big picture or sings only one song in his entire lifetime?”

I knew what he spoke about. I was suffering the same, but had avoided to think of it.

“Do what you want in your spare time. Reduce practice. You must take a break” I suggested, “A long break.”
To lighten up the mood, I added, “Although people will immediately say that some pharmaceutical sponsored your holiday and fun”.

“I wish I cared what people thought” he smiled, “And I don’t want to run away. I don’t want to do anything half hearted. I want to walk out gracefully. Like a saint or a seer walking out upon the world and going to the Himalayas. Why is that more respectable than a doctor wanting not to be a doctor?”
I did not have an answer.
© Dr. Rajas Deshpande

Dedicated to those who understood this post.

Hans Zimmer’s Discombobulate music video:

(https://www.youtube.com/watch?v=R89UGKuyodk&index=2&list=FLHqY_yEsrcQFcedWLQUF2Pg)