Monthly Archives: December 2017

The Unholy Medicine

The Unholy Medicine
© Dr. Rajas Deshpande

“Close your eyes and take it. Absolutely no reason to worry. It is excellent in improving mental and physical health. It improves memory, skin texture, hair thickness and even vitality” said the medical shop salesman, winking one eye, handing over a big plastic bottle to the posh middle aged couple.

“It is all natural. These products have zero side effects” he said.
“But it costs nearly two thousand rupees” said the wife.
“What’s costlier than your health, mam,? This product is selling so fast, you will come back again to ask for it once you realize how good you feel without all the side effects”.

I had stopped on my way back from the hospital to buy some vitamins from a large medical store on the way. The shop, like all other medical shops now, had far lesser allopathic medicine . Most prominently displayed were sex boosters, chocolates and beauty products, from various pathies and with pics of different Babas. The next most prominent were various “organic” products, from juices to tablets in blingy packaging. © Dr. Rajas Deshpande

One common factor was prominently printed matter on most such products: “Guaranteed to cure”, “100% natural, free from side effects” “No adverse effects” “100 % Scientific secret formula” etc. Some packets claimed to even cure incurable diseases. Most of these did not have the content printed. Most of these also had valid licenses.

The shop owner and staff didn’t know that I was a doctor. Out of curiosity, I looked for the same bottle on the shelves, and read what it was that the assistant so confidently vouched for. It was a juice of some routine vegetables, with an additional “unspecified” herbal formula. It was made locally, and wasn’t refrigerated. The cleanest ‘Natural” food we cook at home with love, even “Maa ke haath ka Gajar ka Halwa” rots in three days if kept without refrigeration. I wondered what magic formulas kept these “Natural products” free of the millions of microorganisms. But then, I had no right or authority to question the massacre of scientific medicine. I was merely a doctor, not a highly uneducated politician or a religious preacher. © Dr. Rajas Deshpande

Just last week we had in critical care unit, a lady from an affluent family, who was given some precious powder by a “self-proclaimed” natural products expert, (wife of a politico in a taluka place). The 100 grammes powder had cost 45 thousand rupees, and came with a guarantee of “reducing wrinkles and hairfall”. The patient had consumed it for a week, and came to the casualty with a convulsion on the eighth day, found to have poisonous levels of heavy metals in her blood. Few months ago we had a young man who almost died because of clotting in the brain, after taking some injection of a “secret formula” given by his Gym trainer!

Bacteria, viruses and other microorganisms in some of these “natural” products grow for a few weeks, and cause infections, many a times life-threatening. This usually happens after 2-8 weeks or even later, when the patient has long back finished the doses. Some have heavy metals/ ingredients that may cause kidney / liver problems or other diseases months or years after consumption. © Dr. Rajas Deshpande

Wake Up, India! Long gone is the era of “secret formulas”. It is the right of every consumer to know what is the content of every medicine he / she bought. Unfortunately, the “Planned propaganda against allopathy to sell the products of the influential” blinds even the well educated. © Dr. Rajas Deshpande. There is a huge number of people who ask “some medicine” for all their complaints from a medical shop salesperson to avoid paying the fees of a qualified doctor. This qualified / unqualified pharmacy assistant, without even touching the patient, makes his own diagnosis/ conclusion and decides the treatment, the patient happily pays for it, thinking that he / she has saved a lot by not visiting a doctor!

The very governments which cap the prices of allopathic medicines allow other pathies and “homemade remedies and secret formulas” to be sold for the cost of gold and diamonds. Apparently many people have enough money to buy extremely costly herbals, beauty / personal care products, chocolates and sex boosters, but suddenly become poor when a scientific medical product by a standard international pharma company is to be paid for.

In India, movies make 100-500 crores, cricket matches fetch billions in betting and tickets, most of the lawmakers are crorepatis, but everyone seems concerned only about the fees of doctors and cost of allopathic medicine!

The same people in administration who ask qualified doctors to reappear for tests to reprove their merit frankly allow rampant “cross pathy”, babas and gurus, hakims and other self-proclaimed experts to keep on selling health products at unimaginably high prices. Imagine the bribes and commission is involved at all levels in the sale of such “natural” products. What more can describe the paradox in Indian Healthcare where aloe, karela (bitter gourd)and doodhi / lauki (bottle gourd) juices sell at a price far higher than many essential medicines? © Dr. Rajas Deshpande

No surprise we get many patients now a days, who come with early- age blood clots, digestive problems, severe headaches and vertigo, serious allergic reactions, convulsions, kidney, liver and other metabolic problems, thanks to the “secret and purely natural 100 % scientific formulas absolutely free of side effects” that they had consumed weeks / months / years ago.

Is it impossible for the Courts to act here?
What’s the proof?
There cannot be any proof unless each of these products is scrutinized with the same vehemence that once a famous international noodles brand was scrutinized. There cannot be any proof till the scrutiny and people involved in it are completely corruption and influence free. There cannot be any proof till those in power are involved in the sale of such products. Those who have basic deduction powers intact will know it for themselves. From public transport busses and autorickshaws to malls, there are blatant lies in advertisements selling such health products. The word “Scientific” is now used by almost every such product.

The fact that most of those in power use imported phones and cars, and visit foreign countries for medical treatments is enough clue.

As I paid for my vitamins, I asked the salesman what sold most at his shop.
We all know the answer.
It is not any medicine.And sadly, there appears to be no treatment!

© Dr. Rajas Deshpande

Issued in the interest of everyone who likes to be mentally and physically healthy. Please share unedited for the benefit of your patients.
Jai Hind!

Doctor Versus Doctor : Ego, Jealousy and Plain Stupidity

Doctor Versus Doctor : Ego, Jealousy and Plain Stupidity.
© Dr. Rajas Deshpande

The angry relatives entered my cabin, and threw a file upon my table.

“Doctor, our patient’s kidney function has gone worse because of the injection used in MRI” the patient’s daughter said, quite loudly, pointing a finger at me. The way she spoke spiked my anger, I was already tired: two of my critical patients were fluctuating, I was worried about them, had had a bad day already. I am short tempered. © Dr. Rajas Deshpande

This was a tricky situation, and every expression, every word mattered. One wrong step, and my career and reputation would be open for politicians and media to criticise, for the government and law to give me sermons of compassion and ruthless punishments based upon assumptions. Right and wrong is immaterial in India, so long as there is sensational populist material.

“Patience. You don’t have to react” said my inside Buddha.

I requested the family to sit down. “Please let me see all the papers” I asked.

The elderly patient with diabetes, high BP and kidney failure had seen me more than 6 weeks ago. She had symptoms which can be caused by blockages in the blood vessels of lower brain. Any accident in this area can be dangerous, sometimes fatal. There often are no clues from external examination. Such “Paralysis warnings” are called ‘TIA’s (Transient Ischemic Attacks). The only way to know if the blood vessels are blocked is to do an Angiogram of the brain. © Dr. Rajas Deshpande

The dye / contrast injection used for some radiological tests may cause kidney damage. However, the MRI angiogram does not usually require such a dye. Moreover, if at all a dye is required for an MRI study, the clinician and radiologists update the patient, take a consent, and check renal functions.

I checked the papers in detail. No such dye / injection was used during the MRI. The papers clearly mentioned so. In fact, as the patient was being investigated, even I had not prescribed her anything new. I showed this to the daughter.© Dr. Rajas Deshpande

“We don’t know. Our family doctor XYZ told us that because of the dye given in MRI, her kidney functions have worsened and she has become critical.” The daughter said, again in an accusative tone.

The name she uttered was a big name, a very senior doctor who was in practice over 50 years. I wasn’t surprised.

“Has he given you anything in writing?” I asked.
“No” she replied.

I showed her also that according to the reports the patient had gone critical because of urinary infection that had spread to her blood, not because of kidney functions alone.

“Oh! Then why did Dr. XYZ tell so to us? He gave us an impression that you were grossly wrong, and this was entirely due to the MRI”.

I had the right answer. There are many doctors who use this tactic: especially the ones who are threatened by competition or those who are just plain jealous of any attention that any other doctor gets. Not that they have any less success, practice or income, but they cannot help belittling others in an attempt to prove their own superiority. © Dr. Rajas Deshpande

In this case, the senior doctor wasn’t even aware that MRI Angiogram does not require a dye. He had chosen to loosely malign another doctor.

Doctors indeed develop a certain ego and superiority, thanks to years of hard work and merit and never realize when it turns harmful. Then these tactics begin: sarcastic smiles and remarks about other doctor’s diagnosis or approach, loosely commenting that tests or treatments were wrong or unnecessary, telling the chamchas / junior doctors (in front of the patient) how the earlier doctor was wrong, pretending to know beyond one’s specialty (taking advantage of one’s age), and in general speaking low of other doctors: this instantly gains the trust and goodwill of most patients who are not aware of such ‘games’. Then they can be manipulated as wanted. © Dr. Rajas Deshpande

These “gaming doctors” often speak to impress upon the patients that only they are the sane torchbearers of this profession, all others are corrupt. It is these doctors who have caused so much more damage to the medical profession and the image of medical professionals than media and politicians. Especially in today’s times, these doctors should introspect what damage they are inflicting upon future generations by fueling distrust. To gain a repute amongst the media and those in power, such doctors lick many a dirty shoes and empty many a gold bags, begging for titles and rewards that again unfortunately impress our illiterate and poor majority. They are often supposed to be the faces of the profession in the eyes of our society. There definitely are some honourable exceptions, but rare.

Such “disreputable” doctors must be openly confronted by the IMA, and they should be made aware that medical ethics dictate that one should not malign / criticise a colleague. In case one thinks that there indeed was a mistake, he / she should call up the concerned colleague and clarify, obtain a second opinion, and if it is a medicolegal matter, forward it to the medical council, taking precautions to protect the colleague’s reputation from unnecessary damage. One must remember that there is no doctor who is always correct, we all commit mistakes. Those who pretend to be free of mistakes are probably the worst doctors we can have. © Dr. Rajas Deshpande. No one ever grew bigger by showing someone else’s faults, mistakes or inferiority.

Even patients must also be aware of such tactics: it is the sign of a “low-morality” bad doctor, who criticizes other doctors or their approach / diagnosis. This is not allowed in our noble profession. The right approach of complaining to the right authority must be strictly followed. Those who have survived using such dirty tricks cannot be changed, but at least the newer generations must imbibe a healthy professional culture.

A good doctor is never made of other bad doctors. © Dr. Rajas Deshpande

© Dr. Rajas Deshpande

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Dictatorial Actions?

Dictatorial Actions?
© Dr. Rajas Deshpande

If one minister commits a mistake, does the entire government go?

Even the wrong ministers rarely go.
If one doctor / department has committed a mistake, how fair is it to cancel the license of an entire super-specialty hospital, where over a hundred specialists work, many hundred patients are already admitted and many thousand patients follow up for their regular treatment? What about those who had planned major surgeries and treatments there?

There indeed was a grave mistake. The relatives have suffered an immeasurable loss, and this must be investigated and the guilty must be brought to justice. Every doctor feels sympathy for every life lost. This is a science and practice of life where human mistakes are not impossible, they should be scrupulously avoided. If however they do occur, one must not overreact, especially for populist advantages. © Dr. Rajas Deshpande

Whether it was one person or an entire team that was wrong, they must be tried. But how fair is the action of closing down the entire hospital? Is this not affecting the basic human rights of the other patients, doctors and staff working there?

Is this a good tradition to follow in a country with an already collapsed government healthcare system? Someone has lapsed. Who made the hospital protocols? Who implemented them? Were they followed? Who issued the hospital license without confirming standards? If license was issued that means some standards were defined. If not, why was the license issued in the first place? If these standards were defined, it is easy to find out who was at fault, and take action accordingly. © Dr. Rajas Deshpande

It is well known that corporate / majorhospitals have to pay hefty bribes almost everywhere to get every permission. They are business houses promoted by an administration that cannot deal with the country’s healthcare overload. That is also a reason why some hospitals / teams may not follow standard protocols, and confidently overbill the patients. Why doesn’t the government define the limits of profits on commodities rather than capping doctor’s fees? The answers are simpler to the wise. © Dr. Rajas Deshpande

What about the many other good doctors who worked at this hospital, who had joined there as a career, who had bought homes nearby to reach the hospital faster? What about the students who had joined there as post graduates in various specialties? What about the staff?

Was it impossible to hand over the charge to some doctor’s body / organisation or under a competent authority for better running rather than closing down the hospital? The correct action then should have been suspension of the involved department / team till the facts were found out, and after medical and legal opinions, trial as per law. This is what every minister, every administrator, every TDH of any significance demands and gets as a basic right even after grave crimes. © Dr. Rajas Deshpande

There was of course a basic investigation. Why not exactly find out and take strict action against the medical / non medical administrators or owners involved? Add to this the apathy shown by medical bodies and other hospitals in this case.

Welcome to this glimpse of future that will be commonplace for all hospitals if no one acts now. Populist headlines will never solve the grave healthcare that deficits India faces.
© Dr. Rajas Deshpande

My sympathies, as those of every good doctor in India, lie with the relatives who have suffered. They must get justice.But that should not be at the cost of destroying the careers of many other medical and non medical people who were not guilty

© Dr. Rajas Deshpande

Respect: The Depreciating Indian Salary

Respect: The Depreciating Indian Salary
© Dr. Rajas Deshpande

“Over 1.5 Crore Every Year! That becomes more than ten lacs per month! Wow!!” my student showed me the news that some brilliant engineering students passing out from India were hired by some software biggies in Campus Interviews, “They will start their careers at that salary. That’s life!”

I felt proud, as always, these news and similar have always made me feel that the Indian academic talent has always been looked up to and rewarded by the developed world. The tiny speck of jealousy that we earlier felt for our classmates who went for engineering and had their own homes and cars while we were still finishing internships has faded away long ago. The only regret that sometimes peeps out from the past is that of never having fully enjoyed our teens and youth. The fact that most doctors from India also earn huge salaries in the west as well as the middle east speaks a lot about the flaws in our “Indian” thinking.

“Doctors get respect and that is the best that you can get in life. People think of doctors as Gods. You should never think about money” told every sore-throated, pot bellied and self proclaimed socialist who did not become a doctor, and mostly had no doctor in family. This ranged from our own classmates to the highest administrators in the country.

Over the years, I now feel that even the engineering or other stream’s graduates are almost in the same boat. I cannot wish upon the newer generations what we went through.
What is really making us proud here? That India cannot afford to use its own best talent in any field? That the best in all fields are taken away, because what the best Indian companies can offer them is nowhere near what the world outside offers them? That the best salaries in all government jobs are reserved for bootlickers above the age of 55? That in no field can the government find the young talents superior to white haired yes men? © Dr. Rajas Deshpande

Or boast with a shameless pride that the most revered Satya Nadellas and Sundar Pichais made in India cannot find career scope in their own country?

Or, while proclaiming “Vasudhaiv Kutumbakam” (The World Is My Family) on one hand, are we going to perpetually cry the same song of socialism and patriotism, expecting all of them to only follow the examples of the rare (and respectable) ones who chose to shed material life for the country? India needs a million good volunteers in every field who will live and die poor while serving the society. But to force this upon all those who graduate from India is to invite them to leave the country. From politics and administration to Judiciary and lawyers, we need people who will work free or low cost, because the main disease: poverty and illiteracy, is a never ending curse in India. These are the people who choose the governments who throw “low cost everything” crumbs at the society, rather than uplifting the society to respectable self sustaining, paying capacity. © Dr. Rajas Deshpande The lifelong perks of representatives elected for even five years, from any political party are regularly updated, but the salaries and pensions of doctors and other employees who work lifelong are never upgraded without agitations and then only with allegations of greed!

No doctor wants to be a bad doctor, but no doctor wants to spend life in poverty and insecurity.

If at all a doctor decides to do charity and see all patients free/ concessional all his / her life, not only will they be lost to poverty and anonymity, but our government or media will never notice them. All they get is more paperwork to comply with every day, fear of suspension humiliation by the administrators and a salary that’s a shame given their talent and hard work.

There is this curious tendency in India: to force or to beg in the name of charity, social service or patriotism rather than rewarding the talent. There are very few examples of honesty, hard work and talent rewarded without political connections. © Dr. Rajas Deshpande

Are the medical students any less talented than their counterparts in engineering or other streams? Don’t they study equally hard and work 24/7 many more years before they qualify? Even after that, the highest salary that the government offers the starting doctor (even engineer) is laughable, and if they wish to work at a private/ corporate hospital, they cannot decide the rules of payment strategies. If they must start their own set up, they need huge investments, over fifty permissions, many recurring, every one requiring bribe in some form or other. And whichever one they choose from the three career options above, from day one the society and media will have already presumed them guilty of extracting money from patients, the government and even some judges urging them to understand the feelings of relatives beating up doctors. I wonder how many ministers , judges or media bosses would like to understand the feelings of those who beat them up for something their client/ petitioner didn’t like. The most pathetic part is that while all of the above officers are inaccessible to common man, they still have armed security, and the junior most doctor who faces armed relatives is denied security even by law! © Dr. Rajas Deshpande

Most top medical graduates and postgraduates, like almost all other streams from India are leaving voluntarily because of this situation. To deal with this, the best options that some governments came up with were long term bonds to force govt. service (without telling anyone where the govt. spends so much on medical education), and canceling permissions to leave India even after the bond is completed. Bravo! © Dr. Rajas Deshpande

The Hon’ble PM has time and again declared many institutes like AIIMS to be opened across India. This is welcome, but we must also look at the state of conditions and staff in the existing health institutes run by the government. That needs billions for repairs, facilities and hiring better staff. Unless the salary structure for young and talented medical specialists increases , there are no chances of any AIIMS-like institutes running efficiently, they will soon become dirty buildings with low budget staff, where desperate patients are chronically dissatisfied and mobs find chances to vent anger.

Earlier I had immense respect and pride for every doctor who decided to return to India with a positive attitude and a wish to serve the society, their only expectation being living a modestly good life. Now I doubt if they are doing justice to themselves or their family, by choosing a life of financial and personal compromises, where they not only sacrifice, but are still looked upon as “looters”, face a violent society and a prejudiced government.

Ten years ago, I would have told this student of mine “let go of a good life, stay in India, we have a lot to do for our country”. Today, I don’t interfere with their decisions to make a career outside India. Because I love my India as much as any soldier would,and I also love the talented people in it.

Jai Hind!
© Dr. Rajas Deshpande

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