Monthly Archives: June 2019

The Brilliant ‘Bad’ Doctor And Mossbacks

photo 19-09-16, 22 52 52
© Dr. Rajas Deshpande

“Be careful”, my lecturer warned me, “He is a genius, but he is eccentric. Almost mad. You will easily pick up wrong traits from him. Take care that you limit yourself to only Neurology. There he’s a king”.

I was posted in another hospital as a part of my curriculum, to work with Dr. Shaw. He had worked in some of the best hospitals of the world. Most of his colleagues either hated him or were jealous of his abilities. He gave them nothing to criticize, so the most common ‘gossip’ about him was his being asocial, eccentric etc… but his earlier students had always told us: that he was the best teacher. His diagnosis was near perfect, he was excellent with patients, although quite sharply sarcastic sometimes.© Dr. Rajas Deshpande.
I wished Dr. Shaw as I entered his room. He was a picture-perfect doctor. Clean shaved, well dressed, smiling and emanating a healthy, positive feeling. He did not speak much. Patients started coming in, and I realized something different: he made no attempt to please patients by anything artificial. No extra words. No false reassurances or jokes. No pretending that he was being good to them. Case after case, he spoke maybe two sentences about the key pointers to his diagnosis, the most important tests needed, and started treatment. His manners with the patient were perfect too, he behaved with them with the same earnest kindness that he treated other doctors with. Still, he took care to be formal, to keep everyone at a certain distance where they could not get personal.

He worked incessantly. He thought and walked maniacally fast and took breaks only for his coffee during his long days. He achieved alone in a day what was difficult for four people working together, with less blah about it. I fell in love with his personality. Much like my hero, Howard Roark.

During such coffee breaks, I summoned courage and asked him questions.
“Sir, why are people so scared of you? Why do you maintain a distance from everyone?”

He spoke without hesitation or shame, as if he had answered this same question a million times. “Rajas, I wasn’t the same earlier. Then I started realizing that people hated anyone doing better than them. Even friends and family get somewhat jealous if you are above them. We are in a mossback society where you are traditionally groomed to hate anyone with a bigger car, better income or (he smiled) even a better girlfriend! People immediately presume that you must be doing something wrong, conning others, or that you must be easy on morals and ethics. People just cannot swallow the idea that someone can actually do better than them without doing anything wrong. Cyclewalla envies and hates scooterwalla while scooterwalla jealously loathes carwalla, travelling in the same direction on the same road. Translate that into intellectual achievements”.© Dr. Rajas Deshpande.

There was no boast in his speech. I had realized this just as anyone else. “My abilities, my intellect and my hard work are not my crime. But the only reaction for those doing better is to throw stones at them or to subdue them emotionally. People want a rein for you in their hands. If not, they have a hunter ready. If you do not please them, they are ready to tear you apart, not by logic but by weapons like defamation, gossip, or forceThe same doctor who is like God while expecting free service becomes a corrupt devil when they see bills or if the outcome is negative. The law considers this a profession, while politicians and People still expect 24/7 free world class service. I want to be a professional, not a slave ”.

This was magnificent revelation. There are many millions who earn better than doctors, especially politicians, but they forget that the respect that a doctor gets is not for his / her earnings, it is for the knowledge and wisdom, the hard work, the easing of suffering and saving of lives of thousands. That makes some of them so jealous that they have to ‘show down’ doctors in a bad light always, to suppress their fraternity. Most brilliant geniuses in history who took the world forward were not only hated, but hanged, poisoned, jailed and isolated. How else does one justify that people hate and attack some of the most intelligent non-violent beings in their own community? Some doctors are indeed greedy and corrupt, one can lawfully punish them, but otherwise how are millions of patients in India are getting better from even most critical conditions? Are our politicians treating them? © Dr. Rajas Deshpande.
Dr. Shaw did not mince words. “Is it a fault that I studied more, that I have better speed of thinking and analysis, that I got to learn from excellent teachers? Is it my fault that my patients like me? Yet I realized that this is exactly what I am disliked for”.

“I have many faults; I do not think I am superior to anyone. But if you still treat others as equal, they can not grasp it and keep reaping benefits from your association, while contributing nothing to your life. So I prefer to be alone, groom my life better than trying to average out with everyone around me. I have but one life, and I want to live it being myself, not a people-pleasing pimp”.

On my last day with him, I was too emotional, but still decided to ask him what haunts most Indian medicos: “Sir, then why are you still in India? People hate doctors, they cannot tell a good doctor from a bad one, they hate anyone who has intelligence or money. They think every doctor skins people for money. It is such a sad state.”

“I am here because I see the suffering of the millions of people who need good doctors. They may hate me, but I can still do them good. I do not want to beat drums and blow trumpets about my love for India. I leave that for politicians and those who have nothing else to do. If I leave, many will die. That’s why. The only care I take is to stay away from parasitic people, and unsafe patients. I don’t explain myself, those who have that ability and grasp will understand me.” He was beautifully, profoundly blunt, like a saint!

I had changed forever as a doctor, due to this “Brilliant, Bad Doctor” I worked with!

© Dr. Rajas Deshpande

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Wrong Diagnosis: The Secret Child Of Every Doctor

© Dr. Rajas Deshpande
“I don’t agree with your diagnosis” said the senior gynaecologist to me, as the rich patient and his family heard with interest and confusion, “I don’t think this patient has Parkinsons Disease”.
I had just returned from an advanced University Hospital in Canada after completing a fellowship in Parkinson’s Disease, a post-doctoral course under one of the best specialists in the world. This senior and famous gynaecologist with a large hospital had referred a case, I had seen the patient, after which he, the senior OBGY, had come to my room. I had spent over an hour studying the patient’s symptoms, and conducted the most difficult and extensive of all clinical examinations in medicine: the complete neurological examination. I had, like all doctors trained well by their teachers, deliberated the possibilities (what the doctors call ‘differential diagnosis’), and then come to this conclusion. There are no shortcuts in medicine, and I took pride in not missing any details. © Dr. Rajas Deshpande
I was open to the idea of my diagnosis being wrong. No doctor is above the patient, and ego cannot be a factor while making a diagnosis. But the ease with which this senior doctor had refuted my diagnosis without so much as touching the patient really offended me.
Obviously, this senior OBGY wanted to impress the patient by showing “I know better Neurology than this junior doctor”. The patient and his family were quite close to that senior doctor and had deep trust in his opinion. The look on their face changed immediately. They no more cared for what I had to say. My first response was anger. Then I remembered what one of my great professors had imbibed upon me: You cannot match the tendencies of some idiots. State your point, smile and leave. Truth will unmask itself in all medical cases.
“What do you think this patient has, Sir?” I asked.
“Maybe he is just tired mentally” the senior doctor said, and the family bobble-headed in assertion.
“I disagree with you Sir”. I said firmly, “All my findings are written on that paper, the patient can go to any qualified Neurologist. Only they can identify or treat such cases well”. I left the room without waiting for his infamous wise wordplay. Three years later, the same patient returned in a wheelchair, referred by another physician, and is now improving with treatment for Parkinson’s disease. The fact that he was deprived of correct treatment for over three years will remain a dark medical secret. © Dr. Rajas Deshpande
Two years ago, a seventeen year old boy was brought by his parents. He had fits, we had started him on anticonvulsants. Adequate instructions were given to reluctant parents, and the dangers of stopping medicine were explained. They never returned. Last month, his parents came. Few months ago, they were told by some doctor to stop the anticonvulsants, and start on some herbal supplements. “We thought let us try” the parents said, and stopped his medicine. The boy had a fit while sitting in his 9th floor balcony, fell and died with a head injury.
Many such cases, where light-gossipy comments by unqualified doctors about the (correct) ongoing diagnosis or treatment being wrong kill many patients with heart attacks, strokes, other heart and brain diseases, liver and kidney failures, cause worsening of otherwise treatable cancers, blood and bone diseases, and many more conditions in almost all specialties of medicine. Patients sadly prefer to choose what is convenient and cheap. Some doctors make personal comments about other doctors being wrong, corrupt, charging high, having no experience etc. Some doctors rely solely upon a “Low Fees and Sweet Talk (LFST)” formula of practice and keep on defaming the entire profession, gradually brain-washing a frightened, confused and frustrated patient. Unfortunately, many patients, both literate and illiterate, easily fall prey to such tactics. © Dr. Rajas Deshpande
What if the diagnosis is really wrong? We often meet smartypants (and smartyskirts!) medicos who just go on challenging any and every diagnosis made by others, be it their specialty or not. A simple understanding of one’s own capacity is enough marker of the intellectual level of that person for me (recall the famous Dunning Kruger Effect). To translate this crudely, stupids seldom realise they are being stupid. They create confusion and wise wordplay to dilute the reality. It is only the idiotic ignoramuses among doctors who cannot ever say “I don’t understand, you know better”.
Medicine is a logical, scientific methodology of algorithms. If a doctor thinks someone else is wrong, they must first state in writing their own examination findings, diagnosis and reasons to refute someone else’s diagnosis. Then they should explain this to the patient, and then start treatment in view of their own diagnosis, taking responsibility if that turns out wrong, and telling the patient so too. It is also an offence in the rules of medical councils to defame a fellow practitioner.
Every person in every field makes mistakes, even the best minds. It is no secret that every doctor, however qualified or experienced, makes a wrong diagnosis many times in his / her career. In most cases these are simple analytical/ judgement mistakes, rarely dangerous. To concentrate on one’s own specialty, and to refrain from pretending being an expert in “all other specialties” is the key to becoming a great doctor, especially in these days of information flooding and subspecialty training. To say that someone else is wrong, a doctor should be equally or better qualified in that subject. Age has nothing to do with it.
In a hyper-emotional, media biased, politically influenced and mostly illiterate country like India, most doctors, however straightforward and honest, find it difficult to frankly tell about their own mistakes to the patient, as the reactions and defamation are out of proportion and our law is primitive still in this field. Sometimes when the patient is capable of understanding it, I have seen many doctors, surgeons explain their mistake and the patient graciously accepting that it wasn’t intentional. This is rare though. © Dr. Rajas Deshpande
We must educate the society in general that no doctor who says “earlier doctors were wrong” or speaks ill of fellow practitioners can ever be a good doctor. The patient should first ask such a doctor “ Have you never been wrong?” and listen to the wise wordplay that follows! While we often blame patients who are arrogant, those who do not trust treating doctors, those who google-treat themselves, and in general bring stress to the medical practitioner, we must first also look inwards for our faults that have multiplied and amplified such perceptions by the society.
What hurts me most is that this is almost exclusively an Indian phenomenon.
© Dr. Rajas Deshpande
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What A Doctor Can Not Prescribe. .

(c) Dr. Rajas Deshpande

“What’s the nature of your work?” I asked the patient.

“Nothing much.. I just sit like you all day long. It’s an office job” he replied, and winked looking at his wife, who rebuked him visually. I chose to ignore the sarcastic slur. I wanted to concentrate upon the diagnosis. After a thorough examination I wrote him a prescription and explained him changes in lifestyle.

When I advised him sleep and food discipline, he proudly told me “That I am very particular about.. since so many years I eat three times a day and sleep peacefully over eight hours”. I had a strong urge to tell him that in last twenty-five years of practice, there was never a night of undisturbed sleep thanks to hospital and patient calls, and there rarely was a straight week without skipped meals. I held my rebellious tongue, another patient waited outside. All said and done, I had myself chosen this career, and the fact that people were bitter towards doctors didn’t deter me from offering to solve their health puzzles.

The next patient walked in with a big “Hullo! Raja, pehchana kya (recognise me?)?”.. he was an old schoolmate, had come with his wife. She had had complicated neurological problems. After a lengthy clinical examination, review of many reports, and a long consultation, I wrote her a prescription. (c) Dr. Rajas Deshpande

“You charge so much for only writing these few words on the paper?” asked my schoolmate, desperately trying to sound jovial but overtly being critical and again, sarcastic.

I politely asked him to sit in my chair. “Please sit here and see if you can write the same three lines” I requested him. He hesitated at first, but then came over, held the pen and asked me: “Tell me what to write..”.

I told him to first write his wife’s name on that paper, date it, and then write Rx, which begins the drug prescription. Then I told him the name of the first drug. He wrote it down correctly.

“What’s so difficult about that?” he asked..

“Now tell your wife that this drug can either do good or bad, it can solve the problem in most cases, but it has a potential to cause serious side effects, including death if she is allergic to it. It may cause bleeding in the brain, stomach or anywhere, it can cause asthma-like cough, or any unpredictable reaction”. (c) Dr. Rajas Deshpande

His wife looked suspiciously at him. “Why don’t you let the doctor write?” she said, and then turning towards me said, “Bhaisaab, my husband has this nasty habit of arguing with everyone. Excuse us, I know it takes decades of study to be able to write that prescription”.

My schoolmate was not done with being offensive yet. He smiled sarcastically. “You are trying to scare me. Have you seen any death due to this simple medicine?” he asked.

“Yes” I replied him in truth. Aspirin causes many deaths indeed!

“Write the second medicine now” I told him, “it can have reaction with the first medicine or other medicines she is already taking”.

“What to do in that case?” He asked, now hesitant.

“It depends upon what side effects emerge. Many possibilities, many different answers. But each of that line has a potential to cause serious damage.” I replied.

He rose from my chair.

“Sorry yaar. I thought you were just charging fees for sitting there and writing effortlessly. How do you remember so many hundred drugs, their side effects, their reactions with each other? Aren’t you scared?” he asked.

“I am sometimes scared. Every doctor is. You never know which prescription can turn into a nightmare. The more you have studied, the more you have experienced, the safer you feel. You can imagine the stress of writing forty prescriptions a day, an average for every doctor. Still more dangerous is the surgeon’s job, every patient entering an operation theatre has some degree of fatal risk”. (c) Dr. Rajas Deshpande

“Oh so that’s why doctors charge so much fees for every prescription!” He was indeed a fighter!

I didn’t want to explain to him that the land, the rent, the petrol, paper, and time cost the same to a doctor just like any other citizen. (c) Dr. Rajas Deshpande

Just then there was a loud noise outside. We rushed out. A patient’s child was having a fit, her body all twisted and eyes white. Such was the impact that her head was bleeding, and she was frothing at mouth. The nurse was already by her side, I wore my gloves and tried to stop the bleeding, comforting the head of this child. In some time, the fit stopped, and the pateient became all floppy. Her respiration had been blocked by the blood and froth that choked her throat. A resident doctor ran around to get a crash cart, we opened the patient’s mouth, sucked out the blockage as the nurse pushed in the injectables. The child stabilised, her breathing resumed. As the wardboys kept her on the stretcher, I noticed my schoolmate behind me who was watching this in horror. He suddenly held his head and sat down.

“He gets a chakkar (giddiness) when he sees blood” his wife told me.

The earlier patient, who had commented “I sit like you all day” was also still in the lobby, watcing this whole episode. . He came over. “I help people too – just like you. People come to me every day for my advice. I am a social worker for XYZ political party. I have also saved many lives like you doctors.” he said.

I had no prescriptions for his mentality!

No pharmaceutical makes a common sense tablet, and there’s no injection for jealous egos!

(c) Dr. Rajas Deshpande

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