Monthly Archives: February 2021

The Bullet Indian Doctors Bite

The Bullet Indian Doctors Bite
© Dr. Rajas Deshpande

“Her health is fluctuating. We need to admit her in ICU. Why didn’t you bring her earlier?” I asked the daughter of a 75 year old lady who had developed weakness in both hands and legs about two weeks ago.

“Doc, we thought she had weakness due to age, gave her some herbal boosters and vitamins, as we were scared of modern medicine. We hear a lot of bad things nowadays” there was no trace of any regrets in her voice that she was telling me this.

Wish I could tell her all that we hear about the reality of people criticising modern medicine nowadays. But who has that kind of time?

“Can we please treat her at home? She is scared. Also, we have limited finances, my husband is not in town. My daughter has her exams on”. she requested. We often accommodate many requests, but really, our society never stops asking for more than possible. I explained her in detail that not everything can be managed at home, admitted the old lady in ward and gave all instructions to the staff. She had had very low potassium levels, we corrected them. On the second day, she started feeling slightly better.

Third morning, as I continued my OPD, I got a call from the ward. The nurse had a panicky tone “Doc, this patient has become drowsy suddenly since a few minutes. Her daughter is not here, I noticed when I went to check her. Pulse rate is high, no fever, and oxygen levels nomal. But she is breathing faster”.

“Sis, please check her blood sugar and send her blood sodium- potassium levels, and haemogram, I will be there in a few minutes” I said. I called the lab and requested them to process her samples urgently.

The sugar level was low, we gave her sugar and she became alert. In a few minutes we got the electrolyte levels, her sodium was also low, we started the correction.

“I have informed her daughter, she is on the way” the agile nurse said. As much as doctors, the credit of saving lives goes to the millions of active and alert nurses and junior doctors. I went back to the opd, apologised to the waiting patients and started again.

In some time, I received a call again. The nurse was still panicky. “Doc, the patient’s daughter has just returned. She is creating a ruckus here, shouting and abusing. Please come asap”.

I went there again. Indeed the daughter was furious.
“I will post this on facebook, I will write about the hospital, I will sue them. How can they do any tests without my permission?” she went on.

I said hullo to her, stepping between her and the patient nurse. © Dr. Rajas Deshpande

“Why did you do her blood tests without asking me? We had done blood sugars last month, they were normal. Also we had done the sodium and potassium two days ago. You should have asked me before sending blood tests” she went on.

Two angry humans is too much of a mess. I summoned my inner peace. I had done what was good for the patient, I wasn’t scared of anyone. Especially ruckus makers. Her anger was her problem.

“Madam, may I explain?” I asked in a calm voice. Not that I am not short tempered, but I am a doctor.

I told her how some tests need to be repeated, and how there’s no time always to ask permissions by calling relatives. Patient’s life is always more important than the permission of relatives, especially if they are not on site. Sometimes, we need to do tests just based upon suspicion of certain complications. Every passing second increases the valley between life and death, the doctor and nurse must have the fastest brains and actions upon earth. To explain everything to every relative till they grasp and understand is another stupid, idiotic expectation in emergency. It’s like asking a soldier on the border to explain every citizen in the country why he fired each bullet. A medical soldier has to do the best, be medico-legally safe, document everything, explain to the relatives and obtain permissions, and still face anger, humiliation and social media threats, rating scams and attacks on reputation by anyone anytime. All this while having the best intention- saving the patient! © Dr. Rajas Deshpande

“You take fever by a thermometer many times a day – once is not enough as the condition is still persistent. Likewise some tests, even if costlier, need to be repeated. Unless you have written that we do not want any tests, we have to do what we think is good for the patient, that’s our sacred duty” I told her.

She calmed down.

“See, doc, I am sorry, I exploded, I am going through much stress at home due to issues with my daughter and my husband is not supportive. Now that you have explained I am okay with the tests”. she said.

“What about the shouting, the abuse, the insults to allopathic doctors treating you right now, the humiliation of the nursing staff and waste of my time, that caused discomfort and delays to other patients?” I wanted to ask, like most doctors, but we have no time. She wasn’t going to change anyway. Like most of our society.

When I discharged the patient, now walking on her own, the family was still upset, because the hospital did not comply with their expectation of a “discount”. A genuine “Thank You” is extremely rare in Indian hospitals, even when the critical walk home.

Three months fast forward. I received a call from the daughter again “Doc, my mom has become drowsy again, shall we come to the hospital?” she asked.

“Sorry, I am not available, please see another doctor at any hospital of your choice” I replied.

Many good doctors have exhausted their patience and will to be kind and compassionate due to such incidences happening every day. Now most are concentrating on patients who have better common sense and manners, politeness and willingness to understand the use and limitations of modern medicine. Money is the last thing a doctor can think of, but sadly it is the first and only thing that most relatives think about. While treating the patient, the first thing- patient’s life – has not remained the priority for most hospitals, it is now the safety about medico-legal aspects and reputation. A wise doctor has to learn how to balance in between.

Doctors in India must bite many such bullets every day!
© Dr. Rajas Deshpande

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The Story of a Deadly Brain Aneurysm..“Doc, was the treatment delayed?”

The Story of a Deadly Brain Aneurysm..
“Doc, was the treatment delayed?”

© Dr. Rajas Deshpande

“Doc, was the treatment delayed?”
The angry husband, Mr. Mane asked in a calm voice but the accompanying relatives had a menacing look upon their faces.

The patient, his wife Mrs. Sujata 35 years old, was brought unconscious two days ago, in a comatose state, at about midnight. I was out of city, so my colleague Neurologist rushed to the hospital and started treatment. We were constantly in touch, within an hour Sujata’s scans were completed, and she was shifted to a critical care unit. She had large bleeding in the brain, and was already beyond a possibility of surgical treatment.

About five years ago, she was diagnosed with an aneurysm in the brain. It is a defect in a blood vessel which balloons out as its walls become thinner and may rupture suddenly, causing either instant death or bleeding in the brain, many a times huge. This diagnosis needs immediate treatment, the right words that describe its risk are: “This is like sitting on a time bomb, not knowing when it is set to explode “.

Many patients do not have much symptoms besides headaches or minor neurological issues usually found on examination by a neurological expert. There are many NeuroIntervention specialists in India since last two decades, who can reach the balloon via a catheter/ tube and close the balloon/ aneurysm so the risk is eliminated and patient cured. Sometimes neurosurgeons are required to operate if the aneurysm has a wide base, and close the connection between the balloon and the artery from which it arises, by an open surgery. © Dr. Rajas Deshpande

Five years ago, we had informed all this to Mr. Mane and Mrs. Sujata. Like many educated patients nowadays, they obtained multiple opinions. Almost all doctors had told them what we had told. However one retired allopathic doctor, now quite old, and one non-allopathic practitioner told them “It is not necessary to do the surgery. Doctors these days advise unnecessary costly treatments”. They started some vitamins and health boosters. © Dr. Rajas Deshpande

The couple decided to wait. The came for follow up once after two years, we told them it was better to operate, but they said “We met our neighbour doctor, he is very senior, and he said that there’s no danger in waiting. I think he knows, see, nothing has happened in two years.. we are happy as it is!”

After that they did not follow up. They had even stopped allopathic medicines. They had come now, when she was beyond any possibility of rescue.

When after a day we told the family that she was brain dead, they asked the question above: “Was her treatment delayed?”.

After explaining to them that everything was done faster than even the best centers in America would have done, they calmed down.

Out of curiosity I asked Mr. Mane: “What did your neighbouring Doc say, the one who had advised to not operate her?”

“Oh, he was very kind. He said nature is cruel and anything can happen anytime to anyone. He arranged for an ambulance too for us.”.

Mrs. Mane didn’t make it, we all felt very sad that a young life that could have survived was lost to a wrong advice. Many doctors who do not specialise in certain complicated and advanced branches of medicine often try to please the patient by giving them an advice that attempts to impress the patient by saying what they want to hear.

It is true that sometimes surgeries are wrongly advised and performed, hence the social confusion about trust. There’s only one way out- explaining the patients and giving them credible websites to refer to, referring them to another specialist who is qualified in that branch. Some trust-less patients will still pay with their health and life. © Dr. Rajas Deshpande

If such cases go to the courts of law, challenging the speed and/ or efficiency of treatment, the honourable courts should consider delays and decisions at every step beginning from the day of onset of symptoms, the delays in visiting doctor, specialist, performing advised tests, obtaining another opinion if advised and getting the prescribed treatment in time. Just holding the doctors and hospitals responsible for not being able to rescue the patient at the last stage is not justified.

Leave aside a few wrong ones, but most surgeons only advise a surgery after deeply thinking about all possibilities, risks and outcomes. Sometimes even when the outcome is uncertain, they must operate. At such times their reputation and career is at a stake, because every mistake is nowadays amplified into a media blast. Still they think about what’s the best for the patients, and try to do their best. Surgeries and procedures, even the costliest, are the cheapest in India since last thirty years- surgeon’s fees are still lowest in all branches, and if we consider the medicolegal and media risk and a violent mobs backed by some politicos, actually the doctor is at a high risk during every major surgery. © Dr. Rajas Deshpande

A doctor is not a merchant or politician to sweet talk to the patient and give them a pleasant but wrong advice and jeopardise their future just to “retain the customer“. This is a noble profession where sometimes strongly worded and unpleasant solutions are essential to save the patient. To expect all the patients and relatives to understand complicated medical concepts and treatments (which takes even brilliant doctors years to grasp) is comical.

We sincerely hope that our society recognises the huge stress every doctor goes through, every day, trying to do their best for patients.
We also wish that the law, politicians and media note that it is often the delays before admission that kill the patients than those after.

© Dr. Rajas Deshpande

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