Category Archives: doctor’s fees

Doctor 2025: What Happened After The Pandemic?

© Dr. Rajas Deshpande

The whole family was happily relishing desserts after a sumptuous dinner, when Mr. Shah suddenly went blank. His eyes rolled up, and he started having violent movements of his body. His daughter Amira shouted “Mom, call the emergency ambulance number” and tried to comfort her father who was now in a full blown convulsion, blood oozing from a corner of his mouth with froth.
The ambulance came with paramedics. Its driver handed Mrs. Shah a cellphone: “Please enter his Aadhar card and Insurance policy number, we will take care of everything” he said.

They collected a drop of blood, which would give all the necessary information about the patient. A video scanned the patient and recorded history and legal statements of the family members.
The sugar level was high.

“Was he given sweets? asked the paramedic.
“Yes” said Mrs. Shah.
“Did you take permission from the government? He is a diabetic, sweets are illegal” the paramedic said.
Amira pulled out a big pink note from her purse.
“Listen, please delete that video. Please take another clip, Mom doesn’t know, I will speak” she said. The attendant agreed. His salary had been halved since the pandemic.

They reached the nearest hospital in few minutes. The nurses hooked the patient with various tubes and told the relatives to wait in a counselling room. The patient appeared stable now. “This is really cool. India has made such great progress” Amira said to her sweating mother.

After a few minutes a Doctor on the TV screen greeted them, and explained them that Mr. Shah had developed bleeding in his brain. Interrupting the doctor, Mrs. Shah, sobbing, asked if her husband will be out of danger. Amira too, very anxious, asked many questions. The doctor replied very pleasantly “Just after this video call, you will see a video of all the likely things that can go wrong in your patient’s case. You will also be provided interactive links like a telephone menu, to ask any questions you want, the answers are scientifically standard. All treatment and billing is standardised”.© Dr. Rajas Deshpande.

In a fit of anger, Amira loudly asked “But doctor, we want to see you and speak with you. When will you visit the patient?”.

Smiling, the doctor replied “Oh! Sorry, but we abolished that practice long ago. We don’t directly meet thee relatives now. For every patient, we give you the diagnosis and condition, all the information is made available on the internet, you can read for yourself.”

Mrs. Shah took out the Bramhastra “But we are paying your fees. You must answer and explain to us. You must be available for the patient all the time”.

The Doctor’s smile now became distant and curt.

“No madam. The law requires that I see the patient every day and treat him / her well, which I will continue. The insurance company and the hospital to whom you pay require me to visit the patient only once in 24 hours, which I will do. I am supposed to inform you, which I just did. You are paying the hospital and the insurance company for my services, from which they both cut some amount and pay me, you are not buying my time or me. You are free to request to change the doctor, or for a second opinion at an extra cost. The government has now made it mandatory to treat the patient at the hospital that they will decide, unless you are a special category. There is nothing like personal care now, everything is standardised by the ministry. We have a PRO who can assist you with searching all the information you need”.

Amira, wiser to the world, asked directly, in a cautious, lower pitch “Doc, what can we do to get your direct services? We can pay anything you want. We want you to personally see my father, make all the treatment decisions, and we also want to speak with you daily, in person. Do you have a private hospital? Please, I beg of you, have some compassion”.

The Doctor paused with a sad face, then said in a more personal tone “ I am sorry mam, all private healthcare has been abolished in India. . Many relatives attacked and injured doctors, most spoke in an abusive, rude manner, many wasted our precious time with illogical, repetitive and absurd questions. So the unnecessary was eliminated . During the pandemic of 2020, doctors were abused by our society so badly, that many died, many left either the profession or the country. Now the number of doctors is very low, We have a wild, abusive society that swings between begging for compassion and free treatment to violently attacking doctors. So all hospitals are now controlled by the government, and all doctors just follow the treatment recommendations set by the government. Even the brands and quality of medicines, stents, instruments for each patient are decided by the government, according to that patient’s category”

Mr. Shah’s condition was worsening day by day. Once every day, Amira received updates about her father via a lengthy SMS, with advertisements of big business houses, who had access to every data in the country. Nothing was private anymore.

Amira asked the PRO one day “What happens to the poor patients who don’t have money?”

The PRO smiled in disdain. “There are special insurance schemes and different stadium-hospitals for them. They have the same system, but low cost everything, including medical staff. Those who cannot afford even basic insurance are sent a CD of patriotic songs and motivating sermons. After the pandemic, this has emerged as the most cost effective way of healthcare.”

“What if I want to take my father outside India for treatment?” asked Amira, now fed up with all the robotic answers. All human touch in medicine was lost.

The PRO looked at her in awe. “Are you in Politics? Are you super-rich like celebrities? Because taking someone out of India for medical treatment is reserved only for them, or those who have special links”.© Dr. Rajas Deshpande

Every morning, Amira and her mother went to a temple and prayed. One day, Amira asked the doctor: “Doctor, what if this was your father. Would you do the same?”

The doctor replied “Mam, My father died because I was posted in the pandemic ward. He was a high risk case but I did not get exemption. I think I am already doing far more for your father than I did for mine”.

On the fifth day, Mr Shah woke up. In a week’s time, he was scheduled for a discharge. Arguing about the hospital bills or complaining about the treatment with the insurance company or the government was now considered anti-national, so she carefully remained silent and paid all the bills, right from that for the first drop of blood collected at home and the ambulance. The pandemic tax and GST almost doubled every bill. Everything was authentic and standardised.

On the day of his discharge, a political leader came over, and a picture was taken with Mr. Shah. “Recovered due to the untiring efforts of the party and the government” said the newspaper the next morning.

On the way home, Mr. Shah told Amira “That doctor was fantastic. When will we see him again?”

Amira replied “I don’t know. The government will assign a doctor for you to follow up now”.

Mrs. Shah looking far away, said “At the temple every morning, I prayed for two things: for your health and for return of the good old days of personal relations with our doctors”.

© Dr. Rajas Deshpande

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Much of this is happening right now. This is the foreseeable unavoidable future.

Change The Medical Scene, India: Article One. Healthcare Failure In India: Problems And Solutions

1: Etiopathogenesis
(c) Dr. Rajas Deshpande

This is my heartfelt attempt towards initiating a change in the Indian healthcare system. We all, even the government, wants it to improve but nobody seems to know where to start.

I appeal the younger generation of doctors to please think deeply about this article in terms of your future, unless you want to face the same humiliation, insecurity, inhuman attitudes, suppression and threats all your life, just because you are divided. I intend to offend no one, my non-Utopian aim is that every patient as well as every doctor should be happy, healthy and satisfied. There indeed are more good than bad doctors in India, but guess who dominates the scene.

In this series of articles I have tried to first identify the basic problems, and will propose probable answers in my later articles. Before we analyse outsiders, let us first take an honest look at ourselves.

Problems Within Medical Community:

  1. We have many class differences between doctors. This is the most prominent cause of non-unity of doctors. These class differences may be summarised as (a): Intellectual: some doctors are far more intelligent and skilful than others. (b): Cultural: some doctors know the best ways to behave and speak with patients, others have an arrogant, ill-mannered, abusive and sometimes filthy, inviting a bad reputation. (c): Academic/ Clinical: some doctors are trained at extremely good institutes, some put in gigantic self-study efforts, and therefore are academically and / or clinically better even if their medical degree is the same. (d): Financial: some need financial support and critical effort to survive through medical courses, fighting till in their thirties to settle down, while for some others, financially it’s a cakewalk.
  2. Shameful tendency amongst doctors, of discrimination based upon State, Caste, Region, Religion, Academic Institute, City, Financial Status or Political party, generating an “Insider-Outsider” culture. This has also resulted in many hospitals employing doctors from a particular religion or socio-cultural/ financial status even if better candidates are available. Few honourable exceptions.
  3. Jealousy, Insecurity and Envy: There are successful and struggling doctors in every branch. The shameful tendency of some established doctors to suppress and disallow juniors in their institutes is well known. Most wise institutes now employ two or more competing masters in every branch and fire up their egos against each other, to have them fight tooth and nails. Guess who profits and who bleeds. The comic tragedy is that even very brilliant doctors fall prey to such tactics. © Dr. Rajas Deshpande.
  4. Financial desperation: Juniors who come from poorer backgrounds, in spite of better abilities, have no money to invest, make their own hospitals, and must work at bigger hospitals under such competing seniors, and the only way they are allowed to survive is by getting better numbers. This results in a very hostile, bitter work culture.
  5. Killing Humanity: The entire medical community is guilty of perpetually ignoring, intimidating, suppressing and blackmailing medical students, especially postgraduate resident doctors. India has probably the worst inhuman treatment for its budding and junior doctors, with no one interested in addressing their problems. They live in most pathetic conditions, often six in a single room. They are inhumanly overworked, with a shameless answer “We did it, now you do it” from their seniors. “No food and No sleep” is nothing to be proud of, it is Torture. Post graduate students and resident doctors are not only FORCED to work far beyond human capacity, they are overtasked with mindless curriculums. The “Slaves” in our history were far better off compared to how the resident doctors are treated today in India.
  6. Extremely low quality medical institutes: Guess who owns and runs these, still churning out valid degree holders.
  7. Nepotism: Where “Premium” students, often children of the powerful, politicians, administrators, doctors, socially prominent are treated differently, groomed specially and airlifted to success while others, however meritorious and efficient, are humiliated and suppressed. © Dr. Rajas Deshpande.
  8. Master-Slave Culture: In every private or Corporate owned hospital, there is an unwritten rule: never cross the Master-Slave boundaries, never ask questions, you are here because we allow you to be. Should you dare to correct someone about policies, ethics, financial irregularities, excess profiteering, you are unceremoniously thrown out, given the title of a rebel, a troublemaker, and your reputation as a doctor is torn beyond redemption. This is the worst for surgeons than physicians, as ‘badmouthing’ / deliberate ill-reputing of a surgeon can ruin their entire career. Unfortunately, it is not only the hospitals, but different classes of doctors mentioned above participate in this mudslinging too. No institute in India has an honest troubleshooting department for doctors. There is no respite, there is no organisation, doctor’s body, government department that protects a doctor thrown out, defamed or harassed by corporates or big hospitals. Very few hospitals are doctor- friendly.
  9. Even in government service, sycophancy is the strictest tradition.
  10. The SP Syndrome: Shoelicking-Postholders are the worst tragedy in healthcare. Even after being qualified doctors, these ‘doctors’ have learnt the quick-ladder culture to sit in a medical administrative chair. They know which side to please, and are seldom seen working in the interest of either the doctors or the profession. They have but one agenda: strengthening their chair-bum glue. They are found almost everywhere in healthcare, and many enjoy the administrative superiority and control over better qualified and even senior doctors. There are rare honourable exceptions who try and balance the hospital and doctor’s sides. However, those involved in policy making are rarely in direct contact with the patients, have rarely had a reputation / experience of good medical practice, and are happy with hypothetical speeches sweetened for their powerful masters. Senior doctors have never stood up for an unfairly fired or colleague, and often our own community disowns a doctor harassed by healthcare giants or government. Thousands of excellent doctors have either left the country or live in dark anonymity just because there was no Godfather for them. This is a major cause of policy failures and pathetic research in Indian healthcare, inspite of having some of the best medical brains upon earth.
  11. The only thing that helps a good doctor is long-term goodwill generated over years, where patients spread a good word about their relief from that doctor. Against this is pitched the permission to hospitals for self-advertising, which often misleads the society.
  12. Once a doctor starts a hospital, there are so many taxes / overheads that he / she must shoulder, so much paperwork, that it is difficult to concentrate upon patients alone. Add innumerable laws, restrictions, rules that make it impossible to sustain over long term. Bribes are a stark reality wherever rules, restrictions are involved. This is why many doctors have closed down smaller hospitals.
  13. While doctors are only allowed to charge their (mostly) limited fees, almost everyone else in the profession earns a lot more profit, often unjust. From rooms, service, nursing, gloves, catheters, to procedures, from canteen to labs to radiology to pharmacy, the hospital and pharmas earn profits everywhere (this is acceptable in proportion of the investment). The one paid least in the final bill is the doctor / surgeon, who usually earns a piddly sum in spite of being the most important factor in the chain. The doctor is also primarily responsible medico-legally for every case. Patients are upset with the doctor even after saving their lives because the bill is fat, not knowing that most doctors have no say in hospital billings. © Dr. Rajas Deshpande.
  14. The Corruption: There is no denying the fact that some doctors participate in various “unethical” means of earning via “commissions”. While all corruption is wrong, this is an extremely hot and debatable issue, where many questions are unanswered. For example, if a doctor owns a hospital and a lab and a pharmacy, he can profit under all three headings, but if a doctor working with him is also paid from this profit, it is presumed unethical. Our society is too financially biased, and it will never accept the necessity of profits in healthcare. However, the same society or its government has no answers to what a good ethical doctor should do if there are financial emergencies like this pandemic where his / her income is near nil. Hence the doctor is left to ensure his / her own income, with or without patients. Our society will preach doctors a lot of pompous lessons of ethics and compassion, but won’t feed the doctors family if he is in financial trouble due to all the good and free work he does. To completely eliminate “backdoor incomes”, the only way is that the doctor’s fees will shoot up.
  15. Over-smart Attention seekers: This community of doctors will do anything to garner attention. They will make news for being cheapest, they will construct new theories of individual, private research and blabber about them on national / state channels, massage the egos of power, speak against their own colleagues just to get praise from society and media and so much more. They hunt celebrities and powerful to be seen with, always speak the language of “Sweet, Beautiful, Positive” and imply from their wisely framed speech that only they can understand compassion and patient’s feelings while other doctors don’t. These are the usual early birds on TV, who criticise their own professional colleagues whenever there is violence against doctors, preaching about communication, making the society feel that ‘bashing up of junior doctors’ is justified, just because they could not communicate well. They will go to any unscientific extent to fool the public to be in good books of the government and administration, and completely vanish when their profession is suffering. This attention-seeking community has done the worst harm to medicos and the reputation of our noble profession.
  16. Doctor’s Organisations: “………………………………………………………………………………………………………………………………………………………” .

To Be Continued
© Dr. Rajas Deshpande

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© Dr. Rajas Deshpande
“Sir, we are screwed. The Chief Minister and other ministers have closed all doors, they won’t respond. Our careers are in grave danger. Can you please help us?” I frantically spoke.
From the other end of the phone, the Don, Dr. Nitu Mandke answered: “See me at my home at 12 midnight”.
The Maharashtra state resident doctor’s agitation for dignity, national pay parity and better living conditions was on, and I was given the responsibility of coordinating and being the face. We had successfully established a multilevel network.
When students go on a strike anywhere in any field, it is almost always out of desperation, either for dignity or for rebellion against some sort of suppression by the system. Students never rebel for money or power. This raw student power is almost as mighty as the army, and although it falls prey to political misuse sometimes, it has tremendous capacity towards achieving intellectual evolution of the society. The government always treats any unrest as an offence to its ego, and uses everything at its disposal: CID, Police, Administration, Force, Threats, Caste Politics, Cheating and Legal torture to mow down student agitations. Students have no money, no experience and rare political or social backing, and must unite and stand up for themselves. © Dr. Rajas Deshpande

On the fourth day of the strike, a big politico from the ruling alliance came over to our office at Mumbai KEM. There was no telling between him and a mafia goon. The members of student’s central committee: Dr. Sanjay Singh, Dr. Dinesh Kabra, Dr. Narender Sheshadri, Dr. Pramod Giri, Dr. Nilesh Nikam, Dr. Kuldeep, Dr. Vishal Sawant, Dr. Noor, Dr. Shahid, and few others were with me. The politico did not have any scruples using an arrogant, raw and filthy language to threaten that if we do not stop and withdraw the strike, our careers and even life will be in danger. As he was from the ruling party and threatened us in presence of the police, there was nothing we could say.
There are angels everywhere. A senior police officer who was supposed to “keep a constant watch” upon us ‘student leaders’ was quite fatherly. He told us “Do what you must, but don’t declare. Dumb people cannot interpret silence. Stay away from any violence”. © Dr. Rajas Deshpande
Unknown calls kept threats alive. That is when a resident doctor suggested we meet the Don: Dr. Nitu Mandke, the famous heart surgeon who was known to be a fearless, straightforward celebrity doctor.

We went to his home, and waited, hosted by his extremely courteous family. He returned home past midnight. We briefed him the details. He asked a few questions to assess our determination and strength. He asked us to stay united and avoid any misbehaviour during the agitation. To our surprise, he picked up the cellphone and called the Chief Minister’s PA. The CM was fortunately available, and talked to Dr. Mandke. © Dr. Rajas Deshpande

After the call, Dr. Mandke told us: “CM has advised us to meet the Deputy CM tomorrow. Two of you come to Lilavati Hospital tomorrow at 2 PM. I will take you to the DyCM.”.
At Lilavati hospital, Dr. Mandke’s chamber was intimidatingly clean and posh, yet simple. He checked our applications for the CM and corrected them with his beautiful pen. His briefcase had every essential of writing stationary, the mark of a perfect man.

As we waited, I asked him cautiously: “Sir, shall we start?” He replied that he was waiting for someone to carry the bag on his table. I offered that I will carry it. He laughed his thunderous laugh, and looked at us as if we were small puppies. “ Deshpandyaa, that bag has two and a half crore rupees cash for construction of my hospital. A professional bodyguard will carry it. People kill for that. Do you want to carry it?”. I shut up.

In his big car, for the 45 minutes that his bodyguard drove us to the DyCM, I asked Dr. Nitu Mandke questions about what was going through his mind when he was actually operating the Shiv Sena Supremo Mr. Balasaheb Thackeray. Such an enormous pressure it must have been!
“Oh yes, it was stressful. But he is a gentleman, and he had assured my safety. His word is enough”.© Dr. Rajas Deshpande.

That’s when we told him how some politicos had threatened us recently. He laughed and replied something that has been tattooed upon my cortex permanently:
“Rajas, a doctor is a doctor and king of lives forever. Politicos come and go. Idiots misbehave with others when the have any post or power, in any field. You should not budge. It is pathetic to see doctors licking shoes of those in power, under various pretexts. It is up to you to maintain your dignity and pride. That is the true luxury, everyone cannot afford it. So long as you do the right thing, fear nothing. The few crores in that bag is nothing compared to how I feel about myself”.

We entered the VIP zone and bungalow. His car was not stopped anywhere. The DyCM offered us tea, and gave us a patient listening.
“These junior doctors and students are my boys, our own boys, they will look after the health of our people tomorrow. You must help them” Dr. Mandke insisted. The DyCM assured he will. The spell was broken, talks resumed.
Many twists and turns later, one of the most memorable strikes was called off.

A year later, I saw a white Lexus car in our KEM campus at Mumbai. Fond of cars and having never touched a Lexus, I went to see it from a close distance. Just as I tried to touch it, the driver’s window rolled down, and I heard “Deshpandyaa, open the door and come in. Do you like my new car?”
And I sat besides the King of proud men, one of the most proficient Cardiac Surgeons, Dr. Nitu Mandke, in his Lexus. The feeling is unforgettable, not only for the Lexus, but for his simplicity, love and affection for a ‘nobody’, a junior doctor like myself!

Needless to say, then onwards, I have guarded my dignity and pride as a doctor more than any other possession I have. That took away many opportunities and huge finances, still I am doing quite well by God’s grace, and Dr. Mandke’s blessings.
How I feel about myself is more precious than anything I can earn. The luxury of pride is mine.
© Dr. Rajas Deshpande

Dedicated to all students, resident doctors, proud people in every field, student unions and their apolitical fearless leaders.
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The Dictators in Hospital © Dr. Rajas Deshpande

“Let my father die. It’s ok. I will not take him anywhere. I don’t want anyone else to treat him” said the 60 year old son loudly. His old father who could listen and understand the conversation, but could not speak or move due to a paralysis, just closed eyes. Tears emerged from the corners of those closed eyes.

Like most doctors nowadays I have learned to master personal opinions and emotional responses, especially with ill-behaved patients, but this was beyond me. Not because he had shouted at me, but because he had just stabbed his father’s heart. Loudly, so that the patient could hear, I said “I think your father should feel better soon, let us see what we can do”. Then I gestured the angry son to see me out of the room. Two other men accompanying him came out and towered upon me.

About five days prior, this son had come to me with his father’s reports. The patient was admitted at a rural hospital. He had severely compromised heart function and his heart rhythm was abnormal. This caused formation of many blood clots in the heart, which went to the brain blocking blood vessels. One such large blockage had caused paralysis and inability to speak. © Dr. Rajas Deshpande

I had asked the son not to shift the patient, as the treatment started by the rural physician was accurate, we had to just wait and watch. Still, they had brought the patient in an ambulance, travelling for over 4 hours. Naturally, the patient had worsened , becoming drowsy. His heart rhythm was dangerously worse. He was unable to swallow, there was a big risk of his saliva/ mouth secretions going to his windpipe blocking his breathing.

Whenever a patient has problems out of a specialist’s expertise area, it is mandatory that an opinion of the concerned specialty expert be obtained. I asked the best heart specialist I knew to see the patient, and also a small ENT test to see if we could initiate training for swallowing. Our physiotherapists were already working upon his hands and legs gently.

However, the son (a retired govt. officer from a very respectable post) and two others attending the patient created a big scene when my junior doctor visited the patient. They started shouting and cursing that by calling other specialists we were just “increasing the bills”, and that they did not want anyone else except me to see the patient, not even the junior doctors. © Dr. Rajas Deshpande

My assistant physician called me in panic and updated about this, asking me to immediately act to deescalate the situation. Although there were many patients waiting to be attended in OPD, I had gone to this patient’s room. I explained to them that the patient needs to be seen by a heart specialist too, as his heart condition was very delicate. I also offered them to choose any specialist or hospital they wanted, if they were unhappy here, but they could not waste time as the patient was critical. That’s when the son shouted that he would rather let his father die than be seen by any other specialist.

When they came out of the room, their body language and general disposition suggested aggression. I tried to politely reason with the son that any specialist cannot sit with the patient 24/7, that junior doctors and other specialists as required will have to be called in for the best care, but they declined. The efforts of our medical superintendent and best patient coordinator went in vain. © Dr. Rajas Deshpande

“We will not allow anyone except Dr. Deshpande in the room. Our patient must get better” the son said loudly.

“I will see him till he is under my care, but I cannot guarantee any outcomes” I told them. “Let’s see” he said. He did sign the document informing about criticality of the patient.

No doctor should treat patient under pressure, duress or threat in the interest of the patient. I went to our medical director and requested that the patient be transferred under some other specialist. The hospital offered them freedom to choose, but the relatives declined. “We have come here for Dr. Deshpande, he will have to treat the patient alone” the son said. The hospital decided to take a call next day after a meeting.

That evening as I finished the OPD, I wondered how the patient was. However much angry I may have been with the relatives, the patient was more important than my anger, pride or anything else. I went to their room and checked the patient. He opened eyes and smiled. I asked him his name, and he replied in a husky tone. He was speaking now!!

The next day again, the relatives refused to transfer the patient under someone else, and I kept the treatment on. The trustless atmosphere was quite volatile, and if something had gone wrong, things would have taken an ugly turn. In the next three days, the patient spoke well, and even accepted some sips of water. His hand and leg started moving too.

“Can we take him home now?” the relative asked on the fourth day.

Happy for many reasons, but mainly the fact that the patient had improved, I discharged the patient. I had learnt my lessons. © Dr. Rajas Deshpande

Adamant, unreasonable and illogical demands by patient’s relatives jeopardising the patient’s life is a huge medical problem in India. Illiteracy, political interference, goonda culture and media support make such horror stories a routine reality. The law still expects the best patience and non-reacting approach of medical personnel, with the onus of saving lives still upon them under this pressure. Innumerable instances of harassment and humiliation of nursing staff, especially women go unreported. Relatives, especially politically connected, behave like dictators in any hospital, threatening one and all. Unless this culture ends and doctors are at a freedom to do their best for every patient, medical care in India will always remain inaccurate, incomplete and purely financially guided rather than scientific or even legal. Doctors can actually file a complaint or take legal action in such cases, but they are too many, and no doctor has time for such legal courses. In the best interest of our patients’ lives we go on forgiving and tolerating such abuse. Because neither law nor administration wants to correct the causative factors effectively.

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

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Robodoc

© Dr. Rajas Deshpande

“The doctor wasn’t even replying. He didn’t answer my questions” the patient, an angry lady, told me about one of my colleagues. The patient’s husband sat besides her, expressionless.

I reviewed her case in detail. She had had varying complaints for over four years, mostly severe pain at various points on her body. When a patient has symptoms (complaints) grossly disproportionate to the signs (doctor’s findings), there always is a suspicion of ‘exaggeration’ or ‘lying’. This can happen involuntarily due to stress, depression or anxiety, or voluntarily usually for seeking attention. She had seen many specialists, and had received strong doses of almost all types of pain killers and other pain control medicines, still her response after every course was ‘zero relief’. That was definitely suspicious. I looked at her husband. He appeared tired and aloof, reluctant to participate in any discussion. I had to make him talk.

“Is she stressed? Have you noticed any change in her personality?” I asked them the question that usually opens the dreaded can of worms.

“I am fed up, doctor” said the husband, “She needs continuous attention. Since our marriage four years ago there’s never been a month when we did not visit a hospital. All doctors tell her to go to a psychiatrist, but she refuses. The moment I return from office she starts complaining about her health. I don’t know what to do now, I feel I am better out of my own home” he avoided looking at her.© Dr. Rajas Deshpande.

His wife started crying, and in a shrill voice, shouted at me “Why are you speaking with him, doc? I am your patient, speak to me. No one believes me. I am suffering so much!”

I assured her that I was going to help her sort out the issue. Once she calmed down, I was able to explain to her the way stress affects human mind and body, and that it was possible to get well soon. I told her that being stressed was not a “psychiatric illness” but an overworked, burdened state of mind that needs attention, and that it can often be cured by speaking with the right person. She asked me many questions. As a special case, I made an effort to reply to each one of them, even the irrelevant ones, sometimes repeatedly. She agreed to visit an excellent counsellor colleague of mine. She drastically improved in a month after the counsellor worked upon her. However, she came back with new complaints within two months. She visited me twice more, and each time cried a lot, then when I pacified her, asked the same long list of questions mixed with new ones.

My sympathy and compassion started waning. I have promised myself never to be rude to any patient ever, and I religiously follow that. Yet my patience was wavering now.

The more compassionate, patient, sympathetic a doctor becomes towards the patient and their family, the more it is taken for granted and misused. The doctor is then expected to be an unending source of “psychological support”, mentoring and motivating, and a punching bag or a cry-to teddy bear. While in a healthy doctor-patient relationship this compassionate attitude is natural and welcome, many doctors do not know when it starts growing upon them and stressing them out. It is not easy to listen to a continuous flow of medical symptomatology especially wrapped in negative emotions. While positive outcomes do bring back life into a doctor’s motivation to do better and more, this expectation to be a listener of all sorrows until the storyteller is satisfied is unnatural and impractical. It tells upon the doctor’s health. This is now happening in almost all specialties, and wise doctors are learning to separate patients into “whimpering, chronically-dissatisfied-with-everything storytellers” versus patients with genuine medical, surgical and psychiatric issues. © Dr. Rajas Deshpande.

To concentrate upon what can be corrected, to treat what is possible should be the right priority, and here’s where a doctor’s compassion, sympathy and patience are best employed. To expect a doctor to resolve issues like ‘Swabhav’ (inherent nature) of a human being is wrong. A doctor also cannot solve the root causes of stress like poverty, unemployment, interpersonal incompatibility, overambitious, over-expectant personality or attention seeking. Many patients and families expect the doctor to resolve ‘every minor issue’ related to ageing, refusing to accept that resuming complete normalcy of health is impossible after a certain age, especially with some medical conditions. Doctors can guide patients, but cannot accompany the patient and family to fine tune every minor issue.© Dr. Rajas Deshpande.

Few paranoid, suspicious, accusative, aggressive patients and the types mentioned above have now made it necessary for the doctor to be extremely aware and alert, cautious, and to some extent emotionally aloof from the patient at least in the initial phase. Every word has to be spoken with caution. This “Robotic Doctor” or “Robodoc” is actually becoming a sad reality in the Western world where every medical consultation is considered a potential chance of litigation. A careful doctor avoids getting trapped into emotional exploitation. While this may upset some patients, much of the educated class is still happy with a proper professional consultation, diagnosis and treatment rather than only a compassionate sweet talk. Given the Indian scenario where patients are driven emotionally rather than scientifically especially in the illiterate and financially challenged echelons, a doctor needs to be better equipped for avoiding misuse of his / her compassion and sympathy, as it also converts readily into a permanent source of rewardless stress. This is unhealthy for doctors.

This is one reason ‘Robodocs’ are on a rise. A sad truth about an essential evolution in the medical profession across the world. The only thing that can change this is individualising patient care.

© Dr. Rajas Deshpande

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The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

False reviews and online beratings against doctors and hospitals have become a reality. However much a doctor goes out of the way to do the best for his/ her patient, following are the reasons why negative reviews are still uploaded, some of them ridiculous:

1. Denial of false certification.

2. Recording truth on paper like addiction (smoking, alcohol, ghutka, sleep medicines etc.).

3. Mentioning preexisting illnesses which the patient / family had hidden from the insurance companies.

4. Denial to falsify diagnosis, treatment and inflating bills to claim medical insurance benefits.

5. Denial to give concessions in standard billing, consultation, visit fees.

6. Advising necessary investigations.

7. Charging for follow up visits (different doctors, specialties and hospitals have different policies, all are usually mentioned in the information prior to consultation. All follow-ups are not same). © Dr. Rajas Deshpande.

8.. Waiting time: This is the saddest in India. The standard waiting times for specialists all over the world range from 30-90 minutes, sometimes longer, but it is only the Indian patients who convert this into a complaint. Sometimes earlier patients may have taken more time, asked more questions, sometimes patients cry when a sad diagnosis is conveyed, one cannot ask them to leave the room, there are incessant calls for emergencies etc. . The same traffic and weather conditions affect a doctor’s schedule too, but some are unforgiving. The fact that Indian doctors are available on usually the same day or mostly a week in spite of a heavy workload means nothing to our people, even those who have visited the Western world and witnessed that it takes months to years to get a specialist’s appointment there.

9. Behaviour of the doctor: Agreed that some doctors are indeed rude, some are in a hurry, and that is wrong. But usually doctors develop a lot of patience as they mature, dealing with all sorts of negativity continuously. Sometimes patients do offend doctors by asking illogical questions repeatedly, by challenging every word that the doctor says, or by making illogical demands. These demands include repeating long explanations about the diagnosis and treatment, requests to speak on phone with a distant relative to re-explain everything because they are too busy to come over, asking questions like “Are these medicines necessary?” etc. © Dr. Rajas Deshpande.

10. Unfair, illogical statements “I cannot tolerate any allopathic medicine” rules this section. What do you expect a physician to do?

11. Unfair, unrealistic expectations: Every drug has side effects, including vitamins, and these side effects are NOT the doctor’s fault. The doctor can alert the patient about common side effects, but cannot explain all side effects of every medicine, as it is impractical. Secondly, while some medicines act within seconds, some take effect over weeks to months. Those without patience who expect relief within few hours / one day usually upload angry reviews about both “no effect” and side effect” commonly.

12. Declining demands for admission. Investigations and OPD treatments are not covered by most insurance companies, so some patients demand admission even when not indicated. When refused, even if the patient was cured, the doctor still gets a negative review.

13. Google masters: Some patients bring a lot of irrelevant questions and conceptually wrong use of medical terms to the doctor’s table, and however politely one declines to waste time over such, a negative review is almost guaranteed. © Dr. Rajas Deshpande.

14. Habitual negative reviewers: I once found a negative review of a patient who had actually responded well to treatment and was cured. He had complained about having to pay for a follow up visit after few weeks. A small google search revealed that he had uploaded many reviews from those about railway stations to collector’s office, from autorickshaws to five star hotels, almost all negative. Unhappy man!

12. Professional Competitors- this is a new reality: doctors hiring agencies to boost their positive reviews and add negative reviews to their competition. The simple fact check of how many positive reviews over how much time reveals the truth.

Some negative reviews are indeed genuine, I have had them myself, and called and apologised to the patient, clarified my stand too. However when they were malicious, I have informed the concerned site manager and also posted a reply about reality.

How to know?

A negative review must have a legitimate name of the person writing it, and details of date and time of the visit. That way the doctor can also confirm whether it is genuine and help resolve it. A nameless review is always questionable, good or bad.

In a recent news, a National restaurant association has decided to sue people who upload negative reviews about food: just because they want more or free, just because of their mindset is negative, just because they are insatiable. Even IMA should consider suing people who upload wrong, defamatory, spiteful reviews about doctors. Even the ‘hired good reviews’ by doctors should be discouraged.

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

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The Beautiful Secret

©️Dr. Rajas Deshpande

“I found her outside the public toilets near sassoon hospital” the lady said almost as a whisper after her daughter left the room. “She does not know. Nobody knows. Please don’t tell her ever”.

That 15 year old girl Teju was brought to me over 10 years ago, with uncontrolled fits. Not all fits / seizures are convulsions, there are many different types. Teju would suddenly behave abnormally without knowing it for a few minutes and then start crying. Her studies were affected as she had such episodes many times a day. She had been to some excellent doctors, but as she did not tolerate the medicines she had stopped them and refused to go to a doctor. Her mother Latha had somehow convinced her to meet a neurologist only once, so they were here.

Latha was a single, middle aged lady, who worked at a few homes all through the day mostly as a cook. Her husband had died long ago, and she barely managed to maintain her livelihood while living with Teju in a chawl. She narrated Teju’s history to me, but when I asked about parents having any fits or other neurological illness, Latha winked at me and said “No, I am okay, even her father was okay”. Then she asked Teju to get her a bottle of water from the canteen, and just as Teju closed the door behind herself, stunned me with her words: “I found Teju outside the public lavatory near sassoon hospital . She does not know. Nobody knows. Please don’t tell her ever”.

Then she explained in a hurry: “Doctor, you are like a brother, I will not lie to you. I had run away to marry my husband, but he was an alcoholic. He died in a road accident. I had no one left in life, and wanted to die myself. One night I was returning home from my job, and went to the public toilet on the way. There in a large heap of waste I saw this girl, only a few weeks old, almost dead. I took her to a doctor, told she was my sister’s daughter, and got her treated. Then I could not think of letting her go, I had found my purpose in life. I am a good cook and get by with salary from cooking at over 5 homes now. I want her to study well, but this epilepsy has been our curse now. I wish I was rich so I could treat her well”.

That last sentence hurt me. One, she was rich. Two, she thought good treatment needs one to be rich.

Teju had reentered, so we changed topic. I explained Teju her diagnosis in medical, scientific terms, and the reasons why this illness happens, how we can control it with the right medicines, and how her quality of life will be far better if her fits were controlled. “You will be able to look after yourself and even your mom well in the future if you are self sufficient” I used the trump card. She agreed to take treatment.

“Secondly, never worry about fees. You are a free case now onwards. You can even get discounted medicines at some pharmacies”. I told them addresses. Latha hesitated: “Doctor, we will pay, we don’t want to take advantage. We don’t want you to hush up because we don’t pay”. Their concern was genuine, and I assured them that I will do my best for them. No good doctor will turn away a treatable patient for want of money, I know many who treat poor patients free, unfortunately it never comes on record.

That was long ago. We were able to control Teju’s fits in a few weeks, and bring her drugs to a single dose of medicine. She followed up every six months regularly, each time with her mother. She gew up well, and always topped her class.

Only last month, she came alone.

“Doctor, I have a good news. I have been selected by a software giant in the USA. They have offered me a gorgeous salary too. I am leaving in a week’s time. I have come to tell you two things: first, please take care of my mother for a year, I am planning to take her with me to USA after that. Secondly, I can now pay the fees for both myself and my mom. I am rich now! So please tell your receptionist to make a bill for all my consultations till now.”

I laughed and congratulated her. “Well. I have promised your mom something, I will sort out about the fees issue later with her. As for her medical care, don’t worry I am here. I am glad you are taking her with you, many can’t”.

“Oh never! I can’t dream of leaving mom alone here. She has grown me up alone after my dad died. I know how hard she has worked for her daughter” shesaid, with wet eyes.

I had an emotional moment, a sudden urge to tell Teju the truth. But I refrained. This indeed was the truth now. Latha was Teju’s mom, and I had no right to change that. I regained my composure.

When she touched my feet, she asked “Do you want anything from the USA doc?”

“Thank you, I have everything I want with God’s grace” I told her the truth. Indeed, He had given me the ability to change lives positively, to contribute to humanity in innumerable ways, to help people live better lives, nay – the best lives they could. What more could I ask for?

©️Dr. Rajas Deshpande

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True Story, names changed.

A big salute to this extraordinary benchmark of values in medical profession.

On 4th August due to rain havoc and release of dam waters there was unprecedented flooding in some areas of Pune. Unfortunately this flooded the new Jupiter hospital in Baner, jeopardising the lives of a hundred patients including critical, and even a tribal baby who had had a heart transplant. Within minutes the hospital authorities reacted with an efficiency comparable only to a military task force. The staff, doctors and nurses worked in coordination to shift every patient to other hospitals in Pune, other hospitals too graciously accommodated them on an emergency basis.

It is extraordinary that Jupiter Hospital not only arranged for a safe transfer of every patient, they sent doctors and nurses with each patient to help them settle in another hospital.

Every bill for every shifted patient till their discharge from other hospitals was paid by Jupiter hospital, not a single rupee had to be paid by the patient. The entire staff and doctors stood by this effort, some offered their salaries of next six months to help this task. The administration very politely declined to accept this, and continued to care for each of their doctors and staff even when the hospital had to be shut down for nearly a week.

As the hospital reopens completely recovered from the damage caused by the calamity, I salute this extraordinary phenomenon which should be hailed by every person with their heart in the right place.

Congratulations Dr. Ajay and Dr. Ankit Thakkar for setting this fabulous example of humanity.

The Euthanasia Named NMC

© Dr. Rajas Deshpande

Sweet Poison, Gorgeous Vamp, Philanthropist Criminal or NMC. All of these have one thing in common: the taste, the appearance is deceptive.

Just a while ago, doctors had complete autonomy and freedom to elect the best to the medical councils. They failed. Doctors had chances to unite and rectify glaring obvious malpractices in their own profession. They failed. Doctors had a freedom to pressurise elected medical council members to enforce ethics and discipline in Indian medicine, to arrest corruption. They failed. © Dr. Rajas Deshpande.

The parliamentary standing committee said something like “MCI looked only after doctor’s interests, not that of public, it is necessary to reduce the monopoly of doctors, so there should be diverse stakeholders at the helm”. The fact was that MCI looked only after its own interests, not even those of the real doctors of India: the thousands who were shouldering the actual healthcare burden especially in govt hospitals and rural areas, underpaid and unprotected. Malpractices became rampant. The general social jealousy about doctors which was earlier suppressed by respect converted into open anger and fuelled a paranoia that did not spare the best of the medical practitioners. For the sins of few, majority suffered. Patients too suffered at all levels. Govt medical services were always pathetic (and will remain so even after NMC), and there was no reign over the corporates who dominated and dictated the scene. Competition and petty egos destroyed any chances of any good unity among doctors. There could not be a deeper nadir for the profession. © Dr. Rajas Deshpande.

That fathered the NMC. Doctors will need to unite now like never before if they want to change this “Law”. Laws can be changed. But is it necessary in this case? Decide for yourself.

1. The ultimate, complete control of this “Autonomous” NMC is is in the hands of the central government. Majority members are govt. officials, a minority are to be chosen by medical professionals, and in every case, all that the central govt. decides is going to be a binding upon the NMC. That is like cutting off the wings of a bird and naming it “Independent and Free”. NMC, its advisory committee search committee or its four component boards will all be dominated by govt.’s chairs. Central Govt will also decide about the funding and salaries of the NMC members and its Chairman. We all know who sits in the top chairs of govt. institutes and how many among them can speak against the govt. So tomorrow if the govt wants to make ANY decision about ANYTHING that governs Indian Doctors, it can. Who will stop them if wrong? Such is the control of Central Govt. over this NMC, that if a doctor is unhappy about some decision of state medical council, he can go to NMC, and if unhappy about NMC’s decision, he will have to appeal to….? Courts of law? No. Something higher: the central govt!! So every medical practitioner’s career is ultimately in the hands of the central govt. Better join the party. Or quit medicine.

2. The entrance examinations are more simplified. All undergraduate examinations will be through NEET. All who have completed undergraduate course (MBBS curriculum) will appear for the Final MBBS exam which will also be common National exam (NEXT) for Medical Licence and PG admissions. Due to legal status of institutes like AIIMS, PGI, etc., they will conduct a separate PG entrance exam. Although this appears simplified, given the history of corruption (at almost all levels) in such exams and delays that waste millions of youth-years, one is worried about an undercurrent ‘sale’ of PG seats. But wait, not everyone must pass the licensing exam. You can entirely skip the difficult MBBS course, do something else, and bridge over in 6 months, without having to pass the licensing exams. That’s the third bullet.

3. Some AYUSH doctors are better than some MBBS doctors. Many who can not get into MBBS in spite of merit opt for other streams, with a hope to become a good doctor. They are actually contributing a lot to our healthcare, many of them know their limitations. One cannot object to their wish to practice allopathy if they want to study and upgrade themselves, the only objection is to exempt them from the common licensing exams. That will be very unfair to our society, most of whom will never know whether the doctor treating them has adequate experience, qualification and wisdom.

A newly passed out lawyer cannot do a “Six Month Bridge Course” to become a High Court Judge. A new recruit in Police cannot become an Inspector though a “Six Month Bridge Course”. A Municipal Councillor / Nagarsewak cannot “Bridge Course” himself into a Health Minister or Prime Minister. One needs to qualify though a common mandatory process. After MBBS, one cannot do a “bridge course” to become an MD that requires three years of intense responsibility handling, studying, treating patients under supervision and obtaining a deep insight into that subject. It is not possible in six months even for an allopath. Likewise, if an AYUSH doctor must practice allopathy, they must go through the necessary training (two to three years) and more importantly qualify the same common licensing exam before they practice the complicated allopathy.

AYUSH is an excellent idea, but it is immature as of now.

© Dr. Rajas Deshpande

4. The Doctor:Patient ratio in India is misquoted. Due to poor payments and infrastructures, very few doctors stay either in rural areas or govt. services, and the whole equation is skewed. The very purpose of AYUSH was to bring in more medical personnel, but that would work if these (3.5 lacs) “bridge” course doctors honoured the opportunity and worked only where there was a scarcity of doctors (urban and rural). What is more likely is that these additional doctors will also join the existing urban trend. Who can blame them for wanting a better life?

5. The newer policies of “more data, more paperwork, more record keeping, tighter control” over doctors will only result in private practitioners becoming more paranoid, giving up all the voluntary charity that they did every day, spending more time per case: and that will reduce numbers and spike fees. I can foresee most private practitioners closing down clinics. More rules and paperwork mean more corruption and exploitation in our country. This will turn into higher cost per consultation. Private healthcare will be out of reach for the poor. The good doctor will no more sit in his own clinic, he will turn to a safer corporate hospital. (Is that the aim?).

© Dr. Rajas Deshpande

6. The NMC bill entirely skips any word about regulating the large private healthcare sector. It does not have any provisions to protect new and good doctors from the tyranny and forces of corporate expectations. Some private hospitals have excellent policies and ethics, some corporates are very doctor and patient-friendly, but many remain to be corrected. There is no authority to the NMC over such hospitals.

7. There is no mention about improving staff and facilities at govt. hospitals, about any rules that ensure the best free healthcare for millions of poor patients in India. The ground reality that many patients suffer and die due to lack of staff, medicines, technology, tests and surgeries at government hospitals finds no mention in the reports of the Parliamentary committees that suggested the NMC. They did not mention the pathetic, unsafe and inhuman conditions in which Indian medical students and resident doctors live and work. They did not mention who will be responsible if a patient dies in a govt hospital due to lack of facilities or medicines. They appear to be more concerned about the price control of 40 percent seats in private medical colleges.

It is sad that in spite of many doctors in and around the central government, the medical field’s autonomy died with this bill. Shall we call it Euthanasia or “Physician assisted death” of the autonomy of medical profession? © Dr. Rajas Deshpande. In the era of the MCI, doctors were orphans, now in the era of NMC, they have become slaves.

The corrections in this bill will have to be put forth and pursued by a totally unified doctor’s organisation. “Painkiller Agitations” will not work. We must ask for complete release of the NMC from the cages of central government. Like in the UK, Indian NMC should be made up of 50% Senior Doctors representing all states and specialties, and the remaining 50% can be selected by the patient organisations: Judges, Media Stalwarts, Journalists, Artists, Ministers and Eminent Social Personalities. We must ask for transparency and fool-proofing of all medical entrance exams. We must ask for the right education, experience and licensing of AYUSH doctors, and welcome them once they qualify.

This article is written with my heart which bleeds for my profession and my patient alike. Bharat Maata Ki Jay!

© Dr. Rajas Deshpande

PS: Thank you Dr. Avinash Deshpande, Aurangabad, for some valuable inputs. If there are any technical mistakes, please let me know so I can correct.

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The Mathematics Of Kindness

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© Dr. Rajas Deshpande

“Are you coming, doctor, or shall we file a complaint? We will go to the police if you don’t come in an hour”.

It was about 12 noon on a Sunday. My sister and her family were visiting for three days, this would be our only lunch together in this year. All other days I am in the hospital at the lunch hour.

A teenager was admitted for last two days with repeated alleged episodes of fainting with unconsciousness. His friends and family were all at the hospital, calling incessantly from different numbers. They were given my cell number by a colleague as he thought it was an emergency. I had seen the patient four times in last two days, rushing from the OPD as there were alarming calls. We had done all the necessary tests and found nothing wrong with the kid, we had concluded that he was malingering / faking these episodes. A neurologist has many tricks to unmask the truth. We had explained the facts to his family, a psychiatrist had confirmed this, and scheduled a meeting with the family on Monday. Till then we had added anti-anxiety pills and told the family to be patient. All the vital parameters were normal. I had explained the family to be patient.

My boss called, he was frustrated too. “Ja ke dekh le ek bar (Go and see him once). Some minister just called for him” he said.

Excusing myself from the lunch, I reached hospital. The teenager’s girlfriend was standing in panic by his side, crying while he was ‘unconscious’. The brother and friends raised their voices: “Why is this happening, doctor, why don’t you do something? Why is he not responding to the treatment? It is three days now. He is suffering so much”.

I am trained as a doctor to tolerate anger, frustration, anxiety, stupidity, bitterness or accusations, but I refuse to tolerate drama.

“I have explained to you many times. This is not real unconsciousness. A psychiatrist will have a meeting with your family tomorrow, till then there’s nothing more we can do”.

“What if he dies? What if you are wrong?” shouted the relative. I did not have an answer. I left the ward after messaging my boss, also asking him to transfer the case under someone else. The next day my psychiatrist friend called me. The teenager’s girlfriend was from another religion, parents on both sides had opposed their marriage, and this illness was their “brilliant solution” to get the parents to change their minds and agree. Cheap drama!

There’s no mathematics to kindness, we have all been taught. Do good, be compassionate and don’t expect any returns. People take advantage, but that is Their nature, you be yourself, kind and compassionate.

I was once returning from my Goa visit, there were long queues of frustrated people. Two apparently rich Indian tourists walked in, typically dressed for a Goan vacay. They saw the long lines, changed their faces, and rushed to the front of the line. One of these approached a foreigner in the line: “Excuse me, we will miss the flight… we were stuck in traffic.. my sister is sick, I must reach Delhi in time”. The foreigner, knowing that these were blatant lies, still allowed him to go ahead of himself. Kindness is almost a compulsion. Once on the other side of security, these “line-jumping liars” had the obvious expression upon their face: “Ullu banaya tum sabko (We made a fool of y’all)”.

At the hospital entrance, I often meet a paraparetic man in his scooter for the disabled. He usually blocks the hospital entrance with his three-wheeler scooter parked there while he talks at leisure with his friends. If anyone honks, they all play this “Can’t you see he is disabled? How rude!” card, intended to make others feel guilty. Even when it is an ambulance or a doctor’s vehicle, he will intentionally slowly move from the spot.

Every doctor, almost every day, meets people who blatantly lie: to bypass waiting lines, to ‘finish off with parent’s health issues over the weekend’, or to get concesions, free treatment. Some lie to exploit kindness and compassion, some to exploit financially. There are no guidelines defining an emergency and the charges for such “pseudo emergencies”. A doctor on duty must always resopnd to an emergency, but if off duty, he should be able to refuse cases on a holiday. All government hospitals have a 24/7 emergency department, the patient can be taken there.

Recently heard that an Indian lawyer charged in crores to an Indian client stuck on an European airport for a legal advice in an emergency. There were no cries about compassion, kindness or even patriotism. What should a doctor charge for a pseudo-emergency, especially when a precious holiday is wasted?

When I discharged this case, they asked me when to follow up. I replied without hesitation: “Never with me”.

© Dr. Rajas Deshpande

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