Category Archives: medical corruption

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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The Remedy of Trust

© Dr. Rajas Deshpande

I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.

I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande

As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!

As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.

I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande

The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!

The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.

She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande

Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and reassured her that it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and that her husband appeared out of danger at that moment.

She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.

Confused for a moment, the old man stared first at his wife, then at me.

He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.

The old couple, the age of my parents, was saying Namaskar to me and touching my feet, although I was many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.

I switched off my cellphone.© Dr. Rajas Deshpande

I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying my services’ would actually be my interest or aim. This was.

I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in this case”.© Dr. Rajas Deshpande

When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.

A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.

© Dr. Rajas Deshpande

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That Order To “Stop Saving Life”..

(c) Dr. Rajas Deshpande

“Arrest! Sir… Code Blue!” the nurse shouted. The casualty was full, all eight beds had serious patients, and their relatives waited near them. Every second matters.

“Everyone out” my co-intern shouted. Some moved out, some stayed. Two other interns were already attending similar patients, two of us ran to the arrested patient. The nurse had already started the chest massage. I gave patient the position for inserting the breathing tube, as my co-intern Dr. Ajoy took over the cardiac massage. The senior medical officer, Dr. Hazare, experienced with a lot of medical wisdom, stood near the bed. He calmly gave orders for the last-attempt medicines in such emergencies.

The chest massage to save lives is rather forceful, its force has to reach the heart. The chest wall has to be pumped down 2-2.5 inches with every compression, and this has to be real fast: over 100 times a minute. It looks very traumatic, but it is useless if not done exactly like this. It is quite a disturbing scene for the relatives. The patient’s son kept on shouting “Don’t hurt him” loudly. The medical officer repeatedly asked him and the five relatives around the patient to leave. They refused.

The Medical Officer Dr. Hazare then asked us to stop the CPR. (c) Dr. Rajas Deshpande

We were baffled. How could one stop the life saving CPR?

The patient who had arrested was from a nearby slum, father of a local goon out on bail, like most goons in India. He (the patient) was in his late fifties, a chronic alcoholic and smoker, with severe liver damage. He’d had excess alcohol on the prior night. That morning, he had had a convulsion, and was brought to the casualty after many hours of delay . An arrogant, drunk, politically supported crowd posing as relatives accompanied him, a common nuisance in almost every Indian hospital.

We continued the CPR. Dr. Hazare went out.

After a direct injection of adrenaline into the heart through the chest, the patient’s heart restarted, and he started to gasp, making some movements. We quickly shifted him to the ICU. The proud feeling of saving a life gripped us. There was no time for celebration, but Dr. Ajoy kept whistling on the way for our midnight tea.

Later that night, Dr. Hazare called us. He was angry, yet calm and smiling, an ability that only the most evolved souls can have.

“Listen, we are in India. Most of the people around us are not only uneducated and ignorant, they are also quite violent and paranoid. Emotional dramas are considered a normalcy. There’s a tendency to shift the blame of delayed treatment and bad outcomes on to the doctors. You were risking your life. If the patient’s heart had not restarted, the relatives could have blamed you, even hurt you”.

“But Sir, they saw that we were desperately trying to save the patient’s life” I argued.

“YOU think so. They don’t know anything about the CPR. They refused to go out. You saw how arrogant they are. These things work only when the outcome is good. If the outcome is bad, the doctor is automatically held guilty. I told you, we are in India. People like to think that doctors are wrong, whatever you do. ” Dr. Hazare said. (c) Dr. Rajas Deshpande

We didn’t think he was right. Still, we respected him for his wisdom, so we just apologised and went on to deal with the casualty again. It was a busy night, still a very negative feeling about what Dr. Hazare had said kept shadowing my thoughts. How could such a senior doctor ask someone to stop CPR?

Dr. Ajoy went to his room at 5 AM and returned by 7 AM to relieve me. I went home at 7 AM, had a quick bath and breakfast, to return at 9 AM.

The casualty was all devastated, ruins were seen all around. Many doctors were rushing in and out. All beds were empty except one.

Dr. Ajoy was on that casualty bed, unconscious, intubated and with blood soaked bandages on his head. He had many cuts on his entire body. Our colleagues were trying to push intravenous fluids fast into his veins. Dr. Anirudh, another intern with us, told me even as he could not stop crying: “That patient we had resuscitated yesterday evening… he had another cardiac arrest in the ICU this morning… his relatives came down and attacked Ajoy. They said that the patient died because of the forceful CPR. They stabbed Ajay and hit his head with iron rods. Dr. Hazare came and tried to rescue Ajoy, they even attacked him. We were waiting for you. Do you have his parent’s contact?”.

In a state of shock, I could not speak. I reached out for my bag, got my diary and called Dr. Ajoy’s father in Calcutta.

“Why?” Dr. Ajoy’s shocked father asked when I told him Ajoy was attacked, injured and serious. How could the father of a thin built, cute, brilliant scholar ever understand that people could brutally attack his child for trying to save their loved one?

I had no answers. Dr. Hazare’s sentences kept ringing in my brain, I could not utter them. (c) Dr. Rajas Deshpande

Eventually, Dr. Ajoy recovered. He is now in the UK. His father came over last week, for a check-up. While leaving, he kept his gracious hand upon my head and said with immense love: “Save many lives beta, but take care of yourself first. I still cannot sleep well due to what happened”.

That night, I stared at the sky, and kept thinking: Actually, this is why no doctor ever sleeps well in India. Saving lives comes with the inherent risk of losing one’s own, and this happens only in our beloved motherland.

(c) Dr. Rajas Deshpande

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Religion? Caste? Race? Nationality?

Religion? Caste? Race? Nationality?
No, I cannot think about that.
A Bullet has shattered the skull, damaged half the brain of this young person of 22 years.
A surgeon has put together the pieces of skull, a fragment of metal is still seen deep inside the brain. This person has a whole future of decades to tackle with a severe disability. As doctors, we only think: what best can be done to repair the brain, how best to resettle the patient in their future life, how to help them overcome their disability.
”Shoot, Kill, Hunt, Enemy, Revenge” are not the words any true doctor in this world can ever like!
We can never think about the race, caste, religion or nationality of any human being. Because a Doctor is always above any sort of discrimination. © DR. RAJAS DESHPANDE
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Slaughtering The Precious

(c) Dr. Rajas Deshpande.

At the casualty door she started shouting at me even before I went in. “We don’t want any tests. We don’t want to admit him in any critical care unit. Keep him in the general ward you have, we are now financially exhausted. Give basic medicines only “. Mrs. Julie, the patient’s daughter, went on:”We have already signed palliative care form”.

“Let me see the patient first “ I said and went in.

The resident doctor had earlier told me that the patient, an old man, was conscious, speaking quite well, aware of his illness. He was intermittently getting unconscious for a few minutes. He had high grade fever. He had lung cancer, and a brain scan a few days prior had revealed that that he had a secondary in the brain too. He had just completed his chemotherapy. The resident doctor had already started medicine for fits just now.

As I examined him, the jovial Mr. Shaw smiled back and told me that he was feeling a little giddy and tired, otherwise he had no complaints. He could even stand and walk without support. His blood pressure was normal, but the heart rate was quite high due to the fever.

“I think you have probably developed seizures due to the secondary in brain. There seems to be some infection too, we will run some tests and start antibiotics” I told him.(c) Dr. Rajas Deshpande.

“When will I feel better, doctor?” He asked, “I want to be home and spend every possible day of my remaining time with my grandchildren. I want to also finish a book I am writing. I am told I have only a few months left. How much time do I have? Six months? Four atleast?” he asked, still smiling. Only doctors know what a smiling face with a crying heart actually looks like. “Every passing moment is extremely precious for me, doc! Please cure me fast” he said.

I assured him that if the tests showed nothing serious, he could go home once fever subsided, but the fits needed long term treatment. While we were having this talk he suddenly stiffened and his body developed jerky movements, then he became unconscious.

Ordering the emergency injections for fits, I told the casualty doctor to shift him to the critical care unit.

Coming out, I explained this to the angry daughter.

“Doc, we don’t want to treat him in any ICU. We also do not want any tests now. Please give him tablets instead of injections, we want to take him home as soon as his fever goes down” she replied.

This has become very common now, relatives of elderly people admitting them in hospitals, but refusing to do any tests, use injectable / costly medicines or shifting to critical care units. A doctor cannot refuse patients in such a condition, and it is an extremely painful, stressful situation to not be able to correctly investigate, treat a patient because relatives are unwilling. Ninety Nine percent of the times, money is the only reason. There are many charity, low cost and even good government hospitals, but the relatives also want the “show”of having admitted the patient at some posh hospital. Beyond a certain level, Private

hospitals cannot go on funding tests and treatments of hundreds of such patients even on a compassionate basis, because the poverty in India is never ending.

Compassion is the most abused entity in India.(c) Dr. Rajas Deshpande.

I told her that even if they had signed for palliative care, his current condition was treatable, his fever and fits caused him distress and could be treated, but she staunchly refused to let us send any tests. We started with oral medicines after a lot of deliberation, keeping fingers crossed that he responds. He did.

On the third day, Mr. Shaw walked out of the hospital with his patent smile.

Just next week, his daughter returned to the OPD: “Doc, dad passed away two days ago. After going home he had fever again, but we decided to manage him at home. Somehow he could not get through this time. I have come to get your signature on these bills from his last medicines, we want to get reimbursed”.

“Was he seen by a doctor at home?” I asked her.

“No doc, we gave him the same medicines that he was earlier given for fever. We also searched online and ordered them. But in a way we also feel he is now relieved of all his troubles” she said, hushing up the topic.

I signed the papers, a duty and an obligation.

In every hospital, every day, we see parents rushing, crying, selling everything they have, urging doctors to save their children on one side, and grown up children urging doctors to hasten up the deaths of their parents on the other . Many sweet, politically correct and legally blurred terms are now available for masking these murders.

A patient with a terminal illness may himself sign for “non-aggressive / palliative” care (meaning pain relief, superficial / minor treatment without aggressive effort to save or maintain life), or if the patient is not in a good mental condition to sign such a consent, the relatives may sign so. However, in India where children mostly are responsible for the medical bills of the elderly, they flatly refuse to treat even treatable, reversible conditions citing “öld age” as a reason. Even in case of patients with terminal illness, to presume that someone is immediately unfit to live, or fit to die is like saying it is okay to terminate their life at someone else’s wish. This is cruel, unethical, immoral, and should stand supported in no courts of law.

However, these murders are a daily routine in India, and law has tied the hands of treating doctors and hospitals as one cannot investigate or treat a patient when the relatives haven’t given a consent. An evolution in the fraternity as well as in this society is necessary if a change is expected.(c) Dr. Rajas Deshpande.

Otherwise, when we all will eventually be old, however much we want to live on for a few more days, one day someone will decide that we don’t deserve to continue to live, without ever wanting to know what we wished.

(c) Dr. Rajas Deshpande

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Doctor Abuse: A Medical Specialty

© Dr. Rajas Deshpande

Using the doctor’s private cell / social media accounts for free consultation, second opinion and opinion about investigations. Stalking to send reports, messages whenever online. These are now getting on the nerves of many doctors. I have completely stopped replying to any medical messages on social media / whatsapp.

Relatives, family and friends seeking free medical consultations on holidays, weekends. Directly coming home for a free consultation on holidays (On one unfortunate Sunday morning, back when I was naïve, one neighbour with a Luxury car came home and discussed his old age problems for two hours, reviewed his wife’s reports, then keeping 100 rupees on my table, said “Actually in my childhood doctors would charge only two rupees for consultation, but now it has all become costly”). I have now completely stopped this, refusing politely to see anyone without appointment, except in a true medical emergency.

Expressing Anger, Bitterness, Distrust and Sarcasm towards the doctor for diagnosis (especially incurable), for advising surgery, admission or costlier treatment options (the rich are unhappy with costly medicines, the poor usually do not complain). © Dr. Rajas Deshpande. I have now started to explain in the second consult, after finalizing diagnosis, what to expect, what not to expect.

Expecting the doctor to replace the lost bonds in family because the children do not want to spend time or efforts for their parents (‘you tell him, you spend some time counseling him’). I have started to refer such patients to qualified counsellors.

Taking an advantage of compassion and kindness to save money (Cannot bring patient to hospital, patient is too old, I am too weak to travel, we are out of station etc.). A general rule is that one must be treated, especially in emergency, only after a thorough examination by a doctor. I am now refusing to be emotionally blackmailed.

Seeking free consultations: relatives, friends, classmates, staff, other doctors, watchmen, maids, neighbors, drivers: there’s an unending list who the doctors are expected to see free. Add to these political leaders, VVIPs, government officials, administrative staff etc. Sometimes the doctor voluntarily waives off charges as respect, and some of the above actually request to pay themselves, but most expect a free consultation and in fact argue about it. I have made my own rules about treating only the deserving poor free, and those who need it. I refer them to the right center for help.

Multiple free consultations. This is a paradox: that many who get free consults / treatments usually think it is “not correct or adequate”, take a paid consult somewhere, and then come back knowing that the best was already being done for them. Such patients, when they know t is free, come every week even if they are told to follow up after three months. I have now started specifyinfg that the free consultation in a non-emergency is only once in three months.

Many patients book multiple appointments on the same / consecutive days and then do not bother to cancel the unused slots. This results in heavy losses for the doctor. Some patients call multiple times to book appointments and finally do not turn up, never bothering to inform. I have started to make a list of such patients.

Lying. Many patients / relatives lie about why they did not follow up in time, why they did not take treatment, why they did not do the advised tests, about multiple treatments at the same time, about their condition being an emergency etc.. Many a times parents are abused by their children, and multiple lies are told about why basic care was being denied to the patient. The doctor is supposed to cover up and compensate for the lack of care and compassion at home. © Dr. Rajas Deshpande. I have decided not to cover-up, and to refer them to a family counsellor.

Unnecessary information: Many patients do a lot of unnecessary tests and expect the doctor to “just have a look” at those even when normal. Few understand that time is the most precious commodity for a doctor, (most efficient doctors run late because of unnecessary discussions) and when one seeks opinion, it should be a targeted exercise to resolve the immediate concern. For regular check-ups, one must prefer to visit their regular general practitioner. I have started to refuse to see tests I have not advised, if they are normal.

“Resolve all my life’s problems”: many patients, when they find the doctor caring and compassionate, expect him / her to resolve all the issues pertaining to their old age, relationship issues and spend a lot of time “listening to the sad stories” about their life, and their opinion / rants about them. While in some cases it is necessary to wholly understand the patient’s mind, this is primarily an issue to be addressed by a psychiatrist and a counsellor.

A patient in distress is often not in a position to understand the doctor’s expectations and the nitty-gritty of manners and etiquette, and while still being caring and compassionate, we doctors must learn to politely decline such abuse in the kindest words possible. Once educated, most patients follow the instructions well.

Happy Doctoring!

© Dr. Rajas Deshpande

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Hope-Milking: An Ugly Medical Curse

© Dr. Rajas Deshpande

Mrs. Patel sounded very happy, almost on the verge of shouting: “Dr. Deshpande, did you see the new video? Finally there is a cure for my husband’s condition. I have already booked tickets, we are travelling tomorrow”.

I had seen the video. I knew from experience that it would not help her husband much. Yet, the words in that video advertisement were framed so effectively, that even a low-brainer medic would be confused about the truth.

The effects are indeed magical, but not for the patient. By the time the hype of such viral videos dies down, thousands of patients have already bought the product, earning unprecedented fame and/ or funds to the makers of such videos. This has become an excellent tool for attracting patients under a false pretext.

There are many medical conditions which have no treatment or cure. This is saddening, and we doctors face the justified frustration of such patients and their relatives many times every day. We are also equally eager for cures. It is taxing and nerve-wrecking to hear patients vent the pain of the same issues repeatedly for years. But for the sake of the patient, we must listen, be patient, and keep reassuring them with compassion and sympathy. But we must never lie to them. © Dr. Rajas Deshpande

“Transfer the patient to our hospital, we will manage better” some doctors say, get the patient transferred under themselves, and after a lot of ‘costly surgery, treatment etc.” simply tell the relatives that it was all inevitable and unfortunate. Wrong assurances and milking the hopes of such critical patients is uncalled for, and to a great extent, unethical. Add the tags like “cheap, charity and low-cost” to healthcare, and such a trap is complete. © Dr. Rajas Deshpande

Many videos and articles claiming “dramatic relief, cure”, “new technology”, “diet therapies”, “herbal treatments”, “sexual weakness / ED”, “weight loss”, “sugar control”, “stem cell therapy in unindicated medical conditions” “hair growth” etc. circulate and become viral. Both educated and uneducated patients who hope for a better life fall pray to such hidden advertisements. Months or years later, they realize that their condition is the same or worse. Some develop adverse effects like damaged kidneys, liver or brain, and never realize that it was related to unscientific decisions from years ago.

This is medical pickpocketing.

The saddest part is this: many patients respond to any medicine or procedure / surgery (placebo effect) for a short while, and some with psychosomatic illnesses indeed feel a ‘dramatic relief’. Those who do not benefit seldom come forward. Such medical ads never show how many patients suffered side effects, how many did not respond, or what are the hidden costs. © Dr. Rajas Deshpande

It is sad that this “Hope-Milking” disease has spread rampantly among all streams, including allopathic / modern medicine. Some doctors now publish videos of their own personal discoveries, formulas, potions, without declaring contents, without scientific studies (or with mock/ manipulated scientific trials), as if there is no FDA, Medical Council, experts in respective fields or any such authority. There is no difference between such doctors and roadside herbal medicine quacks or different Babas / Maulas selling ‘magic medicines’ to a predominantly illiterate nation.

Besides being unethical, such practices falsely convey “I know better than all other experts in my field”. That is cheap! Medical councils, doctor’s bodies and IMA should strongly discourage such practices, from all genuine and other streams of medicine.

After a few weeks. Mrs. Patel followed up. “Dr. Rajas, I am sorry. We were carried away by the ad. Initially he felt better, we spent a lot of money, but now we realize it was too costly, it had a lot of side effects and it was not a permanent cure as advertised. We were happy with the earlier treatment”.

Just as I walked in the hospital lobby, I saw a large crowd in front of the television set. National news bulletin was on, dead soldiers and their crying families were being shown. Simultaneously running were the ads by different quacks. A lady was asking her son to jot down the number of a man who claimed to “completely cure all heart diseases with a single medicine”.

I prayed for the health of whoever her patient was, and walked ahead. I had a lot of genuine medical work to attend.

Written in the best interests of my beloved patients and profession.

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© Dr. Rajas Deshpande

PS: My dear patients, before falling pray to any “new dramatic medical treatment/ cure” traps or ads, please consult your regular doctor and confirm authenticity. You can also visit authentic medical sites like Medscape, Medline Plus, National Institute of Health (NIH), Mayo Clinic, UpToDate to know about the latest approved treatments for all medical conditions. Do not rely upon blogs, support groups, viral videos or personal/ individual sites for making treatment decisions. This can be very dangerous.

The Most Precious Jewels Upon Earth

© Dr. Rajas Deshpande

“Sir, next is our old free patient” my receptionist announced on the phone.

Divya, the smart young girl of 8 years jumped into my cabin, and grabbed her chair with an authority. Confidently looking at me, she questioned, “how are you today?”

Her parents, embarrassed and charmed at the same time with her sense of ease in this big hospital, facing a doctor, hesitantly stood behind her. I requested them to sit down and went through the routine questions.

“She is all good now, no fits since last two years. She has been regular in her school and has started studying well too” her father reported.

I examined her and wrote her a renewed prescription. I noticed the mother wiping tears.

“What happened?” I asked.

Quickly smiling, she just gestured with her head “nothing” and looked at her husband.

“Do we need any tests, Sir?” Her husband asked, “We will do whatever is required”. I could feel his palpitations. They were scared that I may tell them tests, and that would mean financial disaster.

He works as a pantry boy and can barely pay the home rent with his salary. His wife somehow makes ends meet, looking after this sweet daughter and a younger son.

At the age of five, Divya had had her first convulsion. Her parents had rushed her to the government hospital. They did not have the money required for Divya’s tests and medicines even at the government hospital. So they resorted to something that hurt them worst: they had to sell little Divya’s silver jewelry, which was the most precious thing in their house. Even that was not enough, so they borrowed money and started her treatment, her father worked extra hours.

That was about three years ago. Divya’s fits continued, but her parents did not give up. Their whole life had but one aim: to stop her fits. Even after being less educated, Divya’s parents decided to go with scientific treatment, ignoring all pressures to take her to different weird people including magic healers. They did not give up hope, their will power was their boon.

Two years ago, a doctor friend sent Divya to me. With some changes in prescription, her fits completely stopped, she has now become just another normal child.

“No tests are required. Please make sure that she is regular with the medicines” I told them.

As I wrote this, I got a little emotional myself, this was the first time I had heard of any parents having to sell their daughter’s jewelry for her treatment. On one side, I was proud that even after being surrounded by perpetual pits of poverty, this girl child’s parents did not skimp upon her treatment just because she was a girl child (this often happens), but on the other I felt anger and shame that my country still lacks a basic healthcare infrastructure that can offer free quality treatment to at least children.

Yet, this had taught me my lesson. Willpower and hope are the mightiest and most precious jewels upon earth, far tougher and far more beautiful than any diamonds. For there are many who own diamonds but have neither willpower nor hope.

Meeting this rich family today was joy enough, but a greater bliss was when the kiddo put her arm upon my shoulder with the same confidence. The world is indeed hers!

© Dr. Rajas Deshpande

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Doctor Arrested. Patient Died. Who’s Guilty?

(c) Dr. Rajas Deshpande

“Doctor arrested. Patient died due to a wrong surgery”.

The black headline was shining. There was a file photo of the accused doctor, and angry, crying relatives. Sad and angry, I read through the news that did not affect me directly, yet knowing that every patient who read that news will go further away from their doctor. The already delicate and dying bond will die a little more.

Is it enough to punish this doctor?

Who all is guilty here?

The parents who forced him to become a doctor because they couldn’t?

The corrupt educational boards which allowed leaking papers and increasing marks so the student could get a medical admission? (c) Dr. Rajas Deshpande

The politicians who made it possible for even the undeserving, low-aptitude students (which has nothing to do with one’s caste or religion: it’s more to do with money and power) to become doctors and play with patient’s lives?

The governments who allowed the “Medical Business” by establishment of substandard medical colleges owned by the rich and powerful, to sell medical degrees? The managements of such substandard institutes who chose the “low”quality teachers who agreed to work at low salaries and tolerate all humiliation? The teachers who didn’t care how their student was trained? (c) Dr. Rajas Deshpande

The medical councils which ignored the ‘temporary’arrangements made by such substandard institutes to just ‘Pass the Inspection’, never providing students with adequate education or experience?

The medical policy makers who made theoretical, mcq-type education more important than clinical training?

The offices of law which ignored the repeated applications and complaints of good students from such institutions about incompleteness of educational facilities?

The Universities that allow ‘manipulation’ of medical exam passing under influence of money or power?

Or the politics of allowing cross-specialty practice without adequate training, the ‘jump-over to any pathy’ decisions to please vote banks?

Or the corporate hospitals who prefer such “substandard” doctors because they can work at lowest payments? Aggressive and “market oriented” junior doctors are preferred by many commercial-headed hospitals over those with best academics and clinical knowledge. (c) Dr. Rajas Deshpande

It is indeed a reality that some doctors cannot speak a straight sentence, some cannot spell medicine names correctly, some treat even what is not their qualification skill, and some substitute knowledge with style, overconfidence and sweet talking. At various stages in their career, there are teachers who have tried to correct them, but in these unfortunate times of “pleasing one and all” including students, it is quite difficult to ‘mentally’ train a doctor to be good and perfect.

If only the doctor mentioned above is punished, leaving all others above without correction, then it will be a classic example of example of medical negligence and injustice. It will be like treating only the heart attack without treating the blood pressure and diabetes which cause that heart attack. We know the outcome in such cases.

(c) Dr. Rajas Deshpande

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