Category Archives: medical corruption

Take me for granted

©️Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

“Is your food more important than the patient?” asked a angry voice on the other end of the phone.

It was a Saturday night, about 11 PM, and I had already had a tough day. I had not had time for even lunch, my head was hurting already. I had known the patient for over five years, her husband wanted to “discuss something” urgently. I had requested him to call next day, honestly mentioning to him that I was on my way for dinner. That’s when he asked if food was more important than patient.

“No. Food is not important than the patient”, I said, “Please tell me.”

“Listen doc, today after dinner me and my wife had our usual walk in the society, when we met a neighbour who told us about a new herbal treatment for neurological patients. He said it worked like magic in paralysis cases and the cure was guaranteed. He had some extra bottles, but it is very costly. So we decided to call you and ask”.

“What is so urgent about it?”I asked.

“Not urgent, but we were both very excited and anxious, so we decided to call you and ask” He replied. I told him that that they were free to try anything they wanted, yet cautioned him to check the contents and then alone take any medicine.

I wasn’t angry.

The next morning, I had to visit a government office. There was a huge queue. By noon, as the queue extended, the officer got up and with a calm face went for his lunch, displaying a a sign “Lunch Hour”. I wasn’t angry.

©️Dr. Rajas Deshpande

I remembered the time when I had to visit a minister, a bigshot political leader for some issues about resident doctors. We had to repeatedly call for appointment, it was cancelled many times, then we were made to wait for hours, securitymen surrounded the elected representative, considered a public servant. Then at six he suddenly got up and left, quoting an urgent meeting. I wasn’t angry.

Because as a doctor I am perpetually alive to the fact that people take me for granted. That they will misuse compassion, avail of my private time for trivial reasons without feeling any guilt or compensating for it. That they will expect me to be sympathetic even with arrogant, abusive and blatant liars who treaten me with assault.

Because big ministers and political leaders who have a checkered past and disrepute of lying can openly make allegations that tarnishes the image of all doctors in the eyes of our “Election Elite Public”. Blanket allegations by many that accuse all doctors of indulging in malpractices and foreign tours or worse, ‘asking for women from pharma’ have become common.

Don’t these people know that thousands of most successful doctors in India are in fact women, and it is such a huge insult to those as well as the glorious careers of many thousand other medical professionals who live a life of an ideal doctor, who have trained millions of medical students successfully in that tradition?

©️Dr. Rajas Deshpande

More than half of those in the parliament must have been successfully delivered by a qualified doctor, and most of them must have had their children brought up/ treated by expert doctors. Most politicos must be under the treatment of some or other specialist, so that they can work well, still they have this habit of “Attention seeking” by trying to disgrace the whole profession of best qualified people of their own country.

What ingratitude!

The other day I also saw a video of some sermon in some village, making fun of doctors and specialists. The religious speaker, who could have easily qualified as a stand up comedian, and had no clue what a doctor does and why, was making cheap fun of doctors. What was more alarming was the way public was laughing and clapping, thousands of them! I wondered how many of them, their family members were treated by some doctor, and how many of them remembered it. I can understand and enjoy jokes and fun. But this was maliciously criticising an entire profession of highly educated people serving India 24/7, inspite of the hate and paranoia that surrounds them, that too by a person without any medical background or qualification! Many comedians have actually gone beyond “graceful” and “quality” comedy to cheapest low levels to criticise doctors. Hope they meet good doctors who avoid head traumas at least when their children are born!

©️Dr. Rajas Deshpande

You cannot and should not make fun of militarymen. That never means there cannot be anyone wrong in themilitary / army. But there’s a system to deal with that, it is not open for politicos, temporary ministers, and self proclaimed godmen / women / artists to criticise the military. The guilty must be punished, whether in any profession or service, and it should be done legally, and others should stop speaking about it. This should apply to the medical profession too. There indeed must be some doctors who are wrong, they must be dealt with, but we do not go out and blame everyone from other profession!

The most common allegation is about doctor’s handwriting. Well, if you have the guts and patience to listen to over 50 crying/ complaining people every day, while writing for them a “Scientific” list of medicines, which can save life or kill, without committing a single mistake, for decade after decade, then you are welcome for a handwriting challenge with doctors. Google the word “Scientific” and see how much of your speech is scientific before you speak abut doctors! For government hospitals, the daily patient number crosses 150 per doctor. Every prescription is a huge liability. If the chemist can read it and others cannot, who is illiterate?

©️Dr. Rajas Deshpande

I have seen the most artistic and best handwriting by doctors at all levels: students to specialists. Indeed, some doctors may have a bad handwriting, but in a country that has many illiterate leaders, some who never completed school or college, a society with one of the highest illiteracy rate in the world, it is such a paradox that they all have such a unity when laughing at doctors who write 40-200 pages every day, each page bringing back someone or other from suffering to relief, from death to life!

No amount of a leaders’ loud and chest thumping speech will ever save a patient from a heart attack or paralysis. No amount of comedy will take off the ventilator of a comatose patient in critical care unit. No poetry in beautiful handwriting will safely deliver a child. No political leader can stay awake in a casualty to treat a dying poor found injured on the road. All Doctors do this.

Still, I am not angry, because I have come to accept the fact that Indian society hates their most meritorious, studious children: the doctors.

Take me for granted, I am all yours.

For now.

An Indian Doctor, happy with his purpose of saving lives, reducing suffering of Patients from across the world, too busy to stand up and waste my anger on cheap attention seekers.

©️Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

He had a sudden, severe chest pain, so he told his office-colleague so. The colleague first called his wife and alerted her “Bhabhiji please don’t panic, I am taking your husband to this hospital, please reach there as soon as possible and give me a call once you reach”.

The cab driver grasped the situation at once and drove as fast as he could. He prayed in his heart. Just a kilometre before the hospital, there was a huge mob blocking the road. A great leader was shouting aloud about his pride for his religion and patriotism, least aware that they were all blocking many children and mothers trying to reach home, patients and doctors trying to reach hospitals. The bought crowd was eagerly listening to the violence provoking words of this rich politician, also a convict and suspect in many crimes, There was less audience at the real places of God’s worship nowadays than at political speeches giving religious sermons, mixing them with the love for one’s nation!

The cabbie honked. Two monstrous looking goons peeped in his window and started abusing him insanely, least aware about the women and children around. The cabbie was abused first for his profession, then his language, and the state he had come from, threatened to be burnt alive along with family if he honked again when the ‘great’ leader was speaking.©️Dr. Rajas Deshpande

The cabbie begged with folded hands: “Sirji forgive me, I accept my mistakes, but there’s a patient on the back seat. He looks serious, we must reach the hospital as quickly as possible. For god sake, let us go”.

One of the goons opened the back door and asked this patient his name. After he saw the chest-clutching patient almost gasping, they made way and allowed the cab to leave.

Now the patient had started profusely sweating. His face had turned bluish, and he was making efforts to even breathe well. He could not speak. As they entered the hospital, the patient’s friend noticed that the patient had stopped breathing.

He shouted in panic. The wardboy and the cabbie lifted the patient on a stretcher and ran towards the emergency room.

A frantic, fearful sound of thuds of the last heart massage was now heard, along with breaking of many glass syringes and instructions shouted by doctors and nurses. A tube to restart breathing artificially was inserted in the patient’s throat. ©️Dr. Rajas Deshpande

There was no one to cry for this patient there. His friend was sitting outside the emergency room, clutching his head, stunned. The cab driver had left without taking his bills. Religion and Patriotism stayed outside the hospital campus, they couldn’t save lives.

A young and dynamic heart specialist who had just returned to India saw the ECG of this patient. An urgent action was required. He called upon the patient’s friend to sign a consent.

The friend hesitated and refused. There were a lot of news every day everywhere about doctors fleecing patients, earning money by misuse of stents and surgeries. The friend no more believed in what this doctor told him.

“I don’t know. Wait till his wife arrives, she will be here in an hour”.

Every millisecond was crucial. The dynamic heart specialist called his medical director. “Sir, I take full responsibility for this case, he needs immediate action”. The medical director cautioned him: “Doc, if anything goes wrong, if the outcome is not good, they will file a murder case against you. Why do you want to risk your bright career at the very beginning? You must also think that you don’t have any political godfather”.

The doctor rushed the patient to the cathlab and inserted three stents in the patient’s heart, that resumed the normal blood flow to heart. The patient’s heart function returned to near normal in an hour. By the time the patient’s wife arrived, the lost life of the patient was brought back. The next day, the patient could breathe well by himself.

Now the most crucial puzzles: which state did the cabbie come from? What was the caste of this patient? To what country did the helpful friend belong? Why didn’t they go to the government hospitals run by those who criticise private doctors and hospitals? And lastly, what was the religion of the doctor who saved this patient risking his own life and career?

Any sane person with an ounce of humanity in his heart won’t ask these stupid questions. But some Indian leaders and their followers do. And it is very sad and unfortunate that the answers to these questions cannot be openly revealed in my beloved India.

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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The Medical Court Martial and the Punishment

The Medical Court Martial and the Punishment

(c) Dr. Rajas Deshpande

“What is the exact diagnosis?” the patient, Mr. Abhishek asked.

In his early thirties and succesful, Abhishek was anxious too. I told him that his looked like a stress headache, migraine was a possibility, the tests I had told him would help us rule out other possibilities. There is no lab test for confirming the diagnosis of migraine.

“What is each one of these medicines for?” Abhishek asked. That the doctor had an experience equalling his total age had nothing to do with his right to ask questions. He was buying the doctor’s services after all! For a moment I wished I was not a doctor, that I could tell people off by snubbing them, that I could rudely decline to reply to questions that were against common sense. But then I reminded myself: that I did not have this liberty. I must face the court martial of a doctor, a chosen punishment, every time I see a patient.

“Sir, you have told me you had a headache. These medicines are for headache” I replied, smiling.

“Is it necessary?”he asked.

“No”. I said., “As a doctor I have only three options: prescribe you medicine which I did, recommend a surgery which is not applicable in your case, or suggesst you a non-medicine path like lifestyle change” I replied. Practice makes one patient too.

“Are these steroids or antibiotics?” his wife asked.

“No” I replied, and thanked God that they believed me here and did not ask for proofs.

“Are these tests necessary?” Abhishek.

I told him the pros and cons of doing the tests, and reassured that it was not an emergency. Even if they did not trust me, I had to do them good. That’s the duty of a doctor.

“What lifestyle changes do you suggest?” he asked.

“Ensure 8 hours of sleep every day, give up cellphone use after evening, reduce screen exposure to less than three hours at a stretch, maximum eight hours. Eat fresh and healthy home cooked food three times, and eliminate fast food. Resolve relationship and work stress issues. Reduce weight by consulting a qualified dietician. Start exercising.” I told him. This simple formula for a healthy life is mostly possible for the poorest of the poor illiterates, but impossible for the educated affluent! What a paradox!

“Impossible, doc! Tell me something practical. My work needs me to use screen and cellphone over 12 hours a day. I mostly work at night, I have to use fast food or tiffins. My wife also works, she has stress of her own, we haven’t had time to even have children yet! There’s no energy left for any exercise when I return” . Abhishek was genuinely frustrated with his schedule without even knowing it.

“Then Sir, please take the medicines as prescribed, and gradually make changes that eliminate stress. Please do these tests especially if you do not have relief in next two-three days” I thought it will be over now.

I was so incorrect!

“Do these medicines have any side effects?” his wife asked.

“Yes, all medicines have side effects, these are the ones with least side effects for your condition” I started getting faster and shorter with my replies now.

“What if he develops any side effects? Can we call you on your personal number?”

How could I tell them that every doctor prescribed over 100 different medicines every day and all of them could have some side effect or other, minor or major, and that if everyone kept calling for each side effect, the doctor won’t be able to practice!

“Usually side effects are not seen with these medicines. If you have any allergic reaction, please stop these and report to the nearest doctor or hospital. I may not be reachable always” I wondered what people did before the cellphone era: how happy the doctors then must have been!

They appeared partially satisfied and left. My court martial in this case was over. “Only twenty more court martials remaining for today!!” I reassured myself.

After about two weeks, I received a call from the casualty. Abhishek was admitted in an unconscious condition. His wife was in a state of shock.

“What happened?” I asked her.

“Doc, sorry, but he did not want to take any medicine with side effects. So we went to someone who gives a herbal medicine without side effects, made at home. We took it for about five days. The headache improved first, then went on worsening. Then Abhishek had a lot of vomiting and did not eat anything for three days. Today he got up and collapsed while taking a bath”.

“Did you ask the person what was the content of his potion?” I asked while examining an unconscious Abhishek.

“No doctor, he says it was his own invention, a secret” she replied.

Abhishek was paralysed on the right side. His MRI showed many blood clots due to dehydration and a small bleeding on the left side of the brain. This is called cerebral venous thrombosis.

Many people who go on prolonged fasting, drink less water, overexert without enough hydration develop clots in the veins of the brain as their blood becomes thick. Some diseases of the blood and some medicines like hormonal preparations, alcohol, contraceptives etc. (even herbal) can exaggerate this tendency. This is a major cause of clotting, bleeding and swelling in the brain, resulting in paralysis or even death. One should never make sudden changes in diet without consulting a qualified expert.

We admitted Abhishek in the ICU. He gradually recovered over few weeks, but his speech remained patially slurred. His company ruthlessly fired him, they did not care how dedicated he was to them. The most fortunate thing was that he retained his intellect, memory and ability to move. The couple has now changed their lifestyle and are far happier although not richer. He is off all medicines now.

Almost every doctor bears the punishment for the few who overprescribe and overinvestigate: a trustless court martial, bitterness and allegations by not only educated but even totally uneducated patients. A doctor must be compassionate and kind, but the limits to how many unnecessary questions he should patiently reply to remains a dilemma.

This daily court martial of doctors must end. The doctor’s consultation time and peace of mind is as much important for the next patient as for himself. Newer generation doctors should also be taught to politely deal with such situations.

A polite reminder to ask only relevant questions, to book another appointment for more time is justified in such cases. The society should understand and accept that a qualified doctor has repeatedly proven his merit, acumen, ability and correctness before being allowed to practice.

Unlike the many we vote for.

(c) 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 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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Mob IQ Versus Indian Doctors

© Dr. Rajas Deshpande

Woke up with a bad headache one morning, probably a sudden change in weather. Felt lethargic, did not want to get out of the bed. It was raining heavy, a perfect day to stay in bed and snack with a book and a huge black coffee. But the usual inhibition of a doctor: that many patients will have travelled only to see me worried me. Another important fact that I still depend directly upon my daily work, that ‘No work’ translates into ‘Zero income’ for me like for every doctor, made it more difficult. Just then the cellphone rang.

“Can you see the patient in ICU urgently?” my colleague called, “The relatives are quite powerful people. Very troublesome”.

If it was only to help the patient, I would get up from my grave, but even for a million rupees, today I was not in a mood to balance wits and swordfight my knowledge with an over-expectant crowd whose only qualification to ask me questions was that their patient was serious and I was expected to be compassionate and courteous. But then, I could feel from his voice that my colleague was exasperated. “Okay, I will see him in an hour” I said. Two hot black coffees masked the headache (please don’t try this at home) and pumped some fuel into my blood.©️ Dr. Rajas Deshpande.

I noticed a huge crowd outside ICU. I went in and examined the patient. Indeed critical, a case of stroke. Educated young man, stressful job, smoker, high blood pressure, was given medicines to control it, but did his own “gossip research”, stopped medicines, some atrocious diet, some herbals and one morning suddenly had bleeding in the brain. A story that is a routine now.

I called in the relatives, expecting two, but about 15 people walked in. Few of them had the most deadly dress upon earth: stiff white linen with gold necklaces. As I explained them with two other senior Consultants, questions poured in. If it is plain curiosity and worry about the patient, one can be compassionate, but this was more like police grilling criminals. At the end of every sentence highlighting critical situation of the patient, came the same question: “But he will become normal again no? Do anything you want, we want him to recover”.

It was like throwing a stone at the sky, it never lands there!©️ Dr. Rajas Deshpande.

Where do these people come from? How can so many people wait with the sick patient? At one end we have labourers whose families must work to pay for their treatment in even government hospitals, at the other we have doctors who must work every day without any benefit for future. The whole spectrum is otherwise dominated by these crowds. What is the source of earning for these people in crowds? If these men in hundreds are here all day looking well fed and complacent, who is working for them and their families? Is India rich enough that people can do away with work?

Crowds with patients, with leaders, shouting and vandalising, mobbing.. who is sponsoring their livelihoods? Or is it that we have authentically become a country of slave mobs that entirely depend upon their leadership to feed them? Are we encouraging poverty and dependence to the extent that this makes it easier to control a majority?

Everyone who is working hard and earning, paying taxes is being implied to be not only a fool but a villain. It has become fashionable to be poor and become a mob. Then a majority vote bank, forgiven by those in power, you can choose to break and mend laws as per your wish, still get sympathy. Poverty plus majority together can control anything in India. Beggars everywhere is Indian specialty. Not surprising then that any political party or government promising ‘free’ stuff, subsidised stuff and schemes to look after generations and generations of poor youth at the cost of taxes paid by working class will not only encourage such ‘poor mobs’ to become lethargic, expectant, unproductive slaves, but also provide them with enough time to divert their youthful energy towards the temptations of violence thrown by the powerful. All this at the cost of taxes paid by every hardworking profession who cannot even afford a holiday!©️ Dr. Rajas Deshpande.

While other professions escape the brunt of such free-monger mobs, medical professionals suffer the worst, not only because of over expectations of impractical charity, violence and vandalism, but because of the interference with treatment, duress, and most importantly the time they have to spend answering and explaining repeatedly to those who refuse to understand. Some are incapable intellectually to grasp complicated medical situations. How much time will a judge, IAS officer, minister or police officer spend with arrogant crowd explaining the same thing? Will they go on forever till the other person understands? If a doctor does not wait till the crowd understands, he / she is supposed to have not communicated effectively. Is an uneducated, illiterate, stubborn relative’s understanding and grasp a doctor’s responsibility? It is unfair waste of time. To expect every doctor to satisfy a mob of illiterates or even non-grasping literates is itself an indication of our social immaturity.

Time has come now for doctors to take a firm stand: that we will speak to only two relatives, who have signed and accepted the responsibility of patient’s medical care and expenses, that we will reply every question only once, and explain once if necessary, that whatever we say will be first written then video recorded so there is no later ambiguity or common tomfoolery of lying. Informing and explaining once is indeed a doctor’s duty, but satisfying the relatives cannot be a doctor’s responsibility. No doctor can afford that kind of time and patience. Any further cross-questioning by relatives should be a paid service consultation based upon time. ©️ Dr. Rajas Deshpande.

Our patience, compassion and understanding is not for being taken undue advantage of.

Happy Doctor’s Day!

Jai Hind!

©️ Dr. Rajas Deshpande

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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