Category Archives: Meditation

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 Brilliant ‘Bad’ Doctor And Mossbacks

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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Wrong Diagnosis: The Secret Child Of Every Doctor

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

©️Dr. Rajas Deshpande

Religion and medicine should never be mixed. Yet it is extremely necessary that a good doctor understands the mindset of a patient, especially a frightened, disturbed patient, and holistically plan the treatment rather than just writing a prescription for an ailment. To calm the mind of an irate patient, it is necessary that the doctor has that ability and self restraint, acceptance and compassion. A doctor who thinks in terms of religion and has a resultant bias can never understand patients even from his own religion as there’s no single path in any religion.

Science has to think of human body and mind only logically, with a sharp reasoning and on the basic presumption of equality. Genes may differ across races, but their numbers, function and dysfunction are the same across the human species. Racism is a serious disease of human mind. ©️Dr. Rajas Deshpande

I have always lived a parallel, isolated life to evolve mentally to be able to understand myself better. Only if I understand myself, my fears, my wants, necessities and my preoccupations, my expectations from others and my thought processes well, will I understand other human beings- in my case, the patient. This inward journey makes me a better doctor than knowledge, experience and information alone. This understanding is superior to even medical and social wisdom.

To achieve this, I have kept acquiring insights and inspiration from various religious texts and their translations, commentaries on religion and philosophy across cultures, and of course many scientific analyses of human mind. This of course comes after the dedicated time reserved for studying scientific medical sites and texts on a daily basis. ©️Dr. Rajas Deshpande

One prominent requirement of today’s doctor is to advise on meditation as many patients seek that from their treating doctor. I cannot advise something impractical or anything which I have not found myself to be useful. Researching this, I came across a beautiful article written by an army officer about the essence and technique of meditation. He had suggested this book above as an ‘Ultimate’ commentary on the science and practice of meditation. It has nothing to do with religion, it is an effort to delve into the depths of human nature. I reiterate, when I go to the hospital (and outside my home in general), I don’t see myself as belonging to any religion. I truly believe in the equality and beauty of every human being. Starting to read this immensely complex book today, hopefully it will help me and my patients too.

©️Dr. Rajas Deshpande