Category Archives: Meditation

Till I’m Alive

Over 4 years ago, a late night frantic call from the casualty baffled me. Quite a complicated case. After seeing the patient I met her anxious family and explained them my thoughts, that the diagnosis wasn’t clear yet, and that we needed to observe the patient. I had already started treatment based upon a presumption. The Mandke family, in spite of being extremely well connected socially and able to afford treatment anywhere they chose, still decided to invest their trust and faith in a junior Neurologist like me. The onus to prove them correct was now upon me.

In a few days Mrs. Madhuri Sudhir Mandke was completely cured of the transient illness she had developed, and discharged. After a few follow ups, I told her the good news: she no more required to see me.

Yet every Diwali, she comes personally or sends someone from her family with extraordinary sweets and gifts. When she came over today, I told her this was not necessary, I had just done my duty. Then she said something that moved me: “Till I am alive I you will receive these every Diwali”.

This gratitude not only increases my responsibility, it is also a perpetual reminder of how important it is for every doctor to take it upon himself/ herself to justify, to stand up to that trust which involves health and life. Every outcome may not be what one strives for, but every effort can be made genuinely to let the patient and family feel that they have trusted the right doctor. It is NEVER sweet talking, wise talking or jovial attitude alone, never pure medicolegal attitude, but a combination of scientific, ethical and compassionate care that brings home the rewards of appreciation by the patient: the highest achievement in medicine.

There’s nothing more precious to earn upon earth!

©️Dr. Rajas Deshpande

The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

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

1. Denial of false certification.

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

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

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

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

6. Advising necessary investigations.

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

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

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

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

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

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

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

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

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

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

How to know?

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

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

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

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The Beautiful Secret

©️Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

Only last month, she came alone.

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

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

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

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

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

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

©️Dr. Rajas Deshpande

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True Story, names changed.

The Fairy And The Prince

© Dr. Rajas Deshpande

The beautiful radiant lady wheeled in the patient’s chair and wished me with a pleasant smile. Some smiles, however beautiful, have a tragic shade. I looked at the patient Rohan. A very well built fair young man in his late twenties, must have been very handsome in the past. He sat paralysed below the shoulders, one eye closed, face twisted, and a large surgical scar upon his head, partially covered by a cap. He could not speak. Any movement would cause violent tremors. He was wheelchair bound and had to be assisted even for toilet.

Rohan and Riya had married just two years ago, against the wish of their parents. Both from very affluent, but uneducated families. Both worked at the same office. In a few months after marriage, Rohan had developed high blood pressure, and was advised treatment. Unfortunately, he got carried away with some false claims about some herbal medicines shown on National Television channels and stopped the BP medicines. The obvious happened: one of the blood vessels in his brain ruptured due to high BP, and there was a huge bleeding. A Neurosurgeon had done an excellent job by taking this high-risk case on operation table in emergency, to suck out the blood clots and save his life. However, the damage was already done by then, much of his brain was damaged on one side. Riya had been caring for him since then. She looked after him just as a mother cares for her newborn.

“Doctor, we know his paralysis will not improve now. But he is brilliant, I know his brain thinks fast and accurate. Since this stroke he cannot speak. We have come with some hope for his speech. If he could just tell me what he feels, if something is bothering him, what he wants, etc., I will be very grateful” his wife said.

We started treatment. In a few days, Rohan could speak legibly, so she was very happy. Rohan’s parents were very happy too. © Dr. Rajas Deshpande

One day, Riya’s father came with her. He asked her to wait outside my room for a few minutes, she reluctantly left. With folded hands and tears, he spoke: “Doctor sahab, my daughter married against our wish. I have forgiven her now. But I cannot see her spending her life like this. She was the most brilliant girl in our town, she had even rejected job offers to go to America because Rohan wanted to stay in India. You can see that she is still young and beautiful. Anyone will marry her; she is one in a million. I’m not saying this because she is my daughter, but you can see for yourself from how she cares for her husband. She has become his attendant now. What is her fault? How can a father see his daughter wasting away her youth like this? They have no family life. I cannot even speak to her about this. Her mother tried but Riya refused to speak. She speaks very highly of you, so I have come with this hope. Please help us”.

This was very difficult, but a duty too. If not me, who could even attempt to resolve this?

“Let us ask her about her thoughts” I told her father and requested him not to react when she spoke. We called her in. I told her in short how her father felt. She sat straight. Her face became distorted and she wept silently. Her father kept on patting her while weeping himself.

“Papa, when Rohan could recently speak after so many months, the first thing he told me was to leave him and marry someone else. He refused to eat his medicines, saying that I should leave him. Then I promised him that I will leave him after two years. That was a lie. I know he will die if I leave. I could feel his love even when he could not speak, that’s something more precious to me than whatever you think I will get if I marry someone else. Till the day he had this bleeding in the brain, he made sure I was best taken care of. He never had his food before me. How can I spend even one happy moment with anyone else knowing that Rohan is suffering in this same world? Would you be proud of me if I did that? Did you teach me to be so selfish?” She broke down. © Dr. Rajas Deshpande. Her father did not say anything. They left.

In a few weeks, Rohan followed up again with Riya. He is now gradually learning to operate a computer. He plans to start his own online business. Riya is helping him do that, while continuing to work. They are now planning for a child soon.

This fairy I met was more beautiful than any other in the dreamy stories I had heard all through my childhood. I am glad that I am a witness to this divine fairytale.

I know even of another couple, where the girl had developed a paralysis in her college days. I had counselled her and her boyfriend about future uncertainties and a possibility of a compromised married life, given her illness. “That’s not the most important thing for us” he had said. They married. Today, about 8 years since then, they have a healthy, happy kid, and he still cares for her as much, now when she is in a wheelchair. This knight lives in a rented house, runs a small grocery store, rides a bicycle, wears the simplest of clothes, yet has a heart that would put to shame many a real princes!

My world as a doctor is full of beautiful fairies and knights, named caretakers. It is because of them that thousands of patients are surviving with dignity today. Medical care is so incomplete without them! I remember my favourite author Richard Bach’s words from “The Bridge Across Forever”: “Princesses, Knights, Enchantments and Dragons, Mystery and Adventure… not only are they here and now, they’re all that EVER lived on earth!” How true!! © Dr. Rajas Deshpande.

Among the stories of sadness and suffering, most doctors also come across best of the human hearts and minds, highest forms of love and care. Such patients and relatives reinforce our own trust and faith in the ability of human efforts to heal. Thanks to what I learn from my patients, my gratitude for being a doctor is endless!

© Dr. Rajas Deshpande

Dedicated to all caretakers, young and old, who silently sacrifice much of their life caring for their loved ones.

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Quit Quit

© Dr. Rajas Deshpande

In the first year of medical school / MBBS, I had a heart break. It made me feel like quitting medicine as I did not feel like going to the same class again. I started bunking classes, spending a lot of time in a small book house which allowed you to read books without having to buy them. Costly coffee shops were not a fashion then. The phase lasted for about three months, till a professor (God bless him!) who knew me informed my parents when I bunked his class. A lot of firing, two tight slaps by mummy dearest, and I was back on track. I had hated that professor for some time and did not talk to my parents for the firing for a few days.

Towards the end of second year I got so engrossed with philosophy, poetry and study of different religious texts from various religions, that I was convinced I wanted to give up medicine and be a philosopher, author. I attended college but my mind was too occupied to concentrate. It was then that I came across a professor who was very brilliant and approachable. He told me to just ‘sail through’ and let the storms in my mind settle. “Teenagers like you must learn to tame the fires within” he said it wisely. I carried on.

Motivation to me is a myth. Some have it within themselves, some don’t. One who needs motivation keeps needing it all the time. I will do something else better maybe, but then I will have quit medicine. Over a period of time I learnt that no one succeeds by being half hearted. I don’t want to leave an unfinished task behind me. I didn’t want to be a quitter.

Then onwards I did fairly well and secured my MD seat. But a crueller test was written for my future.

I joined DM Neurology course in Mumbai. In a few days I had a terrible non-academic argument with one of the professors and was told to get out. Hurt, I left Mumbai and came to Pune. My sister had a rented flat, I stayed with her and mostly roamed alone, usually sitting and musing in a local garden Sambhaji Park. Grew a beard and a belly. I was ashamed to go back to my parents because I did not want to face them with an “I Can’t”.

A few days later, my father called. “Start the next thing today. Quit or don’t quit, but don’t waste time. Any decision in life should not take more than a few seconds to make. You only have to listen to your heart. Take a step, if wrong, correct it. Don’t hover”. © Dr. Rajas Deshpande.

I had desperately wanted to be a Neurology DM. That’s what my heart resounded. I joined back the next day. Since then, I have always made this rule for myself: never to prolong any decision making about my own life. It does not take more than a few peaceful seconds to listen to your heart and act upon it. The moment you allow others to choose for you, you create a mess. There are sometimes great sacrifices involved, one must give up a lot to pursue the path of the heart. But it is the most rewarding path to pursue. There’s nothing money can buy for an unhappy heart, so the choice of money over what your heart truly craves is always a mistake. © Dr. Rajas Deshpande.

There were times when I was angry and upset with parents, teachers, others who meant well and told me I was wrong. Looking back at what life has given me, I regret that. They too did not know the future like me, but they had deep faith in what I could achieve. Their anger, advice and reprimands came with the purest intentions of making my life the best it can be. Today when I have achieved more than what I set out to, I crave for one opportunity to meet each one of them and express my heartfelt gratitude towards them.

Medicine is gruelling. It is not for the weak hearted. Study for decades amongst a culture of corruption, socio-politically motivated decisions, unfair competitions, pathetic living conditions, and then face the tears, sickness, frustrations, accusations, deaths and ungrateful wrath of multitudes for all your life. But it is also the only profession which allows one human to literally take away pain, suffering and death from another. It is the only vocation that brings one closest to the highest form of human achievement: saving lives, easing pain, curing diseases. © Dr. Rajas Deshpande.

Many medical students as well as doctors at different stages in their career feel like quitting. I just want to remind them: one saved life, one smiling patient defeats all other negatives about this profession. You are the ONLY ONE who can make this possible. Others may or may not recognise this, it is for yourself. This is the best gift you can give yourself: the ability to save life.

It is the tendency to hover upon indecision, confusion and delay that one must quit. Quit the choice to quit. Life’s too beautiful to waste time when your heart always knows where to go.

In the memory of my father Dr. Kalidas Deshpande, on his birth anniversary (Ganesh Chaturthi).

© 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 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