Category Archives: MS

The King Of Merit

The King Of Merit
© Dr. Rajas Deshpande


“My work and my merit is my answer to all my fears” Yashwant Gade replied.

During first year in MBBS I once had a fight with a classmate. We belonged to two different communities, and the student body politics in medical colleges was not very evolved then. Someone tried to blow up the matter into a caste issue.

That is when I first met Yashwant Gade. He was in final MBBS, and I had seen him often engrossed in his books in the library. Curly hair, thin built, and the proud, fearless attitude of a lion. He was involved in most student activities. He listened to me patiently and immediately called my rival from the hostel, resolved our ego problems and averted what could have become an unwanted, ugly memory.

“Both of you are only medical students in this campus. A medical student cannot afford to lose even a single minute. I don’t want to hear about any fights hereafter from either of you” he warned us.
His warm nature and smiling face encouraged us to become his friends. He had the knack of saying things in a straightforward yet wise way. “Aren’t you scared of speaking your mind?” I asked him once.

“My work and my merit is my answer to all my fears” he replied.

Then we gradually realised that we were in the company of an exceptional hero.

He could not afford travelling to the school by bus, so he had walked to and from his school over five kilometres away. He stood first in the Maharashtra state in the 10th standard board exams.

He did not have money to pay the fees for junior college. The management of Shahu college invited him to join them, waiving off his fees. He did them proud when he topped the 12th standard exams in the state.

He topped all three MBBS exams in the Marathwada University. Then he won the open merit post graduate (MS) seat in Orthopaedics. The postgraduates were underpaid and over-utilised then too, but Dr. Yashwant’s younger brother had become an architect by then. He supported by paying for Dr. Yashwant’s fees.

Dr. Yashwant then naturally topped the MS Orthopaedics exam! More importantly, he appeared for the MPSC with non-medical subjects and topped the state in that exam too, in the same year as he topped the MS!

Although a topper throughout his career, the saddest aspect of merit: that it is useless unless one has money enough to sell it, hit him hard. He had no money to start a surgical set up so essential for his practice. Financial insecurity he could not afford then. He decided to do what was needed: enough stability to support the family.

He joined as a deputy collector.
He was posted in dangerous areas away from civil world, and often walked long distances just to eat his meals. He had decided to give it his best, dreaming of setting examples in administration.
It was not to be. The political interference in his work that tied his hands was too much for his self-respect to tolerate. He resigned and returned after two years, and decided to kickstart a new career.

He started working with a friend Dr. Bipin Miniyar.
In a few years, Dr. Yashwant Gade created his own identity in the Orthopedic world, simultaneously working at a government hospital as a teacher, earning his rank as Associate Professor and Head of the Department of Ortho-Oncology in the Government Cancer Hospital at Aurangabad.

In a society running after glamorous stars and scions of rich business houses, where clothes and cars and watches and houses now make a man, the greatness of a lion who fought all odds and tore through all exams to emerge first in every single one of them will appeal only to those who understand the meaning of the word “Merit”. The ability to defeat fate year after year till it has hailed you with the crown of a winner is not given to everyone.

Had he chosen to work in the developed world, I am sure he’d have a private jet by now!

Some egos stink of merit, some of their position, and most with money stink the worst. But even after winning all these three “Oscars” of life, Dr. Yashwant is as simple and down to earth as he was when I met him as a medical student.

Like respect and love, Merit cannot be bought. I am proud to know this ‘King’ of hard work and merit. He is still deep rooted in his background: maintaining a farm and encouraging the rich cultural traditions of an Indian Farmer.

Dr. Yashwant Gade, you are an outstanding role model for any medical student anywhere in the world. You are also the type of icon India desperately needs!

© Dr. Rajas Deshpande

Targets and Doctors: A Fatal Flaw

Targets and Doctors: A Fatal Flaw
© Dr. Rajas Deshpande
“What will you become when you grow up?” a common question heard in childhood. Always weary of doing the routine and fond of a little spice in life, I had kept a list of answers to surprise and occasionally shock the questioner uncle / aunt, based upon the spontaneous dislike they generated by other questions and general behaviour and replied something like “It’s a secret” or “It depends upon when in future” etc. There is no better revenge than vagueness for some. In the moment when they paused to react to that vague answer, I would make an innocent face and ask “What was your percentage when you were my age?”. Then the explanations of how things were more difficult and in general marks were lower back then were very entertaining! Curiously, those uncles / aunties did not ask me further questions. Target hit.
© Dr. Rajas Deshpande
For the better and polite class of grown ups, I had the standard answers that my parents would like: Doctor, Scientist etc. The real answers were too “out of the league” for the culture I grew up in then. One thing was sure: the big-eyed respect that the words “I want to be a Doctor” evoked from the listener was sure better than any other response.
Somehow the wish to become a doctor caught hold better, probably because of parental influence. Once I completed MBBS, I loved the actual interaction and started realising the enormous satisfaction potential that the skill generated. The ‘high’ of vast complicated knowledge sharpened daily by experience was superior to the ability of a non-medico to understand or praise it. It was an autonomously growing satisfaction.
Then came the thought that I want to learn more. There are better skilled people, who could treat better than me. Getting admission to MD Medicine was very difficult, there was no question of paying in private colleges as we could barely even afford the govt. medical college fees. A lot of somersaults later, I got admission. There was an explosion of medical knowledge and wisdom suddenly, and there was no choice but to comply. Good and bad patients, good and bad teachers, good and bad friends, good and bad times were all drowned by the prime necessity and survival technique of every genuine doctor: Study!© Dr. Rajas Deshpande
Ego is greedy. Mine too. After MD, there was a desire that I want the highest specialisation: DM. More battles. More scars. All worth the title. With that degree, it felt like I have won the world.
At that time if anyone had said I worked for a financial target, I would have declared a war.
Many more steps in education later, I woke up to the naked reality: however good a specialist you become, you have to either have your own multicrore hospital, or work at someone else’s. Basic medical practice is far different from specialty practice, which requires more time, more investigations, intensive care and complicated treatment strategies / surgical techniques.
When one joins a private hospital, one realises this more intensely: there really are good and bad specialists. Some are very thorough in their academic base but cannot convert that in good patient outcomes or numbers. Some are very sweet and courteous with patients but they lack proper skill, knowledge or experience. The spectrum is wider than one can imagine. Obviously like in every profession, some think of earning more money as their primary aim.
Anyone who owns a hospital must invest many crores of their private money, directly or via bank loans. Sometimes the govt. helps in reducing the cost of land. But in each case, the maintainence cost of any hospital runs usually in lakhs to crores, more with each bed added. Intensive care beds are the costliest investment.© Dr. Rajas Deshpande
When the owners of any hospital invest crores of rupees, they have targets to return their loans., to maintain the expenses that run in crores again: right from 24/7 failproof electricity and water arrangements to the availability of medicines, stents, catheters etc. in the hospital premises. The nursing, reception, helper, technician staff (in most major hospitals, the staff runs in thousands) must be engaged in three shifts, and paid in time commensurate with other establishments/ professions.
The only help that comes from the govt. is initial subsidy in land / water prices. There are no tax relaxations for any hospital/ staff. 20% of all services and beds are reserved for the poor. (If anyone has doubts that the poor-reserved services are not utilised, they can verify with the charity commissioner any day). On top of this all govt. employees must be seen at pathetically low rates, and even that amount is usually pending to be paid for years if not decades.© Dr. Rajas Deshpande
Add to this the profiteering that the medical insurance companies have created: on one hand twisting the arms of private hospitals to provide specialty medicare at bare minimum rates, while on the other hand declining many deserving patients medical coverage due to idiotic reasons.
In this scenario, the last thing that a corporate / private hospital can afford is a non-performing specialist, whose salary runs in lacs of rupees every month (which is what that cadre deserves).
Most corporates / private hospitals are aware of this, and usually support a budding practitioner till his practice picks up. After that, the least he / she is expected to do is to maintain that level of practice or increase it, returning the investment that the hospital has made in his growth. The provision of a furnished room, electricity, washroom, cafeteria, parking, staff and salary to a non-performing or underperforming doctor is not affordable for every hospital.© Dr. Rajas Deshpande
This generated the word “Target”, which was quickly coloured villainous by many. Which financial endeavour can be run without setting financial targets? If anyone is naïve enough to think that all hospital owners will invest their hard earned crores for charity and leave the returns to fate, they must get examined by a qualified practitioner. If the hospital cannot generate enough profit money, there won’t be any growth in medical technology. If they cannot repay loans, the hospital will be confiscated by banks.
Many hospitals of excellent doctors have closed down because they could not sustain the charity they attempted. Indian poverty and healthcare need is beyond the capacity of even the govt. to cope up with, so to expect a private company / doctor / hospital to provide free / concessional high quality continuous medical care to everyone can only be a fool’s dream. This applies to the MRI centers, diagnostic facilities, labs, physiotherapy units etc. where multiple crores are invested.
Some hospitals realised the potential of profit making in this “Target setting” and turned greedy. Mostly good specialists do not stay at such hospitals. Even if most hospitals pinch most doctors to achieve certain numbers, not every specialist works to achieve that target. I know many who would rather keep their ethics and be good clinicians, still staying in the lesser favourite class of management, rather than selling their ethics to shine among the administrators.
The notion that “Every specialist in every big hospital is working to achieve targets by deceiving the patient” is a fatal flaw developing in the mind of our society . Fatal because this also generates fear of going to the right specialist or reaching too late for them to be able to save life.© Dr. Rajas Deshpande
If I cannot afford a Mercedes, I will drive the car I can actually afford, rather than blaming and maligning the entire car industry. Many other cheaper, equally safer options are available for travel.
The problem is, everyone wants the best, highest class of super specialty medical care in luxurious set-ups, at the price list of a sarkari dawakhana. Most doctors who studied in govt. hospitals know that the quality of doctors is very good there too, but if we give that option to the patient, they say “No, not in sarkari” because they want to avoid long lines and “general population treatment”.
As the doctor is the only responsible face that the patient sees in the hospital, many obviously end up thinking that every penny they pay is going to the doctor, at least in percentage. Many will be surprised to know that a doctor usually gets less than 10 % of the total hospital bill as his fees in most cases.
Few will understand that the real “Target” that most doctors work for is to do good to the patient, to save lives. Millions of successful treatment and surgical outcomes from the corporate and other hospitals are a proof of this.
© Dr. Rajas Deshpande
Dedicated to the private hospitals started with the aim of making available specialty medical care for the society and caught up in unfair, unjust allegations because everyone wants free healthcare.
PS: There are greedy doctors and hospitals, like in every other profession. This article is not about them. It is wrong to advise patients unnecessary procedures / tests to achieve financial targets. This article is to explain to the society that target setting is essential for any hospital where recurring investment in new technology and maintenance is also the responsibility of the owner.
Please share unedited.

The God Pendulum

The God Pendulum
© Dr. Rajas Deshpande

Dr. Aman handed over his car to the valet, and went to the rooftop restaurant, his favourite rendezvous. The captain soon brought over his favourite coffee pot and some starters.

‘The look of love’ by Kenny G started playing. It is impossible not to feel inner peace and romance while listening to that piece. Dr. Aman started to think. Yes. He had much in life to sort out.

Sunday late afternoon. The only afternoon to relax if lucky. A moment of peace so precious, that even family duties take a back seat, the mind is so tired of the heavy duty medical practice. Heavy duty because mistakes are not allowed, and seldom forgiven. © Dr. Rajas Deshpande

It is difficult to relax at home too. The society security staff, maids, some ‘sudden’ old friends from god-knows-what-stage-of past will want home consultation, and it is rude for a doctor to say no to any health queries by anyone, anytime, anywhere. Cellphones have become the worst health hazards, more so for the doctors.

He had two patients under his care in the hospital, so he decided not to switch off the cellphone, he was responsible should they have any problem in the hospital.

The phone of course rang.

“Sir, casualty. One GP has referred for you an old lady with convulsions. She is quite bad” the medical CR appeared disturbed.

“On my way” said Dr. Aman, paid his bills, and reached the hospital. On the way he kept on giving intructions to the junior doctor.

The 65 year old lady had had fever for a week, not taken to the doctor, treated by her non-medico daughter and son with home remedies. On the seventh day, yesterday, she had had many vomitings and became unconscious. The local GP gave her some basic treatment, and sent her to the city as she had no facility to treat such a critical case. Since that morning she had also had convulsions.

She was already intubated in the critical care unit when Dr. Aman reached. CT scan of her brain was normal. Her sodium levels turned out to be dangerously low. The management requires skilful vigilance, and it was already started. © Dr. Rajas Deshpande

Her daughter and son were waiting outside the ICU. Dr. Aman updated them about her condition.

The angry son asked “Why is her sodium low? Is it because of the medicines given by the doctor yesterday? I it the side effect of those medicines?”

Dr. Aman had now acquired the skills to tame his anger. He told that it was because of the vomitings, and that they should have taken her to the doctor earlier when she had fever.

The daughter started with an emotional appeal, speaking loudly “Do whatever you want, doctor, please save my mother. You are like God to us. Nothing should happen to her. We are ready to do anything. Please save her”.

“We are trying our best. Let’s hope she recovers” Dr. Aman said the legally correct thing.

“So when will she become normal?” asked the patient’s son.

“It is not predictable, we need to reassess her after convulsions stop and sodium levels are corrected” Dr. Aman replied. © Dr. Rajas Deshpande

“So why don’t you correct her sodium levels right now?” asked the son, as looking at the surrounding relatives as if he was suggesting the obvious that the doctor had missed.

“If sodium is corrected faster than a certain rate, she will develop paralysis, it can also be permanent” Dr. Aman replied, and added “Look, boss, if you do not have trust in our treatment and skills, you can please shift her to any other hospital you wish.”

“No. no doctor. We trust you. You are like God for us. We brought her here because this hospital is big and famous, and has all facilities” said the daughter. The son just kept on looking angrily at the doctors.

On the third day, the lady became conscious. On the fourth day, she was off the ventilator.

“When will she be shifted out?” the daughter asked.

“After a day of observation in the ICU” said the junior doctor.

“Why is it necessary to be in ICU now?” asked the son.

“Because she still has fluctuating oxygen levels, and needs continuous observation” replied Dr. Aman. © Dr. Rajas Deshpande

“Why cannot you observe her in the ward room? The ICU is so costly” the angry son kept muttering.

On the fifth day they requested discharge, as the patient was walking. Her weakness was still fluctuating, and her BP was low. She was discharged on request.

Within an hour, a crowd surrounded Dr. Aman.

“What is this? Is this any bill? Are you doctor or a thief?” the daughter started shouting, to a full audience of the waiting patients.

“Listen. You knew these charges when she was admitted. I do not own this hospital. The rates are standard, and so are the criteria for free or concessional patients. Please speak to the billing department.” Dr. Aman kept his tone low still. He did not want to point at the two costly cellphones that the son flaunted.

They did not qualify for free treatment as per the govt. norms.

“Doctor your fees is also there in the bill. Atleast cut that off. We cannot afford.” The son insisted. The waiting crowd surrounding them stared at the face of Dr. Aman. “Will the doctor be human and help this poor?” was the mob expression.

To save time, Dr. Aman asked the billing clerk to scratch off all his consultation fees. Saved time is more precious than earned money for the doctor.

While leaving, the daughter looked angrily at Dr. Aman and said “We never thought that doctors will be so rude and commercial. Curse upon such doctors who extract money from the poor”.

A doctor must digest all kinds. All patients who had witnessed the scene were doubtful and upset. They knew nothing about the patient and what had actually happened. They had just witnessed the last scene.

Just five days later, the whole family returned in panic. The lady had developed many convulsions as she had stopped the medicines after going home. Now she was unconscious because of the low oxygen that had damaged her brain. This could take a long time. © Dr. Rajas Deshpande

The daughter started “You are God, Doctor, please save her” etc. etc.

Dr. Aman gave instructions about the basic management to the emergency team, then turned to the daughter and said “I am sorry. I am busy with other patients, please take her to another doctor or hospital. I cannot attend her”.

“Can you refuse a patient?” asked the son, as if he had taken a special training from Mr. Ram Jethmalani.

“Yes, I can” said Dr. Aman “No one can expect a doctor to take correct decisions under duress, threats or abuse, and if I think there’s risk to my life or reputation because of ill behaved, hostile relatives, I can even refuse emergencies”.

There was no guilt in his mind when he started the car. He had become a doctor to serve the sick and suffering. Those who did not value him, his work and his profession did not deserve his service. His dignity was as important as his humanity, he would not sacrifice it for those who didn’t deserve it.

© Dr. Rajas Deshpande

The Sweetest Pinnacle Of Life

The Sweetest Pinnacle Of Life© Dr. Rajas Deshpande

To many students who are lost in their search for the right aims and goals in life, who trusted me enough to ask that question, I have suggested that they imagine what they actually want in their life at its Pinnacle.

Success, riches, fame, awards and accolades, a legacy, achievements are all good to show and leave behind oneself. The truth is far more than that. Love and care, affection and respect in one’s evening of life is what everyone deserves, but few are fortunate to achieve. For what good is s life that spends its aged years in desolation, isolation, despair of an uncaring, loveless family one has sacrificed much to bring up well?

Hollow words of “show- love” and “pretend care” are commonly employed everywhere, especially among the rich, educated and culture-claiming pundits of humanity.

One experience I have is worth sharing: that the poorest of the poor, like the farmer in the wheelchair here, are cared for with far more genuine love and affection than many. This family collected alms and help to get him to India, and never asked for any concessions, free treatment etc., always saying they were willing to do anything for the happiness and health of this grandpa. His son standing by his side is an illiterate farmer, but is caring for his father . quoting proudly “He brought me up!”. There is no smell of “I am obliging my parent” in his behaviour.

I have met hundreds of Arabic Muslim patients who care for their parents, sons and daughters equally well, willing and with total faith in the treating doctor. It does not change with their financial status. They insist on the parents staying with them, ask questions about their food, exercise, medicines, happiness and comply strictly with the given instructions.

They naturally do not know the words “Culture, Rights, Medicolegal, Elderly care, Nursing Homes, Mercy Killing etc.”. Rarely have I seen them unemotionally “okay” with a bad diagnosis of a parent.

This old man, in my personal opinion, is one of the luckiest human beings upon earth!

© Dr. Rajas Deshpande

Thank you, Mr. Naser Ali, Mr. Abdul Hakim Mohd. Al Malahi, Mr. Majdi Jamil Aiselwi, Mr. Ahmed Anwar Aqlan!

The Definition Of Love


The Definition Of Love
© Dr. Rajas Deshpande

How frequently do we use the phrase “True Love”! As if there existed some other form of Love..
Mr. Claude Gatien, a farmer from the city of Tours in France, decided at the age of 36 that he wants to change his career. He started to work as a music salesman, selling CDs. Eventually he got a job as an assistant to a psychotherapist in Paris.
He met Ms. Marie Briquet there. She was a social worker, dedicating all her time to the sick as a volunteer. He respected her work, and helped her often. They fell in love. She told him she was having some mild neurological symptoms, mainly tremor and fatigue.
His thinking was as innocently clear as the first rays of a rising sun. Love was the only bond and the most precious thing between them. They stayed together, and started taking care of each other.
The psychotherapist who they worked with was a spiritual man, with immense love for India, mainly for its spirituality. Like most with a heart, he followed his calling. By then, Claude and Marie had developed the same affection towards spirituality, and followed their ‘Spiritual Guru’ to India.
“We fell in love with India”, Claude told me; “because for some reason I find that my mind is at peace here. We have everything in France, still we felt happier in India, because there is so much spirituality in the region, and even among its people”.
They are staying together for over 27 years now. “We never thought of marriage as we thought it is not necessary to perform rituals to prove either love or honesty of intention” Claude said, after consulting Marie in cute French. “It was her answer, but I feel the same” he added, winking!
Multiple Sclerosis, that scary disease of brain and spine, took away Marie’s ability to walk over 5 years ago. She has become almost completely dependent and wheelchair bound. Claude attends her 24/365. “I enjoy caring for her. It gives me many more opportunities to tell her how much I love her” he says.
Mostly people swear about anything that they want others to believe. A teacher taught me long ago never to “swear or promise”, but instead keep every word, complete every commitment without using the words “Promise or Swear”. “Everything you say is actually your commitment” he infused. I met the personification of that principle in Claude.
About a month ago, Marie suddenly had to be admitted in the ICU for some serious complication. Needless to say, Claude was by her side all the time. She was unconscious for over two days. One late night I had to attend some call, and went to the ICU to check if there was a change in her condition. Claude was sitting by her side, sleepy but awake, looking at her face.
“I can wait here for some time. Do you want to take a nap?” I asked him.
“Oh no, Thank you doctor. I won’t sleep till she wakes up. If she wakes up and does not see me, she will worry about me. That may stress her. Once she opens eyes, I will tell her she is ok, make her smile, then I will sleep” he said.
That was a month ago. They came for a visit yesterday. I requested their permission to share their love story. He said he was willing, then asked for her permission.
Then I saw the beautiful smile that had made Claude fall in love with Marie.
“Yes.. She says this is all there is to share about life.” Claude told me, translating.
© Dr. Rajas Deshpande