Category Archives: Multiple Sclerosis

“Is The Diagnosis Wrong, Doctor?”

“Is The Diagnosis Wrong, Doctor?”
© Dr. Rajas Deshpande

“Doctor, there is no improvement at all” said the angry husband, throwing the case-file upon my table.

Well this is not an extraordinary sentence for any doctor, one must be prepared to openly deal with this. I had been quite polite and well mannered with them, there was no reason he had to cross that line. I could understand though. When they pay my fees, they expect some result or satisfaction.

While teaching my students, I have always insisted that if the patient / relative says that there is no improvement or change with the prescribed medicine, one must first consider the possibility of a wrong diagnosis, a missed condition or a misinterpreted finding. Doctors are humans, and do commit mistakes, or misinterpret findings. This is normal, and happens with every doctor. Medicine is far more complicated than most people think they know. A good doctor knows this and learns, while all the time keeping patients safe, but a doctor with ego kills his own practice, and may cause harm to the patient.

I asked them to sit down and reassessed the case in detail. A 28 years old female. Headache, giddiness, imbalance, palpitations, breathlessness. Lack of sleep and bouts of crying. Past and family medical history not contributory. Physical examination completely normal. MRI of brain normal, Vitamin B12 and D levels low. I had started vitamin supplements, anti-anxiety medicines and an SOS for headache.

She told me all her earlier complaints had improved, but now she had a severe backache. I told the patient that I was trying my best to understand her condition, and to resolve her problem, but her findings and complaints didn’t match. She looked at her husband, and asked him “May I speak frankly to the doctor?”.

Openly agitated, the husband sarcastically offered to wait outside if she needed privacy. However he stood glued to the chair as if he knew her answer. © Dr. Rajas Deshpande

The patient thought for a moment, told him it’s ok he can wait inside, then started to talk. She revealed that she was the only child of her affluent parents, had passed engineering, but now had to quit job and stay at home to raise children. They lived in an extended family, with grand in-laws, in laws and an elder brother, his wife and two children. This patient was the ‘last in the line’ to take orders, all others being senior to her. Her husband and in-laws were perfectionists, and she was tired of their continuous expectations. She had dreamed of making a career too, wanted some free time outside home for herself, but year after year, she didn’t get even a minute for herself. She was tired of it all and there seemed no respite. © Dr. Rajas Deshpande

“I am not averse to hard work, but the continuously condescending and fault-finding attitude makes me feel that I am useless”, she said, and added cautiously: “We were in the same institute and my ranks were always better than him. Look at where I am now” she started crying.

I offered them water and coffee, and waited for her to settle down. The husband became restless and defensive, but his tone was far lower. “I understand her problem, doctor, but what can I do? I cannot leave my family. My work pressures are quite high too, the IT industry is going through a bad phase”.

“I can assure you that she has no neurological problem now’ I replied, “she should improve with lifestyle changes, counseling for the family, and adequate free time for herself. I will refer you to a good counselor” I told them.

The husband laughed. “I can understand, but my parents will not. We will see what best we can do for her”. A bitter tone in his voice didn’t escape me.

‘Sir, she told us what bothered her, and must not be held guilty for trying to speak her mind. It will only help identify and treat the problem better. Please see a counselor together and avoid discussing this at home right now” I requested the husband. © Dr. Rajas Deshpande

There are many reasons why a patient does not improve. Untreatable medical conditions, depression, seeing the wrong specialist are the most common reasons, but there also are patients who want medical leave,those who want to avoid work, who want attention, so will keep on complaining of false symptoms. They do not improve with drug treatment.
On the other hand there are many who keep on taking the wrong medicines for years, those who self-medicate, do atrocious / injudicious dieting and exercises, yoga that doesn’t suit them, and do not follow the doctor’s instructions about abstinence, who keep on indulging salt, sweet, oil, alcohol, tobacco and other drugs freely available in India. © Dr. Rajas Deshpande

A doctor remains a lifelong medical student. A doctor who thinks he / she is always correct is most dangerous. It is not uncommon to meet doctors who are angry / upset with the patient / colleagues when their diagnosis, treatment is questioned. The first thought of a doctor when the patient does not respond positively should be to consider a misdiagnosis, reevaluate the case in more detail, reassure the patient, and obtain a second opinion if necessary. All this done, one must look into other possibilities, with an approach to resolve the issue rather than trying to shove down the patient’s throat their own faults.
We all go through bad patches in life, doctors and patients. If the child is wrong, the parents correct them still with love. A doctor’s attitude should be similar, with due care to also protect themselves. If not the doctor, who will understand the patient whose family refuses to understand them? In so many ways, especially in the Indian society, the doctor must don the role of an elder brother/ sister. Although patronising is legally discouraged in medical practice, and should be refrained from in cases where trust is questionable, one can make exceptions for some cases that need reassurance where the family fails to do so.

The nobility of our profession also lies in reassuring the patients that they are well cared for by their doctor, through the thick and thin of their life.
© Dr. Rajas Deshpande

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The Medical Secret Service: Unknown Angels

The Medical Secret Service: Unknown Angels
© Dr. Rajas Deshpande

“Hullo, Vishwa? Please consider this an emergency. One of my rural patients is here, she is on XXX brand of tablets, she has finished the dose, needs more immediately for another three months. She cannot get them. She has to return by an evening bus. Can you do something?” I was in a hurry, between patients.
“Yes, Sir, I will arrange within a few hours” Vishwa said, and indeed, within two hours, the nearest medical shop called, saying that the medicine was available for the patient at a discount.
That evening I called to thank Vishwa, only to be shocked.
“Sir, you were in a hurry today morning so I didn’t tell, I had a heart attack last night, and an angioplasty was done. I am ok now.” said the 30 year old to me.
Like the thousands of his community, the Medical Representatives, he is immensely contributing to the healthcare industry, unrecognized and unacknowledged. © Dr. Rajas Deshpande

“”What is your job? Just passing on bribes to the doctors? My cousin said to me, Sir, and I did not reply. You should not argue with the one who has poison in his heart. People look down upon us, but they will never understand what we do” said a 60 year old man who had spent life as a medical representative, now a national manager. “We have no choice of judgment, our job is to be the link between the doctor and the company, and to make sure our medicine is available” he said.

Millions of busy doctors, overloaded with their work, have no clue how many pharma companies exist, what medicines they make, what medicines are newly launched, what is the brand name or price etc. It is not practically possible to read the whole new drug launch book every month. This community of medical representatives alone is the link between the pharma companies and the doctors, updating us about various new drug launches in India, their availability etc. They also arrange for academic events so necessary for the doctors and medical students. © Dr. Rajas Deshpande

“Some Doctors are very good and treat us respectfully” said Janvi, who has spent over 20 years in this profession, “but some expect favours from the companies, in the form of tours, dinners and other things. Sometimes, I have had an occasional trespassing of moral lines by some doctor, but that was rare. One needs to be able to take care of one’s dignity and self -respect. Especially Indian women face a lot of difficulty and gender bias when making a career, at all levels.” she said.
“The pressure for women in this industry is immense, and like any careerist woman, I faced a lot of presumptive hate too. If a woman, and especially good looking, is successful, our society already has made its judgment as to the reasons of her success. Most Indian men do not tolerate the idea of a woman succeeding ahead of them. Of course, one must clearly set priorities as to whether one wants to make a career or family, and if both, where the compromises will be, because both are full time jobs at least for any woman. Most doctors have treated me well though, and most doctors also want to do good for their patients”. © Dr. Rajas Deshpande

In my 20 years of career as a doctor, I have never come across a Medical Representative who turned down my request to help a patient: lacs of rupees worth of medicines I have asked them to arrange free for my patients, and they have arranged without a question. Thousands of poor patients receive free / discounted costly medicines, injectables, even stents etc., thanks to the generous efforts of this community and their companies. Thousands of medical camps are arranged all over India, where patients get free check ups from doctors and free medicines by pharmas, arranged by the Medical Representatives, but there is seldom any recognition of this service.

Unlike in most other professions, this community helps out its members without bringing in the competition, and in a recent event, when a regional manager suffered a critical head injury, MRs from different companies collected funds to pay for his bills.

Very few people notice how cruelly difficult the life of a medical representative is. They have to meet a certain number of doctors every day. They often stand for uncertain hours and have days longer than 18 hours, as some doctors finish their OPDs long after midnight. Family life is screwed. They are also responsible for making available the stocks of their brand medicine at different medical shops, and have to bargain with everyone: the stockist, distributor, hospitals, and sometimes the medical shops for making their brand available. The final sale figures are their assessment at every month-end. To achieve targets is essential in pharma industry as in any business, to survive. It is the Medical representatives community that faces the brunt on both sides: company pressure and the medical profession.
Unfortunately, our hate-bespectacled society cannot see anything beyond its suspicions: that all companies offer bribes and all doctors take them, that all doctors deliberately prescribe costlier medicine to earn cuts, and that the whole medical service is driven by money. This is somewhat like a suspicious husband who has a very beautiful and loyal wife, but cannot be happy with her because of his own paranoia. © Dr. Rajas Deshpande

I know many doctors who do not ask for any personal favours from the pharma, do not accept gifts, and pass on all the benefits to their patients. But I do not know any mention of gratefulness for such doctors anywhere. Without the medical representatives playing their part well, the medical profession will be quite helpless.

This article is to salute the thousands of medical representatives who work hard day and night, live an extremely compromised life, and still contribute to the service by medical profession, making life easy for millions of patients.
© Dr. Rajas Deshpande

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Living By The Words ‘Being A Doctor’.

 

Living By The Words ‘Being A Doctor’.

 

© Dr. Rajas Deshpande

“He is critical, an emergency heart surgery is planned tomorrow morning. The surgeon says there is very little chance of surviving this. I don’t know what to do. I cannot imagine this is happening to us.” Dr. Ranjeeta Joshi was crying on the cellphove, still making an effort to keep her voice even. Her squeezing agony about the sudden illness of her Orthopedician husband Dr. Sudhir Joshi reflected in each word she uttered.

This was a weird coincidence! I was not working that day, attending a court summons because a patient was being divorced for having epilepsy. On the way back I also had had a terrible argument with a very precious friend, we were both hurt. Both these had emotionally upset me badly, and so on my way back to Pune, I changed my route to visit my favourite Ganesh temple, where I usually rediscover my lost calm when life batters my patience and bludgeons my peace. Just as I entered this temple premises, I had received this call from Dr. Ranjeeta.

I knew the couple well because Dr. Ranjeeta is struggling bravely with two bad diagnoses: Multiple Sclerosis and Rheumatoid Arthritis. The fluctuations of both cripple her often, but she stands back stronger every time. I knew she was already using a walker. Dr. Sudhir is one of the most renowned Orthopaedic surgeons in Mumbai, with his own hospital at Dadar. Dr. Ranjeeta looks after the administration of that hospital.

I was shocked. I didn’t know exactly how I could help. I reassured her. I told her I was praying for both of them, and urged her to have complete faith in a good outcome. One of the best cardiac teams, Dr. Ramakant Panda, Dr. Vijay DeSilva, Dr. Tilak Suvarna and their colleagues were to operate Dr. Sudhir in few hours. I prayed for the couple, informed her so, and returned to Pune.

She kept updating me. The surgery lasted over 11 hours. Dr. Sudhir was shifted to CCU.

Dr. Ranjeeta ran the show at their Dadar hospital. The staff of their hospital refused to accept salaries that month, and told Dr. Ranjeeta: “You have always looked after us and our families. Now it is our turn to stand by”.

Every passing day was like a slow mountain of fear heavy upon the shoulders of everyone involved. While using her walker and occasionally a wheelchair, Dr. Ranjeeta successfully managed to attend all his needs as well as home and hospital. Dr. Sudhir gradually came out of critical status, in a few days started walking again, and within two months started attending his patients.

Barely after 10 weeks of this major calamity, this medical phoenix started performing major surgeries again, back to his “Doctor Normal”.

When they came today, I was quite moved to see him all back to normal. Of course the love that the couple emanated for each other is beyond words, and I will refrain from expressing what is more beautiful unsaid!

Dr. Ranjeeta, with tearful eyes and a smile, said “We are so happy and grateful to God that we won! I feel every doctor must decide to be a survivor, strive to keep fit, because so many lives depend upon him / her.” she said.

“You are such a brave motivation!” I told Dr. Sudhir.

“It is my privilege to be a doctor, not everyone is lucky enough to become one. In death no one has a choice, but in life we do. I wanted to live and practice again, because being a doctor is a special ability! I can do so much for so many. I love this so much, that this itself became my motivation to survive and become fit again.” Dr. Sudhir replied.

As I stood mesmerised by his words, a beautiful guide to every doctor, he extended something.

A Montblanc Special Edition JFK Fountain Pen, something I was window shopping for so long!

What I ever did to deserve it, I will never know. But this beautiful pen will always remind me of the great JFK,, and more importantly, how I must make the best of my own life as a doctor .

One of the most famous quotes of JFK reads: “As we express Gratitude, we must never forget that the highest appreciation is not to just utter words, but to live by them”. There are thousands of prayers involved in becoming a doctor, in surviving, in reaching where we are today, each one of us. If only we live by our words, what we promised ourselves to be, never giving up, we can defeat so many adversities that stand between us and our life-goals.

Thank you, Dr. Sudhir and Dr. Ranjeeta Joshi, for this reminder, and being a great example.

© 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.
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The Customer and The Patient.

The Customer and The Patient.
© Dr. Rajas Deshpande
“I have seen the patient. In my opinion she has multiple lesions (injuries) in her brain because her nerve fibre coating is destroyed. You will need some tests, and an MRI of brain.” I told the family.
Affluent, educated and polite. Patient, her parents, brother and an uncle.
Then there followed a 30 minute viva. All of them asked me questions about her medical condition. They had extensively googled, and had over fifty questions about the causes, types, her symptoms, diet, lifestyle, job, exercise, physiotherapy, marital life, treatment options all over the world and what not. I am proud of my patience, but when the questions started repeating, I politely reminded them not to.
This disease being my specialty, I was only too glad to be able to answer every question. As I wrote down the investigations, they looked at each other as if they had planned a surprise for me. The brother went out and brought in a huge bag. © Dr. Rajas Deshpande
There were consultation notes of at least 5 other neurologists, two from my own town. Repeated tests were done. Four of the five had diagnosed her correctly, and had also written the standard tests and management.
“We were very upset at the earlier neurologist. He did not have time for consults at all. And she was not happy with his attitude. So we wanted to know if he was right. That’s why we didn’t mention it earlier.” said the mother.
I kept my poker face on. As all tests were already done, I reviewed the results and wrote them the treatment plan. There was further screwing about the side effects of the medicines (I want your personal number in case I have side effects) etc. © Dr. Rajas Deshpande
The father spoke. “Yes Doc. I am working as a senior govt. officer, and we have free tests and medical consultation. If you want to repeat any tests, we can get them done at any hospital at low rates”.
They got up. I noticed that the uncle was fiddling with the smartphone. Alarmed, I asked him, “What is that? Were you recording?”
“Yes doctor, we don’t remember the conversation so we keep recording every time we meet anyone” he said without any change of expression.
I lost my patience but did not react. I was not scared of the recording, but they had to know it is wrong to record an informal conversation without the doctor being aware. But there was no time. Outside, they fought with the receptionist about my fees, and demanded that they be included as govt employee category (which has to pay @ 52 Rupees as a specialist consultation fees).
I declined. The first consultation and a second opinion can be free for such govt patients, not the whole medical hopping and shopping.
The next patient came in. a lively and smiling software professional with her father. He had obvious signs of Parkinson’s disease and was having too many side effects of medicines. As I changed his prescription and informed him of possible complications, he smiled and said “I am in your hands, Doctor. I know you are not God, but you are like a God to me. I accept all the risk. I know my illness is not your fault. Do what you think is best for me. We are not very rich, but we will try and do whatever you say”. © Dr. Rajas Deshpande
The first case went down in my mental diary as a “Customer”. The second one as a “Patient”.
There is a lot of difference that the doctor has to opt for when dealing with these two categories. In case of an arrogant, suspicious, accusative patient / relative, the doctor automatically turns his medical safety switch on. These patients will require more documentation, longer consults (hence more fees), more tests (courts always ask for proofs), safest, low profile medications that may take longer to act, and lowest reassurance. That because a simple “he should get better” is being recorded and “you said so“ will be questioned in future. So the doctor, even when asked in front of the patient, has to frankly tell all the bad possibilities about the patient’s illness. That further depresses many patients, especially the elderly and anxious. Most of these “offenders” are usually continuously dissatisfied, whatever you do for them.
One cannot put a gun to a doctor’s head and then expect him / her to be loving, compassionate and perfect. As many doctors will have realised, medical optimism is dangerous. © Dr. Rajas Deshpande
The doctor wants the outcome for each patient to be the best too: which doctor would like to be a failure?
One can easily deduce that the patients will also make such categorisation as “Doctor versus Businessman”. That is true too. But the difference is that the “Businessman” doctor is still an educated, qualified person who is trying to do good to the patient in most cases.
A judge can knock his hammer and shout “Silence” and punish the misbehaving. A policeman will lock you up if you misbehave or offend him. A minister or a government officer will have you thrown out by his security. A performer or a musician will not tolerate disturbance. There is no other profession where you tolerate insults and demeaning behaviour. © Dr. Rajas Deshpande. The nobility of a doctor (or a nurse) is that he / she will still try to do good to their offender.
Once the complete and genuine trust is felt, most doctors go out of the way to help the patient. Many will never realise, but almost every doctor has over hundreds of non paying patients: relatives, other doctors, teachers, poor patients, maids etc., hospital staff and many more. Add the forced free patients: politicos, govt. employees, and the pseudopoor.
Every “Doctor” wants to treat “Patients”, and this sacred relation still exists, although waning. I feel it is more of the doctor’s responsibility to improve this relationship. For their own good, as much as for their patient’s good.
As for the “Customers and Businessmen” mentioned above, I think they complement each other, and the true “Doctors” and “Patients” should avoid both of them.
© Dr. Rajas Deshpande

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 Revenge

© Dr. Rajas Deshpande

“I want to see the doctor immediately. It is an emergency” the woman outside the OPD chamber was loud enough, and it was for the third time that she had said this. Dr. Rahul was explaining a long prescription to the elderly couple in front of him.He dialed the reception, and asked “What’s all that noise?”. The exasperated receptionist replied : “Sir, this lady has come without an appointment, there are six waiting patients, two on a wheelchair. Other patients are already angry. She is not willing to listen”.

Dr. Rahul apologised to the elderly couple in front of him and opened the door. “What’s the emergency?” he asked the fuming lady.
“I cannot tell here. May I come in after this patient?”
“Sorry mam, there are patients already waiting. If you cannot wait, please go the the emergency department, they will check you immediately”.

To everyone’s surprise, she waited till her number came up. She came in fuming, and muttered a few words to express her anger at having to wait, the ‘F’ words were clear.

In her thirties. From a very affluent and highly educated community. Gold shouting for attention, and a ring with a solitaire so large that it usually speaks of much except love. She had come to Dr. Rahul two years ago for a Neurological problem.

“I have a severe headache since last seven days. last two days I have had chest pain and a feeling of suffocation on and off. Also, I have lost control of urine five days ago. It’s very embarrassing, I cannot leave house. I have had fever before that”.
Naturally, she is worried, thought Dr. Rahul and felt guilty. “I am sorry I couldn’t see you earlier. Why did you wait seven days? You should have come earlier, knowing your neurological diagnosis”.

“My husband was away. He said I should wait. I have a seven year old son, I can’t leave him alone”.

“Why don’t you hire help, knowing your condition?” Dr. Rahul asked.

“I can’t explain, doc. My husband is very skimpy. All he thinks about is more money. Believe me, there’s nothing else he even talks about. I am fed up. He says we don’t need help as I am not working”. She also revealed that she had not seen any doctor as her husband thought it was unnecessary, and kept on suggesting her home remedies based upon his net search. She had stopped her BP medicines a year ago, and had had headaches since a year.

Dr. Rahul asked her to change and asked if she required a nurse attendant. “No” she said, “I am ok”.

The Neurological examination was abnormal, and the Blood pressure was quite high too.
“You need admission, ECG, some blood tests, and an urgent MRI, and we will probably have to use some injections” Dr. Rahul told her.
“Out of question, doc! My husband feels all doctors are out to make more money, he says all my complaints are psychological.” / She said, tearful.
“Then please go to the casualty, we will arrange tests without admission and start treatment. But you will please have to write that you are not willing for admission”. She wrote so, and Dr. Rahul gave her a prescription.

She never went to the casualty.

Next morning at 4 AM she developed chest pain, and was shifted to nearby hospital. When they too suggested an admission, her husband brought her to the hospital where Dr. Rahul worked.
At 5 AM there were frantic calls from her husband. Dr. Rahul went and checked her again. She was stable. Her husband waited outside the ward.

“She is stable” Dr. Rahul told him.

“I am very upset with the hospital. They charged us for the ambulance, and also for the emergency tests. Also, your assistant wrote on her file that she has blood pressure since five years”.

“Yes. She has high BP since five years, we have it in our notes. We must mention only the truth by law, Sir” Dr. Rahul said.

“But we have not told her insurance company about her high BP and her Neurological diagnosis. If they come to know, they will increase the premium and not sanction this bill. Please change that or I will file a complaint”. He raised his voice.

“Complaint about what, Sir? That you did not let her follow up for two years, stopped her BP medicines, endangered her life till she almost had a heart attack, or that you treat her like a a traditional wife-slave?” shouted Dr. Rahul in his mind. A bad start of the day is nothing new for a doctor, but this was too much.

“Please go ahead Sir. We cannot change medical facts for your financial gains” he replied and left.

As the blood, urine and sonography reports came in, she turned out to have a bad urinary infection. Within hours of admission, two super specialists had attended her and explained her diagnosis and treatment plans.
The insurance company declined to sanction her bills, as they had lied. The Medical Director plainly refused to change the facts mentioned on the indoor files.

“We want discharge” the angry couple started shouting at the junior doctor in the ward, a girl who had just passed out her MBBS. When she called Dr. Rahul, she was already crying: “Sir they are using such foul language. What should I do?”
“Please discharge her as per request, mention it on the paper and obtain her signature. Send her file to me for prescription of treatment upon discharge” Dr. Rahul instructed. Standard procedure.

They went home.
Next morning, there were two emails.

The first was a complaint note from the patient’s husband, that mentioned how everyone ill behaved with them. There were also allegations of delays and excess tests done without reason. There was a huge lament about the bills, questioning everything.
The second was from the customer relations cell. The patient had alleged that a male doctor had done her sonography and 2D-Echo tests, and had not obtained her permission to “touch” her.

Next three days, there were legal discussions, explanations, meetings and much writing to furnish the correct answers to everyone concerned. Useless paperwork destroys millions of intellectual human hours. The sonologist and the doctor who had done the 2D Echo categorically explained how every rule was followed, and how the patient’s permission was obtained prior to the tests. Of course the couple was never going to be satisfied, they kept changing stance, threatening a “big revenge” through Press, and adding new allegations. Many patients could not meet Dr. Rahul, busy with this idiotic activity, and the ones who met him found him too upset.

Dr. Rahul wrote to his Medical Director to hand over this case to someone else, he didn’t want to meet that patient again.

To his surprise, the lady came back to the OPD after five days. She was feeling far better. All her complaints had vanished. She behaved as if nothing ever had happened.

Politely, Dr. Rahul told her that he did not want to continue seeing her. She laughed. “Oh you are still upset at the emails, doc? My husband was too upset because the mediclaim was declined. But we have not complained about you”.

Dr. Rahul pointed out that if the patient is admitted under his care, all complaints are directed to him and he is still responsible for everything.

“Look, Doc”, she said with an icy cold tone, “I could have complained anything against you too. I didn’t”.

That was more than what qualified for any compassion or understanding. But there was no time to fight. He stood up, opened the door, and called in the receptionist.

“Please call a female security officer and escort this madam to a female customer care executive” he instructed the receptionist “and she will not follow up with me hereafter”.

“I will make things difficult for you, doc” said the fuming lady.

“Oh, I practice Medicine in India. You cannot make it more difficult for me” he replied, now regaining his smile. A doctor is not allowed revengeful attitude.

But a goodbye smile, he knew by experience, was the best established revenge.

© Dr. Rajas Deshpande

Based upon a real experience.
Please share unedited.

The Definition Of Love

 

The Definition Of Love
© Dr. Rajas Deshpande

claude-and-marie
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

The Last Wish

The Last Wish
© Dr. Rajas Deshpande

“What is the biggest problem with you right now?”
I asked Mr. Jason.

This was Mr. Jason’s last consult with a Neurologist. At the age of 45, he knew he had only a few weeks’ life left. His wife was all composure, but the sad pressure bottled in her heart was clearly seen in her eyes, the weak effort she made to smile only worsening the suffering on her face.

He was smiling. With shaking hands, Jason grabbed the control stick of his motorised wheelchair, and positioned himself well. He turned left, and from a straw that was attached to the back of his wheelchair, he sucked some water in hasty sips. In slow, haphazard and jerky movements of neck and eyes, he looked at his wife sitting on his other side, then turned his head to me. He appeared to be thinking.

“The biggest problem I think right now is the amount of money spent on wars. So many million children remain hungry, illiterate and unclothed, still billions of dollars are wasted in wars”..

For one moment I thought he was mentally slipping. Another moment I thought he misunderstood the question. Then, as a tear slowly formed in his eye and started to roll down upon his still smiling face, he answered the question in my mind: “You are from India, right Doc? I read from your mythology that all humanity is one, single soul. .. My body will go now, so will my illness.. My only worry is for those who remain after me. I am used to pain, but not defeat. I wanted to work for deprived children. I have donated much of what I have for the underprivileged children.” © Dr. Rajas Deshpande

Then, ignoring the tears he could not wipe as his hands could not reach his face, he added “I came today only to say thank you. You doctors do such a wonderful job upon earth! You listen to all worries, suffering every day of your life. Death and tears are your daily company. How horrifically this must affect you all! You save lives, you take away suffering, but you give away your own life in doing so. I just wanted to say thank you to every doctor who has treated me”.

I held his shaking hand, now violently shaking because he had become emotional. As I choked upon words, I realised his wife was crying too.
“My wife will write to you later. God Bless You. Goodbye.” he said.

In this set up from a Western University, patients of terminal neurological conditions were brought in, aware that it was their last consult with the specialist, and hereafter they shall only receive general care from their GP. They came prepared with a list of questions, sometimes certain legal documents that they wanted the specialist to sign. Some patients were beyond awareness, their relatives completed the formalities for them. © Dr. Rajas Deshpande
They were often required to obtain signatures about mental fitness from the Neurologist, while finalising their will. This sometimes included the wishes about the details of their last rites: the space in the cemetery, the quality, type, size of and the engraving upon their own tombstone, and other details.

In an ironical way it was a severer punishment for the doctor and relative, for they would endure this memory longer.

A young boy of 26 who knew he would die in a few months came over once to obtain signatures on his will. He had requested to not spend anything or even mark his place of burial, donating all his belongings to a charity. “I want the world to forget me. I want to forget this life myself”. He explained, “There are better things than me for the world to remember”.

How difficult it is to overcome oneself? How difficult is it to think for others above oneself, at least at par with oneself? Spending years after years in Me, Mine, Myself, we waste away such a brilliant chance to extend happiness to so many others who desperately need it, in the form of love, affection, food, respect and other basics of life! © Dr. Rajas Deshpande

Competition, enmity and bitterness in our rat race of earning more, being above others and accumulating more than we need has become a routine. Truly blessed are those who are not addicted to accumulation, those who realise that nothing lasts beyond their last breath!

My boss Dr. GR repeated almost every day: “Rjaas, there’s nothing more stupid than dying with too much money in your bank. It passes on the wrong culture to the next generation”. Of course the money-wise world around him was scared of his attitude, which they thought was ‘impractical’. Coming from India, where almost all major saints advised against accumulation, I respected him deeply for his maturity.

After a few weeks, I received a note sent by Mr. Jason’s wife:

“Jason left us quietly in his sleep three days ago. I have decided to continue his work. I am leaving next week for the aid of children in war torn middle east. Jason felt that the only proof of humanity in someone was their caring for others. He so much wanted to visit India, he often said it is a land of saints. I hope I will fulfil his dream one day and visit India. If so, we will meet. Thank you for caring for us”.

© Dr. Rajas Deshpande

Please feel free to share unedited.