Category Archives: neurology

The Good News: ‘Life Is In Brains’

Last three years we were planning a beautiful, comprehensive and patient friendly, “All under one roof” Neuroscience set-up at Ruby Hall Clinic.

Specialty Clinics for Multiple Sclerosis, Parkinson’s Disease, Epilepsy, Vertigo, Stroke, Brain Tumors, and all neurological investigations will be available here, on this floor. Also Neuropsychology, Speech Therapy and Counsellor for family members dealing with difficult illnesses.

My dynamic CEO Mr. Bomi Bhote has long dreamt of a world-class Neuroscience department at Ruby Hall.
“Give our society something to remember you for” he said often. I have tried my best to design this fully new Superspecality Neuroscience Department. After many meetings and many precious inputs from Dr. Purvez Grant, Dr. Manisha Karmarkar (COO), and Dr. Rebecca John, and the blessings of senior Doctors like Dr. Ravi Gulati, MD Dr. Sanjay Pathare we added one stop troubleshooting and convenience so that patients do not have to roam around.

Mr. Iqbal Chaney, Dr. Abhijit Rokade, Mr. Shailesh Kelkar, Mr. Avro Chatterjee, Mrs. Nilofer Shaikh, Mr. Tushar Patil, Ms. Ansha and so many others contributed to the efficient beauty of this set-up.

One item on the top of my bucket list thus ticked off: giving Pune, Maharashtra and India a Neuroscience Department to bank upon. This is just the beginning.

© Dr. Rajas Deshpande

Orphaned Doctor, Change and Future

Orphaned Doctor, Change and Future

© Dr. Rajas Deshpande

For two decades, I have taught medical batches one highest principle in medicine: To go out of your way to earn the patient’s confidence and trust, make the patient comfortable, understand their anger and frustration, and to never lose temper with a patient. Unfortunately, Covid 19 has started to change some of that. Because some patients and relatives do not listen. They do not care if they endanger other people’s life. They have no concept of importance of time and avoidance of “medical gossip”.

We must now treat everyone a potentially infectious source and take adequate care. Longer the exposure to a potential case, higher the chance of infection. That creates a new covid19 complication in our medical practice: dealing with the adamant, the slow, the repeating and the illogical. The days of personally explaining everything logically and patiently seem to be over, at least till the pandemic lasts, as extra time now means that much prolonged exposure. We should now record history with direct questions, examine and diagnose the patient, handover the list of tests if required and a prescription, and arrange for a telemedicine follow up of limited time to explain and discuss. In confirmed diagnoses, we can give the list of authentic websites which patient can read from and get their answers. That will eliminate a lot of unnecessary discussion and “unlimited questions because I paid for this consult”. © Dr. Rajas Deshpande

To risk his / her own life can be a doctor’s choice, but I don’t think any doctor has the right to risk the lives of his / her own children, spouse and parents. I don’t think it is right for the doctor to ignore his responsibilities towards his children, spouse and parents because he has to serve others outside family.

No doctor can endanger other innocent patients and hospital staff by exposing them to adamant, careless patients who refuse to wear masks in waiting rooms. A doctor cannot have time to go out and fight, especially with our politically powered criminals. The only way-out seems to be politely refusing to see the patient who does not follow basic mask etiquette. What is the point of explaining to a patient or a relative who wears a mask on their neck, leaving the nose and mouth open?

Many a times the doctor can diagnose and prescribe for common ailments within minutes, but it is customary to listen to the patient, to pacify their anxiety, to explain in detail and address many a fears born of google searches. The more difficult a medical condition, the more frustrating it is to explain it to patients. In every branch of medicine, there indeed are many extremely complicated medical conditions, situations which the most brilliant doctors also must make efforts to grasp.

It took me 3 years of specialty education after completing DM Neurology to understand Multiple Sclerosis or Parkinson’s Disease well enough to treat it, and even after 25 years of practice, neither me nor any of my teachers- some topmost authorities in the world- who spent their life studying these conditions can claim to have understood them fully. There are far more complicated conditions of the brain we must still keep on studying. How can these be explained to everyone from every background in few minutes?

While the medical treatment is the same for the intellectually challenged and endowed, the former takes the cake here because they stop once they trust their doctor, the later rarely can. © Dr. Rajas Deshpande

The Indian Doctor has been long orphaned by all. The pandemic has revealed the cruelty with which doctors are being exploited all over the country: especially the UG and PG students, interns and junior doctors. It is high time that every doctor takes charge of his / her own career, come out of exploiting contracts and services, even go to the courts if necessary, to be relieved of injustice, and start a good clean practice. That way at least one can serve many more patients, earn peace, satisfaction and funds, while also fulfilling the responsibility to safely look after one’s family. Resident doctors should seriously consider a national level petition to the courts of law about the various unfair practices being enforced at present.

We cannot change the clumsy, clueless, perpetually failing yet adamant mismanagers of the situation who unfortunately hold the reigns.

I’ve worked with orphans. They are most self-sufficient, beautiful souls who learn how to survive independently in a big bad world. I have learnt a lot from them, but the best thing they taught me was to not be affected by the false sympathy, artificial display of love, sweet talkers with black agendas and mean exploiters. They taught me that just holding hands without words at difficult times is far more meaningful than any huge boxes of chocolates, gifts, and to wit: thali, diya etc..

The key to wisdom is in silence. Doctors should silently change now.

© Dr. Rajas Deshpande

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#covid19, #pandemic, #India

Doctor 2025: What Happened After The Pandemic?

© Dr. Rajas Deshpande

The whole family was happily relishing desserts after a sumptuous dinner, when Mr. Shah suddenly went blank. His eyes rolled up, and he started having violent movements of his body. His daughter Amira shouted “Mom, call the emergency ambulance number” and tried to comfort her father who was now in a full blown convulsion, blood oozing from a corner of his mouth with froth.
The ambulance came with paramedics. Its driver handed Mrs. Shah a cellphone: “Please enter his Aadhar card and Insurance policy number, we will take care of everything” he said.

They collected a drop of blood, which would give all the necessary information about the patient. A video scanned the patient and recorded history and legal statements of the family members.
The sugar level was high.

“Was he given sweets? asked the paramedic.
“Yes” said Mrs. Shah.
“Did you take permission from the government? He is a diabetic, sweets are illegal” the paramedic said.
Amira pulled out a big pink note from her purse.
“Listen, please delete that video. Please take another clip, Mom doesn’t know, I will speak” she said. The attendant agreed. His salary had been halved since the pandemic.

They reached the nearest hospital in few minutes. The nurses hooked the patient with various tubes and told the relatives to wait in a counselling room. The patient appeared stable now. “This is really cool. India has made such great progress” Amira said to her sweating mother.

After a few minutes a Doctor on the TV screen greeted them, and explained them that Mr. Shah had developed bleeding in his brain. Interrupting the doctor, Mrs. Shah, sobbing, asked if her husband will be out of danger. Amira too, very anxious, asked many questions. The doctor replied very pleasantly “Just after this video call, you will see a video of all the likely things that can go wrong in your patient’s case. You will also be provided interactive links like a telephone menu, to ask any questions you want, the answers are scientifically standard. All treatment and billing is standardised”.© Dr. Rajas Deshpande.

In a fit of anger, Amira loudly asked “But doctor, we want to see you and speak with you. When will you visit the patient?”.

Smiling, the doctor replied “Oh! Sorry, but we abolished that practice long ago. We don’t directly meet thee relatives now. For every patient, we give you the diagnosis and condition, all the information is made available on the internet, you can read for yourself.”

Mrs. Shah took out the Bramhastra “But we are paying your fees. You must answer and explain to us. You must be available for the patient all the time”.

The Doctor’s smile now became distant and curt.

“No madam. The law requires that I see the patient every day and treat him / her well, which I will continue. The insurance company and the hospital to whom you pay require me to visit the patient only once in 24 hours, which I will do. I am supposed to inform you, which I just did. You are paying the hospital and the insurance company for my services, from which they both cut some amount and pay me, you are not buying my time or me. You are free to request to change the doctor, or for a second opinion at an extra cost. The government has now made it mandatory to treat the patient at the hospital that they will decide, unless you are a special category. There is nothing like personal care now, everything is standardised by the ministry. We have a PRO who can assist you with searching all the information you need”.

Amira, wiser to the world, asked directly, in a cautious, lower pitch “Doc, what can we do to get your direct services? We can pay anything you want. We want you to personally see my father, make all the treatment decisions, and we also want to speak with you daily, in person. Do you have a private hospital? Please, I beg of you, have some compassion”.

The Doctor paused with a sad face, then said in a more personal tone “ I am sorry mam, all private healthcare has been abolished in India. . Many relatives attacked and injured doctors, most spoke in an abusive, rude manner, many wasted our precious time with illogical, repetitive and absurd questions. So the unnecessary was eliminated . During the pandemic of 2020, doctors were abused by our society so badly, that many died, many left either the profession or the country. Now the number of doctors is very low, We have a wild, abusive society that swings between begging for compassion and free treatment to violently attacking doctors. So all hospitals are now controlled by the government, and all doctors just follow the treatment recommendations set by the government. Even the brands and quality of medicines, stents, instruments for each patient are decided by the government, according to that patient’s category”

Mr. Shah’s condition was worsening day by day. Once every day, Amira received updates about her father via a lengthy SMS, with advertisements of big business houses, who had access to every data in the country. Nothing was private anymore.

Amira asked the PRO one day “What happens to the poor patients who don’t have money?”

The PRO smiled in disdain. “There are special insurance schemes and different stadium-hospitals for them. They have the same system, but low cost everything, including medical staff. Those who cannot afford even basic insurance are sent a CD of patriotic songs and motivating sermons. After the pandemic, this has emerged as the most cost effective way of healthcare.”

“What if I want to take my father outside India for treatment?” asked Amira, now fed up with all the robotic answers. All human touch in medicine was lost.

The PRO looked at her in awe. “Are you in Politics? Are you super-rich like celebrities? Because taking someone out of India for medical treatment is reserved only for them, or those who have special links”.© Dr. Rajas Deshpande

Every morning, Amira and her mother went to a temple and prayed. One day, Amira asked the doctor: “Doctor, what if this was your father. Would you do the same?”

The doctor replied “Mam, My father died because I was posted in the pandemic ward. He was a high risk case but I did not get exemption. I think I am already doing far more for your father than I did for mine”.

On the fifth day, Mr Shah woke up. In a week’s time, he was scheduled for a discharge. Arguing about the hospital bills or complaining about the treatment with the insurance company or the government was now considered anti-national, so she carefully remained silent and paid all the bills, right from that for the first drop of blood collected at home and the ambulance. The pandemic tax and GST almost doubled every bill. Everything was authentic and standardised.

On the day of his discharge, a political leader came over, and a picture was taken with Mr. Shah. “Recovered due to the untiring efforts of the party and the government” said the newspaper the next morning.

On the way home, Mr. Shah told Amira “That doctor was fantastic. When will we see him again?”

Amira replied “I don’t know. The government will assign a doctor for you to follow up now”.

Mrs. Shah looking far away, said “At the temple every morning, I prayed for two things: for your health and for return of the good old days of personal relations with our doctors”.

© Dr. Rajas Deshpande

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Much of this is happening right now. This is the foreseeable unavoidable future.

The Suicide In Our Brain


© Dr. Rajas Deshpande

My mom once badly thrashed me up for jumping into a river for swimming (and for many other things I cannot mention here). The sadness of not getting my dream PG seat of surgery nearly killed me. A very brilliant, extremely mischievous and beautiful girlfriend of mine had to marry someone else. Years later, I went through a divorce. During each of these phases, thoughts of suicide crossed my mind like every normal person, several times. During all exams, thoughts of suicide, poetry and a rebellious dropout haunt many. After every suicide, disturbing thoughts of ‘exactly what, how and when’ haunt any sensitive mind.

During my student days, I spent an hour daily in a small space behind our boys hostel to use the double bar, the only facility for exercise. One senior, Sunil, was also a regular visitor, and we became friends. He was repeating a term. He was always smiling, calm and an introvert. Many students made sarcastic fun about his being aloof. Somehow he was nice to me, we usually spoke about stamina building.
One morning I woke up to the shocking news of his suicide. He had hung himself in his hostel room. I had met him only two days prior, and he was as smiling and quiet as ever, had exercised well, spoken in a normal tone, and while leaving had said his customary words of parting “chal bhetu parat” (okay, we’ll meet again)”.

Many theories came forward, and a professor who was always rude to many including Sunil was gossiped a lot about. It was also revealed that Sunil was under treatment for depression since a few years. Some said he was frustrated with his failure and poverty. For a good few months, I did not dare go to that double bar again. I wondered about his parents. How could he have done this? I asked one Dr. Madhu, a psychiatrist who often visited our college from UK. He replied “Well, there is no point in presumptions and allegations. How can one not think about near and dear ones, especially while doing something so drastic with themselves? Suicide is way beyond the grasp of a normal mindset. We must never forget that although immediate causes may act like triggers, usually suicidal thoughts build up over a long period”.
I started reading more about it.

Since then I know of many medicos (and others) who committed suicide for various reasons: failures, stress and negativity, depression, disturbed relationships, blackmail, boredom, harassment etc. I’ve also managed many suicide-attempt cases like burns, hanging, poisoning, drowning or self inflicted wounds. I have followed up with some of these patients for medical issues. It is indeed difficult to deal with some of those cases. To add to the problem, some (not all) anti depressants and other medicines may worsen suicidal tendencies or cause them in a patient who did not have them earlier.

The mental suffering of a genius is beyond the realms of a normal and mediocre mindset. The more extraordinary your mind is, the more it suffers, and only a better brain is able to understand that suffering. One who can feel for others suffers most. © Dr. Rajas Deshpande.

Two other common triggers for suicide- failure and loss- are more manageable. We are so engrossed in marrying our dreams with the rude reality around us, that we create a perpetual high-friction, tense atmosphere in our own mind. Instead, we must learn to unchain our dreams and expectations from the current reality. One can always attempt to change the situation around, but that needs a healthy mind. Unfortunately we do not have gyms made for the mind.

Human brain compels to repeat. We can develop an addiction for anything: negative or positive. The thoughts of futility, ‘having no other options’ can also make home in one’s mind. To be able to catch and prevent this can help some, but not all. Suicidal thought or intention is NOT a mental weakness. No one is any braver for not killing oneself. Suicidal thinking is a state of mind not in control of the owner of that mind, and can be reversed if the right steps (seeing a psychologist) are taken in time. © Dr. Rajas Deshpande.

The importance we all give to complete acceptance and best success is cruel. Parents today want to grow up only gold-medal champions, who can then never be graceful in their failures, or satisfied with being the second best. Lesser success is no success today. No one achieves all that they want. To be able to accept failure must be taught from school. A different, failure-accepting attitude by parents and society during development of a child’s mindset is desperately required. Tying failure to the feeling of being inadequate and worthless is a common crime we all commit.

That brings us to the last thought of this article: we must learn to never let the behaviour of others affect our joys. The wise will get this immediately: one deliberate hurt is too many, never allow another. Exit the situation, it is not called running away, it is protecting yourself. A Mahatma Gandhi cannot feel comfortable amongst a gang of mafias. That said, if all suicides are investigated well, many others in future can be prevented: white collared and financial criminals, trust-breakers who instigate others for suicide are quite common in our society.

Sometimes it is an internal phenomenon to have suicidal thoughts, some other times a sudden emotional shock or breakdown can provoke such an action. We must take every mention of a suicide seriously, even if the person is smiling or casual while saying it. A change in behavior pattern of a beloved introvert can also be an alarm, one must spend more time with them without being intrusive. © Dr. Rajas Deshpande.

Glamorisation of suicide is an open abuse perpetrated upon our social conscience, worst in India, and should be declared criminal, as this may fatally affect some potential young minds. The mindless repetition of suicidal news has a devastating effect on many stressed minds, and who is not stressed today?

Medicine is a difficult career: long, hard and emotionally fatiguing, with late rewards (rarely financial), and legendarily thankless. Many doctor work on the verge of thoughts about quitting. The concept for vacation, rest or good sleep is not allowed to most doctors. This drives some across the edge. The only way to stop this is that each and every doctor looks after their own stress levels, that they take adequate rest and sleep, find leisure and entertainment, every few days. Socio-federal expectations never end, while our life withers away.

A change in career is a good idea, if you feel frustrated for long. One can always excel in a PG branch once not wanted, one can reappear and pass exams, one will meet better people. Most importantly for medicos, education is not a forever state, and after passing, medicine enables us to practice anywhere we like. Let us not make drastic decisions affected by transient scenarios like bad seniors, frustrating workloads or those recurring breakup’s! © Dr. Rajas Deshpande

If given a chance again, I will choose nothing but to be the Neurologist that I am today. The memories of that thrashing by mom strengthen my resolve to stand up to the unpleasant and stern parenting duties so crucial for the safety of my own children. That divorce liberated me (and her) from many more years of painful discomfort. Life, even without anything that I possess now, is still beautiful. Still, every single thing that I possess today is a dream for many, and adds to the inherent beauty of my life. That deeply roots my faith in the wisdom “Whatever happens is for good“. © Dr. Rajas Deshpande.

There are many glaring examples of those who turned tables to win over fate, overcame failures, deception, breakups, crises- financial and emotional, defamation, bullying and humiliation. Almost all of them have dealt with suicidal thoughts, some sought right help, and now are living proofs that this is possible only if one lives on.

I feel like whispering to every silently suffering soul out there: Dream, fight, chill, win or lose, but never give anyone the right to take away your charm. That little muscle-machine ticking in your chest right now, the insane neurochemical chatter of your neurons which makes you say ‘I think’, are miracles specifically made for you. That little hand you hold, someone’s moist eyes upon seeing you, and the enormous capacity of your coconut to imagine a beautiful future – are all precious blessings. Let’s not belittle them by asking for something more just to smile once again.
Smile NOW for what you are, smile NOW for what you have!

About that b. em.& b.. girlfriend… well I fondly miss her still, but every time I think of her, I cannot help smiling!

© Dr. Rajas Deshpande


© Dr. Rajas Deshpande
“Sir, we are screwed. The Chief Minister and other ministers have closed all doors, they won’t respond. Our careers are in grave danger. Can you please help us?” I frantically spoke.
From the other end of the phone, the Don, Dr. Nitu Mandke answered: “See me at my home at 12 midnight”.
The Maharashtra state resident doctor’s agitation for dignity, national pay parity and better living conditions was on, and I was given the responsibility of coordinating and being the face. We had successfully established a multilevel network.
When students go on a strike anywhere in any field, it is almost always out of desperation, either for dignity or for rebellion against some sort of suppression by the system. Students never rebel for money or power. This raw student power is almost as mighty as the army, and although it falls prey to political misuse sometimes, it has tremendous capacity towards achieving intellectual evolution of the society. The government always treats any unrest as an offence to its ego, and uses everything at its disposal: CID, Police, Administration, Force, Threats, Caste Politics, Cheating and Legal torture to mow down student agitations. Students have no money, no experience and rare political or social backing, and must unite and stand up for themselves. © Dr. Rajas Deshpande

On the fourth day of the strike, a big politico from the ruling alliance came over to our office at Mumbai KEM. There was no telling between him and a mafia goon. The members of student’s central committee: Dr. Sanjay Singh, Dr. Dinesh Kabra, Dr. Narender Sheshadri, Dr. Pramod Giri, Dr. Nilesh Nikam, Dr. Kuldeep, Dr. Vishal Sawant, Dr. Noor, Dr. Shahid, and few others were with me. The politico did not have any scruples using an arrogant, raw and filthy language to threaten that if we do not stop and withdraw the strike, our careers and even life will be in danger. As he was from the ruling party and threatened us in presence of the police, there was nothing we could say.
There are angels everywhere. A senior police officer who was supposed to “keep a constant watch” upon us ‘student leaders’ was quite fatherly. He told us “Do what you must, but don’t declare. Dumb people cannot interpret silence. Stay away from any violence”. © Dr. Rajas Deshpande
Unknown calls kept threats alive. That is when a resident doctor suggested we meet the Don: Dr. Nitu Mandke, the famous heart surgeon who was known to be a fearless, straightforward celebrity doctor.

We went to his home, and waited, hosted by his extremely courteous family. He returned home past midnight. We briefed him the details. He asked a few questions to assess our determination and strength. He asked us to stay united and avoid any misbehaviour during the agitation. To our surprise, he picked up the cellphone and called the Chief Minister’s PA. The CM was fortunately available, and talked to Dr. Mandke. © Dr. Rajas Deshpande

After the call, Dr. Mandke told us: “CM has advised us to meet the Deputy CM tomorrow. Two of you come to Lilavati Hospital tomorrow at 2 PM. I will take you to the DyCM.”.
At Lilavati hospital, Dr. Mandke’s chamber was intimidatingly clean and posh, yet simple. He checked our applications for the CM and corrected them with his beautiful pen. His briefcase had every essential of writing stationary, the mark of a perfect man.

As we waited, I asked him cautiously: “Sir, shall we start?” He replied that he was waiting for someone to carry the bag on his table. I offered that I will carry it. He laughed his thunderous laugh, and looked at us as if we were small puppies. “ Deshpandyaa, that bag has two and a half crore rupees cash for construction of my hospital. A professional bodyguard will carry it. People kill for that. Do you want to carry it?”. I shut up.

In his big car, for the 45 minutes that his bodyguard drove us to the DyCM, I asked Dr. Nitu Mandke questions about what was going through his mind when he was actually operating the Shiv Sena Supremo Mr. Balasaheb Thackeray. Such an enormous pressure it must have been!
“Oh yes, it was stressful. But he is a gentleman, and he had assured my safety. His word is enough”.© Dr. Rajas Deshpande.

That’s when we told him how some politicos had threatened us recently. He laughed and replied something that has been tattooed upon my cortex permanently:
“Rajas, a doctor is a doctor and king of lives forever. Politicos come and go. Idiots misbehave with others when the have any post or power, in any field. You should not budge. It is pathetic to see doctors licking shoes of those in power, under various pretexts. It is up to you to maintain your dignity and pride. That is the true luxury, everyone cannot afford it. So long as you do the right thing, fear nothing. The few crores in that bag is nothing compared to how I feel about myself”.

We entered the VIP zone and bungalow. His car was not stopped anywhere. The DyCM offered us tea, and gave us a patient listening.
“These junior doctors and students are my boys, our own boys, they will look after the health of our people tomorrow. You must help them” Dr. Mandke insisted. The DyCM assured he will. The spell was broken, talks resumed.
Many twists and turns later, one of the most memorable strikes was called off.

A year later, I saw a white Lexus car in our KEM campus at Mumbai. Fond of cars and having never touched a Lexus, I went to see it from a close distance. Just as I tried to touch it, the driver’s window rolled down, and I heard “Deshpandyaa, open the door and come in. Do you like my new car?”
And I sat besides the King of proud men, one of the most proficient Cardiac Surgeons, Dr. Nitu Mandke, in his Lexus. The feeling is unforgettable, not only for the Lexus, but for his simplicity, love and affection for a ‘nobody’, a junior doctor like myself!

Needless to say, then onwards, I have guarded my dignity and pride as a doctor more than any other possession I have. That took away many opportunities and huge finances, still I am doing quite well by God’s grace, and Dr. Mandke’s blessings.
How I feel about myself is more precious than anything I can earn. The luxury of pride is mine.
© Dr. Rajas Deshpande

Dedicated to all students, resident doctors, proud people in every field, student unions and their apolitical fearless leaders.
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We are suffering, India!


© Dr. Rajas Deshpande

After witnessing hundreds of careless, maskless and even purposeless (sitting by roadside) people today, I don’t know how many more weeks it will take for the pandemic to go. The longer it takes, the longer will all of us who work for patients have to use excessive precautions that include an extremely uncomfortable get up. When you use such masks in closed hospital environments, in few hours your head aches, you start feeling suffocated, giddy, hot and tired. You cannot just remove everything and buzz off in two hours like many officials or politicos do after meetings/ TV bytes (many of whom btw don’t even know how to properly use even simple face masks).
I bet no one other than doctors or nurses can wear a proper covid gear for 8-12 hours for days in a row while being among patients. Even to take phone calls, drink a sip of water or have a desperate morsel of food after hours of work is a dangerous circus because this get up comes with a lot of precautions. When this happens because others are irresponsible, it is time to stand up for oneself.
Every doctor, every nurse is suffering this torture every day, since months, thanks to both sides. On one side are those in administration unable to control careless, arrogant, irresponsible people all over the country, and are therefore exerting all their angry pressures upon doctors and hospitals, trying to impress public by ceaselessly speaking against these frontline warriors. On the other side are irate, fearful, frustrated and poor and middle class patients and relatives who vent all their anger upon healthcare workers, because none of the “TV Star” faces claiming to be on their side on TV is actually reachable in real life for them. Have you seen a rich or powerful patient ‘suffering’ in this pandemic?
The ever irresponsible Indian media is also creating a havoc greater than the pandemic by spreading poison against healthcare set-ups, and an entirely new crop of ‘social workers’ looking for loopholes, blackmail material, tiniest mistakes to make viral news/ videos against doctors and hospitals. This is their moment of awaited glory: exploiting a rotten situation. It is surprising that while many doctors / interns and nurses have been served notices and have faced suspensions for speaking out the truth, no action is taken against false information deliberately being spread by either media or those who are making videos in and around hospitals during lockdowns.
We are suffering, India, and the careless, irresponsible attitude of our people is causing many deaths as well as extreme torture to all healthcare workers. Many doctors and nurses have been infected, many have died, and many are on the verge of a breakdown. Some have started thinking about quitting.
We are proud to serve, to risk our lives, for every patient from every religion, every state, rich or poor, but we can not continue to die for stupid, egoistic crowds who do not care if others die even when that is avoidable. That is indirect murder, and everyone irresponsible during this pandemic- not wearing masks, not following social distancing, not obeying healthcare guidelines should be charged with criminal offences.
In the 25 years of my career in this glorious profession, I have seen worst of the worst, including bird flu, swine flu epidemics, natural disasters and thousands of helpless bleeding patients lying around. I have met violent relatives face to face, restarted dead hearts and worked under gunpoint. I have dealt with highest and lowest social cadres of people in society. I’ve met hundreds of brilliant students and insisted that they practice in India. But for the first time ever, this pandemic has created a doubt in my mind about the mindsets and perceptions about doctors in India.
I am not sure if I should advise anyone to live an unprotected life without respect, forced by everyone’s whims and caged by society’s expectations after sacrificing so much to become a doctor. There are so many other ways to show our love for our country. Best way currently appears to be only speaking, sm-posting and shouting about one’s love for their country. You always see rich businessmen and celebrities with highest ministers and those who run various governments, but never the greatest Indian doctors. So we medicos must not be enough patriots to shine with the biggest administrators of our land. That says a lot. We should prefer other ways to show our love for India. There are anyways many non-medicos everywhere who think they can run Indian healthcare very well. Let them handle, they don’t seem to need good doctors or nurses.
Think, my beloved India.
Your Doctors and Nurses are Suffering.
Jai Hind!
© Dr. Rajas Deshpande

The Last Bullet For Indian Private Healthcare


© Dr. Rajas Deshpande

Many doctors, nurses and other staff, police officers are dying due to corona exposure. Recently the quarantine period of doctors was cancelled. To add to this, very ridiculously, doctors’ salaries were reduced, and covid funds were deducted from even frontline warriors’ salary. This is like taking money from a soldier’s paycheck to fund the army!!

When I recently heard some people shouting about excess bills in hospitals, doctors not working etc., I felt like shouting back too, but one cannot argue with a sold TV screen.

For decades India has had
Excess urban crowding,
Very poor hygiene.
Very high poverty and illiteracy.
Lack of town-planning for slums.
Severe lack of state/ national healthcare infrastructure.
Tiniest budget for healthcare.
Perpetually under-functioning government hospitals. Every season hundreds die due to epidemics.

Where were you till before the pandemic? Who is responsible for all of the above? Do you want to discuss these factors which are responsible for the pandemic chaos today? Or now you just blame it all upon Doctors and Private hospitals?© Dr. Rajas Deshpande

Only private doctors with small nursing homes and dispensaries, clinics were shouldering all healthcare needs that government hospitals could not provide. They had low profits and catered to middle and lower class. These were destroyed in last few years because of too many stringent regulations and costly licensing. Many closed down. Legal troubles by relatives, politicos supporting them and vandalising hospitals forced many private doctors to stop admitting patients. Protection to doctors was denied by almost all governments till before this pandemic.

Indian poverty is never ending, and charity cannot run anything perpetually unless there’s a strong fund generating mechanism supporting it. If someone expects that doctors charging 2 rupees fees are the ideal healthcare for all our medical needs, they should happily go to such a doctor. We highly respect them too, but it is their choice and there are obvious limitations to that. To develop advanced healthcare in India, higher profits were necessary for higher investment. Corporates, some businessmen and the likes of Mr. Ambani pitched in. Advanced healthcare with heart and liver transplants, complicated brain surgeries, cancer treatments came to India because of these investors. They accepted all the conditions of governments to accommodate over twenty percent poor, nonpaying patients via various schemes. The payments for running these schemes were delayed by various govts for years, and the hospitals were arm-twisted in still continuing to treat everyone. The only source of profits was private and some insurance patients who were paying a higher fees for facilities: from air-conditioning, food to choice of specialists. Higher quality of staff, especially nursing and technicians who can operate high end machinery and robotics requires very high salaries. Maintenance costs are heavy. A specialist cannot do much without such a very good team. Each of these requires good if not great salaries, as they are continuously invited by developed countries who pay far higher.

But then every patient wants the highest facilities, best staff and specialist team, with no payment or basic payment. There’s no concept of billing beyond actual price of medicines and room charges. Service and maintenance is considered a ‘free right’. © Dr. Rajas Deshpande
Even in this modern era of equality, a higher class Indian officer like a minister gets a higher room, better food and other facilities, even higher medical bill sanctions, whereas the labourer from his department gets minimum basic facilities and bill eligibility only for general ward. Law allows higher healthcare’s standards and payments for higher officials. Why do they even have classes in railways and airplanes? If a “Gareeb bechara” migrant wants to fly home, should we offer him road transport or compassionate air travel? Why don’t we do for all the poor something that you all expect doctors and hospitals to do?

We don’t mind if basic and emergency healthcare is uniformly cheap or free for everyone. But when you force a high-end medical commodity (skill-time-investment-staff) to be sold at a loss or extremely marginal profit, you kill the system.

Doctors do not differentiate when making a diagnosis or treating anyone from any financial/ power background. But the private hospitals must be allowed to cater to different classes, earning their profits. That is their only stimulus to grow forward, engage best personnel and bring advanced healthcare to India. Different governments have failed at maintaining high standards of healthcare in their respective set-ups (with some proud exceptions- but because that’s where our powerful go). Some hospitals indeed take more bills for better class of services, including staff, but none of them forces a patient to come to them. Even these hospitals never deny free emergency treatment to anyone.

“But isn’t healthcare a charity? Haven’t you taken oaths to serve?” our loudmouth hypocrites ask.

Yes we have taken an oath to serve everyone rich and poor equally, but no, we have not taken any oath to neglect our own health and well being. Yes we have taken an oath to serve, but we have not taken any oath to live in perpetual poverty and financial stress. Yes we are under an oath to do our best for every patient, but we will not be bending backwards to fulfil their unreasonable demands. Yes we want to save every life, even if it is dangerous , but we will not unnecessarily endanger our own life because someone forces us. We haven’t taken an oath to abandon our families. The Hippocratic oath does not ask any doctor to stay hungry, work without sleep, and do the unscientific because various governments cannot pay for adequate number of doctors. Still we are doing all this already. Let us be clear: we proudly and intellectually serve our country, but we refuse to be considered slaves of either the system or the society. © Dr. Rajas Deshpande

Capping bills in private hospitals will be the last bullet for all advances in healthcare development in India. Be prepared to go back to the chaos of ancient times in that case. Quality will suffer most: right from specialists to nurses to medicines. You can of course force one generation of doctors to work like this, under low cost and excess work. People aren’t fools to send their children to such hells of social slavery. Yes you read that right. There’s a difference between service and slavery. Do not attempt to turn medical service providers into slaves. It will backfire very sourly.

Instead of this, the government can invest in existing private healthcare players to create low cost infrastructure alongside their private hospitals, or privatising its own healthcare institutions with increased capacity. Our governments do have friends in very high places who can invest.

We love India. We are not against any particular government, and this post is not against any leader or party. But we do feel very strongly that healthcare decisions must be made involving everyone concerned, that this people-pleasing for short term will turn out to be a huge disaster in long run, and it will be irreversible. If any government thinks that cancelling hospital permits and doctors’ licences in a country with severe shortage of medical services is the right way forward, God help it.

If private and corporate hospitals start shutting down now, it will be permanent. India will then have to mostly rely upon prayers alone for healthcare. And of course those who think they know medical science more than doctors. India has no dearth of such “fatally self-medicating” ignoramuses.

Jai Hind

© Dr. Rajas Deshpande

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An Interview With a Neurology Legend

An Interview With a Neurology Legend

Dr. Satish Khadilkar

MD, DM, DNBE, FIAN, FICP, FAMS, FRCP (London)

Dean and Professor and Head, Department of Neurology,

Bombay Hospital Institute of Medical Sciences, Mumbai.

He is a living legend, one of the best neurologists anywhere, a stunning example of what an ideal doctor should be like.

He needs no introduction to those in the medical world: he has carved his golden name in global neurosciences with his passion for Neurology and especially NeuroMuscular diseases, pioneering this specialty in India. I am grateful to Dr. Satish Khadilkar for agreeing to guide us all.

Q: How does it feel at the top?

A: Grateful to life!

In the health pyramid, ‘top’ really means ‘more useful’! And there are at least three parts to being useful: providing service, teaching and conducting research. Indeed, I am grateful to life for having provided me with the opportunities to be useful to colleagues and disease sufferers in all the three spheres.

Q: What are the most essential qualities that a doctor must possess?

A: As mentioned above; service, teaching and research are the three main pillars of medical careers. Each of these requires different virtues. Service requires patience, availability, affordability and the capacity to empathize with the sufferers. Teaching requires clarity of ideas and the ability to be inspirational to the new entrants and younger colleagues. And research requires an analytical mind to understand questions, be unbiased to design experiments in search of the answer.

Depending upon which field you choose, relevant qualities will need to be enhanced. In my mind now, as I have gone on, service has emerged as the noblest frontier for the medicine man. So the essential qualities are compassion, knowledge and the desire to help.

Q: What do you suggest we do to improve the clinical sense among newer generations of doctors?

A: Simple answer: bedside clinics by masters of clinical medicine and shadowing them to see how they utilize the limited resources.

Q: How do you deal with the ever widening knowledgebase while effectively practising as one of the busiest practitioners in the country?

A: Knowledge is of two types, one to know it yourself and the other, to know where to find it! In the present times; we have moved on to the second mode. The great thing about this era is that knowledge is freely available. We only need to develop the ability to design the search to get rapid answers to our questions. There are courses available to this effect.

While this is true for problem-based daily issues, in one’s own area of interest, one has to acquire all the manuscripts and threadbare them, assimilate them and understand them, for deeper knowledge.

Q: How do you handle the incessant negativity which doctors face while dealing with so many incurable conditions and gradually deteriorating patients?

A: Negativity in the doctor’s mind stems from the perceived personal inability to help or to provide solutions. Doctors need to appreciate that their role is limited to being knowledgeable helpers. If we keep in mind the inadequacies of medicine as a science and our restricted role, negativity is less likely to take roots.

Q: What is your take on making holidays, vacation compulsory for doctors to overcome stress?

A: Personally, I do not see the need to take holidays, as my daily work itself is a never ending holiday! I do not remember taking a holiday in last three decades. The better you gel with your work, less it stresses you and less is the need to break.

Having said that, as our work relates to human life, we have to make sure that we take adequate rest and are “on the top of our game” for the hours that we work, as our shortcomings can have consequences.

Q: What advice will you give about handling family responsibilities and duties to the new generation doctors?

A: Human relationships take very long to build and only one indiscretion is enough to undo these. So, in relationships and family, equal attention needs to be given, as you would in your profession. In today’s competitive India, we tend to take the family granted and actually end up doing the least for those who matter most!

It is best to think of this early on while planning the professional career.

Q: What best can be done to stop the exodus of doctors from India?

A: Talented Indian doctors need to be appreciated by the society and the health system in India. System needs to be more humane and responsive to the doctors’ needs. Doctors also need to understand the process of medicine, its goals, trials and tribulations. Till this happens, we shall see movement to greener pastures, where this process has evolved better.

Q: Your guiding thoughts for future Indian Doctors?

A: Let us all remember that we are in medicine to help suffering people. That is the core of medicine. We are healers and scientists. If we don’t veer from this ideal and have patience, all material wants and requirements will automatically fall in place. So to understand medicine, one must never forget that this is the noblest of all professions. I have chosen its nobility as a guiding principle for myself. I found my solace in drowning myself deep in the vast oceans of knowledge about neuromuscular disorders and using it in the service of suffering multitudes.

©️Dr. Satish Khadilkar & Dr. Rajas Deshpande

Take me for granted

©️Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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

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

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

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

“What is so urgent about it?”I asked.

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

I wasn’t angry.

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

©️Dr. Rajas Deshpande

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

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

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

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

©️Dr. Rajas Deshpande

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

What ingratitude!

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

©️Dr. Rajas Deshpande

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

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

©️Dr. Rajas Deshpande

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

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

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

Take me for granted, I am all yours.

For now.

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

©️Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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Diagnose This Indian Disease

© Dr. Rajas Deshpande

“Doctor, we had gone to the UK” the patient’s husband was telling me, “What an advanced world that is! Extremely clean and very systematic! People are so well mannered, everyone is respectfully treated. So many facilities… and there’s no pollution at all! I think that world is at least thirty years ahead of us.”

His wife was an extremely complicated case of a subtype of Parkinson’s disease, under my treatment for over three years now.

“I agree”I replied, and I meant it, although it somehow felt sad about it.

“By the way, doc,” he continued hesitantly, “while we were there our son had taken an appointment with the best Neurologist there. Actually we had to pay 250 Pounds, but we thought we could use the opportunity to get a second opinion. We met the doctor there and showed your papers. He checked the patient and advised us to repeat all the tests. He confirmed the same diagnosis and asked us to continue the same medicines given by you, and said there’s nothing more to be done. I am sorry, we completely trust you, but our son insisted on a second opinion. Now we will continue to follow up with you”. © Dr. Rajas Deshpande

I smiled and replied “I am absolutely not offended. A second opinion is a patient’s right and we all exist for the patient. I am happy that the neurologist there has agreed with the current diagnosis and treatment. The only problem is that you had to pay twenty three thousand rupees just for that one consultation ”.

“That was only for the consultation, doc! We paid separately for all the tests” his voice picked up.

Almost every patient who seeks medical care and treatment in the advanced world has experienced that things are easier, faster and cheaper in India when medical treatment is concerned. While Indian doctors may be equal to those in the western world, the technology definitely lags behind because of the red-tapism and taxation, the expectation of charity (and thereby socio-political misuse) from every investment. © Dr. Rajas Deshpande.

While the Western world is decades ahead of India, most medical specialists in India is at par with the western world, and are available at a far lower cost to almost everyone. Faster appointments, much faster turnout of investigations and reporting (probably the best in the world), diagnosis and treatment is something every Indian and especially administrations should be proud of. It takes months to get appointments with the specialist, for MRIs, and for treatments too in most cases outside India, so many from the advanced world actually travel to India for medical treatment. The costs are extremely high in most world, so are insurance premiums, and doctor’s salaries.

All the credit of this medical advance in India goes to the private medical practitioners and institutes, corporate hospitals. Yet most Indians speak in derogatory terms about them. Deliberate attempts of fault finding, accusations of greed and malpractice by politicians, society and media, allegations about medical colleagues by the dissatisfied, unsuccessful practitioners and seekers of quick fame, and an environment of perpetual mistrust and legal action has really made practising difficult for many Indian doctors. Still, we have the best turnaround time and accuracy at lowest costs. Some day someone sane in the administration will hopefully realise this.

When I handed over the prescription to the patient, the husband winked at me “Doctor, I am a pensioner old man. My son made me spend for all the medical in UK, as he had no insurance cover. Can you give us some senior citizen concession?”

Like every Indian doctor who accomodates every Indian patient, I did!

What do you call the condition where you do your best for someone, but the expectations of more never cease at the other end?

© Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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