Category Archives: Parkinson’s Disease

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

Please share unedited

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

Please share unedited

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

Please share unedited

Survival Of The Quickest

© Dr. Rajas Deshpande

This young and brilliant man, Adil Masalawala, suddenly appeared to have changed. His behaviour became different and unusual. He started mumbling and replying irrelevantly. He also had fever intermittently. His caring and worried wife Mrs. Venus consulted a physician who sent them to a psychiatrist.

The psychiatrist checked Adil and advised him admission. He started with some medicines, but suddenly Adil’s behaviour became hyper, his body started becoming stiff. Then he became drowsy, and his body started shaking violently. An MRI of the brain was reported normal. That’s when the psychiatrist advised a reference for neurologist.

When I first saw the patient, he had many features that could also be caused by side effects of some medicines. Sometimes it is impossible to conclude whether it is the disease or the medicine which is causing certain symptoms. I suggested that we stop all antipsychotic medicines. That could also be a dangerous decision. The family was counselled, and they agreed. Adil’s drowsiness improved, but he became very agitated, and his stiffness and shaking worsened.

There are many neurological diseases of the brain which start as abnormal behaviour. Strokes, some infections, tumors and swellings are examples of treatable, but there are many untreatable and dangerous conditions too. The only way was to urgently investigate the patient further. Although the family was baffled and panicked, Mrs. Venus expressed complete trust in our decisions, and allowed us to shift the patient to the ICU. I could not answer many of their questions, I did not clearly understand what exactly was happening, but this uncertainty and challenge is what medicine is all about.

There is fluid in and around the brain, which nourishes the brain and also acts as shock absorber between the skull bone and the brain. Many diseases like cancers and infections can be diagnosed by studying this fluid, which can be taken out by inserting a needle in the lower (lumbar) spine. We checked this fluid, and we got the first clue: that we were possibly dealing with a viral infection of the brain. Many more costly blood tests were required to find out which virus was causing this. The family clearly stated “Do whatever is needed in your opinion”. We sent the tests and found the answer: Adil had one of the most rare and dangerous viral infection of the brain, called Japanese Encephalitis.

About 30-40 percent of patients with this diagnosis do not survive. There is no definite treatment for this virus, but many of the manifestations can be treated and excessive care is required to avoid life threatening complications of the swelling that it can cause in the brain.

On the fourth day, Adil had convulsions. His condition worsened. We kept on treating each complication as fast as possible and tried to balance the effects and side effects of the many strong medicines that were being used to control convulsions, shaking, and the brain swelling. Besides knowledge, wisdom and experience, our major strength was the trust of patient’s family who never questioned any decisions.

Many patients who develop abnormal behaviour are mistreated as having a psychiatric problem. Most qualified psychiatrists are aware of the red flags and refer patients for a Neurologist’s opinion. However, a majority of patients with psychiatric problems in India are first taken to quacks, magic healers, mantrik-tantriks, who delay the whole process of correct evaluation, diagnosis and treatment. This leads to many deaths, and this is worst in case of cancers treatable in earlier stages.

False advertisements, some even approved by highly placed offices, celebrities and authorities attract people from all classes and cause severe delay in initiation of the correct scientific treatment. While our governments rightly pressurise allopaths to write generic medicines, they mostly turn a blind eye towards rampant misleading false advertisements claiming cures of incurable diseases and centers that flourish reaping from the hope of millions of illiterates.

We almost thought we had lost this case to a permanent disability. Adil’s body had become completely stiff, his memory had become unreliable to a great extent, and he had an incapacitating tremor. After a few days we could gradually stabilise his general condition and shift him out of the ICU. In a few weeks he was discharged, improving slowly. His family, especially his wife fought for his normalcy like a true warrior, and once he resumed his senses, Adil too made every possible effort to recover fast. One day after a few months, he was back to normal again, we declared him cured and fit, physically and mentally. He resumed his job.

Today after about ten years, Mr. Adil Masalawala and his wife Mrs. Venus came over for some trivial issue, and we recalled the horror that we went through and his victory over it. In this case, I thought it was the “Survival Of The Fastest” as the family did not waste any time in quacks, arguments, objections or mistrust, and let us doctors do the best for the patient in the fastest possible way. We are grateful to the family for this trust, and Adil’s survival and recovery itself is our reward. God bless the couple with a long and healthy life!

© Dr. Rajas Deshpande

Real Story, Real Names, With Patient’s Express Permission. Grateful to Mr. Adil and Mrs. Venus for the permission to share the story of their victorious battle.

Please share unedited.

The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

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

1. Denial of false certification.

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

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

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

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

6. Advising necessary investigations.

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

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

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

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

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

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

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

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

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

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

How to know?

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

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

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

Please share unedited.

The Fairy And The Prince

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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

Please Share Unedited.

“Dev Borem Korum” (Thank You)

(c) Dr. Rajas Deshpande

As the plane landed, I called up the driver who was scheduled to pick me up from Goa airport.

“Hullo, Mr. Clement? I’m Dr. Rajas”

“Haan daktar. Tu aaya kya? Bahar nikalke miss call de mai ayega” (Have you arrived? Come out and give me a missed call, I will come there”) . He would have said the same sentence to the President as well. Goans are least hung up on artificial flowery language, they are the friendliest lot as a society. It was after a year, that the same Clement said to me: “Tere liye apun jaan bhi dega parwa nai” (“I can give my life away for you without any hassles”), when I thanked him for something.

Goa has some excellent Neurologists, and my visiting is actually redundant. Yet somehow, maybe because they keep quite busy, or sometimes patients seek a second opinion, I have been seeing a good number of patients every visit. In the very first visit, after I saw an elderly lady and explained her the treatment, she bowed and said “Dev Borem Korum Doctor”. That means “Thank You Doctor”.

Then I pleasantly noticed: irrespective of what was the diagnosis, what treatment was given, whether there was treatment for the patient’s condition or not, whether the patient improved or not, almost every patient said either “Dev Borem Korum” (Thank You) or “God Bless You Doctor”. Even if surgery was advised, even if there were side effects of medicines, even if the outcome was not as expected in rare cases, the “Thank You”and “God Bless You” never changed. It had nothing to do with any particular social class. The rich, the poor, the educated as well as the uneducated, people from every religion, every age group said it. It is a part of that culture: the Goan culture.

Late one night after the OPD, when we were driving on a beautiful long empty Goa road near the beach, I mentioned this fact to my friend Dr. Samuel (God Bless Him for the exotic dinners he takes me to!), he stopped his car and looked quite affected. “I wondered whether anyone else had noticed that. It feels so beautiful! When the patient is grateful and brings you blessings, you automatically feel responsible to do the best for them. Money never matters in that relationship. We must never take patient’s kindness for granted. So many of them actually say Thank You, God Bless you, but sometimes we are too preoccupied with work, anger, ego and other things to reciprocate and encourage that kindness”.

I told him about my late Professor Dr. Sorab Bhabha, who stood up and greeted every time a patient entered or left his cabin. The onus of initiating a good doctor-patient relationship primarily lies upon the doctor, and it is extremely essential to follow the best of manners and etiquette, kindest of language when dealing with patients.

A very sweet girl who followed up for epilepsy recently told me that she visited me not only for medical purpose but because she was inspired by the way I appear calm and composed, the fact that I never raised my voice and always spoke compassionately with everyone. I had to tell her the truth. “Thank you mam, but I am quite short tempered outside the hospital. Even the junior doctors working with me sometimes find me intimidating. But I have to change when I am with a patient. I don’t think that any patient comes to me because I am any better than anyone else in the profession. I prefer to think that they choose me because they trust I can solve their problem. Will you be rude to someone seeking your help? Then how can I get angry with a patient? Every patient coming to me has that hidden trust, which I must justify. Only rarely, if the patient misbehaves or says something insulting, do I lose my calm.”.

“That’s what I like. So humble!” she had to have the last word!

Yes! The day I bring my ego inside the hospital, I will no more be a good doctor. Even the most illiterate patient understands when the doctor is being rude or artificial. Only when it is genuine, the patient will feel the warmth of my compassion and care. It has nothing to do with sweet talking or a show of affection. The only way to do this is to actually incorporate it within one’s depths so that it becomes one’s originality. Kindness and compassion must be the original, genuine qualities of every doctor who expects gratitude from each one of his patients. It does work in most cases.

After dinner, Dr. Sam took me with two other friends to the beach and we silently stared at the luminous moon for a long time. The music of those waves matched the dance of that moonlight upon the ocean. Just as one can feel the glow of the moonlight upon one’s skin, I could feel those numerous blessings keeping my soul warm and happy.

(c) Dr. Rajas Deshpande

Please Share Unedited.

Hope-Milking: An Ugly Medical Curse

© Dr. Rajas Deshpande

Mrs. Patel sounded very happy, almost on the verge of shouting: “Dr. Deshpande, did you see the new video? Finally there is a cure for my husband’s condition. I have already booked tickets, we are travelling tomorrow”.

I had seen the video. I knew from experience that it would not help her husband much. Yet, the words in that video advertisement were framed so effectively, that even a low-brainer medic would be confused about the truth.

The effects are indeed magical, but not for the patient. By the time the hype of such viral videos dies down, thousands of patients have already bought the product, earning unprecedented fame and/ or funds to the makers of such videos. This has become an excellent tool for attracting patients under a false pretext.

There are many medical conditions which have no treatment or cure. This is saddening, and we doctors face the justified frustration of such patients and their relatives many times every day. We are also equally eager for cures. It is taxing and nerve-wrecking to hear patients vent the pain of the same issues repeatedly for years. But for the sake of the patient, we must listen, be patient, and keep reassuring them with compassion and sympathy. But we must never lie to them. © Dr. Rajas Deshpande

“Transfer the patient to our hospital, we will manage better” some doctors say, get the patient transferred under themselves, and after a lot of ‘costly surgery, treatment etc.” simply tell the relatives that it was all inevitable and unfortunate. Wrong assurances and milking the hopes of such critical patients is uncalled for, and to a great extent, unethical. Add the tags like “cheap, charity and low-cost” to healthcare, and such a trap is complete. © Dr. Rajas Deshpande

Many videos and articles claiming “dramatic relief, cure”, “new technology”, “diet therapies”, “herbal treatments”, “sexual weakness / ED”, “weight loss”, “sugar control”, “stem cell therapy in unindicated medical conditions” “hair growth” etc. circulate and become viral. Both educated and uneducated patients who hope for a better life fall pray to such hidden advertisements. Months or years later, they realize that their condition is the same or worse. Some develop adverse effects like damaged kidneys, liver or brain, and never realize that it was related to unscientific decisions from years ago.

This is medical pickpocketing.

The saddest part is this: many patients respond to any medicine or procedure / surgery (placebo effect) for a short while, and some with psychosomatic illnesses indeed feel a ‘dramatic relief’. Those who do not benefit seldom come forward. Such medical ads never show how many patients suffered side effects, how many did not respond, or what are the hidden costs. © Dr. Rajas Deshpande

It is sad that this “Hope-Milking” disease has spread rampantly among all streams, including allopathic / modern medicine. Some doctors now publish videos of their own personal discoveries, formulas, potions, without declaring contents, without scientific studies (or with mock/ manipulated scientific trials), as if there is no FDA, Medical Council, experts in respective fields or any such authority. There is no difference between such doctors and roadside herbal medicine quacks or different Babas / Maulas selling ‘magic medicines’ to a predominantly illiterate nation.

Besides being unethical, such practices falsely convey “I know better than all other experts in my field”. That is cheap! Medical councils, doctor’s bodies and IMA should strongly discourage such practices, from all genuine and other streams of medicine.

After a few weeks. Mrs. Patel followed up. “Dr. Rajas, I am sorry. We were carried away by the ad. Initially he felt better, we spent a lot of money, but now we realize it was too costly, it had a lot of side effects and it was not a permanent cure as advertised. We were happy with the earlier treatment”.

Just as I walked in the hospital lobby, I saw a large crowd in front of the television set. National news bulletin was on, dead soldiers and their crying families were being shown. Simultaneously running were the ads by different quacks. A lady was asking her son to jot down the number of a man who claimed to “completely cure all heart diseases with a single medicine”.

I prayed for the health of whoever her patient was, and walked ahead. I had a lot of genuine medical work to attend.

Written in the best interests of my beloved patients and profession.

Please share unedited.

© Dr. Rajas Deshpande

PS: My dear patients, before falling pray to any “new dramatic medical treatment/ cure” traps or ads, please consult your regular doctor and confirm authenticity. You can also visit authentic medical sites like Medscape, Medline Plus, National Institute of Health (NIH), Mayo Clinic, UpToDate to know about the latest approved treatments for all medical conditions. Do not rely upon blogs, support groups, viral videos or personal/ individual sites for making treatment decisions. This can be very dangerous.

Be A Woman!

©️Dr. Rajas Deshpande

A major part of the pride of being a doctor is the freedom from any discrimination between humans. Every woman or man, from any religion or country is equally important, and also equally cared for.

Yet as a doctor I have often witnessed women being stronger than men when life presents any calamities, however explosive. Women are probably more emotionally destroyed with a traumatic event, yet they pick themselves up and fight like a mother for whoever they choose to stand by and protect. And we know, a mother makes a strong army! Any patient cared for by a woman heals faster, be it a nurse, a sister, servant, daughter, wife or mother, be it a girlfriend or just a woman without any relation. In any family, it is usually the women who keep the bonds of humanity and culture alive. We have so many biases about cultures and how women are treated, but it is an unfortunate fact: that women do things men find impossible. Hence the title, Be A Woman!

We often hear from working men in the metropolises how they cannot bring a parent in wheelchair to the hospital as it would be a lot of trouble and time.

Ms. Eshrak (a psychologist) and her sister (a bank employee) brought their mother on a stretcher all by themselves, all the way from Cairo, Egypt, to Pune India, in a hope to see her walk again. To travel to another country without knowing anyone there wasn’t their biggest problem. Reaching India from the war-torn middle east is a nightmare, but once they reach, local Indians, especially police officials are very cooperative in helping out especially patients coming for treatment to India.

They found a friend in a local Arabic student Mr. Ashraf Olafi, and had him search my clinic (I am sure any good qualified neurologist could have treated them equally well!). Their mother, suffering from Parkinsons Disease, walked after many months today, so they came with the two greatest gifts for their doctor: a smiling gratitude and blessings. Of course they brought a material token!

What better proof can there be of women not being dependent upon men? If only we recognised how incomplete and incompetent humanity would be, without the strength of women!

To artificially write about gratitude for women in one’s life and to thank them superficially to impress press and public has become a fashion, few do it from their heart. I pity those “high flying, successful” men who boast about how they respect women and consider them equal, while their wives are in fact taking care of their home and children, opting for hugely compromised careers. The truth is, a man, however strong, is always indebted to some woman!

Be A Woman!

That should always have been the correct slogan..

©️Dr. Rajas Deshpande