Category Archives: Politics

The Proud Indian

 

The Proud Indian
© Dr. Rajas Deshpande

“I was a man of action. It hurts me inside when I look at myself now” said the huge gentleman.
It was indeed sad to see the state he was in. Parkinson’s disease not only slows the body, but also makes one quite stiff, as if the body is made of some heavy stone. The side effects of levodopa, the most common medicine used in Parkinson’s disease patients, was also causing too many abnormal movements.I told him that some changes were required in his doses, and that I needed his cooperation and patience. He agreed, then I wrote him a new prescription.

“By the way, Doctor, if any of your poor patients needs any help with treatment or medicines, please let me know. I will arrange” he said once I finished with the instructions. Always needy for this cause, I took down his details.© Dr. Rajas Deshpande

He came over a month later, happy. This time he donated for an orphanage I often wrote about. I was more than happy, and told him he did not have to pay my fees ever.

“Thank you, Doctor, but you must let me help your poor patients” said Mr. Abdulkadar Mulla.

Over a period of time, I came to know that he donates medicines and free check up kits required for the treatment of young girls from interior adiwasi areas. He spends thousands of rupees every year, since many years, to help run health camps for such children, mostly through the BKL Walawalkar hospital at Dervan in Ratnagiri district.

This time Mr. Abdulkadar Mulla came over, I tried to understand why he is going out of the way to help out children from the interior.

“Because most people are interested in the kind of show-off charity. When you donate to famous organizations in the big cities, your contributions are recognized and published instantly. That is one reason, charity does not often reach where it must: the interior, deprived sections of our country”.
He paused.
“I must say this, doctor, please don’t misunderstand. I feel very bad when someone thinks of me less of a patriot just because I am a Muslim. I have served in Indian police, I have been in the elite VVIP security, I have served India as my own country. It hurts me when some people loose talk that all Muslims should go to Pakistan. India is my country too, I was born and brought up here, studied alongside classmates from many other religions, I have friends in almost every religion. I have served the nation honestly in an extremely responsible position, and am now serving the society by contributing in the most impartial way I can. There are limitations to what I can do as an individual to go on proving my honesty to my country. It hurts when people accuse us without even knowing us. From film stars to cricket players, so many Muslims are making India proud, still some people generalise against us”.

I had no answer. I told him that at least doctors are bred to never entertain that discrimination, that no medical student is fit to become a doctor until he / she can see each patient only as a human life without any other tag. Whether it is policemen or criminals, dirty politicians or reporters who paint our profession in the worst shades, patient from this country or that, from one religion or another: we doctors have only one duty: save life, safeguard health. There is no religion to the happiness of a saved life, nor to the agony of a death. There is no religion to the hand that helps. © Dr. Rajas Deshpande

I remembered the many Muslim classmates I had through my school and medical college. In fact, I was so close to one in my medical college, that his mother loved me like her own child, and cooked me delicious ‘vegetarian’ dishes whenever I went to their home. Some of my Muslim friends now have their own hospitals treating patients from all religions, especially poor. One of my extremely religious Muslim friends, a super-specialist, treats hundreds of poor patients from all religions: without any discrimination in his treatment or approach.

All of us have been through this, everyone who truly worships God knows love for other human beings. It is very important to pass this “Indianness” on to the future generations, and not fall prey to lesser thoughts, however loud. © Dr. Rajas Deshpande

Mr. Mulla told me he had had a spinal surgery, during which a surgeon mentioned the charity work at Dervan hospital. “I decided to donate to this hospital at Dervan. This way my hard-earned money reaches where it is most needed” he said. This institute, presently headed by Dr. Suvarna Patil, conducts multiple health-centered activities for children on a charity basis. Many renowned doctors and other professionals from India and abroad participate in their activities.

“Saare Jahan Se Achcha Hindosta Hamara” by the poet Iqbal brings tears to my eyes every time I hear it! I am proud to meet the likes of Mr. Abdulkadar Mulla, who prove by their silent actions who they truly are. I am also proud to belong to the community of doctors, for whom human life is beyond any discrimination.

Jai Hind! Happy Republic Day!
© Dr. Rajas Deshpande
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Beyond Ridiculous!

Beyond Ridiculous!
© Dr. Rajas Deshpande

A 9 year old child with fits / seizures was taken to a renowned Paediatric Neurologist. He started treatment with one of the most commonly recommended (by almost all textbooks) used medicine in the treatment of seizures: carbamazepine. One of the most effective medicine, used since over 50 years in children, that can cause side effects of rashes in less than 1/1000 cases. Still rarely, the side effects can be very severe, causing extensive damage to the skin.
The doctor explained this to the child’s parents, and then started the recommended doses. Pediatric doctors are the best trained doctors in dose calculation, they are more aware than any other specialty about the side effects in general, because children often cannot even speak and parents may not notice some side effects. © Dr. Rajas Deshpande

Every medicine has side effects. Even vitamins do. Any medicine can potentially cause life threatening reaction, and that’s why the common warning with each medicine: do not use if you are sensitive to this medicine. How will one know whether there will be any allergy / reaction to the medicine without having used it?

Most medicines can cause side effects at high doses, but some can cause dangerous reactions even with the tiniest dose, or test dose. Some medicines (even the one mentioned above) can cause side effects after many months / years of safe use. While the dose dependent (high dose= higher side effect) side effects are somewhat predictable, the ‘idiosyncratic’ (meaning occurring in individual, not all cases, because of the natural tendency of that person) and “allergic” side effects are totally unpredictable, and can be caused by even such common medicines as paracetamol, aspirin, antibiotics or vitamins. Even deaths have been reported after the use of some common medicines, but even in the highly legalized western world, no court holds doctors guilty for the side effects of medicines, if these were discussed and informed to the patient / family. This is against common sense. © Dr. Rajas Deshpande

This child unfortunately developed a rare but well known side effect of this drug, called Stevens Johnson Syndrome (severe skin rashes), had to be admitted and treated, it cost them one lac rupees. While we sympathise with the child and the family, and wish them the best recovery and health, this is hardly the mistake of a doctor.
But the forum, in a regressive decision, held the doctor guilty, fined him 90000 rupees. This is beyond ridiculous. The court observed that “ if the doctor knew that this drug can cause side effects, he should not have prescribed it”. Translated intellectually, that means NO DOCTOR CAN PRESCRIBE ANY MEDICINE! © Dr. Rajas Deshpande

Moreover, what will this court advise for the child now? Every seizure medicine has some rare dangerous side effects. There are no medicines free of side effects. Shall the child be left without treatment now? Which doctor will want to treat such a case? Which court will guarantee that the rarest of the rare side effect cannot happen again in this case, and with such ill-informed forums, the next doctor trying to do good to the child will not be held guilty? © Dr. Rajas Deshpande

Technically, if using a drug that can cause side effects is a crime as per this court, it should hold everyone concerned guilty: the textbooks / medical bodies that recommend this drug, the pharma which produced it, and even the government which allowed it to be sold. Applying the same logic, if some child developed peanut allergy in a hotel or side effects of pollution and dust by travelling on Bangalore roads, will this court hold the hotelier or the city administration guilty and punish them too? Has this forum/ court banned tobacco and alcohol yet, or will it punish the government for the side effects and thousands of deaths caused by these? © Dr. Rajas Deshpande

The IMA, other medical bodies, Neurological society, and intellectuals should stand by this doctor who has suffered the mental agony. This decision must be challenged in higher courts.
We regret that some patients suffer side effects, no one should, but at the same time, the “side effects of medicine” is not the doctor’s fault, especially in this case where he had explained the parents about such possibility.
We need medically educated forums and judges who can refrain from populist tendencies.
© Dr. Rajas Deshpande
PS:
I respect courts. I respect higher courts more. But I refuse to believe that every decision made by every judge is correct, that every decision is impartial, that it is not affected by pressures. This article is solely based upon the attached news clip. I must admit that this reporter Ms. Meghna Singhania has done an excellent and impartial reporting. Doctors must please stand united against this decision.

https://medicaldialogues.in/side-effects-of-prescribed-m…/…/

Fate and The Fatal Healthcare Gamble

Fate and The Fatal Healthcare Gamble.
© Dr. Rajas Deshpande
 
In the rush of a local station, a 25 year old man suddenly shouted in a scary way and threw a fit. His eyes rolled up, his body shaked violently, and he fell down. The jerks kept rocking his body and shocked people around him noticed blood stained frothing from his mouth.
 
Some strong person, too eager to be a hero by the demonstration of gym-built strength, kept his foot on the leg of this patient and pulled his tightened hand to straighten it, till one heard the obvious sound of a bone breaking. Another slapped at the face of this convulsing patient, abusing, and telling the bystanders that the ghost holding this patient must be scared off. © Dr. Rajas Deshpande
 
Yet another, with the confidence of experience, thrust a dirty leather footwear under his nose. Someone else shouted for an onion or chilli, guaranteeing that it will immediately stop this voodoo. This too was then applied to the nose of this patient who was still convulsing. The patient had a lock-jaw, his teeth were clenched together. A spoon was then forcibly inserted between the teeth, and so strong was the effort that few teeth broke and blood oozed out.
 
By this time the convulsion had stopped, and everyone who had thus “treated” the patient proudly explained how each of these tricks always worked.
 
None of them knew that an epileptic attack would automatically stop within a minute and a half, that one should not force open the mouth or straighten the hands or legs, because that will only hurt the patient. The excessive electrical discharge in the brain that causes such fits will not stop by doing anything externally. Within a minute, such activity stops automatically as the brain energy and the currents cannot sustain, and the patient recovers consciousness in most cases. Rarely, such fits go on beyond a minute or two, in which case, only the trained medical practitioners must handle the case, preferably physicians or neurologists. © Dr. Rajas Deshpande
 
This patient was still unconscious.
An ambulance which had the “contract” for that station arrived, and the “paramedics” got the patient in. Relieved that all was well, people, as always after whatever happens, carried on.
This ambulance then took the patient to a “contract” hospital far away, even when there were many good hospitals on the way, thus wasting the most precious time. The patient had aspirated: his blood and saliva had now blocked his respiration.
By the time he was taken to this hospital, he was almost gasping.
 
The contract hospital, owned by an organization that had excellent political links, was designed to hide the deficiency of the most important element in good healthcare: well qualified and experienced, genuine specialists. Being the one to provide the lowest cost treatments, it only employed doctors willing to work on the lowest salaries. Poorly qualified, rarely experienced and already fed up with the workload. But in these days of beautiful, colourful signboards and deceptive advertising, declarations of “world class healthcare”, one rarely questions the training, qualification and experience of doctors. © Dr. Rajas Deshpande
 
The patient was taken into ICU, intubated and ventilated. An orthopedic surgeon attended his manmade fractures.
Legally everything was completed and correct. All forms signed. Critical status explained, understood, accepted. Relatives happy about the charges and the behavior, explanations by the doctors and specially appointed PROs. A qualified Neurologist was called in for a visit, who guided the treatment and went away. He was scarcely in a position to advise the relatives that the basic life support systems require great experience in such cases, and this hospital didn’t have that kind of a team. That would be unethical, plus the hospital had enough connections. That’s what got them the contract in the first place. Also, his calls would stop if he spoke beyond what he was called for.
 
The patient had suffered damage to the brain due to the delay in starting the treatment. He remained unconscious. Then in a week he developed septicemia: infection from the lungs that spread via blood to all his body. © Dr. Rajas Deshpande
The relatives were explained everything, except the fact that the team was inexperienced, ill qualified to treat. They were broken when the patient passed away., blaming their ill fate
It was indeed the fate of that patient to have a fit just there, just then. A young man who could have come back to normal health in few minutes was killed.
 
Or was this fate alone?
 
This death was preventable: a fit generally needs no treatment while it is happening. In this case, people had broken his bones and teeth, forced dirt in his nose, and caused bleeding. The ambulance, due to the obvious “loops”, wasted precious time reaching the “contract” hospital rather than the nearest hospital, the contract hospital took the case in spite of not having well qualified expertise and team to handle the situation, and the relatives did not care much beyond the financial implications. All equally guilty. This was a murder with multiple murderers.
The only thing one can do to help a patient having a fit is to make sure their head does not bang upon a hard surface, remove any sharp objects upon or near the patient, and turn the neck gently to one side, so that the food / tobacco/ anything that the patient has in the mouth comes out and does not block their respiratory pipes. Simultaneously, call an ambulance. © Dr. Rajas Deshpande
 
Remember the 6×6 feet supermarket that sells everything, in the corner of your lane? Something similar is happening with healthcare now. One wants every specialist in the nearest location, with cheapest competitive rates, and so long as their advertisement is good, people are happy when quality takes a backseat. A specialist is a specialist, so long as he / she has any degree, so long as the govt. approves, and especially if they offer concession, nobody cares about tomorrow.
 
The extensive training that goes into making of quality doctors is now replaced by many options: some low quality private medical colleges run by those in power, where money buys almost everything and merit/ hard work doesn’t matter, cross pathy and bridge courses, allowing too many unscientific treatments to take center stage in the country’s healthcare, defaming those who try to improve the system , projecting the philosophy that “all healthcare that is cheap is alone good, costly means corruption” etc. © Dr. Rajas Deshpande
Who suffers when inadequately qualified doctors with poor merit, experience and dedication treat the patients? Who suffers when those who have made their career based upon political support or corruption, treat the patients?
The worst gambling in India is in healthcare. People happily stake their lives to save some money.
 
God save my dear India in this healthcare crisis.
Jai Hind
© Dr. Rajas Deshpande

Are You Respectable, Doctor?

Are You Respectable, Doctor?
© Dr. Rajas Deshpande
 
“Send in the next patient” I told the receptionist.
As no one came in for a few moments, I opened the door. A trembling, shuffling old man in his eighties, standing with the support of his son and daughter in law, was fumbling to remove his sandals outside my door.
“Let it be, it’s ok” I told him.
Smiling, embarrassed that he was unable to move fast, he folded his hands and said ”Namaskar Doctor! You are like a God and your room a temple for me. You give life to so many. I don’t wear sandals in a temple. Let me remove. I am sorry, please give me one minute more”.
It was my turn to be embarrassed. Do I deserve this respect from a stranger just because I am a doctor? © Dr. Rajas Deshpande
 
Mr. Wamanrao, who was a teacher before retiring decades ago, walked in. After examining him, I explained to him and his family that he had a degenerative problem of brain that caused imbalance and stiffness. The concerned family asked some questions earnestly.
 
“Tell them I am old and must leave this world now” said a smiling Wamanrao.
 
Pausing to think for the right words, I explained them the condition, and told him “At present I do not see a reason to worry. I don’t find anything life threatening in your examination, we will also do some tests. But there is no need to think about an end at this time. You should improve, let us try. And yes, it is very fortunate and enviable that your family loves you so much”. It was impossible for me not to remember my own father.
 
In tears, he folded his hands, then blessed me by keeping his hand upon my head, and left.
 
Many patients came in that day, and I kept on thinking: that most of them, especially the illiterates, poor and elderly came with a lot of respect, behaved politely, and followed the instructions well. Some came in bitter with their experiences with some other doctors and hospitals and confessed the reason of their angst. The young, rich and highly educated mostly walked in with a paranoia and refusal to trust. But these were very few, mostly because I don’t dance different for the high class patient. The most difficult class to handle were the uneducated rich and the politico poor, who think everything can be bought, threatened or manipulated, including a doctor. © Dr. Rajas Deshpande
 
This last class offends and frustrates most doctors who work with a feeling of dignity for their profession. Not because they ask too many questions, but because they misbehave, are too arrogant to tolerate, and cannot trust anyone. The last thing that a doctor wants is a trustless patient: it means trouble in future even if the best is done for such a patient. Even if saved from a coma, they will belittle the entire profession and file cases for bills. © Dr. Rajas Deshpande
 
We always claim that some doctors are bad and the good ones bear the brunt, then we must also understand that some patients behave bad, but most others suffer the consequences. The “On-Guard” new generation doctors have now started to become too ‘legally correct’, talking in terms that lack feelings. They are not always wrong, because the law of the land, the crass class of media and many administrators openly badmouth this noble profession that carries the entire healthcare of this country upon their shoulders.
 
However, we as doctors must also think if we always behave respectably. There still is an inherent respect for the profession, in the minds of most. But if a doctor thinks that he / she should be treated like God just because they have a degree, there is a grave misunderstanding. One must be proud of one’s merit, but the patient shouldn’t have to pay the fees for that pride. © Dr. Rajas Deshpande
 
Many doctors are usually well behaved, but we also see very rude, “head in the clouds” type of doctors. A little success, a little affluence, and a ballooning ego is a common picture. Such doctors then refuse to acknowledge the patient (or even their own junior) as another human being to be treated as an equal, with dignity and respect. They will crowd their waiting rooms, make patients wait unnecessarily while they chat / entertain “rich and influential clients” etc. They will behave high handed and rude with patients and juniors, pretend to be in a hurry when the patient starts asking questions and even walk out to see another patient in another room. Many quite senior big doctors actually classify the patients financially, so that the assistant filters out and treats a certain class of patients.
 
Some doctors talk “only the legal” language to patients who are emotionally disturbed, in a state of shock or grief. The other end is the “Always smile and keep the patient in a state of false hope till they can pay bills” type of doctor, who disappears once the patient cannot pay or takes a bad turn of health. Some doctors do not even follow the common decencies of respecting elders and women. Manners and etiquette are fast disappearing among doctors, it is time to remind ourselves that a doctor is one of the highest respected intellectual in our society, and just like the heroes upon the big screen, many, especially children emulate the good behaviors of doctors too.© Dr. Rajas Deshpande. It is sad that our media, movies and comedy shows take pride in belittling Indian medical profession, considered one of the best in the world, but it is also true that some doctors indeed provide them with a reason to do so. © Dr. Rajas Deshpande
 
No one will salute a doctor just for his / her degrees, experience, post or affluence. If a doctor wants to be respected, he / she must carefully learn to respect others, use the right language, and follow manners and etiquette at his end. There indeed are a minority who will mistreat a doctor, who will take advantage and misunderstand manners as weakness or an inferiority complex. Give them a sincere chance to change their opinion. If they are still paranoid, arrogant or rude, then a doctor must move on, politely refusing to see them again. © Dr. Rajas Deshpande
 
In absence of any support from the politicians or media, we must learn to cultivate a positive doctor-patient relationship culture rather than ourselves becoming paranoid. We must learn the new language of “legally correct yet compassionate” medical talk. Patients are an inseparable part of our profession, success and daily life, we cannot be at war with them just because of a few imbeciles.
 
I myself am not free of mistakes, and I want to continue to improve, for the day that I think I cannot improve anymore, that I am the best, I can no more be a good doctor.
 
For my birthday tomorrow (07. January), it was necessary that I reminded myself what my parents and the best of my teachers taught me. The best gift life has given me is the ability to be a doctor, and I must take in stride everything that comes with it.
© Dr. Rajas Deshpande
 
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Dictatorial Actions?

Dictatorial Actions?
© Dr. Rajas Deshpande

If one minister commits a mistake, does the entire government go?

Even the wrong ministers rarely go.
If one doctor / department has committed a mistake, how fair is it to cancel the license of an entire super-specialty hospital, where over a hundred specialists work, many hundred patients are already admitted and many thousand patients follow up for their regular treatment? What about those who had planned major surgeries and treatments there?

There indeed was a grave mistake. The relatives have suffered an immeasurable loss, and this must be investigated and the guilty must be brought to justice. Every doctor feels sympathy for every life lost. This is a science and practice of life where human mistakes are not impossible, they should be scrupulously avoided. If however they do occur, one must not overreact, especially for populist advantages. © Dr. Rajas Deshpande

Whether it was one person or an entire team that was wrong, they must be tried. But how fair is the action of closing down the entire hospital? Is this not affecting the basic human rights of the other patients, doctors and staff working there?

Is this a good tradition to follow in a country with an already collapsed government healthcare system? Someone has lapsed. Who made the hospital protocols? Who implemented them? Were they followed? Who issued the hospital license without confirming standards? If license was issued that means some standards were defined. If not, why was the license issued in the first place? If these standards were defined, it is easy to find out who was at fault, and take action accordingly. © Dr. Rajas Deshpande

It is well known that corporate / majorhospitals have to pay hefty bribes almost everywhere to get every permission. They are business houses promoted by an administration that cannot deal with the country’s healthcare overload. That is also a reason why some hospitals / teams may not follow standard protocols, and confidently overbill the patients. Why doesn’t the government define the limits of profits on commodities rather than capping doctor’s fees? The answers are simpler to the wise. © Dr. Rajas Deshpande

What about the many other good doctors who worked at this hospital, who had joined there as a career, who had bought homes nearby to reach the hospital faster? What about the students who had joined there as post graduates in various specialties? What about the staff?

Was it impossible to hand over the charge to some doctor’s body / organisation or under a competent authority for better running rather than closing down the hospital? The correct action then should have been suspension of the involved department / team till the facts were found out, and after medical and legal opinions, trial as per law. This is what every minister, every administrator, every TDH of any significance demands and gets as a basic right even after grave crimes. © Dr. Rajas Deshpande

There was of course a basic investigation. Why not exactly find out and take strict action against the medical / non medical administrators or owners involved? Add to this the apathy shown by medical bodies and other hospitals in this case.

Welcome to this glimpse of future that will be commonplace for all hospitals if no one acts now. Populist headlines will never solve the grave healthcare that deficits India faces.
© Dr. Rajas Deshpande

My sympathies, as those of every good doctor in India, lie with the relatives who have suffered. They must get justice.But that should not be at the cost of destroying the careers of many other medical and non medical people who were not guilty

© Dr. Rajas Deshpande

Respect: The Depreciating Indian Salary

Respect: The Depreciating Indian Salary
© Dr. Rajas Deshpande

“Over 1.5 Crore Every Year! That becomes more than ten lacs per month! Wow!!” my student showed me the news that some brilliant engineering students passing out from India were hired by some software biggies in Campus Interviews, “They will start their careers at that salary. That’s life!”

I felt proud, as always, these news and similar have always made me feel that the Indian academic talent has always been looked up to and rewarded by the developed world. The tiny speck of jealousy that we earlier felt for our classmates who went for engineering and had their own homes and cars while we were still finishing internships has faded away long ago. The only regret that sometimes peeps out from the past is that of never having fully enjoyed our teens and youth. The fact that most doctors from India also earn huge salaries in the west as well as the middle east speaks a lot about the flaws in our “Indian” thinking.

“Doctors get respect and that is the best that you can get in life. People think of doctors as Gods. You should never think about money” told every sore-throated, pot bellied and self proclaimed socialist who did not become a doctor, and mostly had no doctor in family. This ranged from our own classmates to the highest administrators in the country.

Over the years, I now feel that even the engineering or other stream’s graduates are almost in the same boat. I cannot wish upon the newer generations what we went through.
What is really making us proud here? That India cannot afford to use its own best talent in any field? That the best in all fields are taken away, because what the best Indian companies can offer them is nowhere near what the world outside offers them? That the best salaries in all government jobs are reserved for bootlickers above the age of 55? That in no field can the government find the young talents superior to white haired yes men? © Dr. Rajas Deshpande

Or boast with a shameless pride that the most revered Satya Nadellas and Sundar Pichais made in India cannot find career scope in their own country?

Or, while proclaiming “Vasudhaiv Kutumbakam” (The World Is My Family) on one hand, are we going to perpetually cry the same song of socialism and patriotism, expecting all of them to only follow the examples of the rare (and respectable) ones who chose to shed material life for the country? India needs a million good volunteers in every field who will live and die poor while serving the society. But to force this upon all those who graduate from India is to invite them to leave the country. From politics and administration to Judiciary and lawyers, we need people who will work free or low cost, because the main disease: poverty and illiteracy, is a never ending curse in India. These are the people who choose the governments who throw “low cost everything” crumbs at the society, rather than uplifting the society to respectable self sustaining, paying capacity. © Dr. Rajas Deshpande The lifelong perks of representatives elected for even five years, from any political party are regularly updated, but the salaries and pensions of doctors and other employees who work lifelong are never upgraded without agitations and then only with allegations of greed!

No doctor wants to be a bad doctor, but no doctor wants to spend life in poverty and insecurity.

If at all a doctor decides to do charity and see all patients free/ concessional all his / her life, not only will they be lost to poverty and anonymity, but our government or media will never notice them. All they get is more paperwork to comply with every day, fear of suspension humiliation by the administrators and a salary that’s a shame given their talent and hard work.

There is this curious tendency in India: to force or to beg in the name of charity, social service or patriotism rather than rewarding the talent. There are very few examples of honesty, hard work and talent rewarded without political connections. © Dr. Rajas Deshpande

Are the medical students any less talented than their counterparts in engineering or other streams? Don’t they study equally hard and work 24/7 many more years before they qualify? Even after that, the highest salary that the government offers the starting doctor (even engineer) is laughable, and if they wish to work at a private/ corporate hospital, they cannot decide the rules of payment strategies. If they must start their own set up, they need huge investments, over fifty permissions, many recurring, every one requiring bribe in some form or other. And whichever one they choose from the three career options above, from day one the society and media will have already presumed them guilty of extracting money from patients, the government and even some judges urging them to understand the feelings of relatives beating up doctors. I wonder how many ministers , judges or media bosses would like to understand the feelings of those who beat them up for something their client/ petitioner didn’t like. The most pathetic part is that while all of the above officers are inaccessible to common man, they still have armed security, and the junior most doctor who faces armed relatives is denied security even by law! © Dr. Rajas Deshpande

Most top medical graduates and postgraduates, like almost all other streams from India are leaving voluntarily because of this situation. To deal with this, the best options that some governments came up with were long term bonds to force govt. service (without telling anyone where the govt. spends so much on medical education), and canceling permissions to leave India even after the bond is completed. Bravo! © Dr. Rajas Deshpande

The Hon’ble PM has time and again declared many institutes like AIIMS to be opened across India. This is welcome, but we must also look at the state of conditions and staff in the existing health institutes run by the government. That needs billions for repairs, facilities and hiring better staff. Unless the salary structure for young and talented medical specialists increases , there are no chances of any AIIMS-like institutes running efficiently, they will soon become dirty buildings with low budget staff, where desperate patients are chronically dissatisfied and mobs find chances to vent anger.

Earlier I had immense respect and pride for every doctor who decided to return to India with a positive attitude and a wish to serve the society, their only expectation being living a modestly good life. Now I doubt if they are doing justice to themselves or their family, by choosing a life of financial and personal compromises, where they not only sacrifice, but are still looked upon as “looters”, face a violent society and a prejudiced government.

Ten years ago, I would have told this student of mine “let go of a good life, stay in India, we have a lot to do for our country”. Today, I don’t interfere with their decisions to make a career outside India. Because I love my India as much as any soldier would,and I also love the talented people in it.

Jai Hind!
© Dr. Rajas Deshpande

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Death and Disability by Overwork:  An Indian Diagnosis 

Death and Disability by Overwork:
An Indian Diagnosis
© Dr. Rajas Deshpande

“We are helpless, our life has no worth in the eyes of authority “ said the school teacher.

He had recovered from unconsciousness just a few hours ago, his brain had developed huge clots due to thickening of blood, because he was dehydrated overworking. Due to back pressure generated in the blocked veins, there was bleeding in his brain.

“I was out on the election duty, and did not get time to eat or have water. I returned late night and felt nauseated because of the bus travel, so just had a little rice and slept off. The next morning I had terrible headache. Just after the breakfast the headache worsened and I started vomiting. As our leaves were canceled, it was compulsory to go to work. So in spite of the headache I went for a bath, then I don’t remember, till I woke up in the hospital”.

His wife continued: “I heard a big noise in the bathroom and rushed there, found him lying in a pool of blood, convulsing”. She paused to wipe tears, still unable to overcome the horror of that memory, then resumed: “I called our neighbors, one of them took us to the rural hospital in his tractor. They did a CT scan and started treatment “.© Dr. Rajas Deshpande

“But you are a school teacher, why were you doing an election duty?” I asked him.

“It is compulsory for all govt staff. We must comply or we won’t get our salaries or promotions.” He replied.

This wasn’t new. Doctors often attend many a police, labourers, and other “government service“ personnel serving either the state of central government (under different political parties), who drop either sick, unconscious or dead while overworking. The common factor is they are almost all low level desperate employees who cannot say ‘No’ to the forced additional work thrust unto them. I have never seen a senior officer or a politician coming to the hospital due to physical overwork. © Dr. Rajas Deshpande

To add to the inequality, it is the senior officials / politicos, ministers who can avail of deluxe / higher budget private medical facilities including overseas medicare, whereas the actual ones who get sick shedding blood and sweat in the field are left at the mercy of scanty healthcare facility in government hospitals or low budget schemes at private hospitals. Much like the red light cars ferrying ministers getting preferences over even the ambulances for the poor.

Recently a police officer was brought by his colleagues, he had developed high blood pressure due to an extended duty. A blood vessel in his brain had ruptured, causing huge bleeding. With a great effort he recovered from the coma in few days, but his speech is now forever gone, and he is bedridden due to paralysis on one side. © Dr. Rajas Deshpande

Doctors working in different state / central hospitals too are not an exception. Many tasks / schemes / targets are mindlessly shoved into their routine, presuming that if someone is a government servant, he/ she is a slave to the whims of authorities who can order anything. Besides being taken for granted about 24/7 availability, besides completely ignoring the human right recommendations about working hours, the threatening, demeaning and pressurising humiliation continues almost in every field, where the lower you rank, the worst your slavery.

In a country with excess population, why should there arise a need for one person being burdened with the work of two or three? Why should a school teacher perform an election duty, population stats/ census duty, etc? Why should a police employee work beyond his / her physical capacity? Why cannot the governments hire more people in a country teeming with unemployed youths agitating about almost everything everywhere?© Dr. Rajas Deshpande

If someone wants to work extra for patriotic or financial reasons, they should be able to. But when one is forced to work beyond capacity and legitimate duty, we are encouraging not only health risks, but creating chances of nothing being done correctly. Stress is a major killer via diseases like diabetes, high blood pressure, heart attacks, strokes and depression/ suicides, and while we encourage Yoga for stress relief, we must also reduce overloading one with the duties of three.

“I sympathise with your condition, you should recover well, but you must avoid such overworking now. Also never fast. Drink plenty of water. I feel bad about your extra duties.” I told him.

He smiled in embarrassment, and said “I feel ashamed that while I teach my students to stand against injustice and inequality, to courageously fight to set right what is wrong, I am myself a coward who cannot do so, for without this job I will not be able to survive. I want to be a good teacher, I love teaching and my students love me very much, but inside, I feel I am lying to them when I accept this humiliation by those who I work for. Believe me, doctor, that even when I got unconscious, no one among those who ordered me extra work cared whether I woke up or not”.© Dr. Rajas Deshpande

He was telling the desperate story of many, and I found myself unable to answer once more: that if we have so many educated people who have time to quote history and protest against various political parties or events, if we have so many rich leaders who openly award crores for killing someone (hello, Milords of Indian Justice!), why cannot we distribute duties well and let a school teacher happily just teach instead of dying forcibly doing something else?

© Dr. Rajas Deshpande

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Dedicated to all teachers.

The Business Of Medical Bargain

The Business Of Medical Bargain
© Dr. Rajas Deshpande

“I will die now” the forty-plus gentleman said in a semi-threatening way, “I haven’t slept all night yesterday as I was with my brother, I even skipped my lunch today. I must sleep now. I will leave my cell number, if something happens to my brother, they can call me. You are around, right?”

“Yes, the ICU team is looking after your brother round the clock, I am around till late night.” I told him. There was no point in telling him that I hadn’t slept for last three nights either.

On the prior night at about 10.15 PM, after my work hours, as I went to receive my sister on the airport, I had received his panic call, as this gentleman’s brother had developed sudden convulsions. This brother had seen me few months ago, in emergency, when he had developed a stroke. I remembered that they were quite unhappy about the bills then in spite of a good recovery. They had left with sarcastic remarks about the bills. A good memory is essential for every doctor.

I asked them to rush to the casualty, gave him the number for ambulance, and went to park my car at the airport.

“One Hundred Rupees, Sir” said the person on the parking desk.
“But I am parking only for few minutes, I have come to pick someone up” I asked him, surprised that the parking charges. © Dr. Rajas Deshpande.
“Even for entry the charge is 100 rupees” he told me with a cold smile. I had started getting calls from my sister, she had landed. I paid his hundred, parked the car and went on to receive her. On the way, I called up the casualty and issued instructions about this patient who was to arrive there.

Sis was tired, but happy to see me. I told her that we had to make a stop at the hospital on the way back, there was an emergency.
“When will you become a senior doctor who does not have to attend patients at night?” she asked with a sarcastic smile.
“Never”, I replied, “All Indian doctors die young and working.”
“Shut up, don’t talk rubbish things like that” she said with her feminine instinct. “I desperately need tea, can I get some and drink it on the way?” she asked.
We went to get tea and my coffee.
“Two hundred and fifty Rupees, Sir” said the attendant at the airport tea stall.
“Why?” I asked a stupid question almost knowing his answer, “Even an MBBS doctor charges less than your tea/ coffee”.
“GST” he replied, calmly. As if airport shops were dishing out cheap before GST!
After counting the money and safeguarding it, he gave me two sips each of tea and coffee. We also bought 500 ml drinking water for another 100 rupees, and drove to the hospital. © Dr. Rajas Deshpande

Leaving Sis in the car, I went to the casualty. The patient arrived in a few minutes, it was nearly 11 PM. He was still unconscious, convulsing and bleeding from his mouth. The casualty team got into efficient action, and in a few minutes the convulsions stopped. Writing his orders and answering many relevant and irrelevant questions asked by his irate brother, explaining him the situation and criticality, I drove Sis home well past midnight.

Three days later, he was discharged, fully recovered. Till then I received innumerable calls day and night because of their complaints ranging from blankets, food and ‘the nurse did not come immediately when I pressed the bell’, to medical management and doses etc. The patient and his brother had spent most of their life in Switzerland (restauranteers). They net-researched a lot and tested my knowledge and patience together, till the time I finally and subtly gave them an option to handover the case to a “Senior” colleague, very good but famous for not answering any questions at all. Then they stopped.

Upon discharge, the patient and the brother brought me the hospital bill. A doctor has the same control on the hospital billing that a common man has on the government, I told them so.
“The hospital bill is okay” he said, “but you have charged a thousand rupees per day. That is too much”.

“What would you charge, Sir, if you were a superspecialist with high qualifications and over 20 years of experience, rushing late night to attend an emergency?” I asked him, “What will you charge if you were to attend a person 24/7 under your care, answerable by law and having a right to sue you for lakhs if you commit simplest of a mistake?” © Dr. Rajas Deshpande

“Three Hundred rupees is the maximum I think a doctor should charge. Our family physician charges us that much since last 5 years” he said without a blink.

“Sorry Mister, we are not bargaining about this. Your family physician is gracious, but even he is charging you far less compared to the western standards of care you expect. What essentials of life have gone cheaper in last 5 years? Even the T shirt you wear is an international brand costing above two thousand rupees. Just because you are in India, you did not buy a three hundred rupees T shirt, or a local brand of car or cellphone. Indian doctors already charge far lower, being aware of the poverty status of multitudes. You must not take advantage of this and claim minimal rates for all medical services. In the western world, a specialist won’t have come for you to the casualty after his work hours, nor would you be able to reach him / her, and every consult would cost you over five times what I have charged you”.

“But Doctors should not think about money” said the patient.

I had decided long ago never to discuss money with patients. This had cost me immeasurable losses, some dupe the doctor / hospital outright, while some think a polite sweet talk is enough fees. Some bring VIPs, some threaten blatantly. © Dr. Rajas Deshpande. Even the insurance companies want every medical service to be available at a concessional rate for everyone!

God has given me enough and I am thankful. I go to work every day with an aim to return God’s favours in whatever small ways I can. However, I don’t understand the rich / affording people who take advantage of what is meant for the poor.

“Indian doctors spend only two minutes with the patient” said a recent headline, adding copious amount of fuels to the anti-doctor sentiments of the society. This is a clear equivalent of the naked pictures such newspapers publish to get attention. They conveniently forget the doctor-patient ratio in the western world, the payments for medical services, availability of specialists, waiting period for appointments, the education and behaviour of patients, non-interference by politicians, working hours and facilities for the doctors, and most importantly the fact that India provides doctors to almost every country upon earth, and gets patients from many developed countries too.
Because they know, people will buy the newspaper only if they print those naked pictures! © Dr. Rajas Deshpande

“Ok, just give us some concession” said the brothers.
“Do you ask concessions in parking lots, in coffee shops, in hotels?” I asked.
Disgruntled, he replied “No, but you are a doctor, you must be compassionate to the patient”.

“Compassionate to the patient or his greed for money and skimpiness?” I wanted to ask, but time was running short, so I wrote a note or the billing to cut off some amount from my consultation fees, and resumed work.

India needs a two-tier medical charging system, with those below poverty line getting all basic medical services free and special services at a basic cost, while all others must pay relevantly.

My businessman friend, who is also an excellent and compassionate human being was laughing at me. “You doctors let people do this to you. There is a difference between being compassionate and letting someone take advantage of you. The later is stupidity. There should be a special window for bargainers of doctor’s charges and medical bills, and the bargaining should begin at the time of admission. That is when the value of saving health and life, and the importance of timing are best felt. Once the patient improves, the value of medical service received becomes zero. If they cannot afford, give them the basic treatment for emergency and let them go to a hospital where they can afford the treatment. There are many choices. To insist on a set of specialists, luxuries and then to refuse to pay is the general tendency, you will always lose in this case”.

Almost every doctor enjoys saving lives, treating thousands to relive their suffering. However, the continuous onslaught of allegations about high fees, legal threats, mudslinging by some politicians and socially prominent influential nitwits, combined with a callous attitude by most media takes away so many proud pleasures from a doctor’s life!

© Dr. Rajas Deshpande

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PS: there are some who continuously fail to grasp the main issue and continue their age-old song about some doctors and hospitals doing too many tests, taking advantage. The simple solution is : don’t visit such doctors or hospitals. Don’t do the tests. Be happy.

The Silent Murders and Medical Suffocation

The Silent Murders and Medical Suffocation
© Dr. Rajas Deshpande

“Your grandfather is admitted and serious. Please come at once” my uncle said on the telephone.
I was in the first MBBS. This maternal grandfather was my closest relative after my father. An expert in many languages and philosophies, he was a constant source of love, wisdom and inspiration from my toddler days.

I submitted a leave application and travelled immediately to attend him. Grandpa was admitted in the general ward at the civil hospital Beed in Maharashtra. As the wards were full, he was kept with two other patients in a sort of a broad corridor, and IV antibiotics with saline were being given. He was delirious, but he managed to smile when he saw me. As civil hospitals do not have many medicines, my uncle arranged them from an outside pharmacy.

There was an elderly retired police inspector, Mr. Gaikwad, on the bed next to my Grandpa’s. He had uncontrolled sugar levels, and was slipping in and out of consciousness. His elderly wife was attending him, she was herself a patient of severe arthritis, and could not even get up or walk without excruciating pain. There were no chairs / stools or even mattresses for relatives attending the patients, so we slept on the floor besides our respective patients, upon our own bedsheets. I naturally attended the elderly couple too, I had enough time to attend humans as that was the pre cellphone era. Mrs. Gaikwad told me how her husband had spent his life without ever being corrupt, and said while she was proud that he was so clean, that also meant hardships like the one she faced. “Those who took bribes can afford to go to the private doctors in big cities and keep attendants. Our virtues translated in more hardships, the vocal rewards of words do not ease physical pain, nor pay any bills” she said with tears. © Dr. Rajas Deshpande

One night at about 3 AM, while I was deep asleep, I heard a scream and got up startled. Mr. Gaikwad was having a convulsion, and his wife shouted in panic. I ran to call the nurse, but there was only one for the entire ward and she was in the washroom. By the time she came out, the convulsion had stopped. She stopped the insulin drip and called the doctor on duty, who was asleep in the casualty. He came and administered some medicines and went away, exhausted. He was on duty for over three days in a row now, tired and irritable, yet had no option but to go on. I dozed off again. © Dr. Rajas Deshpande
In a few minutes, I realized Mrs. Gaikwad was waking me up again, shaking violently, because the IV needle of her husband had come out and he was bleeding. In panic I stood up. There was some water on the floor, and before I realized, I fell face down upon the bare floor. Such was the impact that my upper front tooth broke, and tore through my upper lip. It was bleeding profusely. The nurse had come and inserted another IV line to the patient by then, and the elderly lady felt quite guilty for my injury.

The nurse asked me to go to the casualty. The wardboy there refused at first to wake up the doctor on duty, saying he hadn’t slept for past two nights. However, as the bleeding continued, he took pity and woke up the doctor. Already angry, the casualty doc cleaned and sutured my lip with the available suture material, the correct one was not there. He asked me to get the painkillers and antibiotics from the pharmacy, and to fill up the necessary papers and pay the fees at the window.
With a swollen lip and an aching head, I returned to the ward and slept again. The next day, Grandpa was already feeling better, he could get a bed in a semi-private room, and discharged in two days after that.
Mr. Gaikwad, the elderly retired inspector passed away after two days, obviously a case of far less medical attention and facility. © Dr. Rajas Deshpande

I carry the scars till date.

Not much has changed in the civil / government run hospitals, even today. Far lesser beds and amenities, a constant lack of medicines and instruments, anarchic uncleanliness, underpaid and understaffed faculty, “sarkari” type procedural delays: overall a third-rate or worse experience in healthcare, with bribes and corruption at almost every level.
What is being projected is opposite though. The whole blame is being planted upon the medical professionals, and all the so-called reforms being made are just tightening of working conditions of the allopathic doctors. We do need reforms in medical malpractice and corruptions, and they are of course welcome, but many more thousand patients die due to apathy and lack of medicines and facilities at the government run hospitals than those who die due to medical malpractice. The number of administrators and government employees who do not attend government hospitals is a proof of the massive healthcare deficit we have everywhere in India. © Dr. Rajas Deshpande

Ambulances, thousands of more basic and specialty hospitals, more doctors, nurses, support staff in govt. run hospitals, better facilities and medicines are basic social requirements before any other development, advertisements or beautification is planned. However, the whole system appears to be concentrating upon the earning, eligibility and qualifications of existing allopaths.
MCI and IMA must also look into “Compulsory Basic Healthcare Facility and Patient Rights and Care” at all Civil / Govt. hospitals, specifying what the govt. must mandatorily implement in all its set-ups, what are the responsibilities of the administration. The overall (incorrect) notion that “All the problems in Indian Healthcare are because of the greed of Allopathic Doctors” is on the rise because of the “Govt. pleasing policies, comments and attitudes” by some. This will be extremely harmful in the long run. Progress can only be made in healthcare once the medical “Yes-Men” and “Yes-Women” are gone, once the voices that can boldly speak the truth are heard well.

Till then, the private practitioners must stay united in raising their voice against such “unilateral reforms” and defamation, or prepare to be forever suffocated by the system.

© Dr. Rajas Deshpande
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The Untold Slaughter

The Untold Slaughter
(c) Dr. Rajas Deshpande

In my first year of Residency, I was waiting near the hospital elevator, with a colleague, already late at 8.30 AM. The Dean, who is the highest authority in medical campus, on his morning rounds, came with his routine flock: Medical Directors and Superintendents, Nursing Chief, and Assistant Medical Officers, and waited for the elevator. I wished him a Good Morning, he reciprocated and looked at his wrist watch. I understood. “Sorry Sir, I had an emergency last night, I left wards at 7 AM” I said. He nodded and smiled.

He was a respectable odd man out in the system at Government Hospitals then. He was clean and non-corrupt, extremely punctual and active. This reflected in cleaner wards and better services, availability of staff, medicines and devices, although the patients who benefited rarely knew who was the guardian angel behind the service. He had become Dean by a rare chance: there was no one qualified and willing to take on that responsibility, so he was given the charge. However, now those in the “good books” of power were ready to take over, and awaited the right moment.

Like most straightforward and non-corrupt officers with a spine, he was generally hated by the system. He had stopped the bribery and corruption that started from some ward assistant / ward-boy level to all the purchases, appointing committees of different heads. He had stopped the purchase of medicines and devices / catheters from dubious companies which had flourished for years around the town. “Local Cheap Pharmacies” run by the “Well Connected” or aliases of those in power were affected badly, as their whole set-up was designed to run via such government hospital purchases.

The doctors, clinicians and residents like us were happy that the patients got good quality drugs, it is otherwise horrible to witness treatment failures which can never be proven to substandard drugs or catheters. The only face to blame is that of the doctor for a politician or a patient.

Naturally, he was on the hotlist of many in power. The best weapon in politics: the caste card was being used against him. The labour organisations and staff associations that belonged to a different caste / religion than that of this Dean were continuously active to create nuisance, hoping to spread the fire and bomb the press at the first correct opportunity.

Almost all elevators at government hospitals are the basic old re-repaired ones: slow, jerky, unreliable, like many offices. As we waited, few others joined the elevator queue. Among these was a middle aged sweeper lady, who came limping.

“What happened?” asked the Dean to her.
“I fell at home, it’s just a small sprain, I am taking medicine Sir” she replied politely.
The elevator came. As patients rushed in, the Dean held open the door for her, and asked her to get in first.
“Pehle aap andar aao” he said (“You come in first”).
The lady politely replied “Nahi Sir, aap chaliye pehle” (‘No, Sir, You get in first”).
He went in, some staff went in with him, then he asked the sweeper lady to come in too, by a hand gesture.

That was enough. The next day, there was a huge agitation. The allegation was that the Dean said “Aati Kya” (“Will you come with me”) to a sweeper, and made an obscene hand gesture. There were morchas, road blocks in the campus. The sweeper lady declined to comment, her husband who was among the association leaders gave the press interviews. Some student organisations based upon caste and religion were involved, their gusto fueled by those in power. Two of the doctors who accompanied the Dean that day on the rounds also testified that the allegations were true. One of them was in fact the next in line to become the Dean. Everyone sane in the campus felt ashamed.

I was too insignificant then, just as I am today. But I went to the Dean with my female colleague, and we offered to testify what had actually happened.

He smiled through the hell he was going through.
“It was my mistake, Rajas, that I accepted the post. This is how the system works, this is the power they have. It is never any party or caste or religion, it is merely a human tendency and unfortunately, that is in abundance today. We have no chance against the majority, and if the majority chooses to be a mob, we
are helpless. Because mobs are bought and blinded, they have no logic or reasoning. The wisest thing in certain situations is to continue to survive, do your best, till you can help engineer a change”.
“But Sir, those allegations are so unfair and vulgar” my colleague said.
He looked at her straight in the eye, and said “Do you believe all that the politicians say?”.

The change happened overnight.
Disgraced and sent on leave, our Dean did not resign.
“I am the small good that must remain in the system. Twisting facts, making allegations that need no proof, exposing personal lives and relationships, misusing culture, philosophy and wisdom as per convenience are new-age essentials for most political leaders. Illiteracy is a dangerous force. The only hope is those who do not succumb to pressure, keep their eyes open and think with their own brains” he told his friends.

Two years later, when I met him to give him sweets for my passing, to touch his feet and seek blessings, I found the same sweeper lady and her husband waiting outside his office. I told him so when I went inside.

Calmly, he replied “Yes, their son has passed twelfth standard, they need some financial help for his college fees”.
I did not ask him what he would do. Doing good is an obligation with such human Gods, irrespective of what they get back in return.

That places them above every other form of human being dry-blabbering about humanity. I touched his feet thrice that day.
© Dr. Rajas Deshpande

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PS: Some facts changed to mask identity.