Category Archives: student

The “Cheap Competition” among Doctors: a Hidden Cancer.

The “Cheap Competition” among Doctors: a Hidden Cancer.
©Dr. Rajas Deshpande
Neurologist, Pune.

A majority of medical students in India are actually from poor or middle class background. Most students come in this profession for service to the suffering and also for social respect. Every doctor passing out in India does not pay crores of rupees for education. This is a system created and maintained by all governments for their strongmen as a source of huge earnings. Many of these “paying” students also work hard and earn their degree. However some few look at the amount spent as an investment and try to earn it back by unfair means. This is NOT the fault of the majority of good doctors (both non-paying and paying) who work hard to acquire their skills and help the society. © Dr. Rajas Deshpande

As the society expects “cheapest” advice even for most complicated health issues, some newcomers, those who are under qualified, those who do not have a good number, and some who don’t have the confidence keep their “Consultation fees” quite low, and rely upon alternate income: through tests, procedures and surgeries, through percentage in hospital bills. Thus, though the ‘entry ticket’ is low, the ‘hidden charges’ compensate for the doctor’s (genuine) hard work and skill.
However, not all ‘low fees’ doctors are bad, but keep their rates low to be able to compete, no one wants to criticise those who have low fees for ulterior motives. This competition to keep the consultation fees low to attract patients has generated most evils in the medical practice. Unfortunately, this is unlikely to change soon, as most people prefer this.© Dr. Rajas Deshpande

The low “Consultation fees“ model works best for even good, skilled and experienced surgeons and branches with procedures (plasty/ scopy etc.), where the patient usually does not question the charges for the procedures or surgery, just because every patient prefers best skilled doctor. There is also a recent trend to offer even “procedures and surgeries” at a competitive low cost by some hospitals, who employ the inexperienced or inadequately qualified/ trained doctors, beginners, lowest skilled nurses, technicians and other staff and instrumentation, catheters, joints, other prostheses. The whole show will be put up for “short term goals”, risking patient’s life and compromising many aspects of good care. In many “cheap packages”, the long term outcomes may be at risk.

Those who run hospitals have many profit sources: right from the tea sold inside the hospital campus to the room charges, pathology and radiology, nursing, drugs and everything used, they earn profits under multiple headings. This is also why they can afford to keep their consultation fees extremely low. However, most doctors employed at such hospitals are not paid anything besides their own low consultation fees, while they remain the face of the “total-bill” for all patients. This system encourages rich doctors who invest in alternative sources of income than the consultation fees alone. © Dr. Rajas Deshpande

Physicians / specialists must rely only upon their OPD consultation and IPD visits. If a proper examination is to be done in each case, and all questions of every patient are to be addressed, one cannot see more than 20-25 patients in a day. Thus if he / she keeps low fees, it becomes difficult to sustain in any Indian city. So they must see as many patients as they can, only addressing the immediate medical issue, and unable to answer many queries of the patient and relatives. If a good doctor decides to spend more time with each patient, and gives up relying upon the “hidden income”, he must charge a much higher consultation fees to just sustain in a good city.

The social anger against doctors mostly comes from increased expenditures on health and unrealistic expectations. Although there are greedy doctors, a majority are just doing their best to make a good name by offering the best service at a low price. Quality healthcare will always come with a higher price-tag, a good doctor will have a higher fees, and that if one wants the “backdoor / cut / referral practice “ to end, one must be prepared to pay higher fees.

In a country where loud and sweet talk, deception and lies are preferred by majority over genuine service, honesty and truth, it is difficult to change the basic attitudes: on both sides..

There indeed are some honourable doctors and hospitals who know the value of their own service, and offer the best to their patient. But even they are usually considered “Greedy” by the very patients whose miseries they end. There are senior / skilled doctors who charge from three to ten thousand or more per consultation, and most of our powerful and ministers go to these doctors too. Although this consultation fees appears high, the accuracy of the opinion and advice often save the patients lacs of rupees. If a surgeon advises a surgery, he/ she can earn many thousands, but if the same surgeon with his skills and experience treats the patient conservatively, avoids surgery and gets good results, the patient is unwilling to pay even half the price of that surgery for the same result. What would anyone do in such a case? The concept that “A Right Opinion by the Right Specialist” saves the patient huge amounts of money and discomfort is yet to dawn upon the Indian society.

The market of cheap has always survived, but in the long run, cheap options always come with a greater final price tag upon health: often your life.

It is my sincere appeal to all my fellow practitioners from the newer generations to please change this structure. See a moderate number of patients per day, charge according to your skill, experience and time, do not undercharge or bargain, then alone this system of backdoor incomes will gradually change. Of course you must consider concessions for the really poor, and accommodate those who cannot pay by keeping a separate time/ OPD for them.

© Dr. Rajas Deshpande
Neurologist, Pune.

PS:
Many city-based imbeciles without any doctor in their family will immediately say that all doctors should go to villages. Those who suggest that, please make your own children (if you have) doctors (if they have the caliber) and send them to villages. Why doesn’t the government make it compulsory for every mla and mp who draws lifelong financial benefits from the country’s exchequer, to send their kids to medical schools and serve in rural India compulsorily? Why is it not compulsory for the elected members to take all treatment in their own electorate? Every law is bent every which way possible to accommodate the healthcare requirements of all the rich and powerful, whether it is kidney transplant or joint replacement, but when extending healthcare to the poor and unaffording, the same people from various ruling parties conveniently point fingers at the medical professionals!

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The Colour Of Blessings

The Colour Of Blessings

© Dr Rajas Deshpande

Carefully calculating the dose and mixing it with the intravenous fluid with precision, I told the kind old lady: “I am starting the medicine drip now. If you feel anything unpleasant, please tell me.”

Through her pain, she smiled in reply. Her son, my lecturer Dr. SK, stood beside us and reassured her too. He had to leave for the OPD, there already was a rush today. “Please take care of her and call me if you feel anything is wrong” he said and left.

Dr. SK’s mom was advised chemotherapy of a cancer. It was quite difficult to calculate its doses and prepare the right concentration for the intravenous drip. Just a month ago, my guide Dr. Pradeep (PY) Muley had taught me how to accurately prepare and administer it, so when Dr. SK’s mom was admitted, he requested me to do it for her too.

The drip started. After a few hours, I noticed that her urine bag needed emptying. The ‘mausi’ supposed to do it was already out for some work. Any resident doctor in India naturally replaces whoever is absent. So I wore gloves, requested a bucket from the nurse, and emptied the urobag into it. Just as I carried the bucket with urine towards the ward bathrooms, Dr. SK returned, and offered to carry it himself, but I told him it was okay and went on to keep the bucket near the bathroom where the ‘mausi’ would later clean it. © Dr Rajas Deshpande

Once the drip was over, Dr. SK invited me for a tea at a small stall outside the campus. He appeared disturbed. He said awkwardly: “Listen, please don’t misunderstand, but when I saw you carrying my mother’s urine in the bucket, I was amazed. You are a Brahmin, right? When you were away, my mom even scolded me why I allowed you to do it, she felt it was embarrassing, as we hail from the Bahujan community. I am myself a leader of our association, as you already know”.

I knew it, to be honest. His was a feared name in most circles.He was a kindly but aggressive leader of their community, but always ready to help anyone from any caste or religion, to stand by anyone oppressed, especially from the poor and discriminated backgrounds.

“I didn’t think of it Sir! She is a patient, besides that she’s your mother, and I am your student, it is my duty to do whatever is necessary. Otherwise too, my parents have always insisted that I never entertain any such differences”. I replied. © Dr Rajas Deshpande

“That’s okay, but I admit my prejudice about you has changed,” he said. “If you ever face any trouble, consider me your elder brother and let me know if I can do anything for you”. What an honest, courageous admission! Unless every Indian who thinks he / she is superior or different than any other Indian actually faces the hateful racist in the West who ill-treats them both as “browns or blacks”, they will never understand the pain of discrimination!

As fate would have it, in a few months, I had an argument with a professor about some posting. The professor then called me and said “So long as I am an examiner, don’t expect to pass your MD exams.”

I was quite worried. My parents were waiting for me to finish PG and finally start life near them, I already had a few months old son, and our financial status wasn’t robust. I could not afford to waste six months. © Dr Rajas Deshpande

I went to Dr. SK. He asked all details. Then he came with me to the threatening professor. He first asked me to apologise to the professor for having argued, which I did. Then he told the professor: “Rajas is my younger brother. Please don’t threaten him ever. Pass him if he deserves, fail him if he performs poor. But don’t fail him if he performs well. I will ask other examiners”.

The professor then told me that he had threatened me “in a fit of rage”, and it was all over.

With the grace of God, good teachers and hard work, I did pass my MD in first attempt. When I went to touch his feet, Dr. SK took me to his mom, who showered her loving blessings upon me once again, and gifted me a Hundred rupee note from her secret pouch. © Dr Rajas Deshpande

Like most other students, I’ve had friends from all social folds at all times in school and colleges. I had excellent relations with the leaders of Dr. Babasaheb Ambedkar Association, and twice in my life they have jumped in to help me in my fight against injustice when everyone else had refused. I love the most fierce weapon of all that Dr. Babasaheb Ambedkar himself carried: the fountain pen!

No amount of fights will ever resolve any problems between any two communities, the only way forward is to respectfully walk together and find solutions. Fortunately, no doctor, even in India, thinks about any patient in the terms of their religion or caste. (© Dr Rajas Deshpande). Just like the Judge in the court premises, humanity is the single supreme authority in any medical premises. Blood or heart, brain or breathing are not exclusive to any religion or community. Just like the bigger brain, a bigger heart is also the sign of evolution.

I so much wish that the black clouds of disharmony between different communities are forever gone. The only hope is that our students can open any doors and break any walls, so long as they do not grow up into egoistic stiffs. © Dr Rajas Deshpande

I am proud to belong to the medical cult of those who never entertain any discrimination. A patient’s blessing has no coloured flags attached! Even outside my profession, I deeply believe that the very God I pray exists in every single human being I meet. If at all anyone asks me, I am happy to say that:

My religion, my caste and my duty as a doctor are all one: Humanity first!

© Dr Rajas Deshpande

Neurologist

Pune

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The Extinction of Precious: A Medical Horror Story Happening Right Now!

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The Extinction of Precious:
A Medical Horror Story Happening Right Now!
©️ Dr. Rajas Deshpande

“Sir, we have come from Konkan”, said the father, “to seek your advice and blessings . My son has passed the medical postgraduate exams with national rank 30. He wants to decide which branch he should choose”.

I congratulated the genius. Passing medical entrances with high merit requires great talent. It does not earn the glamour, claps and appreciation of stage and limelight, for we live in a society that only worships looks, muscles, bhashanbazi, financial success and sports (sorry, one sport. Even if someone wins a world gold in any other sport than cricket, they go home in an auto rickshaw when they return to India!).

Speaking with the boy, I realised that he was very sensitive, compassionate and had an excellent logic and reasoning. Besides having a calm bearing, he was also a hard worker. A perfect blend for becoming a great physician or a surgeon, in a world that is fast losing able clinicians. I suggested him to prefer Internal medicine.© Dr. Rajas Deshpande

They looked awkwardly towards each other. The boy garnered some courage to speak.

“Sir, I saw our family doctor being beaten up by a local politician, his clinic was ruined. He was humiliated in the worst language in front of his wife and children, and instead of protecting him, other patients in his hospital kept on recording videos of the incident, which later became viral. He left, we don’t know where he went. I cannot ever think of directly dealing with patients now. I want to choose a non- clinical or para-clinical branch.”

I appealed to the father: “Your son has a great potential and matching talent to become a good clinician, we desperately need many more. It is not necessary that he practices in your own town or even in India. The whole world needs good doctors. Please think about this”.

The father, a simple teacher from a primary school, thought for a prolonged moment. His eyes reddened up.
“I don’t know, Sir. When he said he wanted to become a doctor, his mother and I always thought that he will become a saviour, running around saving people’s lives. We were never interested in only money. But the day that we saw our own doctor being beaten up by a crowd and the local politician, we realised how helpless a doctor’s life is. We knew our doctor for over 25 years, he was like a God for many in our town. All he did in 25 years became a zero in a few minutes, thanks to a hooligan politico and his crowd. We don’t want our son to ever face that. If we had a daughter in his place, we wouldn’t even have made her a doctor, women as doctors suffer a lot more trouble and get no returns, sometimes even from their family. And this is our only son, we want him to stay in India near us.”

Somehow I didn’t want to give up convincing him, he was an ideal candidate for becoming an excellent clinician.© Dr. Rajas Deshpande “Think of the future. Hopefully there will be better laws, he can also consider working in bigger, safer hospitals if he is scared”.

“What would you advise your own son if you were in my place, Sir?” asked the father.

He had bombed my mind.
I was trained by parents and teachers to always do good, be compassionate and kind. My kids had a potential to become great doctors coming from this background. I worry a lot about the extremely critical condition of deteriorating healthcare standards and reducing number of good clinicians that is destined to cause a havoc in a few years. Still, honestly, I did not wish upon my children the insecurities and threats I face. I don’t want them to live under the perpetual fear of being vandalised, defamed, tortured by over-expectation and punished by committees made up of politicians and medically inexperienced judicial experts. I won’t want their lives, work hours and remunerations to be dictated by a corrupt bunch living for votes of free mongers.© Dr. Rajas Deshpande

It would be hypocrisy to advise someone else what I wouldn’t choose for myself. That’s how a doctor makes the best possible decision. With a heavy heart, I advised him what I always advised my children:

“I agree. Please choose what suits your heart most, what gives you fearless happiness in your work and also leaves you with some time for yourself and your family, ensures a good income and is not dependent upon jealous people’s expectations of what you should do and for what price. You have so many options for social service other than becoming a clinician. I am sure you will stay a good human being all your life.” I suggested him two para-clinical branches that offer good scope.© Dr. Rajas Deshpande

The world indeed will have to suffer the gradual extinction of good clinicians. We need many more excellent doctors in para clinical and non clinical areas too, but the face of the profession is the clinician, and we certainly, desperately need many thousand more. It is a fact that in spite of increasing number of doctors, patients still die travelling in an ambulance to reach good healthcare far away from most homes in India. Many federal orphans who cannot even afford government healthcare die at home.© Dr. Rajas Deshpande

The father asked his son to touch my feet. As he did so, the melancholy of my own advice bit my heart. I couldn’t let down the flag of my noble profession.

“Listen, dear. I am speaking this against my own convictions. I am struggling. Think about becoming a good clinician and practising in a safe country, take your parents with you. I will be happy whatever you finally decide, but not everyone has the ability and talent to become a good doctor, it is rarest of the rare traits.”© Dr. Rajas Deshpande

They left. So did a part of my hope for the future of good healthcare.

When the next couple walked in with an infant baby in their hands, I looked at the smiling baby, and forced a smile. She didn’t know it yet, but I had just bought a precious gift for her.

©️ Dr. Rajas Deshpande

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“What If This Was Your Father, Doctor?”

“What If This Was Your Father, Doctor?”
© Dr. Rajas Deshpande
 
“Doctor, I want to know about this illness. I want to understand it” she said.
It had taken me an entire medical career and a lot of experience to understand this disease in steps, no neurologist in the world claims to have fully understood it. It was my duty to simplify things for her, but it was impossible to transfer years of knowledge and experience in few minutes. I decided to give it a try. If I learn to understand the patient and relative one step more, I will be a better doctor hopefully. This lady, with her Prada and Dior accessories, also appeared well educated.© Dr. Rajas Deshpande
 
“Your father has frontotemporal dementia, a condition that causes progressive loss of memory and abnormal mentation, thoughts, or behavior. This is because certain parts of his brain degenerate faster.” I started.
“One minute doctor” she interrupted “How does that explain why he starts undressing, passing urine anywhere in front of others, even children or guests? He uses such foul language sometimes”.
 
I hate being interrupted. Especially when someone butts in a second question before I finish answering the first. But I must accommodate the patient’s and the relative’s anxiety.
“That is because we have an area in the brain that controls our behavior, stops us from doing social-inappropriate things. This is why we stop from doing certain things in certain situations, while we retain the ability to do them in privacy. That is called inhibition. When those areas in the brain degenerate, there is thus a ‘disinhibition’, whereby the patient does not know what is inappropriate. Somewhat similar to losing mental control after taking alcohol”.
“So the blood supply is cut off in the brain?” she fired.
“I never said that. I said this is due to degeneration. The cells in his brain die faster. Although at this age loss of blood supply is an additional reason for worsening”. When you know too much of something, it is difficult to not confuse.© Dr. Rajas Deshpande
 
You know, I am no Mangeshkar or Tendulkar myself, but this is like asking Lataji “I want to understand music and sing that song just like you” or telling Sachin “I want to make a century like you right now. Teach me cricket in ten minutes”. What they have learnt in decades with extreme hard work cannot be taught / understood or explained in few minutes. I can explain it in a nutshell, but it is not possible to ensure that the relative or patient “completely understood” everything I knew. But then again, the better this lady understood the disease, the better she will care for her father. So I decided another approach.
 
“Ma’m, I request you to please read about this disease from these two websites. Then write down your questions and please book another appointment. We will save a lot of random discussion then.” I told her.
“Ok Doctor” she agreed reluctantly “But tell me what you would have done if this was your father. I thought that with so many advances and researchers, there must be some good cure by now for such diseases” she said. The hidden disdainful sarcasm didn’t escape me. I ignored it.© Dr. Rajas Deshpande
 
“Now please tell me the list of all medicines that your father is currently taking, and their doses” I asked her.
She emptied a huge bag upon my table, with over 20 medicines from different pathies, some unlabeled, and including some bottled oils. She started asking her father one by one, he wouldn’t reply.
“I don’t know doctor” she said, frustrated. “He lives alone near my house, and takes these medicines by himself. We lost my mom few years ago. I guess some of these oils are for his massage”.
Some of those medicines were past an expiry date. The old man hadn’t a clue what he was taking.
 
“But you just told me he has severe memory problems and cannot understand much” I questioned.
“Yes, but we thought he knew what medicines he was taking” she said.
I did not want to embarrass her further.© Dr. Rajas Deshpande
“Ma’m, wouldn’t it be better if you understood the daily necessities of your father before you questioned anyone else about his disease? You can ask the doctor any number of questions, it is my duty to answer them. But I would definitely not have left my father to look after himself in such a situation.”
“No, doc, we are looking for a care center for him already. I cannot look after him, I have my own family and the kids need all my attention”.
“Then please stop blaming the medical researchers for not finding a cure for everything. Please accept that everyone ages and needs care, the same care that you were provided as a child”.
I didn’t want her to be unhappy, it was also my prerogative to understand her situation. I reassured her:
“Please read about this well, and come back next week, I am sure that at least a few problems can be resolved. I want to help you and him”.
 
What would happen if there was a cure for everything? How many of them elderlies will be taken care of, provided for? How long will their children look after them? In most cases, even the healthiest of parents are considered a nuisance once they have grown up the grandchildren. After that, they become an irritating liability.
Then, the annoyance of having to look after them, the exasperation of even a small illness they may have, and the extreme anger to have to spend time and money for their healthcare / treatment is all unloaded upon the doctor. While we are learning to deal with this in our everyday practice, I have decided to spend an extra minute to educate the family about their own responsibilities in every such case. © Dr. Rajas Deshpande
 
As she left the room she asked “Doc, he is elderly, you must give him some concession”.
I smiled. This wasn’t a medical question. It was my turn not to reply now.
© 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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The Richest Doctors

The Richest Doctors

(c) Dr. Rajas Deshpande

“He needs an urgent bypass surgery. Very risky, high chances of death on table.” the cardiologist told us.

My friend’s father, a businessman, was admitted just after midnight for chest pain and breathlessness. The cardiologist rushed to the hospital within an hour and arranged for an agiography. As my friend’s father did not have any cash upon him, and neither my friend nor myself had sufficient amount in the bank, we requested the cardiologist to please proceed without deposits (most hospitals charge the complete bill to the doctor if the patient does not pay). I told the cardiologist that I was working as a resident doctor. He told me not to worry, signed on the paper that he will be responsible for the bills, and the patient was wheeled into the cathlab. When he came out, the doc told us that patient will need an urgent bypass surgery. (c) Dr. Rajas Deshpande

My friend and his mother were devastated. They were passing throough a bad financial phase, and had no funds ready. The patient himself had taken big loans from few business partners / friends, and started a new venture recently.

“You find out the best heart surgeon, we will try and arrange something” my friend told me while his mother kept on repeating prayers, crying in a corner of the waiting hall.

I spoke to my teachers and found out two names who had excellent results in cardiac surgery. Of course they were fully busy, appointments were difficult to obtain, and the surgical costs were an embarrassing thing to bargain: knowing that the best will come at a cost.

“Don’t bargain, I want my father to be operated by the best, I don’t want the doctor to feel that we will skimp. I will arrange somehow”my friend told me.

The best advantage of becoming a doctor came my way to help me: many medical doors open easily for the co-professionals as with any other profession. The same evening I was sitting in front of one of the best Cardiac surgeons in Mumbai with my friend. The VVIPs in the crowded waiting room angrily looked on at two youngsters allowed in ahead of them. (c) Dr. Rajas Deshpande

“He needs surgery urgently for sure. I will plan it tomorrow, although I will have to readjust my schedule, but you will have to shift him to this hospital where I am operating the other case too. We will arrange for the cardiac ambulance, don’t worry.”said the surgeon. (c) Dr. Rajas Deshpande

“Sir, how much will be the charge?” I asked, hesitant and already scared of the answer.

He replied without a blink. Our hearts skipped a beat together, and my friend looked at the ground with wet eyes.

“Sir”, I said pleadingly “Can we get some discount?”

My friend squeezed my hand, and said firmly, but with tears: “No Sir, please proceed, please do the best for my father. We just want him to recover. We will arrange for whatever charges you say”.

“Don’t worry. Please sign the papers so my juniors will arrange to shift your father here early tomorrow morning. I will do my best”said the heart surgeon.

That night, my friend called up many relatives and his father’s friends to get some help. As expected he got none. But after an hour, he started receiving many calls from those who had lent money to his father. They wanted it back immediately. (c) Dr. Rajas Deshpande

By early morning, most of those ‘friends’ from whom the patient had borrowed money gathered in the hospital. They had a meeting with my friend’s mother, who pleaded them and assured that all the money will be returned once the patient recovers.

“What’s the guarantee? We heard that he may die during the operation. We cannot afford that” said the calm leader of the group.

“Please don’t talk such words, I beg of you” cried the lady, visibly torn by what she was facing, “I will sell our house and return your money, we just need some help till his surgery. Please wait for a week”. (c) Dr. Rajas Deshpande

As my angry friend got up to reply, his mother asked him to just shut up. She pleaded the group with folded hands “I promise you, we will sell our house and return your money”.

The group whispered for some time.

“We will wait only if your husband signs that on a bond paper before going in for the surgery. Otherwise we will block his ambulance”. The leader said.

While shifting the patient, a ‘break’ in the ambulance journey was arranged during which the patient on the stretcher was taken into a ‘friend’s’ home on the way to the hospital, made to sign various papers while still wearing his oxygen mask, and only then did the lenders allow him to be shifted to the next hospital. Business is business, and our society condones everything in the name of money, except when paying for health. Along with my friend, I earned quite a big scar that day.

He was taken in the Operation Theater. Inside, the cardiac surgeon’s junior told the boss about the horrific “break” they had to take. The cardiac surgeon didn’t react.

The surgery was successful, the patient was discharged in seven days. (c) Dr. Rajas Deshpande

The cardiac surgeon didn’t charge the patient. He did not mention it to us too, we came to know during discharge. We went again to thank him. He was smiling now.

“It’s Ok. Carry it forward” he told me, then turned to my friend “You too”.

We touched his feet and left.

As we finished our coffee that night at the famous cafe on Marine Drive, my friend told me “Earlier I thought there is no money in medical profession, you people work too hard for what you get. Doctors are kind of “Use and Throw“ community. Now I feel, you people are still the richest whether you earn or not! That cardiac surgeon, by just not charging my father even after saving his life, owns everything I will ever earn in my life! Thank you!”

(c) Dr. Rajas Deshpande

Based upon a true story.

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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.

Busting Medical Myths

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Busting Medical Myths
© Dr. Rajas Deshpande

Just one month after his marriage, this young man suddenly developed weakness on the right side of his body, slurring of speech and started becoming drowsy. His mother, a labourer who collects empty liquor bottles with him for survival, brought him to one of the biggest hospitals in Pune. The whole family had been dependent upon him after the death of his labourer father.

His MRI showed swelling in the brain, likely due to infection. One test on the cerebrospinal fluid suggested possible tuberculosis of the Brain. This being the most common, rampant infection in India, we started with the anti-tuberculosis medicines, and other drugs to reduce swelling over his brain. He improved, and was discharged in seven days.

In the case of any nervous system tuberculosis, the treatment has to be taken for 18 months. If ignored / delayed, this disease can cause serious problems like paralysis, convulsions, permanent disability or even death. This poor family with inadequate education not only reached the hospital in time, but completely trusted their doctors, and followed all instructions. They refuted the innumerable powerful traps of unscientific treatments, taboos and ignorance, broke through the poverty barriers to reach one of the private superspecialty hospitals in a city like Pune, and were cared for without any discrimination.

Today, Nitin Londhe completed 18 months of treatment and is being declared free of his dreadful illness “Tuberculous MeningoEncephalitis”. He has continued his labour work since after the discharge. He told me today that many truckloads of empty liquor bottles are collected in every city every day, (No wonder people cannot afford medical treatments!) many agents sell these bottles back to the liquor companies for a commission, and labourers like Nitin get 200-300 INR per day for collecting such bottles.

Happy that he had recovered and was stopping the treatment, he told me “My mother is uneducated, but she believes that there is nothing costlier than health and life, one must never ignore illness, money has no meaning if health or life is at risk. We wanted the correct treatment”.

I told him I wanted people to know his story for two reasons: that even the most difficult cases of Tuberculosis like that of the brain can also completely improve, and that most of the biggest corporate and rich hospitals admit and treat the poorest of the poor, saving thousands of patients every day. The myths generated by some politicians, media and some filmstars, that all doctors and private hospitals just “mint money” and kill people while all political leaders, filmstars and media reporters are holy saints, who are true saviours of the poor had to be busted with such examples.

Millions of poor, non-paying as well as concessional, are treated and saved by private practitioners and biggest of the big private hospitals every day, everywhere in India. Unfortunately, the hole of Indian poverty is too big to patch, national / federal healthcare systems are failing, and so the demands and expectations from private practitioners are never ending.

“Do you have any questions?” I asked after thanking him.

Shyly, he asked “Can I do dancing stunts? I love dancing and I like to dance on headstand”.

If anyone deserved madly dancing today, it was him. I told him so.

© Dr. Rajas Deshpande

PS: Thank You, Mr. Nitin Anton Londhe for the courage and permission to share this story.

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