Category Archives: student

“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

Please share unedited.

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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The Bleeding Curse of an Extraordinary Doctor

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The Bleeding Curse of an Extraordinary Doctor
© Dr. Rajas Deshpande

“I cannot sleep well, I cannot forget what happened” said the doctor who had come to consult. I was shattered myself. My usual poise was blown to pieces listening to what this mountain of sacrifice was telling me.

As Dr. Anil Dadarao Waghmare told me about his past, I was in frightful tears.

Son of a humble education officer, he had joined MBBS on merit basis, and completed it in time. He wanted to honour the government bond for two reasons: he had an inner desire to serve rural areas in India where medical care was not available, but he also had no other source of income and had no money for investment. This is the common story of most doctors graduating in India.

He joined as a medical officer and was soon posted in a very remote tribal area, where he went beyond his duty to help the illiterate poor tribals. He worked ‪24/7‬, attended all their problems like deliveries, poisonings, snake bites etc., but also went to visit homes of those who could not reach him. He offered his designated vehicle as an ambulance whenever someone was to be taken to a higher rural hospital. His wife and children accompanying him sacrificed normal life. Two of their kids went to the local primary school, the quality of education was extremely poor but they had no option. The third child was only 9 months old. This youngest daughter was often looked after by a 12 year old girl who lived next door, and helped Dr. Anil’s wife with her chores.

One day, Dr. Anil’s wife received a phone call. The lady caller who spoke in local dialect told her that this youngest 9 month old daughter was in her possession, and threatened to kill her if a certain amount was not paid immediately. By the time they could arrange anything, the infant was found dead by suffocation. The 12 years old girl who looked after the child was found dead in a local well after three days, a huge stone tied to her body.
The murderers were soon arrested: the lady confessed to the crime, assisted by her parents, for want of money.

All the three: the murderer lady and her family were being treated by Dr. Anil for over a year, as free patients.

Dr. Anil was transferred elsewhere, and decided to still continue serving the rural population. He has now joined a postgraduate course, but he wants to keep working in rural areas.

“No one cares about a doctor’s life, family or especially security. The situation is worst in the rural areas, where illiteracy, superstition, witchcraft, murders and rapes are commonplace. Local politics is at its worst” says Dr. Anil, “I was ready to sacrifice every pleasure in life to serve rural population, I even compelled my family to sacrifice, but I did not deserve this punishment. This pain is beyond description, sometimes I feel whether my decision to go to such unsafe place with family was correct. This bleeding curse kills me every moment”.

Thank you, those who keep saying that our society considers doctors ‘like Gods’!

While air conditioned hypocrites advise doctors to go and serve in the rural areas, no one will look at the big picture: there are no facilities, but worse, there is no security. You are left at the mercy of local criminals, often politicians.

Film stars, directors, politicians and many judges will never notice this kind of a story, just as they won’t ever comment about the sickest lowly traditions in their own individual profession. Communities ripe with rapists and murderers, and onlookers who film rapes or murders rather than trying to stop them, expect the best brains to work for their healthcare at meagre salaries.

There is nothing wrong with a short term bond for service in rural areas, but while signing such a bond or joining such areas, the doctors should also ask the government a written guarantee of security. This should be the part of the bond. If security can be provided to every TDH in politics, filmdom or to even the lowest ranks in the judiciary, even some criminals, it can definitely be extended to the doctors serving in rural areas. A doctor who feels threatened cannot work and in fact should not continue to work unless adequate security is provided to him / her and family.

Dr. Anil Dadarao Waghmare, you deserve the highest medal any doctor can ever get: because you showed this selfish society how big a doctor’s heart can be, by continuing to serve in rural India. From now on when the loudmouth foghorns in politics and administration try to malign our profession, or try to cover the gaping deficits in basic facilities at rural level by pointing fingers at the doctors, we can tell them your story.

As for the loss of your 9 month old daughter murdered by your own patient, I stand up in tearful, shameful regret of the state of affairs of Indian Rural Doctors.
© Dr. Rajas Deshpande

PS
It is high time the doctors unite to take a strong stand against aggressive attitudes of society, against stupid policies and being taken for granted and spoken against by uneducated loudmouths.

This story should reach every blabbering idiot who has no doctor in the family and keeps on expecting all doctors to be servants of this society. To those among doctors who try to impress faceless media or administrators by continually talking negative about our own colleagues, this story should serve as an eye opener.

Thank you, Dr. Anil Waghmare for the courage and permission to share this story.

What Your Doctor Never Tells You

What Your Doctor Never Tells You

© Dr. Rajas Deshpande

This small girl who had had her third convulsion in last three days was now looking frail. Her mother, extremely anxious, asked me what can be done to “immediately stop” her convulsions. This hyper-mother had stopped all the epilepsy medicines of this kid few days ago. Patiently, I asked why.

“Because I read on an article describing ‘what your doctor hides from you’, in which the author had recommended a particular diet of natural ingredients “, she replied, adding “the article said that all allopathic doctors give you medicines that will keep you sick for longer, so that they can earn more. It also said operations like joint replacements or procedures like angioplasty should never be done.”

Needless to say, this lady was buying the “Purest Natural Guilt Free” products from that website, at a price that was way costlier than all of her allopathic medicine combined.

I told her that it was a mistake to stop the kid’s medicines, and issued her a new prescription. © Dr. Rajas Deshpande

“What do you do, mam?” I asked her.

“We run a bakery, I sell exotic cakes, muffins etc.” she replied.

“Do you lie to your customers? Do you sell them products that will harm or kill them?” I asked.

“No, never! How will my business run then? We have to obtain licenses for food quality.” she retorted.

“It is the same about us doctors, mam. All the medicines, stents and joints that your article has slammed, are approved by government, and additionally, they are scientific products, not just claims. The government also earns tax on each medicine, stent or joint sold in India”.

I was offended somewhere, and so continued:

“We come from similar families as yours, mam. Even our parents teach us culture, compassion and good habits just as yours do. We doctors learn in the same schools as you, and common school teachers have taught us the importance of good. We too have parents, spouses and family, kids whom we teach good values by practice. Why will such doctors hide the truth from you and suggest you something that will harm you, who have come to us in good faith? Do you presume that all of the thousands of brilliant patriotic doctors will hide a cure from patients, and continue to let people suffer? Just because some bakery is selling rotten cakes, how would you like someone badmouthing your bakery, your integrity? ”

“Not you doctor, but not all doctors are like you” she said.

“Thank you for your faith mam, but I know that most doctors are like myself, who have struggled hard to achieve their degrees, to be able to save lives and bring an end to the suffering of millions. It is not an easy task, there are many easier ways to earn money with lesser hard work and sacrifice. You will rarely find the children of stars, sportsmen, industrialists and other ultra rich becoming doctors, no one wants so much hard work for such less money.” © Dr. Rajas Deshpande

“We cannot advertise, while most of the alternative medicine companies, gurus and babas keep on blatantly claiming cures for incurable diseases, spreading rumors about allopathy and some other recognised pathies, cleverly selling their own products to desperate patients who hope for relief, and spend far more in the wrong direction. Look at who all is earning crores while claiming that allopathic doctors are cheating people”.

She said she agreed, and won’t interfere with the right treatment of her child now onwards.

This is a complication of a deliberate and sick propaganda which has been orchestrated to tarnish the image of especially allopathic doctors, to be able to sell innocent patients one’s own unscientific products. It is sad that the very people who complain about the consultation charges of qualified doctors go and buy extremely costly “magic remedies” like some unproven, unscientific laser instruments, vibrators, garments, herbals, extracts etc. © Dr. Rajas Deshpande

The fact that vegetables and fruits are costlier than many medicines, that weekly vegetable expenses or family dinners in India are far more pricey than a specialist’s consultation which can be obtained urgently, speak a lot about where we stand. In the developed western world, there are year-long waiting lists to see most specialists. The fact that Indian doctors are the best and hardest working is appreciated all over the world, but so many Indian gurus, babas and fraudulent quacks run campaigns against our own doctors, in our own country! © Dr. Rajas Deshpande

Want to really know what the doctor doesn’t tell you?.

A doctor never tells you to go to herbal babas when you come to the emergency and need immediate attention. A doctor never asks you to take your lot to the websites that slam medical profession, when you need help. A doctor never abandons even a faithless and arrogant ignoramus, does not ask them to go search internet for blogs and natural remedies when someone is dying of a heart attack or a stroke or accident. While many recent fulminant ads claim that all doctors are greedy and deceptive, there are thousands of doctors in the hospitals all over world, who are not eating, sleeping or being with their family right now: not because they want more money, but because many will die if we don’t work hard. It is so sad that this had to be explained in India!

What a doctor really doesn’t tell you is: how difficult it is to treat and to save lives of the very people who have no faith in the one trying to do them good!

© Dr. Rajas Deshpande

PS: Recently the number of posts circulating to slam all medical professionals, especially allopaths, have increased, especially in an attempt to market certain products. This extremely harmful trend is ignored by all concerned authorities. This article is an attempt to defend the glorious scientific profession I belong to.

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The Cult of Good Blood: Superhero Medical Students

The Cult of Good Blood:
Superhero Medical Students
© Dr. Rajas Deshpande

He grew up selling vegetables and fruits grown by his mother. He went door to door and in the village market to sell those. He also walked for two miles every day to catch a bus to a school over 20 miles away. He then enrolled in a private class that waived off his fees, because he had a passion: He desperately wanted to become a doctor.

Atul Dhakne, son of a school teacher Mr. Nivruttirao Dhakne and farmer Mrs. Mandabai Dhakne, with his hard work and merit, got admission in the prestigious B.J. Medical College in Pune.

But he wasn’t satisfied. “What about those like me who are from the poor rural background, those who have no access to good classes and education, but want to become doctors?” he worried.

Good Blood speaks, whichever soul it flows in. Young medical students of different origins, studying with him, decided to resolve this. Ketan, son of a lawyer Mr. Avinash Deshmukh (who mostly handles cases for the non-affording,) wanted to do charity like his father. Farooque Faras, whose father raised a family in one small room, was burning with the desire to give. Many others joined in (names below), and the Cult of Good Blood multiplied. They all wanted to uplift the deserving.

“Lift For Upliftment” was born, formed by the superheroes among medical students.

They printed posters and went to almost all junior colleges in Pune, appealing students from poor backgrounds to join their free tuitions / classes, to prepare for the CET /NEET. In the first round, over 40 students joined. After the medical college hours, Atul and his friends took turns to teach these poor students, give them notes, set question papers, conduct exams, assess and counsel for improvement. All expenses were borne from their own puny pocket-money.

There was no fixed place for the class. One local bakery owner, Mr. Dinesh Konde, decided to help these students. He planned the logistics and took them to the corporator Mr. Avinash Shinde, who asked for only one thing in return of his help: commitment to continue this good work. The Cult agreed whole-heartedly. With him, they approached Mrs. Meenakshi Raut, Asst. Director in the education department in Pune, who helped them get two classrooms in a Municipal school after the school hours. The classes thus became regular, every day, from 6-9 PM.

The cult lacked stationery, the huge backup of notes and question paper sets for 40 students, so they approached Mr. Sanjeevkumar Sonavne from Latur, who runs many educational institutes, helps poor students, and even pays the fees of some who cannot afford college. Mr. Shelke and Dr. Harish from Sassoon Hospitals also joined hands to help.

The results were impressive: from the first such batch, 6 students qualified for MBBS, 3 for BDS, 11 for BAMS and 2 for BHMS.

No one had earned anything, but Good Blood flowed forward. Many medical students from subsequent batches came forward to teach free, imparting their fresh acquired knowledge and skills to those who could otherwise have no access to it.

There is no discrimination while accepting junior college students for their class. They have two batches now with 60 students in each. They have also started weekend classes for poor students preparing for NEET in the extremely backward area of Maharashtra, named Melghat. These medical students go to Melghat with their own expenses, teach the rural junior college students over the weekend, and return to attend the tough schedules of medical college again!

“I learned helping others from my mother. We don’t earn anything, but we learn something precious every day” tells Atul, who has now passed MBBS. Ketan Deshmukh, Abhiraj Matre and Farooque Faras help him supervise the group. Their endless enthusiasm only reminded me of how much more I can do. I came to know of this group “LFU” during the recent “Quest Medical Academy” event arranged by Dr. Sushant Shinde.

They are naturally, perpetually short of funds.
I am not rich, but I won’t feel right about myself if I didn’t contribute. They graciously accepted.

When these students came to meet me today, I offered them dinner at a good restaurant (knowing that they stay in hostels). Farooque said “Sir, we will rather use that money to print some more question paper sets”. Farooque’s father has stopped all celebrations in the family, and sends all the money he can, from his one small room home, for the torch of humanity that his son carries forward!

When they asked for an advice, I had but one small request for them: that a Doctor should be completely free of all political and religious influence at work, in teaching, and especially while treating a patient. They assured me that “Lift For Upliftment” has decided to never be affiliated to a political or religious organization, keeping humanity as their highest ideal.

There is no better lamp than the one which carries the light from soul to soul. There is no better definition of humanity than holding hands of those who need it most. I feel very happy today, that I could contribute to this beautiful, divine cause.

Long Live the Cult Of Good Blood, and may we all find it in abundance within ourselves!
© Dr. Rajas Deshpande

The group “LFU” also includes: Esha Agarwal, Shivkumar Thorat, Satyender, Tanvi Modi, Mayank Tripathi, Nikhil Nagpal, Sitanshu, Arvind Kumar, Nagesh Pimpre, all from the B. J. Medical College Pune.

PS: My heartfelt appeal to all medical students and doctors to contribute by starting similar activity in your region, by teaching poor students who want to become doctors, by joining this group and / or by donating for this cause.

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