Tag Archives: Career

“Is The Diagnosis Wrong, Doctor?”

“Is The Diagnosis Wrong, Doctor?”
© Dr. Rajas Deshpande

“Doctor, there is no improvement at all” said the angry husband, throwing the case-file upon my table.

Well this is not an extraordinary sentence for any doctor, one must be prepared to openly deal with this. I had been quite polite and well mannered with them, there was no reason he had to cross that line. I could understand though. When they pay my fees, they expect some result or satisfaction.

While teaching my students, I have always insisted that if the patient / relative says that there is no improvement or change with the prescribed medicine, one must first consider the possibility of a wrong diagnosis, a missed condition or a misinterpreted finding. Doctors are humans, and do commit mistakes, or misinterpret findings. This is normal, and happens with every doctor. Medicine is far more complicated than most people think they know. A good doctor knows this and learns, while all the time keeping patients safe, but a doctor with ego kills his own practice, and may cause harm to the patient.

I asked them to sit down and reassessed the case in detail. A 28 years old female. Headache, giddiness, imbalance, palpitations, breathlessness. Lack of sleep and bouts of crying. Past and family medical history not contributory. Physical examination completely normal. MRI of brain normal, Vitamin B12 and D levels low. I had started vitamin supplements, anti-anxiety medicines and an SOS for headache.

She told me all her earlier complaints had improved, but now she had a severe backache. I told the patient that I was trying my best to understand her condition, and to resolve her problem, but her findings and complaints didn’t match. She looked at her husband, and asked him “May I speak frankly to the doctor?”.

Openly agitated, the husband sarcastically offered to wait outside if she needed privacy. However he stood glued to the chair as if he knew her answer. © Dr. Rajas Deshpande

The patient thought for a moment, told him it’s ok he can wait inside, then started to talk. She revealed that she was the only child of her affluent parents, had passed engineering, but now had to quit job and stay at home to raise children. They lived in an extended family, with grand in-laws, in laws and an elder brother, his wife and two children. This patient was the ‘last in the line’ to take orders, all others being senior to her. Her husband and in-laws were perfectionists, and she was tired of their continuous expectations. She had dreamed of making a career too, wanted some free time outside home for herself, but year after year, she didn’t get even a minute for herself. She was tired of it all and there seemed no respite. © Dr. Rajas Deshpande

“I am not averse to hard work, but the continuously condescending and fault-finding attitude makes me feel that I am useless”, she said, and added cautiously: “We were in the same institute and my ranks were always better than him. Look at where I am now” she started crying.

I offered them water and coffee, and waited for her to settle down. The husband became restless and defensive, but his tone was far lower. “I understand her problem, doctor, but what can I do? I cannot leave my family. My work pressures are quite high too, the IT industry is going through a bad phase”.

“I can assure you that she has no neurological problem now’ I replied, “she should improve with lifestyle changes, counseling for the family, and adequate free time for herself. I will refer you to a good counselor” I told them.

The husband laughed. “I can understand, but my parents will not. We will see what best we can do for her”. A bitter tone in his voice didn’t escape me.

‘Sir, she told us what bothered her, and must not be held guilty for trying to speak her mind. It will only help identify and treat the problem better. Please see a counselor together and avoid discussing this at home right now” I requested the husband. © Dr. Rajas Deshpande

There are many reasons why a patient does not improve. Untreatable medical conditions, depression, seeing the wrong specialist are the most common reasons, but there also are patients who want medical leave,those who want to avoid work, who want attention, so will keep on complaining of false symptoms. They do not improve with drug treatment.
On the other hand there are many who keep on taking the wrong medicines for years, those who self-medicate, do atrocious / injudicious dieting and exercises, yoga that doesn’t suit them, and do not follow the doctor’s instructions about abstinence, who keep on indulging salt, sweet, oil, alcohol, tobacco and other drugs freely available in India. © Dr. Rajas Deshpande

A doctor remains a lifelong medical student. A doctor who thinks he / she is always correct is most dangerous. It is not uncommon to meet doctors who are angry / upset with the patient / colleagues when their diagnosis, treatment is questioned. The first thought of a doctor when the patient does not respond positively should be to consider a misdiagnosis, reevaluate the case in more detail, reassure the patient, and obtain a second opinion if necessary. All this done, one must look into other possibilities, with an approach to resolve the issue rather than trying to shove down the patient’s throat their own faults.
We all go through bad patches in life, doctors and patients. If the child is wrong, the parents correct them still with love. A doctor’s attitude should be similar, with due care to also protect themselves. If not the doctor, who will understand the patient whose family refuses to understand them? In so many ways, especially in the Indian society, the doctor must don the role of an elder brother/ sister. Although patronising is legally discouraged in medical practice, and should be refrained from in cases where trust is questionable, one can make exceptions for some cases that need reassurance where the family fails to do so.

The nobility of our profession also lies in reassuring the patients that they are well cared for by their doctor, through the thick and thin of their life.
© Dr. Rajas Deshpande

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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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White Paper of a Doctor’s Dilemma

White Paper of a Doctor’s Dilemma
© Dr. Rajas Deshpande

“Sir, I come from a family of doctors, who have always practised high values in Medicine. There was always this burning desire in me to do good. I felt that the country needs young doctors who are willing to work hard. but somewhere something inside me has changed. Now, with the on-going assaults against doctors, this clinical establishment act in West Bengal and in general the distrust and anger the public has against doctors, it has suppressed my older self. So much so, that I’m considering going to the USA now, even if that means doing residency all over again. I see my batch-mates and friends who went to USA after MBBS, really happy, earning well, enjoying holidays with friends and family. I do not envy the work part, I will always choose a day in the Operation Theatre rather than at the movies or hiking.. just that slowly my main motive for becoming who I am today is fading away.”

What a heartfelt question, a dilemma not only haunting me, but many doctors, especially from the younger generations, who started out to do something good for the country, have been dynamic, brilliant and hard-working, and now want to leave India!

Dear Dr. S,

Firstly, yes, the times have changed. Doesn’t the first page of most standard textbooks teach us: “Medicine is an Ever Changing Science”, now we must add the external scenario to this. We must change accordingly. Add laws, add medically inept judiciary, add media, add too many impractical conditions of practice where among the two sides involved in a profession, only one is legally answerable. I should write a prescription not of the best medicine I know, but of the cheapest one. In the face of lost faith and partial law, no relationship can be very cordial. Nor can any empathy be forced for a patient who suspects the doctor of wrong intention or inadequate skills. © Dr. Rajas Deshpande

Given the increasing number of Google empowered pseudo-literates and even genuine illiterates who are now questioning every medicine prescribed, every test advised, not because of curiosity but in an obvious visible distrust, it is becoming increasingly difficult to keep patience with practice. The combination of a western/ over-legalised medical service with a free-monger society, where instead of education, science, research and health, the taxpayer is happy paying for corruption in almost every sphere, lifelong deluxe travel, food and living expenses of everyone who has been elected even once to almost any civic body, no one wants to think logically about why there is healthcare failure in such a huge country that generates such high taxes.

Recently a headline about “Doctors prescribing costly medicines” hit the media. Why doesn’t the government make available free / cheap healthcare for everyone? Make all medicines free at all government hospitals. Why expect those who invest decades in making a medical career and then practicing under loans to keep on working with minimum incomes? Why aren’t there any laws against the corporate hospitals? Why don’t the same politicos speak about some of the capitation fees institutes that generate trillions, and also allow the quality of the medical education to be compromised? I wish the prime minister also says some day that we will make all medical education free for all merit holders, because the country needs more doctors. Why make it difficult at both ends for the doctors? © Dr. Rajas Deshpande

I can also be a high handed hypocrite and advise you the humbug: that a doctor is a social servant, that a doctor must only choose to live the life of a saint and never think about earning or a decent / luxurious life, that the society needs you etc. We live in a society where while searching for a groom, every father’s first question (if not the bride’s) is “How much does he earn?”. The stupid thought that a doctor should not earn a profit for his talent and hard work is redundant. If the society needs good doctors, it must also learn how to remunerate and treat them. It should also learn not to generalise that every doctor is corrupt. It should be intelligent enough to know that medical care can neither be free nor can be entirely based on charity or profitless structure. © Dr. Rajas Deshpande

But our society is far away from understanding this. The “High” of hate and criticism drives mobs berserk in the land of logicless thinking, and we Indians lead this game. To be opinionated by media and illiterate politicos and speak without studying is the sign of a degrading time. © Dr. Rajas Deshpande

My dear friend, I will be honest with you. Ten years ago, I strongly felt I should return to India and serve people. I doubt it now. I have urged hundreds of students to return to India after their higher medical education in the west. Now when some doctor is beaten up, killed or tried by media before law, I don’t feel justified to urge anyone to stay here.

You have only one life, and living it fully, enjoying health and peace of mind, joys of living is also your duty to yourself and your family. Are you inclined to do social work without recognition, with allegations and trials, in a society that refuses to respect a good doctor? Are you inclined to let a “Social change in the attitude of public over decades” take effect, by which time your career / life will be almost over? Are you ready to be tried by the media, taunted by the court even before being proven guilty, and punished by those in power, not because you are wrong, but merely to please people? Are you prepared for a scenario that even if you do 50 years of cleanest practice and save thousands of lives, when you are blasted all over the media for your first mistake, not a single patient will stand up and say”This is a good doctor”? If so, stay in India, this country really needs very good and honest doctors, even though it cannot respect or trust any. © Dr. Rajas Deshpande

In this country without a healthcare vision for the future, this is indeed a sinking ship, with opportunistic invasions not only from various unrecognised pathies, but with a society that is increasingly destroying the possibility of good healthcare for all in future, in its quest for free, and cheap, under the threat of violence.

If you want peace for yourself while doing good to the society and earning well at the same time, choose a developed and civilised country: at least payments are better, you get time for yourself, the law looks at both sides, and politicos can be questioned. You can also fund some health charity in India from your earnings there. Last but not the least, no F. B. will raise a hand upon a doctor, and still will be justified by law, media or government.

© Dr. Rajas Deshpande

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The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

“He fell down while checking the patient”, said the panicked Dr. Mrs. Sane about her husband, “and became unconscious”.

Dr. Sane tried to maintain his calm. A sick doctor has the curse of knowing the worst of everything, and has a perpetual feeling of sitting upon a ticking time-bomb. It was a sad feeling to see this middle aged brilliant general practitioner fighting tears.

“Sir, the OPD numbers have shot up because of these epidemics, especially dengue. I see over a hundred patients every day. The Inpatient beds are full. There are daily problems: medical, administrative and medico-legal.. those I am used to. But now there are too many politico-social and press-related issues that worry me”.

Dr. Deshmukh, a senior practitioner and a common friend, accompanied Dr. Sane. He cautiously poked him “You must tell the doctor what happened the day before”.
“Oh that’s a part of our profession” Dr. Sane replied.
I insisted that he must tell me.

Reluctantly, he disclosed: “Some goons came in with a municipal councillor and threatened to waive off the bills of a dengue patient. He was in the ICU for five days, quite bad, but went home walking. Till the time he improved, they kept on threatening us to break the hospital and thrash us if something went wrong. Upon discharge, they didn’t pay a single rupee. There’s nowhere to complain, as the hospital requires many municipal permissions”. © Dr. Rajas Deshpande

Dr. Mrs Sane lost her cool. She started sobbing. “No one blames those who dump garbage, keep their surroundings unclean. No one is blamed when epidemics spread and thousands die. No one is held responsible for failures of almost all preventive services and lack of basic facilities at government’s healthcare institutes. But the already overworked general practitioners must bear the brunt of everyone’s anger: the public and press are always free to bash the last face they see: the doctor who is actually helping every patient,.. Dr. Sane has not had a proper lunch, not spent a full day with kids in months.. That hospital has become our curse“ She broke down.

It was so logical! The offices responsible cannot even be reached. The court does not see any of these system failures that cause millions of deaths all across India, happily ordering lakhs and crores and imprisonments for doctors, for trivial mistakes.
Whom to blame? Oh yes, the doctor who has studied to treat the sick!

Anyway, in a country fond of muscular heroes and billionaire godmen, who expects a brainy analysis? © Dr. Rajas Deshpande

“I had a dream of making best health facilities available for my area. I have taken a big loan. We treat poor patients free anyway. Many rich are sent by local politicians, leaders, administrators with instructions to attend immediately and free too. Paying patients are mostly suspicious because of all the negative things publicised by press about all doctors., they also expect immediate and positive outcomes. I have not slept for many a nights. “

I examined him.He had obvious features of being fatigued mentally and physically.. A syncopal attack, where the BP drops down suddenly and makes the patient unconscious, was likely. I advised him tests and told him to take rest for there days.

“Not possible, sir! Even now the OPD is waiting” he replied. An angry Dr. Mrs Sane requested me to intervene.

“Your duty to the society does not free you from the duty towards your own health and family” I requested him. But Dr. Sane agreed only when Dr. Deshmukh offered to send over a junior doctor to his hospital to take care of the OPD.

“How have you been, Sir?” I asked Dr. Deshmukh. He is one of the most respected and busiest general practitioners in town, with a big hospital. © Dr. Rajas Deshpande

Dr. Deshmukh smiled.
“I had an angioplasty three months ago. The only risk factor was high BP and stress. There is no use fighting or explaining our situation to the society, government or press. I have closed down my hospital. I only see OPD patients now. Anyway many patients thought that I worked day and night for earning more money. Let them go to the corporate or government hospitals.”

The death of his hospital was not a surprising news, many small private hospitals and nursing homes are either closing down or converting into profit-making franchises. Many doctors are suffering high BP, cardiac and neurological problems and even dying due to excessive stress.

The meaning of this nightmare will soon unfold upon our society.
Till then, this is a heartfelt appeal to all the over-stressed doctors to rethink about their priorities, rearrange life and make sure stress does not kill.

For the morphine of “medical social service” is only good in small doses, it kills when overdone!
© Dr. Rajas Deshpande

“Get Out, Doctor! You Are Finished!”

“Get Out, Doctor! You Are Finished!”© Dr. Rajas Deshpande
“Doctor, it’s this way or highway. We have many from your specialty in the waiting list. Do you accept to go by our policies or do you want to resign? Mind well, if you disagree, we will see to it that your name is blacklisted in every hospital in this city”.
As Dr. Sumeet stood there thinking, one of the administrative doctors, always a first class bottom licker, commented “These days doctors are like W*****, throw money at them and you get them to do anything you want”.
One junior doctor, still hot blooded, walked away. Dr. Sumeet asked that medical superintendent to mind his language. There was no reply. The bosses had really enjoyed the comparison, and while eating their pistachios at the hands of their secretaries, laughed aloud.
Dr. Sumeet felt devastated in that super luxury office, among the administrative officers and his own senior doctors from that hospital. He had returned from Germany a year ago, and joined this corporate hospital that was recruiting specialists. They had also offered him a decent salary, and accepted his condition that no patient will be sent back from his OPD for lack of money. © Dr. Rajas Deshpande
However, he had had to face a lot of jealousy and hatred from his senior doctors as he was looked upon as a competition. This is extremely common in India, and however stifled, a major truth. But no one ever stood against the bosses of corporate hospitals, so they had to accept his appointment.
The same corporate also owned other industries, namely Gold, Cement, Cloth, Petroleum etc. They were a “closed” community, all in the administration belonged to a particular caste. This hospital was another of their ‘profit oriented investment’, and did really well as most of the public can easily be fooled by the words “Free, Concession, Accreditation, World Class etc”. Medical illiterates (read general public) are really taken for a ride by healthcare advertisements of corporate hospitals.
Few months after Dr. Sumeet joined the hospital, the CEO changed, and another “extremely loyal invertebrate profitmaker insider” came in as the new CEO. From prehistoric period, he was considered as the best pet of that corporate family. The new CEO started by applying all the labour and profit criteria of cement industry to this hospital. If anyone argued, his famous dialogue was “If Sirjee (the owner of the corporate) wants, he will make the sun rise from the west. You are not aware that his reach is beyond the highest in India”. Anyone who uttered a word against any policy was isolated, humiliated and finally thrown off. Various allegations and ‘proofs’were easily furnished by a dedicated ‘execution panel’.
The new CEO changed the conditions that were accepted when Dr. Sumeet had joined. He was now given a target that his patients have to increase by 25 percent every six months, so should his tests, surgical referrals, etc. Free cases were cancelled. Many doctors spoke in private about this, but no one wanted to lose their job, as it is very difficult to get attachments in multispecialty hospitals. © Dr. Rajas Deshpande
As Dr. Sumeet had argued, he was given this ultimatum. He appealed to the senior doctors in that room, most of them looked away. Some told him they had always warned him not to be ‘over-smart’.
“I will reply in three days” said Dr. Sumeet and left the room.
He had nowhere to go. He had shifted his family to this new city and his children were already adjusted in their school. He had chosen this city after long deliberation, and had recently bought a flat with a loan, so he needed a stable income. His parents were teachers, he did not have the kind of money required to make his own hospital. All his friends had one answer: “Adjust “. He decided to plead once more to the management, to allow him to provide free consultation to really poor patients, and to continue a contract not based upon income generation. © Dr. Rajas Deshpande
Next morning, as he entered the hospital, one of the servants (being from the inner caste, his title was ‘General Manager’) came to see him with a huge grin upon his face. “The CEO sahab has asked you to empty your belongings by afternoon. This office is given to another doctor”.

He went to the CEO, who refused to see him.

The same medical superintendent came out.

“Doc we do not require your services any more. Get out, You are finished” he said.

“Why?” asked Dr. Sumeet. “I want an explanation”.

“We have many reasons. You do not fall in line with our policies. You are insubordinate. Also, some staff say you are having an affair with another doctor in the hospital. We also had a complaint about you yesterday from a patient”. © Dr. Rajas Deshpande
The complaint was obviously custom-made, and there was no way to argue about the affair allegation. Medical staff working together in an extremely orthodox country has to face those allegations very commonly. How such allegations disqualified him as a doctor was beyond him.
There was no argument now. He was escorted by security team out of the hospital, in full view of many specialist doctors (his friends), patients (treated by him), and others, but no one had a word to say. After he came out of the campus, one doctor friend accompanied him home silently.
He wrote to many senior doctors. There were no replies. He wrote to the medical councils. There was no reply. One senior member of the medical council told him in confidence: “ All the Medical Council rules are only for doctors. Medical councils in India have zero control over private hospitals, especially corporate hospitals”. IMA and other doctor’s bodies are clueless and directionless about the open exploitation, humiliation and destruction of doctor’s careers, especially new-coming specialists. In a country devoid of specialists, it is paradoxical that so many specialists are continually fired / thrown off / made to leave corporate hospitals which take advantage of the competition among doctors. Sadly, the doctor community, with too many self-proclaimed geniuses, has failed to unite and protect itself from this corporate onslaught. It is pathetic to see some greedy doctors competing to see each other down. © Dr. Rajas Deshpande
His practice was super-specialised and required a multispecialty set up with inpatients. There are very few government set ups in India like those. The rules, conditions in most govt. hospitals are idiotic, age-old, and the payments are laughably low. Also, the govt institutes are mostly headed by you know whos.There are indeed some charity super-specialty set ups, but most are religion / cult / faith based.
Dr. Sumeet decided to work it out his way. The corporate hospital which fired him made sure that his name was defamed in every possible way, they left a many pronged negative feedback everywhere. © Dr. Rajas Deshpande. There is no remuneration for the career murders of the intellectuals in every field in India, caused by two-faced systems run by invisible hands.
Gradually, he picked up, losing years of his career. He found out a hospital that respected his wishes to treat the poor free, and did not insist on numbers.
The complete ignorant and irresponsible stance of senior doctors when someone wrongs the junior doctors, the complete lack of any control over the policies of corporate hospitals by any medical council or governments, and the impotent stance by many a doctor’s organisations has spread the healthcare-toxic corporate medical culture all over India.
Doctors should at least make directories and online lists (maybe anonymous to begin with) of hospitals which force doctors to accept malpractices, or do not respect terms of agreement and sack doctors without any mistake. These should also be reported to the medical councils. Any hospital sacking any doctor should have to send an explanation to the Govt., medical council and IMA for the reason of dismissal, and the doctor should also be able to explain his / her side of the story. Hospitals which “use and throw” doctors as per wish, without reason or logical explanation must be brought to the book. © Dr. Rajas Deshpande
Most corporates have excellent backup and protection from the government, and all they will do is to shift the blame on the doctors’ fees, hiding from the patient, media and society the umpteen other profiting headings that the patient thinks are benefit to the doctors. This is a tough war.
Another joke is that while the educational qualification and training of any doctor is strictly scrutinised by medical councils and media, the qualifications of those who own hospitals, run them are completely neglected. No wonder illiterate politicians, “Business Class” corporate houses and CEOs bully doctors into practicing policies which are often against the best practice principles of healthcare.
Very few non-medical CEOs actually have a good knowledge of medical ethics and principles, agree to logical arguments.© Dr. Rajas Deshpande
The media and society who advise umpteen things and expect a lot from the doctors never stand up for a good doctor. Everyone who has met one bad doctor cries all his / her life about all doctors. As if there were no bad apples in their field! The ‘hyper idealistic’ population expects that the entire healthcare comes under the heading of ‘charity practices’., unwilling to spend upon their own health. If malpractices and backdoor incomes are to go, the public should realise that the actual fees will increase.
Governments will always make populist, ultra-short term policies in healthcare, without involving the brainy specialists in practice. If the Medical Council or IMA do not take a firm stand, any doctor who takes a stand against existing corporates / medical malpractices will be orphaned by his / her own community, often boycott, and categorically defamed: until their career is destroyed or they leave the country.
Many Dr. Sumeets are actually suffering this right now in India, with no respite.
Doctors must also realise that this war will never be won fighting alone. If the subsequent generations are to get better quality healthcare, we should start by identifying the problems first.
An easier, nay, wiser option for every super-specialist is to leave India.

© Dr. Rajas Deshpande
PS: The “Chamcha Doctors” who line up with the corporates to compromise in healthcare principles must do some soul searching. Earning profits is not a crime, compromising medical principles is. A real “Doctor” will never do so.
Dedicated to the thousands of young medical specialists who are right now suffering this hell.

RD

Take a Break, Doctor!

“Are you going to Switzerland, Doctor?” asked this business-class patient with a pregnant smile upon his face.
When I told him I was on leave the next week, he thought what most patients naturally think about doctors: “Every doctor gets free luxury trips to coveted destinations sponsored by pharma industry”.
I did not explain to him that my mother had a surgery planned.
Everybody needs a leave, a break, a vacation. Sometimes for problems, illnesses etc. in family. Sometimes a cut off from the routine and mundane. Sometimes to find oneself, sometimes to lose oneself. Sometimes to run away from it all, sometimes to meet life.
A doctor cannot. Wonder why?
There are scheduled follow-ups, complicated cases, people on dangerous prescriptions, admitted patients all the year round, from which one cannot detach completely. Even when on leave, a doctor in-charge who cares about patients prefers to be somehow reachable, albeit via assistant or hospital or email.

Imagine watching a beautiful sunset or being in the arms of your beloved at the dawn, and receiving calls about critical cases, complications or prescription renewals. The moment and the life in it dies instantly.

Many specialists in fact get maximum patient communication via email, whatsapp, sms or calls on Saturdays and Sundays, thinking that the doctor will be free. The doctor, catching up with the missed life among family and children gets worst irritable on the weekends. His cellphone, kept ‘ON’ for the admitted critical cases becomes a mass communication device on weekends.

When a teacher visited recently, he asked what only a parent will ask: “Do you find time for yourself?”.
When one becomes a doctor, they almost always (rare exceptions) sacrifice any other talent they may have, like singing, music, writing, sports, research etc. Seeking solace only in patient happiness (in most cases) or financial success or fame (in some), a doctor then becomes a “Medical Practice Machine” for his / her own happiness. This is the death of the non-doctor individual in a doctor.
© Dr. Rajas Deshpande
Hence the thought: Take a break, doctor.
Many students ask in curiosity to their favorite teachers: What would you have preferred to become if not a doctor / a neurologist etc. (Formula 1 Racer, Singer, Running an infant daycare, Connoisseur of love and peace, Professor of poetry, Philosopher, Vagabond, Scientist, Monk… so many things I wanted to be have stayed within, the smoke sometimes sizzles at midnight.)

In any field when you achieve excellence, it is always at the cost of many sacrifices, especially your chances and wish of doing well in other fields. But about the doctor, the concept has a caveat: that it is no more as rewarding as it was few years ago. A patient becoming a customer has hurt both ends, and this appears irreversible. Now that this is a professional activity, successful recovery is just “buying the treatment” for most. Thankfulness sinks in the bills. So even in a great recovery, good treatment, survival and cure of a patient, the doctor is “just doing his / her job, and my insurance is paying for it” is the usual attitude.
Only the few doctors who “enjoy” the process of clinical evaluation, correct diagnosis and good treatment response or surgery can find hidden solace in this process, also passing it on to newer generations. Others run frustrated from degree to degree, hospital to hospital, or patient after patient. Add conference after conference for some. For the nonclinical and paraclinical specialties, it has become a humiliating task to apply to the business oriented set-ups and keep shifting base in search of career.

Of all the professionals, doctors are the only ones who can never get “meaningful” vacations. Even the tiny time they are on leave is polluted by interference. This practice is more so in India, where individual practice culture and “salary-less” pay structures in most big hospitals precludes the possibility of “handing over the charge” to another doctor while one can enjoy a break. This is more so as one climbs higher in a specialty, as equivalent skills become rarer. A doctor on leave anywhere in the world MUST make arrangement for someone else to attend patients in his / her absence. Why only a doctor? With millions of court cases pending, why not everyone in the judiciary? Why not everyone in all departments in the police and government, where “Sahab is on leave, come back after few weeks” is the standard answer? Why doesn’t every other department dealing with public tasks work 24 / 7 as responsibly too?

And the irony of all this is that most of the society thinks it is for “earning more via illegal means” that every doctor is busy!

There are many hidden assets within every person. Doctors should not “cage” themselves in medical practice. They must learn also to “switch off” being a doctor for atleast a few weeks every year and be a “Normal Human Being” who can stop thinking of death and disease 24/7. They should breathe in the fresh air of being oneself, work upon their own good health, family’s expectations and inner desires to “catch on with life one day”.

The scariest fact: that as general life expectancy is increasing, the life expectancy, stress morbidity and mortality among medical professionals is on a decline. Starting from 12th standard where medical entrance has a “killing” competition, the highest levels of stress in a doctor’s life NEVER go down.

Sacrificing life is not worth it, Doctor. One can definitely be a better doctor with lesser stress.

Catch Up! Take a break!
© Dr. Rajas Deshpande

Negligence cases deserving severe punishment.

Negligence cases deserving severe punishment.
© Dr. Rajas Deshpande

A police sub inspector in civil dress, his wife and three kids aged 8, 5 and 1 were brought to casualty. All profusely bleeding. My job as an intern was to secure IV line and stop bleeding. As the CMO questioned the PSI, we all realised as suspected from the stink that the police officer was drunk. He had run into a braking truck from behind. One kid and the wife died the same night. He created a ruckus in his drunk state, threatening to kill everyone in the casualty. “If my wife dies, I will see to it that your life is ruined” he threatened to the CMO. The CMO kept on doing his duty, stressed and hurt. We were all real scared next few days. Everyone sympathises with such a loss. No one will aid or enjoy anyone’s death in a hospital.
Then why this curse of blames?

“This happened due to that doctor’s wrong treatment” : common words now heard in many clinics daily. Who causes maximum deaths due to negligence? Can only a doctor cause medical negligence? No.

These medical negligence cases must be punished too, with bad press, crores of rupees in fines, and public humiliation. You be the judge who is guilty:

Teenager son of an MLA. Played with wild snakes as a hobby, proudly encouraged by this MLA. Bitten by a cobra, landed in icu critical. A patient on ventilator was ‘shifted out early’ to accomodate the MLAs son.

Doctor advised a blood thinning medicine to prevent clots after diagnosing clotting disorder,. Patient went with her husband to a quack, took unknown herbal medicine and stopped blood thinner. Developed strokes, now in a vegetative state.

Patient advised to quit alcohol,,as it caused fits. Counselled with family and friends. In a week had alcohol with same friends, had fits, died in casualty.

Diabetic, told to control diet, continued to binge-eat sweets, lovingly cooked by wifey. Landed in coma due to very high blood sugars.

Pet dog, unimmunised, bit many on the same day, the dog died in three days. One diabetic patient bit by this dog died of sepsis / infection (not rabies). Immense horror among the ten-odd families of bitten members till date after a year.

Kid aged 14, parents allowed him to ride two wheeler on road without licence, killed on spot colliding with a truck. Toddler unwatched on the road died, run over by a truck.

60 year old Mother has giddiness for three days, son and daughter in law not free till fourth day to take her to hospital. Dies in casualty due to stroke.

Patient advised not to fast as it may increase chances of having fits. Fasted and landed in ICU with status epilepticus (a series of continuous fits).

Traffic police at a crowded junction busy with his “routine” away from his spot. Head on collision, two dead.

Unfortunately, in almost all above cases, the treating doctors were beaten up, casualty staff and hospitals vandalised, doctors sued, bad press judged an entire profession almost like a criminal, for not saving the victim.
© Dr. Rajas Deshpande

Often the relatives refuse to take patients to higher centers, expecting “big, advanced treatments and impractical outcomes” from low-cost, small nursing homes not equipped with specialty facilities, then end up vandalising or blaming such set-ups upon inevitable disappointment. Missed medicine, overdose, unobserved children, helpless neglected elderly parents, smoking, alcohol, traffic accidents all cause millions of deaths. So do delayed admissions, some herbals and “unknown” medicines, hunger, poverty, stress at home and workplace.

But it is the “death in hospital” that alone matters, and by default the blame is pinned upon the doctor!

Some actors can kill, rape, go naked, smoke, drink, race, gamble, pee in public, set records for drunken misdemeanours on and off screen, knowing that most illiterate and immature populations imitate them blindly. But they will tell the nation how the medical profession (for which they themselves did not opt in spite of excellent merit in school or in some cases even college) should behave and treat patients!

The few honourable judges who have now realised the “blackmail potential” of medical negligence cases, have fortunately started referring these cases to panels of medical experts before concluding and fixing charges. The only maturity issue that remains is about local goons and politicos with flitting loyalties looking for publicity at the cost of the harmless and intellectual population of doctors. These goons turn the helpless frustration, panic reaction towards tragedy and poverty of our society into anger against doctors and hospitals. As long as there are sane people in the responsible media, there is good hope.

Doctors must start recording without bitterness, any hostile tendencies, lies, deviation from duties towards the patient, advised and declined tests and treatment, neglect and avoidance patterns to provide adequate care for the patient by the relatives. Also the exact circumstances of onset of the problems (patient was drunk / drugged / under medication effect / fasting / missed medicine) etc. and relevant past that may have contributed to the event. This will minimise the allegations and misrepresentation of facts.
© Dr. Rajas Deshpande

Ofcourse the doctors must also discharge their duty with the highest standards of practice possible in their set-up. They must communicate well and explain the condition atleast once to the concerned relatives. They must behave courteously, sympathetically and try to understand and forgive the panic states of relatives within the sphere of civilised behaviour. We all love our patients. But like in every other relationship, we fail to say it aloud and make it clear with our behaviour, thanks to heavily stressful and inadequate lives we lead. Let us make an effort on our side to take one more step in the direction of kindness and understanding, in a hope of saving this profession from defamation at the hands of middlemen.

Let us make a greater effort to tell the society that it is only a doctor who will never intend harm. The only reliable rescue from the clutches of death, even a doctor fails sometimes. The effort has to be recognised if not always rewarded, but never suspected.

Negligence, you see, is easy to pin only upon the doctor.
All others are forgiven any number of deaths in all other types of negligence.
© Dr. Rajas Deshpande

Please share without editing and with credits.

Delusion, Doc? Part-I

Delusion, Doc? Part-I
© Dr. Rajas Deshpande
This post is primarily meant for doctors.

For one moment, stand naked and shed the language public likes. Be yourself as a “non-doctor” person. Right, the one under the shower.
Not enough time for self, peace, family, health, food, sleep, happiness, hobbies or even introspection. No stress free days. Continuous social and media criticism. Highest moral and ethical conduct expected under scrutiny, even the most criminal and immoral can deride you publicly.
Do you want this to be the schedule all the rest of your life?
Doc, are you living your life then?

The dream has materialised. Became doctor, served people, most patients happy, some unhappy. Some earned a lot, some didn’t. Some achieved personal / social goals. Some made mistakes, some suffered unfortunate violence. Some are beginning with new hopes and vigour, confused still confident of better futures.

Some fortunate and vocal got awards, fame, medals. Some fell for the hypocrisy of having to tell everyone how rewarding and pious their career was. Thousands of stories. Some genuine.

Some questions and material answers:
What is the ultimate aim of a doctor?
Serve as many patients as possible, earn money and fame, stay free of problems, and be respected for all this. Be the best in one’s field. If possible, achieve something great. (What?.. Oh! Haven’t had time to think about that yet.).

What was the last stress-free phase of life?
School. After that, only merit, hardwork, compromises and stress. Medical stress is worst, dealing with uncertainty of life itself. One may choose to accept, mature, ignore, meditate and come to terms with some situation, but never have “Peace” of mind in true sense. Absence of irritation is not peace of mind.

How is your family life?
Compromised. No peaceful, happy togetherness. A torn relationship especially if both are doctors. Worst if a surgeon. More irritability, more self neglect, less “love making” time, disturbed nights due to serious patients and other endless calls: a practice essential.

As a parent: Guilt, Shame and Tears. So much want to spend time with kids, watch them grow up. But mostly irritable and completely tired while with them. Sunday is the peak fatigue day for doctors, paralysed with the past week and outstation visits, or plans of the oncoming one. Kids find you happy and energetic only rarely. We catch up with their childhood years later in photo albums!

Personal life?

Food: not always in time, irregular, cold if home-cooked. Cannot afford / even plan healthy eating time wise.
Romance: What’s that? Oh Ok! Yes yes we imagine that
sometimes among the bleeding, crying, whining and violence.
Sleep: Shut Up! Just please SHUT UP!
Exercise: Only what the running around in and between hospitals, stairs.
Social: Hardly a weekend with friends. If hoteling or travelling, accused of being bribed by pharma. At any other social event, grabbed by opportunists who will discuss their health problems, especially bowel habits (during buffet) with you. Or ask you references of a cheap but very good doctor who will treat without investigations or surgery.
In a beautiful Santoor concert, my next-seater described her Tinnitus for a good 20 minutes, entirely spoiling my favourite Raag Shivaranjani!

Time for parents: Rare. Most doctors cannot even accompany / attend their own parents in illness properly.

If you are away from work, someone else is waiting to take your place. Patients cannot wait.

Work satisfaction:
Private practitioners: Moderate income, huge risk and stress, long work hours if charges are competitive. Surgeons earn better, but have higher stress. Physicians have to see more patients for decent income. Good work satisfaction.

Corporate/ Nursing Home practitioners: Moderate income. Most corporates using “divide and rule” policy to encourage competition for earning more. Most doctors have to continually increase revenue. If you are not making good profits for the hospital you work at, there’s someone else in line with better ideas.Hospitals must make profits. So most specialists must work at different hospitals for a decent income. Not everyone can afford to open hospital with all facilities. Low-Moderate satisfaction.

Govt. servants: I am yet to meet a genuinely happy govt. doctor. (Exceptions: those whose transfers / promotions or some other “special requests” are pending). Right from Resident Doctors to Professors, even Deans, are paid pittance, their only satisfaction being : atleast this is better than the earlier generations. Too many non-medical paperwork ‘dumped’ tasks by govt. Low-Moderate satisfaction.

There are some claims:
“I am happy because I don’t care what happens once I am out of my clinic”. Difficult if one is really involved in their patients.
“It is my choice to be in this much stress”. I wonder how happy their families are with this attitude.
Two classes say: “I enjoy serving the poor for free and am proud to be in this profession. I live for this”. Typically a MSS (Medal Seeker Syndrome). Will write separately soon about this.
Class ‘A’: Have it alls. Please explain your merc or beamer sir.
Class ‘B’: Dying for recognition, attention, praise etc. Explain your outcomes sir.

Are you happy with the perpetually unstable state of affairs that has become lifestyle for this profession now? Anyone can make any rules and you must follow them, all specialties must obey what semi literates and non specialists dictate.

The “High” of actually saving lives, curing diseases, easing suffering can never be understood by anyone else, but we too never understand the addiction part of it. We must work, or we are afraid people will die. There is no compensation for being a good doctor, you are at par always by law with anyone with a similar degree.

There are few seekers of perfection, of “doing the best for most”. They are villains in the public eye, for earning more, for being in a hurry, not explaining themselves to the system and general public. They do a lot but never get the deserved “social” accolades, which are typically reserved for the A class mediocre hypocrites.

All in all, the “Doctor”, under the delusion of respect and recognition, is subjecting him/her self to extreme stress, social and media criticism, health and legal risks, and most importantly, a life of a slave to their own delusion.

You income stops, your reputation dies the day you stop practice. Many retired Indian doctors of yesterday, who served the society without thinking of money and who are unfortunate to be alive today, live in a miserable poverty. None of the “Ethics and Morals” lecturing idiots ever cares what happens to them

Like times, we must change or die..

In Part II let us see some of the solutions.

(c) Dr. Rajas Deshpande

Cure This Headache

Cure This Headache
© Dr. Rajas Deshpande
This young woman in early thirties complained of severe headaches. She was accompanied by a caring but frustrated husband, and two sweet kids. One withdrawn and cranky while the other one was hyperactive.
“These headaches started only after shifting to this city 5 years ago” she said. They were from a state far away.
“I am usually fine on holidays, but on almost all other days I wake up feeling sick, without energy, and even a small factor like bright light, loud noise or reading brings on the headache. It then becomes so severe that I have to sleep or take pain killers. I can’t sleep every day, so I take this painkiller daily. Even small stress at work makes me very irritable, and when I return home I have no energy left to do anything. We have started fighting a lot” she said looking at her husband with wet eyes. “I know he is tired of my headaches, but what can I do? We have seen so many doctors in so many places”.
“She used to be very happy when we married, doc” said the husband, “I feel this is a totally different girl now. I do everything I can to help her, but I have work pressure too”.
Nuclear family. Both working 6/7 days. Both on highly responsible posts. Long hours. Changing shifts too.  Kids attended by maids when not in a day care. Their parents on both sides far away.  They have had two kids with a very short interval between them, so their “growing up” is almost together.
“Is it possible that one of you change the job?” I ask this very cautiously, almost knowing the answer.
“No, Doc, our current jobs have excellent prospects and incomes too” said the husband.
“Can you change the timings, so you get an hour ‘s rest without having to attend any tasks?”
“I can’t change the timing. I don’t think I am stressed.  My husband helps me a lot by cooking and looking after the kids. It’s a daily affair now. If these headaches are gone, I will be all right”.
The caring husband who was until now attending both the kids, especially the hyperactive one, said “I have suggested her that she can take a break, but she wants to continue as she thinks she will get bored at home”. He threatened the hyperactive one, now climbing upon my table, with his hand.
I explain that the habit of taking painkillers may itself be worsening the headaches, in addition to the “dual” stress at work and home. All said and done, a woman usually attends two jobs when she works. I also enquired if they can have their parents stay with them alternately, so things will be better arranged at home.
“They don’t get along well with us, doc. My parents irk him and I don’t get along well with his parents too. We have had a love marriage”.
“Sometimes I feel like ending my life” she started crying.
Her examination was completely normal.
As I wrote the notes, I wondered how many of these things were correctable. Nobody wants “Gyaan /Philosophy” or counselling. No amount of medicines were going to take away the basic problem: lifestyle without rest or peace, and no time for love. What happens to a relationship where there is no more “Gelling”of the husband and wife, of parents and kids because they don’t get time to be together?
One of my Yoga teachers, Mr. Mohandas (at the Kaivalyadham Center on Marine Drive Mumbai) always told me: When you mix the “sample curd” and milk, it will not all become curd immediately. It has to stand for some time before the mixture forms new curd. Any relationship that has to mature into something meaningful will require quality time spent together, both with and without the kids. This time has to be separate from merely eating or sleeping together, or travelling for work.
Fast friends who fall in love and marry end up in tangled fights after becoming too busy, sucked up in the work and family routine so much that they become strangers again. Everything for a good life is at their footstep, but life itself has taken a vacation for lack of time. Bodies change, and so do minds. Too much company becomes an irritating nag. Need for personal space is disputed if at all recognised. Meditation is not truly possible when chores keep knocking your door.
As I advised her some medicines and Yoga, I could not help but suggest her that they both need to rearrange priorities in life.
It is not my place and these are not the times that one can “politically correctly” suggest the right options: but kids growing up neglected because both parents are either working or tired when at home is certainly not a healthy option. Lifestyle choices should not take childhoods for granted.
In Canada, they have a law: that one must have one separate bedroom for each kid above three years.
In India, we desperately need this: that at least one parent / grandparent must spend few dedicated hours with kids every day, quality time without being exhausted or irritable.
I wished the mother well via my prescription, but my heart was with those two kids.
For what those two kids were unknowingly suffering is beyond our society’s conscience to deal with, and maturity to logically talk about.
© Dr. Rajas Deshpande

The Critical Diagnosis of the Indian Doctors

The Critical Diagnosis of the Indian Doctors: Doctor’s day special.

This article is also a test of how our society tolerates truth.

Recently read a flash news about Eminent Doctors taking cuts / referral fees. There cannot be any justification. But if a whole system based upon corruption, a whole society facing inflation expects only one of its components to be sane, it’s insanity. Hence these thoughts.

I apologise in advance if this hurts some feelings. This isn’t a placebo though.

For the “Nautanki” people who appear so shocked to hear about corruption in the Medical field, here’s the naked truth:

There is corruption in every aspect of every field including religion, law and judiciary, government, politics, police, press, military, film industry, YOUR FIELD, and also medicine, as the doctor is a part of this very same society, not from Mars. There is corruption in every aspect of medical field: referring a patient, lab tests, CT/MRI, Surgeries, Cross referrals, almost everything.

But as in every field, there are people who do it by choice, there are some who have to be a part of the system to survive in India, and some who refuse to be a part of it all, facing many other problems including a perpetually low income.

Think Simple: why would a person with highest of merit, hardest of hard work, tendency for helping others want to become corrupt? Not by choice. No one becomes a doctor for greed (Someone might attempt, but these people drop out in the first six months or a year: Those not dedicated to a hard life cannot endure medical education in India).

Every doctor wants to do good to his patient and also live a decent life. After a lifelong meritorious career, why should he be expected to toil in villages / rural areas without any rewards for it? Why should he not want his kids to go to the best schools? Why should he not want a decent lifestyle? Why should one give up a lucrative career in the west and return to the homeland feeling patriotic, to just be told that in your own country you are doomed to a life of sacrifices just because the society expects so?

“Someone who wants money should not become a doctor” said a dropout actor who is seen doing all immoral things (from peeing openly in a garden for press in real life to cruel crimes and revengeful murders on film: while running a show to change India to an ideal country.. I hope he and his family only use Indian things, medicines etc.). Why?

Why should a doctor not want money for a decent life? Why should he endure the humiliation of so many non-meritorious people from his class livin in luxury because they chose not to be  a doctor, while he chose the noble profession?

Listening day-in and day-out to patient’s problems, tears, cries, allegations, threats, and expectations, not ever having a peaceful sleep for a week at a stretch, not eating in time, not having enough time for family, why should a Doctor NOT want to earn well?

We are not supposed to refuse a case in emergency. Do the Judiciary or Police or Politicians do that?

We are fined crores for medical negligence. What if the Judge is wrong? What if the police are wrong? What if the politician is wrong? What do they pay even when proven wrong? Why the presumption that the negligent doctor’s intention was bad? Negligence is possible in all fields (reactors/ bridges/ buildings/ food/ trains/ public transport), can cost life in many, how come the doctor alone pays in crores for a life that he was attempting to save, while in all other cases the motive was profit, not saving life…?

How come the judges decide the amount of fine? In a recent case, the fine was in crores. If the patient had survived, would the court have ordered the same payment for the doctors? Doctors  save millions of lives. Some through heroic / exceptional efforts, without thinking of rewards. If a young patient is saved, shall we charge according to all the income he can make all his remaining future? Than why this criteria for fines?

World has become a global village. People travel to the developed world often. Highly specialised doctors in India are expected to be at par with their western counterparts. They often are, because half the world travels to India for medical advice.

But the Indian community is yet to awaken to the Doctor’s fees. An average specialist in the developed world charges between 10,000 to 30,000 INR for the first consult. Appointments are very difficult to get. They don’t work out of 8 am -4 pm slots except in emergencies (some honourable exceptions).  And yet they get so many benefits from the hospitals they work at, and also from the government. THEY SEE NO FREE PATIENTS. Most doctors live in luxury in the western world.

An Indian doctor on an average charges 300 rupees for an OPD patient. Sees many free patients (almost 40-50%) everyday. Continuously has to be occupied with:

  1. Patient’s health and benefit
  2. Relative’s expectations, their anger (many think that every patient must get well irrespective of his / her health status). Many hold the doctor responsible for their illness / failure to improve/ complications.
  3. Continuous suspicion: Many patients think Doctors are out to loot! Every investigation is with an intention to get more profit out of the patient. They want the best, but like “sabji”, they want to bargain.
  4. There is also a widespread belief that pharma industry is actually serving the doctors, not patients.
  5. Google searchers who think they know better medicine just because of what they recently read about a tiny drop in the ocean of medicine. They eat up a lot of time, but don’t want to pay for that additional time.
  6. The very relatives who shout at the doctor seldom know what medicines the patient is taking: it is all supposed to be the doc’s responsibility.
  7. So many Toms, Dicks and Harrys coming over and threatening: this is everyday nuisance in ALL casualties in India. There is no sensible Director in Bollywood to have realised a Doctor’s plight while working under threat in casualty. Everyone loves the populist “Doctor-Threatening” hero!

Then the seemingly innocent weapon (The secret bleeding wound in many a Doctor’s heart!!)

“But Doctor, You are like God / Next to God. The whole society respects you”

That respect is divine for us, that respect and the satisfaction of doing something godly by saving lives, helping people live better lives alone keeps us from going on and not quitting the profession for better incomes. Don’t you think we had the options of making more money had we used our talents elsewhere, especially in today’s IT world?

But that respect does not substitute for our children’s fees. Not for our rents, electricity, travel ANY expense. Almost all doctors and their family members end up paying full bills for themselves at the very hospitals that they work in… some minor exceptions. Everywhere a doctor goes, he pays the same money that any other citizen. There isn’t a separate queue for a doctor anywhere in any office just because he / she has patients waiting. There is no pension. There is no security. I can show you some highly successful (in patient care) ethical doctors who can’t pay for their own treatment TODAY!! If a doctor is sick, his / her income is zero as long as he does not work: No one cares if he has treated hundreds for free.

The respect does not substitute for the stress a doctor bears: of years of listening to and attending pain and tragedy, years of sleepless life, fasting days, lost precious time with dear ones.. as with anyone else, the DOCTOR ALSO HAS ONLY ONE LIFE… WHICH HE CHOOSES TO SPEND HELPING OTHERS.. is it a crime to be living well for such a person?

As for the other side:

There are corrupt doctors, corrupt practises. But please understand, a single doctor did not create them, nor did a group plan them These developed over time as the system evolved.

Like in every field, there are greedy among doctors. They ruin the reputation. But a single doctor cannot do anything. Those who try to change the system are boycott, thrown away, maligned.  There are some continuously fighting this.

Every doctor cannot afford to start a hospital of his own. He has to choose a specialty hospital which has all the facilities to practice his specialty. These come at a price. I appeal the people who feel bad about investigation prices to just enquire the rates of the machines/ skills/ licences/ manpower/ maintenance required to make these facilities available. The government makes it compulsory to attend many of its employees free / at subsidized rates, and never pays.. who will pay for them?

So hospitals have their systems. A single doctor cannot change them.

The Medical councils do not have any protocol / system to protect a doctor who faces vindictive attitude from hospitals if he / she wants to argue. Many specialists DO NOT RETURN TO INDIA OR HAVE ALREADY LEFT INDIA AFTER RETURNING due to this one reason.

Doctors who want to run their own hospitals face same bribery, same licencing scams, same corrupt government practices that any other business does. The rates are probably higher, and the regulations stricter.

Doctors are a weak vote bank., hence not on priority of any party. It is more practical for the politicians to openly criticise the doctor / profession in hope of gaining public sympathy / attention. No one wants to attend to their problems, which are many.

The medical council never protected any doctor against court cases or hospital victimising them for fighting against corruption. The regulations made are ancient, primitive. When a whole medical system is corrupt in almost every step, they have taken the approach of superficial actions against individual cases: typically populist. The medical councils KNOW every aspect of corruption, but have opted to fit in some screws where the whole building needs extensive repairs. One’s degree and education of fifteen years becomes meaningless in the eyes of medical council just because there is delay in renewal of licences. How can rules be applied only partially in a system? While many people practice without degrees or knowledge, the councils choose to target the qualified for not renewing their licences: a process that involves acquiring CME points, the money for most such events, travel etc comes from pharmaceuticals, the patient pays: they do not have the online option of CME / licence renewal like most western countries, even in this advanced age! So a doctor is expected to leave his town and practice, get involved in events sponsored by pharmaceuticals, travel with help from pharma companies, stay in hotels with their money so as to renew his licence. But not online. And there is no compulsion that he has to attend the event for his specialty. So a Neurologist could attend a gynaecology event just for CME points and its ok for the renewal!! One can easily get such CME credits without attending the event!  There has to be an online option, or a rethinking of this whole business.

The whole Mediclaim business in India is a fraud: they don’t pay for

  1. OPD consultation / investigations of a patient.
  2. Patients with genuine illness, but without injectables or surgery.
  3. When they do not understand the diagnosis or the fact that some cases do not have a proper diagnosis.
  4. Emergency / Critical care / Specialist charges etc.
  5. Even when they pay, it is their choice how much.

This results in many a wrong practices.

So in a mediclaim case, no one benefits except the company: Patients, Hospitals, Doctors all lose. Still, the Medical councils do not want to do anything. In fact, they don’t have a say.

Add to these:

Incessant calls / emails/ wtsapp messages for any enquiries that pop up in the patient’s or relatives (usually the cousin in America) mind at any time of the day or night: and bitter words to follow if reply is delayed. (That doctor has advised so so… what is your opinion?… I just read on google about stem cell therapy to improve my anger… what say? Etc. etc.).

Then there are sons and daughters who stay in US / UK etc., but leave their parents back in India. They expect the same care but at a low price, and also a daily update by the treating doctor. NO WESTERN DOCTOR GIVES OUT HIS CELLPHONE or EMAIL ID  TO PATIENTS, THEY KNOW THIS, but they talk from there as if fron the top of a mountain..They don’t want to come and attend their dying parents, but vent out this guilt in form of anger towards the treating doctor: Do everything doctor, don’t worry about the money.. I am unable to come to attend my MOM because of business meetings/ no tickets / kid’s exams etc. I lose my patience here often.

If a Judge / lawyer is ever reading this article, Your Honours, please consider these when you next fine crores to a doctor (even if insured, he has to pay huge:

A doctor should not be held negligent if

  1. The patient does not follow advice as written
  2. Patient continues to drink / smoke / eat tobacco/ does anything that the doctor has prohibited.
  3. Does not follow up as directed (most patients miss their follow up dates: doctors are supposed to jump from illness to illness).
  4. Does not show the same care towards his own life that the doctor is expected to take.
  5. Has not given all correct information about himself / herself / his/ her illness
  6. Hidden some information from the treating doctor.
  7. Has lost treatment details.
  8. Self medication / cross consultation without knowledge of the earlier doctor, resulting in multiple medications.
  9. Has had unknown allergies / reactions in the past.

There should be a doctor’s board for each specialty which opines about every particular medicolegal case before the court makes its final decision.

I always wanted to be a good doctor, like most other colleagues I know. I have always heard the courts of justice demand that one speaks the truth.  Here it is. Hope I am not punished. I am not always correct, I am sure some of my friends will correct me. I will keep learning too.

A warning. When the whole medical system becomes non corrupt, patients will end up paying far higher consultation / surgical fees than what is paid now. This is inevitable. Add the legalities to everything, and many specialists will become non-affordable / non available to most. The many many who get free treatment now will be denied that.

Or the next generations will see less and less specialists opting to settle in India.

I love my profession. I Love my country. I love my patients too.

But I also deserve a good life. It is time I stop thinking I am God because the society has presumed so.

May God confer best of health upon all humanity.  May I always do good to my patient.

© Dr. Rajas Deshpande