Tag Archives: Compassion

An Interview With a Neurology Legend

An Interview With a Neurology Legend

Dr. Satish Khadilkar

MD, DM, DNBE, FIAN, FICP, FAMS, FRCP (London)

Dean and Professor and Head, Department of Neurology,

Bombay Hospital Institute of Medical Sciences, Mumbai.

He is a living legend, one of the best neurologists anywhere, a stunning example of what an ideal doctor should be like.

He needs no introduction to those in the medical world: he has carved his golden name in global neurosciences with his passion for Neurology and especially NeuroMuscular diseases, pioneering this specialty in India. I am grateful to Dr. Satish Khadilkar for agreeing to guide us all.

Q: How does it feel at the top?

A: Grateful to life!

In the health pyramid, ‘top’ really means ‘more useful’! And there are at least three parts to being useful: providing service, teaching and conducting research. Indeed, I am grateful to life for having provided me with the opportunities to be useful to colleagues and disease sufferers in all the three spheres.

Q: What are the most essential qualities that a doctor must possess?

A: As mentioned above; service, teaching and research are the three main pillars of medical careers. Each of these requires different virtues. Service requires patience, availability, affordability and the capacity to empathize with the sufferers. Teaching requires clarity of ideas and the ability to be inspirational to the new entrants and younger colleagues. And research requires an analytical mind to understand questions, be unbiased to design experiments in search of the answer.

Depending upon which field you choose, relevant qualities will need to be enhanced. In my mind now, as I have gone on, service has emerged as the noblest frontier for the medicine man. So the essential qualities are compassion, knowledge and the desire to help.

Q: What do you suggest we do to improve the clinical sense among newer generations of doctors?

A: Simple answer: bedside clinics by masters of clinical medicine and shadowing them to see how they utilize the limited resources.

Q: How do you deal with the ever widening knowledgebase while effectively practising as one of the busiest practitioners in the country?

A: Knowledge is of two types, one to know it yourself and the other, to know where to find it! In the present times; we have moved on to the second mode. The great thing about this era is that knowledge is freely available. We only need to develop the ability to design the search to get rapid answers to our questions. There are courses available to this effect.

While this is true for problem-based daily issues, in one’s own area of interest, one has to acquire all the manuscripts and threadbare them, assimilate them and understand them, for deeper knowledge.

Q: How do you handle the incessant negativity which doctors face while dealing with so many incurable conditions and gradually deteriorating patients?

A: Negativity in the doctor’s mind stems from the perceived personal inability to help or to provide solutions. Doctors need to appreciate that their role is limited to being knowledgeable helpers. If we keep in mind the inadequacies of medicine as a science and our restricted role, negativity is less likely to take roots.

Q: What is your take on making holidays, vacation compulsory for doctors to overcome stress?

A: Personally, I do not see the need to take holidays, as my daily work itself is a never ending holiday! I do not remember taking a holiday in last three decades. The better you gel with your work, less it stresses you and less is the need to break.

Having said that, as our work relates to human life, we have to make sure that we take adequate rest and are “on the top of our game” for the hours that we work, as our shortcomings can have consequences.

Q: What advice will you give about handling family responsibilities and duties to the new generation doctors?

A: Human relationships take very long to build and only one indiscretion is enough to undo these. So, in relationships and family, equal attention needs to be given, as you would in your profession. In today’s competitive India, we tend to take the family granted and actually end up doing the least for those who matter most!

It is best to think of this early on while planning the professional career.

Q: What best can be done to stop the exodus of doctors from India?

A: Talented Indian doctors need to be appreciated by the society and the health system in India. System needs to be more humane and responsive to the doctors’ needs. Doctors also need to understand the process of medicine, its goals, trials and tribulations. Till this happens, we shall see movement to greener pastures, where this process has evolved better.

Q: Your guiding thoughts for future Indian Doctors?

A: Let us all remember that we are in medicine to help suffering people. That is the core of medicine. We are healers and scientists. If we don’t veer from this ideal and have patience, all material wants and requirements will automatically fall in place. So to understand medicine, one must never forget that this is the noblest of all professions. I have chosen its nobility as a guiding principle for myself. I found my solace in drowning myself deep in the vast oceans of knowledge about neuromuscular disorders and using it in the service of suffering multitudes.

©️Dr. Satish Khadilkar & Dr. Rajas Deshpande

The Dictators in Hospital © Dr. Rajas Deshpande

“Let my father die. It’s ok. I will not take him anywhere. I don’t want anyone else to treat him” said the 60 year old son loudly. His old father who could listen and understand the conversation, but could not speak or move due to a paralysis, just closed eyes. Tears emerged from the corners of those closed eyes.

Like most doctors nowadays I have learned to master personal opinions and emotional responses, especially with ill-behaved patients, but this was beyond me. Not because he had shouted at me, but because he had just stabbed his father’s heart. Loudly, so that the patient could hear, I said “I think your father should feel better soon, let us see what we can do”. Then I gestured the angry son to see me out of the room. Two other men accompanying him came out and towered upon me.

About five days prior, this son had come to me with his father’s reports. The patient was admitted at a rural hospital. He had severely compromised heart function and his heart rhythm was abnormal. This caused formation of many blood clots in the heart, which went to the brain blocking blood vessels. One such large blockage had caused paralysis and inability to speak. © Dr. Rajas Deshpande

I had asked the son not to shift the patient, as the treatment started by the rural physician was accurate, we had to just wait and watch. Still, they had brought the patient in an ambulance, travelling for over 4 hours. Naturally, the patient had worsened , becoming drowsy. His heart rhythm was dangerously worse. He was unable to swallow, there was a big risk of his saliva/ mouth secretions going to his windpipe blocking his breathing.

Whenever a patient has problems out of a specialist’s expertise area, it is mandatory that an opinion of the concerned specialty expert be obtained. I asked the best heart specialist I knew to see the patient, and also a small ENT test to see if we could initiate training for swallowing. Our physiotherapists were already working upon his hands and legs gently.

However, the son (a retired govt. officer from a very respectable post) and two others attending the patient created a big scene when my junior doctor visited the patient. They started shouting and cursing that by calling other specialists we were just “increasing the bills”, and that they did not want anyone else except me to see the patient, not even the junior doctors. © Dr. Rajas Deshpande

My assistant physician called me in panic and updated about this, asking me to immediately act to deescalate the situation. Although there were many patients waiting to be attended in OPD, I had gone to this patient’s room. I explained to them that the patient needs to be seen by a heart specialist too, as his heart condition was very delicate. I also offered them to choose any specialist or hospital they wanted, if they were unhappy here, but they could not waste time as the patient was critical. That’s when the son shouted that he would rather let his father die than be seen by any other specialist.

When they came out of the room, their body language and general disposition suggested aggression. I tried to politely reason with the son that any specialist cannot sit with the patient 24/7, that junior doctors and other specialists as required will have to be called in for the best care, but they declined. The efforts of our medical superintendent and best patient coordinator went in vain. © Dr. Rajas Deshpande

“We will not allow anyone except Dr. Deshpande in the room. Our patient must get better” the son said loudly.

“I will see him till he is under my care, but I cannot guarantee any outcomes” I told them. “Let’s see” he said. He did sign the document informing about criticality of the patient.

No doctor should treat patient under pressure, duress or threat in the interest of the patient. I went to our medical director and requested that the patient be transferred under some other specialist. The hospital offered them freedom to choose, but the relatives declined. “We have come here for Dr. Deshpande, he will have to treat the patient alone” the son said. The hospital decided to take a call next day after a meeting.

That evening as I finished the OPD, I wondered how the patient was. However much angry I may have been with the relatives, the patient was more important than my anger, pride or anything else. I went to their room and checked the patient. He opened eyes and smiled. I asked him his name, and he replied in a husky tone. He was speaking now!!

The next day again, the relatives refused to transfer the patient under someone else, and I kept the treatment on. The trustless atmosphere was quite volatile, and if something had gone wrong, things would have taken an ugly turn. In the next three days, the patient spoke well, and even accepted some sips of water. His hand and leg started moving too.

“Can we take him home now?” the relative asked on the fourth day.

Happy for many reasons, but mainly the fact that the patient had improved, I discharged the patient. I had learnt my lessons. © Dr. Rajas Deshpande

Adamant, unreasonable and illogical demands by patient’s relatives jeopardising the patient’s life is a huge medical problem in India. Illiteracy, political interference, goonda culture and media support make such horror stories a routine reality. The law still expects the best patience and non-reacting approach of medical personnel, with the onus of saving lives still upon them under this pressure. Innumerable instances of harassment and humiliation of nursing staff, especially women go unreported. Relatives, especially politically connected, behave like dictators in any hospital, threatening one and all. Unless this culture ends and doctors are at a freedom to do their best for every patient, medical care in India will always remain inaccurate, incomplete and purely financially guided rather than scientific or even legal. Doctors can actually file a complaint or take legal action in such cases, but they are too many, and no doctor has time for such legal courses. In the best interest of our patients’ lives we go on forgiving and tolerating such abuse. Because neither law nor administration wants to correct the causative factors effectively.

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

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Young At 98. Secret?

Young At 98. Secret?

©️Dr. Rajas Deshpande

A few months ago I had received an emergency call for a stroke case. The resident doctor informed me that the patient was a lady of 98 years. Her basic tests were normal.

Worried, because stroke is a dangerous diagnosis at any age but more so at that age, I ran to her room as soon as I reached the hospital. A group of her worry-faced relatives waited outside her room.

I entered the room and introduced myself to the patient. She got up.

“Namaskar! How are you doctor? My name is Champadevi Gupta” she said with a big smile and such gusto that I wondered if she was the right patient.

“I am ok, thanks. What happened today?” I asked her.

“Nothing much. I had some giddiness but my children worry so much about my health that they rushed me here”.

Although her examination revealed only mild signs, her MRI had shown a small block in a blood vessel supplying a crucial area of the brain. I explained it to her. She laughed aloud again “I feel okay now. When you feel ok, let me go home”.

She was discharged next morning.

She came in thrice after that, every time walking in with a big smile, lighting up everything around her, keeping her hand upon my head and sumptuously blessing me, inviting for a meal at her home.

Today she came with her youngest son. She is as fit and fine as any young teenager, only happier and more content.

“She has always been like this: happy and content with whatever life brings, in good and bad times” her son Satish told me, “we are 5 brothers, we all look after her, but she still lives alone near my home. She is like a treasure and source of life for all of us”.

Indeed. A laughing, smiling, truly happy, positive and content person is probably the most precious form of human being, and so rare now, that sometimes I want to tell those running behind one thing after another, killing themselves every day: “Look at this lady’s face! This is the secret of a good life, the best health and happiness”.

It is so sad that we are evolving into a “Want more” type of materialistic, selfish, disconnected world with misplaced icons! I was amazed at the willing, involved enthusiasm with which this lucky lady’s children cared so well for her! Incidentally, I had had a tough argument with my teenager kid that morning and had left home in a slightly bad mood. After meeting Champadeviji, whose eldest son of over 80 years still visits her regularly, I was relieved. Parenting is a long term, never ending activity, and may be my own stresses of being a doctor were also distressing my kids sometimes.

As I told her that she was fine and need not visit me for another year, she held my hands, hugged and blessed me, and with mock-anger said “Now if you don’t come to my home I will come to yours without telling you “.

I am now in a true dilemma.

©️Dr. Rajas Deshpande

Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

He had a sudden, severe chest pain, so he told his office-colleague so. The colleague first called his wife and alerted her “Bhabhiji please don’t panic, I am taking your husband to this hospital, please reach there as soon as possible and give me a call once you reach”.

The cab driver grasped the situation at once and drove as fast as he could. He prayed in his heart. Just a kilometre before the hospital, there was a huge mob blocking the road. A great leader was shouting aloud about his pride for his religion and patriotism, least aware that they were all blocking many children and mothers trying to reach home, patients and doctors trying to reach hospitals. The bought crowd was eagerly listening to the violence provoking words of this rich politician, also a convict and suspect in many crimes, There was less audience at the real places of God’s worship nowadays than at political speeches giving religious sermons, mixing them with the love for one’s nation!

The cabbie honked. Two monstrous looking goons peeped in his window and started abusing him insanely, least aware about the women and children around. The cabbie was abused first for his profession, then his language, and the state he had come from, threatened to be burnt alive along with family if he honked again when the ‘great’ leader was speaking.©️Dr. Rajas Deshpande

The cabbie begged with folded hands: “Sirji forgive me, I accept my mistakes, but there’s a patient on the back seat. He looks serious, we must reach the hospital as quickly as possible. For god sake, let us go”.

One of the goons opened the back door and asked this patient his name. After he saw the chest-clutching patient almost gasping, they made way and allowed the cab to leave.

Now the patient had started profusely sweating. His face had turned bluish, and he was making efforts to even breathe well. He could not speak. As they entered the hospital, the patient’s friend noticed that the patient had stopped breathing.

He shouted in panic. The wardboy and the cabbie lifted the patient on a stretcher and ran towards the emergency room.

A frantic, fearful sound of thuds of the last heart massage was now heard, along with breaking of many glass syringes and instructions shouted by doctors and nurses. A tube to restart breathing artificially was inserted in the patient’s throat. ©️Dr. Rajas Deshpande

There was no one to cry for this patient there. His friend was sitting outside the emergency room, clutching his head, stunned. The cab driver had left without taking his bills. Religion and Patriotism stayed outside the hospital campus, they couldn’t save lives.

A young and dynamic heart specialist who had just returned to India saw the ECG of this patient. An urgent action was required. He called upon the patient’s friend to sign a consent.

The friend hesitated and refused. There were a lot of news every day everywhere about doctors fleecing patients, earning money by misuse of stents and surgeries. The friend no more believed in what this doctor told him.

“I don’t know. Wait till his wife arrives, she will be here in an hour”.

Every millisecond was crucial. The dynamic heart specialist called his medical director. “Sir, I take full responsibility for this case, he needs immediate action”. The medical director cautioned him: “Doc, if anything goes wrong, if the outcome is not good, they will file a murder case against you. Why do you want to risk your bright career at the very beginning? You must also think that you don’t have any political godfather”.

The doctor rushed the patient to the cathlab and inserted three stents in the patient’s heart, that resumed the normal blood flow to heart. The patient’s heart function returned to near normal in an hour. By the time the patient’s wife arrived, the lost life of the patient was brought back. The next day, the patient could breathe well by himself.

Now the most crucial puzzles: which state did the cabbie come from? What was the caste of this patient? To what country did the helpful friend belong? Why didn’t they go to the government hospitals run by those who criticise private doctors and hospitals? And lastly, what was the religion of the doctor who saved this patient risking his own life and career?

Any sane person with an ounce of humanity in his heart won’t ask these stupid questions. But some Indian leaders and their followers do. And it is very sad and unfortunate that the answers to these questions cannot be openly revealed in my beloved India.

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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Mumbai Diary -1. Deeply Yours

Mumbai Diary-1

Deeply Yours

After finishing the day-long opd at Lilavati Hospital Mumbai, I rushed out with an intention of driving back to Pune in four hours. An old friend- a junior doctor from Mumbai (don’t think too much in depth about her) was waiting for me in the lobby.

“There’s a Starbucks in the next lane. Have a coffee before you take off” she said. I am not a sinner to decline a coffee. And this beautiful genius doctor always enriched my soul in magical ways. Usually a double shot kenya roast espresso shoots up my IQ by a few hundred points and makes my brain tap-dance for atleast three hours. She sat in the car and we went to the coffee shop. There was no place to park, so she went in to get take-away cups and I waited in the car. The bandstand seashore was only three minutes away, We decided to go there. With Shahrukh and Salman living there, no one bothers to look at us in that area, and we can thus have a cool few minutes for coffee etc. (I repeat, don’t think too deeply about this).

Just a few feet away, an elderly fruit vendor with a ripened straight proud face, white hair and a thick white moustache was sitting with his legs folded backwards. The heaps in front of him were full, most likely he hadn’t had much business today. He stared at nothing in front of him, completely unaware of the rush hour noise.

I felt for him. I wanted to see him happy, help him without hurting his pride.

When my friend returned, I requested her “Hey, could you please do me a favour and get two kg apples from that uncle over there? Give him this, and ask him to keep the balance. Make it look polite and casual, as if at the spur of the moment“. I gave her some notes. We didn’t need to impress anyone, she would have naturally done it herself too, that’s the reason we have been friends for so long.

My friend returned with the apples, and I waited a few moments to sip some coffee, actually I wanted to witness the smile on that old fruit vendor’s face. He counted the money twice, smiled and came to our car, knocking at her window.

“Beta (my child), I have enough by the grace of God. I am happy. One has to account up there for everything they take without working for it” he pointed at the sky. Then he kept a large custard apple in my friend’s hands, and said “This if from me to you and your friend with the necktie”.

Then, smiling proudly, he went back and sat in his place.

Now, please think in depth about that.

©️Dr. Rajas Deshpande

Mumbai/ Pune

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Survival Of The Quickest

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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

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Robodoc

© Dr. Rajas Deshpande

“The doctor wasn’t even replying. He didn’t answer my questions” the patient, an angry lady, told me about one of my colleagues. The patient’s husband sat besides her, expressionless.

I reviewed her case in detail. She had had varying complaints for over four years, mostly severe pain at various points on her body. When a patient has symptoms (complaints) grossly disproportionate to the signs (doctor’s findings), there always is a suspicion of ‘exaggeration’ or ‘lying’. This can happen involuntarily due to stress, depression or anxiety, or voluntarily usually for seeking attention. She had seen many specialists, and had received strong doses of almost all types of pain killers and other pain control medicines, still her response after every course was ‘zero relief’. That was definitely suspicious. I looked at her husband. He appeared tired and aloof, reluctant to participate in any discussion. I had to make him talk.

“Is she stressed? Have you noticed any change in her personality?” I asked them the question that usually opens the dreaded can of worms.

“I am fed up, doctor” said the husband, “She needs continuous attention. Since our marriage four years ago there’s never been a month when we did not visit a hospital. All doctors tell her to go to a psychiatrist, but she refuses. The moment I return from office she starts complaining about her health. I don’t know what to do now, I feel I am better out of my own home” he avoided looking at her.© Dr. Rajas Deshpande.

His wife started crying, and in a shrill voice, shouted at me “Why are you speaking with him, doc? I am your patient, speak to me. No one believes me. I am suffering so much!”

I assured her that I was going to help her sort out the issue. Once she calmed down, I was able to explain to her the way stress affects human mind and body, and that it was possible to get well soon. I told her that being stressed was not a “psychiatric illness” but an overworked, burdened state of mind that needs attention, and that it can often be cured by speaking with the right person. She asked me many questions. As a special case, I made an effort to reply to each one of them, even the irrelevant ones, sometimes repeatedly. She agreed to visit an excellent counsellor colleague of mine. She drastically improved in a month after the counsellor worked upon her. However, she came back with new complaints within two months. She visited me twice more, and each time cried a lot, then when I pacified her, asked the same long list of questions mixed with new ones.

My sympathy and compassion started waning. I have promised myself never to be rude to any patient ever, and I religiously follow that. Yet my patience was wavering now.

The more compassionate, patient, sympathetic a doctor becomes towards the patient and their family, the more it is taken for granted and misused. The doctor is then expected to be an unending source of “psychological support”, mentoring and motivating, and a punching bag or a cry-to teddy bear. While in a healthy doctor-patient relationship this compassionate attitude is natural and welcome, many doctors do not know when it starts growing upon them and stressing them out. It is not easy to listen to a continuous flow of medical symptomatology especially wrapped in negative emotions. While positive outcomes do bring back life into a doctor’s motivation to do better and more, this expectation to be a listener of all sorrows until the storyteller is satisfied is unnatural and impractical. It tells upon the doctor’s health. This is now happening in almost all specialties, and wise doctors are learning to separate patients into “whimpering, chronically-dissatisfied-with-everything storytellers” versus patients with genuine medical, surgical and psychiatric issues. © Dr. Rajas Deshpande.

To concentrate upon what can be corrected, to treat what is possible should be the right priority, and here’s where a doctor’s compassion, sympathy and patience are best employed. To expect a doctor to resolve issues like ‘Swabhav’ (inherent nature) of a human being is wrong. A doctor also cannot solve the root causes of stress like poverty, unemployment, interpersonal incompatibility, overambitious, over-expectant personality or attention seeking. Many patients and families expect the doctor to resolve ‘every minor issue’ related to ageing, refusing to accept that resuming complete normalcy of health is impossible after a certain age, especially with some medical conditions. Doctors can guide patients, but cannot accompany the patient and family to fine tune every minor issue.© Dr. Rajas Deshpande.

Few paranoid, suspicious, accusative, aggressive patients and the types mentioned above have now made it necessary for the doctor to be extremely aware and alert, cautious, and to some extent emotionally aloof from the patient at least in the initial phase. Every word has to be spoken with caution. This “Robotic Doctor” or “Robodoc” is actually becoming a sad reality in the Western world where every medical consultation is considered a potential chance of litigation. A careful doctor avoids getting trapped into emotional exploitation. While this may upset some patients, much of the educated class is still happy with a proper professional consultation, diagnosis and treatment rather than only a compassionate sweet talk. Given the Indian scenario where patients are driven emotionally rather than scientifically especially in the illiterate and financially challenged echelons, a doctor needs to be better equipped for avoiding misuse of his / her compassion and sympathy, as it also converts readily into a permanent source of rewardless stress. This is unhealthy for doctors.

This is one reason ‘Robodocs’ are on a rise. A sad truth about an essential evolution in the medical profession across the world. The only thing that can change this is individualising patient care.

© Dr. Rajas Deshpande

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Cerebral Palsy and The Californian Driver

AlKhalil Mohammed Qasem was noticed to have one sided weakness shortly after birth. His parents were told that nothing can be done, they have to accept that the child will always be bedridden. They decided to fight fate. They knew that their child was intelligent, that he had only problems with movement. Cerebral Palsy is a most misunderstood, misdiagnosed and mistreated medical condition. It is best handled by paediatric / adult neurologist or a paediatrician. There are some types of cerebral palsy where the child indeed has good intellectual functions yet severe abnormal movements, stiffness or imbalance. Few have fits too.

He came to us five years ago. There was a huge language barrier, I explained to his parents through the interpreter that all the medicines I wanted to try for him had side effects, some serious. They gave me permission in good faith. We started treatment. He improved. They went to USA. AlKhalil started going to school. He topped his class always. The parents made extraordinary efforts to provide best for him. His father works as a supermarket executive.

Now AlKhalil has finished school and joined college. He is also working part time to help his father at the supermarket, and drives his own car.

He came all the way from California today for a follow up.. He showed me his driving license with a pride and smile I have seldom seen! Driving a car is such a fond dream of everyone growing up!

AlKhalil and his parents have defeated cerebral palsy!!

Most cerebral palsy patients can have a significantly better quality of life if they reach the right specialist, usually a paediatric or adult neurologist as per their age group. I found no better example.

Miracles are not only possible, they are human too!

©️Dr. Rajas Deshpande

PS

Cerebral Palsy care is a teamwork between neurologist, paediatrician, orthopaedic surgeon, speech therapist and physiotherapist.

Till I’m Alive

Over 4 years ago, a late night frantic call from the casualty baffled me. Quite a complicated case. After seeing the patient I met her anxious family and explained them my thoughts, that the diagnosis wasn’t clear yet, and that we needed to observe the patient. I had already started treatment based upon a presumption. The Mandke family, in spite of being extremely well connected socially and able to afford treatment anywhere they chose, still decided to invest their trust and faith in a junior Neurologist like me. The onus to prove them correct was now upon me.

In a few days Mrs. Madhuri Sudhir Mandke was completely cured of the transient illness she had developed, and discharged. After a few follow ups, I told her the good news: she no more required to see me.

Yet every Diwali, she comes personally or sends someone from her family with extraordinary sweets and gifts. When she came over today, I told her this was not necessary, I had just done my duty. Then she said something that moved me: “Till I am alive I you will receive these every Diwali”.

This gratitude not only increases my responsibility, it is also a perpetual reminder of how important it is for every doctor to take it upon himself/ herself to justify, to stand up to that trust which involves health and life. Every outcome may not be what one strives for, but every effort can be made genuinely to let the patient and family feel that they have trusted the right doctor. It is NEVER sweet talking, wise talking or jovial attitude alone, never pure medicolegal attitude, but a combination of scientific, ethical and compassionate care that brings home the rewards of appreciation by the patient: the highest achievement in medicine.

There’s nothing more precious to earn upon earth!

©️Dr. Rajas Deshpande

The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

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

1. Denial of false certification.

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

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

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

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

6. Advising necessary investigations.

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

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

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

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

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

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

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

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

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

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

How to know?

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

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

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

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