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The Babaji Doctors

The Babaji Doctors
© Dr. Rajas Deshpande

“Today’s young doctors of today don’t know anything” the famous Senior Surgeon told her, smiling bitterly, “You have nothing wrong. Go home and take a pain killer, you will be fine tomorrow.”
The next day, at 2 AM in the morning, she was comatose, as my Neurosurgery professor in Mumbai prepared to operate her brain. She was found to have a huge tumor in her middle part of brain, that was about to kill her in few minutes.

This student, a girl aged about 21, came to me with a severe headache and mild imbalance. A senior physician was accompanying her as a local guardian, as her parents were in Mumbai. I had found that she had some warning signs, and told her to go for an urgent MRI. This is a standard protocol for any headache with neurological dysfunction. The accompanying physician told her in front of me “We will go and have a second opinion from the famous senior doctor. He is my friend”. I was not offended at all, this is the right of every patient. A senior doctor would definitely have better experience if not knowledge or specialty training. But I did feel sad about the ease with which this senior physician had underplayed my opinion. That he didn’t understand something did not give him a right to challenge it. © Dr. Rajas Deshpande

Next morning the girl messaged me that the F.S. doctor had told them “Nothing was wrong, that new doctors advised unnecessary tests, told her to take a painkiller and go to college next day.’

She went home and rested that night. The headache was a little less by morning, she texted me so. By afternoon, in the college, she started feeling drowsy and had a vomiting. Her local guardian physician asked her to travel to Mumbai to her parents and take rest. On the way to Mumbai by car she became unconscious. Her friend accompanying her called me (the F.S. did not pick up their call). I advised them to immediately contact my Neurosurgery professor in Mumbai for further help. I called him and informed so too. They reached Mumbai late evening. Her MRI showed a large brain tumor that was blocking the flow of fluids around the brain, and causing compression on the lower part of the brain. She was minutes away from death. My professor decided to operate her immediately.

Starting new practice, in the beginning weeks in India after three years of fellowships in Canada, I had far less patients, and more time to spend with each one. Very proud, I was also somewhere pleased by the brilliant competition I faced, and the fact that malicious bitterness was usually a certificate of good work. According to a saying, critics help one thrive. So long as I set my practice standards high and respected them myself, I wasn’t interested in any competition, nor feared any. Silence was the best weapon and I used it freely in many situations especially when refusing to be dragged in low level gossips and backbiting, not uncommon even in the medical world. © Dr. Rajas Deshpande

“Say what you must. Make your point twice and move on. Don’t argue, because then you presume everyone is equally intellectual. The greatest rule of all is that truth will prevail.” Dr. Sorab Bhabha, my professor had taught me. I follow that to date, but I fail in the test of tolerance sometimes.

Many times, to impress the patient more than one’s competitor, some doctors resort to quite unfair and unethical means. To cunningly use patient’s dissatisfaction, reluctance and doubt about medical expenses and to say ‘immediately pleasing and gratifying’ things to make the patient happy is an art which some (senior and junior) doctors wisely incorporate into their practice.
“Don’t do surgery that the other doctor advised you, Those tests were all unnecessary, We will take a second opinion because I am not sure about this doctor, etc.” are the common tricks used. This gets them the instant faith of the unsuspecting frightened patient. This can then be gradually used to drive home the same advise as of the first doctor, but in different words that please the patient. © Dr. Rajas Deshpande

I am not against unnecessary sweet talking, although I don’t want to ever do that. Most doctors of my generation don’t believe in it. The patient must be told the truth compassionately, in the least hurting, non-frightening way, and any queries / doubts that may arise should be realistically addressed. Patients should be told the good and bad of every treatment option, and they should be encouraged to make informed decisions.

A doctor is a scientific, intellectual and compassionate service provider, and should refrain from being a pleasing-gratifying, patronizing or clownish entertainer at the cost of patient’s health by making compromised healthcare decisions, just to keep his/ her “Famous and beloved” status.

Some doctors also think of patients as their “personal property” and when they refer such patients to the specialist, they send a list of instructions and interfere with the specialist’s planned strategy. Some admit under their care patients who do not belong to their own specialty, then pay a good specialist for the correct diagnosis, and then google-treat the patients from standard treatment protocol sites (harmful, because the same treatment protocols do not apply to each patient). This unhealthy practice, mainly based on referral / cuts, will hopefully reduce with laws against cut practice.

Any intellectual will understand this: that with the vast expanse of medical field and research, no doctor can claim to “know it all”. One can only be proficient in one’s own specialty. Where a specialist is not available, or in emergency (this is the term most misused in such cases) one can use the best of one’s knowledge to treat the patient. Unfortunately, India is full of illiterate and poor (and also educated paranoid) patients who will only believe what is most financially suitable to them, will easily fall prey to the magical sweet talking abilities of a doctor, and blindly follow what is told, without ever knowing right or wrong. That is the reason of a rise in the “Babaji Doctors” in this country with so many Godmen in almost all religions! © Dr. Rajas Deshpande

These medical equivalents of “Baba”s will have a benevolent smile, talk very reassuringly, speak only what the patients like to hear, and wisely try to convey that they know better than any other doctor, even the best specialists who have had excellent training in very specialized areas. Quite fortunately, younger generation patients are far wiser than to be affected by these pseudos: sweet talking without a reason is an immediate turn off for most intellectual young.

The hierarchy of education, qualification and specialised training is always superior to the hierarchy of experience. An MBBS passed out 50 years ago cannot be better than a MD passing out today. The ones with higher qualifications and training, even if far younger / junior, must be treated as above one’s expertise in their respective field. Yes, if the degrees and training are equal, then experience matters. © Dr. Rajas Deshpande

“ I don’t agree with your diagnosis, I don’t think that this patient has Parkinson’s disease” a senior surgeon once told me in front of a patient he had referred.
I know no one can be perfect, and I can be wrong. But I also know who is qualified to say that I am wrong.
“With all due respect, Sir, you are not qualified to comment in this specialty, just as I cannot challenge your diagnosis in yours” I replied. Age that does not match its behavior need not intimidate me, especially where a patient’s diagnosis is concerned. A doctor’s first duty is to tell the truth to his patient, and a part of that truth is what the doctor does not understand.

Pretending expertise in medicine may be fatal for a patient, no true blooded doctor can accept that.

As for the girl who was operated that midnight, she is now married and has two kids. She called a few months later to tell me she was doing well.

I continue to meet patients every other day, who have visited the F.S. doc, and tell me how he told everyone else was wrong.
Unfortunately, the only treatment in such cases is awareness.

© Dr. Rajas Deshpande

PS: Most doctors follow the ethics of not criticizing other doctors, which is required by the Medical Council. However only very few senior doctors have a heart big enough to welcome competition. This causes immense difficulty to the newer generations of specialists. Hence this article.
Please share unedited.

The only way towards a solution: A 13 point charter for Doctors

The only way towards a solution:
A 13 point charter for Doctors
Happy Doctor’s Day!
© Dr. Rajas Deshpande

1. If we want to survive without being exploited and improve healthcare, we must forget all our differences and unite for this cause. We must be able to overcome all personal differences to realize what great strength we are. This is the only solution for ourselves and our dear patients!

2. We must form specialty-wise groups of doctors in each city / state and elect a steering committee that will decide the regional regulations. The charging system for consults, procedures and investigations according to “gradation” of hospitals (facilities, location, quality of advanced care, nursing) etc. should be devised by these regional steering committees alone. State committees should elect a National Medical Steering Committee.

3. The specialty groups in each town must include all consultants from that specialty, and decide the correct fees for consultation, procedures, intensive care, emergency availability and surgeries based upon seniority, qualifications, skill, time, complications and other factors intrinsic to that specialty. This schedule must be binding upon all the small and big hospitals in that region, insurance companies and private practitioners. Sharing fees must be the doctor’s prerogative.

4. There should be no free cases, except those below poverty line and in emergency. Doctors should get tax benefits for every free patient (CGHS /CSMA/ ECHS or BPL in India) treated by them, as per the regional schedule. There should be a regional coordinator for all the Free beds in private hospitals, which are often misused by rich officials. Every consultant must see free patients one day in a month by appointment.

5. Govt. must provide all cost of prescribed medicines, surgeries, equipment, medicines and manpower for the treatment of free patients. This should happen real time, as sometimes the dues are not paid to hospitals by govt. for decades. All existing dues should be settled immediately, so hospitals can provide better care. In patients who cannot afford costly treatments / medicines / surgeries, the funds allotted to the local representative (MLA / MP) may be used by priority. Also allow the pharmaceuticals to pay for the poor patients upon request by the treating doctor.

6. Every hospital must provide free available treatment for all the consultants working for that hospital and their families. All doctors should be collectively insured against: illness, disability, death, accident, loss of job, medicolegal cases and violence induced damage (mental and physical). This must be done at state / national level. The medical insurance companies which earn billions by eating from the doctor’s plates must insure them against all these calamities. Also the corporates and other healthcare giants should be answerable to the regional committees.

7. Any medicolegal case / negligence issues must first be presented to these committees, which will refer it to the national committee, whose decision will be recommended to the courts of law. The current compensation system based upon inequality of “value of life” should be eradicated. All patients are equal, and the compensation value of every life must be the same. If one expects “Indian rates of Treatment”, one must accept “Indian rates of Compensation”. In cases of patients treated free, the govt. should pay the compensation to the patient, otherwise no private doctor will want to treat free patients and invite more legal liability (the misuse of medicolegal cases by the poor and political is an emergency in waiting for future generation doctors). Patients should also have an option of committing complete faith in the doctor and signing a “No Legal Liability” bond, which will make it easier for the doctor to do his best for the patient, unaffected by legal fears. Also, any interference in patient care including intimidation, threats etc. must be punishable by law.

8. Doctors must collectively develop a national medical research funding by compulsory contribution, and start advanced centers for research which are not imprisoned by the lack of initiatives , funding, or intellect. This should be autonomous and purely merit based, with no interference from govt. or anyone else. We should also find practical solutions to accessibility and excellent rural healthcare system. Only we can, govt. never will.

9. There should be revamping of medical education: MBBS in four years, internship, one year bond of rural service, then PG, SuperPG, Fellowship and then practice. This is long enough. All other bonds must be cancelled. Payment structures of all Medical officers, Teachers should be compatible with highest in the govt: IAS / IPS, as these doctors deal with life and death everyday, saving millions. PG exams must be conducted on time, and court interference must be avoided, the decisions of National committees must be final. This will save millions of youth-years of generations of doctors. PG seats should increase every year, there must be unified national payment strategy for PGs. They must also get free food, hostel and internet, and compulsory 8 hours daily sleep time.

10. Doctors must also introspect and improve wherever they are really lacking in the social eye: proper compassionate communication, dignified behavior (avoid this talk of the town when someone overdrinks especially in conferences). We must also start “Positive Connection” strategies with patients, and limit / improve upon the existing crisis of faithlessness by encouraging and rewarding trust. There should be doctor-patient coordination committees in every town to facilitate this.

11. A unified “Paperwork and SOP” National committee of doctors must make such paperwork available on the internet for all doctors to use. The laws governing hospitals must be freed from the innumerable “NonMedico” interferences, red-tapism, corruption etc. roadblocks and must be common all over India.

12. Violence against doctors/ hospital staff must be severely punished. All govt. hospital deans must request 24/7 casualty police.

13. All practicing doctors must receive a compulsory paid vacation at least one month in a year to de-stress, and if the govt. or their own hospital cannot pay for it, let other parties willing to pay be discussed without objections or paranoid suspicions. All said and done, it is extremely stressful to be a doctor. Yearly paid vacation is only human.

This is a sweet dream. But what’s life without a dream? Don’t we wish each other sweet dreams? I mean it this time. Let us work to wake up in this dream. We are a great force, let us overcome our differences and become the Great Doctors who ably carry the Nation’s healthcare like Pros, not slaves.

This seems to be the only way. Happy Doctor’s Day
© Dr. Rajas Deshpande