Tag Archives: Corruption

The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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The Zen Of a Doctor: An attempt of honest meditation

The Zen Of a Doctor
An attempt of honest meditation
© Dr. Rajas Deshpande

I am now tired, mentally fatigued, I want to recover to joy. I do not want to lie to myself.

I love treating patients, resolving their health problems. I love the feeling of their recovery. I love the gratitude that comes my way. I am proud of this ability to be compassionate, to harbor empathy and to understand and fight suffering of another human being. I am proud, that money is not on the top of my priority lists. © Dr. Rajas Deshpande

But now I am tired of the whining: not the whining of suffering, for that is mine to destroy happily, but the whining by choice of adopting an extremely stressful, dirty, unclean, unhealthy lifestyle, not preparing to change, not preparing to pay for health, and then blaming it all upon a doctor. Women openly suppressed by husbands and large families, children tortured by parent’s whims, men exploited by their own desires and careers, and an orthodox, superstitious society where the most literate and educated believe in sometimes poisoning themselves with unknown medicines, and then have the audacity to question a qualified doctors’ intentions in writing a prescription. © Dr. Rajas Deshpande

They want everything of the best quality, from panipuri to cars, and are willing to pay extra for every luxury, while expecting that only healthcare must come free, and the very doctor whom they cannot trust, cannot tell the truth to, must treat them with best empathy and honesty, give them enough time to ask unnecessary questions and doubts, and then should waive off the fees out of sympathy. © Dr. Rajas Deshpande

I am also tired of the corrupt practices in medicine, and the hopeless scenario that everyone rather tends to believe that the doctors are all corrupt (some indeed are, but so are few in every profession, shut up pseudo Einsteins of argument!) rather than seeing the open markets established by uninhibited corporates who are seen hand in hand with the administrators, some pharmaceuticals and some in power. Corruption by those in high places, that ranges from producing some of the worst quality, inexperienced doctors, to dispensing lower quality everything just because they have understood this trick: people fall for low cost anything, even health. Such a disaster that people do so many unnecessary tests under the “Health Check” scams themselves, but when the doctor advises even one test, suspect him / her of wanting more money! © Dr. Rajas Deshpande

I refuse to be exploited. I can only change myself, not the world. Hence this meditation.

I want to live a good life: not full of gold and diamonds, but of joy, health and inner peace. Of independence, financial as well. Of my own choice and preference, not what the society decides for me. I want quality time for myself and my family too. © Dr. Rajas Deshpande

I do not want to be a busy doctor irritated and shouting at everyone: I would rather earn less and guard my composure. Those who cannot respect this will be given a chance to understand, but only once.

I will continue to stay highest in my principles. I will refuse to compromise on the quality of healthcare I want to practice, just because someone wants a cheaper, faster but less ethical alternative, less correct choice. I will see less number of patients and rather spend enough quality time with each of them, and charge them higher as per time and expertise, rather than hurrying through.

I will choose to encourage trust in my patients with my own behavior and words, but if I realize they are still trustless and question my integrity, I will refer them to their choice of another specialist, because I want to retain my best peace of mind for my next patient.© Dr. Rajas Deshpande

I will not take the extra effort to explain everyone why I do what I do, my duty is to be honest to myself and my God, my patients. I have limited time, now and in life, and I will expect that faith, trust and a level of basic intelligence (that has nothing to do with education) will enable everyone to see clearly that I mean well. That is my promise to myself: I will always mean well to my patients, and offer them my best. That should never preclude my own happiness. This will enable me achieve my inner peace so essential for a doctor.

I feel better with this already.

© Dr. Rajas Deshpande

Naked Cavemen, Einstein and Calvin Klein

Naked Cavemen, Einstein and Calvin Klein
© Dr. Rajas Deshpande
Lower courts give judgements. Higher courts change them. Higher courts give judgements, other benches change them. Government fights with courts. All of them work less than 8 hours (few exceptions) and have sumptuous vacations. Judges without medical training will decide about medico-legal cases. But any of them do not require exams to improve performance or to deliver better in spite of huge backlogs. © Dr. Rajas Deshpande
Almost in every government office, in most departments controlled by them, bribery is a rule rather than exception. Piles of files do not move, pensioners die without pension and farmers commit suicides. But the concerned authorities who work 8 hours per day do not need any corrective courses or exams to assess their performance, to compare where the developed world is today.© Dr. Rajas Deshpande
In most of the healthcare facilities run by governments, there are severe deficiencies: no appointments of doctors, no proper salaries, no facilities or backups, no security, and worst of all, no vision. But the people who are responsible for making these policies do not need any training, assessment or exams. The very people who want youngest generations of doctors to provide world class medical services to rural India do not want to change their decade old failing policies.© Dr. Rajas Deshpande
The thousands of practicing Babas, Gurus, Quacks who are officially seen tied up with the highest of the land and bash the allopathic and scientific medicines spreading poison in the society do not need any exams to preach or practice. The lawmakers who do not ban tobacco, alcohol, helmetless driving, the people who eat unhealthy and mistreat themselves or family do not need any exams. The transport offices that issue driving licences to unfit drivers do not need training or exams.
We see many military men and out of respect treat them free. They are so patriotic that they seldom expect anything in return from the country. But they often relate how bad the conditions are for them and their families. There is a crop of people who quote the military sacrifices as if it was their own credit! Those who are responsible for the upgradations in facilities for the military personnel do not still need any exams.© Dr. Rajas Deshpande
There are deaths due to hunger and malnourishment. But the ones who are in a position to change this by making right laws do not need any exams. Illegal buildings are erected, labourers die when they collapse, but the concerned professionals do not need exams or assessment.
547 extremely responsible and respected representatives who waste the public money in daily crores over a month due to ego issues, not being able to come together in the interest of the nation to resolve issues, blaming it all upon each other do not need any exams to assess their performance.
But the actual allopathic doctor, who has stood highest merits in all exams, stayed on the top of the competition to earn his / her degree late in life, all of whose exams had 50 percent as passing limit as opposed to 35 percent in all other professions, who has sacrificed family life, sleep and food for over 10-15 years just for learning, who works almost 24/365 and solves health problems on a daily basis, updates his / her knowledge with CMEs, stays in touch with the latest and delivers it to the poorest of the poor with equal affection, carries the country’s failed healthcare upon his / her shoulder is not good enough for them! Now they want the allopath to appear for exams lifelong, suspecting that his / her knowledge is still not enough good for them, even after the CMEs.© Dr. Rajas Deshpande
If the millions of doctors are forced to give exams repeatedly all their life, they will happily do so (for they are not afraid of exams). But this will take away billions of doctor-hours out of service (exam leaves) in an already failing healthcare system, will tax the patient more, will open up new channels of corruption and another universe of chaos will add itself to India. Who cares? The ruling mood seems to be ”Patients will die, patients will pay”.
The current CMEs are world standard, do not tax patients, and enough effective. But our system seems to want “better than the developed-world class of doctors”.
This is like the stone-age naked cavemen asking Einstein and Calvin Klein to appear for yearly exams to stay updated for serving them.
© Dr. Rajas Deshpande
PS 1: The nicer you are, the worse your troubles. Doctors must unite upon an apolitical platform to fight stupid laws being proposed.
PS 2 For those who are not able to think beyond medical malpractices and corruption, please make an effort to understand that there are other issues in medical practice, and this post is not about money.
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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

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

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Did you plan your murders and suicide at 17?

Did you plan your murders and suicide at 17?
© Dr. Rajas Deshpande

What were you doing when you were 17?
I know not all questions can be answered fully and truly. But some truth applies to all at this age. At 17, we are full of dreams of a good, respectable and if possible luxurious life. And of course of true love.
Well, what options do we have at 17 for such a rich and respectable life?
If you google-search top grossing Indian careers, you will find management, IT, Chartered Accountants, Law, Data management, Sports, Entertainment, Politics and Medicine. Which option would you choose out of these, if you are intelligent and hardworking?
A 9-5 work life with family time and regular food and sleep and holidays, with healthy, alive people around you, or one with no sleep, highest stress, no family life, always being surrounded by illness, crying and death, lifelong exposure to deadly diseases, having to study every day of your life, lifelong competition and struggle, unsure when some patient or mob or press will end your life or career?

No teenager thinks “I will become a corrupt doctor carelessly treating patients to earn all the money I can by prescribing wrong, unnecessary tests and risking my life with deadly diseases just to earn the title of a doctor, and enjoy harming and killing many many patients all my life, long after my classmates have retired..”.
There is far more money and often more respect in many other professions. Illiterate politicians at age 30 roam in Red-beacon cars, Finance, IT and management professionals at age 30 flaunt Beamers and Mercs, while most Superspecialist Doctors aged 45 drive scooters / small cars in India. Why will a talented, hardworking teenager choose at 17 to spoil his / her life by becoming a doctor? This is not for the mildly intelligent to understand.

Where does the “doctor” class come from? Usually academic, poor, middle class families, rarely from rich class. Which parent will teach their children to do bad to ill patients to earn more money? Do you teach your children at age 17 to “loot” sick people?

The govt. failed to provide enough medical colleges and doctors, allowed private colleges, and decided who will start these colleges and what fees they will charge, the courts agreed to this. How is today’s doctor guilty of this? If paying high fees for the desire to become a doctor and serve sick people and later earning enough to repay that fees is a crime, why not ban all private medical colleges and send all patients to govt. hospitals compulsorily? There always will be those who take advantage of any system where money is generated, how come all doctors are blamed?
© Dr. Rajas Deshpande

The govt. made service compulsory after graduation, made bonds, doctors complied in most cases. Those who didn’t, paid fine. After that, they do not remain “PUBLIC SERVANTS”. They become private practitioners, whose service comes under a “consumer law”, thereby the court has decided it is a business. You have govt. hospitals in every small town now. Why don’t you go there and get the cheapest treatment, with usually no tests (because they are not even available!)? No one will force you for extra money or tests or wrong treatment there. That system, where there is absolute guarantee of no “CUT PRACTICE” and referral fees, will never deny service to anyone. Most doctors there are excellent too.

No. You want premium service, best available medical facilities. You want sweet words and better guarantees. You want highly qualified superspecialists in ultramodern A/c buildings with state-of-the-art machines and tests and operation theatres and stents and medicines and catheters attended 24/7 by teams of all experts under one roof, with the best trained nursing staff. Above all you want the freedom to blame and sue someone for everything that may go wrong. “Science is so advanced, doctor, can’t you do something?” you often ask, “My cousin in USA got this same problem, they lifted him up with a helicopter and he was discharged in a week”. You forget one part of the picture entirely: the insurance premium your cousin paid, the treatment charges levied, and the doctor’s fees in those cases. Above all, you didn’t enquire how many poor / compassion / politico/ VIP / govt. servant free patients that doctor in USA sees all his life.
© Dr. Rajas Deshpande

You want the “USA class” service at “Indian” rates. You want the cheapest treatments by world-class doctors, with the ability to sue for crores. If medical tests are unnecessary, ask the govt. to ban them, or go to the people who can treat you without those tests. Ask the fulminant (google this word, my friend) anti-doctor media for the best options from the various quacks they advertise daily. If medicines / instruments / stents / catheters are costly, please ask govt. to only sell cheaper brands and use them. Why doesn’t the govt. ban all foreign medicines? Have guts to go to the doctor and say in writing “Use only Indian and cheapest medicines, catheters, instruments and procedures, I will accept the outcomes as long as the doctor is technically correct”.

No doctor will force tests or medicine. Choosing the doctor, tests and medicines are all your rights and privileges. Own the responsibility of what you do. If you think the doctor was wrong, do file a complaint with authorities, and follow the legal procedure. If you were wrong, face defamation. Just don’t pretend to be lone saints in a world full of criminals.

About the loose talk that our own brethren / doctors unleash upon social media about “most doctors being corrupt”, I think the medical councils and associations must seriously deal with such defamation of our profession. If someone has an issue with medical corruption or malpractice as a doctor, they must go to their specialty association or medical council, not general or social media, as this is just misleading the public. API / IMA must start filing defamation suits if any media plays judge in medical cases before the courts of law have convicted the doctor.

How does one choose a doctor for oneself? Cheapest or Best? How did the doctor you chose become famous / best? Never by only a degree. Of all the rich careers, the richness of a doctor is the costliest, having to toil the hardest over many years to attain that success, with no support from the society, govt. or media. Corruption may make some doctors rich, but never famous.

Let the govt. publish a book of standard tests and treatment of every medical condition and have every doctor follow it, irrespective of the outcome. Alternatively, have faith in the doctor’s education and opinion.

All malpractices in all fields must go: Political, Social, Government, Educational, Public works, Religious, Media, Entertainment Industry, Judiciary, Police and ofcourse medical.

For all those who missed the Indian medical train, enjoy your journey without jealousy! Believe me, you are lucky to not be a doctor in India. For us, the meaning of “Happy Diwali” ended for life when we entered medical college. This Diwali, put on your new clothes, pack some sweets and visit any casualty near you to know what being a doctor means. Then dare to blame an entire profession.
© Dr. Rajas Deshpande

Hide, Don’t Seek

Hide, Don’t Seek
© Dr. Rajas Deshpande

We are all experts in this.

Mr. SP suffered a stroke, lost his job. Still has to run a family that has kids in engineering college. Since last six months he is looking for work, and is freelancing as an interior designer. To go to work he needs special vehicle. To buy it he needs loan. Bank does not give loan because he does not have a job. RTO will not issue license unless the vehicle is in his own name. He is ineligible for a handicapped- job opportunity because he cannot get a certificate, because there is a huge line for the same in only one center in a large city like Pune, where the handicapped people are expected to queue up starting 4 AM in the morning, without a place to sit or a shade. He has been in this queue for umpteen times, but could not reach the clerk as only limited number of people are taken in. He keeps on spending on the autorickshaw fares, his own medicines, physiotherapy, and limps his way through life cursing his fate. He has already decided that his children will not settle in India.

All that India has learnt in it’s recent evolution is to address him as “Man with special needs” or “Physically challenged” instead of handicapped.

Now he awaits Mr. Mark Zuckerberg or Mr. Tim Cook or Mr. Obama to digitally reach out and solve his problem.

In our evolution as the strongest and the most invested nation, we have shoved below the carpet the facts that we have highest number of unhealthy people who cannot reach or afford basic medical care, hunger deaths, a government-run healthcare system that is worse than dysfunctional at best, a valley of inadequate resources created by senseless laws / rules / red-tapism that mock the possibility of a comfortable living of an honest citizen, where bribe is the basis of any function at almost all levels. Traffic kills not only those on the road, but also those in an ambulance.

This even as we pay one of the highest income tax, and probably the highest duties on almost everything.

Neither women nor children are safe, the political backing encourages hooligans to do away with all the eve-teasing they want. Richest of the rich revel in their 100 and 500 crore successes, multimillion ventures and billionaire statuses in Forbes, while there is no answer to innumerable suicides of poverty ridden populace.
Now we will digitally connect them.

We have learnt the western language in an attempt to impress the western press. With our huge population, there always are enough positive numbers to impress the world, while we hide the negative numbers from the world’s eyes. We have learnt perfectly the eternal art of beautifully colouring a home from outside, while there still are decaying crimes, mountains of unsolved legal / procedural basic issues that eat up the lives of those who live within. The rich-poor gap is at its worst, and the onus is upon the citizen to find legal / illegal solutions to their problems. Audacious corruption stinks in almost every govt. office, but we will sing songs of our own greatness and history. We will die to establish an arrogant historic fact rather than help a dying needy in the present.

We need human connections first. We need internal reforms first.

What will an old sick parent “thrown up by children” do with internet? What will a heart attack patient stuck in traffic do with digitalisation, when there are no sufficient paramedics, and they can’t reach him? How will internet, another “profit-based” venture, provide for food and medicines to those who don’t have money?

Will all this internet access / digitalization solve the issues like rehabilitation of thousands of orphans in the country, rehabilitation of women who have suffered rape, whistle blowers being beaten up and killed in open daylight, a perpetually deficient healthcare scenario with increasing gap between doctor and patient, further widened by draconian laws against the tiny number of remaining doctors?

Just Hide, Don’t Seek answers.

Let us all dress up our best for our new girlfriend: the affluent, civilized western world.

© Dr. Rajas Deshpande

PS: I am strongly pro-digitalization, but it is the wrong God to bank upon for a positive change in our country.

My Religion, My Love.

My Religion, My Love.
(c) Dr. Rajas Deshpande

Once when I was studying in Medical College (MBBS), my Grandpa told me not to waste too much time in praying God, as treating patients was a superior worship. I had promised him that if there ever was a conflict between attending a patient and praying God, I will first attend the patient. I grew up to learn that most doctors all over the world do that.

It is not uncommon to receive criticism over my blogs here. Why not neglect film stars and TV shows? Why defend doctors, knowing that some are genuinely corrupt? Who except doctors will read these articles? etc.

Medicine is my religion and also my love. I have come here, like most of my colleagues, to do good by choice. I can not take it easy when the uneducated and cheap, corrupt TDH make allegations about the super-educated Indian doctors. If one has real guts, they should try merit based entry in some Indian Medical College, or just one year of residency, they will know where they stand. This does not mean that only doctors are intellectually superior, just that only those who have achieved something intellectually worthwhile must analyse/criticize this highly complicated field.

If anyone talks ill about one’s Mother, Father, Wife etc., or God or Religion, people are out with swords and guns, and will defend with blood their honor and that of their beloved and respected. It never means that everything about the criticized person or religion is right, just that it is one’s duty to guard one’s own sacred faith, and only the learned and intimate are allowed to interfere.
Not the wayfarers whose real God is public attention.

This is a scientific field which has evolved through lifetime works of Geniuses, Nobel winners and brilliant brains who changed the course of humanity over many centuries. It is made up even today of most who sacrifice their peace, safety and lifetime in serving others. It has its own control and alternative system: no one forces you to go to a specific doctor or hospital, and every hospital offers more than one doctors you can avail services of. Excess population and unhealthy country (and so the hurry) is NOT the doctor’s fault.

Doctors are the only religion-neutral intellectual profession directly in contact with general public, and there have never been any examples that Doctors compromised Medical practice for religious difference. Because this is our religion too. Whichever God patient may have, most Doctors treat that patient’s health as their God. Some speak, express, sweet talk. Others do it silently. Some others may not be well mannered. But all worship the same God in any hospital: patient’s health. Some ask money in return, some enjoy the worship itself. But most do meet their God in their patient’s health.

This amidst filth of almost completely faithless, trustless, paranoid, corrupt, illiterate, inflation-screwed and violent population (mainly in India) which expects miracle recoveries of complicated medical conditions in minimum expenses, an outdated legal system which protects the faces of rapists and murderers but does not protect the alleged doctor’s identity before trial, where laws are mainly used for exploitation, and where a successful doctor is presumed corrupt. Where research is killed at National level by policymakers.

Some choose to advise all doctors to keep calm and take it all in their stride, to project a “Social Doctor” who must accept all the ills and go on selflessly working for the good of all, “not thinking about money”. This is usually to pseudo-glorify themselves in media and public at the cost of the sufferers of injustice and violence among their own. These “Good-public-image-mongers” often speak a different language in private.

I may be wrong in writing these posts to defend my religion: Medicine, and its worshipers. But I am at least not guilty of being dishonest to either myself or my religion.

This I can vouch: I have met hundreds of Good and Bad behaved doctors, but never one who wanted to harm or neglect the patient. Even the best of the ‘moneymakers’ in Medicine keep patient safety their top priority. Some may have been wrong in their practice, and they must be tried, but everyone generally does their best to do good to the patient.

There is no other career superior in its Humanity Quotient than health services. Just because someone must throw stones at others to get attention, we will not sit back and be the target.

(c) Dr. Rajas Deshpande

Drug Quality, price and risk in India

Drug Quality, price and risk: repost

(c) Dr. Rajas Deshpande​

Sir, What about the responsibility of quality of drugs used for the treatment? These are the only weapons with which we fight a disease. Does it make pharma a share holder of responsibility in case of adverse outcome ? This is another grey zone to elaborate.

Dear Dr.
Thank you for asking this question.

We must demand as doctors that we will only prescribe local medicines / stents/ catheters, needles etc., but then make it compulsory for everyone including the ministers, govt officials, the actors who comment irresponsibly etc. to only use Indian / cheap healthcare products. Let us see how many rich and famous want to use local drugs / stents / caths for themselves or their families!

We have a society so immature that it does not blame the government for allowing production and sale of low quality medicine / not guaranteeing and monitoring quality of each drug locally produced and marketed, and banning the costly drugs, but thinks that the Doctor should take responsibility of their “Multimillion Health” by prescribing cheapest drugs and tests available, produced locally without any knowledge of their quality!

There are set international standards of quality control for manufacturing of Medicines / Drugs. These apply with minor legal (but not scientific) variation to all pharmaceutical companies. Along with the major international players, there are also major/ minor Indian players in this industry. Many major international pharmaceuticals have been legally tried and punished for manipulating drug related information / bribing or compromising upon its quality: billions of dollars worth such punishments have been on record. There are no examples like this in India, which must mean, the entire industry and the government’s arms dealing with it must be absolutely innocent and honest, and all drugs produced in India must be absolutely good!

Secondly, the control over quality is not over with production of the drug. The transport, storage, sales and instructions given to the patient with each single drug also matter.. You know very well how many Indian drugs even have “readable” information printed upon them.. Leave aside the separate printout/ labels about precautions that must accompany every sale.. All this information is left for the Doctor/ Nurse / Pharmacist to tell the patient, forget the waste of time. This reduces the price of the medicine at the cost of the Doctor’s / Nurse’s time, while everyone else in this chain of sale earns their profit..

Then the after-sales feedback and documentation of serious adverse effects / ineffectiveness of each single drug marketed has to be recorded and reviewed / analysed. We all know this system does not exist in our country… there have been no cases about the drug quality at all: in fact the Doctor is automatically presumed responsible for either greed or guilt of prescribing any drug, either way! If you know the horror of real life story called “Rosche Versus Adams”, it will blow your mind to think what must be going on in a country widely infamous for corruption in all fields..

Always in shortage and underpaid, shouldering all nonmedical aspects of healthcare (which are social / govt. responsibility), the Indian doctor does not have the time / money / power / authority to monitor / report / check / complain against any medicines. If he / she does, we know what might happen. There are mighty, powerful, political, medical, corporate, international, kingmaker people who own much of pharma sector, some mafia too. Can we imagine a simple doctor will be able to fight these?

I am not accusing anyone, but these two links are enough embarrassing, and we can understand that money and power can gag almost each and everyone in India from a ministers to media, so these news will be rare.

http://articles.economictimes.indiatimes.com/…/47705608_1_d

http://www.fiercepharma.com/…/indias-quality-lap…/2014-03-18

There are some good and standard pharmaceuticals, who tell the doctors about their quality control, ask for feedback, and also update the certifications, accreditation etc… so we know they are standard. There are those whose brands have been internationally reviewed, those which are in the market for decades, with established safety. There are new ones with no data, where the only trust is about the maker’s reputation. The onus is upon the doctor to choose. I know most doctors would prefer the best for their patients, and some would consider a relative safety if price can be reduced. Honestly, no doctor can assure the quality of a given medicine, he / she has no way to assure that. But if you prefer Indian made smartphones, Indian made clothes / perfumes / cars, etc. etc., you may also rely upon Indian made drugs/ stents / catheters. The difference is then you absolve the doctor about the responsibility of what he thinks is best for the patient. I know some Indian pharma which have excellent quality of drugs, but most also have heard of frauds. Knowing this, a good doctor cannot vouch for the safety of any drug, Indian or International. The patient must make a choice.
There are umpteen examples of ineffective / low quality Tuberculosis and other drugs scandals (sold in some Govt hospitals) some years ago, but there was never any case decided against this. There were / are examples of doctors making and prescribing their own medicines, which they may know the quality of.
The effective percentage of the active ingredient, its purity, its binding with the excipients, its bioavailability after consumption, its effects on the liver / kidney, brain, eyes, heart etc are all also linked to how much and how rapidly it is absorbed and metabolized. The doses we use are all western-standardised, and we Indians have a tendency (even in Medicine) to presume that those biostats will exactly apply to our population, irrespective of genetic / ethnic/ cultural (food) differences.

A drug may kill (either by its action or inaction) if its quality is not accurate, and this “quality” NO doctor knows. Doctors can only go by their own experience about that particular drug and the company that makes it. So if the patient insists upon buying a certain medicine brand produced in a certain country, it is his / her prerogative and responsibility.

We call many things “ Chinese” and usually mean it as a cheaper / “no guarantee” quality.. We cannot blame if some western / other countries felt same about Indian made medicines, even after the racist / competitive aspect is excluded. Pharma industry has good and bad in ALL countries, including India. The only difference is that we know the levels at which corruption works in our country : Every!

It is easy for filmstars who shoot outside India, drive foreign cars, endorse foreign brands, wear foreign clothes and run to foreign countries for every health issue to cry on national TV and urge everyone to use :Generic” / local drugs. It’s not their life, and if something happens there’s always the Indian Doctor to blame!
We must demand as doctors that we will only prescribe local medicines / stents/ catheters, needles etc., but then make it compulsory for everyone including the ministers, govt officials, the actors who comment irresponsibly etc. to only use Indian / cheap healthcare products. Let us see how many rich and famous want to use local drugs / stents / caths for themselves!

© Rajas Deshpande

The Good Doctor Myth

The Good Doctor Myth:
This article may hurt some feelings. I apologize in advance, but this is how I truly feel. Basically for students and patients.

“Just looking at the doctor took away half my pain / illness”
“The doctor always makes me laugh and reassures.. A very nice human being, very compassionate”
“I am very close to the doctor.. he/ she calls me his younger brother / sister etc.”
“He / She is so busy, but still saw me and advised”

It is quite common to hear these sentences in a hospital. It is expected from a doctor that he / she must dress well, speak well, be nice, mannerful and compassionate, and ease out the patient’s worries.

This I agree is essential, but is this all? Would any smiling / laughing pleasant, well dressed and well behaved doctor who takes away your worries by well – chosen words (and a pat on the back) be enough to handle your life?

Think again.

For making a health decision, what all qualities must the qualified doctor have?

1. Exactness of current knowledge and literature about that particular illness.
2. Experience in handling that particular illness and its complications, without
involving ego (Many would just decline counter-opinion just because it came
from a rival / junior etc.)
3. Analytical abilities based upon a combination of the above two.
4. Concentration: possible only when you are not very busy or supermultitasking.
5. A complete knowledge of the patient’s health profile: Detailed history, medical
conditions, ongoing treatments (allopathic and other), ongoing diet, allergies,
other specialists treating the patient, addictions etc.
6. Surgical skills in that particular specialty.
7. A readiness to explain the true nature of illness, its complications, all
treatment options etc., a respect for patient’s choices (not persuading the
patient to make a choice by telling only the worst possibility) , readiness to
accept mistakes and explain the patient about them.

We are in the age of superspecialisation. This means the basic doctor (MBBS) goes through specialisation (MD /MS = 3years) in a specialty, then through Superspecialisation (DM /MCh = 3years), then through fellowships (2-3 years) as a postdoctoral superspecialist. (There are many other true and fake degrees, which again is a debatable topic).

As one climbs higher in a specialty, he /she becomes less and less expert in other fields as they need more concentration upon one subject for many years. One is supposed to refer the patient to another / superior specialist in case of a condition that is not one’s own specialty or beyond experience.

However, many doctors who appear very pleasant to the patient because of the qualities mentioned above, take advantage of the patient’s faith in them, and keep on treating the patient either themselves or through specialists of their choice / liking / etc. (This is what the patients know as ”rackets” in our profession).

This results in:

False reassurance of safety / lifespan in treatable / untreatable medical conditions.
Delay in treatment / incorrect / overtreatment (Stroke / Cancer / Parkinsonism)
Wrong drug / dose choices (most common example: epilepsy).
Complications due to drug interactions / disease worsening/ combinations of these two.
Falsely attributing complications to some pre-existing disease.
Incomplete evaluation / screening before surgery that results in surgical / postsurgical complications.
Accidents due to non-treatment of conditions that may make the patient unconscious.

The “Good Doctor” is the one who, besides being polite, nice, compassionate and understanding, spends time for interacting / talking to the patient, examining him / her in detail, explaining the diagnostic possibilities and need for investigations advised, risks involved, and realistically addressing the patient’s fears in a kind manner. The good doctor will also answer all questions that the patient has about this consult / diagnosis, and offer all possible options of treatment. He / she will also freely mention the dilemmas in diagnosis (instead of “impressing the patient” by pretending to understand and answer everything) and also the problems he/she could not solve, and suggest references to other colleagues / specialists for a second opinion.

A good surgeon will talk to the patient after surgery, mention his / her associates / assistants who helped during the surgery, and explain good and bad outcomes boldly, thus gaining patient’s confidence in truth.

Gone are the days of a smiling / laughing “I-know-it-all-don’t-you-care” pseudoreassuring doctor who would definitely uplift a patient’s mood, but certainly cause harm by mis/delayed diagnosis. Also gone are the days when patients should accept a “quick” consult in a hurry by a very busy doctor continuously attending phone, handling a hundred things simultaneously etc… A decision for treatment, and especially surgical intervention must always come from a calm and concentrated mind.

The patient must also know that if a doctor is to spend more time with you, he/ she will have to see less patients, so the consulting fees may increase as per time / skill. Patients should concentrate upon what is being told, avoiding repetition of the same questions. Google based interview of the specialist should be avoided. One must have complete faith in the qualities, abilities of his / her doctor, unless proven otherwise.

The purpose of this article is to highlight that only external appearances and behaviours do not make a good doctor, as is the general perception especially among the frightened, depressed and illiterate patients.

Wishing best health to all.

Rajas Deshpande