Tag Archives: Criticaldiagnosis

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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The Fairy And The Prince

© Dr. Rajas Deshpande

The beautiful radiant lady wheeled in the patient’s chair and wished me with a pleasant smile. Some smiles, however beautiful, have a tragic shade. I looked at the patient Rohan. A very well built fair young man in his late twenties, must have been very handsome in the past. He sat paralysed below the shoulders, one eye closed, face twisted, and a large surgical scar upon his head, partially covered by a cap. He could not speak. Any movement would cause violent tremors. He was wheelchair bound and had to be assisted even for toilet.

Rohan and Riya had married just two years ago, against the wish of their parents. Both from very affluent, but uneducated families. Both worked at the same office. In a few months after marriage, Rohan had developed high blood pressure, and was advised treatment. Unfortunately, he got carried away with some false claims about some herbal medicines shown on National Television channels and stopped the BP medicines. The obvious happened: one of the blood vessels in his brain ruptured due to high BP, and there was a huge bleeding. A Neurosurgeon had done an excellent job by taking this high-risk case on operation table in emergency, to suck out the blood clots and save his life. However, the damage was already done by then, much of his brain was damaged on one side. Riya had been caring for him since then. She looked after him just as a mother cares for her newborn.

“Doctor, we know his paralysis will not improve now. But he is brilliant, I know his brain thinks fast and accurate. Since this stroke he cannot speak. We have come with some hope for his speech. If he could just tell me what he feels, if something is bothering him, what he wants, etc., I will be very grateful” his wife said.

We started treatment. In a few days, Rohan could speak legibly, so she was very happy. Rohan’s parents were very happy too. © Dr. Rajas Deshpande

One day, Riya’s father came with her. He asked her to wait outside my room for a few minutes, she reluctantly left. With folded hands and tears, he spoke: “Doctor sahab, my daughter married against our wish. I have forgiven her now. But I cannot see her spending her life like this. She was the most brilliant girl in our town, she had even rejected job offers to go to America because Rohan wanted to stay in India. You can see that she is still young and beautiful. Anyone will marry her; she is one in a million. I’m not saying this because she is my daughter, but you can see for yourself from how she cares for her husband. She has become his attendant now. What is her fault? How can a father see his daughter wasting away her youth like this? They have no family life. I cannot even speak to her about this. Her mother tried but Riya refused to speak. She speaks very highly of you, so I have come with this hope. Please help us”.

This was very difficult, but a duty too. If not me, who could even attempt to resolve this?

“Let us ask her about her thoughts” I told her father and requested him not to react when she spoke. We called her in. I told her in short how her father felt. She sat straight. Her face became distorted and she wept silently. Her father kept on patting her while weeping himself.

“Papa, when Rohan could recently speak after so many months, the first thing he told me was to leave him and marry someone else. He refused to eat his medicines, saying that I should leave him. Then I promised him that I will leave him after two years. That was a lie. I know he will die if I leave. I could feel his love even when he could not speak, that’s something more precious to me than whatever you think I will get if I marry someone else. Till the day he had this bleeding in the brain, he made sure I was best taken care of. He never had his food before me. How can I spend even one happy moment with anyone else knowing that Rohan is suffering in this same world? Would you be proud of me if I did that? Did you teach me to be so selfish?” She broke down. © Dr. Rajas Deshpande. Her father did not say anything. They left.

In a few weeks, Rohan followed up again with Riya. He is now gradually learning to operate a computer. He plans to start his own online business. Riya is helping him do that, while continuing to work. They are now planning for a child soon.

This fairy I met was more beautiful than any other in the dreamy stories I had heard all through my childhood. I am glad that I am a witness to this divine fairytale.

I know even of another couple, where the girl had developed a paralysis in her college days. I had counselled her and her boyfriend about future uncertainties and a possibility of a compromised married life, given her illness. “That’s not the most important thing for us” he had said. They married. Today, about 8 years since then, they have a healthy, happy kid, and he still cares for her as much, now when she is in a wheelchair. This knight lives in a rented house, runs a small grocery store, rides a bicycle, wears the simplest of clothes, yet has a heart that would put to shame many a real princes!

My world as a doctor is full of beautiful fairies and knights, named caretakers. It is because of them that thousands of patients are surviving with dignity today. Medical care is so incomplete without them! I remember my favourite author Richard Bach’s words from “The Bridge Across Forever”: “Princesses, Knights, Enchantments and Dragons, Mystery and Adventure… not only are they here and now, they’re all that EVER lived on earth!” How true!! © Dr. Rajas Deshpande.

Among the stories of sadness and suffering, most doctors also come across best of the human hearts and minds, highest forms of love and care. Such patients and relatives reinforce our own trust and faith in the ability of human efforts to heal. Thanks to what I learn from my patients, my gratitude for being a doctor is endless!

© Dr. Rajas Deshpande

Dedicated to all caretakers, young and old, who silently sacrifice much of their life caring for their loved ones.

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A big salute to this extraordinary benchmark of values in medical profession.

On 4th August due to rain havoc and release of dam waters there was unprecedented flooding in some areas of Pune. Unfortunately this flooded the new Jupiter hospital in Baner, jeopardising the lives of a hundred patients including critical, and even a tribal baby who had had a heart transplant. Within minutes the hospital authorities reacted with an efficiency comparable only to a military task force. The staff, doctors and nurses worked in coordination to shift every patient to other hospitals in Pune, other hospitals too graciously accommodated them on an emergency basis.

It is extraordinary that Jupiter Hospital not only arranged for a safe transfer of every patient, they sent doctors and nurses with each patient to help them settle in another hospital.

Every bill for every shifted patient till their discharge from other hospitals was paid by Jupiter hospital, not a single rupee had to be paid by the patient. The entire staff and doctors stood by this effort, some offered their salaries of next six months to help this task. The administration very politely declined to accept this, and continued to care for each of their doctors and staff even when the hospital had to be shut down for nearly a week.

As the hospital reopens completely recovered from the damage caused by the calamity, I salute this extraordinary phenomenon which should be hailed by every person with their heart in the right place.

Congratulations Dr. Ajay and Dr. Ankit Thakkar for setting this fabulous example of humanity.

God, Doctor and The Killer Snake.

© Dr. Rajas Deshpande

Dattaram started breathing fast and coughing. Red skin, rashes. Pulse 140. BP not recordable. This unfortunate young labourer, bitten by a cobra only a few hours ago, had now developed severe dangerous reaction or ‘anaphylaxis’ to the only medicine that could have saved him: the injection of anti snake venom. I stopped the intravenous drip immediately and shouted at the sister to bring the crash cart. We injected him with the most powerful drug Adrenaline which we had kept ready in a syringe.

He was brought by a friend to the hospital just after 10 PM. His villager friend who had brought him directly from the farm had gone back to bring Dattaram’s family. They were not expected for a few more hours. So the patient was all ‘care-of’ me, then a junior intern at the government medical college hospital. That was the era before cellphones and ventilators in government hospitals. © Dr. Rajas Deshpande.

Some venomous snake bites cause death by paralysing the breathing muscles, while others kill by clotting the blood inside the arteries. Dattaram was bitten by a paralysing snake, and his eyelids had already started drooping, he was also having difficulty in swallowing and coughing. Other medicines were started to counter the paralysis, but the killer venom was spreading. Time was running out. I started having palpitations. I was to be the active witness to his destiny. The ward was already full, the second intern was busy too.

The only way out was to give him extremely small doses of the antivenom again, gradually increasing the dose every few minutes, till a full concentration dose could be given. This is called desensitisation. I had never done it earlier. If he reacted again to any such smaller dose, there was nothing else to do. This was dangerous, and required a written consent by patient’s relatives. There was none. His pulse was now 120, and his BP was now recordable. I kept reassuring him. © Dr. Rajas Deshpande

I called up my professor through the ward landline and informed him in short.

“Go ahead, be careful. I will take care of the stupid consent from the medical director. Call me if required” he said.

I went to Dattaram. “Listen, Dattaram, I need to use a medicine against the snake venom. Some patients may may have reaction to that medicine. I will try and do this very carefully, but sometimes it may cause problems. Is it Okay?”

In a hoarse voice, he said with great difficulty: “You are my God. Do whatever you can. Keep me alive atleast till I meet my wife and daughter”. I told him I will.

I started to inject him the antisnake venom doses. First extremely diluted, then in gradually increasing concentration. His blood pressure was stable. However, after a few minutes, his breathing became shallow. He became drowsy. His respiration was paralysed. The snake venom was winning the race. I put in a breathing tube. The nurse started pumping air in his lungs through a rubber bag. I was sweating, thinking, panicking, observing and praying all at the same time. © Dr. Rajas Deshpande

He was tolerating the antivenom well. After a few hours, I decided to give him the final big dose again. I restarted the same medicine that had almost killed him a few hours ago.

His wife and daughter arrived. I quickly explained them what had happened, as the lady kept on patting her unconscious husband’s head. The daughter, barely 12 years old, was crying muffled. There’s a state of numbing that comes after extreme shock: that is terrifying to witness. Big city and poverty on one side, hopelessness of the situation on the other. The lady suddenly got up, took out a few ten-rupee notes and extending them to me, touched my feet “I will sell everything we have, please save my kumkum (husband). Look at the face of my daughter. Where will we go without him? You are God for us” she said repeatedly.

I did not crave to be a God, I just wanted to be a good doctor. Shall I be angry that she was trying to bribe me? Never. I remembered what my grandpa had said on the day that I joined medical college: “If you want to be a good doctor, try to imagine yourself in the place of your patient”. I suddenly realised that even though I was not God, in the eyes of this lady, her husband and the daughter, I was their only hope. I have always hated wordplay, I am rather a feelings man. I understood what they meant. The life of every patient depends upon my best effort and nothing less. © Dr. Rajas Deshpande

“Tai, I will try my best. Don’t worry. Keep that money with you. You don’t have to sell anything; we have all the medicines. You can both have tea if you want, this sister will get you some. Let me please attend your husband now.” I requested.

A few hours after that, by morning, Dattaram opened eyes. He met his wife and daughter. By noon, he started to breathe by himself, so we removed the tube. By the time my professor took rounds, Dattaram appeared stable. Medical professors never openly praise students. My professor kept his hand upon my shoulder, smiling. “Too bad, this did not happen on a cricket ground or a film theater, otherwise you would be rewarded with cars and bungalows.” he said with his characteristic red-chilly-smeared wisdom.

When Dattaram was discharged, his wife got me some sweets, and invited me to their village. “Doctor, we are very poor, but I will cook for you the best meal you will ever eat” she said.

Most doctors make a genuine best effort to save the patient: who would want otherwise? Yet sometimes we win, sometimes we don’t. In this case my effort was blessed. I will perpetually be grateful to my own God, praying that he rewards the effort of every doctor trying to save a patient.

As for the cars and bungalows, who has enough time to use them when lives are to be saved?

© Dr. Rajas Deshpande

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The Euthanasia Named NMC

© Dr. Rajas Deshpande

Sweet Poison, Gorgeous Vamp, Philanthropist Criminal or NMC. All of these have one thing in common: the taste, the appearance is deceptive.

Just a while ago, doctors had complete autonomy and freedom to elect the best to the medical councils. They failed. Doctors had chances to unite and rectify glaring obvious malpractices in their own profession. They failed. Doctors had a freedom to pressurise elected medical council members to enforce ethics and discipline in Indian medicine, to arrest corruption. They failed. © Dr. Rajas Deshpande.

The parliamentary standing committee said something like “MCI looked only after doctor’s interests, not that of public, it is necessary to reduce the monopoly of doctors, so there should be diverse stakeholders at the helm”. The fact was that MCI looked only after its own interests, not even those of the real doctors of India: the thousands who were shouldering the actual healthcare burden especially in govt hospitals and rural areas, underpaid and unprotected. Malpractices became rampant. The general social jealousy about doctors which was earlier suppressed by respect converted into open anger and fuelled a paranoia that did not spare the best of the medical practitioners. For the sins of few, majority suffered. Patients too suffered at all levels. Govt medical services were always pathetic (and will remain so even after NMC), and there was no reign over the corporates who dominated and dictated the scene. Competition and petty egos destroyed any chances of any good unity among doctors. There could not be a deeper nadir for the profession. © Dr. Rajas Deshpande.

That fathered the NMC. Doctors will need to unite now like never before if they want to change this “Law”. Laws can be changed. But is it necessary in this case? Decide for yourself.

1. The ultimate, complete control of this “Autonomous” NMC is is in the hands of the central government. Majority members are govt. officials, a minority are to be chosen by medical professionals, and in every case, all that the central govt. decides is going to be a binding upon the NMC. That is like cutting off the wings of a bird and naming it “Independent and Free”. NMC, its advisory committee search committee or its four component boards will all be dominated by govt.’s chairs. Central Govt will also decide about the funding and salaries of the NMC members and its Chairman. We all know who sits in the top chairs of govt. institutes and how many among them can speak against the govt. So tomorrow if the govt wants to make ANY decision about ANYTHING that governs Indian Doctors, it can. Who will stop them if wrong? Such is the control of Central Govt. over this NMC, that if a doctor is unhappy about some decision of state medical council, he can go to NMC, and if unhappy about NMC’s decision, he will have to appeal to….? Courts of law? No. Something higher: the central govt!! So every medical practitioner’s career is ultimately in the hands of the central govt. Better join the party. Or quit medicine.

2. The entrance examinations are more simplified. All undergraduate examinations will be through NEET. All who have completed undergraduate course (MBBS curriculum) will appear for the Final MBBS exam which will also be common National exam (NEXT) for Medical Licence and PG admissions. Due to legal status of institutes like AIIMS, PGI, etc., they will conduct a separate PG entrance exam. Although this appears simplified, given the history of corruption (at almost all levels) in such exams and delays that waste millions of youth-years, one is worried about an undercurrent ‘sale’ of PG seats. But wait, not everyone must pass the licensing exam. You can entirely skip the difficult MBBS course, do something else, and bridge over in 6 months, without having to pass the licensing exams. That’s the third bullet.

3. Some AYUSH doctors are better than some MBBS doctors. Many who can not get into MBBS in spite of merit opt for other streams, with a hope to become a good doctor. They are actually contributing a lot to our healthcare, many of them know their limitations. One cannot object to their wish to practice allopathy if they want to study and upgrade themselves, the only objection is to exempt them from the common licensing exams. That will be very unfair to our society, most of whom will never know whether the doctor treating them has adequate experience, qualification and wisdom.

A newly passed out lawyer cannot do a “Six Month Bridge Course” to become a High Court Judge. A new recruit in Police cannot become an Inspector though a “Six Month Bridge Course”. A Municipal Councillor / Nagarsewak cannot “Bridge Course” himself into a Health Minister or Prime Minister. One needs to qualify though a common mandatory process. After MBBS, one cannot do a “bridge course” to become an MD that requires three years of intense responsibility handling, studying, treating patients under supervision and obtaining a deep insight into that subject. It is not possible in six months even for an allopath. Likewise, if an AYUSH doctor must practice allopathy, they must go through the necessary training (two to three years) and more importantly qualify the same common licensing exam before they practice the complicated allopathy.

AYUSH is an excellent idea, but it is immature as of now.

© Dr. Rajas Deshpande

4. The Doctor:Patient ratio in India is misquoted. Due to poor payments and infrastructures, very few doctors stay either in rural areas or govt. services, and the whole equation is skewed. The very purpose of AYUSH was to bring in more medical personnel, but that would work if these (3.5 lacs) “bridge” course doctors honoured the opportunity and worked only where there was a scarcity of doctors (urban and rural). What is more likely is that these additional doctors will also join the existing urban trend. Who can blame them for wanting a better life?

5. The newer policies of “more data, more paperwork, more record keeping, tighter control” over doctors will only result in private practitioners becoming more paranoid, giving up all the voluntary charity that they did every day, spending more time per case: and that will reduce numbers and spike fees. I can foresee most private practitioners closing down clinics. More rules and paperwork mean more corruption and exploitation in our country. This will turn into higher cost per consultation. Private healthcare will be out of reach for the poor. The good doctor will no more sit in his own clinic, he will turn to a safer corporate hospital. (Is that the aim?).

© Dr. Rajas Deshpande

6. The NMC bill entirely skips any word about regulating the large private healthcare sector. It does not have any provisions to protect new and good doctors from the tyranny and forces of corporate expectations. Some private hospitals have excellent policies and ethics, some corporates are very doctor and patient-friendly, but many remain to be corrected. There is no authority to the NMC over such hospitals.

7. There is no mention about improving staff and facilities at govt. hospitals, about any rules that ensure the best free healthcare for millions of poor patients in India. The ground reality that many patients suffer and die due to lack of staff, medicines, technology, tests and surgeries at government hospitals finds no mention in the reports of the Parliamentary committees that suggested the NMC. They did not mention the pathetic, unsafe and inhuman conditions in which Indian medical students and resident doctors live and work. They did not mention who will be responsible if a patient dies in a govt hospital due to lack of facilities or medicines. They appear to be more concerned about the price control of 40 percent seats in private medical colleges.

It is sad that in spite of many doctors in and around the central government, the medical field’s autonomy died with this bill. Shall we call it Euthanasia or “Physician assisted death” of the autonomy of medical profession? © Dr. Rajas Deshpande. In the era of the MCI, doctors were orphans, now in the era of NMC, they have become slaves.

The corrections in this bill will have to be put forth and pursued by a totally unified doctor’s organisation. “Painkiller Agitations” will not work. We must ask for complete release of the NMC from the cages of central government. Like in the UK, Indian NMC should be made up of 50% Senior Doctors representing all states and specialties, and the remaining 50% can be selected by the patient organisations: Judges, Media Stalwarts, Journalists, Artists, Ministers and Eminent Social Personalities. We must ask for transparency and fool-proofing of all medical entrance exams. We must ask for the right education, experience and licensing of AYUSH doctors, and welcome them once they qualify.

This article is written with my heart which bleeds for my profession and my patient alike. Bharat Maata Ki Jay!

© Dr. Rajas Deshpande

PS: Thank you Dr. Avinash Deshpande, Aurangabad, for some valuable inputs. If there are any technical mistakes, please let me know so I can correct.

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The Mathematics Of Kindness

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© Dr. Rajas Deshpande

“Are you coming, doctor, or shall we file a complaint? We will go to the police if you don’t come in an hour”.

It was about 12 noon on a Sunday. My sister and her family were visiting for three days, this would be our only lunch together in this year. All other days I am in the hospital at the lunch hour.

A teenager was admitted for last two days with repeated alleged episodes of fainting with unconsciousness. His friends and family were all at the hospital, calling incessantly from different numbers. They were given my cell number by a colleague as he thought it was an emergency. I had seen the patient four times in last two days, rushing from the OPD as there were alarming calls. We had done all the necessary tests and found nothing wrong with the kid, we had concluded that he was malingering / faking these episodes. A neurologist has many tricks to unmask the truth. We had explained the facts to his family, a psychiatrist had confirmed this, and scheduled a meeting with the family on Monday. Till then we had added anti-anxiety pills and told the family to be patient. All the vital parameters were normal. I had explained the family to be patient.

My boss called, he was frustrated too. “Ja ke dekh le ek bar (Go and see him once). Some minister just called for him” he said.

Excusing myself from the lunch, I reached hospital. The teenager’s girlfriend was standing in panic by his side, crying while he was ‘unconscious’. The brother and friends raised their voices: “Why is this happening, doctor, why don’t you do something? Why is he not responding to the treatment? It is three days now. He is suffering so much”.

I am trained as a doctor to tolerate anger, frustration, anxiety, stupidity, bitterness or accusations, but I refuse to tolerate drama.

“I have explained to you many times. This is not real unconsciousness. A psychiatrist will have a meeting with your family tomorrow, till then there’s nothing more we can do”.

“What if he dies? What if you are wrong?” shouted the relative. I did not have an answer. I left the ward after messaging my boss, also asking him to transfer the case under someone else. The next day my psychiatrist friend called me. The teenager’s girlfriend was from another religion, parents on both sides had opposed their marriage, and this illness was their “brilliant solution” to get the parents to change their minds and agree. Cheap drama!

There’s no mathematics to kindness, we have all been taught. Do good, be compassionate and don’t expect any returns. People take advantage, but that is Their nature, you be yourself, kind and compassionate.

I was once returning from my Goa visit, there were long queues of frustrated people. Two apparently rich Indian tourists walked in, typically dressed for a Goan vacay. They saw the long lines, changed their faces, and rushed to the front of the line. One of these approached a foreigner in the line: “Excuse me, we will miss the flight… we were stuck in traffic.. my sister is sick, I must reach Delhi in time”. The foreigner, knowing that these were blatant lies, still allowed him to go ahead of himself. Kindness is almost a compulsion. Once on the other side of security, these “line-jumping liars” had the obvious expression upon their face: “Ullu banaya tum sabko (We made a fool of y’all)”.

At the hospital entrance, I often meet a paraparetic man in his scooter for the disabled. He usually blocks the hospital entrance with his three-wheeler scooter parked there while he talks at leisure with his friends. If anyone honks, they all play this “Can’t you see he is disabled? How rude!” card, intended to make others feel guilty. Even when it is an ambulance or a doctor’s vehicle, he will intentionally slowly move from the spot.

Every doctor, almost every day, meets people who blatantly lie: to bypass waiting lines, to ‘finish off with parent’s health issues over the weekend’, or to get concesions, free treatment. Some lie to exploit kindness and compassion, some to exploit financially. There are no guidelines defining an emergency and the charges for such “pseudo emergencies”. A doctor on duty must always resopnd to an emergency, but if off duty, he should be able to refuse cases on a holiday. All government hospitals have a 24/7 emergency department, the patient can be taken there.

Recently heard that an Indian lawyer charged in crores to an Indian client stuck on an European airport for a legal advice in an emergency. There were no cries about compassion, kindness or even patriotism. What should a doctor charge for a pseudo-emergency, especially when a precious holiday is wasted?

When I discharged this case, they asked me when to follow up. I replied without hesitation: “Never with me”.

© Dr. Rajas Deshpande

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The Sunshine Girl

The Sunshine Girl

(c) Dr. Rajas Deshpande

The beautiful 14 year old girl was almost motionless. Her body was completely stiff, eyes fixed in one position, she could not move at all. Any attempt to speak or move would send her entire body in violent spasms. She could not even cry for the fear of this painful stiffness, but her pillow was wet with the tears rolling down her eyes. Her parents had wheeled her in on a stretcher. They had landed just yesterday in Mumbai, travelling from Iraq with her. Her father was illiterate, while the mother was a science graduate from Baghdad University. While internally torn with the condition of her daughter, the mother very calmly and peacefully explained me the condition of her daughter Khazan.

On the day of school annual function just five months ago, Khazan’s teachers in Iraq noticed that she was limping while dancing on the stage. They told her mother about this. Khazan was taken to a Neurologist there, who found that she had some neurological signs, with brown coloured rings in her eyes. This ring called a ‘KF’ring is usually found in patients who have a rare disease called ‘Wilson’s Disease’. Due to a fault in Liver, copper cannot be excreted out of body, it accumulates in the liver and in the blood, rising to high, toxic levels. This excess copper in the blood then starts damaging every organ in the body, but first it causes severe damage in the brain and eyes. If not treated, the patient becomes disabled soon and dies. The biggest problem is that many patients may worsen with treatment in the initial phase, with medicines which act fast. The cheaper medicine (Zinc) which does not cause such worsening, is too slow to act, it takes months. (c) Dr. Rajas Deshpande. Khazan was started with the first medicine in Iraq, but unfortunately, she became paralysed due to the side effects of the medicine. The Neurologist in Iraq started with the second, extremely costly drug. Her parents sold off their land, business and even home, and shifted to a rental small house to afford this medicine that had to be imported from USA. As fate would have it, Khazan reacted adversely to this too and further worsened. She became completely paralysed, could not eat or speak, and was then advised the last option, the curative treatment for this disease: Liver transplant. (c) Dr. Rajas Deshpande

They applied for loans from some charity organisations, and landed in India for Liver trasnsplantation. “We were told that the doctors in India are the best in the world, and the cost of treatment is lowest in India. So we decided to come here” her mother told. Indeed, the cost of medical as well as surgical treatment in India is lesser than half compared to the developed world. For simple appointments with specialists, the waiting list in the developed world exceeds weeks to months, and surgical appointments take years. Once, in my childhood, one of my uncles gave me some dessert, like everyday, which I didn’t care to finish. My aunt asked me with surprise: “Why don’t you eat such a delicious dessert?”. My uncle immediately said “Because he gets it so easily. Ask those who don’t get it, they will love it”.

We found that Khazan was almost skin and bones, dehydrated, and anemic. She had developed many Parkinson-like symptoms and some psychosis. I explained her condition and told her mother: that she was semi-critical, that I wanted to start with the cheaper, third medicine and give her supportive care, but it would take a long time, I could not guarantee anything. Her mother told me via the Arabic interpreter Mr. Tabrez: “Doctor, we do not want surgery for her. Do what you would have done for your own daughter. We will close our eyes and do whatever you say. We will hope she improves, but we understand you cannot guarantee anything”. Now the onus was upon me, the responsibility was mine. We started treatment. Khazan’s graduate mother knew more about Wilson’s disease than many medical students, yet she never came across as arrogant or argumentative. She politely asked doubts. A good doctor grows with every patient. (c) Dr. Rajas Deshpande

My students started helping out the family, making Khazan feel at home. Love and compassion for the patient enhances the effects of all medicines in most cases. Add the trust and willpower of the patient, and you usually have a winning prescription. From the shadows of a near-certain death, Khazan’s body and soul started to awaken to the sunlight called life. She gradually started speaking, drinking water, and in a few weeks, eating small morsels. They had to return to Iraq, and we communicated via video chats. They returned twice to India for reassessment and change in treatment.

A few months after their last visit, I received a letter. It was written in English, by Khazan. She had joined college now, and wrote that she wanted to become a doctor like me. Her mother had added in Arabic: “My girl is the sunshine of my life, thank you for bringing her back from the claws of death”. I had received my reward. Khazan is doing very well now since last three years, with God’s grace. Of course I did not forget to remind her that most of the credit of her recovery was to the unparallelled grit and efforts of her mother.

Magical, Near-supernatural, Miraculous recoveries happen every day in India. Patients, young and old, with almost nil chances of survival, walk home smiling every day, in almost every Indian town, even in the most rural areas, thanks to the efforts of thousands of doctors working 24/7. These doctors are never appreciated or rewarded. This post is dedicated to those messiahs of Indian Medicine.

(c) Dr. Rajas Deshpande

This story is real. Many doctor colleagues and physiotherapy students have helped me treat this patient over years. Wilson’s Disease can be completely cured, there are many experts working on tis in India.

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What A Doctor Can Not Prescribe. .

(c) Dr. Rajas Deshpande

“What’s the nature of your work?” I asked the patient.

“Nothing much.. I just sit like you all day long. It’s an office job” he replied, and winked looking at his wife, who rebuked him visually. I chose to ignore the sarcastic slur. I wanted to concentrate upon the diagnosis. After a thorough examination I wrote him a prescription and explained him changes in lifestyle.

When I advised him sleep and food discipline, he proudly told me “That I am very particular about.. since so many years I eat three times a day and sleep peacefully over eight hours”. I had a strong urge to tell him that in last twenty-five years of practice, there was never a night of undisturbed sleep thanks to hospital and patient calls, and there rarely was a straight week without skipped meals. I held my rebellious tongue, another patient waited outside. All said and done, I had myself chosen this career, and the fact that people were bitter towards doctors didn’t deter me from offering to solve their health puzzles.

The next patient walked in with a big “Hullo! Raja, pehchana kya (recognise me?)?”.. he was an old schoolmate, had come with his wife. She had had complicated neurological problems. After a lengthy clinical examination, review of many reports, and a long consultation, I wrote her a prescription. (c) Dr. Rajas Deshpande

“You charge so much for only writing these few words on the paper?” asked my schoolmate, desperately trying to sound jovial but overtly being critical and again, sarcastic.

I politely asked him to sit in my chair. “Please sit here and see if you can write the same three lines” I requested him. He hesitated at first, but then came over, held the pen and asked me: “Tell me what to write..”.

I told him to first write his wife’s name on that paper, date it, and then write Rx, which begins the drug prescription. Then I told him the name of the first drug. He wrote it down correctly.

“What’s so difficult about that?” he asked..

“Now tell your wife that this drug can either do good or bad, it can solve the problem in most cases, but it has a potential to cause serious side effects, including death if she is allergic to it. It may cause bleeding in the brain, stomach or anywhere, it can cause asthma-like cough, or any unpredictable reaction”. (c) Dr. Rajas Deshpande

His wife looked suspiciously at him. “Why don’t you let the doctor write?” she said, and then turning towards me said, “Bhaisaab, my husband has this nasty habit of arguing with everyone. Excuse us, I know it takes decades of study to be able to write that prescription”.

My schoolmate was not done with being offensive yet. He smiled sarcastically. “You are trying to scare me. Have you seen any death due to this simple medicine?” he asked.

“Yes” I replied him in truth. Aspirin causes many deaths indeed!

“Write the second medicine now” I told him, “it can have reaction with the first medicine or other medicines she is already taking”.

“What to do in that case?” He asked, now hesitant.

“It depends upon what side effects emerge. Many possibilities, many different answers. But each of that line has a potential to cause serious damage.” I replied.

He rose from my chair.

“Sorry yaar. I thought you were just charging fees for sitting there and writing effortlessly. How do you remember so many hundred drugs, their side effects, their reactions with each other? Aren’t you scared?” he asked.

“I am sometimes scared. Every doctor is. You never know which prescription can turn into a nightmare. The more you have studied, the more you have experienced, the safer you feel. You can imagine the stress of writing forty prescriptions a day, an average for every doctor. Still more dangerous is the surgeon’s job, every patient entering an operation theatre has some degree of fatal risk”. (c) Dr. Rajas Deshpande

“Oh so that’s why doctors charge so much fees for every prescription!” He was indeed a fighter!

I didn’t want to explain to him that the land, the rent, the petrol, paper, and time cost the same to a doctor just like any other citizen. (c) Dr. Rajas Deshpande

Just then there was a loud noise outside. We rushed out. A patient’s child was having a fit, her body all twisted and eyes white. Such was the impact that her head was bleeding, and she was frothing at mouth. The nurse was already by her side, I wore my gloves and tried to stop the bleeding, comforting the head of this child. In some time, the fit stopped, and the pateient became all floppy. Her respiration had been blocked by the blood and froth that choked her throat. A resident doctor ran around to get a crash cart, we opened the patient’s mouth, sucked out the blockage as the nurse pushed in the injectables. The child stabilised, her breathing resumed. As the wardboys kept her on the stretcher, I noticed my schoolmate behind me who was watching this in horror. He suddenly held his head and sat down.

“He gets a chakkar (giddiness) when he sees blood” his wife told me.

The earlier patient, who had commented “I sit like you all day” was also still in the lobby, watcing this whole episode. . He came over. “I help people too – just like you. People come to me every day for my advice. I am a social worker for XYZ political party. I have also saved many lives like you doctors.” he said.

I had no prescriptions for his mentality!

No pharmaceutical makes a common sense tablet, and there’s no injection for jealous egos!

(c) Dr. Rajas Deshpande

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“Dev Borem Korum” (Thank You)

(c) Dr. Rajas Deshpande

As the plane landed, I called up the driver who was scheduled to pick me up from Goa airport.

“Hullo, Mr. Clement? I’m Dr. Rajas”

“Haan daktar. Tu aaya kya? Bahar nikalke miss call de mai ayega” (Have you arrived? Come out and give me a missed call, I will come there”) . He would have said the same sentence to the President as well. Goans are least hung up on artificial flowery language, they are the friendliest lot as a society. It was after a year, that the same Clement said to me: “Tere liye apun jaan bhi dega parwa nai” (“I can give my life away for you without any hassles”), when I thanked him for something.

Goa has some excellent Neurologists, and my visiting is actually redundant. Yet somehow, maybe because they keep quite busy, or sometimes patients seek a second opinion, I have been seeing a good number of patients every visit. In the very first visit, after I saw an elderly lady and explained her the treatment, she bowed and said “Dev Borem Korum Doctor”. That means “Thank You Doctor”.

Then I pleasantly noticed: irrespective of what was the diagnosis, what treatment was given, whether there was treatment for the patient’s condition or not, whether the patient improved or not, almost every patient said either “Dev Borem Korum” (Thank You) or “God Bless You Doctor”. Even if surgery was advised, even if there were side effects of medicines, even if the outcome was not as expected in rare cases, the “Thank You”and “God Bless You” never changed. It had nothing to do with any particular social class. The rich, the poor, the educated as well as the uneducated, people from every religion, every age group said it. It is a part of that culture: the Goan culture.

Late one night after the OPD, when we were driving on a beautiful long empty Goa road near the beach, I mentioned this fact to my friend Dr. Samuel (God Bless Him for the exotic dinners he takes me to!), he stopped his car and looked quite affected. “I wondered whether anyone else had noticed that. It feels so beautiful! When the patient is grateful and brings you blessings, you automatically feel responsible to do the best for them. Money never matters in that relationship. We must never take patient’s kindness for granted. So many of them actually say Thank You, God Bless you, but sometimes we are too preoccupied with work, anger, ego and other things to reciprocate and encourage that kindness”.

I told him about my late Professor Dr. Sorab Bhabha, who stood up and greeted every time a patient entered or left his cabin. The onus of initiating a good doctor-patient relationship primarily lies upon the doctor, and it is extremely essential to follow the best of manners and etiquette, kindest of language when dealing with patients.

A very sweet girl who followed up for epilepsy recently told me that she visited me not only for medical purpose but because she was inspired by the way I appear calm and composed, the fact that I never raised my voice and always spoke compassionately with everyone. I had to tell her the truth. “Thank you mam, but I am quite short tempered outside the hospital. Even the junior doctors working with me sometimes find me intimidating. But I have to change when I am with a patient. I don’t think that any patient comes to me because I am any better than anyone else in the profession. I prefer to think that they choose me because they trust I can solve their problem. Will you be rude to someone seeking your help? Then how can I get angry with a patient? Every patient coming to me has that hidden trust, which I must justify. Only rarely, if the patient misbehaves or says something insulting, do I lose my calm.”.

“That’s what I like. So humble!” she had to have the last word!

Yes! The day I bring my ego inside the hospital, I will no more be a good doctor. Even the most illiterate patient understands when the doctor is being rude or artificial. Only when it is genuine, the patient will feel the warmth of my compassion and care. It has nothing to do with sweet talking or a show of affection. The only way to do this is to actually incorporate it within one’s depths so that it becomes one’s originality. Kindness and compassion must be the original, genuine qualities of every doctor who expects gratitude from each one of his patients. It does work in most cases.

After dinner, Dr. Sam took me with two other friends to the beach and we silently stared at the luminous moon for a long time. The music of those waves matched the dance of that moonlight upon the ocean. Just as one can feel the glow of the moonlight upon one’s skin, I could feel those numerous blessings keeping my soul warm and happy.

(c) Dr. Rajas Deshpande

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The Remedy of Trust

© Dr. Rajas Deshpande

I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.

I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande

As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!

As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.

I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande

The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!

The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.

She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande

Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and reassured her that it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and that her husband appeared out of danger at that moment.

She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.

Confused for a moment, the old man stared first at his wife, then at me.

He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.

The old couple, the age of my parents, was saying Namaskar to me and touching my feet, although I was many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.

I switched off my cellphone.© Dr. Rajas Deshpande

I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying my services’ would actually be my interest or aim. This was.

I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in this case”.© Dr. Rajas Deshpande

When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.

A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.

© Dr. Rajas Deshpande

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