Tag Archives: cut practice

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

Painful Injection

Injection
© Dr. Rajas Deshpande

“Anyone Treat Anything” and the “Add-On complaints”.

“Doc I have come to you for this severe headache since last five months”.
Examined, investigated, prescription given.
5 days later:
“Doc there is no relief. This back pain is killing me”.
“What about the headache you had?”
“Oh that went away the next day, but this backache has been there for years now. I forgot to tell you last time. I also want you to review and advise about my Sugar and BP medicines”.
……………..
Specialty practice in India is considered to be just like family practice. The concept of “problem-based” consultation is yet to arrive. Once seen by a specialist, all the subsequent health issues are thought to be automatically the responsibility of that doctor, and he / she is supposed to solve them at a “Follow-Up” charge for years. The concept of “New health issue, New consult” is yet to dawn.

Unfair to compare, but this is like visiting a hotel once to eat an unlimited Rice Plate, and then keeping on visiting repeatedly later to reap the “unlimited” benefit from the bill paid on the first day.

There are two sides. Some specialists also encourage this “treating everything” once the patient comes to them, and often transgress their field of expertise to keep on treating everything till the time something goes wrong, when alone a cross-reference is made. Once someone starts practice in some specialty, they should ideally only stick to that branch, unless it is an emergency.

Even at the cost of patient “misunderstanding and blaming”, some specialists follow this correct practice of referring to another specialist where indicated.

“You only give the treatment, doc for everything.. we have faith in you” is very rewarding and beautiful to hear, but at the same time a doctor who thinks he/she can should think twice.

The second issue is that of “Going on adding” the complaints even after the doctor has finished examination and has already issued a prescription.

The whole process is logical, and disciplined: recording the complaints and other medical details, then performing a physical examination, reviewing old test reports and advising new, writing a prescription, and explaining the condition and management to the patient. There are limitations in the time spent for one patient, and a single significant complaint added later after the prescription is written can change the diagnostic possibilities (“I just remembered, I had episodes of unconsciousness / tuberculosis / head injury in the past”). It then becomes imperative that the doctor rewrites the case history, and changes tests advised and even treatment sometimes.

There are simple solutions, but these become difficult in India.
1. The doc must spend extra time with every patient to give them sufficient time to remember. This is feasible only when the charges are time based, as some patients are not done talking even after 30 minutes. The experienced docs then learn the skills and tricks to save time and to “steer” the patient.
2. Patient can fill up / record forms while in the waiting room, where almost all important questions are already mentioned, so one cannot miss. This is difficult in two ways: most of our population is illiterate, and even the literates do not fill up these forms properly. Also, most of the working class come “flying” in a hurry to “get over with this quickly and fly to another meeting/ chore”, so they keep busy with their cellphones in the waiting area (sometimes even in the doctor’s chamber). Secondly, such mention of “all earlier health issues” also invites unwanted exaggeration of otherwise minor complaints especially in the depressed / suppressed / anxious and overenthusiastic patients, often diverting from the main health issue.
3. Doctor’s assistants / junior doctors “filtering” the information for each case: this may be the best option, but again the specialist must take responsibility for their mistakes. Also, one must remember that patients often do not take the “assistant doctors” seriously and may omit crucial information while talking to them. Also, a patient who pays for a specialist’s service deserves interview and examination by that specialist, not only a quick overview of an assistant’s opinion.
4. Patient must make and retain a notebook / digital diary common to all his / her medical issues, consults, details of all prior treatment and tests and carry it for every consult, minor or major. While the doctors / hospitals are supposed to keep their own records, they are blind to what happens outside their medical jurisdiction, so it becomes almost useless. A unified national healthcare software is at least 10 years away.

The IMA / MCI must devise large scale patient education programmes that will help curb the misunderstandings, hate, violence which society harbors towards medical professionals. Encouraging correct referrals, specifying doctor’s fees based upon the equation of “Time + Skill + Experience + Complications in a case” at different levels from family practitioners to super specialists may also help. A basic model of “Primary General Practitioner” who attends simple health issues with referral to a specialist based upon patient’s choice / proximity / GP’s honest opinion and suggesting at least two specialist names will help control this “Anyone Treat Anything” practice so rampant today.

There always will be allegations of “cut practice” whenever there is referral, as average human nature finds pleasure in blaming others especially successful and presuming everyone else a sinner while imagining oneself a moral-ethical icon.

To imagine that everyone in the medical profession is a sinner and guilty, and everyone in the society is innocent is a sign of immaturity of intellect. This is our working diagnosis right now.
© Dr. Rajas Deshpande