Tag Archives: doctor patient relationship

The Last Bullet For Indian Private Healthcare


© Dr. Rajas Deshpande

Many doctors, nurses and other staff, police officers are dying due to corona exposure. Recently the quarantine period of doctors was cancelled. To add to this, very ridiculously, doctors’ salaries were reduced, and covid funds were deducted from even frontline warriors’ salary. This is like taking money from a soldier’s paycheck to fund the army!!

When I recently heard some people shouting about excess bills in hospitals, doctors not working etc., I felt like shouting back too, but one cannot argue with a sold TV screen.

For decades India has had
Excess urban crowding,
Very poor hygiene.
Very high poverty and illiteracy.
Lack of town-planning for slums.
Severe lack of state/ national healthcare infrastructure.
Tiniest budget for healthcare.
Perpetually under-functioning government hospitals. Every season hundreds die due to epidemics.

Where were you till before the pandemic? Who is responsible for all of the above? Do you want to discuss these factors which are responsible for the pandemic chaos today? Or now you just blame it all upon Doctors and Private hospitals?© Dr. Rajas Deshpande

Only private doctors with small nursing homes and dispensaries, clinics were shouldering all healthcare needs that government hospitals could not provide. They had low profits and catered to middle and lower class. These were destroyed in last few years because of too many stringent regulations and costly licensing. Many closed down. Legal troubles by relatives, politicos supporting them and vandalising hospitals forced many private doctors to stop admitting patients. Protection to doctors was denied by almost all governments till before this pandemic.

Indian poverty is never ending, and charity cannot run anything perpetually unless there’s a strong fund generating mechanism supporting it. If someone expects that doctors charging 2 rupees fees are the ideal healthcare for all our medical needs, they should happily go to such a doctor. We highly respect them too, but it is their choice and there are obvious limitations to that. To develop advanced healthcare in India, higher profits were necessary for higher investment. Corporates, some businessmen and the likes of Mr. Ambani pitched in. Advanced healthcare with heart and liver transplants, complicated brain surgeries, cancer treatments came to India because of these investors. They accepted all the conditions of governments to accommodate over twenty percent poor, nonpaying patients via various schemes. The payments for running these schemes were delayed by various govts for years, and the hospitals were arm-twisted in still continuing to treat everyone. The only source of profits was private and some insurance patients who were paying a higher fees for facilities: from air-conditioning, food to choice of specialists. Higher quality of staff, especially nursing and technicians who can operate high end machinery and robotics requires very high salaries. Maintenance costs are heavy. A specialist cannot do much without such a very good team. Each of these requires good if not great salaries, as they are continuously invited by developed countries who pay far higher.

But then every patient wants the highest facilities, best staff and specialist team, with no payment or basic payment. There’s no concept of billing beyond actual price of medicines and room charges. Service and maintenance is considered a ‘free right’. © Dr. Rajas Deshpande
Even in this modern era of equality, a higher class Indian officer like a minister gets a higher room, better food and other facilities, even higher medical bill sanctions, whereas the labourer from his department gets minimum basic facilities and bill eligibility only for general ward. Law allows higher healthcare’s standards and payments for higher officials. Why do they even have classes in railways and airplanes? If a “Gareeb bechara” migrant wants to fly home, should we offer him road transport or compassionate air travel? Why don’t we do for all the poor something that you all expect doctors and hospitals to do?

We don’t mind if basic and emergency healthcare is uniformly cheap or free for everyone. But when you force a high-end medical commodity (skill-time-investment-staff) to be sold at a loss or extremely marginal profit, you kill the system.

Doctors do not differentiate when making a diagnosis or treating anyone from any financial/ power background. But the private hospitals must be allowed to cater to different classes, earning their profits. That is their only stimulus to grow forward, engage best personnel and bring advanced healthcare to India. Different governments have failed at maintaining high standards of healthcare in their respective set-ups (with some proud exceptions- but because that’s where our powerful go). Some hospitals indeed take more bills for better class of services, including staff, but none of them forces a patient to come to them. Even these hospitals never deny free emergency treatment to anyone.

“But isn’t healthcare a charity? Haven’t you taken oaths to serve?” our loudmouth hypocrites ask.

Yes we have taken an oath to serve everyone rich and poor equally, but no, we have not taken any oath to neglect our own health and well being. Yes we have taken an oath to serve, but we have not taken any oath to live in perpetual poverty and financial stress. Yes we are under an oath to do our best for every patient, but we will not be bending backwards to fulfil their unreasonable demands. Yes we want to save every life, even if it is dangerous , but we will not unnecessarily endanger our own life because someone forces us. We haven’t taken an oath to abandon our families. The Hippocratic oath does not ask any doctor to stay hungry, work without sleep, and do the unscientific because various governments cannot pay for adequate number of doctors. Still we are doing all this already. Let us be clear: we proudly and intellectually serve our country, but we refuse to be considered slaves of either the system or the society. © Dr. Rajas Deshpande

Capping bills in private hospitals will be the last bullet for all advances in healthcare development in India. Be prepared to go back to the chaos of ancient times in that case. Quality will suffer most: right from specialists to nurses to medicines. You can of course force one generation of doctors to work like this, under low cost and excess work. People aren’t fools to send their children to such hells of social slavery. Yes you read that right. There’s a difference between service and slavery. Do not attempt to turn medical service providers into slaves. It will backfire very sourly.

Instead of this, the government can invest in existing private healthcare players to create low cost infrastructure alongside their private hospitals, or privatising its own healthcare institutions with increased capacity. Our governments do have friends in very high places who can invest.

We love India. We are not against any particular government, and this post is not against any leader or party. But we do feel very strongly that healthcare decisions must be made involving everyone concerned, that this people-pleasing for short term will turn out to be a huge disaster in long run, and it will be irreversible. If any government thinks that cancelling hospital permits and doctors’ licences in a country with severe shortage of medical services is the right way forward, God help it.

If private and corporate hospitals start shutting down now, it will be permanent. India will then have to mostly rely upon prayers alone for healthcare. And of course those who think they know medical science more than doctors. India has no dearth of such “fatally self-medicating” ignoramuses.

Jai Hind

© Dr. Rajas Deshpande

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Suspend All Doctors, Cancel Their Registrations…


© Dr. Rajas Deshpande

Have you ever spoken with a doctor, a judge, a police, minister or an an IAS officer in their office? Almost every common man has had almost a similar experience: an arrogant air of authority, hidden hints of superiority and a subtle dose of “I know better than you” whenever one tries to argue. Now we know all of the above can be wrong occasionally, at all levels. Of course, there are exceptions in all professions. In a new world which is now shedding away traditional chains of inequality and racist slavery, we Indians are probably the most reluctant to change. In performing one’s duty, no one is superior to those they serve.

A doctor needs to be patient and compassionate with the ill-behaved and arrogant, unlike police, judge or minister who will punish people for such behaviour. Additionally, far before COVID19, there have been fatal infections like MDR Tuberculosis and other viruses which have endangered and even killed doctors. The stress of this daily fear of death is difficult to explain to the idiots who argue “but you yourself chose this profession, nobody forced you, you knew all the time about these risks”.
My dear infinite stupid, yes, I chose this profession willingly, knowing the risks, but to live on and serve, not to willingly and knowingly expose myself to fatal infections. A soldier joins the military ‘to live on and fight and protect the country, not with a wish to die with enemy’s bullets’.
When a citizen tells them from the comfort of a protected home that “You already knew you could die in the army”, it is ingratitude and insult to their profession. We choose to be in this profession because our compassion and courage is higher than our fear, not because we want to die. To be honest, we do not expect many to even grasp this concept. © Dr. Rajas Deshpande

I have deep respect for some Judges, IAS and police officers who are geniuses, and the first mark of a genius is a humble openness to all logical argument, with parsimony of words and zero presumptions of having a superior knowledge. Even a few minutes with them enhances your life. They are calm and respectful of others. Their language is never “Suspend, Fire, Transfer or Shoot”, because they know what it takes for a genuine person to reach where they are. These geniuses are far above attention seeking, cheap media publicity, arrogant show of authority and blame-mud-slinging to cover their own mistakes, inferiority complexes, and inadequacies.

It takes longest time and a hardest curriculum with hands-on experience of years to make every single doctor. The more specialised a doctor becomes, the rarer it is to replace his experience. Still anyone can commit mistakes.
If a Judge, a police Officer, a Minister, an IAS officer is wrong, does our constitution allow any TDH in media or society to get up and threaten them with suspension? Can you imagine a nagarsewaks / municipal councillor / local politico, goons or even major/ minor officers threatening a judge, IAS officer or a commissioner with cancellation of their rank, licence or degree? Even the courts of law do not suspend anyone or strip them of their hard earned registration without giving them a complete and patient hearing.

Yet almost every TDH in almost every nook and corner in India, from temporarily elected less-schooled representatives to highly educated junior and senior administrative officers often threaten on TV channels that doctors’ registration, licence and degrees will be cancelled. This apparently gives them a sense of pride and accomplishment and also sends a wrong message to a public that these doctors must serve.

In a country where the policy makers have miserably failed for generations to create enough doctors for their population, where we still continue to have that discrepancy, suspending a doctor is like snatching away food from someone already dying of hunger. One doctor gone screws up many patients’ lives. There’s no other profession where generations are taken care of, lifelong, by one person. Yet apparently, some officer’s egos are more important than those patient’s families, health and lives.

Every day there are news of political, social reasons of suspending, threatening doctors. Deny concessions, freebies, shoe-licking, decline to compromise upon scientific principles or accept inhuman conditions for doctors, and almost every officer unleashes their administrative adrenaline pumps against the entire medical profession. Refuse to accept incorrect policies and guidelines that are against patient’s interests, and insubordination leads to losing your jobs. The most shameful and pathetic addition to this “Suspend-Crazy” admin category are some senior doctors who fail to guard the principles and juniors of their own glorious, noble profession. © Dr. Rajas Deshpande

Like every Judge, Police or IAS officer, even politician, every doctor has also worked very hard to earn their degree and licensing. Every Medical college and University in India is approved by the government. The Medical Council of India has been given the authority and statute to license a medical practitioner upon presenting his / her degree and following principles it has laid down. No one other than the MCI should be able to cancel the licence of a registered medical practitioner. Every case of suspension of a doctor: whether a postgraduate or a senior doctor should be referred to a separate impartial MCI committee. Even the Hon’ble courts of law usually request expert opinion before concluding about medical issues / cases. Yet, our admins and politicians from different states suspend and threaten doctor’s registration cancellation as if it was granted by them or their party or government as a favour. No. We don’t accept that. Every IMA branch in every city must stand by such victimised doctors, protest such injustice, represent the harassed doctor and protect him/ her.

There of-course are doctors who commit mistakes, like Police Officers, IAS officers, Ministers or even some Judges. All of them should be accountable and be brought to the right penalty with the same dignity as others. No one has the right to pretend that a doctor is a slave to their whims, greed and tantrums. © Dr. Rajas Deshpande

The Hon’ble Supreme Court has very clearly stressed the fact that it is very important that doctors should be able to work and make their decisions without stress, insecurity, duress or fear. The article above intends to highlight that same purpose, especially in the light of some recent happenings. Every doctor out there is risking life only to save others, serve the nation. They do have problems, issues and insecurities that need sorting out. Please address their issues scientifically and logically, rather than inhumanly threatening them by suspension and cancellation of licences because you have no resources, funds or answers. Treat your doctors with the same compassion that you expect from them. Or, if you know better, if you want doctors to blindly follow unscientific instructions of admins and whims of politicos why make doctors? Suspend all doctors at once and do it all yourself.

India will definitely be healthier if you listen to the doctors, and don’t threaten or suspend them for trivial reasons.
Jai Hind!

© Dr. Rajas Deshpande
Written with a sad heart that on one hand where the Hon’ble PM has asked people to respect and appreciate the efforts of doctors, nurses and other corona warriors, many are looking for reasons to corner, threaten and suspend them at the drop of a hat, sometimes just for headlines.

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A Superhero Doctor’s Dresscode
© Dr. Rajas Deshpande

A Doctor cannot enter home every day and start giving injections to her kids. A policewoman cannot wield a danda/ stick every day upon return, at her family members. A Judge probably cannot say “Order-order” when a child cries at home. We are not supposed to carry our professional mindset and attitude in certain places. Likewise, one cannot expect people from other professions to advise others what is beyond their domain. A doctor will never understand how complicated a politician’s or a policeman’s job is, and vice versa.
A clean and clear mind is essential for every doctor. Even a small mistake in thinking and decision making or actions may cause grievous, even fatal mistakes. © Dr. Rajas Deshpande
There are many doctors who have become infected even before the pandemic with diseases like tuberculosis and hepatitis, while trying to save patients.
It is very essential that every doctor, especially junior, learns to ignore what is not a doctor’s domain. The unscientific territories of political thinking and religion or discrimination are not for the doctor, however tempting and patriotic they may be touted to be. Pressures from society and media can ruin the peace of mind so essential to make a good doctor. A doctor who falls in line with sociopolitical expectations to do something unscientific is not only dangerous to the patients, but can never be called a good doctor.
There are those in higher offices, including doctors, who cannot overcome the ‘superior-inferior’ discriminatory mindset and will advise one and all what to do, taking credit for all good and blaming others for all bad in every situation. They take for granted that a military type hierarchy works everywhere. No doubt it is extremely essential in the military, but in medicine we need brainstorming at every step, a student cannot be expected to act on patients if a senior gives a wrong instruction. One must know, challenge, ask, resolve doubt and then act. © Dr. Rajas Deshpande
Like a Judge in the court who cannot rush an unlawful decision even in an emergency, a Doctor should also only choose what is scientific, even in an emergency. Of course there always should be a sense of time and good. A superhero doc may choose to be a couch potato in his/ her shorts etc. at home, but when on duty, he/ she must don the special dress called pure ethical medical science.
Every Judge who gives a legally correct decision all his life, without being affected by any pressures whatsoever is indeed a superhero. A doctor who takes care of all precautions and helps every patient all the way is indeed a superhero. The heroism lies in defeating the disease and saving every patient one can, NOT in being unscientific and risking lives. Wishing you all decades of success, and millions of saved lives. Always proud of our frontline doctors and nurses!
© Dr. Rajas Deshpande

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Women’s Day and A Frightening Secret

Women’s Day and A Frightening Secret
©️Dr. Rajas Deshpande

A well respected senior, a social celebrity, walked in with his daughter. Cultured, proud people. Probably highly educated and rich. While he was richly dressed in a traditional Indian attire, she wore a saree. Many phone calls had told me since a day prior that he was very important, and that I must make sure he doesn’t have to wait. They sat down cautiously, the daughter in her late twenties looking at the floor.

“Doctor, my daughter is behaving strangely, she is not speaking normally with any of us, and seems lost since last two months. She has a lot of giddiness and has not slept for many days now. We have seen many doctors, done all the tests advised, but no one has been able to tell us what’s wrong. You see her and tell me if you can help.” Somehow the father was intimidating. I asked the patient her name. The father replied. I asked her about her complaints. He replied again. It is often very difficult to make a woman speak in the Indian scenario. I politely asked the father: “Could you please let her reply?”.

She replied in single words, mostly yes or no. She appeared to have given up. It is indeed tough to deal with such ‘mentally closed’ patients. I obtained her permission for a clinical examination and found nothing abnormal.

“Are you stressed ?” I asked what was inevitable now. ©️Dr. Rajas Deshpande

The father repied promptly: “There’s nothing to stress about, doctor. She works as a lecturer at a prestigious institute, we are quite well off, and although we want her to marry soon, she refuses to meet anyone. We are okay with that too, we are in no hurry. I dont think there’s any stress here. She just needs to be mentally strong. She has lost her will power”.

At this point the daughter looked up at her father, begging him to stop.”I have done whatever you asked. I came to every doctor you took me to. I am not weak. Please stop all this now, I will recover in few days”. I sensed something wrong here. I asked her if she wanted to speak in privacy and confidence, offering a nurse to attend instead of her father. Her father was visibly annoyed at the suggestion, and terribly surprised when she said yes. With a firm face, she said “Can I speak with the doctor alone for a few minutes, Baba?”. Her father walked out. ©️Dr. Rajas Deshpande

“Doc, I don’t know what to do. I am in a terrible situation. As you see, everyone is scared of my father, so no one tried to speak to me in privacy prior. To be able to trust you, I need your word that you will never tell my father about this discussion. If you cannot keep that word, it is best that I don’t speak with you about my problem”. This was a common request. A doctor’s first loyalty is to his / her patient. I reassured her that whatever she speaks won’t go beyond me, and also told her that she should be completely honest and open, that I was not here to judge her but to help her.

She paused, embarassed. The stress and shame of what she was going to say reddened her face. She sipped some water and took a deep breath.

“Okay doc. Five years ago, I was in love with a classmate of mine. He is from a well known politician’s family, and we were very close. We were planning to marry after a few years. He had alcohol frequently, but had promised me he would stop after marriage.”

She paused again, now tears in her eyes. “Please don’t misunderstand doc, but like all other lovers of our age we exchanged naked pictures and video clips. We also recorded some of our own, making love. As my father often checked my phone, I deleted everything immediately. I told him too to delete them, but apparently he stored them. After a few months I found out that his alcohol addiction had become worse, and he was going around with another girl, so I stopped seeing him immediately. He never cared, and he married someone his parents had chosen”.

“However, three months ago, out of the blue he called me and asked me to meet at his home as his wife had left him. I refused. Now he is threatening that if I do not meet him he will upload my nude pics and videos on the internet. Their’s is a very strong and rich political family, I know he can do anything and get away with it. You just met my father, you can imagine his reaction to this. My family is proud of me, but they will never accept or forgive me for what I have done. I feel ashamed, but there’s nothing I can do about it now. I am loved where I work, my students look up to me as a teacher. All is on the verge of being lost for me now. I feel like I should permanently disappear. I don’t know what to do” and she let out all the sobs she had held for months.
©️Dr. Rajas Deshpande

This wasn’t new to me. While virtual exchange of ‘love’ in form of nudity and self recorded sex between couples is a reality of current times, it strongly contrasts with the social preparedness for it. Our society is not only orthodox, but shamefully, violently critical of anything that offends their cultural tastes that vary from family to family. An exchange of such nudity between couples in love is their personal choice and preference, no one should feel offended by it. However the dilemma of its correctness arises when situations of such blackmail as mentioned above create catastrophic consequences.

Many women (and I am sure even men) face threats of their privately exchanged nudity being exposed. This rampant blackmail that extorts anything from money, sexual favours etc. to various other compulsions are a nightmare turning into a reality now. Although the cyber-crime cells admirably track down the culprits, the victims still go through a lot of humiliation till then. Many victims do not know where to get help, and women’s organisations, NGOs need to reassuringly come forth with plans that ensure complete privacy and confidentiality of the sufferer. What offends most is the callous allegations of cheapness, wrongdoing , shame and derision with which our society criticises the victim. Some people and many in media actually take a perverted interest in exploring private nudity and sex, as if looking for certificates of their own piousness in someone else’s ‘moral adventures’. ©️Dr. Rajas Deshpande

I told my patient that we could help her, and handed over the case to a female counsellor who is well versed with such cases. Although she has proper connections in the cyber crime department, usually this is not required, as the threatening cowards usually come to their knees oncethey know that the victim has someone’s support. The last I heard, the matter is resolved.

Stronger laws to respect privacy, stronger punishments for those who use such threats to their ex-lovers and a social revolution to accept the realities of today and reassure the victims rather than shaming them are essential. A complete ban on reporting of such cases as “Spicy News”in media is awaited.

On this Women’s day, I humbly bow to the higher gender, the mother and the sister, the wife and the best friend called woman. Only what a man learns from a woman makes him the man that he is, and in that, she is the teacher: of patience, of modesty, of hard work and sacrifise, and the soul of true love.

©️Dr. Rajas Deshpande

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P.S.
Partly Imaginary story.
I truly respect a woman’s freedom, and her ability and right to defend it. My views above are to express that respect. I am not a socio-cultural legal expert and certainly not a moral judge. Never mean to offend anyone.

Doctors and Religion?

Doctors and Religion?

Abdul Majid, (middle) my classmate, stayed across my room in the boys hostel, all 5 years of MBBS. I have never seen him sleeping or eating. Whenever we saw his room door open, he was either studying or offering prayers. I have often borrowed his luna moped to go for a tea in late nights. He comes from a very humble family, and had always been among the toppers in every batch: MBBS, MD, and then DM. We have attended many cases together before he finally settled in Aurangabad and made a big name for himself. I have not seen a more hardworking doctor than Dr. Majid.
Ateeq-Ur-Rehman (Right) is another such brilliant doctor, coming from my small town called Nanded, who has scaled highest levels of education in India with sheer merit, and has now settled as a successful Neuro-Intervention specialist in Hyderabad.
While I treat hundreds of Muslim patients who come with complete faith and trust without thinking about my religion, Dr. Majid and Dr. Ateeq have also served thousands of patients from all religions including Hindus, who have complete faith and trust in their ability and acumen.
Whichever religion, state or country a doctor may come from, there never is any thought about religion or caste when we treat patients. Humanity, compassion and Scientific logic is the ground upon which medical science is based. There’s no place for any discrimination, racism or even enmity. Thousands of doctors from all religions: Hindu, Muslim, Sikh, Christians, Buddhist, and many others treat millions of
Indian patients every day. We doctors take pride in rising above all differences, thinking of all humans as one and equal, and in the trust that our patients show in us, irrespective of our names and external appearance. Inside, every doctor, whichever religion or country they may belong to, represents only one principle: the desire to do the best for those suffering.

I am proud to belong to this medical culture and tradition of unity.

© Dr. Rajas Deshpande

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An Interview With a Neurology Legend

An Interview With a Neurology Legend

Dr. Satish Khadilkar

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

Dean and Professor and Head, Department of Neurology,

Bombay Hospital Institute of Medical Sciences, Mumbai.

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

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

Q: How does it feel at the top?

A: Grateful to life!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: Your guiding thoughts for future Indian Doctors?

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

©️Dr. Satish Khadilkar & Dr. Rajas Deshpande

The Dictators in Hospital © Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

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Young At 98. Secret?

Young At 98. Secret?

©️Dr. Rajas Deshpande

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

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

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

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

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

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

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

She was discharged next morning.

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

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

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

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

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

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

I am now in a true dilemma.

©️Dr. Rajas Deshpande

Diagnose This Indian Disease

© Dr. Rajas Deshpande

“Doctor, we had gone to the UK” the patient’s husband was telling me, “What an advanced world that is! Extremely clean and very systematic! People are so well mannered, everyone is respectfully treated. So many facilities… and there’s no pollution at all! I think that world is at least thirty years ahead of us.”

His wife was an extremely complicated case of a subtype of Parkinson’s disease, under my treatment for over three years now.

“I agree”I replied, and I meant it, although it somehow felt sad about it.

“By the way, doc,” he continued hesitantly, “while we were there our son had taken an appointment with the best Neurologist there. Actually we had to pay 250 Pounds, but we thought we could use the opportunity to get a second opinion. We met the doctor there and showed your papers. He checked the patient and advised us to repeat all the tests. He confirmed the same diagnosis and asked us to continue the same medicines given by you, and said there’s nothing more to be done. I am sorry, we completely trust you, but our son insisted on a second opinion. Now we will continue to follow up with you”. © Dr. Rajas Deshpande

I smiled and replied “I am absolutely not offended. A second opinion is a patient’s right and we all exist for the patient. I am happy that the neurologist there has agreed with the current diagnosis and treatment. The only problem is that you had to pay twenty three thousand rupees just for that one consultation ”.

“That was only for the consultation, doc! We paid separately for all the tests” his voice picked up.

Almost every patient who seeks medical care and treatment in the advanced world has experienced that things are easier, faster and cheaper in India when medical treatment is concerned. While Indian doctors may be equal to those in the western world, the technology definitely lags behind because of the red-tapism and taxation, the expectation of charity (and thereby socio-political misuse) from every investment. © Dr. Rajas Deshpande.

While the Western world is decades ahead of India, most medical specialists in India is at par with the western world, and are available at a far lower cost to almost everyone. Faster appointments, much faster turnout of investigations and reporting (probably the best in the world), diagnosis and treatment is something every Indian and especially administrations should be proud of. It takes months to get appointments with the specialist, for MRIs, and for treatments too in most cases outside India, so many from the advanced world actually travel to India for medical treatment. The costs are extremely high in most world, so are insurance premiums, and doctor’s salaries.

All the credit of this medical advance in India goes to the private medical practitioners and institutes, corporate hospitals. Yet most Indians speak in derogatory terms about them. Deliberate attempts of fault finding, accusations of greed and malpractice by politicians, society and media, allegations about medical colleagues by the dissatisfied, unsuccessful practitioners and seekers of quick fame, and an environment of perpetual mistrust and legal action has really made practising difficult for many Indian doctors. Still, we have the best turnaround time and accuracy at lowest costs. Some day someone sane in the administration will hopefully realise this.

When I handed over the prescription to the patient, the husband winked at me “Doctor, I am a pensioner old man. My son made me spend for all the medical in UK, as he had no insurance cover. Can you give us some senior citizen concession?”

Like every Indian doctor who accomodates every Indian patient, I did!

What do you call the condition where you do your best for someone, but the expectations of more never cease at the other end?

© Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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Lost and Saved Life: The Indian Puzzle

Mumbai Diary-2

Lost and Saved Life: The Indian Puzzle

© DR. RAJAS DESHPANDE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

©️Dr. Rajas Deshpande

Neurologist

Mumbai/ Pune

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