Tag Archives: doctor patient relationship

Illegal Heroes

Illegal Heroes

© Dr. Rajas Deshpande

“I was at the disco last night. We danced a lot, I exceeded my ususal capacity of 180 ml alcohol, and had two or three large pegs extra. I must have smoked a little extra too yesterday, I was too stressed”’ said the 30 year old man, who was admitted one afternoon in an unconscious state. He had had a fit in the office that morning. The MRI had shown a large bleeding / haemorrhage in his brain. This illness, cerebral venous thrombosis, is quite common among those who are dehydrated, those who have untreated sinus infections, and among those who take contraceptive pills. If not treated in time, it can quickly cause brain swelling that may lead to disability or death.

Over next three days he gradually improved. Brain swelling started to recede, and he asked for a discharge. Faster and to-the-point care had improved his condition, thanks to modern healthcare. A psychiatrist had already counselled him about deaddiction. When we sent his file for discharge, his mediclaim insurance was declined because this illness was related to alcohol consumption. Immediately, his tone became bitter, his colleagues dissected the case papers asking for justification of each test, each medicine, and also why he was even hospitalised. Gratefulness is often waived off by doctors as a lost quality among saved patients, but it is difficult to tolerate arrogant distrust. We firmly explained him what was done and why.

“We will pay your bills, we will claim the insurance later, but you must change your notes, remove alcohol and smoking from his papers” said the patient’s brother.

“We cannot change the case notes, it is illegal. Also, we have already sent copies to the insurance company, a standard procedure. You are not obliging us by paying the bills, we have provided healthcare service that saved your brother, who was about to die due to alcohol consumption” we replied.

Within an hour, a local politician, an elected member, who came in his Range Rover with his personal armed bodyguards and human doggies, started his anti-medical show that had drama, emotion, tragedy, threats of violence and revenge and everything else but truth and honesty. He spoiled the day for everyone involved, caused disruption of hospital work for over six hours, and left with a threat of “burning down the hospital soon”. When our PRO asked him whether he wants to pay the bills of this patient to help them, his reaction was the hallmark of a true politician: change of topic to how the medical profession has lost its reputation.

Almost every doctor, every hospital in India is being threatened and pressurised by our own lawmakers at almost all levels into changing facts, writing false details, extorting concessions for the rich and poor both, only to increase their own vote banks at the cost of the healthcare industry. Most politicians, many government officers instead of financially helping the patient, ask the hospital to treat free or cut off bills.

How legal is this authority? If a politician writes to a court or lawyer or hotel or an Airline to waive off fees/ bills of a poor person, will they ever? Why are the doctor’s services and hospitals taken for granted here? How sad that such illegal means make pseudo-Heroes in our country!

Everytime the politicos pressurise a doctor or a hospital to treat their paying cronies free or concessional, some other truly deserving patient suffers because hospitals, small or big, can only do a certain level of charity. How fair is it to deny healthcare to the deserving poor just because they cannot flex a political muscle? This phenomenon is ruining the whole purpose and concept of charity healthcare measures all over India.

Aren’t these elected members responsible for the disgusting state of the civil and government hospitals and healthcare all over India? That is their domain of authority. This is like messing up one’s own home and family and requesting the one with a better home and family to pay and comply for one’s own needs. How shameful is it for the elected members of different parties to have to send people, especially the poor, to the private hospitals, because their own set-ups are failing perpetually? Empty posts, inadequate staff, poorest funding, non-availability of quality technology and medicines and red tapism have created massive monuments of the healthcare failures of different lawmakers all over India, and these are the very people who come threatening to the hospitals of burning them down! Hear this, any Milord?

If the honourable Prime Minister and Health Minister invite feedback from every patient leaving every civil and government hospital, the gravity of this situation will be understood better. Many repairs “at home” are required before “the neighbours home” is raided. We as doctors and hospitals must together request these authorities and offices to protect us from such daily insults, extortions and exploitation.

The very next day, an old man, a retired Indian Military officer, was expressing himself in the OPD with tears in his eyes: “Ye desh ka kuchh nahi honewala (This country cannot progress). People here, at all levels, want corruption, legal escapes to save money, and will elect anyone who throws them petty bits. Votes are bought for such favours as alcohol, gifts and cash. Sycophants rule, criminals are seen hand in hand with some rulers. Who do you think will get elected with such means, saints? You can guess what progress we expect if the lawmakers are first in line to break laws..”

There was nothing more sinister I heard that day. I am worried about the healthcare in my beloved country. God save the future generations from such illegal heroes!

© Dr. Rajas Deshpande

Please share unedited.

The Duty And The Reward

The Duty And The Reward

Highly educated and informed, Mrs. Vinodini Bapat came with a worried face about a year ago. Her MRI had shown a tumour. When I told her that it was likely a large Tuberculoma (A tumor mass caused by tuberculosis of the brain), she was naturally very worried. There was no definite way to know if it was a cancer.

After a long discussion based upon what she researched herself, helped by her loving husband and daughter, she was convinced that we can take a chance and start anti-tuberculosis medicines.

I was quite pleasantly surprised when I found that the whole family had completely trusted everything I had explained. To be very honest, doctors expect disbelief and multiple opinions mostly with the well educated and literate patients. However, although they asked many questions, tried and understood every step in the treatment, they were extremely polite and cooperative.

The test time came when her brain swelling increased, as happens with some Tb patients in the first few weeks if starting the treatment, and she threw a mini-fit. We had to admit her and treat as an emergency. Many questions popped up, but the family was as cooperative as ever, with complete trust.

The medicines caused many side effects, and we adjusted the doses to suit the patient best. She was extremely patient and tolerant in spite of so many ups and downs.

Now, one year later, Mrs. Bapat followed up today with her fresh MRI scan: the brain was now completely normal, there was no trace of tuberculosis. The tumor had disappeared!

When she handed over this beautiful note written for me, I told her that she and her husband were extremely cooperative and I was grateful for that.

Then they told me what I Wish every medical student learns: that it is important not to get annoyed with patient’s questions so long as they are relevant, to understand that it is the patient’s desire and right to know the details of their illness, treatment options and side effects, to participate in decision making, and above all, to be treated respectfully with compassion.

Educated patients who keep their faith in their doctors intact, and ask relevant questions without paranoid accusations should not be misunderstood. It is the duty of a treating doctor to honestly keep all the cards on the table and let the patient understand and participate whenever possible.

Once again my day is blessed with the ultimate rewards in medicine: a happy patient and words of gratitude.

©️Dr. Rajas Deshpande

Humanity Face / Off

Humanity Face / Off

© Dr. Rajas Deshpande

“Your father in ICU has probably had bleeding in the brain. We need an urgent CT scan” I told the son waiting outside. The old man was admitted late in the evening, although he had had severe headache and weakness on one side since that morning. His son had just returned after a “one-hour” quick meal. Besides flaunting many brands upon his person, he had already told me that he was the vice president of a well known software company.

“Yes, doctor, I am just waiting for the approval from his insurance company.” The son replied. For doctors running in and out of critical care units, the “Cool Calm” of such educated relatives is beyond understanding. Most insurance companies work office hours, approvals come at their own speed, they are least concerned about the patient outcome.

Everything was being kept on hold. Hospitals do not want to proceed with costly tests and investigations unless they are life saving, because most relatives flatly refuse to pay if the insurance company denies approval. The doctor suffers a double blow emotionally: because things are delayed and also because relatives blame only the doctor.

“This is urgent. Please consider making the payments and filing for reimbursement later, so we can make decisions faster” I told him.

“If it is urgent, why don’t you get it done? I will not pay, his insurance company will have to approve” said the son.

I thought about the patient. In the waiting room, the patient’s wife, an old lady, kept praying. I wished she was also praying for a better son. © Dr. Rajas Deshpande. I requested the hospital authorities, and as always, they agreed to help. A CT scan was done, it did show bleeding in the old man’s brain. When informed, the son winced. “How many more days in the hospital?” he asked.

“Usually it takes a week for such patients to stabilize” we told him.

“Can you discharge him? I will arrange for some nurse to give him treatment at home. Just write the medicines he needs” he said. His mother, hesitant, asked “Is it necessary to treat here, doctor? If his health is in danger, we will stay”.

Angrily, the son cut off his mom. “No, mom, this has become a business. They will extend stay even if it is not necessary. If it is only medicines, why does he need to be in hospital?” he asked me.

“Because such patients often develop excess swelling in the brain, or other complications. They can also develop convulsions or lapse into a coma if swelling worsens” I unchained my patience.

“Do you guarantee that those complications will not happen if we keep him here?” he asked.

“No. Only that he can be managed in time, if any complication develops” I replied. There’s no word called “Guarantee” in the medical dictionary. It is only a quack’s favorite trick. © Dr. Rajas Deshpande

“Then why stay here? I have a nursing home nearby, we will go there if there is any problem” the son said, turning his back upon his mother.

The open-secret was revealed soon: the insurance cover that he had bought for his father was minimal, it was over now, and he didn’t want to pay anything from the pocket.

I explained the patient’s wife about the medicines and care, updated her with the warning signs of danger in such cases. © Dr. Rajas Deshpande

“Doc, I am alone at home with my husband all day. My son and daughter in law both work and return late. What will I do in case there is an emergency?” I gave her some contacts near her home, ambulance numbers and doctors.

“Is it okay if she calls you daily to inform the patient’s condition and ask what medicines are to be given in case of an emergency?” the son asked.

“Sorry, we cannot manage patients on phone” I replied.

“Sorry doc, don’t take this personally, but there’s no humanity left in this profession now a days. No one wants to help even an old patient” he commented. I didn’t reply.

They returned in three days, the patient comatose. The brain swelling had increased to dangerous levels. Patient was operated in emergency, saved with a great effort. The son had to foot the whole bill this time. “This is quite unfortunate” he kept saying, reminding me to keep expenses “lowest” because he was paying from his pocket. Finally came the day of discharge. Knowing the questions, I explained them the medicines on discharge.

“Doc, he is a senior citizen. You must give us discounts” said the son.

“Sorry, the hospital decides the billing. My charges are already minimal”. I told him the truth.

“Just as I said, there’s no humanity left” he looked at his mother and said. It was now the time to chain my patience. I knew the right reply this time.

“Yes, Sir”, I said “ I agree. Humanity is indeed on a decline, but more in your family than in my profession”

© Dr. Rajas Deshpande

Please Share Unedited.

To pause for respect

To pause for respect

To pause for respect

© Dr Rajas Deshpande

After completing the neurological examination, I asked Mr Harkishan Budhrani to sit down and put his shoes on. His son accompanying him got up, sat near his father’s feet and started to adjust his father’s shoes for comfort.

To pause for respect was my only choice.

Mr Harkishan Budhrani is a British citizen, and so are his sons Mr Naresh and Mr Raj. Every time one of them accompanies Mr. Budhrani for the consultation. They not only come prepared with their father’s health details, but also take notes and follow all the suggestions. Yet what is most noticeable for me as a doctor is the care and respect with which they speak to their father and treat him. There’s nothing artificial about their attitude, which makes it special! They take his permission for every change we agree to make, explain him and patiently wait for his consent and questions. They hold his hand and even ask him whether it is ok to walk ahead! Rarely do we see children from very affluent families being so careful and loving to their parents.

In an era where many a times sons and daughters accompanying their parents either bluntly ask “How long is the parent going to survive, What basic minimum can be done without much expenditure, Is it okay not to treat at all” etc., when we come across such extremely gratifying moments, I feel that all is not lost. By experience now I don’t think that this belongs specifically to Indian culture, in fact people from most cultures in the world treat their parents far better than many Indians. The very fact that Our govt and courts have to make laws and take steps for abandoned and neglected parents speaks a lot about what is happening. In fact, the more affluent a family is, the less likely that the children genuinely care for their parents.

Taking for granted that the parents do not want to live longer, deciding on their behalf that expensive treatments are useless and unwanted, oversimplifying all complaints as ‘age related’ and completely neglecting medical care are common observations in our practice.

This moment therefore brought me a beautiful ray of hope.

21st July 2018 is Mr. Harkishan Budhrani’s 85th Birthday. While I pray for his excellent health and perpetual happiness, I wish that every parent is as fortunate as him and that Mr Budhrani lives on many more hundred years as an example for all of us.

©️ Dr. Rajas Deshpande

A Habit That Protected Me

A Habit That Protected Me

(c) Dr. Rajas Deshpande

“I cannot bear this. Help me doctor”shouted the Old man fom the waiting room, just as I entered the OPD. There were appointments before him, I requested others to wait, and most of them agreed, although a little upset. I called in the old man. He was accompanied by two of his sons, both probably professional bodybuilders.

He was a known case of Trigeminal Neuralgia, a condition that causes severe, shock like or stabbing, excruciating pangs of pain on one side of the face. This usually brings the patients to tears, and most patients come frustrated, unable to talk or eat, with the telltale sign of their hand covering that side of the face, scared to open mouth even to reply. He had had this condition over ten years now, and was quite stable, usually visiting me once a year. He had last visited only a few weeks ago, smiling and pain free. There were no new findings. He kept on shouting, saying that the pain was unbearable. This was unusual. I asked him if he had done any of the prohibited things that usually increase the pain of Neuralgia: cold drinks, icecream, shaving harshly, exposure to breezes etc. He said he had had an icecream a few days ago, but the pain had only restarted yesterday.

The sons were staring menacingly at me. “How come this has suddenly worsened doc? Is this the effect of your medicines?” one asked. I wondered why they don’t teach simple logic and reasoning in primary schools. Everyone going to a gym must, in my opinion, first be mandatorily taught normal human conversation. Otherwise they speak with their biceps. Not knowing that language, I chose not to reply him. (c) Dr. Rajas Deshpande

He was already on high doses of the medicines that controlled his pain. He also had diabetes, so I could not use the best emergency medicine for such pain: steroids. Once earlier, he had developed severe infection while on steroid, so that was out of question.

I started him on a short course of a strong pain killer. Warning him that he should take it only for three days. “His pain must stop immediately” said the other son, threateningly. “I wish so too. It should subside soon, usually it takes two to five days” I concluded the consultation.

They returned five days later. (c) Dr. Rajas Deshpande

“I am very good now, Doctor”said the old man, “The pain went away the very next day. Thank You”.

Just as I prepared to look at the musclebuckets proudly, the old man said “Doctor I need a certificate that you had advised me bedrest for five days”.

I was almost prepared to write, this appeared a justified request given what had transpired. Curious, I asked him: “But you have your own business. Why do you need this certificate?”

It was then that one of the biceps spoke: “He had a court appearacne in a criminal case on the next day of our visiting you. He could not go to the court. Now the court has asked for a certificate”.

Alarmed, I told them: “I had not advised him rest. I cannot issue a false certificate.” (c) Dr. Rajas Deshpande

They looked at each other. Then the old man said “I request you doctor. My cousin has filed a false murder charge against me and my sons. Please help us. Your certificate will save us trouble”he folded his hands.

Now the secret of why that pain had worsened suddenly had unfolded. This condition is indeed known to suddenly worsen, but when such “situations”coincide with illnesses, a doctor is the easiest to squeeze the arm of.

“But we paid your fees. His pain was actually severe that day. How can you deny us a certificate now?”asked the elder biceps.

Many video clips of daylight, open murders that happen around us daily ran through my mind. Even under the heading of compassion, was it right to help this patient, who was one of the accused? As a doctor, I am not to judge anyone and must purely decide based upon the medical merits of this case.

I had not advised him rest. I declined their request for the certificate. Angrily, the trio left my room, and on the way out, in the waiting room, loudly enough for other patients to listen, the old man said something derogatory about all doctors being heartless looters. Every new patient who walked in that day had a question mark of suspicion on their face, it took me extra effort to wipe that away in each case. (c) Dr. Rajas Deshpande

Whether it is addiction to pain killers or sleep medicine, whether it is false certificates or deceiving the medical insurance companies for claims, many patients abuse their doctors’ compassion and services. Some doctors fall easy prey to such tactics, some do it for money. Majority refuse to contribute. It is this majority that such “demanding”patients always cry against.

The doctors who help such people with such causes not only endanger themselves, but may in fact add disgrace to their profession, because it is these same patients who tell others how any doctor can be fooled, or bought with some money or threat.

As fate would have it, one of the sons came to visit me the very next month, for his wife. As I examined her and then wrote a prescription for her, I enquired about his father.

“Oh he is alright now. We got a certificate from one of our relative who’s a doctor” said the son, smiling shyly: “That’s why I brought my wife to you.. I know you will do only the right thing”.

I could only thank my teachers who had tattooed that habit upon me, and taught me that only good begets good. It is a habit that has protected me always.

(c) Dr. Rajas Deshpande

Please share unedited

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

©️Dr. Rajas Deshpande

A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.

Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.

Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.

As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.

“You must respect the authority “ the court said.

“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.

“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande

When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.

The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande

In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.

The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.

The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.

There were no answers. The kind court asked if the doctor had to say anything else in his own defence.

The doctor said

“Yes Milord, but the real answers will hurt:

Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande

“A culture of exploitation of non-votebank groups

and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande

“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande

“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”

Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

“What could have happened ?” asked the kind but sweating judge.

The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.

The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande

“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”

“I understand what you mean” said the kind judge.

Needless to say, the doctor was released without a blame.

Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?

(C) Dr. Rajas Deshpande

Please share unedited

The Colour Of Blessings

The Colour Of Blessings

© Dr Rajas Deshpande

Carefully calculating the dose and mixing it with the intravenous fluid with precision, I told the kind old lady: “I am starting the medicine drip now. If you feel anything unpleasant, please tell me.”

Through her pain, she smiled in reply. Her son, my lecturer Dr. SK, stood beside us and reassured her too. He had to leave for the OPD, there already was a rush today. “Please take care of her and call me if you feel anything is wrong” he said and left.

Dr. SK’s mom was advised chemotherapy of a cancer. It was quite difficult to calculate its doses and prepare the right concentration for the intravenous drip. Just a month ago, my guide Dr. Pradeep (PY) Muley had taught me how to accurately prepare and administer it, so when Dr. SK’s mom was admitted, he requested me to do it for her too.

The drip started. After a few hours, I noticed that her urine bag needed emptying. The ‘mausi’ supposed to do it was already out for some work. Any resident doctor in India naturally replaces whoever is absent. So I wore gloves, requested a bucket from the nurse, and emptied the urobag into it. Just as I carried the bucket with urine towards the ward bathrooms, Dr. SK returned, and offered to carry it himself, but I told him it was okay and went on to keep the bucket near the bathroom where the ‘mausi’ would later clean it. © Dr Rajas Deshpande

Once the drip was over, Dr. SK invited me for a tea at a small stall outside the campus. He appeared disturbed. He said awkwardly: “Listen, please don’t misunderstand, but when I saw you carrying my mother’s urine in the bucket, I was amazed. You are a Brahmin, right? When you were away, my mom even scolded me why I allowed you to do it, she felt it was embarrassing, as we hail from the Bahujan community. I am myself a leader of our association, as you already know”.

I knew it, to be honest. His was a feared name in most circles.He was a kindly but aggressive leader of their community, but always ready to help anyone from any caste or religion, to stand by anyone oppressed, especially from the poor and discriminated backgrounds.

“I didn’t think of it Sir! She is a patient, besides that she’s your mother, and I am your student, it is my duty to do whatever is necessary. Otherwise too, my parents have always insisted that I never entertain any such differences”. I replied. © Dr Rajas Deshpande

“That’s okay, but I admit my prejudice about you has changed,” he said. “If you ever face any trouble, consider me your elder brother and let me know if I can do anything for you”. What an honest, courageous admission! Unless every Indian who thinks he / she is superior or different than any other Indian actually faces the hateful racist in the West who ill-treats them both as “browns or blacks”, they will never understand the pain of discrimination!

As fate would have it, in a few months, I had an argument with a professor about some posting. The professor then called me and said “So long as I am an examiner, don’t expect to pass your MD exams.”

I was quite worried. My parents were waiting for me to finish PG and finally start life near them, I already had a few months old son, and our financial status wasn’t robust. I could not afford to waste six months. © Dr Rajas Deshpande

I went to Dr. SK. He asked all details. Then he came with me to the threatening professor. He first asked me to apologise to the professor for having argued, which I did. Then he told the professor: “Rajas is my younger brother. Please don’t threaten him ever. Pass him if he deserves, fail him if he performs poor. But don’t fail him if he performs well. I will ask other examiners”.

The professor then told me that he had threatened me “in a fit of rage”, and it was all over.

With the grace of God, good teachers and hard work, I did pass my MD in first attempt. When I went to touch his feet, Dr. SK took me to his mom, who showered her loving blessings upon me once again, and gifted me a Hundred rupee note from her secret pouch. © Dr Rajas Deshpande

Like most other students, I’ve had friends from all social folds at all times in school and colleges. I had excellent relations with the leaders of Dr. Babasaheb Ambedkar Association, and twice in my life they have jumped in to help me in my fight against injustice when everyone else had refused. I love the most fierce weapon of all that Dr. Babasaheb Ambedkar himself carried: the fountain pen!

No amount of fights will ever resolve any problems between any two communities, the only way forward is to respectfully walk together and find solutions. Fortunately, no doctor, even in India, thinks about any patient in the terms of their religion or caste. (© Dr Rajas Deshpande). Just like the Judge in the court premises, humanity is the single supreme authority in any medical premises. Blood or heart, brain or breathing are not exclusive to any religion or community. Just like the bigger brain, a bigger heart is also the sign of evolution.

I so much wish that the black clouds of disharmony between different communities are forever gone. The only hope is that our students can open any doors and break any walls, so long as they do not grow up into egoistic stiffs. © Dr Rajas Deshpande

I am proud to belong to the medical cult of those who never entertain any discrimination. A patient’s blessing has no coloured flags attached! Even outside my profession, I deeply believe that the very God I pray exists in every single human being I meet. If at all anyone asks me, I am happy to say that:

My religion, my caste and my duty as a doctor are all one: Humanity first!

© Dr Rajas Deshpande

Neurologist

Pune

Please Share Unedited

The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

“He fell down while checking the patient”, said the panicked Dr. Mrs. Sane about her husband, “and became unconscious”.

Dr. Sane tried to maintain his calm. A sick doctor has the curse of knowing the worst of everything, and has a perpetual feeling of sitting upon a ticking time-bomb. It was a sad feeling to see this middle aged brilliant general practitioner fighting tears.

“Sir, the OPD numbers have shot up because of these epidemics, especially dengue. I see over a hundred patients every day. The Inpatient beds are full. There are daily problems: medical, administrative and medico-legal.. those I am used to. But now there are too many politico-social and press-related issues that worry me”.

Dr. Deshmukh, a senior practitioner and a common friend, accompanied Dr. Sane. He cautiously poked him “You must tell the doctor what happened the day before”.
“Oh that’s a part of our profession” Dr. Sane replied.
I insisted that he must tell me.

Reluctantly, he disclosed: “Some goons came in with a municipal councillor and threatened to waive off the bills of a dengue patient. He was in the ICU for five days, quite bad, but went home walking. Till the time he improved, they kept on threatening us to break the hospital and thrash us if something went wrong. Upon discharge, they didn’t pay a single rupee. There’s nowhere to complain, as the hospital requires many municipal permissions”. © Dr. Rajas Deshpande

Dr. Mrs Sane lost her cool. She started sobbing. “No one blames those who dump garbage, keep their surroundings unclean. No one is blamed when epidemics spread and thousands die. No one is held responsible for failures of almost all preventive services and lack of basic facilities at government’s healthcare institutes. But the already overworked general practitioners must bear the brunt of everyone’s anger: the public and press are always free to bash the last face they see: the doctor who is actually helping every patient,.. Dr. Sane has not had a proper lunch, not spent a full day with kids in months.. That hospital has become our curse“ She broke down.

It was so logical! The offices responsible cannot even be reached. The court does not see any of these system failures that cause millions of deaths all across India, happily ordering lakhs and crores and imprisonments for doctors, for trivial mistakes.
Whom to blame? Oh yes, the doctor who has studied to treat the sick!

Anyway, in a country fond of muscular heroes and billionaire godmen, who expects a brainy analysis? © Dr. Rajas Deshpande

“I had a dream of making best health facilities available for my area. I have taken a big loan. We treat poor patients free anyway. Many rich are sent by local politicians, leaders, administrators with instructions to attend immediately and free too. Paying patients are mostly suspicious because of all the negative things publicised by press about all doctors., they also expect immediate and positive outcomes. I have not slept for many a nights. “

I examined him.He had obvious features of being fatigued mentally and physically.. A syncopal attack, where the BP drops down suddenly and makes the patient unconscious, was likely. I advised him tests and told him to take rest for there days.

“Not possible, sir! Even now the OPD is waiting” he replied. An angry Dr. Mrs Sane requested me to intervene.

“Your duty to the society does not free you from the duty towards your own health and family” I requested him. But Dr. Sane agreed only when Dr. Deshmukh offered to send over a junior doctor to his hospital to take care of the OPD.

“How have you been, Sir?” I asked Dr. Deshmukh. He is one of the most respected and busiest general practitioners in town, with a big hospital. © Dr. Rajas Deshpande

Dr. Deshmukh smiled.
“I had an angioplasty three months ago. The only risk factor was high BP and stress. There is no use fighting or explaining our situation to the society, government or press. I have closed down my hospital. I only see OPD patients now. Anyway many patients thought that I worked day and night for earning more money. Let them go to the corporate or government hospitals.”

The death of his hospital was not a surprising news, many small private hospitals and nursing homes are either closing down or converting into profit-making franchises. Many doctors are suffering high BP, cardiac and neurological problems and even dying due to excessive stress.

The meaning of this nightmare will soon unfold upon our society.
Till then, this is a heartfelt appeal to all the over-stressed doctors to rethink about their priorities, rearrange life and make sure stress does not kill.

For the morphine of “medical social service” is only good in small doses, it kills when overdone!
© Dr. Rajas Deshpande

Essentials Of Being A Smart Doctor

“Essentials Of Being A Smart Doctor”FB_IMG_1470417314264
Guest Lecture at National Undergraduate Students Conference ‘RESPIRARE’ at the
BJ Medical College
August 3 in B. J. Medical College
© Dr. Rajas Deshpande

My dear friends,
If you are sitting in this hall today, you have already proven that you are smarter human beings, but that alone is not enough for becoming a smart doctor. However intelligent or smart anyone else may be in the outside world, your ability to save their life, help them in illness gives you an upper hand, hence the perpetual tag “Doctor sahab” bestowed upon you by the world. To be able to gracefully deserve that tag is a difficult task.
Like success, riches and many other achievements in the world, medical smartness too is not an accident. One has to earn it with a great effort.
There are really smart and good doctors, and there are also those who pretend so. Most patients can tell the difference. So if you plan to be a really smart doctor, you will have to imbibe the essential qualities in your very subconscious, so they become your basic self, a part of your personality. You will have to force yourself to change certain habits, traits of your behaviour and thinking, and allow the inception of newer, better methods within your being. I am very happy that I can speak this to you at this budding stage, while you still have ample time to modify the DNAs of your medical smartness. Once you accept to change for better, never go back or compromise. © Dr. Rajas Deshpande
Let us consider a small question: What quality is universally liked in a human being by almost everyone, including their enemy?
Genius?
Looks? Money?
Muscle power? Political Connections?
No.
Compassion. Kindness.
It is irresistible. Even when a patient has come to you with a prejudice or suspicion, the first thing that will change his / her attitude is your kind words, your compassionate attitude. It is not very easy to be kind and compassionate to everyone, especially the ill-behaved. This is where you will need to train yourself to be smart: by avoiding use of bad words, not raising your voice and not being aggressive. Keep your words to a minimum, and do not use negative, accusing words. Do not speak arrogantly with the relatives. You don’t know when things may take a bad turn.
However, the first few steps that you take to be kind to the patient will get you the biggest reward that this field has to offer: your patient’s trust, and if you care for it, it is usually lifelong. © Dr. Rajas Deshpande
When the patients come in, they are not willingly entering the hospital in most cases, but out of desperation. They are scared, angry and often extremely worried that something bad will turn up as their diagnosis. Add to this the resentment caused by having to be questioned and touched by a total stranger, whom they have to tell private information. This has already made them jittery.
A smart doctor understands this mental state of the patient completely, and makes the best effort to ease out the patient by welcoming them, wishing them, and initiating a genuinely friendly chat. Such simple sentences like “Good Morning, How are you?”, “Hope you are not very tired”, “I am sorry that you had to wait” reassure the patient that they are dealing with a nice human being, and put them at ease.
Whether the patient comes from rich or poor, educated or illiterate background, the doctor must have utmost respect for their privacy and dignity. Asking private questions, undressing and examination should never embarrass the patient. Standing up and wishing the patient while they enter and leave your room makes the patient feel respected, and adds flair to your smartness. © Dr. Rajas Deshpande

FB_IMG_1470417305344
How should a doctor dress?
It is common to see few doctors, both junior and senior, wearing short sleeves and open collars, sometimes even low rise jeans, trying to show off their physique. One can only imagine what kind of reaction they will generate if things go wrong.
There have been many scientific studies about this. If you yourself want to be treated, you will never prefer a shabby looking, ungroomed, unclean person with a stink. You will want someone who looks healthy and positive to make health choices for you. The patient always wants to see a neat, clean and reassuring doctor. Your demeanour should not be frivolous: unnecessary excessive laughing, smiling, joking, bad language are not welcome to be used in front of a worried patient. © Dr. Rajas Deshpande

It is wise to dress up as good as one can, without too much show and fashion. A very richly dressed doctor in a suit may turn off an already nervous patient from lower socioeconomic classes. The best attire is formal, simple, clean and ironed clothes which cover you well, apron, shoes, and no jewellery. Fortunately, tattoos and piercings have not yet much entered this field. One must avoid religious clues, and refrain from religious and political talk while practicing as an allopath.
A smart doctor cannot forget that our field deals with people from different socio-economic strata. He / she should be able to irradiate the feeling of being a trustworthy person and invoke positive, peaceful feelings in those who come to see him / her.
Personal hygiene is an indicator of a doctor’s smartness, and such simple things as hand-washing after every case, using sanitizers, wearing gloves etc. speak a lot about a doctor’s dedication towards good health. Best clinical practices must be learnt and complied with voluntarily by everyone who wants to be a smart doctor. © Dr. Rajas Deshpande
Humility, manners and etiquette
A Spanish TV anchor who follows up with me for Multiple Sclerosis told me once: that many patients travelling to India complain about the doctors being very good clinically, but worst in manners. “I was amazed that you actually offered me a glass of water when I was crying during my first consult” she said. Such simple manners affect the patients so much!
Many doctors, as they ascend the merit scales in this profession, develop a complex that they are unbeatably smart. They end up becoming ego-balls disliked by almost everyone, because of their high handedness. A smart doctor will never let that happen to himself / herself. There are far more smarter people than most doctors in almost every other field, even some illiterates are sometimes smarter than the most literate. One must never shed humility, whatever one’s achievements. We often see students smarter than teachers, juniors smarter than seniors and we all know what happens in those cases. The best policy is to never presume oneself better than the other. A smart doctor always knows his manners and etiquettes very well. © Dr. Rajas Deshpande
Language and communication:
“What do you mean by dizziness?” my teacher asked a tired female patient once.
“Oh I feel abnormal noise in my ears” she replied. Dizziness, in patient’s language, may mean anything from imbalance, blackout, vertigo, to heavy-headedness or blurring of vision. It is always wise to dig into what they actually mean. A knowledge of regional language often helps resolve misunderstandings. Similarly, the patient may also misunderstand the words that a doctor uses.
A smart doctor will learn to communicate so as to make the patients from different streams understand exactly what is being conveyed. We do not always have too much time, hence it is necessary to develop the skill of using minimum words. One must use simple words, and know the colloquial alternatives (e.g. use “Heart” instead of “Cardiac”, use “Brain infection” instead of “Encephalitis” etc.). If the patient does not understand, one must encourage him / her to ask questions. Use pictures if necessary. Many patients / relatives do not stick to time or subject, often asking irrelevant questions based upon their googling, but a smart doctor must be able to steer them on to the right path with a smile and a gentle reminder of time limitation.
The most difficult part of being a doctor is conveying the bad news. There is no good way, one has to be very careful and diligent. On one hand one must offer sympathy and readiness to help further, while on the other hand, one must also be aware of aggressive, impulsive and shocked reactions, making sure not to risk one’s safety.
While conveying the bad news, surgical risk or complications, a doctor must have the patient / relatives sit down, have witnesses around, and speak compassionately but confidently, offering all possible help to ease out their suffering. A hesitant doctor invokes suspicion even if correct. However, an overconfident liar will invite more trouble, so be careful that you speak what is the exact truth. That never fails in long run. © Dr. Rajas Deshpande
Professional Smartness
Friends, as you become more and more specialised, you will unfortunately face rivalry and jealousy. Doctors are the most ingenious professionals in their ability of pulling legs or sabotaging careers, and you may sometimes be facing your own teachers in such situations. A smart doctor will never compromise his / her own grace or the dignity of our noble profession. Fight all that you must, and I will stand by you if you are correct, but always use the best language, think about and mention the best things about your competitor, and always keep the door for direct discussion open. Refrain from allegations, cheap comments, mockery and defamation. If you feel that a colleague is wrong in some clinical decision, please reach out to them and talk, before you discuss it with others. Everyone usually has a reason for their decisions, one must respect it. If your reaching out is unwelcome, then alone mention on paper what you think about the case. A smart professional will have no friends or enemies, no senior or juniors, but only colleagues. Immediate reporting of any adverse clinical events to the authorities, and correct documentation are essential. © Dr. Rajas Deshpande
Medico legal Smartness
We live in a country with too much poverty and illiteracy. If there is a chance that a doctor’s mistake can be proven, there is every chance that the relatives will drag that doctor into the courts of law, demanding millions in compensation.
In these days of exponential medico legal cases, where patients, relatives, authorities and even some colleagues are usually unforgiving if you commit a mistake, real smartness is to document everything perfectly. Just as an example, a young patient of mine recently had a stroke, without any known risk factor. Upon repeated questioning, he reported that he was taking some unknown herbal medicine since three months, in a mixture of some oils, to improve memory. One must mention every such detail on the paper, including poor known history, delayed admission and alternative treatments. Every interaction with the patient and relatives must be recorded on paper. Recording the date, time and your name and designation at the beginning of every note is an indication of you basic smartness. A proper written consent must be obtained for every procedure, however trivial. Information about dangerous medicine being given to the patient / relative should be recorded, a consent for the same signed by the relatives. © Dr. Rajas Deshpande
Academic Smartness
I do not know if I am enough qualified to talk about this, because I was often beaten up by my primary school teachers for not doing my home work and some other curiosities which I cannot mention here.
A doctor is expected to be on top of the pyramid of scientific advances, and there is nothing more pathetic than a doctor who quotes medical knowledge from decades ago. While we respect the past, we cannot disrespect what every standard medical textbook mentions on its first page: Medicine is an ever-changing science. A smart doctor, therefore, will still study on a daily basis even after achieving the highest degrees, and keep himself / herself updated with the most recent medical knowledge relevant to his / her field. Studying on a daily basis, I feel, is the most important basic quality every smart doctor must inculcate. One must register on smart medical sites like up-to-date, emedicine or many others, to stay updated about one’s medical interests. Yours is a lucky generation, having all information at your fingertips, thanks to your smartphones. Check drug interactions every time you use new medicines. Cross check your differential diagnoses. © Dr. Rajas Deshpande
Digital Smartness
Everyone is semi-addicted to their smartphones. However, they are also a great hindrance to the super-essential concentration required of a smart doctor while interacting with patients or making medical decisions. Smartphones can be wisely used to record data and expedite certain protocols, accessing information etc., but they should be switched off while with a patient. It is very humiliating and irritating for a patient when the doctor is occupied with a cellphone during a consult.
Social Smartness
There is a competition now among some doctors to post everything they do on the social media. A colleague of mine recently posted a video of a huge tumor that she removed from the abdomen of a patient. She is now under an enquiry for compromising patient privacy. One must refrain from posting any information that discloses patient’s identity on the social media.
Most of you google your crush, actor or actress you like, don’t you? Well, some of you will honestly agree.
Patients are as curious and inquisitive as you are, and may google you. So please refrain from posting undignified pictures / matter / vulgar jokes, etc. and pictures while drinking / smoking, hugging etc. on social media. Also refrain from posting stuff that maligns your own profession or colleagues. You can improve things from within, not by publicising them.
A smart doctor will learn over time to refrain from giving out personal number to the patients / relatives, as this may lead to many disadvantages later, including unwanted calls, messages, advertisements and other misuse.
While patronising should be avoided completely, (“You are my brother, sister, mother, father etc.), in some cases it may reassure a frightened patient, hence it may only rarely be used. © Dr. Rajas Deshpande
It is not at all uncommon for a doctor or a patient to get a crush upon the other. In case you sense a love interest blossoming within your patient or yourself, immediately rethink about your life’s choices and refrain from any further progress in that direction, as this could turn disastrous for your career. Do not encourage meaningless chats, messaging or personal comments when dealing with patients. An allegation of molestation, sexual harassment or mal-intention can ruin you.
Most doctors feel proud of their excess hard work, and often mention that they work without proper food or sleep for days together. While this is really commendable, it is also a granted feature of this career. One must learn not to milk a pardon for one’s ill behaviour or mistakes by quoting excess work. A mistake is a mistake and the best policy about a medical mistake is being completely honest about it. © Dr. Rajas Deshpande
Moral Smartness
My recently published book, “The Doctor Gene” ends with the words “A good doctor is the best a human being can be”.
You belong to a community that practices the highest of morals not just because the society expects it, but because you have voluntarily sworn to. You have chosen this career yourself. Right from now, please imbibe the best of morals and truthful attitudes in your blood. Believe me, every human being has the hidden sense to perceive a genuinely good person, make sure that your patients get this feeling about you. © Dr. Rajas Deshpande
Serenity Smartness
One important art in medicine is almost on the verge of extinction: that of immense concentration. What with the hustle-bustle and digital exposure that every medico must work with, we are fast losing the ability to switch off the world and concentrate, think or meditate. These things bring the serenity, so essential an ingredient of medical smartness. Learn to find time, preferably on a daily basis, to be with yourself, and sort out the tangles in your mind before they strangulate you.
Higher education
I get atleast one question everyday from some or other medical student on my facebook page:
Which branch is best? What PG should I do?
You will eventually realise what you like. You may seek opinions, but not decisions from others. Be smart enough to identify what you want and respect your own inclinations. Keep a list of alternative options, as PG seats are limited. Don’t waste too much time in pursuing a particular branch, there are so many advances happening that every PG branch offers you good futures if you are dedicated enough. There are umpteen examples on the other side: doctors who got their desired specialties but never did anything significant after that, other than customary routine. © Dr. Rajas Deshpande
De-stressing
I am sure that in this very hall, there are beautiful dancers, painters, far better authors than myself, speakers, and artists of infinite ability. I think I should also say some potential models. But you will give up all that art and beauty within yourself, lost in the heavy duty career of being a doctor.
One absolute essential for every medico is a sure-shot de-stressing mechanism. We are all destined to face suffering, poverty, struggle, pain and death on a daily basis, and this takes a toll upon our minds. We tend to grow mentally old very soon. Many think that alcohol or smoking is a respite, but this is ridiculously stupid. A smart doctor knows to find his / her escape in arts, literature, family, travel and other hobbies. It is extremely essential to de-stress as your performance may be affected if you accumulate stress for long. © Dr. Rajas Deshpande
What do patients want?
The best compliment for a doctor is a happy patient, and the best feeling in the world is knowing that your efforts saved a life.
A smart doctor is the one who has the reputation of making the correct diagnosis in majority of cases. A smart doctor is the one who invokes trust in a patient by being genuinely honest and compassionate. A smart doctor is the one, most of whose patients are happy, not only because their health issues are well attended, but also because they met a caring, well behaved human being.
Never think about money or anything else when consulting a patient. Think of every case as an exam case, get the most correct history, do the best clinical examination and give the patient the best treatment options. You will make enough happy money with such practice, if you are smart enough to understand what that means. © Dr. Rajas Deshpande
Dear friends, one thing about smartness which I learnt early in my medical career is that a senior doctor should not give very long lectures, and should end up his speech before time.
I have written many more things about the essentials of being a truly good doctor, and the glorious traditions of our noble, almost divine profession, in my book “The Doctor Gene’. If you did not get a copy outside, please email thedoctorgene@gmail.com to get your copy.
I am sure that you will all be very successful doctors, and I will be very happy if my words today help you deal with your medical life smartly. I thank you for patiently listening to me today.

FB_IMG_1470417301427
Love to you all and I wish you all the best, always!
© Dr. Rajas Deshpande
03.08.2016
Thank you, Mr. Yashodhan Morye and BJMC UG Student’s Council

Have Doctors become Mechanical?

(c) Dr. Rajas Deshpande

Sir, most of your stories you share are from your internship days. I have worked as an intern for past 10 months but almost never encountered/experienced such heart touching events and I don’t think, i am any less humane or sensitive than you must be(guessing by your posts). then why almost every intern is so mechanical about his schedule and work? Has the nature of work/ job profile of interns changed to mere mamagiri? Or Its just that, you always went the extra mile to be the awesome being you are! Awaiting your reply eagerly.. Dr. AA

Dear Dr AA, yes doctors have become more and more mechanical, also preoccupied with too many non-clinical tasks like USMLE / MRCP / pg entrance studies, digital addictions and excess non-duty work. Talking to the patients and making them open up is an extremely difficult art. Just like we don’t open up to any roadside stranger, patients do no talk much to a disinterested doctor in a hurry.

There is no one without problems, no one who does not need more love and kindness, but people will not respond if they sense “artificial” empathy. Most illiterates and even infants sense true versus artificial love. So every doctor must learn to imagine himself/ herself in the patients’ condition, and genuinely solve their problem the best they can. There also is a growing tendency to think oneself “superior” to patient or other professionals. No one talks comfortably with the “high handed”. Indeed there are many patients/ relatives more intelligent than the treating doctor, the respect for a doctor is only for his/her medical prowess and kindness.

The first hint of “trying to show off more than what you know” switches off the patient. This tendency is also increasing among some doctors, who transgress their specialty and adversely talk about other specialists or professions. Even the illiterate patients understand (may not express) your overall nature in a few minutes. One must be very polite, humble and genuinely interested and helpful to every patient to be able to connect. In many cases half the agony is the fear of the medical situation. Every doctor does not have time, but those who spend more time per patient hit it well with the patient.

Hope that answers your question. Also, I have always kept a diary. I spent my internship in quite rural and backward areas, the faith in a doctor was still young, and I loved to talk to the “patient”, so time was not an issue. Like most young doctors, I was (and am) never fond of sleep. I had another advantage: I have been a loner.

I know you are (in fact everyone is) gifted by God / Nature a golden heart with a divine song. It is up to us how to use it. The practice of Good Medicine is almost as difficult as a spiritual life: many sacrifices are required. But one should not expect the patient to “Pay Up” or bear the brunt of our sacrifices. It is a choice we have made.

Take care and use the one chance of touching every heart you meet wisely, with immense passion, forgiveness and love. The returns will not be material, but I am sure you don’t care for material gains because you asked this question.

There is no “Extra Mile” for a good doctor. Whatever Good can be done, must be done.

God bless!

© Dr. Rajas Deshpande

Reply to a question asked by Dr. Arvind Arora, Intern, India.