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Medical Profession and Charity:  A Guideline For Medical Students (Speech at a recent Medical Event)

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© Dr. Rajas Deshpande

My dear friends, you will receive many sermons about your responsibility to do charity and social service from those who do no charity themselves. Many who have never done anything worthwhile for the society will remind you of your Hippocratic oath. Beware of these distractors, your social service and charity is your own choice. Thousands of doctors who chose to settle down in the remote place, purely with an intention to serve people, and carried on general practice for over 50 years are now dependent upon someone helping them for their own medical treatment. Neither the government, nor those whom we help reciprocate. Those who lecture doctors about serving the society never answer this simple question: what if a doctor serving the society very well, needs help? Who will help him? The answer is clear. First safeguard your career, reputation, family, home, parents, future and then do charity like a king, confidently, freely and with pride. Professional goals are not the same for everyone.
Some base the entire concept of charity on the low fees, without any analysis of the quality of medical care provided and the outcomes. A patient treated free but wrong, a patient treated at a low cost with a poor outcome cannot be considered charity. “Self-Declaration” of numbers of such patients treated without an analysis of outcomes and patient feedback is nothing but cheap hidden advertisements.
All of us don’t come from the same background: Some families have lived in perpetual poverty, selling off land and compromising quality of housing, clothes and even food to send their children through the medical education. Some must repay their loans, some must attend too many family duties and some just struggle to survive with a middleclass lifestyle. The first thing that we must overcome while doing any charity or social service is the feeling that those who are unable to do it are somehow lesser to us. That discrimination must go. A doctor doing his / her job well is enough charity, they have sacrificed their youth for the society. © Dr. Rajas Deshpande
Let us look at the career options most Indian doctors have.
Medical teachers have already accepted a very low salary compared to what they truly deserve, The average salary of a medical professor in USA and UK exceeds INR 8 lacs per month, working 8 AM-4 PM, with one emergency per week. Although I do not contribute to the school of thought that one must accept the low Indian financial status, at one-fourth salary per month, our medical teachers work three times more than the doctors in the developed world (because in India the staff is never filled adequately) . Still they continue to put in their blood and sweat, training thousands of medical students, working almost 24/7, seeing far more number of patients in OPD, IPD and Emergency. This is the best possible medical social service, nay, charity being done in India, let me first respect and salute this unrecognized social service. This is an ideal premise for those who want to continue to be available for the poor masses, keep themselves abreast of the most modern medical knowledge, and impart it to the meritorious future generations of doctors.
A similar career is working as medical officers in rural / semi-rural areas, where doctors are most deficient. In most Medical Institutes run by the government or municipal corporations, sycophancy and suppression , hopeless bosses, poor administration and heavy paperwork, punishment transfers and bribery are huge limitations for those who want to honestly serve patients. Life isn’t easy in rural surroundings. Right from the lack of basic amenities like water, electricity, good schooling and transport, to a severe threat to personal security by the rampant Political Gunda culture in a superstitious, orthodox community. Who will want to voluntarily expose their family to these? However, if one does have a social standing in one’s homeland, it becomes an excellent option to serve the society. © Dr. Rajas Deshpande
Coming to the non-government career options in medicine, one is either left to private practice as an individual practitioner, which offers a lot of freedom but limited resources, or a salaried practitioner at a corporate hospital.
In the corporate hospital culture, individual charity and social service becomes almost impossible. Contrary to the image created by the media, most of the corporate hospitals actually comply with the mandatory charity, worth crores of rupees every month to those BPL, but the need of our society is far more than that, the demands are never ending. The new doctor who wants to earn a good name and income, but also wants to do something worthwhile for the society as a free service, the corporate culture offers two options: a low-salaried position for looking after the mandatory charity, or working in their low input peripheral schemes. For a beginner, especially a specialist, these are both excellent options . © Dr. Rajas Deshpande
Coming to the last option: an individual private practitioner, there are many choices but also a stark reality: you are on your own, and on the day that you don’t earn, no one else pays for your innumerable bills. Remember that when you are an independent medical practitioner, you have zero income every day that you don’t work, so a single illness or problem that keeps you home for a month will bring your bank balance to zero. Unless there is an alternative source of income, which is rarely the case with a doctor, this jeopardizes your whole existence. You may be prepared to walk through this, but you will be doing your family a great injustice if you push them into this fate. Look at those who have done the greatest charity upon earth: Bill Gates, JK Rowling etc. They have first earned, secured themselves and their dependents and then returned in plenty to the world. That is the safest way to serve the society effectively and for long.
I know almost everyone in this hall is eager to help the downtrodden, poor and helpless. But there are some things you must first thrash out for yourself. Firstly, do not feel any obligation to copy charity. You can discover your own new ways to serve the needy. Completely ignore those who tell you what should be your financial worth. Once you decide what lifestyle you want, you can chart out how much percentage of your time you can work for charity. You may want to reserve one hour a day or one day every week. Be comfortable, choose what does not become a stress factor, but please stick to whatever you decide.
One hour a day by an Indian doctor means 4-5 free patients a day, that is 30 patients a week, that is 120 patients per month, and 1440 per year. If one consultation is 300 rupees, this way you are giving 4 lac 32 thousand rupees worth service free to the society.
There is a major problem : those who take advantage of free medical service. There already are many affording patients whom most doctors voluntarily see free: relatives, teachers, other doctors and their family, classmates, staff in their hospitals, maids and servants, watchmen, neighbors etc.. There are also others who demand free consultations: administrators, politicos, local heavyweights, ministers and even top businessmen who our bosses accompany. People often say that free service does not have any value, it is not respected, but I will make a small exception here: I feel that the really poor and helpless genuinely respect your free service, remember it for life and place you near God. It is the affluent who are usually thankless for free services, and it is high time that we should stop serving them free, so that we are able to serve the really deserving ones. © Dr. Rajas Deshpande
False poverty/ income certificates, visiting repeatedly for trivial / tiny complaints, daily questioning, become a huge limitation in extending free services openly. Pune teaches you many tricks to identify and deal with such people.
An equal legal responsibility for even the free patients is the law, and a major limiting factor for private practitioners as well as corporates. However careful one may be, every doctor does commit mistakes, and our courts of law are yet unevolved medically, only rare judges are mature enough to understand the intricacies of medical decision making and still rarer doctors understand the law. Look at the big picture: a doctor is treating a poor patient as charity, and unfortunately something goes wrong. The instant conclusion that it was the doctor’s mistake, the sensational news story that follows, and the threat to personal reputation all come to play together. The chance of “Extracting” money from the hospital or the doctor, in case of any complication or death, is considered a lucrative opportunity by many local goons.
A poor young lady with a stroke presented to my free OPD. I found her to have a valvular heart disease with a clot in the heart. We arranged for her free treatment, the best cardiac team in the city operated her free, for a major valve replacement open heart surgery. Everything including all complications was explained, poof on paper. In a month, she developed valve failure, a rare but known complication. The relatives returned with a gang of goons, threatened us in the OPD with dire consequences and legal action. The very family which begged for concessions with folded hands a month ago now spoke of vandalizing the hospital, beating us up. We explained to the patient and family that this is not a surgical mistake, that this is a rare but known complication, and it was still possible to correct it. Fortunately for us, the patient herself agreed for a redo surgery. The cardiac team operated her again, free, and the patient went home walking in a few days, but no one from the family ever expressed any gratitude. We had learnt a precious lesson: do not risk your career for charity or social service, because medical degrees, once cancelled or suspended are almost impossible to get back. © Dr. Rajas Deshpande
My friends, the real richness is that of the soul, and by becoming a Doctor you have already proven all that you need to prove about your soul. Whatever I must earn, I must proudly earn without causing hurt or having to deceive anyone. And believe me, Lord has provided enough for me always. Yes, there was a time when I sat in my hostel room and sung that song “Chaand Taare Ttod Laoon” from Yes Boss . Over the years, the kind Lord has responded to most of my prayers. There is no other profession in which you have such huge opportunity: your charity and service will bring people health and life: so use it freely, every day, always. Just make sure to protect yourself to help others for decades to come, and to pass on this light to the future generations.
Jai Hind!
© Dr. Rajas Deshpande
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