Tag Archives: Good doctor

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

“Get Out, Doctor! You Are Finished!”

“Get Out, Doctor! You Are Finished!”© Dr. Rajas Deshpande
“Doctor, it’s this way or highway. We have many from your specialty in the waiting list. Do you accept to go by our policies or do you want to resign? Mind well, if you disagree, we will see to it that your name is blacklisted in every hospital in this city”.
As Dr. Sumeet stood there thinking, one of the administrative doctors, always a first class bottom licker, commented “These days doctors are like W*****, throw money at them and you get them to do anything you want”.
One junior doctor, still hot blooded, walked away. Dr. Sumeet asked that medical superintendent to mind his language. There was no reply. The bosses had really enjoyed the comparison, and while eating their pistachios at the hands of their secretaries, laughed aloud.
Dr. Sumeet felt devastated in that super luxury office, among the administrative officers and his own senior doctors from that hospital. He had returned from Germany a year ago, and joined this corporate hospital that was recruiting specialists. They had also offered him a decent salary, and accepted his condition that no patient will be sent back from his OPD for lack of money. © Dr. Rajas Deshpande
However, he had had to face a lot of jealousy and hatred from his senior doctors as he was looked upon as a competition. This is extremely common in India, and however stifled, a major truth. But no one ever stood against the bosses of corporate hospitals, so they had to accept his appointment.
The same corporate also owned other industries, namely Gold, Cement, Cloth, Petroleum etc. They were a “closed” community, all in the administration belonged to a particular caste. This hospital was another of their ‘profit oriented investment’, and did really well as most of the public can easily be fooled by the words “Free, Concession, Accreditation, World Class etc”. Medical illiterates (read general public) are really taken for a ride by healthcare advertisements of corporate hospitals.
Few months after Dr. Sumeet joined the hospital, the CEO changed, and another “extremely loyal invertebrate profitmaker insider” came in as the new CEO. From prehistoric period, he was considered as the best pet of that corporate family. The new CEO started by applying all the labour and profit criteria of cement industry to this hospital. If anyone argued, his famous dialogue was “If Sirjee (the owner of the corporate) wants, he will make the sun rise from the west. You are not aware that his reach is beyond the highest in India”. Anyone who uttered a word against any policy was isolated, humiliated and finally thrown off. Various allegations and ‘proofs’were easily furnished by a dedicated ‘execution panel’.
The new CEO changed the conditions that were accepted when Dr. Sumeet had joined. He was now given a target that his patients have to increase by 25 percent every six months, so should his tests, surgical referrals, etc. Free cases were cancelled. Many doctors spoke in private about this, but no one wanted to lose their job, as it is very difficult to get attachments in multispecialty hospitals. © Dr. Rajas Deshpande
As Dr. Sumeet had argued, he was given this ultimatum. He appealed to the senior doctors in that room, most of them looked away. Some told him they had always warned him not to be ‘over-smart’.
“I will reply in three days” said Dr. Sumeet and left the room.
He had nowhere to go. He had shifted his family to this new city and his children were already adjusted in their school. He had chosen this city after long deliberation, and had recently bought a flat with a loan, so he needed a stable income. His parents were teachers, he did not have the kind of money required to make his own hospital. All his friends had one answer: “Adjust “. He decided to plead once more to the management, to allow him to provide free consultation to really poor patients, and to continue a contract not based upon income generation. © Dr. Rajas Deshpande
Next morning, as he entered the hospital, one of the servants (being from the inner caste, his title was ‘General Manager’) came to see him with a huge grin upon his face. “The CEO sahab has asked you to empty your belongings by afternoon. This office is given to another doctor”.

He went to the CEO, who refused to see him.

The same medical superintendent came out.

“Doc we do not require your services any more. Get out, You are finished” he said.

“Why?” asked Dr. Sumeet. “I want an explanation”.

“We have many reasons. You do not fall in line with our policies. You are insubordinate. Also, some staff say you are having an affair with another doctor in the hospital. We also had a complaint about you yesterday from a patient”. © Dr. Rajas Deshpande
The complaint was obviously custom-made, and there was no way to argue about the affair allegation. Medical staff working together in an extremely orthodox country has to face those allegations very commonly. How such allegations disqualified him as a doctor was beyond him.
There was no argument now. He was escorted by security team out of the hospital, in full view of many specialist doctors (his friends), patients (treated by him), and others, but no one had a word to say. After he came out of the campus, one doctor friend accompanied him home silently.
He wrote to many senior doctors. There were no replies. He wrote to the medical councils. There was no reply. One senior member of the medical council told him in confidence: “ All the Medical Council rules are only for doctors. Medical councils in India have zero control over private hospitals, especially corporate hospitals”. IMA and other doctor’s bodies are clueless and directionless about the open exploitation, humiliation and destruction of doctor’s careers, especially new-coming specialists. In a country devoid of specialists, it is paradoxical that so many specialists are continually fired / thrown off / made to leave corporate hospitals which take advantage of the competition among doctors. Sadly, the doctor community, with too many self-proclaimed geniuses, has failed to unite and protect itself from this corporate onslaught. It is pathetic to see some greedy doctors competing to see each other down. © Dr. Rajas Deshpande
His practice was super-specialised and required a multispecialty set up with inpatients. There are very few government set ups in India like those. The rules, conditions in most govt. hospitals are idiotic, age-old, and the payments are laughably low. Also, the govt institutes are mostly headed by you know whos.There are indeed some charity super-specialty set ups, but most are religion / cult / faith based.
Dr. Sumeet decided to work it out his way. The corporate hospital which fired him made sure that his name was defamed in every possible way, they left a many pronged negative feedback everywhere. © Dr. Rajas Deshpande. There is no remuneration for the career murders of the intellectuals in every field in India, caused by two-faced systems run by invisible hands.
Gradually, he picked up, losing years of his career. He found out a hospital that respected his wishes to treat the poor free, and did not insist on numbers.
The complete ignorant and irresponsible stance of senior doctors when someone wrongs the junior doctors, the complete lack of any control over the policies of corporate hospitals by any medical council or governments, and the impotent stance by many a doctor’s organisations has spread the healthcare-toxic corporate medical culture all over India.
Doctors should at least make directories and online lists (maybe anonymous to begin with) of hospitals which force doctors to accept malpractices, or do not respect terms of agreement and sack doctors without any mistake. These should also be reported to the medical councils. Any hospital sacking any doctor should have to send an explanation to the Govt., medical council and IMA for the reason of dismissal, and the doctor should also be able to explain his / her side of the story. Hospitals which “use and throw” doctors as per wish, without reason or logical explanation must be brought to the book. © Dr. Rajas Deshpande
Most corporates have excellent backup and protection from the government, and all they will do is to shift the blame on the doctors’ fees, hiding from the patient, media and society the umpteen other profiting headings that the patient thinks are benefit to the doctors. This is a tough war.
Another joke is that while the educational qualification and training of any doctor is strictly scrutinised by medical councils and media, the qualifications of those who own hospitals, run them are completely neglected. No wonder illiterate politicians, “Business Class” corporate houses and CEOs bully doctors into practicing policies which are often against the best practice principles of healthcare.
Very few non-medical CEOs actually have a good knowledge of medical ethics and principles, agree to logical arguments.© Dr. Rajas Deshpande
The media and society who advise umpteen things and expect a lot from the doctors never stand up for a good doctor. Everyone who has met one bad doctor cries all his / her life about all doctors. As if there were no bad apples in their field! The ‘hyper idealistic’ population expects that the entire healthcare comes under the heading of ‘charity practices’., unwilling to spend upon their own health. If malpractices and backdoor incomes are to go, the public should realise that the actual fees will increase.
Governments will always make populist, ultra-short term policies in healthcare, without involving the brainy specialists in practice. If the Medical Council or IMA do not take a firm stand, any doctor who takes a stand against existing corporates / medical malpractices will be orphaned by his / her own community, often boycott, and categorically defamed: until their career is destroyed or they leave the country.
Many Dr. Sumeets are actually suffering this right now in India, with no respite.
Doctors must also realise that this war will never be won fighting alone. If the subsequent generations are to get better quality healthcare, we should start by identifying the problems first.
An easier, nay, wiser option for every super-specialist is to leave India.

© Dr. Rajas Deshpande
PS: The “Chamcha Doctors” who line up with the corporates to compromise in healthcare principles must do some soul searching. Earning profits is not a crime, compromising medical principles is. A real “Doctor” will never do so.
Dedicated to the thousands of young medical specialists who are right now suffering this hell.

RD

Lifehacks for the Doctor

Lifehacks for the Doctor
With interview of a renowned Cardiologist.
© Dr. Rajas Deshpande

Lifehack:
a strategy or technique adopted in order to manage one’s time and daily activities in a more efficient way.

Are you talented, hardworking, hurried, bitter, artificial, irritable, insecure, obsessive, egoistic, money-minded, dissatisfied and longing for a better life? Yes? Then you must be a successful Doctor!

While medical practice is of paramount and sacred importance, the duties as a spouse and parent are absolute too, there is no replacement for you there (Well, in most cases!). If your “Kick” of being completely swept away by the needs of your practice and competition drowns your own personality and the requirements of your family, you may be a overindulging doctor who is a terrible parent or spouse. Only your family will carry you in their arms few years from now, no one else. Rethink how you treat them today.
Are you really earning “For Them” or for your own super-ego, for overcoming the ever widening valley which converts every luxury into a necessity you must have? The justified feeling that “If I have learnt so much and am so talented, work so hard, I must earn real good”. Has money / affluence become your self-assessment criteria? If so, you may be no different than an attention seeking, beautiful, very very attractive but dumb individual. You trade health, family and life for money.

Calm agility of mind and body are hallmarks of a doctor, and too many tasks, irritability, bitterness, insecurity and lack of satisfaction are making this impossible.

Let us identify how we can reduce stress and improve the quality of life. The only life we have.
1. Separate work and family cellphones. Switch off the work phone outside work hours, except on emergency day. Provide all your patients with casualty / emergency contacts, and only your assistant should be able to reach you on your personal number.
2. Hire and train assistants when feasible, they may assist you with secondary/ nonclinical tasks, paperwork etc.
3. Take a big picture look at your day / time correlation, you will be surprised:
Work (8-10 hours),
Commuting (1 hour),
Sleep (7 hours),
Kids (1 hour) till they are 18.
Spouse (dedicated 1 hour: you married for togetherness all life, right?),
Communication / emails / Internet (1 hour), and
‘Self’ time (1 hour)
Total = 20-22 hours.

You will still have 2-4 hours left for cooking / housekeeping / etc. (to be done by both if both are working). If we expect the society to be modern, we must also give up the traditional “wife at home however educated or smart” and “husband rules” attitude. Family is equal responsibilities to be shared with mutual agreement.

If only one partner is working, it is easier to arrange schedules. If both are working, one may prefer non-clinical / paraclinical duties till kids can take care of themselves. Singles are anyways happier till a certain age!

It is extremely essential to disconnect from the work to be completely with your kids / spouse. Strictly avoid talking about workplace at home, especially do not take your stress to bed.
Switching off cellphone at night is a big step in the evolution of a Doctor’s peace of mind.

You can practice far better with a calm and healthy mind. Hence the necessity of good sleep and self time.

4: Find an activity that makes you feel calm and happy. Don’t need to explain this to anyone, don’t need to feel guilty, this is therapeutic. This must be done alone for an hour everyday , with all communications switched off. Some suggestions:
Music: Listening, Composing, Singing, Learning
Writing, Reading, Painting
Gardening, Watering plants (magically calming effect).
Swimming, Cycling, Dancing, Gymming, Yoga
Long walks / drives if good, uncrowded roads nearby.

One of my senior colleagues Dr. Jagdish Hiremath (Director of the Ruby Hall CathLab) is one of the busiest and renowned Cardiologists in the town, and never skips a smile when a colleague crosses him. Always appears at peace with himself and others. I asked him how he manages such a stressful life of a successful interventional cardiologist. As we talked, I realised his answers are worth what every doctor must think about:

Dr. JSH: “I prefer to be in the present 100%, whether with patient or otherwise. I concentrate upon the task in front of me and blank out all else, so I can do justice to that task. When I am with a patient or in cathlab, my cellphones are diverted to my assistants or receptionist, and I am not disturbed. This helps me, and the patient also feels happy about it. My assistants filter out unnecessary calls and pass on the genuine ones to me as a message, I call and talk to them on my way home”.

Me: “Newcomers, especially superspecialists, face the dilemma: that cut-practice or referral practice is the only way they can start, as no one offers any salary till you have a good patient-base. It is almost impossible for the beginners to start in a decent place without submitting to the existing pay structures”.

Dr. JSH: “Yes that is a shortcoming in our system. But then, the concepts of ethics, morals are quite twisted in medicine today. We must never compromise in doing the best for the patient. But then, others should not decide or dictate how the medical charging systems work: neither insurance people, nor media, community or anyone else. Because they never understand / acknowledge the importance of talent and skill”.

Yes, I thought: who else will allow other professions/ government, society or insurance companies to decide the value of their services? Will they allow others to dictate how they use / share their charges? It is only the doctors who have allowed this, and it is high time everyone else shuts up about this and doctors redefine the charging structures.

Me: “Sir, medical education has become “Earning PG” oriented. MBBS doctors do not get good teachers, and are not clinically well groomed. They are smarter and have better net-knowledge, but not good clinicians. They have become “MCQ Doctors”.

Dr. JSH: “I have always said that MBBS should be ‘the making of a doctor’, and not only stepping stone for PG. We need better institutes, better teaching. A doctor must grow as a human being lifelong, and it must start at this level. Even the PGs are exploited too much. Their teachers should understand that they are no more traditional ‘students’ in college, they are grown up married doctors with families, and must be treated like employees rather than servants”.

Feeling a sense of having learnt something invaluable, I thanked him and left.

There’s this “Becoming a Man (or Woman)” of every Doctor: when they start treating independently and confidently. Then comes the phase of an “All Out” effort to increase practice: extreme self neglect and hardwork, running from one hospital to another. Then one day they wake up to the reality.

All the stories of Morals and Ethics taught and expected of a Doctor are like the things that parents tell their kids not to do, while doing these themselves.

The Indian Doctor’s Enlightenment (approximate latency 5-7 years in practice) comes packed in bitterness and depression towards the very society he / she serves. They realise that the society has lost trust and respect towards us, even the recognition of the extreme education and hardwork doctors have to perpetually live in. An educated patient expects global standard healthcare at Indian rates. The uneducated look upon the doctor as a bandit.

So if you have become the typical successful doctor “Hurried, bitter, artificial, irritable, insecure, obsessive, egoistic, money-minded, dissatisfied and longing for a better life”, it is time for a reboot. No medical bodies stand by or defend doctors. So we must learn and try to sort out this mess ourselves.

For life is change, and wisdom lies in the wish for a better life.
It is high time Doctors learn to take care of themselves.
Wishing all Doctors best of health and a beautiful, rewarding life of success and satisfaction.

© Dr. Rajas Deshpande
(This is Part II of “Delusions, Doc?)

Special Thanks
Dr. Jagdish Hiremath,
Director Cathlab Ruby Hall Clinic

The Good Doctor is on Ventilator Now.

The Good Doctor is on Ventilator Now.
© Dr. Rajas Deshpande

You reach the top of academic pyramid after a tooth-and-nail competition and the worst mental, emotional and physical hardwork. You learn humanity and humility in the broadest perspective. No one else can understand the worth of your work. Then you are told this is your lifelong cross. Your “Obsession and Compulsion” to help solve health issues is held as a gun to your own crown. Being good does not mean getting a good life or income. Now you must live to the wish of many others and not your own, or quit in disgraceful depression. These many other are insurance companies, corporates, people you treat, governments and other organisations made up of people with self-obsessed power agendas, even some colleagues who lust fame.

Ever drove a new car in an Indian city, following all traffic rules? You stand out as an ultimate idiot. People honk crazy when they collectively jump a red signal and you don’t. People hit your car from behind and still beat you up. The worst, some (esp. autorickshaw drivers) will challenge you by driving their vehicles into your path and looking at you with “What can you do?” face. All in the face of traffic police. Well, Indian Doctors are facing the same issue: You are expected to follow all traffic rules while others continue to screw your journey, scratch your car any which way they want. Leave aside the government, even the politically oriented doc’s organisations are busy making unilateral rules / regulations which increase the doctor’s work and further worsen the litigation liability.

Political desperation leads to compromising merit “to increase numbers of doctors” (by charging crores) in India. So the class of real good and meritorious doctors is now mixed with those who can buy everything, including fatalities due to their own medical mistakes. Many of the doctors from private colleges are good, and not all from govt colleges are good. Every passing doctor does not hold the same clinical acumen. No one is perfect. But when you allow money to run the system, only the ones with money will get away with it all. The will to control merit and corruption lacks from the highest administrative offices.

There is a huge difference between a Doctor and a Good Doctor.

The social anger is conveniently misdirected to the practicing doctors. The real players encouraging, cultivating and reaping from medical corruption stay hidden. People get to question, argue with, thrash and litigate the practicing doctor who earns a few thousand every day, but those who earn many lacs, even crores everyday remain behind the screen. Any doctor raising his / her voice against them is thrown out of a system which must work collectively.

The tragedy of perpetually having to face the illiterate poor or arrogant rich, both with political backing to threaten and assault, and expecting charity-priced superhuman service of all doctors is eating up the morale of those who take their professional duties seriously. Add to this a glamour driven primitive legal system which takes upon itself to define Indian culture, which thinks that a rich earning life is costlier than a poor man’s. Add also the semi-literate law makers who think of this profession as “Granted Inherited Slaves” to serve their vote banks.

A good doctor is proud of that good, and will not stay long where his / her pride is raped every day. This is why many many superbly talented doctors have left India, and the few remaining are gasping for dignity, which is their life.

The good doctor is on ventilator now.
© Dr. Rajas Deshpande

The Good Doctor Myth

The Good Doctor Myth:
This article may hurt some feelings. I apologize in advance, but this is how I truly feel. Basically for students and patients.

“Just looking at the doctor took away half my pain / illness”
“The doctor always makes me laugh and reassures.. A very nice human being, very compassionate”
“I am very close to the doctor.. he/ she calls me his younger brother / sister etc.”
“He / She is so busy, but still saw me and advised”

It is quite common to hear these sentences in a hospital. It is expected from a doctor that he / she must dress well, speak well, be nice, mannerful and compassionate, and ease out the patient’s worries.

This I agree is essential, but is this all? Would any smiling / laughing pleasant, well dressed and well behaved doctor who takes away your worries by well – chosen words (and a pat on the back) be enough to handle your life?

Think again.

For making a health decision, what all qualities must the qualified doctor have?

1. Exactness of current knowledge and literature about that particular illness.
2. Experience in handling that particular illness and its complications, without
involving ego (Many would just decline counter-opinion just because it came
from a rival / junior etc.)
3. Analytical abilities based upon a combination of the above two.
4. Concentration: possible only when you are not very busy or supermultitasking.
5. A complete knowledge of the patient’s health profile: Detailed history, medical
conditions, ongoing treatments (allopathic and other), ongoing diet, allergies,
other specialists treating the patient, addictions etc.
6. Surgical skills in that particular specialty.
7. A readiness to explain the true nature of illness, its complications, all
treatment options etc., a respect for patient’s choices (not persuading the
patient to make a choice by telling only the worst possibility) , readiness to
accept mistakes and explain the patient about them.

We are in the age of superspecialisation. This means the basic doctor (MBBS) goes through specialisation (MD /MS = 3years) in a specialty, then through Superspecialisation (DM /MCh = 3years), then through fellowships (2-3 years) as a postdoctoral superspecialist. (There are many other true and fake degrees, which again is a debatable topic).

As one climbs higher in a specialty, he /she becomes less and less expert in other fields as they need more concentration upon one subject for many years. One is supposed to refer the patient to another / superior specialist in case of a condition that is not one’s own specialty or beyond experience.

However, many doctors who appear very pleasant to the patient because of the qualities mentioned above, take advantage of the patient’s faith in them, and keep on treating the patient either themselves or through specialists of their choice / liking / etc. (This is what the patients know as ”rackets” in our profession).

This results in:

False reassurance of safety / lifespan in treatable / untreatable medical conditions.
Delay in treatment / incorrect / overtreatment (Stroke / Cancer / Parkinsonism)
Wrong drug / dose choices (most common example: epilepsy).
Complications due to drug interactions / disease worsening/ combinations of these two.
Falsely attributing complications to some pre-existing disease.
Incomplete evaluation / screening before surgery that results in surgical / postsurgical complications.
Accidents due to non-treatment of conditions that may make the patient unconscious.

The “Good Doctor” is the one who, besides being polite, nice, compassionate and understanding, spends time for interacting / talking to the patient, examining him / her in detail, explaining the diagnostic possibilities and need for investigations advised, risks involved, and realistically addressing the patient’s fears in a kind manner. The good doctor will also answer all questions that the patient has about this consult / diagnosis, and offer all possible options of treatment. He / she will also freely mention the dilemmas in diagnosis (instead of “impressing the patient” by pretending to understand and answer everything) and also the problems he/she could not solve, and suggest references to other colleagues / specialists for a second opinion.

A good surgeon will talk to the patient after surgery, mention his / her associates / assistants who helped during the surgery, and explain good and bad outcomes boldly, thus gaining patient’s confidence in truth.

Gone are the days of a smiling / laughing “I-know-it-all-don’t-you-care” pseudoreassuring doctor who would definitely uplift a patient’s mood, but certainly cause harm by mis/delayed diagnosis. Also gone are the days when patients should accept a “quick” consult in a hurry by a very busy doctor continuously attending phone, handling a hundred things simultaneously etc… A decision for treatment, and especially surgical intervention must always come from a calm and concentrated mind.

The patient must also know that if a doctor is to spend more time with you, he/ she will have to see less patients, so the consulting fees may increase as per time / skill. Patients should concentrate upon what is being told, avoiding repetition of the same questions. Google based interview of the specialist should be avoided. One must have complete faith in the qualities, abilities of his / her doctor, unless proven otherwise.

The purpose of this article is to highlight that only external appearances and behaviours do not make a good doctor, as is the general perception especially among the frightened, depressed and illiterate patients.

Wishing best health to all.

Rajas Deshpande