Tag Archives: Healthcare

The “Cheap Competition” among Doctors: a Hidden Cancer.

The “Cheap Competition” among Doctors: a Hidden Cancer.
©Dr. Rajas Deshpande
Neurologist, Pune.

A majority of medical students in India are actually from poor or middle class background. Most students come in this profession for service to the suffering and also for social respect. Every doctor passing out in India does not pay crores of rupees for education. This is a system created and maintained by all governments for their strongmen as a source of huge earnings. Many of these “paying” students also work hard and earn their degree. However some few look at the amount spent as an investment and try to earn it back by unfair means. This is NOT the fault of the majority of good doctors (both non-paying and paying) who work hard to acquire their skills and help the society. © Dr. Rajas Deshpande

As the society expects “cheapest” advice even for most complicated health issues, some newcomers, those who are under qualified, those who do not have a good number, and some who don’t have the confidence keep their “Consultation fees” quite low, and rely upon alternate income: through tests, procedures and surgeries, through percentage in hospital bills. Thus, though the ‘entry ticket’ is low, the ‘hidden charges’ compensate for the doctor’s (genuine) hard work and skill.
However, not all ‘low fees’ doctors are bad, but keep their rates low to be able to compete, no one wants to criticise those who have low fees for ulterior motives. This competition to keep the consultation fees low to attract patients has generated most evils in the medical practice. Unfortunately, this is unlikely to change soon, as most people prefer this.© Dr. Rajas Deshpande

The low “Consultation fees“ model works best for even good, skilled and experienced surgeons and branches with procedures (plasty/ scopy etc.), where the patient usually does not question the charges for the procedures or surgery, just because every patient prefers best skilled doctor. There is also a recent trend to offer even “procedures and surgeries” at a competitive low cost by some hospitals, who employ the inexperienced or inadequately qualified/ trained doctors, beginners, lowest skilled nurses, technicians and other staff and instrumentation, catheters, joints, other prostheses. The whole show will be put up for “short term goals”, risking patient’s life and compromising many aspects of good care. In many “cheap packages”, the long term outcomes may be at risk.

Those who run hospitals have many profit sources: right from the tea sold inside the hospital campus to the room charges, pathology and radiology, nursing, drugs and everything used, they earn profits under multiple headings. This is also why they can afford to keep their consultation fees extremely low. However, most doctors employed at such hospitals are not paid anything besides their own low consultation fees, while they remain the face of the “total-bill” for all patients. This system encourages rich doctors who invest in alternative sources of income than the consultation fees alone. © Dr. Rajas Deshpande

Physicians / specialists must rely only upon their OPD consultation and IPD visits. If a proper examination is to be done in each case, and all questions of every patient are to be addressed, one cannot see more than 20-25 patients in a day. Thus if he / she keeps low fees, it becomes difficult to sustain in any Indian city. So they must see as many patients as they can, only addressing the immediate medical issue, and unable to answer many queries of the patient and relatives. If a good doctor decides to spend more time with each patient, and gives up relying upon the “hidden income”, he must charge a much higher consultation fees to just sustain in a good city.

The social anger against doctors mostly comes from increased expenditures on health and unrealistic expectations. Although there are greedy doctors, a majority are just doing their best to make a good name by offering the best service at a low price. Quality healthcare will always come with a higher price-tag, a good doctor will have a higher fees, and that if one wants the “backdoor / cut / referral practice “ to end, one must be prepared to pay higher fees.

In a country where loud and sweet talk, deception and lies are preferred by majority over genuine service, honesty and truth, it is difficult to change the basic attitudes: on both sides..

There indeed are some honourable doctors and hospitals who know the value of their own service, and offer the best to their patient. But even they are usually considered “Greedy” by the very patients whose miseries they end. There are senior / skilled doctors who charge from three to ten thousand or more per consultation, and most of our powerful and ministers go to these doctors too. Although this consultation fees appears high, the accuracy of the opinion and advice often save the patients lacs of rupees. If a surgeon advises a surgery, he/ she can earn many thousands, but if the same surgeon with his skills and experience treats the patient conservatively, avoids surgery and gets good results, the patient is unwilling to pay even half the price of that surgery for the same result. What would anyone do in such a case? The concept that “A Right Opinion by the Right Specialist” saves the patient huge amounts of money and discomfort is yet to dawn upon the Indian society.

The market of cheap has always survived, but in the long run, cheap options always come with a greater final price tag upon health: often your life.

It is my sincere appeal to all my fellow practitioners from the newer generations to please change this structure. See a moderate number of patients per day, charge according to your skill, experience and time, do not undercharge or bargain, then alone this system of backdoor incomes will gradually change. Of course you must consider concessions for the really poor, and accommodate those who cannot pay by keeping a separate time/ OPD for them.

© Dr. Rajas Deshpande
Neurologist, Pune.

PS:
Many city-based imbeciles without any doctor in their family will immediately say that all doctors should go to villages. Those who suggest that, please make your own children (if you have) doctors (if they have the caliber) and send them to villages. Why doesn’t the government make it compulsory for every mla and mp who draws lifelong financial benefits from the country’s exchequer, to send their kids to medical schools and serve in rural India compulsorily? Why is it not compulsory for the elected members to take all treatment in their own electorate? Every law is bent every which way possible to accommodate the healthcare requirements of all the rich and powerful, whether it is kidney transplant or joint replacement, but when extending healthcare to the poor and unaffording, the same people from various ruling parties conveniently point fingers at the medical professionals!

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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

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The Extinction of Precious: A Medical Horror Story Happening Right Now!

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The Extinction of Precious:
A Medical Horror Story Happening Right Now!
©️ Dr. Rajas Deshpande

“Sir, we have come from Konkan”, said the father, “to seek your advice and blessings . My son has passed the medical postgraduate exams with national rank 30. He wants to decide which branch he should choose”.

I congratulated the genius. Passing medical entrances with high merit requires great talent. It does not earn the glamour, claps and appreciation of stage and limelight, for we live in a society that only worships looks, muscles, bhashanbazi, financial success and sports (sorry, one sport. Even if someone wins a world gold in any other sport than cricket, they go home in an auto rickshaw when they return to India!).

Speaking with the boy, I realised that he was very sensitive, compassionate and had an excellent logic and reasoning. Besides having a calm bearing, he was also a hard worker. A perfect blend for becoming a great physician or a surgeon, in a world that is fast losing able clinicians. I suggested him to prefer Internal medicine.© Dr. Rajas Deshpande

They looked awkwardly towards each other. The boy garnered some courage to speak.

“Sir, I saw our family doctor being beaten up by a local politician, his clinic was ruined. He was humiliated in the worst language in front of his wife and children, and instead of protecting him, other patients in his hospital kept on recording videos of the incident, which later became viral. He left, we don’t know where he went. I cannot ever think of directly dealing with patients now. I want to choose a non- clinical or para-clinical branch.”

I appealed to the father: “Your son has a great potential and matching talent to become a good clinician, we desperately need many more. It is not necessary that he practices in your own town or even in India. The whole world needs good doctors. Please think about this”.

The father, a simple teacher from a primary school, thought for a prolonged moment. His eyes reddened up.
“I don’t know, Sir. When he said he wanted to become a doctor, his mother and I always thought that he will become a saviour, running around saving people’s lives. We were never interested in only money. But the day that we saw our own doctor being beaten up by a crowd and the local politician, we realised how helpless a doctor’s life is. We knew our doctor for over 25 years, he was like a God for many in our town. All he did in 25 years became a zero in a few minutes, thanks to a hooligan politico and his crowd. We don’t want our son to ever face that. If we had a daughter in his place, we wouldn’t even have made her a doctor, women as doctors suffer a lot more trouble and get no returns, sometimes even from their family. And this is our only son, we want him to stay in India near us.”

Somehow I didn’t want to give up convincing him, he was an ideal candidate for becoming an excellent clinician.© Dr. Rajas Deshpande “Think of the future. Hopefully there will be better laws, he can also consider working in bigger, safer hospitals if he is scared”.

“What would you advise your own son if you were in my place, Sir?” asked the father.

He had bombed my mind.
I was trained by parents and teachers to always do good, be compassionate and kind. My kids had a potential to become great doctors coming from this background. I worry a lot about the extremely critical condition of deteriorating healthcare standards and reducing number of good clinicians that is destined to cause a havoc in a few years. Still, honestly, I did not wish upon my children the insecurities and threats I face. I don’t want them to live under the perpetual fear of being vandalised, defamed, tortured by over-expectation and punished by committees made up of politicians and medically inexperienced judicial experts. I won’t want their lives, work hours and remunerations to be dictated by a corrupt bunch living for votes of free mongers.© Dr. Rajas Deshpande

It would be hypocrisy to advise someone else what I wouldn’t choose for myself. That’s how a doctor makes the best possible decision. With a heavy heart, I advised him what I always advised my children:

“I agree. Please choose what suits your heart most, what gives you fearless happiness in your work and also leaves you with some time for yourself and your family, ensures a good income and is not dependent upon jealous people’s expectations of what you should do and for what price. You have so many options for social service other than becoming a clinician. I am sure you will stay a good human being all your life.” I suggested him two para-clinical branches that offer good scope.© Dr. Rajas Deshpande

The world indeed will have to suffer the gradual extinction of good clinicians. We need many more excellent doctors in para clinical and non clinical areas too, but the face of the profession is the clinician, and we certainly, desperately need many thousand more. It is a fact that in spite of increasing number of doctors, patients still die travelling in an ambulance to reach good healthcare far away from most homes in India. Many federal orphans who cannot even afford government healthcare die at home.© Dr. Rajas Deshpande

The father asked his son to touch my feet. As he did so, the melancholy of my own advice bit my heart. I couldn’t let down the flag of my noble profession.

“Listen, dear. I am speaking this against my own convictions. I am struggling. Think about becoming a good clinician and practising in a safe country, take your parents with you. I will be happy whatever you finally decide, but not everyone has the ability and talent to become a good doctor, it is rarest of the rare traits.”© Dr. Rajas Deshpande

They left. So did a part of my hope for the future of good healthcare.

When the next couple walked in with an infant baby in their hands, I looked at the smiling baby, and forced a smile. She didn’t know it yet, but I had just bought a precious gift for her.

©️ Dr. Rajas Deshpande

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“Is The Diagnosis Wrong, Doctor?”

“Is The Diagnosis Wrong, Doctor?”
© Dr. Rajas Deshpande

“Doctor, there is no improvement at all” said the angry husband, throwing the case-file upon my table.

Well this is not an extraordinary sentence for any doctor, one must be prepared to openly deal with this. I had been quite polite and well mannered with them, there was no reason he had to cross that line. I could understand though. When they pay my fees, they expect some result or satisfaction.

While teaching my students, I have always insisted that if the patient / relative says that there is no improvement or change with the prescribed medicine, one must first consider the possibility of a wrong diagnosis, a missed condition or a misinterpreted finding. Doctors are humans, and do commit mistakes, or misinterpret findings. This is normal, and happens with every doctor. Medicine is far more complicated than most people think they know. A good doctor knows this and learns, while all the time keeping patients safe, but a doctor with ego kills his own practice, and may cause harm to the patient.

I asked them to sit down and reassessed the case in detail. A 28 years old female. Headache, giddiness, imbalance, palpitations, breathlessness. Lack of sleep and bouts of crying. Past and family medical history not contributory. Physical examination completely normal. MRI of brain normal, Vitamin B12 and D levels low. I had started vitamin supplements, anti-anxiety medicines and an SOS for headache.

She told me all her earlier complaints had improved, but now she had a severe backache. I told the patient that I was trying my best to understand her condition, and to resolve her problem, but her findings and complaints didn’t match. She looked at her husband, and asked him “May I speak frankly to the doctor?”.

Openly agitated, the husband sarcastically offered to wait outside if she needed privacy. However he stood glued to the chair as if he knew her answer. © Dr. Rajas Deshpande

The patient thought for a moment, told him it’s ok he can wait inside, then started to talk. She revealed that she was the only child of her affluent parents, had passed engineering, but now had to quit job and stay at home to raise children. They lived in an extended family, with grand in-laws, in laws and an elder brother, his wife and two children. This patient was the ‘last in the line’ to take orders, all others being senior to her. Her husband and in-laws were perfectionists, and she was tired of their continuous expectations. She had dreamed of making a career too, wanted some free time outside home for herself, but year after year, she didn’t get even a minute for herself. She was tired of it all and there seemed no respite. © Dr. Rajas Deshpande

“I am not averse to hard work, but the continuously condescending and fault-finding attitude makes me feel that I am useless”, she said, and added cautiously: “We were in the same institute and my ranks were always better than him. Look at where I am now” she started crying.

I offered them water and coffee, and waited for her to settle down. The husband became restless and defensive, but his tone was far lower. “I understand her problem, doctor, but what can I do? I cannot leave my family. My work pressures are quite high too, the IT industry is going through a bad phase”.

“I can assure you that she has no neurological problem now’ I replied, “she should improve with lifestyle changes, counseling for the family, and adequate free time for herself. I will refer you to a good counselor” I told them.

The husband laughed. “I can understand, but my parents will not. We will see what best we can do for her”. A bitter tone in his voice didn’t escape me.

‘Sir, she told us what bothered her, and must not be held guilty for trying to speak her mind. It will only help identify and treat the problem better. Please see a counselor together and avoid discussing this at home right now” I requested the husband. © Dr. Rajas Deshpande

There are many reasons why a patient does not improve. Untreatable medical conditions, depression, seeing the wrong specialist are the most common reasons, but there also are patients who want medical leave,those who want to avoid work, who want attention, so will keep on complaining of false symptoms. They do not improve with drug treatment.
On the other hand there are many who keep on taking the wrong medicines for years, those who self-medicate, do atrocious / injudicious dieting and exercises, yoga that doesn’t suit them, and do not follow the doctor’s instructions about abstinence, who keep on indulging salt, sweet, oil, alcohol, tobacco and other drugs freely available in India. © Dr. Rajas Deshpande

A doctor remains a lifelong medical student. A doctor who thinks he / she is always correct is most dangerous. It is not uncommon to meet doctors who are angry / upset with the patient / colleagues when their diagnosis, treatment is questioned. The first thought of a doctor when the patient does not respond positively should be to consider a misdiagnosis, reevaluate the case in more detail, reassure the patient, and obtain a second opinion if necessary. All this done, one must look into other possibilities, with an approach to resolve the issue rather than trying to shove down the patient’s throat their own faults.
We all go through bad patches in life, doctors and patients. If the child is wrong, the parents correct them still with love. A doctor’s attitude should be similar, with due care to also protect themselves. If not the doctor, who will understand the patient whose family refuses to understand them? In so many ways, especially in the Indian society, the doctor must don the role of an elder brother/ sister. Although patronising is legally discouraged in medical practice, and should be refrained from in cases where trust is questionable, one can make exceptions for some cases that need reassurance where the family fails to do so.

The nobility of our profession also lies in reassuring the patients that they are well cared for by their doctor, through the thick and thin of their life.
© Dr. Rajas Deshpande

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A Dangerous Disease Called ‘Relatives’

A Dangerous Disease Called ‘Relatives’
© Dr. Rajas Deshpande

“What all can happen, doctor?” asked the young lady accompanying her father.

He had had a vertigo for two years, now had developed headaches and had seen best of the specialists. Some of them had advised him an MRI scan, but the daughter who was “in-charge” of her father had decided to wait. They had undergone many treatments simultaneously: allopathic, Ayurvedic, Homeopathic, Herbal, Diet, plus various random suggestions by relatives (almost all patient’s relatives are experts on all medical topics except actually paying bills and donating blood).

The father, a victim of experimentation by a health enthusiast daughter whose profession was law, was visibly anxious and almost shaking.

After examining him, I told them that there were some soft signs, but also that a physical examination may often be inconclusive, hence it was wise to investigate. What must be done must be done. A true Saint, scientist, soldier or doctor will always live by those words. I must stress the need for the right investigations. I told the daughter that he must undergo a scan. © Dr. Rajas Deshpande

That’s when she asked “What are the possibilities?”
Imagine an anxious person sitting in front of you, dead scared of death or illness. He / she is praying God or providence that the doctor does not use and scary words like cancer, heart attack, paralysis, dementia, parkinson’s or early death. No one likes these words, the doctor likes them least. Almost every doctor thinks of the patient’s mental status before choosing the words in such cases. Some patients can even commit suicides if they are too stressed with the fear of long / grave disease.

However, the hyper daughter refused to be subtle.
I told her “You can ask me all the questions you want. But please remember that some answers may scare the patient, Also, I may not have all the answers at this point.’

“Can this be something dangerous? Like cancer? Can this be an emergency? Can it cause death? If so we will do the MRI today itself. Otherwise we will wait.” She said.

To protect the patient from death, suffering and disease is a doctor’s duty, but the law does not allow the doctor to protect the patient from such insensitive relatives. © Dr. Rajas Deshpande

“Madam, there are limitations of physical examination,and we cannot see inside his body. Sometimes we find things wrong inside that can be cured with the correct early treatment. That is the reason we have tests and scans”. I told her patiently.

“But what are the chances of this being a cancer or something life threatening? If at all the scan shows something dangerous, can you guarantee it will be cured?” she asked.

I gave another shot of adrenaline to my patience. © Dr. Rajas Deshpande

“How does that help you?” I asked her, “Even if the chance of a dangerous possibility is low, say 5 %, will you take a chance on your father’s life just to avoid investigations? How can I guarantee the treatment or cure of something we both don’t know yet? By the way, what is your objection to get his scans done?”

“We will do the scan if you say this is urgent” she said.

My patience kissed me a goodbye.

“It is indeed necessary, I cannot say it is urgent. Now I must see another patient.” I replied. Then looking at her anxious father, I reassured him “It is a very low chance that there will be anything dangerous. Please relax. And we have cures for many diseases now, I am with you. Don’t worry”.
“Then can we wait for the MRI?” the daughter was incurable.
“No” I replied, calling in another patient.

I received many messages for next few days from her and her invisible brother asking if the scan was really necessary, where was it done cheapest, etc. I didn’t reply.

They returned after a week. The MRI showed a tumor causing pressure effects on the vital areas of lower brain. This indeed was an urgency, if not emergency. I told the daughter so.

“How come he developed a tumor? He never had it earlier. No one in our family had it ever” she asked angrily, “Is it the side effect of all the medicines he has taken in last two years?”.

I had almost forgotten in which society I was practicing. Education does not always convert into common sense. Money, skimpiness and hatred replace logic here. © Dr. Rajas Deshpande

“In most cases, a brain tumor is not the effect of commonly used medicines. I don’t know the contents of all the medicines you tried upon him. But the delay in doing tests is one definite major factor that your father has suffered so long”. I told her. What must be said must be said!

She changed the topic, a knack every doctor must learn from some lawyers!

The patient has now undergone a surgery by one of the best neurosurgeons, and fortunately the tumor has turned out non cancerous. His headaches and vertigo have gone. However his anxiety and fear will take a long time to go, he is on the medication for that.

The daughter has changed a lot too. The last time she visited for her own headaches, I told her to get a check scan done, and she showed me the reports the same evening. They were normal, she is happy now!

Many patients suffer for years, develop disability and some die due to such dangerous relatives who experiment upon them, delaying investigations and treatment. The most common purpose is saving money, but there are also whims and illogical, dangerous treatments without the knowledge of the contents and interactions between medicines of different medical and quackery streams. The doctors who try hard to save the damage in the last moments often become victims of criticism. This dangerous disease called “Relatives” who suggest everything but disappear when the patient truly needs them has become rampant in our society!

As for my patience, I had to take it for a long night drive and feed it a lot of icecream that day to agree to return to stay with me again.
© Dr. Rajas Deshpande

(Yes, some doctors take advantage and earn money through tests. This is definitely wrong, but the price of delayed and denied tests is far more. In fact, many relatives make that an excuse to avoid spending for the tests. It is conveniently forgotten that almost all essential tests are available at govt. / charity hospitals at a negligible cost).

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The Bleeding Curse of an Extraordinary Doctor

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The Bleeding Curse of an Extraordinary Doctor
© Dr. Rajas Deshpande

“I cannot sleep well, I cannot forget what happened” said the doctor who had come to consult. I was shattered myself. My usual poise was blown to pieces listening to what this mountain of sacrifice was telling me.

As Dr. Anil Dadarao Waghmare told me about his past, I was in frightful tears.

Son of a humble education officer, he had joined MBBS on merit basis, and completed it in time. He wanted to honour the government bond for two reasons: he had an inner desire to serve rural areas in India where medical care was not available, but he also had no other source of income and had no money for investment. This is the common story of most doctors graduating in India.

He joined as a medical officer and was soon posted in a very remote tribal area, where he went beyond his duty to help the illiterate poor tribals. He worked ‪24/7‬, attended all their problems like deliveries, poisonings, snake bites etc., but also went to visit homes of those who could not reach him. He offered his designated vehicle as an ambulance whenever someone was to be taken to a higher rural hospital. His wife and children accompanying him sacrificed normal life. Two of their kids went to the local primary school, the quality of education was extremely poor but they had no option. The third child was only 9 months old. This youngest daughter was often looked after by a 12 year old girl who lived next door, and helped Dr. Anil’s wife with her chores.

One day, Dr. Anil’s wife received a phone call. The lady caller who spoke in local dialect told her that this youngest 9 month old daughter was in her possession, and threatened to kill her if a certain amount was not paid immediately. By the time they could arrange anything, the infant was found dead by suffocation. The 12 years old girl who looked after the child was found dead in a local well after three days, a huge stone tied to her body.
The murderers were soon arrested: the lady confessed to the crime, assisted by her parents, for want of money.

All the three: the murderer lady and her family were being treated by Dr. Anil for over a year, as free patients.

Dr. Anil was transferred elsewhere, and decided to still continue serving the rural population. He has now joined a postgraduate course, but he wants to keep working in rural areas.

“No one cares about a doctor’s life, family or especially security. The situation is worst in the rural areas, where illiteracy, superstition, witchcraft, murders and rapes are commonplace. Local politics is at its worst” says Dr. Anil, “I was ready to sacrifice every pleasure in life to serve rural population, I even compelled my family to sacrifice, but I did not deserve this punishment. This pain is beyond description, sometimes I feel whether my decision to go to such unsafe place with family was correct. This bleeding curse kills me every moment”.

Thank you, those who keep saying that our society considers doctors ‘like Gods’!

While air conditioned hypocrites advise doctors to go and serve in the rural areas, no one will look at the big picture: there are no facilities, but worse, there is no security. You are left at the mercy of local criminals, often politicians.

Film stars, directors, politicians and many judges will never notice this kind of a story, just as they won’t ever comment about the sickest lowly traditions in their own individual profession. Communities ripe with rapists and murderers, and onlookers who film rapes or murders rather than trying to stop them, expect the best brains to work for their healthcare at meagre salaries.

There is nothing wrong with a short term bond for service in rural areas, but while signing such a bond or joining such areas, the doctors should also ask the government a written guarantee of security. This should be the part of the bond. If security can be provided to every TDH in politics, filmdom or to even the lowest ranks in the judiciary, even some criminals, it can definitely be extended to the doctors serving in rural areas. A doctor who feels threatened cannot work and in fact should not continue to work unless adequate security is provided to him / her and family.

Dr. Anil Dadarao Waghmare, you deserve the highest medal any doctor can ever get: because you showed this selfish society how big a doctor’s heart can be, by continuing to serve in rural India. From now on when the loudmouth foghorns in politics and administration try to malign our profession, or try to cover the gaping deficits in basic facilities at rural level by pointing fingers at the doctors, we can tell them your story.

As for the loss of your 9 month old daughter murdered by your own patient, I stand up in tearful, shameful regret of the state of affairs of Indian Rural Doctors.
© Dr. Rajas Deshpande

PS
It is high time the doctors unite to take a strong stand against aggressive attitudes of society, against stupid policies and being taken for granted and spoken against by uneducated loudmouths.

This story should reach every blabbering idiot who has no doctor in the family and keeps on expecting all doctors to be servants of this society. To those among doctors who try to impress faceless media or administrators by continually talking negative about our own colleagues, this story should serve as an eye opener.

Thank you, Dr. Anil Waghmare for the courage and permission to share this story.

Which Is The Best Festival Upon Earth?

Which Is The Best Festival Upon Earth?
Dr. Rajas Deshpande

“Happy Diwali” said Mr. Abdul as he entered with a box of sweets in the OPD.

Over five years ago he was admitted with a complete paralysis, and had fully recovered as he had reached the hospital within two hours of the onset of paralysis. Since then I had received his Diwali hampers without fail.

A happy gentleman who liked to make funny sarcastic comments (maybe Pune effect), he made me smile every time. “Your fees has increased, doctor, but my feelings of gratitude for you will not change” he said now, silently laughing: “Every Diwali I remember that I was admitted on the Laxmipooja day, and our family was worried if the specialist doctors will be available. My wife was praying that there should be some specialist doctor to attend my case all the way from home when I became unconscious” he recalled. Dr. Rajas Deshpande

Indeed, he was admitted on the auspicious festival day, the junior resident doctor had activated the stroke code, our team had rushed in. I was already in the hospital to see a VIP leader whose headache usually worsened on holidays and then many specialists had to be called in to ego-massage his headache. So I could see Mr. Abdul immediately, and explained to his family that his condition was critical, that there were risks of complications in the first few days. Uncertain with the new doctor, they requested that I talked to their family physician Dr. Feroz. I did.
This is but natural, and there was no reason to feel offended with the anxieties of a serious patient’s family. In the age of trustless relationships where couples check each other’s cellphones like detectives and parents and kids question each other’s intentions, it is hardly possible that a serious patient’s family will blindly trust a new doctor. Even some doctors distrust new (not senior / junior, but the one being consulted for the first time) doctors. The only possible solution is an understanding doctor who takes this in stride, refuses to be offended, and acts in the best interest of the patient, taking an extra step to make the worried family comfortable. There are indeed some who never trust anyone whatever one does to satisfy them, but that is their own cross to carry, one should simply ignore the ugly trait. It is well known that those patients who do not trust any doctor suffer worst, as they don’t take anyone’s advice seriously. Dr. Rajas Deshpande

Three days later, as Mr. Abdul recovered, the family breathed in some confidence, and started believing all that I explained, without having to involve their family physician. Since then, although I have advised that he does not require to see me now, and instead he can follow up with Dr. Feroz, Mr. Abdul visits me every six months for a check up. His wife calls me Rajabhai, a name I would not have allowed anyone to call me with, but couldn’t dare tell this to her!

This is a pretty standard picture across India, most of even the poorest recover well from strokes, accidents, burns, infections, fractures, heart attacks and various other emergencies if they reach hospital in time. While people all over the world wish happy festivities to each other, take holidays, revel and eat and enjoy, while leaders give long festive speeches from their farmhouses to please various voters according to mob IQs, it is the professionals like doctors and servicemen like police, military, etc.who slog and run to save lives. They forget family and enjoyment to be available for those who suffer. The perpetual thankless will immediately say “but this is a choice you made”, but not understand that this choice was made to be respected, to earn well and to save lives, not for the society, the skimpsters and politicians to take advantage of. To see the sick and crying, angry people, to witness death and disability on the very days that your family expects you to be happy with them is not something one can easily come to terms to, and this is lifelong, not a five year term with long vacations. Dr. Rajas Deshpande

The fact that millions of critical patients are attended well during the most auspicious festivals: Diwali, Eid, Christmas, and all other religious festivals included, is conveniently forgotten once the festivals are over, and then the mudslinging about medical professionals starts, with the long speeches advising doctors to work harder with lesser expectations. Dr. Rajas Deshpande

“Doctor, this is not about Diwali or our religions” Mr. Abdul said while leaving, “this is to continue the tradition of humanity. There must be so many patients who can be with their families this festival, because some doctor worked hard to save them. This is my token of respect for those doctors”.

As always, I told Mr. Abdul that I was immensely grateful that the superpowers gave me this opportunity to be a doctor. I meant it. Dr. Rajas Deshpande

I often imagine: what if I was born with too much money, son of a rich father, with no worries for earning and no limits on spending, I would so much love to roam around the world in luxury cars and jets, among beautiful people (you understand), enjoying life to the brim, without caring for any suffering around me. In that case, I might have been very happy probably, but I won’t have respected myself as much. Even the most junior, newest recruit of a doctor is far superior to anyone who has chosen to cunningly ignore the suffering around, speaking big words and doing nothing about it.

Therein lies the best festivity in life: being a doctor, with an ability to abolish suffering and avert death.
Dr. Rajas Deshpande

Happy Diwali to all Patients, Medical Students, Junior and Senior Doctors, Resident Doctors, Nurses, Technicians and wardboys, Hospital staff and administrators, and to everyone who cares for others, showing it in their actions.

Advise Doctors What To Do?

 

For the hypocrites who don’t do anything to correct their own profession (almost every profession has immense corruption), but think they have the right to criticise other professions. Criticising the most intellectual profession of doctors irrespective of one’s own credibility, effort, contribution, or even intellect, has become an ugly fashion.
Here’s the answer:
(C) Dr. Rajas Deshpande

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The Silent Murders and Medical Suffocation

The Silent Murders and Medical Suffocation
© Dr. Rajas Deshpande

“Your grandfather is admitted and serious. Please come at once” my uncle said on the telephone.
I was in the first MBBS. This maternal grandfather was my closest relative after my father. An expert in many languages and philosophies, he was a constant source of love, wisdom and inspiration from my toddler days.

I submitted a leave application and travelled immediately to attend him. Grandpa was admitted in the general ward at the civil hospital Beed in Maharashtra. As the wards were full, he was kept with two other patients in a sort of a broad corridor, and IV antibiotics with saline were being given. He was delirious, but he managed to smile when he saw me. As civil hospitals do not have many medicines, my uncle arranged them from an outside pharmacy.

There was an elderly retired police inspector, Mr. Gaikwad, on the bed next to my Grandpa’s. He had uncontrolled sugar levels, and was slipping in and out of consciousness. His elderly wife was attending him, she was herself a patient of severe arthritis, and could not even get up or walk without excruciating pain. There were no chairs / stools or even mattresses for relatives attending the patients, so we slept on the floor besides our respective patients, upon our own bedsheets. I naturally attended the elderly couple too, I had enough time to attend humans as that was the pre cellphone era. Mrs. Gaikwad told me how her husband had spent his life without ever being corrupt, and said while she was proud that he was so clean, that also meant hardships like the one she faced. “Those who took bribes can afford to go to the private doctors in big cities and keep attendants. Our virtues translated in more hardships, the vocal rewards of words do not ease physical pain, nor pay any bills” she said with tears. © Dr. Rajas Deshpande

One night at about 3 AM, while I was deep asleep, I heard a scream and got up startled. Mr. Gaikwad was having a convulsion, and his wife shouted in panic. I ran to call the nurse, but there was only one for the entire ward and she was in the washroom. By the time she came out, the convulsion had stopped. She stopped the insulin drip and called the doctor on duty, who was asleep in the casualty. He came and administered some medicines and went away, exhausted. He was on duty for over three days in a row now, tired and irritable, yet had no option but to go on. I dozed off again. © Dr. Rajas Deshpande
In a few minutes, I realized Mrs. Gaikwad was waking me up again, shaking violently, because the IV needle of her husband had come out and he was bleeding. In panic I stood up. There was some water on the floor, and before I realized, I fell face down upon the bare floor. Such was the impact that my upper front tooth broke, and tore through my upper lip. It was bleeding profusely. The nurse had come and inserted another IV line to the patient by then, and the elderly lady felt quite guilty for my injury.

The nurse asked me to go to the casualty. The wardboy there refused at first to wake up the doctor on duty, saying he hadn’t slept for past two nights. However, as the bleeding continued, he took pity and woke up the doctor. Already angry, the casualty doc cleaned and sutured my lip with the available suture material, the correct one was not there. He asked me to get the painkillers and antibiotics from the pharmacy, and to fill up the necessary papers and pay the fees at the window.
With a swollen lip and an aching head, I returned to the ward and slept again. The next day, Grandpa was already feeling better, he could get a bed in a semi-private room, and discharged in two days after that.
Mr. Gaikwad, the elderly retired inspector passed away after two days, obviously a case of far less medical attention and facility. © Dr. Rajas Deshpande

I carry the scars till date.

Not much has changed in the civil / government run hospitals, even today. Far lesser beds and amenities, a constant lack of medicines and instruments, anarchic uncleanliness, underpaid and understaffed faculty, “sarkari” type procedural delays: overall a third-rate or worse experience in healthcare, with bribes and corruption at almost every level.
What is being projected is opposite though. The whole blame is being planted upon the medical professionals, and all the so-called reforms being made are just tightening of working conditions of the allopathic doctors. We do need reforms in medical malpractice and corruptions, and they are of course welcome, but many more thousand patients die due to apathy and lack of medicines and facilities at the government run hospitals than those who die due to medical malpractice. The number of administrators and government employees who do not attend government hospitals is a proof of the massive healthcare deficit we have everywhere in India. © Dr. Rajas Deshpande

Ambulances, thousands of more basic and specialty hospitals, more doctors, nurses, support staff in govt. run hospitals, better facilities and medicines are basic social requirements before any other development, advertisements or beautification is planned. However, the whole system appears to be concentrating upon the earning, eligibility and qualifications of existing allopaths.
MCI and IMA must also look into “Compulsory Basic Healthcare Facility and Patient Rights and Care” at all Civil / Govt. hospitals, specifying what the govt. must mandatorily implement in all its set-ups, what are the responsibilities of the administration. The overall (incorrect) notion that “All the problems in Indian Healthcare are because of the greed of Allopathic Doctors” is on the rise because of the “Govt. pleasing policies, comments and attitudes” by some. This will be extremely harmful in the long run. Progress can only be made in healthcare once the medical “Yes-Men” and “Yes-Women” are gone, once the voices that can boldly speak the truth are heard well.

Till then, the private practitioners must stay united in raising their voice against such “unilateral reforms” and defamation, or prepare to be forever suffocated by the system.

© Dr. Rajas Deshpande
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The Babaji Doctors

The Babaji Doctors
© Dr. Rajas Deshpande

“Today’s young doctors of today don’t know anything” the famous Senior Surgeon told her, smiling bitterly, “You have nothing wrong. Go home and take a pain killer, you will be fine tomorrow.”
The next day, at 2 AM in the morning, she was comatose, as my Neurosurgery professor in Mumbai prepared to operate her brain. She was found to have a huge tumor in her middle part of brain, that was about to kill her in few minutes.

This student, a girl aged about 21, came to me with a severe headache and mild imbalance. A senior physician was accompanying her as a local guardian, as her parents were in Mumbai. I had found that she had some warning signs, and told her to go for an urgent MRI. This is a standard protocol for any headache with neurological dysfunction. The accompanying physician told her in front of me “We will go and have a second opinion from the famous senior doctor. He is my friend”. I was not offended at all, this is the right of every patient. A senior doctor would definitely have better experience if not knowledge or specialty training. But I did feel sad about the ease with which this senior physician had underplayed my opinion. That he didn’t understand something did not give him a right to challenge it. © Dr. Rajas Deshpande

Next morning the girl messaged me that the F.S. doctor had told them “Nothing was wrong, that new doctors advised unnecessary tests, told her to take a painkiller and go to college next day.’

She went home and rested that night. The headache was a little less by morning, she texted me so. By afternoon, in the college, she started feeling drowsy and had a vomiting. Her local guardian physician asked her to travel to Mumbai to her parents and take rest. On the way to Mumbai by car she became unconscious. Her friend accompanying her called me (the F.S. did not pick up their call). I advised them to immediately contact my Neurosurgery professor in Mumbai for further help. I called him and informed so too. They reached Mumbai late evening. Her MRI showed a large brain tumor that was blocking the flow of fluids around the brain, and causing compression on the lower part of the brain. She was minutes away from death. My professor decided to operate her immediately.

Starting new practice, in the beginning weeks in India after three years of fellowships in Canada, I had far less patients, and more time to spend with each one. Very proud, I was also somewhere pleased by the brilliant competition I faced, and the fact that malicious bitterness was usually a certificate of good work. According to a saying, critics help one thrive. So long as I set my practice standards high and respected them myself, I wasn’t interested in any competition, nor feared any. Silence was the best weapon and I used it freely in many situations especially when refusing to be dragged in low level gossips and backbiting, not uncommon even in the medical world. © Dr. Rajas Deshpande

“Say what you must. Make your point twice and move on. Don’t argue, because then you presume everyone is equally intellectual. The greatest rule of all is that truth will prevail.” Dr. Sorab Bhabha, my professor had taught me. I follow that to date, but I fail in the test of tolerance sometimes.

Many times, to impress the patient more than one’s competitor, some doctors resort to quite unfair and unethical means. To cunningly use patient’s dissatisfaction, reluctance and doubt about medical expenses and to say ‘immediately pleasing and gratifying’ things to make the patient happy is an art which some (senior and junior) doctors wisely incorporate into their practice.
“Don’t do surgery that the other doctor advised you, Those tests were all unnecessary, We will take a second opinion because I am not sure about this doctor, etc.” are the common tricks used. This gets them the instant faith of the unsuspecting frightened patient. This can then be gradually used to drive home the same advise as of the first doctor, but in different words that please the patient. © Dr. Rajas Deshpande

I am not against unnecessary sweet talking, although I don’t want to ever do that. Most doctors of my generation don’t believe in it. The patient must be told the truth compassionately, in the least hurting, non-frightening way, and any queries / doubts that may arise should be realistically addressed. Patients should be told the good and bad of every treatment option, and they should be encouraged to make informed decisions.

A doctor is a scientific, intellectual and compassionate service provider, and should refrain from being a pleasing-gratifying, patronizing or clownish entertainer at the cost of patient’s health by making compromised healthcare decisions, just to keep his/ her “Famous and beloved” status.

Some doctors also think of patients as their “personal property” and when they refer such patients to the specialist, they send a list of instructions and interfere with the specialist’s planned strategy. Some admit under their care patients who do not belong to their own specialty, then pay a good specialist for the correct diagnosis, and then google-treat the patients from standard treatment protocol sites (harmful, because the same treatment protocols do not apply to each patient). This unhealthy practice, mainly based on referral / cuts, will hopefully reduce with laws against cut practice.

Any intellectual will understand this: that with the vast expanse of medical field and research, no doctor can claim to “know it all”. One can only be proficient in one’s own specialty. Where a specialist is not available, or in emergency (this is the term most misused in such cases) one can use the best of one’s knowledge to treat the patient. Unfortunately, India is full of illiterate and poor (and also educated paranoid) patients who will only believe what is most financially suitable to them, will easily fall prey to the magical sweet talking abilities of a doctor, and blindly follow what is told, without ever knowing right or wrong. That is the reason of a rise in the “Babaji Doctors” in this country with so many Godmen in almost all religions! © Dr. Rajas Deshpande

These medical equivalents of “Baba”s will have a benevolent smile, talk very reassuringly, speak only what the patients like to hear, and wisely try to convey that they know better than any other doctor, even the best specialists who have had excellent training in very specialized areas. Quite fortunately, younger generation patients are far wiser than to be affected by these pseudos: sweet talking without a reason is an immediate turn off for most intellectual young.

The hierarchy of education, qualification and specialised training is always superior to the hierarchy of experience. An MBBS passed out 50 years ago cannot be better than a MD passing out today. The ones with higher qualifications and training, even if far younger / junior, must be treated as above one’s expertise in their respective field. Yes, if the degrees and training are equal, then experience matters. © Dr. Rajas Deshpande

“ I don’t agree with your diagnosis, I don’t think that this patient has Parkinson’s disease” a senior surgeon once told me in front of a patient he had referred.
I know no one can be perfect, and I can be wrong. But I also know who is qualified to say that I am wrong.
“With all due respect, Sir, you are not qualified to comment in this specialty, just as I cannot challenge your diagnosis in yours” I replied. Age that does not match its behavior need not intimidate me, especially where a patient’s diagnosis is concerned. A doctor’s first duty is to tell the truth to his patient, and a part of that truth is what the doctor does not understand.

Pretending expertise in medicine may be fatal for a patient, no true blooded doctor can accept that.

As for the girl who was operated that midnight, she is now married and has two kids. She called a few months later to tell me she was doing well.

I continue to meet patients every other day, who have visited the F.S. doc, and tell me how he told everyone else was wrong.
Unfortunately, the only treatment in such cases is awareness.

© Dr. Rajas Deshpande

PS: Most doctors follow the ethics of not criticizing other doctors, which is required by the Medical Council. However only very few senior doctors have a heart big enough to welcome competition. This causes immense difficulty to the newer generations of specialists. Hence this article.
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