Tag Archives: HealthcareIndia

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

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

©️Dr. Rajas Deshpande

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

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

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

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

“You must respect the authority “ the court said.

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

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

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

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

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

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

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

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

The doctor said

“Yes Milord, but the real answers will hurt:

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

“A culture of exploitation of non-votebank groups

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

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

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

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

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

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

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

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

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

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

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

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

(C) Dr. Rajas Deshpande

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The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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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 Overdose of Medical Advice

The Overdose of Medical Advice
© Dr. Rajas Deshpande
“If the doctors want to go to a five star hotel, they must pay for it” said someone recently in a headline.
Well yes, like any hardworking honest professional, even a doctor may want to go to a five star hotel occasionally, and have a good time, especially given the sadness that surrounds his / her profession. There is nothing that prevents me as a doctor from wanting to go to a five star hotel once in a while, and I do not feel guilty about wanting to live a good life. Earlier, I was happy to attend some great lectures by the world’s best doctors brought to India by the pharma industry (because the government never can), now I will just pay for myself.
Whether a five star meal comes from the profit of pharma industry or the hard work of doctor’s fees, there will be objections for sure. The problem is not the five star meal, the problem is elsewhere. So the different ministries can officially host super luxurious parties on different religious / non religious occasions to woo voters via the taxpayer’s money (and the media will describe the Biryanis and Gulab Jamuns in paragraphs), but the doctor must never eat a free luxury meal!
Many non medical professions, industries, financiers, film industry people, bankers and builders host dinners / other events at five star hotels, and many government officers / ministers attend them. Do they all pay for themselves? Just because a minister attends a five star dinner, he cannot be presumed to be doing a hidden favour to some industry, likewise, a doctor attending an academic event cannot be presumed to be doing a favour to any pharma. © Dr. Rajas Deshpande
It is doubtless that some doctors may have misused this facility and overspent. But the huge advantage: giants in the different medical fields from the developed world coming and educating the doctors in India will be greatly sacrificed by such limitations.
Given the social envy and jealousy against the doctors now rampant, it is probably an inevitable but unfair step by some organisations recently to ban pharma sponsorship of certain medical events at five star hotels. It is also a good initiative to reduce drug prices. But then, can the same organisations and even the federal bodies show the same guts and ban following malpractices too:
Open sale of undergraduate and postgraduate medical seats all over India, that creates funds worth trillions, benefitting even some in the highest offices of the country? Where does this money come from, and where does it finally go? Are we innocent enough to presume that the patient is not ultimately paying for this? © Dr. Rajas Deshpande
Under the medical consumer protection act, is not the government required to make all the facilities of healthcare available at all government hospitals in our country at subsidised rates? It is argued that taxpayers are paying for the education of medical students who enter medical colleges by merit, which is wrong, because the taxpayers are actually paying for good health facilities at the said hospitals. But most of the hospitals / medical centres run by the government are understaffed and run far below acceptable conditions. How many government health set ups have been evaluated for accreditation by standard bodies, and what are the results?
The insurance companies and corporate hospitals have held the private doctors prisoners of their atrocious conditions, and even the paying patients are being provided a substandard service, thanks to a total absence of any willingness to question any of this on the part of administration.
The demand and supply of “Cheap everything” in medical profession has now gone to such a dangerous extent, that substandard staff, incompletely qualified professionals, low rate medical instrumentation and quality of service, and above all, ineffective / low quality medicines have become a horrific reality already, even at some corporate hospitals dominated and dictated by the insurance sector.
They are giving people what they want: Glittering Cheap Healthcare. It is so surprising that the patients are happy with only this one quality of service and drugs: cheapness. The day that our society will understand that like anything else, good healthcare will cost more and will obviously involve more profit-making, our health scenario will improve. © Dr. Rajas Deshpande
The IMA, while trying to play safe and readily making rules like banning sponsorship, should take a firm stand to fight against the one sided war waged upon the medical profession by some.
Written in a state of perfect peace, not frustration.
Because I am not sold out to the desire to be liked by everyone, especially those against doctors.
© 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

Female Foeticide versus Lifelong Socio-cultural Sadism?

 © Dr. Rajas Deshpande

Whenever female foeticide is discussed, many self-crowned intellectuals run the horses of their pseudo-western philosophy against the entire medical profession. Some irresponsible media asks opinions of the very same majority people for whom our desi government has to run billion dollar campaigns, educating them to shit in the toilet. Might as well ask them the solutions for global warming, terrorism and corruption!

What does our society do once a female child is born (again with the help of doctors)? 

Daughter, Sister, Wife and Mother: almost every female around us (except probably a girlfriend) is taken advantage of, ordered around, made to compromise, told that she must accept the limitations of being a woman, and in general made to live an enslaved and dependant life, under sweet names of love, responsibility, security and a “bad world for women out there”. Who makes this bad world?

In many cultures, the girl child is fed poorly: typically the ghee and sweets and “costlier” food goes to the male child, especially in big poor families. Even the rich and educated are seen having many daughters in a hope to have a male child, and after having one, spending far more on that male child. The girl child has little freedom to dress by choice and play, and is forced to believe from pre-adolescence that kitchen and bedroom are her workplaces for life. Many parents are averse to the idea of their girl child going to parlours or theaters and opting for friends, hobbies or even hairstyles of her choice.

Many parents do not spend upon the education of a female child, the “prime investment” goes in educating the male child even when the female child is smarter, intelligent and hard working.  A girl wanting to pursue higher studies is mentally raped by umpteen relatives who pressurise her parents into shame if she is not “married away” before 25 years of age. (RAMP syndrome: “Relatives Affected with Marriage Psychosis). The dreams of a female child are killed every moment, almost all her active life.  Most men in all fields opt that their wives “look after the kids and home” even if equally educated or better in some cases. While some recent generations encourage equality, this is only urban. A girl is trained to think and say “ I enjoy staying at home and looking after the family as this is what a woman is supposed to do. It is okay for the husband to come home tired or drunk, hit me if angry, and in general to take me perpetually for granted”.

Let a grown up girl walk on any street in India and watch our “manly” public’s eyes following her. You will understand how many of them truly respect women. Let a woman grow socially or at work, and observe the comments of her colleagues about her character. Let a woman decide to marry for love, and there are open decrees to kill her. In a country which runs local trains with one out of ten coaches for women, and reserves four out of twenty seats for ‘ladies’ in a bus, how many people really care for equality of a female foetus and it’s life? In a country where women have to be elected by reserving electorates across male-dominant cultures, who will enforce respect of a poor girl child?

In a society which wakes up to graphic contents of rapes and murders of females aged few months to upto seventy years, how many will stand up actually when a female is being raped or murdered? It is easy to shoot hate content against an educated, civil, non-violent community of doctors. It is easy to blame an entire profession for the faults of a few greedy doctors. Do these “pseudoactivists” have enough courage to stand up against their own female-enslaving culture? Do they have courage to treat their own wives, sisters and daughters at par with men in their own family/ community?

 On every street in every metropolis, hundreds of children – girls and boys- are made to beg naked, dancing, cleaning cars and ever hungry. Where are all the activists who fight for the agony of unborn female foetus? What are your plans for the already born female children begging insecure across the country on every street? Also, one wonders about their views on “male foeticide”, a common abortion. How come male child murders are forgiven? Some of these “pseudoactivists” are like typical orthodox husbands, who flirt with their female colleagues at work talking about freedom, but take an offence when their wife talks to other men.

Female foeticide is ugly, bad blot on our society. It must end. But please stop pinning the entire blame on the medical profession. The facts mentioned above are enough proof that even without the doctor being involved, our society continues to be extremely unjust and cruel to women. Introspect. The female foetuses must be saved. But after their birth they must also be nurtured, loved, respected, treated with genuine equality and given equal socio-cultural freedom. Do these activists have guts to fight for that? There should be a precondition for every “activist” of this cause to adopt at least one girl child, and look after her proper food and education giving her complete freedom.

Activism for females should not stop once they are born.

PS: The radiologists and gynaecologists / obstetricians have a lot more practice beyond and unrelated to abortions, and are far more human in caring for women than most of the society. None of the doctors starves without this “abortion business” as claimed by some activists and media. In a country where there is huge shortage of expert doctors, it is ridiculous that they have been made the easy targets for everyone’s mudslinging.  

Jai Hind.

(c) Dr. Rajas Deshpande

 

The Critical Diagnosis of the Indian Doctors

The Critical Diagnosis of the Indian Doctors: Doctor’s day special.

This article is also a test of how our society tolerates truth.

Recently read a flash news about Eminent Doctors taking cuts / referral fees. There cannot be any justification. But if a whole system based upon corruption, a whole society facing inflation expects only one of its components to be sane, it’s insanity. Hence these thoughts.

I apologise in advance if this hurts some feelings. This isn’t a placebo though.

For the “Nautanki” people who appear so shocked to hear about corruption in the Medical field, here’s the naked truth:

There is corruption in every aspect of every field including religion, law and judiciary, government, politics, police, press, military, film industry, YOUR FIELD, and also medicine, as the doctor is a part of this very same society, not from Mars. There is corruption in every aspect of medical field: referring a patient, lab tests, CT/MRI, Surgeries, Cross referrals, almost everything.

But as in every field, there are people who do it by choice, there are some who have to be a part of the system to survive in India, and some who refuse to be a part of it all, facing many other problems including a perpetually low income.

Think Simple: why would a person with highest of merit, hardest of hard work, tendency for helping others want to become corrupt? Not by choice. No one becomes a doctor for greed (Someone might attempt, but these people drop out in the first six months or a year: Those not dedicated to a hard life cannot endure medical education in India).

Every doctor wants to do good to his patient and also live a decent life. After a lifelong meritorious career, why should he be expected to toil in villages / rural areas without any rewards for it? Why should he not want his kids to go to the best schools? Why should he not want a decent lifestyle? Why should one give up a lucrative career in the west and return to the homeland feeling patriotic, to just be told that in your own country you are doomed to a life of sacrifices just because the society expects so?

“Someone who wants money should not become a doctor” said a dropout actor who is seen doing all immoral things (from peeing openly in a garden for press in real life to cruel crimes and revengeful murders on film: while running a show to change India to an ideal country.. I hope he and his family only use Indian things, medicines etc.). Why?

Why should a doctor not want money for a decent life? Why should he endure the humiliation of so many non-meritorious people from his class livin in luxury because they chose not to be  a doctor, while he chose the noble profession?

Listening day-in and day-out to patient’s problems, tears, cries, allegations, threats, and expectations, not ever having a peaceful sleep for a week at a stretch, not eating in time, not having enough time for family, why should a Doctor NOT want to earn well?

We are not supposed to refuse a case in emergency. Do the Judiciary or Police or Politicians do that?

We are fined crores for medical negligence. What if the Judge is wrong? What if the police are wrong? What if the politician is wrong? What do they pay even when proven wrong? Why the presumption that the negligent doctor’s intention was bad? Negligence is possible in all fields (reactors/ bridges/ buildings/ food/ trains/ public transport), can cost life in many, how come the doctor alone pays in crores for a life that he was attempting to save, while in all other cases the motive was profit, not saving life…?

How come the judges decide the amount of fine? In a recent case, the fine was in crores. If the patient had survived, would the court have ordered the same payment for the doctors? Doctors  save millions of lives. Some through heroic / exceptional efforts, without thinking of rewards. If a young patient is saved, shall we charge according to all the income he can make all his remaining future? Than why this criteria for fines?

World has become a global village. People travel to the developed world often. Highly specialised doctors in India are expected to be at par with their western counterparts. They often are, because half the world travels to India for medical advice.

But the Indian community is yet to awaken to the Doctor’s fees. An average specialist in the developed world charges between 10,000 to 30,000 INR for the first consult. Appointments are very difficult to get. They don’t work out of 8 am -4 pm slots except in emergencies (some honourable exceptions).  And yet they get so many benefits from the hospitals they work at, and also from the government. THEY SEE NO FREE PATIENTS. Most doctors live in luxury in the western world.

An Indian doctor on an average charges 300 rupees for an OPD patient. Sees many free patients (almost 40-50%) everyday. Continuously has to be occupied with:

  1. Patient’s health and benefit
  2. Relative’s expectations, their anger (many think that every patient must get well irrespective of his / her health status). Many hold the doctor responsible for their illness / failure to improve/ complications.
  3. Continuous suspicion: Many patients think Doctors are out to loot! Every investigation is with an intention to get more profit out of the patient. They want the best, but like “sabji”, they want to bargain.
  4. There is also a widespread belief that pharma industry is actually serving the doctors, not patients.
  5. Google searchers who think they know better medicine just because of what they recently read about a tiny drop in the ocean of medicine. They eat up a lot of time, but don’t want to pay for that additional time.
  6. The very relatives who shout at the doctor seldom know what medicines the patient is taking: it is all supposed to be the doc’s responsibility.
  7. So many Toms, Dicks and Harrys coming over and threatening: this is everyday nuisance in ALL casualties in India. There is no sensible Director in Bollywood to have realised a Doctor’s plight while working under threat in casualty. Everyone loves the populist “Doctor-Threatening” hero!

Then the seemingly innocent weapon (The secret bleeding wound in many a Doctor’s heart!!)

“But Doctor, You are like God / Next to God. The whole society respects you”

That respect is divine for us, that respect and the satisfaction of doing something godly by saving lives, helping people live better lives alone keeps us from going on and not quitting the profession for better incomes. Don’t you think we had the options of making more money had we used our talents elsewhere, especially in today’s IT world?

But that respect does not substitute for our children’s fees. Not for our rents, electricity, travel ANY expense. Almost all doctors and their family members end up paying full bills for themselves at the very hospitals that they work in… some minor exceptions. Everywhere a doctor goes, he pays the same money that any other citizen. There isn’t a separate queue for a doctor anywhere in any office just because he / she has patients waiting. There is no pension. There is no security. I can show you some highly successful (in patient care) ethical doctors who can’t pay for their own treatment TODAY!! If a doctor is sick, his / her income is zero as long as he does not work: No one cares if he has treated hundreds for free.

The respect does not substitute for the stress a doctor bears: of years of listening to and attending pain and tragedy, years of sleepless life, fasting days, lost precious time with dear ones.. as with anyone else, the DOCTOR ALSO HAS ONLY ONE LIFE… WHICH HE CHOOSES TO SPEND HELPING OTHERS.. is it a crime to be living well for such a person?

As for the other side:

There are corrupt doctors, corrupt practises. But please understand, a single doctor did not create them, nor did a group plan them These developed over time as the system evolved.

Like in every field, there are greedy among doctors. They ruin the reputation. But a single doctor cannot do anything. Those who try to change the system are boycott, thrown away, maligned.  There are some continuously fighting this.

Every doctor cannot afford to start a hospital of his own. He has to choose a specialty hospital which has all the facilities to practice his specialty. These come at a price. I appeal the people who feel bad about investigation prices to just enquire the rates of the machines/ skills/ licences/ manpower/ maintenance required to make these facilities available. The government makes it compulsory to attend many of its employees free / at subsidized rates, and never pays.. who will pay for them?

So hospitals have their systems. A single doctor cannot change them.

The Medical councils do not have any protocol / system to protect a doctor who faces vindictive attitude from hospitals if he / she wants to argue. Many specialists DO NOT RETURN TO INDIA OR HAVE ALREADY LEFT INDIA AFTER RETURNING due to this one reason.

Doctors who want to run their own hospitals face same bribery, same licencing scams, same corrupt government practices that any other business does. The rates are probably higher, and the regulations stricter.

Doctors are a weak vote bank., hence not on priority of any party. It is more practical for the politicians to openly criticise the doctor / profession in hope of gaining public sympathy / attention. No one wants to attend to their problems, which are many.

The medical council never protected any doctor against court cases or hospital victimising them for fighting against corruption. The regulations made are ancient, primitive. When a whole medical system is corrupt in almost every step, they have taken the approach of superficial actions against individual cases: typically populist. The medical councils KNOW every aspect of corruption, but have opted to fit in some screws where the whole building needs extensive repairs. One’s degree and education of fifteen years becomes meaningless in the eyes of medical council just because there is delay in renewal of licences. How can rules be applied only partially in a system? While many people practice without degrees or knowledge, the councils choose to target the qualified for not renewing their licences: a process that involves acquiring CME points, the money for most such events, travel etc comes from pharmaceuticals, the patient pays: they do not have the online option of CME / licence renewal like most western countries, even in this advanced age! So a doctor is expected to leave his town and practice, get involved in events sponsored by pharmaceuticals, travel with help from pharma companies, stay in hotels with their money so as to renew his licence. But not online. And there is no compulsion that he has to attend the event for his specialty. So a Neurologist could attend a gynaecology event just for CME points and its ok for the renewal!! One can easily get such CME credits without attending the event!  There has to be an online option, or a rethinking of this whole business.

The whole Mediclaim business in India is a fraud: they don’t pay for

  1. OPD consultation / investigations of a patient.
  2. Patients with genuine illness, but without injectables or surgery.
  3. When they do not understand the diagnosis or the fact that some cases do not have a proper diagnosis.
  4. Emergency / Critical care / Specialist charges etc.
  5. Even when they pay, it is their choice how much.

This results in many a wrong practices.

So in a mediclaim case, no one benefits except the company: Patients, Hospitals, Doctors all lose. Still, the Medical councils do not want to do anything. In fact, they don’t have a say.

Add to these:

Incessant calls / emails/ wtsapp messages for any enquiries that pop up in the patient’s or relatives (usually the cousin in America) mind at any time of the day or night: and bitter words to follow if reply is delayed. (That doctor has advised so so… what is your opinion?… I just read on google about stem cell therapy to improve my anger… what say? Etc. etc.).

Then there are sons and daughters who stay in US / UK etc., but leave their parents back in India. They expect the same care but at a low price, and also a daily update by the treating doctor. NO WESTERN DOCTOR GIVES OUT HIS CELLPHONE or EMAIL ID  TO PATIENTS, THEY KNOW THIS, but they talk from there as if fron the top of a mountain..They don’t want to come and attend their dying parents, but vent out this guilt in form of anger towards the treating doctor: Do everything doctor, don’t worry about the money.. I am unable to come to attend my MOM because of business meetings/ no tickets / kid’s exams etc. I lose my patience here often.

If a Judge / lawyer is ever reading this article, Your Honours, please consider these when you next fine crores to a doctor (even if insured, he has to pay huge:

A doctor should not be held negligent if

  1. The patient does not follow advice as written
  2. Patient continues to drink / smoke / eat tobacco/ does anything that the doctor has prohibited.
  3. Does not follow up as directed (most patients miss their follow up dates: doctors are supposed to jump from illness to illness).
  4. Does not show the same care towards his own life that the doctor is expected to take.
  5. Has not given all correct information about himself / herself / his/ her illness
  6. Hidden some information from the treating doctor.
  7. Has lost treatment details.
  8. Self medication / cross consultation without knowledge of the earlier doctor, resulting in multiple medications.
  9. Has had unknown allergies / reactions in the past.

There should be a doctor’s board for each specialty which opines about every particular medicolegal case before the court makes its final decision.

I always wanted to be a good doctor, like most other colleagues I know. I have always heard the courts of justice demand that one speaks the truth.  Here it is. Hope I am not punished. I am not always correct, I am sure some of my friends will correct me. I will keep learning too.

A warning. When the whole medical system becomes non corrupt, patients will end up paying far higher consultation / surgical fees than what is paid now. This is inevitable. Add the legalities to everything, and many specialists will become non-affordable / non available to most. The many many who get free treatment now will be denied that.

Or the next generations will see less and less specialists opting to settle in India.

I love my profession. I Love my country. I love my patients too.

But I also deserve a good life. It is time I stop thinking I am God because the society has presumed so.

May God confer best of health upon all humanity.  May I always do good to my patient.

© Dr. Rajas Deshpande

Question from a young Indian doctor who just passed out MBBS:

Question from a young Indian doctor who just passed out MBBS:

GM Sir.
I am pursuing PG after MBBS. I follow your posts regularly. I have a question: Does the passion we have to actually become doctors and serve society and those who need us actually fade away? Many of my friends tell me that there’s nothing like passion, only money matters after a while, and I should choose a degree which ensures good income. If so, sir, then the corporate culture must be right… the more you earn the better.. Then I would be happy to not pursue the PG and start clinic in villages and be happy with it.. Sorry for the long question but I feel I could get an answer.

Dear nextgen doc:
This answer is going to hurt many within and outside the profession. It will also expect your mature interpretation of what is being said. I beg forgiveness of those who find this unpleasant. In the first part I will mention some established facts, in the second I will offer my suggestion to the ever intelligent younger generation, which is always known to fight and improve upon the situation.

Facts as of now:

1. There is a huge difference in talking “Ideal and Good and Moral and Ethical” and actually doing it, and unfortunately we are in a society which blinds itself to this difference. Our society likes people who confidently talk about good and moral, while it harshly punishes / destroys those who try to unveil truth or hypocrisy. This is why the concept of “service to the society” is to be carefully interpreted.

2. By saying “ I want to do social service and help the poorest of the poor patients”, we also accept and sanction that this class will always be present in the society. It is a class created by the failures of society and government, not the doctors. If this class was not there (as in if the rural healthcare policies were worked upon and implemented without only the doctors being held responsible for them.. doctors don’t create patients or poverty), most Indian population would see dramatic evolution of better healthcare in India.

3. I do not see many passionate doctors now. Most who started out with the golden dream of living a respected, settled life and social gratitude for serving humanity are frustrated coping up with their rents, children’s school fees, mid-size car loans, restrictions and new rules by governments that leave the rich and powerful doctors and corporates out but shred the careers and lives of individual / small / middleclass medical practitioners.

4. The society or the government does not care if a doctor who has served it dies of poverty/ sickness / accident / occupational risk etc. There is no example of a good doctor’s family having been helped by society after his / her death. There is no insurance / protection / retirement benefit in return of medical social service of a doctor.

5. If it was only a question of serving and earning respect, let me tell you that patients make their own selfish choices always, and there is nothing wrong in that. But they will seldom stand by you in case of any mistake / problem you face, beyond curiosity and sympathy. On top of this, you are at the wish and whim of different laws, rules, regulations etc made by those who neither studied medicine nor practiced it especially in villages (from IAS to clerical class). They can call/ humiliate / dictate/ transfer / ask for bribe / disrespect/ ask personal favours / and still treat you like servant irrespective of whether you have done Nobel-prize-worthy social service.

6. A culture of choosing high-earning postgraduate seats has been encouraged in India, a nation of perpetually poor / low income intellectuals, who often have to avail of loans for education, and grow up with the natural desire of living a good, respectable and comfortable life, like everyone else. Government, Parents, teachers, senior doctors, etc., everyone has silently witnessed this process over years. However, we also have a highly pseudomoral society which expects service and honesty at the cost of a doctor’s life, without providing for his/ her needs according to his / her socio-intellectual standing, hardwork and skill. So whatever your education be in medical field, if you follow all laws and criteria of patient satisfaction, the equation is pretty screwed up: that you cannot see more than 20 patients in a day, you cannot refuse a nonpaying patient, you cannot advertise as an individual and so have no way to compete with hospitals who can advertise as they wish, the ethics and morals that individuals must follow do not apply to hospitals. There are umpteen impractical restrictions by governments, medical councils, even upon the most critical surgeries / procedures. This all restricts the income way too much, thus encouraging malpractice. Lower income PG seats are the last choice, and the PGs which have procedues / surgeries have become a choice because of multimodal incomes in these. Naturally, medical care is becoming more invasive. Also the pseudoawareness of the educated about medical procedures makes things worse as they think that the “best” must also come cheapest.

7. Very few of our earlier generation doctors feel responsible in any way for not having fought the evolution of medical profession to the state it is in today.. Success is measured by many a desperate doctors as medallions from the government, money and big hospital buildings, social and media image of a “Godman or Messiah” etc.. they have the money (how? Does not matter), they have the fame (for being present longest in the field… from a time there was no competition or even rules), so they go on advising moral and ethical floral bouquets to the younger generation docs publicly, but aimed at pleasing the media and the low intellect masses that highly depend upon the media to form their opinion. I would like to know how many “Rich and Famous” doctors from earlier generations have helped younger generation needy doctors with money / scholarships for higher education. Most PG seats have been created to earn more by selling degrees.

May I suggest:

Never underestimate your passion. It is the most important thing in life to pursue. But first, know your correct passion/ calling without thinking of something to impress others: you should be able to live with it irrespective of what people say about it, and you should be able to accept perpetual failure for that one passion: then alone it qualifies as your true passion. Finances / fame and social acceptance are not the aims of any passion.

The decision to live a life of low income / poverty is not easy, and is to be made only with the consent of your dependents / family: they did not sacrifice their active life so you cannot take care of them in their needy times. Your duty to take good care of your parents / children cannot be neglected. You may choose to pursue your passion without compromising upon your responsibilities. You will have a husband or wife and kids to grow, and it will be great injustice to your kids if you don’t provide them with a good and healthy childhood and education. Which Indian village has this? Also, for a good married life, you need to spend time with your spouse, otherwise you are doing him / her injustice.So if you have to do social service, do not marry or have children.

If your passion is for medicine, do not combine it with social service. Take your degree, go for higher education or research (both of which are pathetically lagging atleast 15 years behind the developed world, and no one is ashamed of this) and make India proud by working in a developed country which does justice to your medical talent.

If your passion is to medically serve the Indian poor patients, do not expect any financial remuneration, recognition or respect. I will personally respect you as a form of God, like the thousands who are actually doing this right now, all over India, without any recognition. Some of these are in govt service, some small individual and some hospital practitioners. Few with good connections get prizes / medallions / recognitions etc, and most of them either at the fag end of career (not because of their work, but the years they spent), or if they are rich. But then be prepared like myself to have to apply for loans, beg financial favours from people who will advise you about career and take advantage of you every which way they can.

I had made a conscious choice to return to India after the highest education as a passion towards serving poorest of the poor, and I have been made to regret this choice by silent earlier generation doctors who didn’t care what happened to next generation (In fact, it is the senior generations in private practice who kill most of the active practice of their next generation by various tactics), an inert government which really does not care about public health or doctors in general, a corporate culture that works purely as a profit making business, impractical rules / regulations not contested by medical bodies, and a society which prefers not to look beyond immediate selfishness.

There is hope, I am optimistic still (that’s why I am still writing this, staying here). But we now need a medical revolution.

(C) Rajas Deshpande

PS
I absolutely do not mean any disrespect towards the senior generation, including my teachers, who made me what I am today. I only mean that most of those who were in a position and power to make changes, did not do so. I have seen closely the financial and social (sometimes legal) frustration of many teachers who had abilities, and skills of a world-class doctor, but had to live perpetually in a state of financial insecurities. In spite of this, they have always encouraged ethical and moral behavior from us students. I must mention at the same time that if I give an impractical advice, which will push my students into a life of desperation, frustration and dependence, I will feel guilty about it.

Please feel free to share on any platform without editing and with credit.

The Murdered Angels of India

The Murdered Angels of India

(c) Dr. Rajas Deshpande​

This simple looking girl in her early twenties walks into my OPD with her parents. They all are dressed up typically worker/ lower middle class, just enough to avoid obviously torn clothes. Everything humble, barely touching middle class, but very well behaved. She starts telling her father’s complaints in perfect English, and as good as a medicine resident doctor would perform in exams, she relates proper history in the correct textbook format, with a polite comment about examination findings. Definitely better than some US / Canadian / European students I had known would present.

“Are you a Doctor?” my curiosity was awakened by the accuracy of her medical description.

“ Yes Sir, I passed out MBBS from BJ, now doing my compulsory Medical Officership, then will try for PG”.

A hot knife cut my heart.

She will start PG in mid-twenties. She will marry sometime then, have children, raise family while slogging as a doctor, while girls her age fully live their life, proud and rich being a doctor, in most of the developed world. This lady will continue to carry the country’s healthcare burden till some arrogant minister / govt. officer / local politician or general public gets her suspended for not delivering results expected by them: like saving their alcoholic / smoker / aged/ chronically diseased, drug-defaulting, multi-pathy medicating relative admitted at the last moment at midnight after their party is over.

Or else she will keep on begging / applying at multiple corporate set-ups for a decent salary and opportunity, where fresh degree holders from all other nonmedical streams who couldn’t get enough merit to get into professional courses will make her stand in a queue, ask her for different certificates and proofs of ability, and some perfume-suited insulting CEOs will ask her of possible income she can generate, and any “procedural gimmick advantages” she has over others.

Or her teachers will give her sermons on social service being service to God, it being her duty lifelong to serve poor and illiterate helpless patients like they had done, neglecting any of her own desires, especially that of a good life. Or her own richer / well settled colleagues who earned wealth from prior generations will tell her to “Chill and take things easy”.

Or some court will send her to jail for documentation mistakes. Or peel off her degree as if it was bought undeserved by money.

Or worse, some bollywood or other celeb with a devastating past and glycerine tears will preach her how a doctor should be a good human being, and never think about money having chosen this profession.

And like a girl at night in the streets of our country, nobody will protect her.

Among billion-some population, mostly poor and illiterate, of a disease-ridden country where everyone in government, police, business continues to get richer by the day, judiciary and lawyers take eternity to conclude cases while millions keep on paying both handsomely, the medical fraternity is pushed into hell by all of these : PG students are exploited under the “teaching-learning phase” excuse, then medical officer in remote villages as a “social binding duty” (which lawyers, judges, engineers, ministers, IAS, IPS, all others can skip) without proper salary / remuneration (all other classes above have multiple “helpers” and other benefits). And when one emerges from all this “Hell”, they are left out in open, without any insurance / health or retirement benefits / holidays/ loans/ any form of help from any source, but a compulsion by law to attend all emergencies they may encounter, anytime, anywhere, lifelong, with punishment for not attending that emergency.

Why not apply the same to all three: ministers, judges and police: that you must attend to any emergency (state, legal or criminal) immediately, anywhere, anytime, all your life, punishable if you do not immediately act accurately and produce correct results always (judged by public!)? Also, write in capital letters accurately everything that happens, and handover a copy immediately, without being provided a clerk for assistance? Also, let people decide the salaries for ministers, judges, lawyers etc all professions, based upon people’s satisfaction, just as in case of doctors. Then again, let people file cases when they are not happy with the outcome. Let doctors also participate in the decision making of such cases.

Doctors understand law and administration as much as government and legal systems understand complicated, critical, superspecialty & specialty medicine!!

It is ridiculous that people who have no idea of what hardwork goes into making of a doctor make laws about medical profession , and have the audacity to suspend doctors at their wish and whim. The IMA / Medical Councils must strongly stand by and defend doctors who face threats, suspensions, injustice and unfair treatment by all and sundry. This is their first duty.

If the govt. spends upon the making of a doctor, it is not obliging the doctor, it is doing this for the society whose poverty, illiteracy and ill-health is the govt.’s failure, not the doctor’s responsibility. The govt. should learn to respect the merit of its own best students, extraordinary talents who also have the heart of gold to serve humanity via their talent and hardwork. It should encourage their well being and provide for their basic needs without pretending to do them a favour. There is nothing more shameful than this: that thousands of “MADE IN INDIA” doctors leave the country every year never to return, while it is being urged that the world must “Make in India”. Indian doctors practicing in other countries earn name, fame and wealth far beyond possibilities in India. They are far more productive in clinical, academic and research areas than those who stay back to tolerate Gutkha /Paan-eating, Gold-laden, Abusive Corrupt Free-monger Tyrants directly or indirectly in power!

It is a big joke that while most of the doctors slog in rural / backward India to fill up the govt’s failures with their blood and sweat, govt encourages corporate cultures and business houses in medicare, and accredition bodies further make things glittery so as to earn more! As if the millions of doctors practicing in small villages / towns/ cities on their own, (each one of whom is no less than any Nobel-winner as they spend an entire lifetime serving the poor) are worthless without such accredition! Who handles the thousands of epidemics / vaccinations / tubectomies / mother-child care and emergencies at the rural / grassroot / PHC / RH level? Do they have any accreditions? Does any govt hospital qualify for any accredition? Then why this new accredition business has suddenly cropped up where the patient and doctor are both harassed while others including mediclaim companies earn crores? On top of this, while everyone acts harshly against individual doctors and suspends them at the drop of a hat, the medical bodies are magically and tragically silent about corporate hospitals owned by big business houses, quoting that there are NO RULES against them, and medical councils are not authorised to take action against these big set- ups. They can get away with false advertising , harassment of doctors and even medical negligence without being acted upon by any medical body in India!! How pathetic and mean!! So anyone with money can form a medical company and start open advertisement about diabetes, heart disease etc., while the medical bodies will act only agsinst individuals who do so.

Even the few rich doctors in our country earn less than a tenth of what they could if they had chosen to practice in a developed country. Still almost everyone doubts the intentions of most doctors.

Coming back to the lady doctor in my OPD, I told her that her father may require an MRI as stroke was suspected. She hesitated for a moment, then her father asked in a shaking voice “How much will it cost? We have one thousand rupees only.” As I begged our kind Radiologist for another free MRI (Which she granted as always!), I avoided eye contact with the embarrassed family.

If a young meritorious MBBS doctor passing out from a premium government medical college (indicating highest standards of medical education in India) has to beg for basic medical facilities, while not being able to properly provide for her own parents, not only us as a profession that has failed to stick together to deserve respect and financial security, but the government, administrative bodies, medical bodies should all be ashamed of the state of affairs of medicine as a profession in India.

It is high time we demand “IMS” (Indian Medical Services) as an autonomous body to develop and control the medical services in India.

After all, Resuscitation is our prime duty.

(c) Rajas Deshpande

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The Human Humbug Virus (HHV)

The Human Humbug Virus (HHV)
© Dr. Rajas Deshpande

It’s a boon that the animals did not learn human languages and are not allowed to have facebook accounts. Otherwise Tigers would have complained about how cruel Lions are, and Rabbits would have intensely criticised Elephants for eating too much.

There is a huge number of “Advisors to the Doctors, Hospitals and Medical Professionals” from various non-medical streams, whose basic qualification in this field is the ability to carry on meaningless humbug that suits the social unrest against Doctors as a class.

Let me clarify few things at the outset: I love and respect my patients and colleagues, but not blindly, and most of the doctors I know also always keep their patient’s good above everything else. Most of my patients also reciprocate positively and many patients like / love / treat their doctor like a family member.

It is some “Good-for-nothing-else” social crusaders that create the rift between patients and doctors, and also prejudice the ‘lesser thinkers’ into believing that the very person treating them is their enemy out to dupe them. These are the victims of “Human Humbug Virus”. This epidemic is spreading fast, and also seems to have affected some doctors who advise their colleagues from other specialties how to practice, without having any experience of practicing that specialty.

A friend recently asked: “What should the average (saamanya) and needy (garaju/ zarooratmand) patient do on holidays if the doctors switch of their mobiles?”. I am surprised.

Are doctors not among the average and needy, given that most Indian docs belong to the middle class? Which other government offices remain open for the average and needy on holidays? If a doctor who has finished his work at 2 AM needs a ride home, who will be ready to provide it? If a doctor is beaten up by drunk relatives, who among the society has spoken against it?

There is this myth being spread: that the doctors beaten up were rude, did not communicate well, did not explain, did not reach in time etc. To tell my own experience in last 20 years, most doctors do their best to explain things to the relatives, especially in a critical case. If the relatives are uneducated, drunk, panicked etc., the doctor cannot wait until they learn and understand. There are lady doctors beaten up in emergencies too: how does our society and the Humbugs explain it?
Then again, anyone right from the prime minister to the supreme court judge can get angry on duty if they don’t like someone or something, so why can’t a doctor get angry at the mannerless, shouting, drunk and violent? How much time and energy is a doctor on emergency duty supposed to waste upon such relatives? Where every second matters, why should other patient’s lives be risked because of relatives who refuse to understand simple logic? Do all these people understand the complicated problems and risks in medicine?

Why presume that it is the doctor’s responsibility to attend all health problems of the poor and the needy on all days? Why don’t these humbugs ask the government about the scanty / absent facilities at all its hospitals meant to serve the poor and needy? So the answer to the question “What should the average and needy patients do on a holiday?” is that “Please go to the government / charity hospital nearest to you, and if you are unhappy about its service, ask the government about it. The doctors who have finished their compulsory govt. services and left govt. jobs are no longer liable to be available 24 /7 for everyone. The only understandable exception is emergencies, in which case too, a doctor at home cannot do much, so one should seek an ambulance and go to the nearest hospital. Most hospitals provide emergency services as duty, and will be happy to help the “emergency” part of it. But is that all? No. On holidays, the emergency facilities are misused as mentioned in the earlier article.

To those who advise the medical professionals on behalf of the “needy and poor”, let it be known that there are hundreds of needy and poor patients in all govt. hospitals RIGHT NOW who need help other than medical care. They need food, medicines not provided by govt., emotional support, transport to and from the hospital, home care and attendance by someone etc., including their toilet. How many of the humbugs who preach sermons to the doctors actually go and help these “poor and needy” patients at home or hospital for their non-medical issues?
© Dr. Rajas Deshpande

Recently an 82 years old orphan was admitted under my care in a critical condition, for 8 days. He needed some medicines from outside the hospital. I requested the young male relatives of some other stable patients in that ward if they can please get the medicines from a shop just outside the hospital (clarifying that I would of course pay for them): they flatly refused! Our security guards at the hospital actually attended to the needs of this patient till his discharge. This is the awareness, readiness and participation of our society in patient care: it just dumps ALL medical & non medical issues of everyone to be attended by the doctors 24/7, nobody cares now about other patients.

If you are really interested in helping poor and needy patients, please go to the nearest hospital and you will find at least few patients who need your help. Stop firing your pompous rifles of hypocrisy from upon the doctor’s shoulders. There are orphanages refusing kids, having no foodstuff / education facilities for those residing in them, there are old-age homes where patients cannot walk because there is no one to support them, there are beggars at each traffic signal openly abusing infants and children by giving them sedatives, keeping their wounds open to create sympathy, carrying them without covering their heads in open burning heat of the summers, there are poor disabled as well as manic, violent beggars on all streets… what has any film star, any politician, any government done for them? Go help those needy and poor, my dear HHV victims, before pointing fingers at the doctors.

Unconscious trauma victims and unknown dead bodies are commonly brought into most casualties. Most doctors go far beyond their duty to make the alive survive and dead reach their relatives. Who among the “Humbug advisors” has helped there ever? Only the doctors know how many sons and daughters write forms “Not to continue medical care / ventilation” for their parents who still have some chance of survival, and how many take home an unconscious / critical patient home from hospital, under different excuses.

I have many patients and mature non-medical friends I adore, and we share a very good bond. They will understand the plight of this situation readily. For the remaining, I clarify: It is every doctor’s duty to help a patient in emergency, but the society must stop abusing and advising the very profession which is striving to serve its interests. A few corrupt doctors is not the whole truth.

It is easy to presume and talk ideals. After 30 years of practice some doctors do get their desired home and peace in life, and then they expect that the newer generations should never expect to do better than they themselves did. ‘In our times”, “All our life” etc. are spoken as if the newer generation is begging / dreaming to be you. They are not. Let the new doctors please do better than to earn a big home or a small hospital in retirement. Let them take India to new heights in medical research, in discoveries, finding cures, winning Nobel prizes, and making world-class medical set-ups in India, for all its citizens rich and poor, and let the government pay for those set ups and the treatments too!
Simultaneously let the new gen docs also live a good life. Let them make better families. Let their wives and children not be punished for their choice of a noble profession.

Our prime minister said to the IAS class conference just yesterday: “Why tense? Quality time with family is a must!”. Why doesn’t this apply to the doctors too?

Coming back to the humbug virus affecting even some doctors, it’s high time we realise that every specialty has its own requirements, problems, methods which have evolved over decades. So a cardiologist cannot advise a gynaecologist how to practice, nor can a pediatrician advise an orthopedic surgeon what to do in a trauma case. (And yes, all of these should also not tell neurologists / psychiatrists to see patients faster and charge lower!!). We must have separate boards of practice control / discipline for different specialties. These boards must decide the practice standards for their specialty and fees too. Blanket rules may apply for the common purpose, but diversity is necessary to evolve our system into a better one than what we have today.

The first measure is to identify and treat the victims of this Human Humbug Virus. Next time someone advises the doctors about their duties and helping the poor and needy, especially on weekends and holidays, please request them for their contacts to upload on public platforms so doctors can start sending the poor and needy patient’s non-medical issues to them. Let the channels crying foul about the medical issues donate all the revenue generated during such news and the ads therein for the care of poor patients in govt. hospitals.

Otherwise the HHV will destroy whatever good has survived in this noble profession.

© Dr. Rajas Deshpande

Issued in good faith.
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