Tag Archives: Medical Malpractice

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

Please share unedited

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

Wrong Doctor, Wrong Punishments

Wrong doctor, Wrong Punishments
© Dr. Rajas Deshpande

“There are many wrong things going on in our profession, and I insist that you must write about them too. Working at a tertiary care center, I see many patients wrongly investigated and treated” my senior professor said on phone last week.
I did not argue. He was correct. He is one of the most brilliant and dedicated superspecialists I know, and I consider myself fortunate that I studied and worked under him. I just explained to him that my page was dedicated to highlight the good side of this profession, as there are umpteen critics but rare sources that speak about the good.
“But we must evolve. It is known that we are humans and there will be mistakes. Many patients die due to medical mistakes too. If we are open about the mistakes, even the law takes a lenient view. Most of the hospitals stand by the doctor if the mistake is honestly reported in time. Many patients understand that too” he said. © Dr. Rajas Deshpande

I disagreed with him then, but as I worship his acumen, I decided to meditate about this.

Yes there undoubtedly are cases we see almost every day, wrongly investigated and treated. Underqualified, wrongly qualified and even unqualified doctors treat patients according to the best of their knowledge, but unfortunately intention alone is not enough to treat a patient correctly. Political support ensures the safety and proliferation of such practices. Although we all know the basic managements, the patient is not then offered the best.

That apart, sometimes, treatable illnesses are missed just because some general practitioners/ paraclinical practitioners/ crossover practitioners who think they know everything never take a second opinion of an expert in the respective field. Many a times though, it is the patients who choose to stay with the least charging practitioner, never knowing their treatable conditions are worsening all the time that they think they are saving money. The practice of obtaining a second opinion is quite healthy and must be encouraged at all levels, although there are some patients dissatisfied with even the twentieth opinion.

Hospitals without the requisite expertise (qualified experts or technology) to treat certain category of patients and conditions often freely admit any patient and treat based upon incompletes skill and resources (under the legal protection of emergency treatment clause). So long as it is cheap, the patient seldom questions treatment. Once they are referred to the higher center, the trust level sinks as bills increase. © Dr. Rajas Deshpande

This often results in a treatable condition worsening to a stage of untreatable emergency. All the anger against this is usually borne by the last doctor / hospital treating the patient and trying to help in their most difficult situation.The non availability of enough staff at many government-run set-ups is never questioned.

Let us consider that a doctor or a hospital has committed a mistake, and the hospital wants to honestly report it to the patient and apologise, then to legally compensate the patient.
It will be wild daydreaming if anyone thinks that our society is presently mature to handle this.

In India, a doctor is presumed guilty of almost every death or failure of improvement in patient’s health. Even a patient who has abused his / her body, not followed any healthcare instructions (smoking, drinking, diet, exercise, reducing work and stress etc., not taking medicines as advised and self treatment) still thinks he is qualified enough to blame the entire medical profession for his / her failing health.
Relatives who have never bothered to know if the patient took his / her meals or medicine in time, procrastinate taking the patient for timely check-ups suddenly become “google qualified lawyers against healthcare system” once something goes wrong. © Dr. Rajas Deshpande

Blatant advertisements of “complete health check up” including hundreds of unnecessary tests are seen everywhere, and the word “concession or free” is probably the sexiest lure in healthcare industry today. Here, the patients or relatives do not mind their blood being drawn, being exposed to unnecessary radiation, or being charged for unnecessary tests just because it is all cheap / concessional. There are umpteen examples where the patient google searches about symptoms, gets the blood tests, MRI and many other unnecessary tests, and then visits a qualified specialist.

Only the qualified doctor advising the necessary tests is labelled an unholy, profitmaking business.

Suppose the doctor declares his / her mistake. Who guarantees that it will be investigated in secrecy, only legally tried by a qualified team of medically updated judges, and if at all the doctor is guilty, then the legal punishment alone will be implemented, guarding the security and the reputation of such a doctor? In a country where the media as well as judiciary is often tainted, how safe is it for a doctor to honestly admit his / her mistake? © Dr. Rajas Deshpande

In a single day, the media will bring down the entire practice of alleged doctors and a reputation hard earned over decades . The mobs with different lawless communities will vandalise their hospitals. The police is unable to always stand by truth, given the influences that gag and tie them. The judiciary will come in later at a time when the doctor’s life will be scarred and damaged beyond repair. Not everyone among the doctors is expected to have a shameless mind structure to go on despite disrepute. Corporate hospitals very easily disown doctors if their reputation is threatened.

Just as there cannot be any compensation of a lost life, there also is no compensation for a doctor’s lost reputation. A doctor’s reputation is his professional life. So long as the society does not offer protection from mobs, media and wrongful allegations in expectation of free / cheap but accurate scientific healthcare, the doctor will never feel safe enough to come out with his / her mistake.

A trial with ensured privacy and security, guarded information to the media in correct format accepted by the court, and very strict guidelines about proceedings in such cases will alone help doctors come out in open about their own mistakes, and also against the malpractices in their own profession.

Till then, we are all at the mercy of the maturity of our politicians, media and society.
© 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

 

“Why can’t the doctor be more compassionate, spend more time with patients?”

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“Why can’t the doctor be more compassionate, spend more time with patients?”

© Dr. Rajas Deshpande

Ms. Bonnie Wilson asks:
“When are doctors (not all) going to grow some compassion or least show some and listen to what we actually have to say and maybe spend just a few more minutes to get to know the patient a little bit???? Then maybe more patients would appreciate their doctor more. I’ve been fighting a disease for 16 years now and a lot of doctors don’t even spend five minutes with you. Only speaking from many years of experience as a patient”.

Dear Ms Wilson, thanks for asking this question, it helps me introspect.

Simple answer:
Give the doc a patient who pays as per time and skill required for the consult, and they will spend an entire day with that patient. Give the doc a patient who writes down “Doctor, I have complete faith and trust in you, do your best to treat me, I promise not to sue you or blame you if in the course of my treatment something goes wrong. I respect your intention, and know that you are a human being capable of mistakes, I will be compassionate to you too.”, and they will cross all barriers to help / satisfy that patient every which way medically feasible.
Also add “I will endlessly wait in the doctor’s waiting room till the earlier patient smiles and leaves”.

Not possible? There you are!
In the 15 years of medical training, we hear innumerable sermons about being compassionate and “Listening to and Understanding” the patient. We have always learnt and taught in medicine to “Listen” carefully, so most doctors attempt this in practice, not all keep it up. Some learn the knack to “extract” the correct info to work faster.

Now imagine the Doctor’s side.

How long is “Little longer”?
75% patients really don’t have the sense of time when they talk about their illness. Instead of being to the point and realizing that this is a “professional consultation”, they go on to recite unnecessary over description / umpteen repetitions of the same complaints, even after the doctor jots them down, with confused details of their own symptoms, changing them often. Some tell their own interpretations about each of the symptoms, and complete detailed conversations that they had with their family / other doctors about those symptoms. Many ask the doctor to repeat long explanations, then some relatives ask it again. Many revise prescription medicines at least three-four times, in spite of writing down correct instructions. Many keep blaming the doctors and crying in our cabin for “incurable” disease diagnoses, thinking that the doctor is hiding good treatment for want of more money! We sympathize and explain, but cannot go on all day, especially if other patients are waiting anxiously for their turn.

Many patients fumble, forget, come disorganized (this is super-exaggerated in India, where there is no unified health record system, and patients carry messed up bundles of test reports / case sheets from many different specialists). Most (even literates) come without even the list of currently ongoing medicines, then call their family from doc’s cabin to enquire about these, and then the huge discussion about spellings, content etc. consumes double the scheduled time of consult, while other patients wait and complain. There is total lack of awareness of one’s own health responsibilities, even those who spend hours chatting in the waiting room don’t organise their thoughts or make notes for the consult, wasting time with the doc in “recalling” things!

In the western world too, there are many patients who go on describing the “unnecessary detail”, some talk too much, some talk slow, take a long time to recall and answer, and mostly come “unprepared” for the consult, without noting down questions they want to ask, and symptoms / medicines they want to discuss. Then the innocent “recalling” in the doctor’s cabin is quite irritating for the overworked doctors.

The third and the most difficult category of patients: the “over-prepared” patients / relatives, who have hyper-googled every symptom, every medicine and then come with a huge (and mostly irrelevant) list of questions about their minor symptoms. Stupidest of the claims on the internet are then discussed unnecessarily, and the frightened patient / relative really test the patience of the doctor. They are seldom satisfied with anything or anyone.

At what price?
Enter medical insurance. Enter the “Charitable Labelling” of healthcare in India, where iPhone will cost the same as in USA and UK, but the superspecialist doctor trained in USA/UK/Canada/ Australia etc. (with his own life, merit and money) must charge as per the basic general practitioner and local socio-political expectations. So the doctor has no freedom to charge the consult as per time required.

Result: more time translates into less income, worldwide.

Reaction of the society: So what if you earn less? You are a doctor. You are a spiritual saint who just earns in goodwill and respect, converts that by magic into money and then we charge you everything including taxes in cash! We all can dream luxury and good life, you can’t!

My question: What’s in it for the doctor in spending more (extra) time with the patient?

It is a pleasure for the good doctor to spend more time, explain in detail and compassionately listen to each patient, but then he/ she returns home to piles of unpaid bills and an unhappy family. Most Indian specialists don’t even afford their own home by the age of 40! Most western doctors are frustrated by the dictat of insurance companies that for a decent earning, they must see higher number of patients. No insurance company pays a good doctor better.

As for Compassion issue:
I have some really innocent questions to ask patients / society:

1. When any doctor was prosecuted for medical negligence in some case, how many times has any patient openly said “This doctor was very good to me”? Many doctors prosecuted must have saved hundreds of lives. Who stood by them when their careers were ruined by single mistakes? How many patients whose life they saved offered to help with the compensations the punished docs had to pay?

2. How many times did society / luminaries / media show compassion to the needs / plights of medical profession? Underpayment and Overwork, Victimisation and Insecurity are universal in this profession. Who showed any compassion ?

3. Can you be compassionate to someone who is being a “Customer” with the right and threat to sue you for an amount that will ruin your life, reputation, career and family? Can you be compassionate to someone who suspects every motive of yours, cross checks everything you say, argues with you, threatens you, does not have faith in you and will forget you the day their health problem is over, only to return when they need you again?

4. Can you be compassionate to someone who records your words of reassurance and uses them against you as a legal proof of “misguiding”? Can you talk nicely to someone who treats you arrogantly, mannerlessly and looks down upon you as a “Money maker” rather than a respectably educated hardworking Doctor?

Indian Docs carry the whole burden of the country’s mismanaged healthcare system upon their shoulders. Millions of poor, unaffording patients are RIGHT NOW being treated by thousands of doctors FREE. Most patients get better than not.
But
When the uneducated filmstars rubbish the whole profession to prove themselves tall, some movie claims that doctors treat dead bodies to earn more money, no one speaks a word against it. Why?
When senior doctors who spent lifetime serving the poor are wrongly suspended by politicians without any enquiry, not a peep from the society.
Why?
When doctors are killed, attacked upon, and abused, media justifies / glorifies such events.
Why?
Some of the senior doctors cannot stop talking ideal, even at the cost of their children’s lives. “Spend more time with the patient, be more compassionate” they say. I agree.
But we never hear from them when a doctor is killed. They are never seen defending those doctors who faced 12 crores worth compensation punishments, when laws like PCPNDT send young and old doctors directly to jail for documentation errors. It is very fashionable and hip to be a hypocrite and speak what people like. To understand any issue, there is a simple formality: think of both sides. Who thinks about the Doctor’s side of the story?

There is a worldwide notion: that doctors are guilty of earning more money by wrong means like hurrying. For those who think this, I have one question: Which Doctor in the world has more money than the price of YOUR life? If they save you, they are blamed for high charges. If they don’t save you, they are sued for unbelievably stupid compensations. This is the paradox: that lost lives have become costlier, saved lives don’t matter anymore.

There of course are a few greedy doctors, who need to improve. These are few and a shame.

The real tragedy of our faithless lives is this: Nobody ever thinks that a doctor may really be working faster and harder to help more patients rather than to earn more money!! He/ She may be struggling with his / her loans, sacrificing his/her own health and family time, fighting frustration, but still listening day-in and day-out to crying, complaining people merely out of the wish to relieve their agonies.

What price is the time you are away from your family? What price is years of sleepless nights? What price is the mental trauma of seeing dead bodies every day? What compassion did any doctor get for these, from media, judiciary, society, anyone?

© Dr. Rajas Deshpande

PS: Less time does not mean wrong diagnosis or approach. Mostly it means “Cut off talk to bare minimum interaction necessary for this consult”.

@ Bonnie Wilson, thanks for the opportunity you created for me to answer this concern. While this is not a personal reply, I agree with you that more time and compassion will go a long good way, but then both sides need to introspect and change.
RD

God help the Indian Doctor.

God help the Indian Doctor.
© Dr. Rajas Deshpande
A court recently awarded a compensation of 12 crores to a patient because that’s what she would have earned if alive, as she held a job in the US. While human life is invaluable, there has to be a logic / discipline to such punishments. What compensation was ever awarded to the families of doctors injured / killed by patient’s relatives? Given that those docs would have saved many lives in their future careers, what does the Indian legal system hold the value of the dignity, career, disability and life of a doctor?

Death consequences in India:

If a politician kills someone, his whole party and the people, media houses favoured by his/ her party, and even police officers in his / her favour will stand by him / her. In cases of rapes and murders, there are umpteen examples where even police refuse to register cases because of political interference / influence. There are extremely rare examples of someone being debarred from making laws and participating in the running of country, even as criminal trials are on against them. They are not suspended or punished in 99% cases.

If anyone among the rich and glamorous drunk-drives over and kills people on the road, their whole profession (who usually pose as social icons) stands behind them, so does almost 90 percent of the media which glorifies the good deeds of such icons in defence of the deaths they have caused. The whole system machinery works as a deaf / dumb spectator to their blatant, laughable lies in the courts of law, and many from the society actually sing praises of their “glory”. They are not suspended or punished in 99% cases, in fact the legal systems ensure best humanitarian services for them.
No judges are suspended for a wrong decision.

The law, police etc. accept openly the presence of Mafia and goon houses, media glorifies the stories of daylight murders and bloodbaths by these for ransom etc., and we seldom see anyone even arrested. “Contract murders” are a blooming eventuality, so are gangrapes. No media glorifying crimes like rapes and murders are seen even reprimanded.

With even a little social uproar, compensations are paid for the dead or other victims, in a hope to suppress their agitation against the criminal.

Now come home to this:
If a patient dies while undergoing treatment and the relatives are upset/ illiterate / goons, they can beat up the doctors, even kill them. Doctors are immediately suspended without enquiry and their careers mostly end there.

While the earlier classes of “rich and powerful murderers” dance naked all over the country, the three classes of most stressed-out servicemen : doctors, military and police are completely neglected, the value of their life being zilch for the system and society alike.

Policemen dying while fighting with terrorists get lesser compensation than sportsmen get awards from the governments. Militarymen’s families live eternal poverty after their supreme sacrifice. And doctors who die while treating patients are not even acknowledged by our society or media.

People can see the same film twice, eat the same costly dessert twice, go on unnecessary vacations to enjoy just because they afford and like it, spend on petrol and internet without thinking twice. Many now go for “complete/ whole body check-ups” even when unnecessary, but when a doctor advises investigations or charges fees, they talk of malpractice. Then again, if there is a death in the hospital, the doctor is readily sacrificed, either in career or in life, without any compensation.

One part of this tragedy is some medical professionals itself who live in a “separate paradise”, talking what public and media likes, denying the reality, pretending “All is well” and declaring how proud they are of being in the current situation, where doctors are attacked and killed every other day. They are like the legendary saints who “missed the opportunity”.

But the saddest part of this tragedy is that our non-medical (and even some medical) social intellectuals choose to keep shut when it comes to the rich and powerful, but vomit poisonously and readily bare their fangs at the medical profession.

God help the Indian Doctor.
© Dr. Rajas Deshpande

Painful Injection

Injection
© Dr. Rajas Deshpande

“Anyone Treat Anything” and the “Add-On complaints”.

“Doc I have come to you for this severe headache since last five months”.
Examined, investigated, prescription given.
5 days later:
“Doc there is no relief. This back pain is killing me”.
“What about the headache you had?”
“Oh that went away the next day, but this backache has been there for years now. I forgot to tell you last time. I also want you to review and advise about my Sugar and BP medicines”.
……………..
Specialty practice in India is considered to be just like family practice. The concept of “problem-based” consultation is yet to arrive. Once seen by a specialist, all the subsequent health issues are thought to be automatically the responsibility of that doctor, and he / she is supposed to solve them at a “Follow-Up” charge for years. The concept of “New health issue, New consult” is yet to dawn.

Unfair to compare, but this is like visiting a hotel once to eat an unlimited Rice Plate, and then keeping on visiting repeatedly later to reap the “unlimited” benefit from the bill paid on the first day.

There are two sides. Some specialists also encourage this “treating everything” once the patient comes to them, and often transgress their field of expertise to keep on treating everything till the time something goes wrong, when alone a cross-reference is made. Once someone starts practice in some specialty, they should ideally only stick to that branch, unless it is an emergency.

Even at the cost of patient “misunderstanding and blaming”, some specialists follow this correct practice of referring to another specialist where indicated.

“You only give the treatment, doc for everything.. we have faith in you” is very rewarding and beautiful to hear, but at the same time a doctor who thinks he/she can should think twice.

The second issue is that of “Going on adding” the complaints even after the doctor has finished examination and has already issued a prescription.

The whole process is logical, and disciplined: recording the complaints and other medical details, then performing a physical examination, reviewing old test reports and advising new, writing a prescription, and explaining the condition and management to the patient. There are limitations in the time spent for one patient, and a single significant complaint added later after the prescription is written can change the diagnostic possibilities (“I just remembered, I had episodes of unconsciousness / tuberculosis / head injury in the past”). It then becomes imperative that the doctor rewrites the case history, and changes tests advised and even treatment sometimes.

There are simple solutions, but these become difficult in India.
1. The doc must spend extra time with every patient to give them sufficient time to remember. This is feasible only when the charges are time based, as some patients are not done talking even after 30 minutes. The experienced docs then learn the skills and tricks to save time and to “steer” the patient.
2. Patient can fill up / record forms while in the waiting room, where almost all important questions are already mentioned, so one cannot miss. This is difficult in two ways: most of our population is illiterate, and even the literates do not fill up these forms properly. Also, most of the working class come “flying” in a hurry to “get over with this quickly and fly to another meeting/ chore”, so they keep busy with their cellphones in the waiting area (sometimes even in the doctor’s chamber). Secondly, such mention of “all earlier health issues” also invites unwanted exaggeration of otherwise minor complaints especially in the depressed / suppressed / anxious and overenthusiastic patients, often diverting from the main health issue.
3. Doctor’s assistants / junior doctors “filtering” the information for each case: this may be the best option, but again the specialist must take responsibility for their mistakes. Also, one must remember that patients often do not take the “assistant doctors” seriously and may omit crucial information while talking to them. Also, a patient who pays for a specialist’s service deserves interview and examination by that specialist, not only a quick overview of an assistant’s opinion.
4. Patient must make and retain a notebook / digital diary common to all his / her medical issues, consults, details of all prior treatment and tests and carry it for every consult, minor or major. While the doctors / hospitals are supposed to keep their own records, they are blind to what happens outside their medical jurisdiction, so it becomes almost useless. A unified national healthcare software is at least 10 years away.

The IMA / MCI must devise large scale patient education programmes that will help curb the misunderstandings, hate, violence which society harbors towards medical professionals. Encouraging correct referrals, specifying doctor’s fees based upon the equation of “Time + Skill + Experience + Complications in a case” at different levels from family practitioners to super specialists may also help. A basic model of “Primary General Practitioner” who attends simple health issues with referral to a specialist based upon patient’s choice / proximity / GP’s honest opinion and suggesting at least two specialist names will help control this “Anyone Treat Anything” practice so rampant today.

There always will be allegations of “cut practice” whenever there is referral, as average human nature finds pleasure in blaming others especially successful and presuming everyone else a sinner while imagining oneself a moral-ethical icon.

To imagine that everyone in the medical profession is a sinner and guilty, and everyone in the society is innocent is a sign of immaturity of intellect. This is our working diagnosis right now.
© Dr. Rajas Deshpande

The Good Doctor Myth

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

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

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

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

Think again.

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

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

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

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

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

This results in:

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

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

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

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

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

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

Wishing best health to all.

Rajas Deshpande