Tag Archives: medical practice

MEDICARDIA: A Doctor’s Diagnosis.

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© Dr. Rajas Deshpande

Rimless spects, ipad, T-Shirt and denims. Brilliant face, thinning hair. Attitude. A face carefully wiped off of any expression. The typical new age intellectual waited outside the ICU. Body language: severe anxiety.

“Doctor, do whatever you must, his convulsions must stop” said Mr. Prasad. His father was having continuous fits for over three hours, he was just admitted directly in the ICU after all the home remedies had failed. His oxygen levels had dropped to dangerous levels. Patient had ready aspirated during his convulsions. His food had regurgitated and entered his windpipe.

The last treatment for continued fits is completely paralysing the patient with general anesthesia, intubating and starting artificial respiration with a ventilator. There is risk, but lesser than if the patient continues to have fits. Every doctor, for every patient, must make a decision based upon the risk-benefit ratio. Every treatment, medicine or surgery, also has potential risks. The decision that can potentially cause someone’s death is not easy to make. Every doctor lives on the edge of this risk.
Add distrust and suspicion, and we are dealing with law more than with medicine. Welcome to the medico nightmares! © Dr. Rajas Deshpande

The critical care team had already explained the risk to the Mr. Prasad. He had signed the consent, including understanding of the critical condition. We intubated the patient and ventilator was started. The fits stopped. A chest physician was also involved in the treatment. Monitoring of the brain waves still showed abnormal currents in his brain, so he was kept paralysed next two days.

On the third day, the patient developed fever, most likely he had developed a chest infection, so common after aspiration. His condition worsened, his blood pressure dropped. We informed the family.

“Why didn’t you prevent this?” asked Mr. Prasad.
“Sir, have you ever had any cough, cold, fever?” I asked.
“Yes, many times. What has that to do with my father’s infection?“ he replied.
“Why couldn’t you prevent it?” I asked, “Anyone can develop an infection or a heart attack anywhere outside the hospital and it is ok, but if it happens inside a hospital, why does it suddenly become a doctor’s fault? Hospital acquired infections are possible in spite of all precautions, in the best of the hospitals across the globe. The elderly population is especially more prone for infections.”
This being a routine question, there was no reason for me to lose my patience. © Dr. Rajas Deshpande

Our team worked hard to maintain the unconscious patient alive. His heart rate fluctuated, blood pressure dipped to non-recordable sometimes, blood sugars went high, liver and kidney functions were deranged, but we kept on playing the “Medical Chess”, where one doesn’t know what move nature will make next, the only possible next step is to accurately, promptly and wisely counter that complication.

His lungs started failing, the chest physician advised steroids. At this stage steroids could either be life saving, or could cause havoc by worsening the infection. Mr. Prasad was explained the situation.

“What are the chances of survival and complete recovery?” he asked.
“Unpredictable, Sir” I replied.
“Then why use steroids?” he asked.
“If we don’t, the chances are less than if we do”. I replied.

Steroids were added. The patient stabilised and then started improving gradually. Over next five days there was a dramatic recovery. Steroids were stopped.. Mr. Prasad remained expressionless, questioning every move. Three days later, once he started breathing by himself, the ICU team informed me that the patient could be extubated- the tube for ventilation could be taken out. I was in the OPD, I okayed the decision.

In a few minutes, Mr. Prasad rushed into my OPD.
“Doc, my father cannot speak. He has lost voice”. He was quite angry and anxious.

“Let me check” I said and went to the ICU.
The patient was otherwise fine. The throat tube inserted for ventilation sometimes causes swelling in the throat, involving the vocal cords, and such “hoarseness” or loss of voice is common after this procedure. Using steroids facilitates recovery, but in this case, it was now risky to use steroids. We explained the situation to Mr. Prasad. © Dr. Rajas Deshpande

“When will he recover from this?” he asked.
“Usually two weeks, but still one cannot say exactly” I replied.

“Why didn’t you tell this to us earlier? This is atrocious. I will file a complaint. We will go to the court. My friend is a reporter. I will also write on social media about this, that because of the treatment here my father lost his voice” he started shouting.

He did file a complaint with the hospital. Everything was on paper, everything was medically and legally correct. Still the administration must ask me questions and I must reply. Many long emails and documentations followed. One reporter called and enquired about the case, I explained her the situation.

I didn’t sleep well those five nights. Medicolegally we were safe, but who was to deal with the media allegations, the resultant defamation, irresponsible hurtful comments by every TDH on the social media?.

The patient was still under my care. I saw him daily, he was making good recovery. His voice became normal in next three days. He was shifted to the wards and then discharged. He was advised to continue anticonvulsant medicines. Mr. Prasad did not say a goodbye, didn’t write a feedback, he didn’t withdraw his complaint. They just disappeared, and did not follow up. I kept on dealing with the paperwork for a few days even after discharge. I still had a thin bleeding layer of patience left. © Dr. Rajas Deshpande

About a month later, at late night, I got a call from the casualty. The same patient was convulsing. Mr. Prasad had requested to call me.

He revealed that after the discharge he had searched for ‘the best’ neurologists in India, took his father to two of them, and was advised to continue exactly what we had advised. Then he researched internet, found an “ancient remedy” for epilepsy rediscovered recently by a famous baba, that guaranteed complete cure. They had stopped the anticonvulsants advised by me three days ago, as the Baba’s site blasted all modern medicine and the dangerous effects of allopathic drugs.

My remaining patience was destroyed, However, the patient was my first responsibility. I advised the treatment, we intubated the patient and started ventilation again.

“What are the chances, Sir?” asked the rimless eyes with expressionless face.

“We have started with the emergency treatment, the patient will be shifted to the ICU. I cannot accept this case, please admit your father under another specialist” I said. © Dr. Rajas Deshpande

“Look doc, I am sorry if you felt bad about last time. We paid full bills and we will pay again, we have mediclaim. I want you to treat him” he said.

“I don’t work for the mediclaim companies. You cannot pay me for the damage you caused to my peace of mind, the waste of time you caused by writing falsified complaints. You cannot pay me for the sleepless nights because of your threats” I told him.

His face changed. Panic appeared on that expressionless face. He folded hands. There were tears in his eyes. “Doc, I am sorry. I got carried away by what people say about modern doctors. I will do whatever you want. Please save him. I promise I will immediately write an apology to the hospital ”.

Needless to say, a doctor’s heart has many hard scars, but it is the easiest to melt. It did, once again!

© Dr. Rajas Deshpande

Real experience, some facts changed to mask identity.
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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 “Cheap Competition” among Doctors: a Hidden Cancer.

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande
Neurologist, Pune.

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

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The Colour Of Blessings

The Colour Of Blessings

© Dr Rajas Deshpande

Carefully calculating the dose and mixing it with the intravenous fluid with precision, I told the kind old lady: “I am starting the medicine drip now. If you feel anything unpleasant, please tell me.”

Through her pain, she smiled in reply. Her son, my lecturer Dr. SK, stood beside us and reassured her too. He had to leave for the OPD, there already was a rush today. “Please take care of her and call me if you feel anything is wrong” he said and left.

Dr. SK’s mom was advised chemotherapy of a cancer. It was quite difficult to calculate its doses and prepare the right concentration for the intravenous drip. Just a month ago, my guide Dr. Pradeep (PY) Muley had taught me how to accurately prepare and administer it, so when Dr. SK’s mom was admitted, he requested me to do it for her too.

The drip started. After a few hours, I noticed that her urine bag needed emptying. The ‘mausi’ supposed to do it was already out for some work. Any resident doctor in India naturally replaces whoever is absent. So I wore gloves, requested a bucket from the nurse, and emptied the urobag into it. Just as I carried the bucket with urine towards the ward bathrooms, Dr. SK returned, and offered to carry it himself, but I told him it was okay and went on to keep the bucket near the bathroom where the ‘mausi’ would later clean it. © Dr Rajas Deshpande

Once the drip was over, Dr. SK invited me for a tea at a small stall outside the campus. He appeared disturbed. He said awkwardly: “Listen, please don’t misunderstand, but when I saw you carrying my mother’s urine in the bucket, I was amazed. You are a Brahmin, right? When you were away, my mom even scolded me why I allowed you to do it, she felt it was embarrassing, as we hail from the Bahujan community. I am myself a leader of our association, as you already know”.

I knew it, to be honest. His was a feared name in most circles.He was a kindly but aggressive leader of their community, but always ready to help anyone from any caste or religion, to stand by anyone oppressed, especially from the poor and discriminated backgrounds.

“I didn’t think of it Sir! She is a patient, besides that she’s your mother, and I am your student, it is my duty to do whatever is necessary. Otherwise too, my parents have always insisted that I never entertain any such differences”. I replied. © Dr Rajas Deshpande

“That’s okay, but I admit my prejudice about you has changed,” he said. “If you ever face any trouble, consider me your elder brother and let me know if I can do anything for you”. What an honest, courageous admission! Unless every Indian who thinks he / she is superior or different than any other Indian actually faces the hateful racist in the West who ill-treats them both as “browns or blacks”, they will never understand the pain of discrimination!

As fate would have it, in a few months, I had an argument with a professor about some posting. The professor then called me and said “So long as I am an examiner, don’t expect to pass your MD exams.”

I was quite worried. My parents were waiting for me to finish PG and finally start life near them, I already had a few months old son, and our financial status wasn’t robust. I could not afford to waste six months. © Dr Rajas Deshpande

I went to Dr. SK. He asked all details. Then he came with me to the threatening professor. He first asked me to apologise to the professor for having argued, which I did. Then he told the professor: “Rajas is my younger brother. Please don’t threaten him ever. Pass him if he deserves, fail him if he performs poor. But don’t fail him if he performs well. I will ask other examiners”.

The professor then told me that he had threatened me “in a fit of rage”, and it was all over.

With the grace of God, good teachers and hard work, I did pass my MD in first attempt. When I went to touch his feet, Dr. SK took me to his mom, who showered her loving blessings upon me once again, and gifted me a Hundred rupee note from her secret pouch. © Dr Rajas Deshpande

Like most other students, I’ve had friends from all social folds at all times in school and colleges. I had excellent relations with the leaders of Dr. Babasaheb Ambedkar Association, and twice in my life they have jumped in to help me in my fight against injustice when everyone else had refused. I love the most fierce weapon of all that Dr. Babasaheb Ambedkar himself carried: the fountain pen!

No amount of fights will ever resolve any problems between any two communities, the only way forward is to respectfully walk together and find solutions. Fortunately, no doctor, even in India, thinks about any patient in the terms of their religion or caste. (© Dr Rajas Deshpande). Just like the Judge in the court premises, humanity is the single supreme authority in any medical premises. Blood or heart, brain or breathing are not exclusive to any religion or community. Just like the bigger brain, a bigger heart is also the sign of evolution.

I so much wish that the black clouds of disharmony between different communities are forever gone. The only hope is that our students can open any doors and break any walls, so long as they do not grow up into egoistic stiffs. © Dr Rajas Deshpande

I am proud to belong to the medical cult of those who never entertain any discrimination. A patient’s blessing has no coloured flags attached! Even outside my profession, I deeply believe that the very God I pray exists in every single human being I meet. If at all anyone asks me, I am happy to say that:

My religion, my caste and my duty as a doctor are all one: Humanity first!

© Dr Rajas Deshpande

Neurologist

Pune

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A Statue For Good Health Please

A Statue For Good Health Please
 
© Dr. Rajas Deshpande
 
The 7 year old child with a swollen face and a bandage upon his skull tried to smile through his hazy awareness. He wasn’t feeling good, and his face said so amply. His father who accompanied him sat cross legged, angry and upset, and said “I don’t want him to take lifelong medicine. Suggest something else”.
 
His son was a known case of seizures / epilepsy, and was advised by each one of the three neurologists he had already seen, to continue the anti epileptic medicine. The adamant father not only did not start those medicines, but kept on searching for opinions that suited his convenience and understanding, and treating the kid with unproven herbal therapies and fanatic diets. The poor helpless child, otherwise healthy, had had over three fits in last one week, this time the boy had fallen off stairs during a fit, and sustained a head injury. The father refused to see his own faults, a very common tendency.
 
“The doctor who bandaged him also gave him some injection. Because of its side effects he is so sleepy” the father added, “He told me to admit the child but I don’t think it is necessary. I want your second opinion ”.
 
There are rare days when I let my patience be gagged by my duty, some people really do not get simple, humble and mannerful language.
 
“Sir, you are making a criminal mistake. You are not a health expert, and have no authority to withhold treatment of your dependant, especially a child. It was your mistake to stop the antiepileptic medicine. The child must be seen by a pediatric epilepsy specialist immediately. He is sleepy because of the fit and the head injury. He needs in-hospital care and urgent restarting of epilepsy medicines” I started to notice I was raising my voice. Realising that the child’s well being was more important than correcting his father’s mistake, I toned down and explained to the father that there was no choice, and more fits could risk the kid’s life.
 
“Can you give hundred percent guarantee that your medicine will cure him?” asked the cunning father.
 
“No doctor in the world can give any guarantees, and should not too. It is my duty to tell you what is necessary for the health and life of the patient”. I so much wished I had the authority to have the father arrested, and so helpless a situation it was, that there was no agency in India to report this to.
 
“It is a huge task for us to take father to hospital, you know” said a millionaire recently to me, because him and his four brothers who lived in the palatial mansion built by the same father did not find enough time to accompany him to the doctor.
 
Thousands of children suffer and even die because their adamant parents refuse to treat them in time, or even refuse to continue the advised treatment. The same fate is meted out to many dependent elderly. The romance of poverty and politics makes it easy to shift all the blame on the govt. / private practitioners who see the patient last, when it is too late.
 
The IMA, which just correctly advised doctors not to drink alcohol or go to parties, should also draft a proposal of “Criminal Child and Elderly Health Abuse” and pursue it with the PMO. All children and elderly must be taken to the doctor immediately when sick, and following the doctor’s advice must be made a legal binding upon them. Then alone this health crime will stop.
 
The same quasi-intelligent people who advise doctors to “Keep calm and communicate properly with the drunken, aggressive relatives of terminally brought patients” should also use the same halfwit to advise the community to treat their dependents in time.
 
This is my sincere, heartfelt request to our kind Prime Minister / Health minister: save our children and elderly who need proper medical care, but are denied the same in time. We need this more than any gardens and decorations, more than statues and memorials, more than any other development. May all the treatment of all the kids below the age of 15 be free all over India, may every kid and elderly be insured for health.
 
In the service of my beloved motherland.
 
Jai Hind!
 
Narendra Modi PMO (India)
 
© Dr. Rajas Deshpande
 
PS: Modified story to mask identity.
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Profit and Loss

Profit and Loss
© Dr. Rajas Deshpande

Case 1:
45 year old man. Many weeks of tiredness, then three days of fever, quack treatment. Developed convulsions, admitted in coma. Blood sugars over 500. The long term past sugar index is very high, suggesting he has had untreated diabetes for months. After stabilizing patient in few minutes, I brief the relatives about critical condition.
His brother asks: Why is his sugar so high? He never had sugar. Is it because of any of the medicines you are giving?
I explain them that he has had high sugars for long, the tests say so. Also that we are giving him medicines to control sugar.
The wife says: “We don’t know all that. I think some medicines have made him unconscious”.
When he was discharged recovered, they fought about the bills saying that wrong medicines had caused delay in recovery. They gave negative feedback because the bills were not reduced to their quotes. “We were duped, we lost so much money” the son kept alleging aloud. © Dr. Rajas Deshpande

Case 2:
Old man, 82. Lung cancer, under radiation. Two episodes of paralysis, diabetes, blood pressure, now has drowsiness since Tuesday. His son and daughter in law come to opd on Saturday evening. The old man needed immediate admission and MRI. I tell them so.
“What is your diagnosis?”, “Exactly why is he drowsy?” “Why admission??” “Exactly what treatment?” “What will be effect of the treatment?” and many such screwing questions (sometimes I wanna ask back: when will you exactly pee next?) later, they went home. In the interest of the life of the old man, I chose not to lose patience.© Dr. Rajas Deshpande

They come back two days later, he had become unconscious.
“Why, doctor, why? He was walking till Sunday” cried the daughter, angrily asking us. “Why can’t you make him conscious? It’s been two days”.
Not only the arrogant tone, but the open distrust was offensive. “What is the exact reason of his unconsciousness?” “When exactly will he become conscious?” “Exactly blah blah?” asked the son, as if he was a Judge, and the doctors were criminals.
I wanted to tell them exactly what they were and where they belonged, but refrained. Patient first.
The treatment was on. Three days later, the old man opened eyes. “He has always had a strong will power. We knew he would recover” told his daughter to us.
Upon discharge, they wrote very bad reviews because the bills were not reduced to their expectation.
© Dr. Rajas Deshpande

Both came for follow up later.
In both the cases, a few years ago, I would have made an effort to spend more time, compromise self respect and continue treating them. Not now. Especially when peacock-fame decision makers decide about the fates of specialist doctors. Now, I tell them to please follow up with whichever doctor they can trust.

What about the probable income from such patients? Let me quote a dialogue that only Mr. Amitabh Bachchan could have delivered, from a film ‘Trishul’ that influenced me much since my college days:
“Zindagi mein kuchh baatein faayde aur nuksaan se upar hoti hain, lekin ye baat kuchh log nahi samajhte” (Some things in life are above profit or loss, but some people don’t understand that)”.
© Dr. Rajas Deshpande

The Zen Of a Doctor: An attempt of honest meditation

The Zen Of a Doctor
An attempt of honest meditation
© Dr. Rajas Deshpande

I am now tired, mentally fatigued, I want to recover to joy. I do not want to lie to myself.

I love treating patients, resolving their health problems. I love the feeling of their recovery. I love the gratitude that comes my way. I am proud of this ability to be compassionate, to harbor empathy and to understand and fight suffering of another human being. I am proud, that money is not on the top of my priority lists. © Dr. Rajas Deshpande

But now I am tired of the whining: not the whining of suffering, for that is mine to destroy happily, but the whining by choice of adopting an extremely stressful, dirty, unclean, unhealthy lifestyle, not preparing to change, not preparing to pay for health, and then blaming it all upon a doctor. Women openly suppressed by husbands and large families, children tortured by parent’s whims, men exploited by their own desires and careers, and an orthodox, superstitious society where the most literate and educated believe in sometimes poisoning themselves with unknown medicines, and then have the audacity to question a qualified doctors’ intentions in writing a prescription. © Dr. Rajas Deshpande

They want everything of the best quality, from panipuri to cars, and are willing to pay extra for every luxury, while expecting that only healthcare must come free, and the very doctor whom they cannot trust, cannot tell the truth to, must treat them with best empathy and honesty, give them enough time to ask unnecessary questions and doubts, and then should waive off the fees out of sympathy. © Dr. Rajas Deshpande

I am also tired of the corrupt practices in medicine, and the hopeless scenario that everyone rather tends to believe that the doctors are all corrupt (some indeed are, but so are few in every profession, shut up pseudo Einsteins of argument!) rather than seeing the open markets established by uninhibited corporates who are seen hand in hand with the administrators, some pharmaceuticals and some in power. Corruption by those in high places, that ranges from producing some of the worst quality, inexperienced doctors, to dispensing lower quality everything just because they have understood this trick: people fall for low cost anything, even health. Such a disaster that people do so many unnecessary tests under the “Health Check” scams themselves, but when the doctor advises even one test, suspect him / her of wanting more money! © Dr. Rajas Deshpande

I refuse to be exploited. I can only change myself, not the world. Hence this meditation.

I want to live a good life: not full of gold and diamonds, but of joy, health and inner peace. Of independence, financial as well. Of my own choice and preference, not what the society decides for me. I want quality time for myself and my family too. © Dr. Rajas Deshpande

I do not want to be a busy doctor irritated and shouting at everyone: I would rather earn less and guard my composure. Those who cannot respect this will be given a chance to understand, but only once.

I will continue to stay highest in my principles. I will refuse to compromise on the quality of healthcare I want to practice, just because someone wants a cheaper, faster but less ethical alternative, less correct choice. I will see less number of patients and rather spend enough quality time with each of them, and charge them higher as per time and expertise, rather than hurrying through.

I will choose to encourage trust in my patients with my own behavior and words, but if I realize they are still trustless and question my integrity, I will refer them to their choice of another specialist, because I want to retain my best peace of mind for my next patient.© Dr. Rajas Deshpande

I will not take the extra effort to explain everyone why I do what I do, my duty is to be honest to myself and my God, my patients. I have limited time, now and in life, and I will expect that faith, trust and a level of basic intelligence (that has nothing to do with education) will enable everyone to see clearly that I mean well. That is my promise to myself: I will always mean well to my patients, and offer them my best. That should never preclude my own happiness. This will enable me achieve my inner peace so essential for a doctor.

I feel better with this already.

© Dr. Rajas Deshpande

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

My Earning As A Doctor

My Earning As A Doctor
© Dr. Rajas Deshpande
 
It was an emergency night, and we were trying to cope up with the excessive load that every government hospital must accommodate. One of my early postgraduate emergencies. The living, the dead and those in between were being rushed in continuously, and we were dealing with the emotional ups and downs at an almost impossible pace. In the same moment we were Gods and heroes for some, and devilish villains for others.
 
Nature, age, illness, delays, illiteracy and poverty are easy to fight with sometimes, but not what people expect from a doctor.
 
I was writing on the ward desk, filling up the necessary paperwork, an irritating interruption in a clinician’s life. Trying to recall something, I stared for a moment at the long stretch of that huge ward. My senior resident Dr. Sunil was performing a procedure called pleural tap, where fluid is removed from the chest. He was from a very poor and rural background, but had excellent merit. Most people made fun of his looks and language, that made him silent and aloof. © Dr. Rajas Deshpande
 
An old man came out of the toilet, accompanied with his wife. He was about 80, was admitted and had recovered from a stroke. He was scheduled to be discharged next morning.
While walking to his bed, this old man suddenly collapsed, his wife unable to hold him. He was about 10 metres away from me. Sunil and myself reached there immediately, shouting for the crash cart, and started resuscitation. We tried for many minutes, as the patient’s wife stood a few metres away, sobbing.
 
He was dead. He had had a sudden cardiac arrest.
It was the third death in the ward that day, among the thirty emergencies admitted.
 
Dr. Sunil went to the patient’s wife. and informed her. He got her some water, and sat with her for some time. Then when he resumed the paperwork, I noticed he was feeling sad and tearful too, like myself. The old man and his wife had both been so nice to us. © Dr. Rajas Deshpande
Only a doctor knows the traumatic feelings of having to resuscitate someone who was talking to them a few moments ago. Believe it or not, almost every death certificate makes a scar on a sensitive doctor’s mind. The trauma is perpetual, hidden, but also real.
 
As we arranged for their transport (the couple had no relatives and were from a nearby village), the old lady sat by her husband, touching his face and crying. When she left, she said “God bless you, you people still tried so much. We are both old, what can you do! This is my destiny. I hope God takes me up quickly too, I have no purpose in life now”.
 
Sunil went to the doctor’s room and broke down. This was unusual. I tried to console him, myself feeling very sad. Then, Sunil looked out of the window and said in a heavy voice: “My mother died exactly like this, in a hospital ward, when I was a child. I was with her. That is when I decided to become a doctor and save lives. At such times I feel very hopeless”.
 
“Oh”, I said, not knowing how to react, “Where is your father now?”
“He passed away long before my mother, he had fever, but they did not have money to take him to a hospital. He died at home.” Said Dr. Sunil.
In some time, we went for a tea and composed ourselves again. The night was to bring many more who needed us stable, so we returned in few minutes.
 
The next day, we presented to our professor the forty two cases admitted in emergency, a usual count at most medicine emergencies. Going home after over 36 hours, I could not eat that day. A doctor should not be too emotional, but then no one makes themselves, one can only control reactions. © Dr. Rajas Deshpande
 
Fast forward to the future: my father, one afternoon at home, collapsed suddenly and was taken to the nearest hospital three minutes away, but could not be resuscitated. I was in Mumbai, far away from him. That phone call still rings in my ears. Sometimes I have to sit down at the memory of that call, it breaks me.
 
I did not curse that doctor to whom my dad was taken. I did not blame anyone. I did not go to the press or police. I did not think that the doctor was wrong or was working for money when someone was dying. It is impossible. One who thinks that a doctor will think of money in the face of a dying patient is probably also the one who never fully believed in God, and also questioned their own mother’s love for themselves!
 
Like almost every sensitive doctor, like Dr. Sunil, the only way for me to forget the agony of losing my dear ones was to prevent this from happening in anyone else’s life.
 
So what if most of them think I worked for money, so what if they refuse to ever acknowledge gratitude in words or in deed. So what if they only look at the money I earn through my hard work.
 
My real earning, like that of every sensible doctor, is the reduced burden of suffering in the human world. The tax I pay is my blood and sweat. Those who do not use these currencies will never know their value.
 
© Dr. Rajas Deshpande
 
Please Share Unedited

A Medical Lesson That Still Hurts

A Medical Lesson That Still Hurts
© Dr. Rajas Deshpande

“Can’t you see I am with a patient? We can talk later. Or may be tomorrow” snapped my lecturer at Pallavi.

Pallavi was 26, had epilepsy herself, but used to sit in our OPD to help other epilepsy patients. She came from her home by local train, travelling over two hours, and went back after OPD to attend her father. She was on many medicines to control her fits and depression, still used to have frequent fits. An epilepsy surgery was not possible, my professor and lecturer who were her caretakers had explored almost every avenue for her. Some unfortunate patients do not respond well.

Obviously she could not get a job and sitting at home worsened her depression. She was quite good looking and kind. However, her father was bedridden with a paralysis attack, and had many problems, even bedsores. That stress made Pallavi cranky and always worried. With no source of income, she was dependent upon help from the staff at our municipal hospital. As she was too proud to accept money without working, my professor had eased her ego by requesting her to help other patients: OPD paperwork, forms, getting medicines, patient education and restrictions etc.

She would either consult us resident doctors or our teachers if there was anything wrong with her or her father. Sometimes her anxiety was too much to deal with, she often asked repeated questions. Some epilepsy and psychiatry patients have worst symptoms around menses, and even get combative.
Most government and corporation hospitals have a never ending line of patients. In that rush it became impossible to answer her repeated questions patiently, and someone or other usually had to either snap at her or prescribe her an anxiolytic. Sometimes being too kind or available results in more attention seeking.

“See if Pallavi is OK” my lecturer told me after a few minutes.

Sulking, Pallavi had gone to the pantry near OPD and sat alone. During our tea break myself and my colleague Dr. Sachin went there too. My thesis / dissertation submission was in final stages, where everything about it seems so pointless and meaningless. I had to submit it within two weeks. © Dr. Rajas Deshpande

“Tea, Pallavi?” we asked her as she sat in the corner.
“No, Doctor. I’ve had it. Thank you” she said. We drank our tea in an invaluable silence.

She suddenly said: “Doctor, my father has started continuously calling me names. He uses very bad language. My headache becomes unbearable when he starts shouting.” She became tearful.
While having tea, I wrote her prescriptions for herself and her father too.
“Doctor, I want to talk” she said, “I need to sort out things in my life” she said.
“Pallavi, the OPD is still heavy, we will talk after lunch, ok?” I replied. It was 3 PM already. We finished tea and returned to the OPD.

A few minutes later, I heard her crying in my teacher’s cabin. “You must learn to be patient” my teacher was trying to pacify her while attending other patients who kept angrily rushing in, demanding their own time. © Dr. Rajas Deshpande

Pallavi got a call from home and left the OPD before it was over.
I went straight to the printer after OPD for the final corrections of my dissertation.

That evening we got the news that Pallavi had fallen off a local train, killing herself. No one knew if it was a suicide.

I have never been able to overcome that till now. What if I would have spent few more minutes, talked her in kinder words, pacified her better?

I learnt one of the most important and precious lessons that every doctor learns eventually: There’s no afterwards. Answer the patient in front of you NOW. Never deny time to one in genuine trouble. A minute of a doctor’s patience can save lives.

This became clearer later, this is true about everyone, not only doctors or patients; no one ever knows which one is the last meeting between any two. Now I make sure to only part with a proper goodbye, a smile and no bad feelings: apologise if I am wrong, forgive if the other one is. Some say that feels too formal, some think it is a way to impress others, or being excessively unnecessarily mannerful. But I know what I mean. There are no guarantees in life: about myself at least. Every goodbye is potentially final.

Patients never seem to stop. Everyone is in their own hurry, tired, pissed off . The doctor is the common point of venting problems, frustrations and also anger. Most doctors acquire the saintly art of not losing patience, raising voice in the worst of situations, but it is at the cost of being inhuman to themselves. To spend 12-16 hours every day (18-20 in case of resident doctors) among the angry, suffering and accusative without losing patience is not a joke. This is one reason why patients see irate/ less interactive doctors commonly and misinterpret it as “ego / pride / snobbishness” etc.

That said, since that incidence in our OPD, I do not refuse any question from any patient in front of me. I do not end the consultation unless I have answered their last question or the patient starts taking advantage by asking repeat or unnecessary questios.

Pallavi, I feel very sorry.
Patient First, Patience Highest, Always, for Every Doctor.
Thank you for the lesson.

© Dr. Rajas Deshpande

Real Story. Identities masked. Please Feel Free To Share Unedited.