Tag Archives: medical practice

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.
Please share without editing.
Thank you.

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
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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.

Goodbye, Doctor

Goodbye, Doctor
© Dr. Rajas Deshpande

“Screw this satisfaction. Dump this happiness. Can you try to understand that I am fed up of both?” said Dr. Sahil. He was one of the busiest and most respected specialist in our town.

Surprised at a superspecialist doctor friend speaking this, still impressed by his ability to identify and speak the truth about himself. I let him go on.

“There’s no guilt. There’s no regret. I have done my best since school. Topped everything. I did not feel the extra effort: I finished graduation, PG and Super PG by merit alone, that too without having to make a great effort. I have practiced over 15 years now. I did some research, but don’t enjoy the kind of research that goes on in Clinical medicine now. I have practiced with all my heart, and all my time. Now I don’t want to. Repetition kills me, and I cannot see anything but that now”. He paused.

We shared the best bond between two humans: mutual respect with no curtains. Either of us didn’t feel the necessity to modify speech for political correctness or covering up naked feelings.

I replied: “I understand. But we always thought that we need to save lives, give back to the society. So many will benefit with your genius”. I realized just as I spoke, there was something hollow about that. Or did he just uncover a mirror in me?

Sahil was as calm as a meditating saint. “I don’t feel so. Nobody’s saving lives. We use scientific knowledge to try and treat the medical conditions we see, try to comfort the suffering with our kindness, and earn our bread under the continuous threat of something going terribly wrong. I have studied for fifteen years, and served the society back for more than that.”

We sipped our coffee in silence for some time. Hans Zimmer’s ‘Discombobulate’ was playing at that time in my chamber. Coincidences are too much sometimes. That heavenly symphony of all disconcerted instruments played by the expert musicians is one of the best things in human history I think (link below).

He smiled at the music. “I did not promise anyone to spend an entire lifetime doing what I don’t want to do anymore. I respect the gratitude I received, although it was rarely pure and sustained. I am sure many better than me will replace me and continue to treat patients who need care. I have never felt respected or accepted in the society, it was always with the caveat of ‘not all doctors are good’ that the people who I served looked at me, not the other way round.“

He became serious. “I don’t want now to work hard all day and night, be serious all the time, and step up my already busy schedule to reprove my abilities again and again. I am fed up of having to prove my worth and abilities to those who I do good to. When almost every illiterate as well as the educated questions my intentions, I don’t think anyone deserves an explanation. Half my time is spent now explaining the patient what is good for them, why they must do the tests and take the medicines, how I cannot predict all side effects or complications and be held responsible for them. I became a doctor to treat people, not to cover up for their suspicious ignorance with my knowledge and time”.

Somewhere deep, I understood him. But the ego of a doctor: that we have “accepted” the responsibility to serve prodded me to argue with him. I said so.© Dr. Rajas Deshpande

“Who are we serving, Rajas?” He asked. “Society? Government? People? To what end? Where do you see this service either recognized, rewarded, acknowledged or reciprocated?. Then again, where does it all end? The line of unaffording poor is unending, the complaints of affording are mounting, and I seldom get a peaceful night’s sleep, inspite of a clear conscience. I will retire without enriching my own life”.

I remembered my favourite author Richard Bach’s view: “The simplest questions in life are also the most difficult ones to answer”.

My lawyer friend, Advocate Shrirang Choudhary, had time and again pulled me out of civil hospital Nanded. I had this habit of ‘living’ inside the hospital, beyong the 12 hours duty. I would just go home to take a bath and one time meal, then return and stay to assist every consultant I could: there was such a sense of fulfillment in learning!

Shrirang would pull me out, we went to the riverbanks and he ensured that we talked for a few hours anything except medical world. “You will kill yourself if you spend all your life in the obvious negativity that is the milieu of any hospital. There’s more to life than being a good doctor. Treat yourself to the immense beauty life has to offer. You have only one lifetime, and limited active years”.

I realized how much I had wanted to pursue a career in poetry, music, philosophy and adventure. It was with such ease and passion that I had given up all of it, proud that I will be saving lives. Now after 15 years of practice I saw another valid viewpoint.

“You get used to the satisfaction and happiness, the challenges and the victories in healthcare. I can understand that some may enjoy the repetition of the same for umpteen years: in fact an entire lifetime. But can you please also understand that to me it feels like an artist who paints only one big picture or sings only one song in his entire lifetime?”

I knew what he spoke about. I was suffering the same, but had avoided to think of it.

“Do what you want in your spare time. Reduce practice. You must take a break” I suggested, “A long break.”
To lighten up the mood, I added, “Although people will immediately say that some pharmaceutical sponsored your holiday and fun”.

“I wish I cared what people thought” he smiled, “And I don’t want to run away. I don’t want to do anything half hearted. I want to walk out gracefully. Like a saint or a seer walking out upon the world and going to the Himalayas. Why is that more respectable than a doctor wanting not to be a doctor?”
I did not have an answer.
© Dr. Rajas Deshpande

Dedicated to those who understood this post.

Hans Zimmer’s Discombobulate music video:


The Braveheart Orthopaedic Surgeon

The Braveheart Orthopaedic Surgeon
© Dr. Rajas Deshpande


The stunned auditorium was hijacked by shame. Nearly a thousand paralysed audience helplessly watched the ongoing horrific drama.

It was the annual day function, the only colourful evening in the year that the whole staff, the Dean, all teachers, resident doctors and students from all batches come together in the medical college. Extraordinary talents that the doctors otherwise have to sacrifice for lack of time: Singing, Acting, Music etc. resurface this one night. I was still in my first year.

Midway through, one resident doctor climbed upon the stage. He was a strong leader, a good student when sober, and had a strong political support, hence usually had his way around everyone. He was excessively drunk. He took charge of the microphone. Few of his friends, some also drunk, were guarding the doors.

“Our Dean is a drunkard. He is also corrupt, he takes bribe from everyone for everything. He is having an affair with this professor of XYZ department. I order the dean to come here on the stage and apologise after I slap him”.

This was beyond anyone’s imagination. One of the teachers requested the drunken offender to please come off stage, but received a flurry of obscene abuses. There was a silence that prayed for relief from this situation.

Dr. Devendrasingh Paliwal got up from the audience.
“Chal, bahot ho gaya drama. Main aa raha hun. Karle kya karega. This is not the place for your allegations. Get down”. Devendra was always known for his physical fitness, and had an intimidating personality. Straightforward and kind, he had almost no enemies.

He went to the stage, grabbed the mic from the offending drunk, handed it over to the MC, and brought down the drunken resident. Within a moment some others joined him to avoid the impending scuffle. The dean and many teachers felt the relief of a lifetime.

Those who anticipated fun at the cost of misery to others were of course disappointed, but at the beginning of my medical career I learnt one of the most valuable lessons of my life: It takes one man to be courageous, not a herd. If you have guts to get up and protest the wrong, there is a fair chance you will succeed. A good man’s fear is the bad man’s strength.

That night at 2 AM, after the programme I went with my friends to the hotel near the railway station for tea. Too much excitement prevailed. Devendra was sitting with his friends at a nearby table. I went to him and introduced myself. He smiled as if nothing special had happened, shook hands and told me “Kisike baap se bhi kabhi nahi darne ka (never ever be scared of anyone).”

We became good friends, we also shared a common mess. Studying at night and going to the railway station (6 kilometres away) for a tea break at 3 AM was also common, and Devendra often asked others to race him to run back those 6 kms after the tea. I can proudly say that I reached second, although a good two minutes after him!

He became an orthopaedic surgeon and started his own hospital, but his ‘Gene’ of fighting injustice and standing up for the good never left him. Stress and anger can be a big hindrance for a doctor, especially a surgeon, so he decided to drown his ‘stress-anger’ into exercise. Always a fitness icon himself, even today he does two hours of cycling and an hour of gymming. “It helps me concentrate better during my practice and surgery, and also keeps me totally fit” he says.

Few years ago, a doctor was arrested in a typical example of a hyperreactive populist system. This was illegal, but many a times the system gets away with the illegal more fluently than the citizen. Dr. Devendrasingh Paliwal was the president of the local IMA (Indian Medical Association) chapter. He took the system, police and politicos “Head On” as was his nature always. The city’s hospitals shut down. This enraged the politicos but encouraged the medical fraternity to unite like never before, and the doctor, wrongfully in police custody for 8 days, was released!

Dr. Devendra then worked to straighten out the relations with the system, and formulated a “Modus Operandi” involving the police and local politicians to protect the interests of both patients and doctors so that goons and petty politicos do not blackmail either. If only all the IMA chapters follow this lead (and I must also mention the excellent IMA unity and extraordinary leadership in Goa: Dr. Sam Arawattigi, and Kalyan: Dr. Prashant Patil), half the irregularities and injustice against doctors and patients will disappear.

“I have always kept friendship, professional courtesies and Humanity above my medical practice” Devendra says, “I take it for granted that it is my duty to treat free those who cannot pay”.

It is pathetic today to see many brilliant doctors working in perpetual fear under those who exploit them, by choice or in desperation, accepting humiliating and patient-unfriendly working conditions.. People like Dr. Devendrasingh Paliwal are a hope our profession can look upto.

All other things may change, but the value of fitness, courage in one’s heart and a kind nature that compels one to help others are some things which will never change their place as the best three human virtues.

Medical careers are drenched with excess hard work, stress and anxiety. The one training that the doctors in making must inculcate from the beginning is that of physical and mental fitness. Doctors leading a stressful life and always having to present a ‘pleasant face’ to the patients and colleagues, either suffer their negativity alone or pour it out upon their family. Daily physical exercise is an excellent remedy of many frustrations that accompany medical practice. Dr. Devendrasingh Paliwal not only sets an example by doing this, he goes way beyond his duties to bail out others from difficult situations: medical, surgical and social.

I consider myself fortunate that I met this fearless braveheart fitness icon who infused the right “mantras” of courage and fitness into me at the beginning of my medical career!
Much obliged, Dr. Devendrasingh Paliwal!
© Dr. Rajas Deshpande

Naked Cavemen, Einstein and Calvin Klein

Naked Cavemen, Einstein and Calvin Klein
© Dr. Rajas Deshpande
Lower courts give judgements. Higher courts change them. Higher courts give judgements, other benches change them. Government fights with courts. All of them work less than 8 hours (few exceptions) and have sumptuous vacations. Judges without medical training will decide about medico-legal cases. But any of them do not require exams to improve performance or to deliver better in spite of huge backlogs. © Dr. Rajas Deshpande
Almost in every government office, in most departments controlled by them, bribery is a rule rather than exception. Piles of files do not move, pensioners die without pension and farmers commit suicides. But the concerned authorities who work 8 hours per day do not need any corrective courses or exams to assess their performance, to compare where the developed world is today.© Dr. Rajas Deshpande
In most of the healthcare facilities run by governments, there are severe deficiencies: no appointments of doctors, no proper salaries, no facilities or backups, no security, and worst of all, no vision. But the people who are responsible for making these policies do not need any training, assessment or exams. The very people who want youngest generations of doctors to provide world class medical services to rural India do not want to change their decade old failing policies.© Dr. Rajas Deshpande
The thousands of practicing Babas, Gurus, Quacks who are officially seen tied up with the highest of the land and bash the allopathic and scientific medicines spreading poison in the society do not need any exams to preach or practice. The lawmakers who do not ban tobacco, alcohol, helmetless driving, the people who eat unhealthy and mistreat themselves or family do not need any exams. The transport offices that issue driving licences to unfit drivers do not need training or exams.
We see many military men and out of respect treat them free. They are so patriotic that they seldom expect anything in return from the country. But they often relate how bad the conditions are for them and their families. There is a crop of people who quote the military sacrifices as if it was their own credit! Those who are responsible for the upgradations in facilities for the military personnel do not still need any exams.© Dr. Rajas Deshpande
There are deaths due to hunger and malnourishment. But the ones who are in a position to change this by making right laws do not need any exams. Illegal buildings are erected, labourers die when they collapse, but the concerned professionals do not need exams or assessment.
547 extremely responsible and respected representatives who waste the public money in daily crores over a month due to ego issues, not being able to come together in the interest of the nation to resolve issues, blaming it all upon each other do not need any exams to assess their performance.
But the actual allopathic doctor, who has stood highest merits in all exams, stayed on the top of the competition to earn his / her degree late in life, all of whose exams had 50 percent as passing limit as opposed to 35 percent in all other professions, who has sacrificed family life, sleep and food for over 10-15 years just for learning, who works almost 24/365 and solves health problems on a daily basis, updates his / her knowledge with CMEs, stays in touch with the latest and delivers it to the poorest of the poor with equal affection, carries the country’s failed healthcare upon his / her shoulder is not good enough for them! Now they want the allopath to appear for exams lifelong, suspecting that his / her knowledge is still not enough good for them, even after the CMEs.© Dr. Rajas Deshpande
If the millions of doctors are forced to give exams repeatedly all their life, they will happily do so (for they are not afraid of exams). But this will take away billions of doctor-hours out of service (exam leaves) in an already failing healthcare system, will tax the patient more, will open up new channels of corruption and another universe of chaos will add itself to India. Who cares? The ruling mood seems to be ”Patients will die, patients will pay”.
The current CMEs are world standard, do not tax patients, and enough effective. But our system seems to want “better than the developed-world class of doctors”.
This is like the stone-age naked cavemen asking Einstein and Calvin Klein to appear for yearly exams to stay updated for serving them.
© Dr. Rajas Deshpande
PS 1: The nicer you are, the worse your troubles. Doctors must unite upon an apolitical platform to fight stupid laws being proposed.
PS 2 For those who are not able to think beyond medical malpractices and corruption, please make an effort to understand that there are other issues in medical practice, and this post is not about money.
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A Prayer For My India

A Prayer For My India
© Dr. Rajas Deshpande

From the hypocritical mindset that “I should look only at the positive things around me and ignore all that is negative”, that is like saying “Only my brother’s room is on fire, I can still keep on idiotically smiling and act only when this fire reaches my own room”,

From people who have brought great religious and social events down to roadside vulgar drunken dancing and loud shows of might, from the leaders who ingratiate themselves with superiors and masses at the cost of dignity,

From intellectual thinkers lap-dancing for the rich and powerful by wordplay and linguistic trickery, from the voodoo of political religious misuse that affects even the biggest brains, from a society that is being officially turned into a slob mob that is aroused only by hunger, sex , glamour and money,

From the powers that arrest the life-saving qualified doctors at the drop of a hat and send them to police custody for suspicion, presumption and spite, just as celebrities and politicians who kill in front of witnesses are politically and judicially protected using all the resources that power grants,

From the Testosterone Tongues of Flaccid Bodies in a political system that talk of change but troll, block, imprison, manhandle and kill anyone who dares to challenge their wrongdoings, where men in power flaunt bodyguards while women are abused everyday, where laws and rules are used to blackmail rather than protect, © Dr. Rajas Deshpande

From a judiciary which is fast losing its reputation, struggling for its own identity and independence, from the judges who act selectively and partially and then blame it upon the system’s limitations, judges who suo moto initiate actions only against the weak,

From the laws made by the chosen few who never knew the people they made those laws for, the laws that were made over 60 and in some cases 100 years ago that hinder normal interaction than protect it, from a system which uses the legal options just like mafia weapons to threaten, intimidate and harass those who challenge the system or bring good, ©Dr. Rajas Deshpande

From the mindlessly idiotic enormous paperwork at every stage in every office that wastes time, resources, money, paper and ink in a country whose leaders appeal it to turn green and modern, and invite the progressed world to witness how backward, how traffic-senseless and mannerless is our population, even the educated, who find it mandatory to bestow blows and abuses at the slightest provocation upon the roads,

From the millions who cannot raise their voice against the hundreds of rapes, brutalities, hunger deaths, epidemics or corruption in our own country because they are engaged in criticising and trolling neighbouring countries, proving one religion superior to another,© Dr. Rajas Deshpande

From the filmstars who go to the lowest levels of vulgarity and female skin depiction in the name of entertainment, and promote violence on screen as a routine reaction, confirming that this is a lawless country where goondaism coupled with male chauvinism is a heroic choice in life, where the entertainment industry is fast turning into a mental porn-industry catering to the whims and fancies of mobs,

From the fears that shut up ever good man and woman who loves this country, from the lethargy of the press and media to remove their bejewelled blindfolds and see the naked truth for once, From those in high chairs of power and policing who see the wrong but do not speak or act against it for the fear of losing their chair, © Dr. Rajas Deshpande

From doctors soaked in greed for money and fame, conducting fake or plagiarised research, from the competition and ego amongst doctors which prevents them to come together, from a tendency to take advantage of patients, and from the mindless permissions of “anyone practice anything in medicine” for political gains,

From a culture of self-obsessed, me-cultured, comfort-addicted men and women who are mostly proudly training their children to leave their own country, from a society that has started to forget the sacrifices made by the likes of Mahatma Gandhi, Bhagat Singh, Maulana Azad, Netaji Bose, Lokmanya Tilak, Veer Savarkar and Sarojini Naidu (and many others),

From mothers and fathers who cannot find enough time to raise happy children, seeking excuses in the name of careers and necessities, From teachers who seek pleasure in material gains and marking rather than bringing up fearless generations, from schooling that teaches everything except humanity,

Lord Almighty, please grant me freedom. Lord Almighty, please save my nation.

I am not free of some of the faults mentioned above. But I get tearful every single time I hear the song “Saare Jahan Se Achcha Hindostan Hamara” or even the National anthem.

The only way I can stand up to this great feeling of calling myself an INDIAN is by accepting the struggle, punishments, hardships and poverty that is inevitable when I try to bring in some good changes in my very beloved India.

This is my own personal small freedom struggle for my great nation, India.
© Dr. Rajas Deshpande