Respect: The Depreciating Indian Salary
© Dr. Rajas Deshpande
“Over 1.5 Crore Every Year! That becomes more than ten lacs per month! Wow!!” my student showed me the news that some brilliant engineering students passing out from India were hired by some software biggies in Campus Interviews, “They will start their careers at that salary. That’s life!”
I felt proud, as always, these news and similar have always made me feel that the Indian academic talent has always been looked up to and rewarded by the developed world. The tiny speck of jealousy that we earlier felt for our classmates who went for engineering and had their own homes and cars while we were still finishing internships has faded away long ago. The only regret that sometimes peeps out from the past is that of never having fully enjoyed our teens and youth. The fact that most doctors from India also earn huge salaries in the west as well as the middle east speaks a lot about the flaws in our “Indian” thinking.
“Doctors get respect and that is the best that you can get in life. People think of doctors as Gods. You should never think about money” told every sore-throated, pot bellied and self proclaimed socialist who did not become a doctor, and mostly had no doctor in family. This ranged from our own classmates to the highest administrators in the country.
Over the years, I now feel that even the engineering or other stream’s graduates are almost in the same boat. I cannot wish upon the newer generations what we went through.
What is really making us proud here? That India cannot afford to use its own best talent in any field? That the best in all fields are taken away, because what the best Indian companies can offer them is nowhere near what the world outside offers them? That the best salaries in all government jobs are reserved for bootlickers above the age of 55? That in no field can the government find the young talents superior to white haired yes men? © Dr. Rajas Deshpande
Or boast with a shameless pride that the most revered Satya Nadellas and Sundar Pichais made in India cannot find career scope in their own country?
Or, while proclaiming “Vasudhaiv Kutumbakam” (The World Is My Family) on one hand, are we going to perpetually cry the same song of socialism and patriotism, expecting all of them to only follow the examples of the rare (and respectable) ones who chose to shed material life for the country? India needs a million good volunteers in every field who will live and die poor while serving the society. But to force this upon all those who graduate from India is to invite them to leave the country. From politics and administration to Judiciary and lawyers, we need people who will work free or low cost, because the main disease: poverty and illiteracy, is a never ending curse in India. These are the people who choose the governments who throw “low cost everything” crumbs at the society, rather than uplifting the society to respectable self sustaining, paying capacity. © Dr. Rajas Deshpande The lifelong perks of representatives elected for even five years, from any political party are regularly updated, but the salaries and pensions of doctors and other employees who work lifelong are never upgraded without agitations and then only with allegations of greed!
No doctor wants to be a bad doctor, but no doctor wants to spend life in poverty and insecurity.
If at all a doctor decides to do charity and see all patients free/ concessional all his / her life, not only will they be lost to poverty and anonymity, but our government or media will never notice them. All they get is more paperwork to comply with every day, fear of suspension humiliation by the administrators and a salary that’s a shame given their talent and hard work.
There is this curious tendency in India: to force or to beg in the name of charity, social service or patriotism rather than rewarding the talent. There are very few examples of honesty, hard work and talent rewarded without political connections. © Dr. Rajas Deshpande
Are the medical students any less talented than their counterparts in engineering or other streams? Don’t they study equally hard and work 24/7 many more years before they qualify? Even after that, the highest salary that the government offers the starting doctor (even engineer) is laughable, and if they wish to work at a private/ corporate hospital, they cannot decide the rules of payment strategies. If they must start their own set up, they need huge investments, over fifty permissions, many recurring, every one requiring bribe in some form or other. And whichever one they choose from the three career options above, from day one the society and media will have already presumed them guilty of extracting money from patients, the government and even some judges urging them to understand the feelings of relatives beating up doctors. I wonder how many ministers , judges or media bosses would like to understand the feelings of those who beat them up for something their client/ petitioner didn’t like. The most pathetic part is that while all of the above officers are inaccessible to common man, they still have armed security, and the junior most doctor who faces armed relatives is denied security even by law! © Dr. Rajas Deshpande
Most top medical graduates and postgraduates, like almost all other streams from India are leaving voluntarily because of this situation. To deal with this, the best options that some governments came up with were long term bonds to force govt. service (without telling anyone where the govt. spends so much on medical education), and canceling permissions to leave India even after the bond is completed. Bravo! © Dr. Rajas Deshpande
The Hon’ble PM has time and again declared many institutes like AIIMS to be opened across India. This is welcome, but we must also look at the state of conditions and staff in the existing health institutes run by the government. That needs billions for repairs, facilities and hiring better staff. Unless the salary structure for young and talented medical specialists increases , there are no chances of any AIIMS-like institutes running efficiently, they will soon become dirty buildings with low budget staff, where desperate patients are chronically dissatisfied and mobs find chances to vent anger.
Earlier I had immense respect and pride for every doctor who decided to return to India with a positive attitude and a wish to serve the society, their only expectation being living a modestly good life. Now I doubt if they are doing justice to themselves or their family, by choosing a life of financial and personal compromises, where they not only sacrifice, but are still looked upon as “looters”, face a violent society and a prejudiced government.
Ten years ago, I would have told this student of mine “let go of a good life, stay in India, we have a lot to do for our country”. Today, I don’t interfere with their decisions to make a career outside India. Because I love my India as much as any soldier would,and I also love the talented people in it.
© Dr. Rajas Deshpande
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Which Is The Best Festival Upon Earth?
Dr. Rajas Deshpande
“Happy Diwali” said Mr. Abdul as he entered with a box of sweets in the OPD.
Over five years ago he was admitted with a complete paralysis, and had fully recovered as he had reached the hospital within two hours of the onset of paralysis. Since then I had received his Diwali hampers without fail.
A happy gentleman who liked to make funny sarcastic comments (maybe Pune effect), he made me smile every time. “Your fees has increased, doctor, but my feelings of gratitude for you will not change” he said now, silently laughing: “Every Diwali I remember that I was admitted on the Laxmipooja day, and our family was worried if the specialist doctors will be available. My wife was praying that there should be some specialist doctor to attend my case all the way from home when I became unconscious” he recalled. Dr. Rajas Deshpande
Indeed, he was admitted on the auspicious festival day, the junior resident doctor had activated the stroke code, our team had rushed in. I was already in the hospital to see a VIP leader whose headache usually worsened on holidays and then many specialists had to be called in to ego-massage his headache. So I could see Mr. Abdul immediately, and explained to his family that his condition was critical, that there were risks of complications in the first few days. Uncertain with the new doctor, they requested that I talked to their family physician Dr. Feroz. I did.
This is but natural, and there was no reason to feel offended with the anxieties of a serious patient’s family. In the age of trustless relationships where couples check each other’s cellphones like detectives and parents and kids question each other’s intentions, it is hardly possible that a serious patient’s family will blindly trust a new doctor. Even some doctors distrust new (not senior / junior, but the one being consulted for the first time) doctors. The only possible solution is an understanding doctor who takes this in stride, refuses to be offended, and acts in the best interest of the patient, taking an extra step to make the worried family comfortable. There are indeed some who never trust anyone whatever one does to satisfy them, but that is their own cross to carry, one should simply ignore the ugly trait. It is well known that those patients who do not trust any doctor suffer worst, as they don’t take anyone’s advice seriously. Dr. Rajas Deshpande
Three days later, as Mr. Abdul recovered, the family breathed in some confidence, and started believing all that I explained, without having to involve their family physician. Since then, although I have advised that he does not require to see me now, and instead he can follow up with Dr. Feroz, Mr. Abdul visits me every six months for a check up. His wife calls me Rajabhai, a name I would not have allowed anyone to call me with, but couldn’t dare tell this to her!
This is a pretty standard picture across India, most of even the poorest recover well from strokes, accidents, burns, infections, fractures, heart attacks and various other emergencies if they reach hospital in time. While people all over the world wish happy festivities to each other, take holidays, revel and eat and enjoy, while leaders give long festive speeches from their farmhouses to please various voters according to mob IQs, it is the professionals like doctors and servicemen like police, military, etc.who slog and run to save lives. They forget family and enjoyment to be available for those who suffer. The perpetual thankless will immediately say “but this is a choice you made”, but not understand that this choice was made to be respected, to earn well and to save lives, not for the society, the skimpsters and politicians to take advantage of. To see the sick and crying, angry people, to witness death and disability on the very days that your family expects you to be happy with them is not something one can easily come to terms to, and this is lifelong, not a five year term with long vacations. Dr. Rajas Deshpande
The fact that millions of critical patients are attended well during the most auspicious festivals: Diwali, Eid, Christmas, and all other religious festivals included, is conveniently forgotten once the festivals are over, and then the mudslinging about medical professionals starts, with the long speeches advising doctors to work harder with lesser expectations. Dr. Rajas Deshpande
“Doctor, this is not about Diwali or our religions” Mr. Abdul said while leaving, “this is to continue the tradition of humanity. There must be so many patients who can be with their families this festival, because some doctor worked hard to save them. This is my token of respect for those doctors”.
As always, I told Mr. Abdul that I was immensely grateful that the superpowers gave me this opportunity to be a doctor. I meant it. Dr. Rajas Deshpande
I often imagine: what if I was born with too much money, son of a rich father, with no worries for earning and no limits on spending, I would so much love to roam around the world in luxury cars and jets, among beautiful people (you understand), enjoying life to the brim, without caring for any suffering around me. In that case, I might have been very happy probably, but I won’t have respected myself as much. Even the most junior, newest recruit of a doctor is far superior to anyone who has chosen to cunningly ignore the suffering around, speaking big words and doing nothing about it.
Therein lies the best festivity in life: being a doctor, with an ability to abolish suffering and avert death.
Dr. Rajas Deshpande
Happy Diwali to all Patients, Medical Students, Junior and Senior Doctors, Resident Doctors, Nurses, Technicians and wardboys, Hospital staff and administrators, and to everyone who cares for others, showing it in their actions.
The Babaji Doctors
© Dr. Rajas Deshpande
“Today’s young doctors of today don’t know anything” the famous Senior Surgeon told her, smiling bitterly, “You have nothing wrong. Go home and take a pain killer, you will be fine tomorrow.”
The next day, at 2 AM in the morning, she was comatose, as my Neurosurgery professor in Mumbai prepared to operate her brain. She was found to have a huge tumor in her middle part of brain, that was about to kill her in few minutes.
This student, a girl aged about 21, came to me with a severe headache and mild imbalance. A senior physician was accompanying her as a local guardian, as her parents were in Mumbai. I had found that she had some warning signs, and told her to go for an urgent MRI. This is a standard protocol for any headache with neurological dysfunction. The accompanying physician told her in front of me “We will go and have a second opinion from the famous senior doctor. He is my friend”. I was not offended at all, this is the right of every patient. A senior doctor would definitely have better experience if not knowledge or specialty training. But I did feel sad about the ease with which this senior physician had underplayed my opinion. That he didn’t understand something did not give him a right to challenge it. © Dr. Rajas Deshpande
Next morning the girl messaged me that the F.S. doctor had told them “Nothing was wrong, that new doctors advised unnecessary tests, told her to take a painkiller and go to college next day.’
She went home and rested that night. The headache was a little less by morning, she texted me so. By afternoon, in the college, she started feeling drowsy and had a vomiting. Her local guardian physician asked her to travel to Mumbai to her parents and take rest. On the way to Mumbai by car she became unconscious. Her friend accompanying her called me (the F.S. did not pick up their call). I advised them to immediately contact my Neurosurgery professor in Mumbai for further help. I called him and informed so too. They reached Mumbai late evening. Her MRI showed a large brain tumor that was blocking the flow of fluids around the brain, and causing compression on the lower part of the brain. She was minutes away from death. My professor decided to operate her immediately.
Starting new practice, in the beginning weeks in India after three years of fellowships in Canada, I had far less patients, and more time to spend with each one. Very proud, I was also somewhere pleased by the brilliant competition I faced, and the fact that malicious bitterness was usually a certificate of good work. According to a saying, critics help one thrive. So long as I set my practice standards high and respected them myself, I wasn’t interested in any competition, nor feared any. Silence was the best weapon and I used it freely in many situations especially when refusing to be dragged in low level gossips and backbiting, not uncommon even in the medical world. © Dr. Rajas Deshpande
“Say what you must. Make your point twice and move on. Don’t argue, because then you presume everyone is equally intellectual. The greatest rule of all is that truth will prevail.” Dr. Sorab Bhabha, my professor had taught me. I follow that to date, but I fail in the test of tolerance sometimes.
Many times, to impress the patient more than one’s competitor, some doctors resort to quite unfair and unethical means. To cunningly use patient’s dissatisfaction, reluctance and doubt about medical expenses and to say ‘immediately pleasing and gratifying’ things to make the patient happy is an art which some (senior and junior) doctors wisely incorporate into their practice.
“Don’t do surgery that the other doctor advised you, Those tests were all unnecessary, We will take a second opinion because I am not sure about this doctor, etc.” are the common tricks used. This gets them the instant faith of the unsuspecting frightened patient. This can then be gradually used to drive home the same advise as of the first doctor, but in different words that please the patient. © Dr. Rajas Deshpande
I am not against unnecessary sweet talking, although I don’t want to ever do that. Most doctors of my generation don’t believe in it. The patient must be told the truth compassionately, in the least hurting, non-frightening way, and any queries / doubts that may arise should be realistically addressed. Patients should be told the good and bad of every treatment option, and they should be encouraged to make informed decisions.
A doctor is a scientific, intellectual and compassionate service provider, and should refrain from being a pleasing-gratifying, patronizing or clownish entertainer at the cost of patient’s health by making compromised healthcare decisions, just to keep his/ her “Famous and beloved” status.
Some doctors also think of patients as their “personal property” and when they refer such patients to the specialist, they send a list of instructions and interfere with the specialist’s planned strategy. Some admit under their care patients who do not belong to their own specialty, then pay a good specialist for the correct diagnosis, and then google-treat the patients from standard treatment protocol sites (harmful, because the same treatment protocols do not apply to each patient). This unhealthy practice, mainly based on referral / cuts, will hopefully reduce with laws against cut practice.
Any intellectual will understand this: that with the vast expanse of medical field and research, no doctor can claim to “know it all”. One can only be proficient in one’s own specialty. Where a specialist is not available, or in emergency (this is the term most misused in such cases) one can use the best of one’s knowledge to treat the patient. Unfortunately, India is full of illiterate and poor (and also educated paranoid) patients who will only believe what is most financially suitable to them, will easily fall prey to the magical sweet talking abilities of a doctor, and blindly follow what is told, without ever knowing right or wrong. That is the reason of a rise in the “Babaji Doctors” in this country with so many Godmen in almost all religions! © Dr. Rajas Deshpande
These medical equivalents of “Baba”s will have a benevolent smile, talk very reassuringly, speak only what the patients like to hear, and wisely try to convey that they know better than any other doctor, even the best specialists who have had excellent training in very specialized areas. Quite fortunately, younger generation patients are far wiser than to be affected by these pseudos: sweet talking without a reason is an immediate turn off for most intellectual young.
The hierarchy of education, qualification and specialised training is always superior to the hierarchy of experience. An MBBS passed out 50 years ago cannot be better than a MD passing out today. The ones with higher qualifications and training, even if far younger / junior, must be treated as above one’s expertise in their respective field. Yes, if the degrees and training are equal, then experience matters. © Dr. Rajas Deshpande
“ I don’t agree with your diagnosis, I don’t think that this patient has Parkinson’s disease” a senior surgeon once told me in front of a patient he had referred.
I know no one can be perfect, and I can be wrong. But I also know who is qualified to say that I am wrong.
“With all due respect, Sir, you are not qualified to comment in this specialty, just as I cannot challenge your diagnosis in yours” I replied. Age that does not match its behavior need not intimidate me, especially where a patient’s diagnosis is concerned. A doctor’s first duty is to tell the truth to his patient, and a part of that truth is what the doctor does not understand.
Pretending expertise in medicine may be fatal for a patient, no true blooded doctor can accept that.
As for the girl who was operated that midnight, she is now married and has two kids. She called a few months later to tell me she was doing well.
I continue to meet patients every other day, who have visited the F.S. doc, and tell me how he told everyone else was wrong.
Unfortunately, the only treatment in such cases is awareness.
© Dr. Rajas Deshpande
PS: Most doctors follow the ethics of not criticizing other doctors, which is required by the Medical Council. However only very few senior doctors have a heart big enough to welcome competition. This causes immense difficulty to the newer generations of specialists. Hence this article.
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The Beacon Of Good Doctors
© Dr. Rajas Deshpande
At 3 AM one night, the patient in the ICU called me. “I am very worried about my kids” he said.
He was a chemistry lecturer at a government college, a job quite prestigious, but underpaid like every govt. job except the ministers. They didn’t yet have their own home, and he was the only breadwinner in the family. They did not have the political and power resources to afford a heart transplant outside India that could have saved him.
He had multiple medical problems, and was one of the most complicated cases I had seen. Along with other medical problems like high sugars and blood pressure, he also had a dilated heart that was failing by the day. My teachers had explained him and his family about a bad outcome, and reassured that we are trying our best to change it. I was in the last year of my residency, doing M.D. Medicine at Govt. Medical College Aurangabad.
I sat besides him and held his hand. Due to his heart condition, he could not lie down at all, his breathing would worsen. Tears flew from the eyes of that brave soul, who had accepted his own fate, but was only feeling bad about the future of his wife and three kids. I tried to reassure that learned man, far above me in age, experience and wisdom. This is often a difficult task a doctor must stand up to.
“I understand fate, but I cannot accept the suffering of my family” he replied.
His son, Abhay was studying in the second year of MBBS. Clearly aware about his father’s condition, Abhay stood up to the responsibility bravely, and kept smiling in front of his father, while attending him all the time after college and in the nights. The medicines required were costly (of course not available at the govt hospital), but we found a kind hearted pharmacist who would give these to us at the company rates.
There are two types of death, sudden and slow, and both kill some part of those who love the dying person. But to witness a beloved father slowly succumb over weeks is a horrible punishment, and Abhay and his family endured it, God knows how!
After a few weeks, fully conscious and aware till the last day, surrounded by his loved ones, Mr. Suresh Pohekar left this world. The family stared into a darkness that had no respite. Abhay’s mother, Mrs. Ratnaprabha, took charge bravely. She joined as a lab assistant in the same college, and sailed through the difficult times, coping with the educational expenses of their kids.
I had completed MD by then, and had joined Abhay’s college as a lecturer. One rainy morning, on the way to the hospital, my scooter slipped as someone ran across the road. I could not get up, I had torn a ligament. A stroke of luck, one of the best orthopedic surgeons in Aurangabad, Dr. Jagannath Kaginalkar was riding on another scooter behind me. He picked me up and plastered my leg at this hospital. I informed the authorities that I won’t be able to work on that day, for which the hospital cut my salary. This was ridiculous, and I quit that hospital.
I started teaching medicine as private tuitions. This would help me prepare for my DM entrance exams too. Abhay joined that class, we stayed in touch. I had a special affection for him given what he had endured. Nothing bonds like shared pain.
Most doctors come from poor families in India, and passing MBBS at the age after 22, face this universal dilemma: whether to start earning by going into practice or pursue postgraduation / superspecialty. It is a difficult decision. (The answer, for those who face this dilemma, is only one: get the highest degree possible). He passed MBBS with excellent marks, and got admission in MD Medicine. Working hard there too, he passed his MD exams from a rural medical college. By then, he had fallen in love with his college-mate Dr. Jayashree, a pathologist, who gelled with his thoughts perfectly. He started his practice in a rented small single room in a remote area in Aurangabad.
They never returned a patient for lack of money. Never asked twice for fees, and extended all help to the poor patients vising them.
“I believe I won’t ever grow any poor by helping those who cannot afford. Nothing I want can be at the cost of insensitivity to others. Everyone goes through pain and suffering, and to ignore it when others need help is inhuman. Fortunately, God has provided me with all that I want, and money has never been our driving principle” Abhay says. It is difficult to do this especially in these days where the tendency to take advantage has become rampant among both doctors and patients, but Abhay and Jayashree, guided by their mother Mrs Ratnaprabha, have continued extending to the society what it lacks the most: love and healthcare. Guidance by Mr. Agashe, a well-known spiritual soul highly renowned for his godliness, helped Abhay overcome many a turmoils in his life.
Dr. Abhay Pohekar now has his own home and a Hospital in Aurangabad, and continues the holy medical tradition of silently extending humanity to those who need it. In an era of fake prizes and medals for faker people, we hardly get to know the real beacons of good in our society. So many hundred doctors coming from humble backgrounds in India want to do so much good, only limited by the society’s attitude towards them, and the atrocious regulations and laws being made without involving the ground-level medical practitioners out there.
Abhay, I know that your father, Mr. Suresh Pohekar, looks upon you and your mom proudly from heaven. You must feel very proud too, that you have converted your father’s tears of agony in those of joy!
© Dr. Rajas Deshpande
PS: Thank you, Dr. Abhay Pohekar, for the permission to write your true story.
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The Medical Secret Service: Unknown Angels
© Dr. Rajas Deshpande
“Hullo, Vishwa? Please consider this an emergency. One of my rural patients is here, she is on XXX brand of tablets, she has finished the dose, needs more immediately for another three months. She cannot get them. She has to return by an evening bus. Can you do something?” I was in a hurry, between patients.
“Yes, Sir, I will arrange within a few hours” Vishwa said, and indeed, within two hours, the nearest medical shop called, saying that the medicine was available for the patient at a discount.
That evening I called to thank Vishwa, only to be shocked.
“Sir, you were in a hurry today morning so I didn’t tell, I had a heart attack last night, and an angioplasty was done. I am ok now.” said the 30 year old to me.
Like the thousands of his community, the Medical Representatives, he is immensely contributing to the healthcare industry, unrecognized and unacknowledged. © Dr. Rajas Deshpande
“”What is your job? Just passing on bribes to the doctors? My cousin said to me, Sir, and I did not reply. You should not argue with the one who has poison in his heart. People look down upon us, but they will never understand what we do” said a 60 year old man who had spent life as a medical representative, now a national manager. “We have no choice of judgment, our job is to be the link between the doctor and the company, and to make sure our medicine is available” he said.
Millions of busy doctors, overloaded with their work, have no clue how many pharma companies exist, what medicines they make, what medicines are newly launched, what is the brand name or price etc. It is not practically possible to read the whole new drug launch book every month. This community of medical representatives alone is the link between the pharma companies and the doctors, updating us about various new drug launches in India, their availability etc. They also arrange for academic events so necessary for the doctors and medical students. © Dr. Rajas Deshpande
“Some Doctors are very good and treat us respectfully” said Janvi, who has spent over 20 years in this profession, “but some expect favours from the companies, in the form of tours, dinners and other things. Sometimes, I have had an occasional trespassing of moral lines by some doctor, but that was rare. One needs to be able to take care of one’s dignity and self -respect. Especially Indian women face a lot of difficulty and gender bias when making a career, at all levels.” she said.
“The pressure for women in this industry is immense, and like any careerist woman, I faced a lot of presumptive hate too. If a woman, and especially good looking, is successful, our society already has made its judgment as to the reasons of her success. Most Indian men do not tolerate the idea of a woman succeeding ahead of them. Of course, one must clearly set priorities as to whether one wants to make a career or family, and if both, where the compromises will be, because both are full time jobs at least for any woman. Most doctors have treated me well though, and most doctors also want to do good for their patients”. © Dr. Rajas Deshpande
In my 20 years of career as a doctor, I have never come across a Medical Representative who turned down my request to help a patient: lacs of rupees worth of medicines I have asked them to arrange free for my patients, and they have arranged without a question. Thousands of poor patients receive free / discounted costly medicines, injectables, even stents etc., thanks to the generous efforts of this community and their companies. Thousands of medical camps are arranged all over India, where patients get free check ups from doctors and free medicines by pharmas, arranged by the Medical Representatives, but there is seldom any recognition of this service.
Unlike in most other professions, this community helps out its members without bringing in the competition, and in a recent event, when a regional manager suffered a critical head injury, MRs from different companies collected funds to pay for his bills.
Very few people notice how cruelly difficult the life of a medical representative is. They have to meet a certain number of doctors every day. They often stand for uncertain hours and have days longer than 18 hours, as some doctors finish their OPDs long after midnight. Family life is screwed. They are also responsible for making available the stocks of their brand medicine at different medical shops, and have to bargain with everyone: the stockist, distributor, hospitals, and sometimes the medical shops for making their brand available. The final sale figures are their assessment at every month-end. To achieve targets is essential in pharma industry as in any business, to survive. It is the Medical representatives community that faces the brunt on both sides: company pressure and the medical profession.
Unfortunately, our hate-bespectacled society cannot see anything beyond its suspicions: that all companies offer bribes and all doctors take them, that all doctors deliberately prescribe costlier medicine to earn cuts, and that the whole medical service is driven by money. This is somewhat like a suspicious husband who has a very beautiful and loyal wife, but cannot be happy with her because of his own paranoia. © Dr. Rajas Deshpande
I know many doctors who do not ask for any personal favours from the pharma, do not accept gifts, and pass on all the benefits to their patients. But I do not know any mention of gratefulness for such doctors anywhere. Without the medical representatives playing their part well, the medical profession will be quite helpless.
This article is to salute the thousands of medical representatives who work hard day and night, live an extremely compromised life, and still contribute to the service by medical profession, making life easy for millions of patients.
© Dr. Rajas Deshpande
If a medical representative has helped you / your patient, please share this article.
© Dr. Rajas Deshpande
Seven years ago, Srinirmala Kanduri and her doting husband Vamsi Krishna came over frustrated by what appeared to be an unending punishment: Srinirmala suffered from a common type of epilepsy called CPS (Complex Partial Seizures), and was already taking three to four different anti epileptic medicines for the same. Her fits were still uncontrolled, and she would become unconscious without warning. She also had severe panic attacks, in which sudden fear grips the person, and a feeling of doom with actual physical symptoms like sweating, breathlessness, palpitations and blackouts keep reappearing. This not only made her own life miserable, but her husband had to rush home many times as she used to be alone. Their whole existence revolved around the fear and uncertainty of her illness, even at this young age, they could not plan any future.
Her physical examination was normal, and in spite of so many issues and side effects of the medicines, Srinirmala always kept a positive attitude. “I want to overcome this. I want to defeat this illness” she said every time. Sometimes, the medicines used for the treatment of epilepsy / seizures may themselves cause / worsen seizures. That’s what was happening with her. We gradually reduced her medicines, and were able to bring her to a single medicine, although she required frequent SOS medicine for her panic attacks.
Her husband Vamsi Krishna, working with Infosys then, relentlessly cared for her like a parent. He adjusted everything in his own life to suit her requirements: job, duty hours and undeclared leaves. He was not only completely supportive and understanding, but never even showed that he was doing anything extra for her. “We married in love” he says even today with his shy smile!
Then came the great trial of a woman with epilepsy. She badly wanted to become a mother. They were quite anxious and apprehensive, like all patients of epilepsy who face this situation. Vamsi was comfortable always with her choices, and said he would even support her if she wanted to avoid having a child. This is a nightmarish situation, given the emotional attachment that the mother and father have with the child they imagine. Now a days some safe medicines are available, although there’s none with a “completely safe” profile. Epilepsy medicines taken during pregnancy, almost all, have some risk for causing adverse effects upon the baby. Adding a simple medicine like folic acid and some supplements reduces this risk significantly.
Srinirmala and Vamsi decided to bite the bullet. These are the decisions that actually make the lives of the successful. We reduced her medicine doses to minimum, folic acid was added, and Srinirmala came with the good news soon. All through her pregnancy, her husband never left her alone except for his duty. Fortunately no fits came during her pregnancy, and she warded off her mild panic attacks with courage.
Then one day, THE call.
Shanmukhapriya was born in Hyderabad, under the care of Dr. Bhagyalakshmi at the Yashoda hospital, and both mother and the baby were smiling fit!
Another battle against epilepsy was won!
“There are ups and downs. There is uncertainty, no one can escape these. Keeping patience in difficult times helped me most, and that’s what I will advise everyone who plans to go ahead with extending the family while battling epilepsy. When I explained my situation rather than hiding it (stigma associated with epilepsy among the ill educated is a curse in India), my colleagues and bosses at Infosys and later Cognizant were very supportive.” says Vamsi Krishna.
Now Srinirmala has completely recovered, and rarely needs to hit the panic button. “I think it is very important to decide once and for all : that I will live normal, I will be fearless, whatever happens. That is what helped me win my battle” she says.
Then, as she asked the cute, sweet, and beautiful Shanmukhapriya (she is my child too, I feel, and the parents kindly allow me that) to blow a flying kiss at me, she commented “The proof is in this pudding”.
© Dr. Rajas Deshpande
PS: Thank you, Mr. Vamsi Krishna and Mrs. Srinirmala for allowing me this write-up for patient education, and Thank you Ms. Shanmukhapriya, for your heart throbbing smiles!