Tag Archives: medicine

“Is The Diagnosis Wrong, Doctor?”

“Is The Diagnosis Wrong, Doctor?”
© Dr. Rajas Deshpande

“Doctor, there is no improvement at all” said the angry husband, throwing the case-file upon my table.

Well this is not an extraordinary sentence for any doctor, one must be prepared to openly deal with this. I had been quite polite and well mannered with them, there was no reason he had to cross that line. I could understand though. When they pay my fees, they expect some result or satisfaction.

While teaching my students, I have always insisted that if the patient / relative says that there is no improvement or change with the prescribed medicine, one must first consider the possibility of a wrong diagnosis, a missed condition or a misinterpreted finding. Doctors are humans, and do commit mistakes, or misinterpret findings. This is normal, and happens with every doctor. Medicine is far more complicated than most people think they know. A good doctor knows this and learns, while all the time keeping patients safe, but a doctor with ego kills his own practice, and may cause harm to the patient.

I asked them to sit down and reassessed the case in detail. A 28 years old female. Headache, giddiness, imbalance, palpitations, breathlessness. Lack of sleep and bouts of crying. Past and family medical history not contributory. Physical examination completely normal. MRI of brain normal, Vitamin B12 and D levels low. I had started vitamin supplements, anti-anxiety medicines and an SOS for headache.

She told me all her earlier complaints had improved, but now she had a severe backache. I told the patient that I was trying my best to understand her condition, and to resolve her problem, but her findings and complaints didn’t match. She looked at her husband, and asked him “May I speak frankly to the doctor?”.

Openly agitated, the husband sarcastically offered to wait outside if she needed privacy. However he stood glued to the chair as if he knew her answer. © Dr. Rajas Deshpande

The patient thought for a moment, told him it’s ok he can wait inside, then started to talk. She revealed that she was the only child of her affluent parents, had passed engineering, but now had to quit job and stay at home to raise children. They lived in an extended family, with grand in-laws, in laws and an elder brother, his wife and two children. This patient was the ‘last in the line’ to take orders, all others being senior to her. Her husband and in-laws were perfectionists, and she was tired of their continuous expectations. She had dreamed of making a career too, wanted some free time outside home for herself, but year after year, she didn’t get even a minute for herself. She was tired of it all and there seemed no respite. © Dr. Rajas Deshpande

“I am not averse to hard work, but the continuously condescending and fault-finding attitude makes me feel that I am useless”, she said, and added cautiously: “We were in the same institute and my ranks were always better than him. Look at where I am now” she started crying.

I offered them water and coffee, and waited for her to settle down. The husband became restless and defensive, but his tone was far lower. “I understand her problem, doctor, but what can I do? I cannot leave my family. My work pressures are quite high too, the IT industry is going through a bad phase”.

“I can assure you that she has no neurological problem now’ I replied, “she should improve with lifestyle changes, counseling for the family, and adequate free time for herself. I will refer you to a good counselor” I told them.

The husband laughed. “I can understand, but my parents will not. We will see what best we can do for her”. A bitter tone in his voice didn’t escape me.

‘Sir, she told us what bothered her, and must not be held guilty for trying to speak her mind. It will only help identify and treat the problem better. Please see a counselor together and avoid discussing this at home right now” I requested the husband. © Dr. Rajas Deshpande

There are many reasons why a patient does not improve. Untreatable medical conditions, depression, seeing the wrong specialist are the most common reasons, but there also are patients who want medical leave,those who want to avoid work, who want attention, so will keep on complaining of false symptoms. They do not improve with drug treatment.
On the other hand there are many who keep on taking the wrong medicines for years, those who self-medicate, do atrocious / injudicious dieting and exercises, yoga that doesn’t suit them, and do not follow the doctor’s instructions about abstinence, who keep on indulging salt, sweet, oil, alcohol, tobacco and other drugs freely available in India. © Dr. Rajas Deshpande

A doctor remains a lifelong medical student. A doctor who thinks he / she is always correct is most dangerous. It is not uncommon to meet doctors who are angry / upset with the patient / colleagues when their diagnosis, treatment is questioned. The first thought of a doctor when the patient does not respond positively should be to consider a misdiagnosis, reevaluate the case in more detail, reassure the patient, and obtain a second opinion if necessary. All this done, one must look into other possibilities, with an approach to resolve the issue rather than trying to shove down the patient’s throat their own faults.
We all go through bad patches in life, doctors and patients. If the child is wrong, the parents correct them still with love. A doctor’s attitude should be similar, with due care to also protect themselves. If not the doctor, who will understand the patient whose family refuses to understand them? In so many ways, especially in the Indian society, the doctor must don the role of an elder brother/ sister. Although patronising is legally discouraged in medical practice, and should be refrained from in cases where trust is questionable, one can make exceptions for some cases that need reassurance where the family fails to do so.

The nobility of our profession also lies in reassuring the patients that they are well cared for by their doctor, through the thick and thin of their life.
© Dr. Rajas Deshpande

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Beyond Ridiculous!

Beyond Ridiculous!
© Dr. Rajas Deshpande

A 9 year old child with fits / seizures was taken to a renowned Paediatric Neurologist. He started treatment with one of the most commonly recommended (by almost all textbooks) used medicine in the treatment of seizures: carbamazepine. One of the most effective medicine, used since over 50 years in children, that can cause side effects of rashes in less than 1/1000 cases. Still rarely, the side effects can be very severe, causing extensive damage to the skin.
The doctor explained this to the child’s parents, and then started the recommended doses. Pediatric doctors are the best trained doctors in dose calculation, they are more aware than any other specialty about the side effects in general, because children often cannot even speak and parents may not notice some side effects. © Dr. Rajas Deshpande

Every medicine has side effects. Even vitamins do. Any medicine can potentially cause life threatening reaction, and that’s why the common warning with each medicine: do not use if you are sensitive to this medicine. How will one know whether there will be any allergy / reaction to the medicine without having used it?

Most medicines can cause side effects at high doses, but some can cause dangerous reactions even with the tiniest dose, or test dose. Some medicines (even the one mentioned above) can cause side effects after many months / years of safe use. While the dose dependent (high dose= higher side effect) side effects are somewhat predictable, the ‘idiosyncratic’ (meaning occurring in individual, not all cases, because of the natural tendency of that person) and “allergic” side effects are totally unpredictable, and can be caused by even such common medicines as paracetamol, aspirin, antibiotics or vitamins. Even deaths have been reported after the use of some common medicines, but even in the highly legalized western world, no court holds doctors guilty for the side effects of medicines, if these were discussed and informed to the patient / family. This is against common sense. © Dr. Rajas Deshpande

This child unfortunately developed a rare but well known side effect of this drug, called Stevens Johnson Syndrome (severe skin rashes), had to be admitted and treated, it cost them one lac rupees. While we sympathise with the child and the family, and wish them the best recovery and health, this is hardly the mistake of a doctor.
But the forum, in a regressive decision, held the doctor guilty, fined him 90000 rupees. This is beyond ridiculous. The court observed that “ if the doctor knew that this drug can cause side effects, he should not have prescribed it”. Translated intellectually, that means NO DOCTOR CAN PRESCRIBE ANY MEDICINE! © Dr. Rajas Deshpande

Moreover, what will this court advise for the child now? Every seizure medicine has some rare dangerous side effects. There are no medicines free of side effects. Shall the child be left without treatment now? Which doctor will want to treat such a case? Which court will guarantee that the rarest of the rare side effect cannot happen again in this case, and with such ill-informed forums, the next doctor trying to do good to the child will not be held guilty? © Dr. Rajas Deshpande

Technically, if using a drug that can cause side effects is a crime as per this court, it should hold everyone concerned guilty: the textbooks / medical bodies that recommend this drug, the pharma which produced it, and even the government which allowed it to be sold. Applying the same logic, if some child developed peanut allergy in a hotel or side effects of pollution and dust by travelling on Bangalore roads, will this court hold the hotelier or the city administration guilty and punish them too? Has this forum/ court banned tobacco and alcohol yet, or will it punish the government for the side effects and thousands of deaths caused by these? © Dr. Rajas Deshpande

The IMA, other medical bodies, Neurological society, and intellectuals should stand by this doctor who has suffered the mental agony. This decision must be challenged in higher courts.
We regret that some patients suffer side effects, no one should, but at the same time, the “side effects of medicine” is not the doctor’s fault, especially in this case where he had explained the parents about such possibility.
We need medically educated forums and judges who can refrain from populist tendencies.
© Dr. Rajas Deshpande
PS:
I respect courts. I respect higher courts more. But I refuse to believe that every decision made by every judge is correct, that every decision is impartial, that it is not affected by pressures. This article is solely based upon the attached news clip. I must admit that this reporter Ms. Meghna Singhania has done an excellent and impartial reporting. Doctors must please stand united against this decision.

https://medicaldialogues.in/side-effects-of-prescribed-m…/…/

The Bleeding Curse of an Extraordinary Doctor

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The Bleeding Curse of an Extraordinary Doctor
© Dr. Rajas Deshpande

“I cannot sleep well, I cannot forget what happened” said the doctor who had come to consult. I was shattered myself. My usual poise was blown to pieces listening to what this mountain of sacrifice was telling me.

As Dr. Anil Dadarao Waghmare told me about his past, I was in frightful tears.

Son of a humble education officer, he had joined MBBS on merit basis, and completed it in time. He wanted to honour the government bond for two reasons: he had an inner desire to serve rural areas in India where medical care was not available, but he also had no other source of income and had no money for investment. This is the common story of most doctors graduating in India.

He joined as a medical officer and was soon posted in a very remote tribal area, where he went beyond his duty to help the illiterate poor tribals. He worked ‪24/7‬, attended all their problems like deliveries, poisonings, snake bites etc., but also went to visit homes of those who could not reach him. He offered his designated vehicle as an ambulance whenever someone was to be taken to a higher rural hospital. His wife and children accompanying him sacrificed normal life. Two of their kids went to the local primary school, the quality of education was extremely poor but they had no option. The third child was only 9 months old. This youngest daughter was often looked after by a 12 year old girl who lived next door, and helped Dr. Anil’s wife with her chores.

One day, Dr. Anil’s wife received a phone call. The lady caller who spoke in local dialect told her that this youngest 9 month old daughter was in her possession, and threatened to kill her if a certain amount was not paid immediately. By the time they could arrange anything, the infant was found dead by suffocation. The 12 years old girl who looked after the child was found dead in a local well after three days, a huge stone tied to her body.
The murderers were soon arrested: the lady confessed to the crime, assisted by her parents, for want of money.

All the three: the murderer lady and her family were being treated by Dr. Anil for over a year, as free patients.

Dr. Anil was transferred elsewhere, and decided to still continue serving the rural population. He has now joined a postgraduate course, but he wants to keep working in rural areas.

“No one cares about a doctor’s life, family or especially security. The situation is worst in the rural areas, where illiteracy, superstition, witchcraft, murders and rapes are commonplace. Local politics is at its worst” says Dr. Anil, “I was ready to sacrifice every pleasure in life to serve rural population, I even compelled my family to sacrifice, but I did not deserve this punishment. This pain is beyond description, sometimes I feel whether my decision to go to such unsafe place with family was correct. This bleeding curse kills me every moment”.

Thank you, those who keep saying that our society considers doctors ‘like Gods’!

While air conditioned hypocrites advise doctors to go and serve in the rural areas, no one will look at the big picture: there are no facilities, but worse, there is no security. You are left at the mercy of local criminals, often politicians.

Film stars, directors, politicians and many judges will never notice this kind of a story, just as they won’t ever comment about the sickest lowly traditions in their own individual profession. Communities ripe with rapists and murderers, and onlookers who film rapes or murders rather than trying to stop them, expect the best brains to work for their healthcare at meagre salaries.

There is nothing wrong with a short term bond for service in rural areas, but while signing such a bond or joining such areas, the doctors should also ask the government a written guarantee of security. This should be the part of the bond. If security can be provided to every TDH in politics, filmdom or to even the lowest ranks in the judiciary, even some criminals, it can definitely be extended to the doctors serving in rural areas. A doctor who feels threatened cannot work and in fact should not continue to work unless adequate security is provided to him / her and family.

Dr. Anil Dadarao Waghmare, you deserve the highest medal any doctor can ever get: because you showed this selfish society how big a doctor’s heart can be, by continuing to serve in rural India. From now on when the loudmouth foghorns in politics and administration try to malign our profession, or try to cover the gaping deficits in basic facilities at rural level by pointing fingers at the doctors, we can tell them your story.

As for the loss of your 9 month old daughter murdered by your own patient, I stand up in tearful, shameful regret of the state of affairs of Indian Rural Doctors.
© Dr. Rajas Deshpande

PS
It is high time the doctors unite to take a strong stand against aggressive attitudes of society, against stupid policies and being taken for granted and spoken against by uneducated loudmouths.

This story should reach every blabbering idiot who has no doctor in the family and keeps on expecting all doctors to be servants of this society. To those among doctors who try to impress faceless media or administrators by continually talking negative about our own colleagues, this story should serve as an eye opener.

Thank you, Dr. Anil Waghmare for the courage and permission to share this story.

What Your Doctor Never Tells You

What Your Doctor Never Tells You

© Dr. Rajas Deshpande

This small girl who had had her third convulsion in last three days was now looking frail. Her mother, extremely anxious, asked me what can be done to “immediately stop” her convulsions. This hyper-mother had stopped all the epilepsy medicines of this kid few days ago. Patiently, I asked why.

“Because I read on an article describing ‘what your doctor hides from you’, in which the author had recommended a particular diet of natural ingredients “, she replied, adding “the article said that all allopathic doctors give you medicines that will keep you sick for longer, so that they can earn more. It also said operations like joint replacements or procedures like angioplasty should never be done.”

Needless to say, this lady was buying the “Purest Natural Guilt Free” products from that website, at a price that was way costlier than all of her allopathic medicine combined.

I told her that it was a mistake to stop the kid’s medicines, and issued her a new prescription. © Dr. Rajas Deshpande

“What do you do, mam?” I asked her.

“We run a bakery, I sell exotic cakes, muffins etc.” she replied.

“Do you lie to your customers? Do you sell them products that will harm or kill them?” I asked.

“No, never! How will my business run then? We have to obtain licenses for food quality.” she retorted.

“It is the same about us doctors, mam. All the medicines, stents and joints that your article has slammed, are approved by government, and additionally, they are scientific products, not just claims. The government also earns tax on each medicine, stent or joint sold in India”.

I was offended somewhere, and so continued:

“We come from similar families as yours, mam. Even our parents teach us culture, compassion and good habits just as yours do. We doctors learn in the same schools as you, and common school teachers have taught us the importance of good. We too have parents, spouses and family, kids whom we teach good values by practice. Why will such doctors hide the truth from you and suggest you something that will harm you, who have come to us in good faith? Do you presume that all of the thousands of brilliant patriotic doctors will hide a cure from patients, and continue to let people suffer? Just because some bakery is selling rotten cakes, how would you like someone badmouthing your bakery, your integrity? ”

“Not you doctor, but not all doctors are like you” she said.

“Thank you for your faith mam, but I know that most doctors are like myself, who have struggled hard to achieve their degrees, to be able to save lives and bring an end to the suffering of millions. It is not an easy task, there are many easier ways to earn money with lesser hard work and sacrifice. You will rarely find the children of stars, sportsmen, industrialists and other ultra rich becoming doctors, no one wants so much hard work for such less money.” © Dr. Rajas Deshpande

“We cannot advertise, while most of the alternative medicine companies, gurus and babas keep on blatantly claiming cures for incurable diseases, spreading rumors about allopathy and some other recognised pathies, cleverly selling their own products to desperate patients who hope for relief, and spend far more in the wrong direction. Look at who all is earning crores while claiming that allopathic doctors are cheating people”.

She said she agreed, and won’t interfere with the right treatment of her child now onwards.

This is a complication of a deliberate and sick propaganda which has been orchestrated to tarnish the image of especially allopathic doctors, to be able to sell innocent patients one’s own unscientific products. It is sad that the very people who complain about the consultation charges of qualified doctors go and buy extremely costly “magic remedies” like some unproven, unscientific laser instruments, vibrators, garments, herbals, extracts etc. © Dr. Rajas Deshpande

The fact that vegetables and fruits are costlier than many medicines, that weekly vegetable expenses or family dinners in India are far more pricey than a specialist’s consultation which can be obtained urgently, speak a lot about where we stand. In the developed western world, there are year-long waiting lists to see most specialists. The fact that Indian doctors are the best and hardest working is appreciated all over the world, but so many Indian gurus, babas and fraudulent quacks run campaigns against our own doctors, in our own country! © Dr. Rajas Deshpande

Want to really know what the doctor doesn’t tell you?.

A doctor never tells you to go to herbal babas when you come to the emergency and need immediate attention. A doctor never asks you to take your lot to the websites that slam medical profession, when you need help. A doctor never abandons even a faithless and arrogant ignoramus, does not ask them to go search internet for blogs and natural remedies when someone is dying of a heart attack or a stroke or accident. While many recent fulminant ads claim that all doctors are greedy and deceptive, there are thousands of doctors in the hospitals all over world, who are not eating, sleeping or being with their family right now: not because they want more money, but because many will die if we don’t work hard. It is so sad that this had to be explained in India!

What a doctor really doesn’t tell you is: how difficult it is to treat and to save lives of the very people who have no faith in the one trying to do them good!

© Dr. Rajas Deshpande

PS: Recently the number of posts circulating to slam all medical professionals, especially allopaths, have increased, especially in an attempt to market certain products. This extremely harmful trend is ignored by all concerned authorities. This article is an attempt to defend the glorious scientific profession I belong to.

Please share unedited.

The Untold Slaughter

The Untold Slaughter
(c) Dr. Rajas Deshpande

In my first year of Residency, I was waiting near the hospital elevator, with a colleague, already late at 8.30 AM. The Dean, who is the highest authority in medical campus, on his morning rounds, came with his routine flock: Medical Directors and Superintendents, Nursing Chief, and Assistant Medical Officers, and waited for the elevator. I wished him a Good Morning, he reciprocated and looked at his wrist watch. I understood. “Sorry Sir, I had an emergency last night, I left wards at 7 AM” I said. He nodded and smiled.

He was a respectable odd man out in the system at Government Hospitals then. He was clean and non-corrupt, extremely punctual and active. This reflected in cleaner wards and better services, availability of staff, medicines and devices, although the patients who benefited rarely knew who was the guardian angel behind the service. He had become Dean by a rare chance: there was no one qualified and willing to take on that responsibility, so he was given the charge. However, now those in the “good books” of power were ready to take over, and awaited the right moment.

Like most straightforward and non-corrupt officers with a spine, he was generally hated by the system. He had stopped the bribery and corruption that started from some ward assistant / ward-boy level to all the purchases, appointing committees of different heads. He had stopped the purchase of medicines and devices / catheters from dubious companies which had flourished for years around the town. “Local Cheap Pharmacies” run by the “Well Connected” or aliases of those in power were affected badly, as their whole set-up was designed to run via such government hospital purchases.

The doctors, clinicians and residents like us were happy that the patients got good quality drugs, it is otherwise horrible to witness treatment failures which can never be proven to substandard drugs or catheters. The only face to blame is that of the doctor for a politician or a patient.

Naturally, he was on the hotlist of many in power. The best weapon in politics: the caste card was being used against him. The labour organisations and staff associations that belonged to a different caste / religion than that of this Dean were continuously active to create nuisance, hoping to spread the fire and bomb the press at the first correct opportunity.

Almost all elevators at government hospitals are the basic old re-repaired ones: slow, jerky, unreliable, like many offices. As we waited, few others joined the elevator queue. Among these was a middle aged sweeper lady, who came limping.

“What happened?” asked the Dean to her.
“I fell at home, it’s just a small sprain, I am taking medicine Sir” she replied politely.
The elevator came. As patients rushed in, the Dean held open the door for her, and asked her to get in first.
“Pehle aap andar aao” he said (“You come in first”).
The lady politely replied “Nahi Sir, aap chaliye pehle” (‘No, Sir, You get in first”).
He went in, some staff went in with him, then he asked the sweeper lady to come in too, by a hand gesture.

That was enough. The next day, there was a huge agitation. The allegation was that the Dean said “Aati Kya” (“Will you come with me”) to a sweeper, and made an obscene hand gesture. There were morchas, road blocks in the campus. The sweeper lady declined to comment, her husband who was among the association leaders gave the press interviews. Some student organisations based upon caste and religion were involved, their gusto fueled by those in power. Two of the doctors who accompanied the Dean that day on the rounds also testified that the allegations were true. One of them was in fact the next in line to become the Dean. Everyone sane in the campus felt ashamed.

I was too insignificant then, just as I am today. But I went to the Dean with my female colleague, and we offered to testify what had actually happened.

He smiled through the hell he was going through.
“It was my mistake, Rajas, that I accepted the post. This is how the system works, this is the power they have. It is never any party or caste or religion, it is merely a human tendency and unfortunately, that is in abundance today. We have no chance against the majority, and if the majority chooses to be a mob, we
are helpless. Because mobs are bought and blinded, they have no logic or reasoning. The wisest thing in certain situations is to continue to survive, do your best, till you can help engineer a change”.
“But Sir, those allegations are so unfair and vulgar” my colleague said.
He looked at her straight in the eye, and said “Do you believe all that the politicians say?”.

The change happened overnight.
Disgraced and sent on leave, our Dean did not resign.
“I am the small good that must remain in the system. Twisting facts, making allegations that need no proof, exposing personal lives and relationships, misusing culture, philosophy and wisdom as per convenience are new-age essentials for most political leaders. Illiteracy is a dangerous force. The only hope is those who do not succumb to pressure, keep their eyes open and think with their own brains” he told his friends.

Two years later, when I met him to give him sweets for my passing, to touch his feet and seek blessings, I found the same sweeper lady and her husband waiting outside his office. I told him so when I went inside.

Calmly, he replied “Yes, their son has passed twelfth standard, they need some financial help for his college fees”.
I did not ask him what he would do. Doing good is an obligation with such human Gods, irrespective of what they get back in return.

That places them above every other form of human being dry-blabbering about humanity. I touched his feet thrice that day.
© Dr. Rajas Deshpande

Please share unedited.

PS: Some facts changed to mask identity.

The Babaji Doctors

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

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!
God Bless!

© 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

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.

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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The Power

The Power

© Dr. Rajas Deshpande

“He is probably brain dead” said the daughter, holding back tears.

“Now we have to make a decision whether to continue treatment or not. We are not that rich. Can you help us decide?”.

Not very pleasant, nonetheless the inevitable duty of a doctor: to decide when to pull the switch off. We suffer these decisions too. I went with them.

The patient had developed a heart attack just after a supra major heart surgery, the risk was already predicted by doctors and accepted by the relatives. Now he had no visible signs of any brain function, and the doctors had updated the family so. What with film stars alleging that “some hospitals keep dead patients on ventilators”, most hospitals and doctors now are on the overprotective / overcautious drive, especially with a society that has more blind faith in cinema than in medical profession. © Dr. Rajas Deshpande

As I examined the patient, the handsome junior cardiac resident doctor, Dr. Paramjeet, standing by my side kept on informing me details. An uncorrupted mind of a resident doctor, who wants to do good to all patients, save every patient with heroic efforts was too evident in his demeanour. As in most cardiac care units, the smartest and fastest nurses were hovering around, silent angels who do such enormous complicated brilliant work without any hoopla about it!

I found some doubtful signs of life in the patient’s brain. I told the relatives “His brain is alive, we do not even have a right to think of stopping treatment at present”.

“Don’t worry, Sir, we want to continue. Make all efforts for him please, we will make arrangements too” said the daughter, with something that most doctors see every day: tears, smile and a heavy throat all at once. © Dr. Rajas Deshpande

As I instructed about the changes in prescription, I noticed that Dr. Paramjeet was tearful too.

Outside the CCU, I asked him what was wrong with him. He told me he had had an argument with his boss that morning, when the boss had told him to inform the relatives about this patient being probably brain dead. He had assisted his boss for this surgery, and was reluctant to let the patient die under any circumstance. However, the boss had seen many more seasons, and knew what was legally required, even if it was against common sense sometimes. The boss cared for the patient as much, but was aware of how things go wrong when the relatives are suspicious and faithless.

I received a call from that unit after two days again. The patient had started moving one leg. Dr. Paramjeet and the nursing staff were very excited when they told the details of his improvement. There definitely were more signs of life. The family was completely cooperative, and repeatedly assured the doctors of their trust in the on-going treatment and the staff’s efforts.

In another week, the patient opened eyes. In a month, he started speaking a few words, and standing without support. He was discharged. © Dr. Rajas Deshpande

Yesterday, the whole family came for a follow up. Dr. Paramjeet accompanied them too, happily carrying his gift bag. The patient had regained almost all his faculties, the cardiac surgery had given him a new life. The family told him once again in front of me, what all had happened. Then the wife, who was always there by the patient’s side but had never spoken a word, folded her hands and handed over to me a box of sweets and a shirt and started to speak, but choked upon her emotions. “You returned me my husband” she said. © Dr. Rajas Deshpande

Well, my mental OCD acts up sometimes too, and I told her that it was the cardiac surgeon, Dr. Paramjeet and the nursing staff who saved her husband, not me.

“Yes, but it was you who told us we must try. You doctors have powers like God” she said.

That was simple to answer.

“Tai (Sister)”, I replied to her, “Whenever a patient completely trusts the doctor, it becomes an automatic responsibility of that doctor to cross all barriers and make every effort to save that patient. That power is in your faith. We have just done our duty”.

When they left, Dr. Paramjeet showed me his gift: a wrist watch and a gold chain. “I am gifting these to my Mom and Dad, Sir, when I go home this diwali!” he told me.

I knew how his parents would feel. Every doctor knows it.

© Dr. Rajas Deshpande

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