Tag Archives: Medico

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?

©️Dr. Rajas Deshpande

A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.

Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.

Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.

As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.

“You must respect the authority “ the court said.

“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.

“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande

When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.

The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande

In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.

The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.

The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.

There were no answers. The kind court asked if the doctor had to say anything else in his own defence.

The doctor said

“Yes Milord, but the real answers will hurt:

Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande

“A culture of exploitation of non-votebank groups

and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande

“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande

“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”

Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.

The shocked judge requested the doctor to examine him.

“He is no more” said the doctor.

“What could have happened ?” asked the kind but sweating judge.

The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.

The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande

“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”

“I understand what you mean” said the kind judge.

Needless to say, the doctor was released without a blame.

Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?

(C) Dr. Rajas Deshpande

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A Medico’s Last Certificate

IMG_20180322_171029_Bokeh

© Dr. Rajas Deshpande

A continuous beeping filled up the air in the ICU. Over twenty hearts kept making rhythmic sounds, the nurses kept on silencing the false alarms that rung every now and then, and informing us about the ones that needed attention.

We had kept the cake in the doctor’s room, we were waiting for the right moment. It was well past midnight, we had all wished Dr. Steve a happy birthday, but the ICU was full and busy, we waited for an opportunity to cut the cake.

A very old Parsi man, just recovering from a massive heart attack, was not maintaining his blood pressure. As his alarm sounded again, we rushed to attend him: Dr. Steve, myself and our nurse Ms. Divya. As we adjusted his intravenous drips, he asked us our names. He was funny, and always made us smile in spite of the deadly shadows that surrounded us. When we told our names, he smiled. “See, there’s a Hindu, a Christian and a Parsi happy in this small 10 by 10 room, but they cannot all stay peacefully outside in this big country!” .. Dr. Steve, always interested in one-upmanship, smiled and said, “If you want, we also have a Muslim and a Sikh doctor outside. Shall I call them in?”

With the typical instant Parsi wits, the old man replied “Arrey no no bawa, all our ********** (I did not completely understand that word) political leaders will die if people from all religions come together”.

It was difficult to say whether we were treating his heart attack or he was treating out tired minds. © Dr. Rajas Deshpande

The CMO called, there was a new patient coming up, a young lady in respiratory failure due to pneumonia. As the nurses prepared the new bed, Dr. Steve took down notes from the CMO. Ms. Divya was one of our most efficient and agile staff nurse. Very beautiful and brilliant, she took responsibility upon herself with a passion that would put to shame even some doctors. We all knew that there was something going on between her and Dr. Steve, but both of them kept mum. I knew for sure though, because Dr. Steve had once confided to me about this crush he had upon her. However, overwork always suffocates personal life in a hospital.

The stretcher rolled in, noisy with calls of panic. The patient was gasping. Urgently shifting her on the ICU bed, Dr. Steve intubated her. She coughed a lot, and both Dr. Steve and Ms. Divya were showered with blood stained secretions. Dr. Steve had his mask on, but Ms. Divya had not had the time to put hers on. He angrily shouted at her, while adjusting the patient’s tube, to wear her mask. I finished securing the IV line, and started pushing in the emergency medicines. © Dr. Rajas Deshpande

The patient was a young lady, who had suddenly developed fever, cough and cold. On the second day she had become restless, was admitted in some nearby hospital, but as she continued to worsen in spite of treatment, she was referred to us. It was a viral pneumonia, an extremely invasive and dangerous viral infection had started filling up her lungs with fluid and blood. Just as her oxygen levels improved, she developed an irregular heart rhythm: viral infections often cause severe damage to the heart, a condition called myocarditis. In two hours after admission, the lady died. Horrible moments followed, telling her broken husband and stunned kids that she was gone forever. Completing the formalities and paperwork, we returned to the grind: we were medicos: there’s no choice for us to sit down, panic, repent, mourn or run away.

No one was now in a mood to cut the cake. No one even spoke about it. Next night, Ms. Divya bought another cake, and we all silently wished Dr. Steve a belated Happy Birthday.

Jutst ten days later Ms. Divya developed fever, cough and cold. The same deadly virus, most likely. We all panicked. Dr. Steve took leave and attended her, as her family was far away in Kerala. She had come to Mumbai to earn enough for her family. In spite of all efforts, Ms. Divya passed away in just three days. The faces of her elderly parents and younger brother became one of the worst memory-scars in our lives. Shortly after, Dr. Steve developed the symptoms too, but survived.

I took him out sometimes, to bring him back from the pit of depression and shock that he had sunken in. One evening, when we sat silently on Marine Drive, he said, “I will never have a Happy Birthday again. You know, Divya’s family has no support at all. I have decided to help them out for some time, till we find an alternative”. © Dr. Rajas Deshpande

Staring at the ocean, I kept wondering: In this country, where crores of rupees are thrown almost every other day for even miniscule achievements in cricket and cinema, where millions are spent from public funds upon the useless travel, security, meetings and social dinners etc. luxuries of the super-rich MLAs and MPs, where billions are spent by every political party in elections, there are no funds for the nurses, doctors and other staff who risk or lose their lives serving their patients. If a bridge collapses and many die, if there’s a major accident due to lapses in administration, there is immediate compensation, in an attempt to seal complaining lips. But if a medico is injured or killed, the best thing our society has to say is: “This is because all doctors work for money, it must be the fault of communication on the doctors part!”

We walked that whole night, along the ocean, silently crying. Sometimes the only solace for a medico is the thought that someday someone will desperately need a good doctor or a good nurse, and not find them around. Many medicos who do extraordinary good to their patients do not get any certificates for what they do. Most don’t care. Because we carry our death certificates in our pockets every day. One last certificate that we work very hard for.

© Dr. Rajas Deshpande

Dedicated to the nurses and doctors, medical staff who suffered / died because they served patients, saving lives.

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“Why Don’t You Marry Her, Doc?”

photo 19-09-16, 22 52 52
Dr. Rajas Deshpande

“Sir, she cannot walk, she is paralysed below chest since last few days. Her husband doesn’t care, he has abandoned her. She has no money or insurance for tests or treatment. I want to help her, I don’t know what to do” I told my junior consultant, who was having his coffee break with senior consultant and the departmental secretaries. He looked at me in a nasty way, and said “Why don’t you marry her?” and they all laughed aloud. However, although my professor smiled with them, he asked me to get the patient’s papers.

She was a case of Multiple Sclerosis, in her early thirties, and had lost ability to walk. Her sensation below the waist, control over urine was also lost. This ghastly illness of the brain and spine often cripples the young. In many cases, when such disability develops, divorces follow. The world as we doctors see it is far more cruel, deceptive and dangerous than most illnesses humanity knows. She was left with a small daughter and no income. © Dr. Rajas Deshpande

I felt insulted, but I was in a foreign country. The junior consultant was known for his sarcastic humour and enjoyed impressing women around him, often at the cost of others, like so many dwarfs who take advantage of their chair to achieve what they otherwise cannot. I chose to ignore him, and got the papers to our boss, who called a colleague to enrol the patient in one of the upcoming research trials. That would ensure her free tests and medicines for a few years. I told her the good news. She started sobbing, then handed me a note written by her:
“I am killing myself as I have nothing left except my daughter, I cannot look after her with my disability. I have no complaints against anyone. Please look after my daughter”.
In some time, after she stabilised, she said “Doc, I had come prepared to kill myself today. My daughter is sitting in the cafeteria. If you had not told me what you did just now, believe me, I was planning to drive my wheelchair off the roof today”. © Dr. Rajas Deshpande

We called her 10 year old daughter from the cafeteria. Little did the cute child know how lucky she was to see her mother again that day.

That evening, my boss, the senior consultant, took me out for a dinner. Once the red wine loosened strained faces, he started to speak: “Rajaas, I know you are kind and you want to help others. I know you feel for your patients. But I must caution you, don’t get carried away. Your job is clear: to listen, to advise the best line of investigations and treatment, to explain, and to compassionately guide. Don’t carry too much weight upon your shoulders”.
“Why, Sir?”I asked politely, “I feel inner peace when I walk an extra mile to help my patient. How can that cause me any harm? Didn’t this lady survive just because you helped her today?”
“Because it is a never ending burden. To be able to effectively help everyone coming to you, you must have too much money and too much time. Doctors seldom have either. I lost a lot of time and money, to realise that this cycle never ends, that newer and more people need your help every day, all your life. I almost went bankrupt, collapsed and quit under stress. Then I realised that I must limit this so I could serve them best the next day”. © Dr. Rajas Deshpande

It felt like dry reasoning at that moment. However, boss continued to help patients beyond duty whenever I asked him. Over years, I realised how correct Boss was!

My dear british colleague Dr. Mindy was trying to help a patient through her divorce, I accompanied her. As the patient opened up, she revealed to Mindy that although she enjoyed marijuana, her husband was involved in the sale of other illicit drugs, and that was one reason that she wanted to divorce him. Dr. Mindy involved a counsellor to help her out. However, after they decided to patch up their marriage, the patient told her husband that she had confided in Dr. Mindy. The husband came over and politely threatened her to keep all the information only to herself, otherwise be prepared for dare consequences.
We all spent many a restless nights after that.

Emotionally disturbed, helpless patients, those who are treated unfair by family often depend upon a kind doctor. They get quite restless at times, worry a lot and then expect an immediate hearing and resolution from their doctor. From suicide threats to blackmails, there are messages that pour in once that channel is opened. This sometimes wreaks havoc in the doctor‘s life, because being disturbed affects clinical practice and decision making. The small time left for self and family is thus shot dead. A patient who becomes emotionally dependent upon the doctor can turn into a nightmare for the doctor. Over years, I learnt to balance this, going out of the way only for the few truly deserving patients.

Thousands of patients have survived just because their doctor emotionally supported them in time, otherwise they would have died of lack of will to carry on. No one ever credits the doctors who become emotional back-ups for their patients: a service that costs them time and stress, without any income. That is unfortunately considered a “duty” of the doctor, to be kind and available at bad times, but to be forgotten in good times. © Dr. Rajas Deshpande. Many actually think that good words, compliments and “a satisfaction of serving” should be sufficient compensation for the doctor. Nothing fully compensates, although kind words do sometimes make one feel good.

However, what caused worse hurt to me was some of my own colleagues who made fun of me and many other doctors who went out of their way to help patients. “Impractical, unnecessary, worthless, drama”, and so many other adjectives are used by colleagues and even seniors/ some teachers for doctors, students, residents who walk an extra mile to help their patients. I was extremely fortunate that I met some good teachers who supported my efforts without mocking me, and I continue to meet students who carry on this noble trait forwards.

When I was leaving, the junior consultant came over for the farewell too, and told me in too many words how I must learn to be “Practical”. I gave him a reply that one teacher with advanced genius had taught me years ago, for people who do less themselves and advise others a lot. This reply saves a lot of time and energy, my teacher had told me, and its beauty is that people don’t even understand that you are saying ‘those two useful words’ when you reply like this:

I just smiled at him.

© Dr. Rajas Deshpande

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The Unforgettable Compliment

The Unforgettable Compliment
© Dr. Rajas Deshpande

All six casualty beds were full, the room was full of noises: nurses, fearful and angry patients, relatives, and wardboys trying to move stretchers and wheelchairs in and out. This chaos didn’t affect my concentration anymore. It was late night, heavily raining, my colleague Deepa and myself were the only two doctors- interns then- in the civil hospital casualty. She was finishing the paperwork in the side room. Behind a curtain, I was trying to remove a metal piece stuck in the back of a kid who had blown a firecracker bomb with a tin container covering it. I started stitching the gaping wound once the metal piece was out and cleaning was complete. © Dr. Rajas Deshpande

Just then a girl walked in, all wet and panicked, with another small girl upon a stretcher. I recognized her instantly: she was a classmate from my junior college, Ruta. As the patient was shifted to the bed, Ruta frantically shouted, enquiring for doctors. The nurses had already started checking her patient’s vitals. I finished bandaging the stitched wound, and came out from behind the curtain, removing my gloves. She saw and instantly recognized me too. “You are Rajas, right? Remember me? I am Ruta, your classmate.” She started sobbing, now that she met a familiar face. Her sister, about 15 years old, had had a head injury, falling from a bike, and had just vomited. She was woozy, irritable and confused. I ordered an X ray (CT scan was not available in that civil hospital) of her head and neck. IV line was started and necessary drugs injected. I reassured Ruta that her sister was stable, and continued with other patients.

My subconscious kept on playing memories of the past on some deep screens.
Ruta was exceptionally beautiful and vivacious. She had many fans. I liked her too, but there was no interaction: her group unlikely to engage with nerds like myself. They were a group of happy-go-lucky, good looking and muscular guys and stylish, good looking girls. They were mostly into movies, masti, dance, gymming, rides and food. I was not only preoccupied with a lot of classes and study, but also too shy to belong to such a group. Somewhere I envied those boys, they had so much advantage interacting with girls, with all the time and money they had. However, muscles are not my kind of statement, although (Thank God!) I have always enjoyed excellent health and fitness. © Dr. Rajas Deshpande

Once we finished the junior college, I never saw them. Medical courses hardly allow any time for extracurricular activities. The only silver lining was that there still were beautiful and intellectual girls in the class, and some of them respected and liked nerds too!

As Ruta waited by her sister, I kept on attending the cases that came in. From women in labour to heart attacks in shock, from bullets in the chest to rapes, one night in a casualty shows more pain than many know in a lifetime.

A foreigner couple came in, with their small boy bitten by a bee, he had developed severe reaction, his breathing was obstructed because of the throat swelling from inside. They kept on weeping as we all rushed to inject steroids and other medicines to the child. In some time the kid stabilized. © Dr. Rajas Deshpande
Then the police brought in a drunk driver who had rammed his Bullet bike into another’s. Our duty was to perform a detailed examination, collect blood sample and opine whether he was drunk or not. I was shocked: he was my schoolmate. He recognized me too. “Raja? Dekh yaar ye log mujhe andar kar rahe hain (Look these people are jailing me) he said, “Tu kuchh kar yaar (please do something)”. This was difficult. He was going to hate me for life probably, but I had no choice. I wrote his report. I felt sad, but there was no time to express it.
A snake bitten farmer and a newly wed woman with over 70 percent burns were brought in almost together, both gasping. Deepa and myself ran around to stabilize them, the medical officer came in too, but the burns woman had arrested just as they entered the casualty. We intubated the farmer, who was sinking, while we struggled to get things right. He was shifted to the ICU upstairs. We started finishing the paperwork. © Dr. Rajas Deshpande

It was about 4 AM, now there was a relative calm in the casualty. Sleepy relatives had found corners to doze off. All six patients were relatively stable.

“Excuse me Rajas, Is there a canteen nearby where I can get some tea?” Ruta asked.
“Yes, across the road, in the lane opposite the gate” I replied.
“Will you please join me?” she asked.
Borrowing an umbrella from a ward boy, and informing Deepa, I walked Ruta across the street. We stood sipping the hot tea by the side of the road, under the beautiful rain.

“I have a confession to make” she said suddenly: “I never knew there was this side to life: I only thought my life was to be enjoyed without a worry. If someone had given me a million rupees yesterday to stay up all night listening to other people cry, see wounds and deaths all night, I would have declined and ran away. I cannot stand anyone whining, and here you all are, listening to nothing else, fighting not only death but also expectation, anger and uncertainty. We made fun of nerds like you, and today I meet one, saving lives! I don’t know if I will ever save a life, and here you are saving many every day! I feel how superficial I was! I respect you and what you do. I now think you docs are superheroes”.
We are used to such overwhelmed compliments by patients just relieved of fear. I just smiled. She read my face. ” No, I am not saying this because my sister is admitted today, but because I feel it inside after seeing what happened here”. © Dr. Rajas Deshpande
I thanked her, adding that it was not wrong to have fun and look good, confessing that medicos often secretly miss those things, none of us gets any time for that.

Needless to say, I walked back thanking God, and feeling proud. This was one simple closure, yet so essential!

My co-intern Deepa gave me the expected wicked mischievous smile when I returned.
“Today the tea must have been very tasty na?” she asked, sarcasm overflowing from a face deliberately made over-innocent.
“Solid” I replied with matching sarcasm; “Oxytocin-Dopamine waali chai thi (It had oxytocin and dopamine)”.

We discharged Ruta’s sister the next day. After two days, I received a handmade greeting from Ruta, in which she had written the most unforgettable compliment I ever received:

“You healed more than what was injured. Thank You!”

© Dr. Rajas Deshpande
Dedicated to all medical students, interns and resident doctors.
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The “Cheap Competition” among Doctors: a Hidden Cancer.

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande
Neurologist, Pune.

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

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The Cult of Good Blood: Superhero Medical Students

The Cult of Good Blood:
Superhero Medical Students
© Dr. Rajas Deshpande

He grew up selling vegetables and fruits grown by his mother. He went door to door and in the village market to sell those. He also walked for two miles every day to catch a bus to a school over 20 miles away. He then enrolled in a private class that waived off his fees, because he had a passion: He desperately wanted to become a doctor.

Atul Dhakne, son of a school teacher Mr. Nivruttirao Dhakne and farmer Mrs. Mandabai Dhakne, with his hard work and merit, got admission in the prestigious B.J. Medical College in Pune.

But he wasn’t satisfied. “What about those like me who are from the poor rural background, those who have no access to good classes and education, but want to become doctors?” he worried.

Good Blood speaks, whichever soul it flows in. Young medical students of different origins, studying with him, decided to resolve this. Ketan, son of a lawyer Mr. Avinash Deshmukh (who mostly handles cases for the non-affording,) wanted to do charity like his father. Farooque Faras, whose father raised a family in one small room, was burning with the desire to give. Many others joined in (names below), and the Cult of Good Blood multiplied. They all wanted to uplift the deserving.

“Lift For Upliftment” was born, formed by the superheroes among medical students.

They printed posters and went to almost all junior colleges in Pune, appealing students from poor backgrounds to join their free tuitions / classes, to prepare for the CET /NEET. In the first round, over 40 students joined. After the medical college hours, Atul and his friends took turns to teach these poor students, give them notes, set question papers, conduct exams, assess and counsel for improvement. All expenses were borne from their own puny pocket-money.

There was no fixed place for the class. One local bakery owner, Mr. Dinesh Konde, decided to help these students. He planned the logistics and took them to the corporator Mr. Avinash Shinde, who asked for only one thing in return of his help: commitment to continue this good work. The Cult agreed whole-heartedly. With him, they approached Mrs. Meenakshi Raut, Asst. Director in the education department in Pune, who helped them get two classrooms in a Municipal school after the school hours. The classes thus became regular, every day, from 6-9 PM.

The cult lacked stationery, the huge backup of notes and question paper sets for 40 students, so they approached Mr. Sanjeevkumar Sonavne from Latur, who runs many educational institutes, helps poor students, and even pays the fees of some who cannot afford college. Mr. Shelke and Dr. Harish from Sassoon Hospitals also joined hands to help.

The results were impressive: from the first such batch, 6 students qualified for MBBS, 3 for BDS, 11 for BAMS and 2 for BHMS.

No one had earned anything, but Good Blood flowed forward. Many medical students from subsequent batches came forward to teach free, imparting their fresh acquired knowledge and skills to those who could otherwise have no access to it.

There is no discrimination while accepting junior college students for their class. They have two batches now with 60 students in each. They have also started weekend classes for poor students preparing for NEET in the extremely backward area of Maharashtra, named Melghat. These medical students go to Melghat with their own expenses, teach the rural junior college students over the weekend, and return to attend the tough schedules of medical college again!

“I learned helping others from my mother. We don’t earn anything, but we learn something precious every day” tells Atul, who has now passed MBBS. Ketan Deshmukh, Abhiraj Matre and Farooque Faras help him supervise the group. Their endless enthusiasm only reminded me of how much more I can do. I came to know of this group “LFU” during the recent “Quest Medical Academy” event arranged by Dr. Sushant Shinde.

They are naturally, perpetually short of funds.
I am not rich, but I won’t feel right about myself if I didn’t contribute. They graciously accepted.

When these students came to meet me today, I offered them dinner at a good restaurant (knowing that they stay in hostels). Farooque said “Sir, we will rather use that money to print some more question paper sets”. Farooque’s father has stopped all celebrations in the family, and sends all the money he can, from his one small room home, for the torch of humanity that his son carries forward!

When they asked for an advice, I had but one small request for them: that a Doctor should be completely free of all political and religious influence at work, in teaching, and especially while treating a patient. They assured me that “Lift For Upliftment” has decided to never be affiliated to a political or religious organization, keeping humanity as their highest ideal.

There is no better lamp than the one which carries the light from soul to soul. There is no better definition of humanity than holding hands of those who need it most. I feel very happy today, that I could contribute to this beautiful, divine cause.

Long Live the Cult Of Good Blood, and may we all find it in abundance within ourselves!
© Dr. Rajas Deshpande

The group “LFU” also includes: Esha Agarwal, Shivkumar Thorat, Satyender, Tanvi Modi, Mayank Tripathi, Nikhil Nagpal, Sitanshu, Arvind Kumar, Nagesh Pimpre, all from the B. J. Medical College Pune.

PS: My heartfelt appeal to all medical students and doctors to contribute by starting similar activity in your region, by teaching poor students who want to become doctors, by joining this group and / or by donating for this cause.

Please share unedited.

Essentials Of Being A Smart Doctor

“Essentials Of Being A Smart Doctor”FB_IMG_1470417314264
Guest Lecture at National Undergraduate Students Conference ‘RESPIRARE’ at the
BJ Medical College
August 3 in B. J. Medical College
© Dr. Rajas Deshpande

My dear friends,
If you are sitting in this hall today, you have already proven that you are smarter human beings, but that alone is not enough for becoming a smart doctor. However intelligent or smart anyone else may be in the outside world, your ability to save their life, help them in illness gives you an upper hand, hence the perpetual tag “Doctor sahab” bestowed upon you by the world. To be able to gracefully deserve that tag is a difficult task.
Like success, riches and many other achievements in the world, medical smartness too is not an accident. One has to earn it with a great effort.
There are really smart and good doctors, and there are also those who pretend so. Most patients can tell the difference. So if you plan to be a really smart doctor, you will have to imbibe the essential qualities in your very subconscious, so they become your basic self, a part of your personality. You will have to force yourself to change certain habits, traits of your behaviour and thinking, and allow the inception of newer, better methods within your being. I am very happy that I can speak this to you at this budding stage, while you still have ample time to modify the DNAs of your medical smartness. Once you accept to change for better, never go back or compromise. © Dr. Rajas Deshpande
Let us consider a small question: What quality is universally liked in a human being by almost everyone, including their enemy?
Genius?
Looks? Money?
Muscle power? Political Connections?
No.
Compassion. Kindness.
It is irresistible. Even when a patient has come to you with a prejudice or suspicion, the first thing that will change his / her attitude is your kind words, your compassionate attitude. It is not very easy to be kind and compassionate to everyone, especially the ill-behaved. This is where you will need to train yourself to be smart: by avoiding use of bad words, not raising your voice and not being aggressive. Keep your words to a minimum, and do not use negative, accusing words. Do not speak arrogantly with the relatives. You don’t know when things may take a bad turn.
However, the first few steps that you take to be kind to the patient will get you the biggest reward that this field has to offer: your patient’s trust, and if you care for it, it is usually lifelong. © Dr. Rajas Deshpande
When the patients come in, they are not willingly entering the hospital in most cases, but out of desperation. They are scared, angry and often extremely worried that something bad will turn up as their diagnosis. Add to this the resentment caused by having to be questioned and touched by a total stranger, whom they have to tell private information. This has already made them jittery.
A smart doctor understands this mental state of the patient completely, and makes the best effort to ease out the patient by welcoming them, wishing them, and initiating a genuinely friendly chat. Such simple sentences like “Good Morning, How are you?”, “Hope you are not very tired”, “I am sorry that you had to wait” reassure the patient that they are dealing with a nice human being, and put them at ease.
Whether the patient comes from rich or poor, educated or illiterate background, the doctor must have utmost respect for their privacy and dignity. Asking private questions, undressing and examination should never embarrass the patient. Standing up and wishing the patient while they enter and leave your room makes the patient feel respected, and adds flair to your smartness. © Dr. Rajas Deshpande

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How should a doctor dress?
It is common to see few doctors, both junior and senior, wearing short sleeves and open collars, sometimes even low rise jeans, trying to show off their physique. One can only imagine what kind of reaction they will generate if things go wrong.
There have been many scientific studies about this. If you yourself want to be treated, you will never prefer a shabby looking, ungroomed, unclean person with a stink. You will want someone who looks healthy and positive to make health choices for you. The patient always wants to see a neat, clean and reassuring doctor. Your demeanour should not be frivolous: unnecessary excessive laughing, smiling, joking, bad language are not welcome to be used in front of a worried patient. © Dr. Rajas Deshpande

It is wise to dress up as good as one can, without too much show and fashion. A very richly dressed doctor in a suit may turn off an already nervous patient from lower socioeconomic classes. The best attire is formal, simple, clean and ironed clothes which cover you well, apron, shoes, and no jewellery. Fortunately, tattoos and piercings have not yet much entered this field. One must avoid religious clues, and refrain from religious and political talk while practicing as an allopath.
A smart doctor cannot forget that our field deals with people from different socio-economic strata. He / she should be able to irradiate the feeling of being a trustworthy person and invoke positive, peaceful feelings in those who come to see him / her.
Personal hygiene is an indicator of a doctor’s smartness, and such simple things as hand-washing after every case, using sanitizers, wearing gloves etc. speak a lot about a doctor’s dedication towards good health. Best clinical practices must be learnt and complied with voluntarily by everyone who wants to be a smart doctor. © Dr. Rajas Deshpande
Humility, manners and etiquette
A Spanish TV anchor who follows up with me for Multiple Sclerosis told me once: that many patients travelling to India complain about the doctors being very good clinically, but worst in manners. “I was amazed that you actually offered me a glass of water when I was crying during my first consult” she said. Such simple manners affect the patients so much!
Many doctors, as they ascend the merit scales in this profession, develop a complex that they are unbeatably smart. They end up becoming ego-balls disliked by almost everyone, because of their high handedness. A smart doctor will never let that happen to himself / herself. There are far more smarter people than most doctors in almost every other field, even some illiterates are sometimes smarter than the most literate. One must never shed humility, whatever one’s achievements. We often see students smarter than teachers, juniors smarter than seniors and we all know what happens in those cases. The best policy is to never presume oneself better than the other. A smart doctor always knows his manners and etiquettes very well. © Dr. Rajas Deshpande
Language and communication:
“What do you mean by dizziness?” my teacher asked a tired female patient once.
“Oh I feel abnormal noise in my ears” she replied. Dizziness, in patient’s language, may mean anything from imbalance, blackout, vertigo, to heavy-headedness or blurring of vision. It is always wise to dig into what they actually mean. A knowledge of regional language often helps resolve misunderstandings. Similarly, the patient may also misunderstand the words that a doctor uses.
A smart doctor will learn to communicate so as to make the patients from different streams understand exactly what is being conveyed. We do not always have too much time, hence it is necessary to develop the skill of using minimum words. One must use simple words, and know the colloquial alternatives (e.g. use “Heart” instead of “Cardiac”, use “Brain infection” instead of “Encephalitis” etc.). If the patient does not understand, one must encourage him / her to ask questions. Use pictures if necessary. Many patients / relatives do not stick to time or subject, often asking irrelevant questions based upon their googling, but a smart doctor must be able to steer them on to the right path with a smile and a gentle reminder of time limitation.
The most difficult part of being a doctor is conveying the bad news. There is no good way, one has to be very careful and diligent. On one hand one must offer sympathy and readiness to help further, while on the other hand, one must also be aware of aggressive, impulsive and shocked reactions, making sure not to risk one’s safety.
While conveying the bad news, surgical risk or complications, a doctor must have the patient / relatives sit down, have witnesses around, and speak compassionately but confidently, offering all possible help to ease out their suffering. A hesitant doctor invokes suspicion even if correct. However, an overconfident liar will invite more trouble, so be careful that you speak what is the exact truth. That never fails in long run. © Dr. Rajas Deshpande
Professional Smartness
Friends, as you become more and more specialised, you will unfortunately face rivalry and jealousy. Doctors are the most ingenious professionals in their ability of pulling legs or sabotaging careers, and you may sometimes be facing your own teachers in such situations. A smart doctor will never compromise his / her own grace or the dignity of our noble profession. Fight all that you must, and I will stand by you if you are correct, but always use the best language, think about and mention the best things about your competitor, and always keep the door for direct discussion open. Refrain from allegations, cheap comments, mockery and defamation. If you feel that a colleague is wrong in some clinical decision, please reach out to them and talk, before you discuss it with others. Everyone usually has a reason for their decisions, one must respect it. If your reaching out is unwelcome, then alone mention on paper what you think about the case. A smart professional will have no friends or enemies, no senior or juniors, but only colleagues. Immediate reporting of any adverse clinical events to the authorities, and correct documentation are essential. © Dr. Rajas Deshpande
Medico legal Smartness
We live in a country with too much poverty and illiteracy. If there is a chance that a doctor’s mistake can be proven, there is every chance that the relatives will drag that doctor into the courts of law, demanding millions in compensation.
In these days of exponential medico legal cases, where patients, relatives, authorities and even some colleagues are usually unforgiving if you commit a mistake, real smartness is to document everything perfectly. Just as an example, a young patient of mine recently had a stroke, without any known risk factor. Upon repeated questioning, he reported that he was taking some unknown herbal medicine since three months, in a mixture of some oils, to improve memory. One must mention every such detail on the paper, including poor known history, delayed admission and alternative treatments. Every interaction with the patient and relatives must be recorded on paper. Recording the date, time and your name and designation at the beginning of every note is an indication of you basic smartness. A proper written consent must be obtained for every procedure, however trivial. Information about dangerous medicine being given to the patient / relative should be recorded, a consent for the same signed by the relatives. © Dr. Rajas Deshpande
Academic Smartness
I do not know if I am enough qualified to talk about this, because I was often beaten up by my primary school teachers for not doing my home work and some other curiosities which I cannot mention here.
A doctor is expected to be on top of the pyramid of scientific advances, and there is nothing more pathetic than a doctor who quotes medical knowledge from decades ago. While we respect the past, we cannot disrespect what every standard medical textbook mentions on its first page: Medicine is an ever-changing science. A smart doctor, therefore, will still study on a daily basis even after achieving the highest degrees, and keep himself / herself updated with the most recent medical knowledge relevant to his / her field. Studying on a daily basis, I feel, is the most important basic quality every smart doctor must inculcate. One must register on smart medical sites like up-to-date, emedicine or many others, to stay updated about one’s medical interests. Yours is a lucky generation, having all information at your fingertips, thanks to your smartphones. Check drug interactions every time you use new medicines. Cross check your differential diagnoses. © Dr. Rajas Deshpande
Digital Smartness
Everyone is semi-addicted to their smartphones. However, they are also a great hindrance to the super-essential concentration required of a smart doctor while interacting with patients or making medical decisions. Smartphones can be wisely used to record data and expedite certain protocols, accessing information etc., but they should be switched off while with a patient. It is very humiliating and irritating for a patient when the doctor is occupied with a cellphone during a consult.
Social Smartness
There is a competition now among some doctors to post everything they do on the social media. A colleague of mine recently posted a video of a huge tumor that she removed from the abdomen of a patient. She is now under an enquiry for compromising patient privacy. One must refrain from posting any information that discloses patient’s identity on the social media.
Most of you google your crush, actor or actress you like, don’t you? Well, some of you will honestly agree.
Patients are as curious and inquisitive as you are, and may google you. So please refrain from posting undignified pictures / matter / vulgar jokes, etc. and pictures while drinking / smoking, hugging etc. on social media. Also refrain from posting stuff that maligns your own profession or colleagues. You can improve things from within, not by publicising them.
A smart doctor will learn over time to refrain from giving out personal number to the patients / relatives, as this may lead to many disadvantages later, including unwanted calls, messages, advertisements and other misuse.
While patronising should be avoided completely, (“You are my brother, sister, mother, father etc.), in some cases it may reassure a frightened patient, hence it may only rarely be used. © Dr. Rajas Deshpande
It is not at all uncommon for a doctor or a patient to get a crush upon the other. In case you sense a love interest blossoming within your patient or yourself, immediately rethink about your life’s choices and refrain from any further progress in that direction, as this could turn disastrous for your career. Do not encourage meaningless chats, messaging or personal comments when dealing with patients. An allegation of molestation, sexual harassment or mal-intention can ruin you.
Most doctors feel proud of their excess hard work, and often mention that they work without proper food or sleep for days together. While this is really commendable, it is also a granted feature of this career. One must learn not to milk a pardon for one’s ill behaviour or mistakes by quoting excess work. A mistake is a mistake and the best policy about a medical mistake is being completely honest about it. © Dr. Rajas Deshpande
Moral Smartness
My recently published book, “The Doctor Gene” ends with the words “A good doctor is the best a human being can be”.
You belong to a community that practices the highest of morals not just because the society expects it, but because you have voluntarily sworn to. You have chosen this career yourself. Right from now, please imbibe the best of morals and truthful attitudes in your blood. Believe me, every human being has the hidden sense to perceive a genuinely good person, make sure that your patients get this feeling about you. © Dr. Rajas Deshpande
Serenity Smartness
One important art in medicine is almost on the verge of extinction: that of immense concentration. What with the hustle-bustle and digital exposure that every medico must work with, we are fast losing the ability to switch off the world and concentrate, think or meditate. These things bring the serenity, so essential an ingredient of medical smartness. Learn to find time, preferably on a daily basis, to be with yourself, and sort out the tangles in your mind before they strangulate you.
Higher education
I get atleast one question everyday from some or other medical student on my facebook page:
Which branch is best? What PG should I do?
You will eventually realise what you like. You may seek opinions, but not decisions from others. Be smart enough to identify what you want and respect your own inclinations. Keep a list of alternative options, as PG seats are limited. Don’t waste too much time in pursuing a particular branch, there are so many advances happening that every PG branch offers you good futures if you are dedicated enough. There are umpteen examples on the other side: doctors who got their desired specialties but never did anything significant after that, other than customary routine. © Dr. Rajas Deshpande
De-stressing
I am sure that in this very hall, there are beautiful dancers, painters, far better authors than myself, speakers, and artists of infinite ability. I think I should also say some potential models. But you will give up all that art and beauty within yourself, lost in the heavy duty career of being a doctor.
One absolute essential for every medico is a sure-shot de-stressing mechanism. We are all destined to face suffering, poverty, struggle, pain and death on a daily basis, and this takes a toll upon our minds. We tend to grow mentally old very soon. Many think that alcohol or smoking is a respite, but this is ridiculously stupid. A smart doctor knows to find his / her escape in arts, literature, family, travel and other hobbies. It is extremely essential to de-stress as your performance may be affected if you accumulate stress for long. © Dr. Rajas Deshpande
What do patients want?
The best compliment for a doctor is a happy patient, and the best feeling in the world is knowing that your efforts saved a life.
A smart doctor is the one who has the reputation of making the correct diagnosis in majority of cases. A smart doctor is the one who invokes trust in a patient by being genuinely honest and compassionate. A smart doctor is the one, most of whose patients are happy, not only because their health issues are well attended, but also because they met a caring, well behaved human being.
Never think about money or anything else when consulting a patient. Think of every case as an exam case, get the most correct history, do the best clinical examination and give the patient the best treatment options. You will make enough happy money with such practice, if you are smart enough to understand what that means. © Dr. Rajas Deshpande
Dear friends, one thing about smartness which I learnt early in my medical career is that a senior doctor should not give very long lectures, and should end up his speech before time.
I have written many more things about the essentials of being a truly good doctor, and the glorious traditions of our noble, almost divine profession, in my book “The Doctor Gene’. If you did not get a copy outside, please email thedoctorgene@gmail.com to get your copy.
I am sure that you will all be very successful doctors, and I will be very happy if my words today help you deal with your medical life smartly. I thank you for patiently listening to me today.

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Love to you all and I wish you all the best, always!
© Dr. Rajas Deshpande
03.08.2016
Thank you, Mr. Yashodhan Morye and BJMC UG Student’s Council