Tag Archives: Medicolegal

MEDICARDIA: A Doctor’s Diagnosis.

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© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

Real experience, some facts changed to mask identity.
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The Changing Blood Group

The Changing Blood Group

(c) Dr. Rajas Deshpande

“He is sinking” shouted Dr. Siya.

The casualty registrar rushed to the bed, checked the vitals. Pulse very fast. Blood Pressure very low. Lips and nails white, hands and feet cold. The young man, unconscious, was on the verge of death.

“He must be bleeding inside. Get an urgent sonography of his abdomen”said the registrar to Dr. Siya, and call the blood bank. He will need at least two units of blood urgently”.

It was Dr. Siya’s first week into internship, she was thrilled with the idea of actually saving lives. At the young age of 22, she was witnessing death almost every other day. Along with that she was amazed to see the darkest sides of human nature: the potential of humans to hurt each other: via rapes, accidents, murders, fights. She had decided to not let this affect her attitude, and to continue to try and save every life she could.

That late night, this young man of about her own age was brought in unconscious by someone, who had just dropped the patient in the casualty and left without leaving any identity of himself. “I found him lying unconscious on the road. I don’t know anything else about him. I am just doing my duty, I have a train to catch”said the stranger and left. The patient was reeking of alcohol. He had a visible head injury. A quick CT scan had revealed minimal bleeding due to a small skull fracture. He also had had bleeding from wounds from his hands and legs, they were sutured. The patient had no identity marks, wallet or cellphone. The policy of the hospital was to provide basic treatment and shift the patient to the government hospital. The police station was already informed. Treatment was started.

Dr. Siya requested two units of blood. The blood bank called. They had only one unit of the blood for his blood group. The registrar had the same blood group, and like many doctors working in the emergency departments, he went down to donate blood.

It was nearly midnight. The fate of the life of a young man depended upon what the junior doctor did just then. There was no one to sign any consents, the protocol was to inform the hospital’s medical director and obtain consent for emergency transfusion or procedure. Dr. Siya finished the formalities, obtained the permission, and started the transfusion. If the patient had reacted or something went wrong now, they all feared, there will be a havoc in the media: that they had let an unknown patient die because they wanted money!

Dr. Siya kept on managing the show. The angry and disturbed relatives of other critical patients kept on taunting her, speaking rude and reluctant to complete simple formalities and paperwork.

The sonography was thankfully normal.

Just as the first unit of blood was over, the patient became conscious, and revealed his name. He was quite shaken with the surrounding, but told in broken sentences about his friend’s number and address. He revealed that while returning from a party, his bike was interrupted by a bunch of goons, he had fallen down, they hit him upon the head and left with all this belongings.

The friend was called, and came in. He revealed that the patient was used to smoking weed and drinking alcohol in huge quantities. They were staying in the hostel of a famous college.

The second blood unit was started, and in a short while the patient threw a convulsion. He was immediately given injectables for controlling the convulsions, he slept off with the effect.

His parents arrived early next morning.. The shocked mother was consoled and explained about the situation by Dr. Siya. The elderly father, like all fathers, equally shocked but being a father unable to cry, kept mum, just holding hands of the boy.

When the patient woke up again, the father came to Dr. Siya, and touched her feet. Too embarrased, she told him that the registrar had donated blood for the patient. The father went and thanked the registrar, again trying to touch his feet.

As Dr. Siya had finished her night duty, she prepared to leave. “Beta, Will you come soon please?”asked the tearful mother to her. “Yes Auntie, I will be back soon. Don’t worry, he is ok now”she reassured and left.

On her way back her genius young mind tried to look at the situation sitting upon her shoulder, the little third person that resides within each one who has a conscience. That booze and weed was easily available to youngsters in almost all Indian hostels, that even educated people rode bikes without helmet, that crimes were happening almost everywhere that injured and killed people, that law and order was a laughable term in many parts ofthe country, that there was no government mechanism in place to provide emergency medical / paramedic support ambulances to raod / traffic accident victims: which one is the most responsible cause, when patients like these died? Who is responsible?

She reached home, told her proud parents what had happened, that she had helped save a life. Her mother folded her hands towards the sky, said “God, let my daughter save many lives everday”.

While having the breakfast, her father turned on the TV. A famous but ill educated political leader, in his mind-and-other- organs blowing speech in Karnataka, was explaining the illiterate public how all Indian doctors charged in excess, how they were only after money, how everyone except himself was the enemy of the millions of patients surviving from critical heart attacks, accidents, strokes and other diseases. All patients getting better all over te country was only thanks to himself and his government!

Dr. Siya’s father laughed bitterly. “Next time you need blood for any poor or unknown patient, call him” he said.

Dr. Siya replied, laughing “That kind of ëver changing blood group doesn’t match anyone, it is useless for any patient, Papa”.

(c) Dr. Rajas Deshpande

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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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The Overdose of Medical Advice

The Overdose of Medical Advice
© Dr. Rajas Deshpande
“If the doctors want to go to a five star hotel, they must pay for it” said someone recently in a headline.
Well yes, like any hardworking honest professional, even a doctor may want to go to a five star hotel occasionally, and have a good time, especially given the sadness that surrounds his / her profession. There is nothing that prevents me as a doctor from wanting to go to a five star hotel once in a while, and I do not feel guilty about wanting to live a good life. Earlier, I was happy to attend some great lectures by the world’s best doctors brought to India by the pharma industry (because the government never can), now I will just pay for myself.
Whether a five star meal comes from the profit of pharma industry or the hard work of doctor’s fees, there will be objections for sure. The problem is not the five star meal, the problem is elsewhere. So the different ministries can officially host super luxurious parties on different religious / non religious occasions to woo voters via the taxpayer’s money (and the media will describe the Biryanis and Gulab Jamuns in paragraphs), but the doctor must never eat a free luxury meal!
Many non medical professions, industries, financiers, film industry people, bankers and builders host dinners / other events at five star hotels, and many government officers / ministers attend them. Do they all pay for themselves? Just because a minister attends a five star dinner, he cannot be presumed to be doing a hidden favour to some industry, likewise, a doctor attending an academic event cannot be presumed to be doing a favour to any pharma. © Dr. Rajas Deshpande
It is doubtless that some doctors may have misused this facility and overspent. But the huge advantage: giants in the different medical fields from the developed world coming and educating the doctors in India will be greatly sacrificed by such limitations.
Given the social envy and jealousy against the doctors now rampant, it is probably an inevitable but unfair step by some organisations recently to ban pharma sponsorship of certain medical events at five star hotels. It is also a good initiative to reduce drug prices. But then, can the same organisations and even the federal bodies show the same guts and ban following malpractices too:
Open sale of undergraduate and postgraduate medical seats all over India, that creates funds worth trillions, benefitting even some in the highest offices of the country? Where does this money come from, and where does it finally go? Are we innocent enough to presume that the patient is not ultimately paying for this? © Dr. Rajas Deshpande
Under the medical consumer protection act, is not the government required to make all the facilities of healthcare available at all government hospitals in our country at subsidised rates? It is argued that taxpayers are paying for the education of medical students who enter medical colleges by merit, which is wrong, because the taxpayers are actually paying for good health facilities at the said hospitals. But most of the hospitals / medical centres run by the government are understaffed and run far below acceptable conditions. How many government health set ups have been evaluated for accreditation by standard bodies, and what are the results?
The insurance companies and corporate hospitals have held the private doctors prisoners of their atrocious conditions, and even the paying patients are being provided a substandard service, thanks to a total absence of any willingness to question any of this on the part of administration.
The demand and supply of “Cheap everything” in medical profession has now gone to such a dangerous extent, that substandard staff, incompletely qualified professionals, low rate medical instrumentation and quality of service, and above all, ineffective / low quality medicines have become a horrific reality already, even at some corporate hospitals dominated and dictated by the insurance sector.
They are giving people what they want: Glittering Cheap Healthcare. It is so surprising that the patients are happy with only this one quality of service and drugs: cheapness. The day that our society will understand that like anything else, good healthcare will cost more and will obviously involve more profit-making, our health scenario will improve. © Dr. Rajas Deshpande
The IMA, while trying to play safe and readily making rules like banning sponsorship, should take a firm stand to fight against the one sided war waged upon the medical profession by some.
Written in a state of perfect peace, not frustration.
Because I am not sold out to the desire to be liked by everyone, especially those against doctors.
© Dr. Rajas Deshpande

White Paper of a Doctor’s Dilemma

White Paper of a Doctor’s Dilemma
© Dr. Rajas Deshpande

“Sir, I come from a family of doctors, who have always practised high values in Medicine. There was always this burning desire in me to do good. I felt that the country needs young doctors who are willing to work hard. but somewhere something inside me has changed. Now, with the on-going assaults against doctors, this clinical establishment act in West Bengal and in general the distrust and anger the public has against doctors, it has suppressed my older self. So much so, that I’m considering going to the USA now, even if that means doing residency all over again. I see my batch-mates and friends who went to USA after MBBS, really happy, earning well, enjoying holidays with friends and family. I do not envy the work part, I will always choose a day in the Operation Theatre rather than at the movies or hiking.. just that slowly my main motive for becoming who I am today is fading away.”

What a heartfelt question, a dilemma not only haunting me, but many doctors, especially from the younger generations, who started out to do something good for the country, have been dynamic, brilliant and hard-working, and now want to leave India!

Dear Dr. S,

Firstly, yes, the times have changed. Doesn’t the first page of most standard textbooks teach us: “Medicine is an Ever Changing Science”, now we must add the external scenario to this. We must change accordingly. Add laws, add medically inept judiciary, add media, add too many impractical conditions of practice where among the two sides involved in a profession, only one is legally answerable. I should write a prescription not of the best medicine I know, but of the cheapest one. In the face of lost faith and partial law, no relationship can be very cordial. Nor can any empathy be forced for a patient who suspects the doctor of wrong intention or inadequate skills. © Dr. Rajas Deshpande

Given the increasing number of Google empowered pseudo-literates and even genuine illiterates who are now questioning every medicine prescribed, every test advised, not because of curiosity but in an obvious visible distrust, it is becoming increasingly difficult to keep patience with practice. The combination of a western/ over-legalised medical service with a free-monger society, where instead of education, science, research and health, the taxpayer is happy paying for corruption in almost every sphere, lifelong deluxe travel, food and living expenses of everyone who has been elected even once to almost any civic body, no one wants to think logically about why there is healthcare failure in such a huge country that generates such high taxes.

Recently a headline about “Doctors prescribing costly medicines” hit the media. Why doesn’t the government make available free / cheap healthcare for everyone? Make all medicines free at all government hospitals. Why expect those who invest decades in making a medical career and then practicing under loans to keep on working with minimum incomes? Why aren’t there any laws against the corporate hospitals? Why don’t the same politicos speak about some of the capitation fees institutes that generate trillions, and also allow the quality of the medical education to be compromised? I wish the prime minister also says some day that we will make all medical education free for all merit holders, because the country needs more doctors. Why make it difficult at both ends for the doctors? © Dr. Rajas Deshpande

I can also be a high handed hypocrite and advise you the humbug: that a doctor is a social servant, that a doctor must only choose to live the life of a saint and never think about earning or a decent / luxurious life, that the society needs you etc. We live in a society where while searching for a groom, every father’s first question (if not the bride’s) is “How much does he earn?”. The stupid thought that a doctor should not earn a profit for his talent and hard work is redundant. If the society needs good doctors, it must also learn how to remunerate and treat them. It should also learn not to generalise that every doctor is corrupt. It should be intelligent enough to know that medical care can neither be free nor can be entirely based on charity or profitless structure. © Dr. Rajas Deshpande

But our society is far away from understanding this. The “High” of hate and criticism drives mobs berserk in the land of logicless thinking, and we Indians lead this game. To be opinionated by media and illiterate politicos and speak without studying is the sign of a degrading time. © Dr. Rajas Deshpande

My dear friend, I will be honest with you. Ten years ago, I strongly felt I should return to India and serve people. I doubt it now. I have urged hundreds of students to return to India after their higher medical education in the west. Now when some doctor is beaten up, killed or tried by media before law, I don’t feel justified to urge anyone to stay here.

You have only one life, and living it fully, enjoying health and peace of mind, joys of living is also your duty to yourself and your family. Are you inclined to do social work without recognition, with allegations and trials, in a society that refuses to respect a good doctor? Are you inclined to let a “Social change in the attitude of public over decades” take effect, by which time your career / life will be almost over? Are you ready to be tried by the media, taunted by the court even before being proven guilty, and punished by those in power, not because you are wrong, but merely to please people? Are you prepared for a scenario that even if you do 50 years of cleanest practice and save thousands of lives, when you are blasted all over the media for your first mistake, not a single patient will stand up and say”This is a good doctor”? If so, stay in India, this country really needs very good and honest doctors, even though it cannot respect or trust any. © Dr. Rajas Deshpande

In this country without a healthcare vision for the future, this is indeed a sinking ship, with opportunistic invasions not only from various unrecognised pathies, but with a society that is increasingly destroying the possibility of good healthcare for all in future, in its quest for free, and cheap, under the threat of violence.

If you want peace for yourself while doing good to the society and earning well at the same time, choose a developed and civilised country: at least payments are better, you get time for yourself, the law looks at both sides, and politicos can be questioned. You can also fund some health charity in India from your earnings there. Last but not the least, no F. B. will raise a hand upon a doctor, and still will be justified by law, media or government.

© Dr. Rajas Deshpande

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The Remedy of Trust

The Remedy of Trust
© Dr. Rajas Deshpande
 
I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.
 
I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande
 
As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!
As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.
I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande
 
The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!
The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.
She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande
 
Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and asked her it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and her husband appeared out of danger at that moment.
She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.
 
Confused for a moment, the old man stared first at his wife, then at me.
 
He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.
 
The old couple, the age of my parents, was saying Namaskar to me and touching me feet, many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.
I switched off my cellphone.© Dr. Rajas Deshpande
 
I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying me services’ would actually be my interest or aim. This was.
 
I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in the case”.© Dr. Rajas Deshpande
 
When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.
 
A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.
© Dr. Rajas Deshpande
 
 

The Lawful Massacres

The Lawful Massacres
© Dr. Rajas Deshpande

“Doctor, my brother has kidney failure, he is awaiting a kidney transplant. but the waiting list is too long, he has very less time and his health is fluctuating. We cannot afford to treat him out of India. We can pay some money if any donor is ready to donate a kidney. Please save his life, doctor, I will be your slave all my life.. What can we do?” the elder brother was begging and crying at the same time. His 28 years old highly educated younger brother is his only blood relation alive. The elder brother himself has renal compromise at an early stage.

“I am sorry. Indian Law does not allow us any other options”. I felt ashamed of what was happening. I wanted to add “Unless you are in power, unless you are stinking rich and have heavy pulls through many corridors, unless our society so eloquent about criticizing doctor’s intentions learns to come forward to donate organs, you are doomed to a long wait for any transplant”.
In fact, you are more likely to be the one among the three that die every day in India while awaiting an organ transplant. That is over a thousand human deaths every year. More like a massacre.

Because the law is always correct, it saves money, it saves against corruption, and it saves against a few wrong practices. This sacrifice of a thousand lives a year is just a small price to pay!

We are so very much against the word ‘corruption’ and the projected legal correctness of any system, that like the blinded goddess of justice, we refuse to see beyond what is the literal meaning of the law. Whether it is correct, whether it is causing more harm than benefit, and whether it discriminates (usually the rich and the powerful from poor) is something we are not allowed to think. Nor the judiciary probably. © Dr. Rajas Deshpande

Whether it is the action against some great kidney transplant surgeons that made them quit the profession and stop all transplant work, whether it is the “Kidney Racket” headlines on TV channels or in newspapers, the medical profession is already presumed guilty, and everyone seems to derive a pervert pleasure from doctor bashing, some even from within the profession. Yes there are unsuccessful, fame seeking doctors who are jealous of doctors who earn more and have a good name in their field, and most bitter losers like to point out only the bad side of the monumental achievements of such successful doctors: that the transplant teams in India have saved millions of lives of the rich and poor alike by developing transplant surgeries and performing them in a resourceless, supportless, poor country ridden with corruption is a deliberately hidden fact.

There of course are corrupt doctors as in every other profession, but one cannot blindly close all hotels because some didn’t serve good food!

Most of our society looks upon any medical money transaction over three hundred rupees (for anything) as corruption. In a country teeming with people who prefer to eat and drink an unhealthy excess and die early (while many die of malnutrition), for a country where there have to be laws for wearing a helmet, many take it upon themselves to criticise other professions without thinking.

We need many lacs of organ donors for the many dying patients awaiting transplants. We see extremely few organ donors. The only interpretation: “I don’t want to donate organs, I don’t want to help save lives, I will only criticise those who are trying to save lives by closely watching where they cross the law line, and then bash, arrest, defame, try and punish them. © Dr. Rajas Deshpande

The government must seriously reconsider the laws about organ transplant. There must be a freedom to at least donate a kidney for someone one knows, and if the recipient wants to compensate for it, it must be allowed. This can all be documented and supervised by a legal team so as to avoid forceful / illegal sale of human organs. One can also consider the possibility of a rich recipient compulsorily paying for a poor recipients’ transplant surgery, if he / she is allowed to legally ‘buy’ a kidney. That way two lives will be saved. If I sound Utopian, so was everyone who thought that the world deserves to be a better place.

The legal correctness of each transplant should be mandatorily okayed by a judge, and if something is legally wrong, it is that judge who should face the consequences. This is because doctors/ other transplant professionals cannot always interpret all laws correctly, and innocent mistakes are then blown up / misinterpreted as deliberate attempts to kill patients. © Dr. Rajas Deshpande

While the rich and powerful get their kidneys and livers fast and safe in and out of India through the similar rackets that have thrown innocent doctors into jails, it is the poor who are left to die awaiting a transplant: because the government set ups have limited facilities and resources, and the private set ups have to do it at a higher cost to safeguard innovation, technology, investment and skilled personnel. But the only highlighted aspect is the money earned by the hospital or the doctor, not the immense effort and saving of hundreds of lives. Ask hundreds of poor patients whom the transplant teams have saved, whether their doctors worked for money.

Those who choose to differ with this opinion are welcome, provided they answer this question: If your brother, son, daughter or you yourself are awaiting an organ transplant under the approaching shadow of death at a young age (God Forbid), will you choose to be legally correct and prefer to die or explore all options including illegal to survive?

As a doctor, it is very difficult to say “As per law, you must wait even if you die”.

© Dr. Rajas Deshpande

PS: These are the sincere feelings of a doctor’s soul tortured by the plight of those awaiting death thanks to the legal tangles and social apathy about organ donation. I do not support any illegal practices, but I do not also presume that all laws are perfectly correct. There is a lot of scope for improvement, and each waiting day costs us three preventable deaths. Jai Hind.

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Wrong Doctor, Wrong Punishments

Wrong doctor, Wrong Punishments
© Dr. Rajas Deshpande

“There are many wrong things going on in our profession, and I insist that you must write about them too. Working at a tertiary care center, I see many patients wrongly investigated and treated” my senior professor said on phone last week.
I did not argue. He was correct. He is one of the most brilliant and dedicated superspecialists I know, and I consider myself fortunate that I studied and worked under him. I just explained to him that my page was dedicated to highlight the good side of this profession, as there are umpteen critics but rare sources that speak about the good.
“But we must evolve. It is known that we are humans and there will be mistakes. Many patients die due to medical mistakes too. If we are open about the mistakes, even the law takes a lenient view. Most of the hospitals stand by the doctor if the mistake is honestly reported in time. Many patients understand that too” he said. © Dr. Rajas Deshpande

I disagreed with him then, but as I worship his acumen, I decided to meditate about this.

Yes there undoubtedly are cases we see almost every day, wrongly investigated and treated. Underqualified, wrongly qualified and even unqualified doctors treat patients according to the best of their knowledge, but unfortunately intention alone is not enough to treat a patient correctly. Political support ensures the safety and proliferation of such practices. Although we all know the basic managements, the patient is not then offered the best.

That apart, sometimes, treatable illnesses are missed just because some general practitioners/ paraclinical practitioners/ crossover practitioners who think they know everything never take a second opinion of an expert in the respective field. Many a times though, it is the patients who choose to stay with the least charging practitioner, never knowing their treatable conditions are worsening all the time that they think they are saving money. The practice of obtaining a second opinion is quite healthy and must be encouraged at all levels, although there are some patients dissatisfied with even the twentieth opinion.

Hospitals without the requisite expertise (qualified experts or technology) to treat certain category of patients and conditions often freely admit any patient and treat based upon incompletes skill and resources (under the legal protection of emergency treatment clause). So long as it is cheap, the patient seldom questions treatment. Once they are referred to the higher center, the trust level sinks as bills increase. © Dr. Rajas Deshpande

This often results in a treatable condition worsening to a stage of untreatable emergency. All the anger against this is usually borne by the last doctor / hospital treating the patient and trying to help in their most difficult situation.The non availability of enough staff at many government-run set-ups is never questioned.

Let us consider that a doctor or a hospital has committed a mistake, and the hospital wants to honestly report it to the patient and apologise, then to legally compensate the patient.
It will be wild daydreaming if anyone thinks that our society is presently mature to handle this.

In India, a doctor is presumed guilty of almost every death or failure of improvement in patient’s health. Even a patient who has abused his / her body, not followed any healthcare instructions (smoking, drinking, diet, exercise, reducing work and stress etc., not taking medicines as advised and self treatment) still thinks he is qualified enough to blame the entire medical profession for his / her failing health.
Relatives who have never bothered to know if the patient took his / her meals or medicine in time, procrastinate taking the patient for timely check-ups suddenly become “google qualified lawyers against healthcare system” once something goes wrong. © Dr. Rajas Deshpande

Blatant advertisements of “complete health check up” including hundreds of unnecessary tests are seen everywhere, and the word “concession or free” is probably the sexiest lure in healthcare industry today. Here, the patients or relatives do not mind their blood being drawn, being exposed to unnecessary radiation, or being charged for unnecessary tests just because it is all cheap / concessional. There are umpteen examples where the patient google searches about symptoms, gets the blood tests, MRI and many other unnecessary tests, and then visits a qualified specialist.

Only the qualified doctor advising the necessary tests is labelled an unholy, profitmaking business.

Suppose the doctor declares his / her mistake. Who guarantees that it will be investigated in secrecy, only legally tried by a qualified team of medically updated judges, and if at all the doctor is guilty, then the legal punishment alone will be implemented, guarding the security and the reputation of such a doctor? In a country where the media as well as judiciary is often tainted, how safe is it for a doctor to honestly admit his / her mistake? © Dr. Rajas Deshpande

In a single day, the media will bring down the entire practice of alleged doctors and a reputation hard earned over decades . The mobs with different lawless communities will vandalise their hospitals. The police is unable to always stand by truth, given the influences that gag and tie them. The judiciary will come in later at a time when the doctor’s life will be scarred and damaged beyond repair. Not everyone among the doctors is expected to have a shameless mind structure to go on despite disrepute. Corporate hospitals very easily disown doctors if their reputation is threatened.

Just as there cannot be any compensation of a lost life, there also is no compensation for a doctor’s lost reputation. A doctor’s reputation is his professional life. So long as the society does not offer protection from mobs, media and wrongful allegations in expectation of free / cheap but accurate scientific healthcare, the doctor will never feel safe enough to come out with his / her mistake.

A trial with ensured privacy and security, guarded information to the media in correct format accepted by the court, and very strict guidelines about proceedings in such cases will alone help doctors come out in open about their own mistakes, and also against the malpractices in their own profession.

Till then, we are all at the mercy of the maturity of our politicians, media and society.
© Dr. Rajas Deshpande

The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

“He fell down while checking the patient”, said the panicked Dr. Mrs. Sane about her husband, “and became unconscious”.

Dr. Sane tried to maintain his calm. A sick doctor has the curse of knowing the worst of everything, and has a perpetual feeling of sitting upon a ticking time-bomb. It was a sad feeling to see this middle aged brilliant general practitioner fighting tears.

“Sir, the OPD numbers have shot up because of these epidemics, especially dengue. I see over a hundred patients every day. The Inpatient beds are full. There are daily problems: medical, administrative and medico-legal.. those I am used to. But now there are too many politico-social and press-related issues that worry me”.

Dr. Deshmukh, a senior practitioner and a common friend, accompanied Dr. Sane. He cautiously poked him “You must tell the doctor what happened the day before”.
“Oh that’s a part of our profession” Dr. Sane replied.
I insisted that he must tell me.

Reluctantly, he disclosed: “Some goons came in with a municipal councillor and threatened to waive off the bills of a dengue patient. He was in the ICU for five days, quite bad, but went home walking. Till the time he improved, they kept on threatening us to break the hospital and thrash us if something went wrong. Upon discharge, they didn’t pay a single rupee. There’s nowhere to complain, as the hospital requires many municipal permissions”. © Dr. Rajas Deshpande

Dr. Mrs Sane lost her cool. She started sobbing. “No one blames those who dump garbage, keep their surroundings unclean. No one is blamed when epidemics spread and thousands die. No one is held responsible for failures of almost all preventive services and lack of basic facilities at government’s healthcare institutes. But the already overworked general practitioners must bear the brunt of everyone’s anger: the public and press are always free to bash the last face they see: the doctor who is actually helping every patient,.. Dr. Sane has not had a proper lunch, not spent a full day with kids in months.. That hospital has become our curse“ She broke down.

It was so logical! The offices responsible cannot even be reached. The court does not see any of these system failures that cause millions of deaths all across India, happily ordering lakhs and crores and imprisonments for doctors, for trivial mistakes.
Whom to blame? Oh yes, the doctor who has studied to treat the sick!

Anyway, in a country fond of muscular heroes and billionaire godmen, who expects a brainy analysis? © Dr. Rajas Deshpande

“I had a dream of making best health facilities available for my area. I have taken a big loan. We treat poor patients free anyway. Many rich are sent by local politicians, leaders, administrators with instructions to attend immediately and free too. Paying patients are mostly suspicious because of all the negative things publicised by press about all doctors., they also expect immediate and positive outcomes. I have not slept for many a nights. “

I examined him.He had obvious features of being fatigued mentally and physically.. A syncopal attack, where the BP drops down suddenly and makes the patient unconscious, was likely. I advised him tests and told him to take rest for there days.

“Not possible, sir! Even now the OPD is waiting” he replied. An angry Dr. Mrs Sane requested me to intervene.

“Your duty to the society does not free you from the duty towards your own health and family” I requested him. But Dr. Sane agreed only when Dr. Deshmukh offered to send over a junior doctor to his hospital to take care of the OPD.

“How have you been, Sir?” I asked Dr. Deshmukh. He is one of the most respected and busiest general practitioners in town, with a big hospital. © Dr. Rajas Deshpande

Dr. Deshmukh smiled.
“I had an angioplasty three months ago. The only risk factor was high BP and stress. There is no use fighting or explaining our situation to the society, government or press. I have closed down my hospital. I only see OPD patients now. Anyway many patients thought that I worked day and night for earning more money. Let them go to the corporate or government hospitals.”

The death of his hospital was not a surprising news, many small private hospitals and nursing homes are either closing down or converting into profit-making franchises. Many doctors are suffering high BP, cardiac and neurological problems and even dying due to excessive stress.

The meaning of this nightmare will soon unfold upon our society.
Till then, this is a heartfelt appeal to all the over-stressed doctors to rethink about their priorities, rearrange life and make sure stress does not kill.

For the morphine of “medical social service” is only good in small doses, it kills when overdone!
© Dr. Rajas Deshpande