Tag Archives: Pathology

New Medical Criminals

New Medical Criminals
© Dr. Rajas Deshpande

“Doctor, Will My Dad Survive?” asked the anxious son.
“Very unlikely, we are trying our best though” said the desperate doc.
The highly qualified son had brought his father late night on a Friday, over 24 hours after he had developed a paralysis. Patient’s blood pressure was high, and heart status was fluctuating. An urgent MRI was advised.

“I will get the MRI done outside, I have a friend who gives me concession” said the son, and returned with an MRI after three hours, it did show a big clot in the patient’s brain. The son had insisted upon admission in the ward instead of a critical care unit, saying that his father “did not appear critical” to him and his family. “You want to admit in ICU because that will increase the bills. I know” he had bluntly told the doctor. The doctor had asked him to sign the refusal to admit in critical care, then sent the patient to the ward. Routine treatment for stroke and blood pressure was started, and tests sent.
“I will also get the medicines from outside the hospital, I have a pharmacist friend who gives me concession” he had told the doctor. © Dr. Rajas Deshpande

Early next morning, the father developed chest pain, and the cardiologist advised immediate stenting, as he was developing a block in the heart. . The son had insisted on using the cheapest stent. Although the angioplasty went well, the patient developed a bleeding in the brain, a complication known in stroke cases. He became unconscious. As the bleeding caused increased swelling and pressure upon the brain, a neurosurgeon was called in to decompress the brain (take off a small portion of the skull bone, to relieve pressure upon the brain). The surgery is usually safe, but the condition in which it is done is usually ultra-critical, thus risk to life is high. The son asked for a guarantee for a good outcome, and was explained that there cannot be any guarantees in medicine. He then refused the surgery, saying “I have read that surgeries are done without necessity by scaring the patient”.

Within hours, the patient’s brain swelling increased to the level of almost a certain fatal outcome. In the evening the son said he was willing for the decompression surgery, it was almost too late. The Neurosurgeon still operated him late night to make a last attempt to save life. After the surgery, the father was shifted to the recovery room. © Dr. Rajas Deshpande

It was here that the son had asked the doctor: “Will my father survive, doctor?”.
The doctor politely replied: “Sir, you have all the reports, you know what is his medical condition, so you can now google search and also ask your political leaders through their famous apps what will be the outcome, what is the next step”.

“But you are the treating doctor, you know better. You are like God for us” said the desperate son.

The doctor uttered the only two words that the doctor would want to use after hearing this:

“I Wish”.

Every Tom, Dick and Harry in the government and in the Media has become a critic of the extremely overburdened Indian medical profession made up of some of the best doctors in the world. Those who cannot run their own govt. hospitals well, cannot provide quality heatlthcare to the taxpayer, those who have corruption seeping through almost every office they own, those in whose authority (read govt. hospitals) hundreds of patients die helpless without care, compassion or treatment, those who suspend peons, ward boys, nurses and doctors for deaths that result from inadequacies like lack of essential facilities at hospitals owned by the govt., are out telling the world how Indian medical practitioners are corrupt, instead of praising how they shoulder what the govt. fails to recognize as its own responsibility: healthcare for the majority.

There are bad doctors, bad diagnostic centers, and bad pharma companies, protected by politicians and working on ‘lowest quality-lowest price’ principle. There indeed are “profit sharing set ups”. Among these, if a good doctor / specialist advises the patient to go to a particular doctor or lab or choose a particular brand, the patient automatically presumes that that the doctor is looking for extra money. So most doctors now tell the patient to “go wherever they want” for specialist consultation or tests. © Dr. Rajas Deshpande

When I must refer a patient to someone, the only thought in my mind is to offer the patient the best: because the patient’s trust is most important for me. This is how most doctors think, every doctor wants to make a good reputation, which is impossible without also good outcomes. I need to be able to discuss and be comfortable with that specialist, so we can plan best for the patient. If a suspicion about financial misappropriation looms over everything that a doctor does, it is difficult for any doctor to work. There must be accountability, but for both: the treatment and the doctor’s time, energy and skill. The doctor must be able to choose the best for the patient and the patient should have more trust in the doctor than the rumors. .

The last person who should play with trust and faith in other professions is a politician.

The patient did not survive. Neither the leaders who spoke lose and caused paranoia to affect the outcome, or the son who delayed admission, the pharmacy that sold cheapest drugs, nor the family that refused a life saving surgery had any blemish upon their reputation.

It was easier for all of them to blame the doctors who tried hardest for the patient.
© Dr. Rajas Deshpande

Thank You Dr Nusli Ichaporia for the technical assistance.

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Never Go To Any Doctor

Never Go To Any Doctor

(c) Dr. Rajas Deshpande

“All doctors are thieves. They spend crores to get the degrees and then squeeze patients all their life to earn, doing unnecessary tests, prescribing costly medicines and doing unnecessary surgeries and plasties. I know. I have many doctor friends who tell me when they are drunk”: Arrogant, khadi, Gold, Perfume, Rolex, Gutkha. Add political party of choice. His breathless wife was advised some tests by some other Doctor, and he was complaining about it.

“Sorry Sir, I cannot take this case” said the Doctor now seeing the case, and wrote upon the paper: “Hostile patient / relative”.

The doctor has till now endured too much deceit and pain out of “presumed innocent” population’s baseless allegations uplifted by media. He will easily give up any possible earning from such cases which drain his blood and his reputation.

This is becoming common now.

Let us take off the Holy Apron for a few moments and sit across the table for some school-grade naked logic.
If all doctors are bad, well, don’t ever go to a doctor or hospital. If all doctors are not bad, stop generalizing.

If you think tests advised by the doctor are unnecessary, either don’t do the tests or go to another doctor. You cannot change or challenge the hard-earned wisdom of a qualified doctor. You cannot force a doctor to treat without his/her comfort of knowledge about the patient’s condition (for which tests are required).

(c) Dr. Rajas Deshpande

Have courage to decline tests, admission, surgery and medical treatment on your own, and also to own that responsibility, for yourself or your dependents. Write freely upon the doctor’s note that you do not believe his / her opinion, want another, and that you decline the tests and medicines. That way nothing is hidden. Stop bickering and backbiting a profession that is by and large coping up with the country’s health burden.
Change the doctor, don’t expect a busy specialist to pleasure-massage your medical knowledge.
If you want old age sweet talking doctors, please do not expect new age technology / medicines / surgeries to be involved, neither new age results which are far better. Illness, Disability and Death were gracefully accepted as “Ill-Fate / Destiny” in old age, doctors were not blamed for any of these. Continue that tradition. If you want don’t want completely “professional” attitude from a doctor, please write to the Judiciary which has termed the patient a “Consumer”. Doctors will also make human mistakes, declare your acceptance and write a note that you will not sue the doctor for any mistake. If you want the freedom to sue for gorgeous compensation amounts, you must sacrifice the wish to have “emotionally connected, involved” doctors who try all that they can for their patients. Highly scientific, legal and professional will also be costlier by definition.

Nothing has ever gone cheaper in the world, stop expecting that medical care will. Doctors have to spend a lot upon education (they do not decide the fees for medical colleges, and it is not their fault to want to become a doctor), and they will of course have to earn atleast what they spend upon their education. Who will become a doctor with a wish to be bankrupt?. From onions to your children’s fees to your current phone, things have become costly by the day, why will the doctor not have to earn more?

To accuse that all doctors earn by wrong means is as idiotic and unfair as blaming an entire religion or gender.

© Dr. Rajas Deshpande

Insurance companies and most corporates are out to earn profit, they do not care about you or the outcome. It is only the doctor whose effort and wish are always oriented towards a good outcome for each patient. No doctor enjoys a bad outcome. His/her own reputation is on the line with the outcome, he / she will never risk that. This is also the reason why doctors have become extremely sensitive to hostile / legal-oriented patients / relatives and either avoid them or make them go through all legal (sometimes unnecessary) formalities to keep a proof of everything, should things go wrong. It is not possible to be compassionate and sympathetic towards someone who is looking at you with suspicion, treating all your motives as malignant, and bargaining every penny they can to get the cheapest test and treatment options. One idiotic comment, one threat or one word of suspicion said to the treating doctor starts the process of converting a good-natured doctor into a consumer-service medical professional who maintains a distance. A little good natured talk may quickly translate into legal traps, so most doctors now take precautions not to indulge beyond “strictly necessary” communication with most patients.
We live in India, corruption is the baseline in most spheres. This goes for some doctors, some hospitals and some investigation centers (pathology, radiology etc.). There is no denying that. Not all pathology labs use standard protocols, not all radiology centers do proper studies. Not all doctors make profitless / correct decisions. So if your doctor tells you to visit a particular lab or specialist, it is not because of financial gains always. One has to justify patient’s faith and advise the best. It is not possible / ethical to speak ill about others, so doctors just go by the preferences which they have by experience of years realized suit their wisdom and ethics.

Take the example of a singer. He/she has to have the musicians of choice, who suit their own thinking, style and sense of singing. You cannot force a violinist or guitarist or drummer of your choice upon the Maestro / singer. It will then become a discordant concert. If the Maestro / singer is responsible for the concert, he / she will need the freedom to choose his / her fellow musicians / assistants / music specialists.
Life is far more complicated than music, and medical decisions are often complicated beyond the understanding of google-graduates. The wise will know to have faith in the doctor they choose and benefit from it. The suspicious and oversmarts will keep on doing themselves / dependents harm by spoiling the whole process.
The only thing more important for a doctor than the patient is his / her own reputation. If you are a risk to that, the doctor may refrain from wholeheartedly trying to do best for you. He will do what is legally correct, which may save the doc, but not always do good to the patient.

Like some idol who you have idolized since childhood shoving you away in his / her bad mood in the one lifetime moment you meet them, young doctors who were always taught in all medical schools to “Love” their patients beyond themselves suddenly come across violent, accusative, paranoid patients and relatives, and almost never recover from that grievous mental trauma.

How much for an eye? How much for a limb? How much to hear your beloved talk again? How much to see your loved one coming out alive from the operation theater? How much to see them smile again? How much for a life?
Choose the cheapest options, google everything, hire a lawyer and find out. Why go to a Doctor at all?

© Dr. Rajas Deshpande

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