Tag Archives: Philosophy

The Last Bullet For Indian Private Healthcare


© Dr. Rajas Deshpande

Many doctors, nurses and other staff, police officers are dying due to corona exposure. Recently the quarantine period of doctors was cancelled. To add to this, very ridiculously, doctors’ salaries were reduced, and covid funds were deducted from even frontline warriors’ salary. This is like taking money from a soldier’s paycheck to fund the army!!

When I recently heard some people shouting about excess bills in hospitals, doctors not working etc., I felt like shouting back too, but one cannot argue with a sold TV screen.

For decades India has had
Excess urban crowding,
Very poor hygiene.
Very high poverty and illiteracy.
Lack of town-planning for slums.
Severe lack of state/ national healthcare infrastructure.
Tiniest budget for healthcare.
Perpetually under-functioning government hospitals. Every season hundreds die due to epidemics.

Where were you till before the pandemic? Who is responsible for all of the above? Do you want to discuss these factors which are responsible for the pandemic chaos today? Or now you just blame it all upon Doctors and Private hospitals?© Dr. Rajas Deshpande

Only private doctors with small nursing homes and dispensaries, clinics were shouldering all healthcare needs that government hospitals could not provide. They had low profits and catered to middle and lower class. These were destroyed in last few years because of too many stringent regulations and costly licensing. Many closed down. Legal troubles by relatives, politicos supporting them and vandalising hospitals forced many private doctors to stop admitting patients. Protection to doctors was denied by almost all governments till before this pandemic.

Indian poverty is never ending, and charity cannot run anything perpetually unless there’s a strong fund generating mechanism supporting it. If someone expects that doctors charging 2 rupees fees are the ideal healthcare for all our medical needs, they should happily go to such a doctor. We highly respect them too, but it is their choice and there are obvious limitations to that. To develop advanced healthcare in India, higher profits were necessary for higher investment. Corporates, some businessmen and the likes of Mr. Ambani pitched in. Advanced healthcare with heart and liver transplants, complicated brain surgeries, cancer treatments came to India because of these investors. They accepted all the conditions of governments to accommodate over twenty percent poor, nonpaying patients via various schemes. The payments for running these schemes were delayed by various govts for years, and the hospitals were arm-twisted in still continuing to treat everyone. The only source of profits was private and some insurance patients who were paying a higher fees for facilities: from air-conditioning, food to choice of specialists. Higher quality of staff, especially nursing and technicians who can operate high end machinery and robotics requires very high salaries. Maintenance costs are heavy. A specialist cannot do much without such a very good team. Each of these requires good if not great salaries, as they are continuously invited by developed countries who pay far higher.

But then every patient wants the highest facilities, best staff and specialist team, with no payment or basic payment. There’s no concept of billing beyond actual price of medicines and room charges. Service and maintenance is considered a ‘free right’. © Dr. Rajas Deshpande
Even in this modern era of equality, a higher class Indian officer like a minister gets a higher room, better food and other facilities, even higher medical bill sanctions, whereas the labourer from his department gets minimum basic facilities and bill eligibility only for general ward. Law allows higher healthcare’s standards and payments for higher officials. Why do they even have classes in railways and airplanes? If a “Gareeb bechara” migrant wants to fly home, should we offer him road transport or compassionate air travel? Why don’t we do for all the poor something that you all expect doctors and hospitals to do?

We don’t mind if basic and emergency healthcare is uniformly cheap or free for everyone. But when you force a high-end medical commodity (skill-time-investment-staff) to be sold at a loss or extremely marginal profit, you kill the system.

Doctors do not differentiate when making a diagnosis or treating anyone from any financial/ power background. But the private hospitals must be allowed to cater to different classes, earning their profits. That is their only stimulus to grow forward, engage best personnel and bring advanced healthcare to India. Different governments have failed at maintaining high standards of healthcare in their respective set-ups (with some proud exceptions- but because that’s where our powerful go). Some hospitals indeed take more bills for better class of services, including staff, but none of them forces a patient to come to them. Even these hospitals never deny free emergency treatment to anyone.

“But isn’t healthcare a charity? Haven’t you taken oaths to serve?” our loudmouth hypocrites ask.

Yes we have taken an oath to serve everyone rich and poor equally, but no, we have not taken any oath to neglect our own health and well being. Yes we have taken an oath to serve, but we have not taken any oath to live in perpetual poverty and financial stress. Yes we are under an oath to do our best for every patient, but we will not be bending backwards to fulfil their unreasonable demands. Yes we want to save every life, even if it is dangerous , but we will not unnecessarily endanger our own life because someone forces us. We haven’t taken an oath to abandon our families. The Hippocratic oath does not ask any doctor to stay hungry, work without sleep, and do the unscientific because various governments cannot pay for adequate number of doctors. Still we are doing all this already. Let us be clear: we proudly and intellectually serve our country, but we refuse to be considered slaves of either the system or the society. © Dr. Rajas Deshpande

Capping bills in private hospitals will be the last bullet for all advances in healthcare development in India. Be prepared to go back to the chaos of ancient times in that case. Quality will suffer most: right from specialists to nurses to medicines. You can of course force one generation of doctors to work like this, under low cost and excess work. People aren’t fools to send their children to such hells of social slavery. Yes you read that right. There’s a difference between service and slavery. Do not attempt to turn medical service providers into slaves. It will backfire very sourly.

Instead of this, the government can invest in existing private healthcare players to create low cost infrastructure alongside their private hospitals, or privatising its own healthcare institutions with increased capacity. Our governments do have friends in very high places who can invest.

We love India. We are not against any particular government, and this post is not against any leader or party. But we do feel very strongly that healthcare decisions must be made involving everyone concerned, that this people-pleasing for short term will turn out to be a huge disaster in long run, and it will be irreversible. If any government thinks that cancelling hospital permits and doctors’ licences in a country with severe shortage of medical services is the right way forward, God help it.

If private and corporate hospitals start shutting down now, it will be permanent. India will then have to mostly rely upon prayers alone for healthcare. And of course those who think they know medical science more than doctors. India has no dearth of such “fatally self-medicating” ignoramuses.

Jai Hind

© Dr. Rajas Deshpande

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Disoriented


© Dr. Rajas Deshpande

“Doc, he appears confused. He has delusions. He was very methodical and logical earlier. He had excellent deduction and was considered a genius among his colleagues. Yet now he himself does not understand that he is making gross mistakes in making simple decisions. He appears completely disoriented…” the lady gave me an update in a deeply concerned voice. The devastating fear of mental, intellectual decline of a beloved is not grasped by all. For want of simplicity, we term it dementia. However, the meaning of this term is far broader and deeper than what most people can grasp, and the mental agony that the spouse goes through is beyond many a people’s emotional basket too. Infections and low sodium levels can often worsen the mental-cognitive personality of the elderly. I advised her a few tests to be done urgently and returned to my quarantine chores.

Her words kept on echoing for some time in my mind. This pandemic has challenged what the humanity perceived as truth till date. Disoriented, demented, illogical, delusional: isn’t that what the whole humanity has become today? Hasn’t this virus uncovered our intellectual, emotional limitations and selfish vulnerabilities? Have we not become exactly what the best human souls taught us never to become: money minded selfish humanoids hiding behind facades of clever and intelligent, politically correct wordplays, fatally attracted to glamour and clamour, emotionally cut off from the world, concentrating upon our families, cults, religions and regions? And of course, intermittently well-crafting the social service façade by donations, our signature face on every penny.

Financial success and numbers have become the new, hidden definition of life. Some wisely hide the word ‘Financial’ in the prior sentence. We won’t be able to name any financially unsuccessful / poor geniuses from the fields of medicine, science, art and even sports. I do not hate capitalism, in fact I believe that wealth creators are the ones who fuel the world. But among these are the compassionate and human who would rather be a million short of their billion rather than destroying a competitor and his/ her business. Squeezing-twisting every arm in the giant machinery that governs laws to finish everyone else and engulf everything with a gluttony that is hailed as business acumen is a real tragedy unfolding right now. We very gladly become the proud cogwheels of such ‘man-eating’ giant machineries that bleed competitors to a certain death.

While never being able to make peace with our neighbours we speak of world peace. We cannot bring ourselves to acknowledge the good in our competitors and enemies, we cannot deal with those with a different religion or country, come what may! While excepting ourselves from laws and rules we blame and blast those others who break laws. While secretly cultivating the filthy “money is all that matters” gene in our next generation, we encourage blindness towards the moral, ethical bypasses required to earn humungous money. The amount of real happiness, truth and honesty that needs to be sacrificed to be extremely rich is the worst inheritance our next generations will have to suffer from. Clever Wordplays is the sociopolitical success mantra of today!

I had never thought that I will witness anything more emotionally traumatic after seeing the hundreds of dead bodies and bleeding, broken-bone victims during the Killari earthquake. Today’s migrant crisis appears to cause deeper wounds than that upon our soul. This is a very tragic question, but what causes more hurt: witnessing dead bodies or extreme suffering of the living? Millions of migrants facing the worst wrath of fate, walking under a scorching sun towards a faraway home with their children, some dying, some delivering on the roads, strong men and women labourers breaking down and wailing – will be a shameful and guilty memory which I will carry for the rest of my life. We have excess caps and shoes; they are walking in rude heat bare headed and barefoot for hundreds of miles. We are discovering new cooking skills, they are discovering new depths of hunger. We are complaining about broken air conditioners, they are gasping for a glimpse of their beloveds in their zuggi-zopdi. We are too comfortable and grateful knowing that we are not them.

That India is overpopulated appears to be our strength on social media. We can show how many million fans, hits and likes there are, but we cannot speak a word about a tragedy which happens right in our backyard. We are scared of the worst: socio-political ostracisation, defamation, destruction of a hard-earned reputation and closure of financial support for survival. An intellectual is more scared of losing freedom of creativity, giving his best to the world and so mostly decides to be a silent spectator around strongmen with their invisible socio-political weaponry. Society as a whole has never protected or rewarded its intellectuals, especially in backward countries.

This pandemic will go. Few will have changed their perceptions of the world. Few understand that anything requiring a crowd must please a crowd’s intelligence quotient. Because crowds gather for hate easier than for love. Look at what content gets the best response: hate mongering, roasts, nudity, vulgar language and sloganeering. None of these is a proud achievement of humanity, yet these are the top hits. Pleasing a crowd can entertain, can earn one money, fame and votes too, but cannot ever bring this world health, happiness or peace. Entertainment, although critically essential for a stress-free mind, although soul-awakening, will never be among the first essentials of reducing hunger, pain, disease and suffering. There indeed was a time when entertainment was creative, with art, literature, acting, music and sports, fulfilling for the soul, but now only the superficial, jaded antics and the gaudy glitter with numbers remains the identity of most entertainment forms.

We indeed are disoriented. Yes, I too am guilty of some such disorientation. I have consciously decided to change. I do not have all answers right now, but I better appreciate the bigger picture now. My perceptions of what matters most have further changed. My faith in human nature has been deeply wounded, but my hope has always won, and I will help it heal even now. The current crises just told me what human race truly needs. My wish to make everyone understand has decided to take a back seat. My wish to do what I can is in the driving seat now. My contribution will be probably too small, but I have started.

I want to be well oriented for the rest of my life.

© Dr. Rajas Deshpande

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Suspend All Doctors, Cancel Their Registrations…


© Dr. Rajas Deshpande

Have you ever spoken with a doctor, a judge, a police, minister or an an IAS officer in their office? Almost every common man has had almost a similar experience: an arrogant air of authority, hidden hints of superiority and a subtle dose of “I know better than you” whenever one tries to argue. Now we know all of the above can be wrong occasionally, at all levels. Of course, there are exceptions in all professions. In a new world which is now shedding away traditional chains of inequality and racist slavery, we Indians are probably the most reluctant to change. In performing one’s duty, no one is superior to those they serve.

A doctor needs to be patient and compassionate with the ill-behaved and arrogant, unlike police, judge or minister who will punish people for such behaviour. Additionally, far before COVID19, there have been fatal infections like MDR Tuberculosis and other viruses which have endangered and even killed doctors. The stress of this daily fear of death is difficult to explain to the idiots who argue “but you yourself chose this profession, nobody forced you, you knew all the time about these risks”.
My dear infinite stupid, yes, I chose this profession willingly, knowing the risks, but to live on and serve, not to willingly and knowingly expose myself to fatal infections. A soldier joins the military ‘to live on and fight and protect the country, not with a wish to die with enemy’s bullets’.
When a citizen tells them from the comfort of a protected home that “You already knew you could die in the army”, it is ingratitude and insult to their profession. We choose to be in this profession because our compassion and courage is higher than our fear, not because we want to die. To be honest, we do not expect many to even grasp this concept. © Dr. Rajas Deshpande

I have deep respect for some Judges, IAS and police officers who are geniuses, and the first mark of a genius is a humble openness to all logical argument, with parsimony of words and zero presumptions of having a superior knowledge. Even a few minutes with them enhances your life. They are calm and respectful of others. Their language is never “Suspend, Fire, Transfer or Shoot”, because they know what it takes for a genuine person to reach where they are. These geniuses are far above attention seeking, cheap media publicity, arrogant show of authority and blame-mud-slinging to cover their own mistakes, inferiority complexes, and inadequacies.

It takes longest time and a hardest curriculum with hands-on experience of years to make every single doctor. The more specialised a doctor becomes, the rarer it is to replace his experience. Still anyone can commit mistakes.
If a Judge, a police Officer, a Minister, an IAS officer is wrong, does our constitution allow any TDH in media or society to get up and threaten them with suspension? Can you imagine a nagarsewaks / municipal councillor / local politico, goons or even major/ minor officers threatening a judge, IAS officer or a commissioner with cancellation of their rank, licence or degree? Even the courts of law do not suspend anyone or strip them of their hard earned registration without giving them a complete and patient hearing.

Yet almost every TDH in almost every nook and corner in India, from temporarily elected less-schooled representatives to highly educated junior and senior administrative officers often threaten on TV channels that doctors’ registration, licence and degrees will be cancelled. This apparently gives them a sense of pride and accomplishment and also sends a wrong message to a public that these doctors must serve.

In a country where the policy makers have miserably failed for generations to create enough doctors for their population, where we still continue to have that discrepancy, suspending a doctor is like snatching away food from someone already dying of hunger. One doctor gone screws up many patients’ lives. There’s no other profession where generations are taken care of, lifelong, by one person. Yet apparently, some officer’s egos are more important than those patient’s families, health and lives.

Every day there are news of political, social reasons of suspending, threatening doctors. Deny concessions, freebies, shoe-licking, decline to compromise upon scientific principles or accept inhuman conditions for doctors, and almost every officer unleashes their administrative adrenaline pumps against the entire medical profession. Refuse to accept incorrect policies and guidelines that are against patient’s interests, and insubordination leads to losing your jobs. The most shameful and pathetic addition to this “Suspend-Crazy” admin category are some senior doctors who fail to guard the principles and juniors of their own glorious, noble profession. © Dr. Rajas Deshpande

Like every Judge, Police or IAS officer, even politician, every doctor has also worked very hard to earn their degree and licensing. Every Medical college and University in India is approved by the government. The Medical Council of India has been given the authority and statute to license a medical practitioner upon presenting his / her degree and following principles it has laid down. No one other than the MCI should be able to cancel the licence of a registered medical practitioner. Every case of suspension of a doctor: whether a postgraduate or a senior doctor should be referred to a separate impartial MCI committee. Even the Hon’ble courts of law usually request expert opinion before concluding about medical issues / cases. Yet, our admins and politicians from different states suspend and threaten doctor’s registration cancellation as if it was granted by them or their party or government as a favour. No. We don’t accept that. Every IMA branch in every city must stand by such victimised doctors, protest such injustice, represent the harassed doctor and protect him/ her.

There of-course are doctors who commit mistakes, like Police Officers, IAS officers, Ministers or even some Judges. All of them should be accountable and be brought to the right penalty with the same dignity as others. No one has the right to pretend that a doctor is a slave to their whims, greed and tantrums. © Dr. Rajas Deshpande

The Hon’ble Supreme Court has very clearly stressed the fact that it is very important that doctors should be able to work and make their decisions without stress, insecurity, duress or fear. The article above intends to highlight that same purpose, especially in the light of some recent happenings. Every doctor out there is risking life only to save others, serve the nation. They do have problems, issues and insecurities that need sorting out. Please address their issues scientifically and logically, rather than inhumanly threatening them by suspension and cancellation of licences because you have no resources, funds or answers. Treat your doctors with the same compassion that you expect from them. Or, if you know better, if you want doctors to blindly follow unscientific instructions of admins and whims of politicos why make doctors? Suspend all doctors at once and do it all yourself.

India will definitely be healthier if you listen to the doctors, and don’t threaten or suspend them for trivial reasons.
Jai Hind!

© Dr. Rajas Deshpande
Written with a sad heart that on one hand where the Hon’ble PM has asked people to respect and appreciate the efforts of doctors, nurses and other corona warriors, many are looking for reasons to corner, threaten and suspend them at the drop of a hat, sometimes just for headlines.

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A Superhero Doctor’s Dresscode
© Dr. Rajas Deshpande

A Doctor cannot enter home every day and start giving injections to her kids. A policewoman cannot wield a danda/ stick every day upon return, at her family members. A Judge probably cannot say “Order-order” when a child cries at home. We are not supposed to carry our professional mindset and attitude in certain places. Likewise, one cannot expect people from other professions to advise others what is beyond their domain. A doctor will never understand how complicated a politician’s or a policeman’s job is, and vice versa.
A clean and clear mind is essential for every doctor. Even a small mistake in thinking and decision making or actions may cause grievous, even fatal mistakes. © Dr. Rajas Deshpande
There are many doctors who have become infected even before the pandemic with diseases like tuberculosis and hepatitis, while trying to save patients.
It is very essential that every doctor, especially junior, learns to ignore what is not a doctor’s domain. The unscientific territories of political thinking and religion or discrimination are not for the doctor, however tempting and patriotic they may be touted to be. Pressures from society and media can ruin the peace of mind so essential to make a good doctor. A doctor who falls in line with sociopolitical expectations to do something unscientific is not only dangerous to the patients, but can never be called a good doctor.
There are those in higher offices, including doctors, who cannot overcome the ‘superior-inferior’ discriminatory mindset and will advise one and all what to do, taking credit for all good and blaming others for all bad in every situation. They take for granted that a military type hierarchy works everywhere. No doubt it is extremely essential in the military, but in medicine we need brainstorming at every step, a student cannot be expected to act on patients if a senior gives a wrong instruction. One must know, challenge, ask, resolve doubt and then act. © Dr. Rajas Deshpande
Like a Judge in the court who cannot rush an unlawful decision even in an emergency, a Doctor should also only choose what is scientific, even in an emergency. Of course there always should be a sense of time and good. A superhero doc may choose to be a couch potato in his/ her shorts etc. at home, but when on duty, he/ she must don the special dress called pure ethical medical science.
Every Judge who gives a legally correct decision all his life, without being affected by any pressures whatsoever is indeed a superhero. A doctor who takes care of all precautions and helps every patient all the way is indeed a superhero. The heroism lies in defeating the disease and saving every patient one can, NOT in being unscientific and risking lives. Wishing you all decades of success, and millions of saved lives. Always proud of our frontline doctors and nurses!
© Dr. Rajas Deshpande

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Women’s Day and A Frightening Secret

Women’s Day and A Frightening Secret
©️Dr. Rajas Deshpande

A well respected senior, a social celebrity, walked in with his daughter. Cultured, proud people. Probably highly educated and rich. While he was richly dressed in a traditional Indian attire, she wore a saree. Many phone calls had told me since a day prior that he was very important, and that I must make sure he doesn’t have to wait. They sat down cautiously, the daughter in her late twenties looking at the floor.

“Doctor, my daughter is behaving strangely, she is not speaking normally with any of us, and seems lost since last two months. She has a lot of giddiness and has not slept for many days now. We have seen many doctors, done all the tests advised, but no one has been able to tell us what’s wrong. You see her and tell me if you can help.” Somehow the father was intimidating. I asked the patient her name. The father replied. I asked her about her complaints. He replied again. It is often very difficult to make a woman speak in the Indian scenario. I politely asked the father: “Could you please let her reply?”.

She replied in single words, mostly yes or no. She appeared to have given up. It is indeed tough to deal with such ‘mentally closed’ patients. I obtained her permission for a clinical examination and found nothing abnormal.

“Are you stressed ?” I asked what was inevitable now. ©️Dr. Rajas Deshpande

The father repied promptly: “There’s nothing to stress about, doctor. She works as a lecturer at a prestigious institute, we are quite well off, and although we want her to marry soon, she refuses to meet anyone. We are okay with that too, we are in no hurry. I dont think there’s any stress here. She just needs to be mentally strong. She has lost her will power”.

At this point the daughter looked up at her father, begging him to stop.”I have done whatever you asked. I came to every doctor you took me to. I am not weak. Please stop all this now, I will recover in few days”. I sensed something wrong here. I asked her if she wanted to speak in privacy and confidence, offering a nurse to attend instead of her father. Her father was visibly annoyed at the suggestion, and terribly surprised when she said yes. With a firm face, she said “Can I speak with the doctor alone for a few minutes, Baba?”. Her father walked out. ©️Dr. Rajas Deshpande

“Doc, I don’t know what to do. I am in a terrible situation. As you see, everyone is scared of my father, so no one tried to speak to me in privacy prior. To be able to trust you, I need your word that you will never tell my father about this discussion. If you cannot keep that word, it is best that I don’t speak with you about my problem”. This was a common request. A doctor’s first loyalty is to his / her patient. I reassured her that whatever she speaks won’t go beyond me, and also told her that she should be completely honest and open, that I was not here to judge her but to help her.

She paused, embarassed. The stress and shame of what she was going to say reddened her face. She sipped some water and took a deep breath.

“Okay doc. Five years ago, I was in love with a classmate of mine. He is from a well known politician’s family, and we were very close. We were planning to marry after a few years. He had alcohol frequently, but had promised me he would stop after marriage.”

She paused again, now tears in her eyes. “Please don’t misunderstand doc, but like all other lovers of our age we exchanged naked pictures and video clips. We also recorded some of our own, making love. As my father often checked my phone, I deleted everything immediately. I told him too to delete them, but apparently he stored them. After a few months I found out that his alcohol addiction had become worse, and he was going around with another girl, so I stopped seeing him immediately. He never cared, and he married someone his parents had chosen”.

“However, three months ago, out of the blue he called me and asked me to meet at his home as his wife had left him. I refused. Now he is threatening that if I do not meet him he will upload my nude pics and videos on the internet. Their’s is a very strong and rich political family, I know he can do anything and get away with it. You just met my father, you can imagine his reaction to this. My family is proud of me, but they will never accept or forgive me for what I have done. I feel ashamed, but there’s nothing I can do about it now. I am loved where I work, my students look up to me as a teacher. All is on the verge of being lost for me now. I feel like I should permanently disappear. I don’t know what to do” and she let out all the sobs she had held for months.
©️Dr. Rajas Deshpande

This wasn’t new to me. While virtual exchange of ‘love’ in form of nudity and self recorded sex between couples is a reality of current times, it strongly contrasts with the social preparedness for it. Our society is not only orthodox, but shamefully, violently critical of anything that offends their cultural tastes that vary from family to family. An exchange of such nudity between couples in love is their personal choice and preference, no one should feel offended by it. However the dilemma of its correctness arises when situations of such blackmail as mentioned above create catastrophic consequences.

Many women (and I am sure even men) face threats of their privately exchanged nudity being exposed. This rampant blackmail that extorts anything from money, sexual favours etc. to various other compulsions are a nightmare turning into a reality now. Although the cyber-crime cells admirably track down the culprits, the victims still go through a lot of humiliation till then. Many victims do not know where to get help, and women’s organisations, NGOs need to reassuringly come forth with plans that ensure complete privacy and confidentiality of the sufferer. What offends most is the callous allegations of cheapness, wrongdoing , shame and derision with which our society criticises the victim. Some people and many in media actually take a perverted interest in exploring private nudity and sex, as if looking for certificates of their own piousness in someone else’s ‘moral adventures’. ©️Dr. Rajas Deshpande

I told my patient that we could help her, and handed over the case to a female counsellor who is well versed with such cases. Although she has proper connections in the cyber crime department, usually this is not required, as the threatening cowards usually come to their knees oncethey know that the victim has someone’s support. The last I heard, the matter is resolved.

Stronger laws to respect privacy, stronger punishments for those who use such threats to their ex-lovers and a social revolution to accept the realities of today and reassure the victims rather than shaming them are essential. A complete ban on reporting of such cases as “Spicy News”in media is awaited.

On this Women’s day, I humbly bow to the higher gender, the mother and the sister, the wife and the best friend called woman. Only what a man learns from a woman makes him the man that he is, and in that, she is the teacher: of patience, of modesty, of hard work and sacrifise, and the soul of true love.

©️Dr. Rajas Deshpande

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P.S.
Partly Imaginary story.
I truly respect a woman’s freedom, and her ability and right to defend it. My views above are to express that respect. I am not a socio-cultural legal expert and certainly not a moral judge. Never mean to offend anyone.

The Dictators in Hospital © Dr. Rajas Deshpande

“Let my father die. It’s ok. I will not take him anywhere. I don’t want anyone else to treat him” said the 60 year old son loudly. His old father who could listen and understand the conversation, but could not speak or move due to a paralysis, just closed eyes. Tears emerged from the corners of those closed eyes.

Like most doctors nowadays I have learned to master personal opinions and emotional responses, especially with ill-behaved patients, but this was beyond me. Not because he had shouted at me, but because he had just stabbed his father’s heart. Loudly, so that the patient could hear, I said “I think your father should feel better soon, let us see what we can do”. Then I gestured the angry son to see me out of the room. Two other men accompanying him came out and towered upon me.

About five days prior, this son had come to me with his father’s reports. The patient was admitted at a rural hospital. He had severely compromised heart function and his heart rhythm was abnormal. This caused formation of many blood clots in the heart, which went to the brain blocking blood vessels. One such large blockage had caused paralysis and inability to speak. © Dr. Rajas Deshpande

I had asked the son not to shift the patient, as the treatment started by the rural physician was accurate, we had to just wait and watch. Still, they had brought the patient in an ambulance, travelling for over 4 hours. Naturally, the patient had worsened , becoming drowsy. His heart rhythm was dangerously worse. He was unable to swallow, there was a big risk of his saliva/ mouth secretions going to his windpipe blocking his breathing.

Whenever a patient has problems out of a specialist’s expertise area, it is mandatory that an opinion of the concerned specialty expert be obtained. I asked the best heart specialist I knew to see the patient, and also a small ENT test to see if we could initiate training for swallowing. Our physiotherapists were already working upon his hands and legs gently.

However, the son (a retired govt. officer from a very respectable post) and two others attending the patient created a big scene when my junior doctor visited the patient. They started shouting and cursing that by calling other specialists we were just “increasing the bills”, and that they did not want anyone else except me to see the patient, not even the junior doctors. © Dr. Rajas Deshpande

My assistant physician called me in panic and updated about this, asking me to immediately act to deescalate the situation. Although there were many patients waiting to be attended in OPD, I had gone to this patient’s room. I explained to them that the patient needs to be seen by a heart specialist too, as his heart condition was very delicate. I also offered them to choose any specialist or hospital they wanted, if they were unhappy here, but they could not waste time as the patient was critical. That’s when the son shouted that he would rather let his father die than be seen by any other specialist.

When they came out of the room, their body language and general disposition suggested aggression. I tried to politely reason with the son that any specialist cannot sit with the patient 24/7, that junior doctors and other specialists as required will have to be called in for the best care, but they declined. The efforts of our medical superintendent and best patient coordinator went in vain. © Dr. Rajas Deshpande

“We will not allow anyone except Dr. Deshpande in the room. Our patient must get better” the son said loudly.

“I will see him till he is under my care, but I cannot guarantee any outcomes” I told them. “Let’s see” he said. He did sign the document informing about criticality of the patient.

No doctor should treat patient under pressure, duress or threat in the interest of the patient. I went to our medical director and requested that the patient be transferred under some other specialist. The hospital offered them freedom to choose, but the relatives declined. “We have come here for Dr. Deshpande, he will have to treat the patient alone” the son said. The hospital decided to take a call next day after a meeting.

That evening as I finished the OPD, I wondered how the patient was. However much angry I may have been with the relatives, the patient was more important than my anger, pride or anything else. I went to their room and checked the patient. He opened eyes and smiled. I asked him his name, and he replied in a husky tone. He was speaking now!!

The next day again, the relatives refused to transfer the patient under someone else, and I kept the treatment on. The trustless atmosphere was quite volatile, and if something had gone wrong, things would have taken an ugly turn. In the next three days, the patient spoke well, and even accepted some sips of water. His hand and leg started moving too.

“Can we take him home now?” the relative asked on the fourth day.

Happy for many reasons, but mainly the fact that the patient had improved, I discharged the patient. I had learnt my lessons. © Dr. Rajas Deshpande

Adamant, unreasonable and illogical demands by patient’s relatives jeopardising the patient’s life is a huge medical problem in India. Illiteracy, political interference, goonda culture and media support make such horror stories a routine reality. The law still expects the best patience and non-reacting approach of medical personnel, with the onus of saving lives still upon them under this pressure. Innumerable instances of harassment and humiliation of nursing staff, especially women go unreported. Relatives, especially politically connected, behave like dictators in any hospital, threatening one and all. Unless this culture ends and doctors are at a freedom to do their best for every patient, medical care in India will always remain inaccurate, incomplete and purely financially guided rather than scientific or even legal. Doctors can actually file a complaint or take legal action in such cases, but they are too many, and no doctor has time for such legal courses. In the best interest of our patients’ lives we go on forgiving and tolerating such abuse. Because neither law nor administration wants to correct the causative factors effectively.

© Dr. Rajas Deshpande

Neurologist Mumbai/ Pune

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Mumbai Diary- 3 To The Silent Patriots

Mumbai Diary- 3

To The Silent Patriots

© Dr. Rajas Deshpande

Neurologist

Mumbai / Pune

Usually I stay in Mumbai on Sunday nights to be able to attend the OPD at Lilavati Hospital on Monday. Strolling by the sea is usually a pleasant addition to a Sunday evening. However, this time there were huge crowds as Christmas was only three days away, and people thronged to have a glimpse and seek blessings of their beloved Mount Mary. I decided to use the evening to visit my favourite Udyan Ganesh Temple at the Shivaji park.

I had my car but didn’t want to drive in Mumbai traffic that day, so I requested for a rental car. As the car came up, a perfectly dressed chauffeur in a white hat got down swiftly and held open the door, politely wishing me. He must be in his sixties. “I am Abdul, Sir” he introduced himself. I introduced myself too.

“Can you please drive me to Shivaji park?. and on the way I also want to visit the Mount Mary for a minute.” I requested.

“Sure Sir” he said.

In a few minutes, as I returned after praying at the Church, we headed towards Shivaji park. © Dr. Rajas Deshpande.

We chatted, he opened up very well, a rarity in a world full of cellphone robots. His father had retired with many honours from Mumbai Police.

“Those were the days, Docsaab! We stayed in a small society, there were three Hindu and a Christian family around us. Yet there was no awareness about religion, any child went and ate in any home. There was also no hesitation in anyone scolding any child for being naughty .. we were like a single big family. Nowadays one has to think a lot before speaking even to one’s own kids!”. I agreed with him.

I met my favourite deity at the Shivaji Park and returned. As we drove back, we crossed a building belonging to an ultra-rich famous businessman. The intention of the owner to show extremely gaudy luxury and glittery affluence in every inch of that construction was truly manifest. Passing by that building, we witnessed the state police guarding its gates.

Mr. Abdul spoke in a tone with hidden bitterness: “Every glass, every brick of this building is cursed, Doctor saab. This man has cheated and looted millions to earn this kind of money. There’s nothing against anyone being rich, I mean who doesn’t like to have a lot of money? But it should not be made by sucking people’s blood”.

In a few minutes his tone normalised. His smile returned. “Docsaab, I have worked for this company belonging to Mr. Ratan Tata Sahab for over 20 years. No one has ever seen any show-off of affluence or power from the Tata family. Once I was posted as a night-duty chauffeur at Mr. Tata’s bungalow. Sitting in my car, I dozed off by midnight At about 3 AM, I heard someone knocking on my car window. I woke up with a shock: it was Mr Ratan Tata, holding his own bag. I came out of the car shaking and apologising. He said to me: “Why do you apologise? Everyone gets sleepy at night. Not a mistake. In fact I am sorry I had to wake you up, but I must reach the airport as soon as possible. Will you be able to drive, or are you feeling sleepy? I don’t mind if you sleep in the back seat, I will drive the car to the airport and wake you up there. You can bring back the car in the morning”.

Pausing to clear his emotional throat, Mr. Abdul said “I felt that it was like meeting God. Since that day I never felt like working for anyone else. People usually show off and become mannerless when they get even little power or money, they insult and mistreat their employees, dependants and staff. But not Mr. Tata, he has the biggest heart I have known”.

That this should happen with me on the very day of Mr. Ratan Tata’s birthday was such a divine coincidence for me! © Dr. Rajas Deshpande. It provoked a different line of thought.

Soldiers, Police, Doctors, and millions of workers, labourers, watchmen work day and nightshifts, silently performing their duty while also serving the nation with their blood and sweat. Somehow people tend to think that these “true patriots” do not have a right to sleep well, eat well, and spend some good time with their families. Many think that sacrificing sleep, hunger and family time comes naturally as a duty when someone chooses such a career. As if it is a crime for a soldier or policeman to feel hungry, or a doctor to need adequate sleep. As if the children of these professionals do not need a father or a mother at home! © Dr. Rajas Deshpande. Our society thinks that, it is okay for them to sacrifise, suffer, even die in the line of duty. That is hardly a sign of an evolved, civilised or humane society!

Most people in our society get to sleep eight hours, have three square meals a day, then watch TV / entertainment, and in the remaining leisure some of them scream about Patriotism, share posts of emotional speeches about loving one’s country. There’s no better patriotism than actually working hard. Those who shout slogans and bellow speeches actually do nothing good for any country.

Through this post I would like to thank the millions of silent nation lovers: men and women from all religions, from all parts of my Great India, who show their love for their nation in their work, in their perfect execution of duty and service. May this New Year bring you immense inner happiness, exuberant health and realisation of the beauty of life.

Of Course, Happy Birthday Mr. Ratan Tata, if at all this post reaches you someday! You are one of the most respected icons in this world.

© Dr. Rajas Deshpande

Neurologist

Pune/ Mumbai

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Doughnuts, Laddoo, Anyone?

© Dr. Rajas Deshpande

He was so cute and plump as a child, that everyone started calling him “Laddoo”. Soon this became his name. His parents were both hyper-educated, and both owned google browsers, so they studied about parenthood in-depth every day, and decided to provide Laddoo with the best parents and upbringing. They had many fights about how to do it right, but they took care that they never ever fought or argued in presence of Laddoo. They never raised their voice in front of him. Laddoo therefore grew up thinking that any arguments, disagreements or raising of voice was so uncivil and wrong. In a calm, disciplined home, he was being given the best of parenthood as suggested by the best parenting websites in the world.

Laddoo’s parents took care that he could only eat the most fresh and clean, organic food. Laddoo was proud that he did not eat garbage like other children of his age. He often envied those who could eat spicy, oily roadside food, especially the panipuri, kachori etc., but he remembered what his mom-dad had told him about the bacteria and viruses in such dirty food. So he never ate anything like that, but he started developing anger towards those indisciplined kids who could eat and digest anything they wanted. In the midst of beautiful, clean plenty, Laddoo started growing up resentful of everything around him. © Dr. Rajas Deshpande. At home though, Laddoo was always a prince. To encourage free thinking, his parents had decided never to shout at him or punish him. They chose only logical, scientific, calm explanations when he was wrong. Once a maid-servant who was cleaning their home shouted sarcastically at Laddoo: “You call yourself a grown up, can’t you keep your clothes in a little order?” Laddoo’s mom was shocked, she fired the maid immediately. “Such ignorant, stupid illiterates! These slumdwellers have no idea how to raise children!” she commented, patting Laddoo on his head.

“You are stupid, Mom, you and Dad both!” Laddoo shouted, “Why do you stay in India with such people around?” His mom was so thrilled to hear this, that she immediately WhatsApped Laddoo’s words to her friends’ group, adding “Laddoo has become so mature now, he’s speaking exactly what I think sometimes. I am so proud!”. Laddoo was pampered more. All that he wanted was being made available. If he did not get what he wanted, he would throw a tantrum, accuse his parents of cruelty, and write about his parents in his famous blog “Parents and Children’s Freedom”. He had many followers. His parents oozed with pride when they referred to their Laddoo as a “Child Celebrity Author”. His proficiency with cellphones and gadgets was their pet boast.

The thoughts that “I can be wrong, someone else can be better than me, someone else can grasp better, be more intelligent or successful” never crossed Laddoo’s mind. “What I think must be the final word” became his perpetual attitude. If at all anyone was successful in proving his mistake, Laddoo would immediately state how some fault of his parents, teachers or friends led him to commit that mistake. He freely used words that scared elders: abuse, violence, childhood trauma etc. This would usually hush up the matter, and Laddoo always kept on convincing himself and others that everything good that happened in his life was solely due to his own heroic efforts whereas everything bad that happened was the fault of someone else. His parents did not want to ever shake his self-confidence, so they never made an effort to correct him.

Once Laddoo spoke arrogantly and then argued rudely with his class teacher. She was so upset, that she scolded him in front of the class, called him stupid, and gave him a punishment of standing for an hour till the class was over. After returning home that day, Laddoo complained of severe pain in both legs and giddiness. He was taken to the best child specialist, then a neurologist. “There’s nothing major, please take him to a counsellor” they were told. © Dr. Rajas Deshpande.

“Indian doctors really cannot understand a thing” said Laddoo’s father, and sent his reports to Laddoo’s aunt in the USA. The experts there commented that the child may have suffered a mental trauma due to the scolding and punishment by his teacher. Laddoo’s parents immediately filed a police case, wrote blogs against the school and the teacher, and then also complained to the school about the teacher with threats of legal prosecution. It was only after the teacher and the school apologised to Laddoo, that the cases were withdrawn, and his pain and giddiness improved. No teacher ever scolded Laddoo throughout his career thereafter.

Now Laddoo is heading a major company in California. His useless, old parents live in an old-age home, pretending to be happy. They believe that their beloved Laddoo does not see them regularly because of their own parenting faults. They cannot express this to others, they just tell people “He is extremely busy”. Laddoos parents also truly believe that his success in grabbing a great job is the highest achievement of their life.

Laddoo does not have any friends. He only has drink-n-game partners in luxurious clubs. His first wife left him long ago (“She was ridiculously orthodox, she wanted to grow up kids and all”). His second wife owns a company in Washington DC, they meet twice a year. Both of them tell people how they are victims of childhood traumas., especially when they fail competing with those “unruly, ridiculously happy” colleagues. They have decided never to have children so as to compensate for their childhood traumas, bullying by friends, teachers and parents etc. “We cannot afford time for such traditional lives” they mutually agree. They believe, understand and cover each-other’s lies so effectively, that they find it difficult to grasp why others around them cannot accept those.

Laddoo does not like anyone arguing, asking him questions. “Geniuses like me do not owe an explanation to anyone” he says, often freely quoting the likes of Newton, Einstein and Steve Jobs. No one really wants to interact with him now a days. Just as people avoid the spoiled brats of rich fathers, knowing that they are beyond any resurrection, they avoid Laddoo too. © Dr. Rajas Deshpande.

“Thay are all jealous about me, my genius, my success” Laddoo thinks. His wife agrees. Both of them spend their time at home and work blaming the whole world, showing people down, being bitter to the happy ones, and repeating the stories of how they suffered in the past, how they struggled through those imaginary problems and how heroic they have been to reach where they are now. They compliment each other like the two halves of a doughnut.

I meet such Laddoos and doughnuts (men and women) everywhere now a days. They are frequent among Doctors, Patients, Engineers, Lawyers, Businessmen etc., but also very common in big offices, major posts in the governments and managements, professors, judicial offices, ministers and even among rulers.

Do you meet any?

© Dr. Rajas Deshpande

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The Doctor Who Took Fees: One Star Review”

© Dr. Rajas Deshpande

False reviews and online beratings against doctors and hospitals have become a reality. However much a doctor goes out of the way to do the best for his/ her patient, following are the reasons why negative reviews are still uploaded, some of them ridiculous:

1. Denial of false certification.

2. Recording truth on paper like addiction (smoking, alcohol, ghutka, sleep medicines etc.).

3. Mentioning preexisting illnesses which the patient / family had hidden from the insurance companies.

4. Denial to falsify diagnosis, treatment and inflating bills to claim medical insurance benefits.

5. Denial to give concessions in standard billing, consultation, visit fees.

6. Advising necessary investigations.

7. Charging for follow up visits (different doctors, specialties and hospitals have different policies, all are usually mentioned in the information prior to consultation. All follow-ups are not same). © Dr. Rajas Deshpande.

8.. Waiting time: This is the saddest in India. The standard waiting times for specialists all over the world range from 30-90 minutes, sometimes longer, but it is only the Indian patients who convert this into a complaint. Sometimes earlier patients may have taken more time, asked more questions, sometimes patients cry when a sad diagnosis is conveyed, one cannot ask them to leave the room, there are incessant calls for emergencies etc. . The same traffic and weather conditions affect a doctor’s schedule too, but some are unforgiving. The fact that Indian doctors are available on usually the same day or mostly a week in spite of a heavy workload means nothing to our people, even those who have visited the Western world and witnessed that it takes months to years to get a specialist’s appointment there.

9. Behaviour of the doctor: Agreed that some doctors are indeed rude, some are in a hurry, and that is wrong. But usually doctors develop a lot of patience as they mature, dealing with all sorts of negativity continuously. Sometimes patients do offend doctors by asking illogical questions repeatedly, by challenging every word that the doctor says, or by making illogical demands. These demands include repeating long explanations about the diagnosis and treatment, requests to speak on phone with a distant relative to re-explain everything because they are too busy to come over, asking questions like “Are these medicines necessary?” etc. © Dr. Rajas Deshpande.

10. Unfair, illogical statements “I cannot tolerate any allopathic medicine” rules this section. What do you expect a physician to do?

11. Unfair, unrealistic expectations: Every drug has side effects, including vitamins, and these side effects are NOT the doctor’s fault. The doctor can alert the patient about common side effects, but cannot explain all side effects of every medicine, as it is impractical. Secondly, while some medicines act within seconds, some take effect over weeks to months. Those without patience who expect relief within few hours / one day usually upload angry reviews about both “no effect” and side effect” commonly.

12. Declining demands for admission. Investigations and OPD treatments are not covered by most insurance companies, so some patients demand admission even when not indicated. When refused, even if the patient was cured, the doctor still gets a negative review.

13. Google masters: Some patients bring a lot of irrelevant questions and conceptually wrong use of medical terms to the doctor’s table, and however politely one declines to waste time over such, a negative review is almost guaranteed. © Dr. Rajas Deshpande.

14. Habitual negative reviewers: I once found a negative review of a patient who had actually responded well to treatment and was cured. He had complained about having to pay for a follow up visit after few weeks. A small google search revealed that he had uploaded many reviews from those about railway stations to collector’s office, from autorickshaws to five star hotels, almost all negative. Unhappy man!

12. Professional Competitors- this is a new reality: doctors hiring agencies to boost their positive reviews and add negative reviews to their competition. The simple fact check of how many positive reviews over how much time reveals the truth.

Some negative reviews are indeed genuine, I have had them myself, and called and apologised to the patient, clarified my stand too. However when they were malicious, I have informed the concerned site manager and also posted a reply about reality.

How to know?

A negative review must have a legitimate name of the person writing it, and details of date and time of the visit. That way the doctor can also confirm whether it is genuine and help resolve it. A nameless review is always questionable, good or bad.

In a recent news, a National restaurant association has decided to sue people who upload negative reviews about food: just because they want more or free, just because of their mindset is negative, just because they are insatiable. Even IMA should consider suing people who upload wrong, defamatory, spiteful reviews about doctors. Even the ‘hired good reviews’ by doctors should be discouraged.

Issued in the best interests of patients and doctors.

© Dr. Rajas Deshpande

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The Secret Illness Of Doctors

© Dr. Rajas Deshpande

She threw the file upon my table.

“I have no relief doctor. This giddiness is killing me. None of the medicines ever works. No doctor is able to understand my illness. Just give me some tablet and end my life” she was shouting and crying. Her parents accompanying her looked at me with anger and disdain.

She had been to many speciaalists earlier. Most earlier doctors had “wisely shuttled her off to another specialist” due to her hysterical behavior. © Dr. Rajas Deshpande.

I ordered a coffee for her and her parents, asked them to calm down, and explained that I had not found any abnormality upon her physical examination. I told them once again that sometimes we do not recognise stress playing upon our minds. We all think that we are supermen or superwomen who can tolerate any mental activity, behavior or abuse of our physical and mental capacity. Explained, they calmed down, open for suggestions. I referred them to an excellent psychiatrist colleague.

My colleague emailed me the next day after meeting them. The girl was being sweetly pressurised by her family for marriage, and the fear of having to leave the “overcaring and comfort” of her parents was stressing her out. She dramatically improved with counseling for the whole family and medicines for her. © Dr. Rajas Deshpande.

Only recently, a case of bleeding in the brain due to high BP was quite critical, and the entire family kept blaming, screaming at and in general mentally screwing the doctor’s team as the patient did not improve as quickly as they expected. Patients with bleeding in the brain may take months to improve. The worst ‘shouter’ in this case was the patient’s elder son. Many days after the patient improved, the family revealed that this elder son had had a continuous fight with his father, the patient, for many days prior over property, and on the night before admission he had slapped his father. That’s probably why the patient’s BP had shot up, causing bleeding in the brain. They had never told us this part earlier.

This is a form of abuse that almost every medical practitioner faces on a daily basis. Quarrels and stresses at home, guilts and anxieties, work pressures, irregular and atrocious lifestyles, eating habits and addictions, relationship frustrations of all kinds, personal failures and insecurities are some of the common reasons angry patients and their families unburden themselves upon the medical practitioner. Many want to avoid in-laws, pregnancy, transfers, heavy duty etc.Many do not follow medical advice and experiment upon themselves. Most of these blame doctors for their continuing ill health, little realising that the actual medicine is omitting the cause of their stress. The doctor can only help one identify this cause, suggest strategies to deal with it, but the actual action has to come from the patient and family. © Dr. Rajas Deshpande.

“Doctor Abuse” is common all over the world, but in India it also converts into frank violence. Blaming ‘compassionate communication failure” by the doctor is a joke, a society where even the closest family members do not understand each other for years, how does one expect a doctor to make someone strange ‘understand” a complicated situation? Will our courts and police “explain and communicate effectively” with criminals so that they do not commit crimes again, or will they “warn and punish” the abusers and miscreants? Abuse and violence are NEVER justified in any civil society.

The stress of such “Doctor Abuse” is phenomenal! It has now become so common, that many doctors have stopped admitting patients, many have reduced work hours, and some have even quit the profession. “Excessive stress and fear of abuse” is a secret illness of almost all doctors now!

If a doctor wanted his patients to suffer or die, why will he/ she even go to the hospital? There’s better money in almost all other intellectual professions, why would one choose to spend a lifetime amongst the sick and dying? Most doctors are doing their best for making the patient happy. A little understanding and cooperation from our society will encourage the good doctors to be better, and the bad doctors to follow their example. Violence and force will only worsen the situation. Doctor abuse must go. © Dr. Rajas Deshpande.

Always praying for the best health of patients and now, even doctors!

© Dr. Rajas Deshpande

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