Tag Archives: social

Who Is Guilty Here?A Typical Indian Case


© Dr. Rajas Deshpande

“Sir my brother is critical. The doctors are not telling us anything about recovery. They don’t even reply to our questions about when the patient will recover. They are so inhuman! They should let the patient die if he is not going to come out of this illness, but they give us false hope that he may recover” said the friend, whose language precluded decency.

Having them seated, I requested details from patient’s friend accompanying the brother.

The patient, now in late thirties, had married against his family’s wish. He was boycot by his family, and started living with his wife. After a few days the couple started having quarrels due to his drinking habit. He frequently beat her up, and she often made a public scene of their private issues. He left her one day and returned to his family. His parents and brothers continued to taunt him. One day he was beaten up by his brothers, and in a fit of anger he drank rat poison.
He started vomiting after a few hours, became unconscious, and was taken to a quack who forced some magic potion in the patient’s mouth. Just after that, the patient had convulsions. “Take him to a doctor” said the quack. That’s when they went to a nearby rural hospital, which had no doctor. When they reached the city, patient was almost comatose. They took him to a low-cost multispecialty hospital. Upon admission his blood pressure was not recordable, breathing was almost nil, and heart was already beating too slow. The doctors there had acted fast and stabilised him, but by then his brain had suffered severe damage due to low blood pressure and very low oxygen.
In a week, he was stable, breathing on his own, opening eyes but unable to recognise anyone. Recovery in such cases is always very slow, unpredictable, and mostly incomplete. He needed supervision and nursing care, that was being done. Doctors were tired of the incessant repetitions of same questions: from relatives, politicians, and many other doctors. There’s a limit to how much compassion can one offer to its abuser. © Dr. Rajas Deshpande

I did what was the obvious thing to do: reassured the relatives that the treating doctors were doing a good job, that things were unpredictable in such cases, and that they should have trust in the ability of those qualified doctors to handle a case whom they had rescued from an almost certain death.

What ate my heart away was the blatant, glaring line of facts here: the family was not kind to him, the wife wasn’t kind to him, his relatives took him to a quack and wasted most precious time that could have saved a lot of brain damage, the quack used something that dangerously worsened the patient’s health, the rural government healthcare was inadequate, but none among the family or politicos ever said a word or questioned that. As if they were all exempt from humanity, and nothing about his health was any of their responsibility. © Dr. Rajas Deshpande
The doctors at that low-cost hospital, with minimum amenities, had still managed to save the patient, they did an excellent job, but were still labelled inhuman – just because everyone expected a full recovery of the patient, as if it was worthless to save a life unless it was complete, quick and cheap!
Indian doctors are already considered among the best all across the globe, we keep abreast of all advances in our respective fields by studying every day, we are easily available to everyone who needs our skill and opinion, we work far more than our colleagues in developed world, yet we are the most stressed, criticised, villainised and also poorest paid class of doctors, living under threats from one and all. Indian healthcare infrastructure is atleast fifteen years behind the developed world, it is us doctors who carry that burden of patient’s (googled) expectations upon our shoulders. It is frustrating to deal with the trustless, paranoid interactions with the relatives of those very patients whom we are trying to save.
What kills us most is the indecent, aggressive, violent way in which most doctors are abused in our country. Even the patients who do not recover completely speak in a vengeful, angry and complaining way to their doctors rather than any trace of gratefulness for whatever recovery was achieved.

The only way to possibly change this scenario is to change the society. Yes, to prefer a developed society where common sense and decency are not optional.

© Dr. Rajas Deshpande

Victim Versus Victim

Victim Versus Victim

© Dr. Rajas Deshpande

He walked in my chamber, trembling and sweating. A typical engineer, cute, nerdy and cultured, he lacked the usual poise, calm and charm that accompanies the true intellectual. Something was wrong.

“Are you ok? Do you need a glass of water?” I asked him, while glancing at the vitals that the nurse had recorded- his blood pressure was high but not in the dangerous range. His breathing was heavy, and his eyes red.

“No, Doctor, I… I .. my head..” he wasn’t able to finish his sentence. I let him relax for a few moments. Taking a deep breath in, he started: “Doc, I haven’t slept in fifteen days. My head is exploding. I feel like I will die. We did a heart check up yesterday as I had palpitations, but the cardio told me everything was normal”.

I examined him, there were no neurological findings except the extreme anxiety he was trembling with. Sometimes the mind is so troubled, it actually causes the body to manifest its suffering- causing giddiness, trembling, headaches, lack of sleep, sometimes even fatal conditions! Stress is indeed a major killer.

“Is someone with you? Are you under some stress? Where’s your family?” I asked, and he started to shake.
“I want to tell you something confidential, doc” he said, and told me one of the most horrific yet increasingly frequent stories of our times.

He is 34, married, and has a six-year-old child. His wife works too, but in a different company. He spilled out what was hijacking his mind:
“Fifteen days ago, on a weekend, my wife dozed off on the sofa besides me. Her cellphone was in the kitchen, and when I went to get a snack, a whatsapp notification appeared on her locked screen, it said ‘I love you too, can’t wait to see you. Wear white, you look beautiful ..”. The sender appeared to be a female name, but I was curious. I had complete trust in my wife and we had a very good life together. I woke up my wife and asked her to open that message, asking for details. She refused. I got very angry as she was trying to hide something. I told her that I was planning to call her father and discuss the issue. Then she told me the truth”. © Dr. Rajas Deshpande

“She had met one of her classmates in one of those ten year class reunions which have sprouted everywhere now. He started praising her, messaging her, and she said that she had fallen in love with him. She did apologise to me. I was devastated and wanted to run away, kill myself, because I had loved my wife dearly. The only reason why I did not do anything serious was our son, who is attached to both of us.”

“After a lot of thinking I decided to forgive my wife. I told her that I was ready to start again, but she had to completely stop seeing her classmate. I also requested her that I want to meet him once. We went to meet him. He is married too, has two kids, but his wife is not aware about all this. He bluntly refused to stop seeing my wife. He and my wife together told me that they cannot stop seeing each other, and that if I create any problems, my wife will approach various associations and police and tell them that I am abusing, harassing and being violent to her. You know what happens, doc, how law can be misused, how things can be twisted to make someone a villain. I am from a very cultured, educated family, we are scared of fights and legal matters, police cases etc.”

“When we returned home, my wife told me not to worry, and that if I did not interfere with their relations, I could also have the same relation with her as earlier. Now I hate her, I do not want to see her, but the thought of what will happen to our son and his future is killing me. I cannot eat, sleep or even think normally. I had severe headache since a few days, and today I vomited. My friend gave me your number, so I am here”.

Whenever someone is fasting for long, or for any reason dehydrated, the headache that follows could be extremely dangerous. We obtained an emergency scan of his brain and found that he was already developing clots in his veins, a condition that could have killed him if not treated in time. He was admitted and treated. His wife did come and attend him. He improved and was discharged in two days. I arranged for a counsellor for them, and now they are both undergoing counselling. © Dr. Rajas Deshpande

Besides the facts that I should never judge someone as a doctor, and that I am not a counsellor, I was appalled at the audacious threats (and in some cases a reality) misuse of police, legal machinery and socio-political forces under various disguises to corner and target someone. Recently a big retired police officer has commented “Show me a person, anyone, and we can show you his crimes”. The selective victimization of whoever one wants to target, while playing victim oneself, is the new name of the game: Victim Versus Victim with blurred definitions is the new world we are welcoming, thanks to the umpteen legal and social immaturities.

From gender to religion, from intellectual to financial achievements, anyone can now be blamed by anyone else, claiming to be a victim after using the system to get what one would never have achieved without that very system in place. In short, we are living in a world where a thief can enter your home, kill your dear ones, steal your belongings and if you catch and punish them, can play a victim card based upon anything from gender to caste, religion, nationality or political affiliation. This certainly cannot be called evolution, as survival of the most vicious villain will never favor human race.

Meanwhile we doctors will try and maintain our sanity to be neutral and treat everyone for their best health.

© Dr. Rajas Deshpande

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Orphaned Doctor, Change and Future

Orphaned Doctor, Change and Future

© Dr. Rajas Deshpande

For two decades, I have taught medical batches one highest principle in medicine: To go out of your way to earn the patient’s confidence and trust, make the patient comfortable, understand their anger and frustration, and to never lose temper with a patient. Unfortunately, Covid 19 has started to change some of that. Because some patients and relatives do not listen. They do not care if they endanger other people’s life. They have no concept of importance of time and avoidance of “medical gossip”.

We must now treat everyone a potentially infectious source and take adequate care. Longer the exposure to a potential case, higher the chance of infection. That creates a new covid19 complication in our medical practice: dealing with the adamant, the slow, the repeating and the illogical. The days of personally explaining everything logically and patiently seem to be over, at least till the pandemic lasts, as extra time now means that much prolonged exposure. We should now record history with direct questions, examine and diagnose the patient, handover the list of tests if required and a prescription, and arrange for a telemedicine follow up of limited time to explain and discuss. In confirmed diagnoses, we can give the list of authentic websites which patient can read from and get their answers. That will eliminate a lot of unnecessary discussion and “unlimited questions because I paid for this consult”. © Dr. Rajas Deshpande

To risk his / her own life can be a doctor’s choice, but I don’t think any doctor has the right to risk the lives of his / her own children, spouse and parents. I don’t think it is right for the doctor to ignore his responsibilities towards his children, spouse and parents because he has to serve others outside family.

No doctor can endanger other innocent patients and hospital staff by exposing them to adamant, careless patients who refuse to wear masks in waiting rooms. A doctor cannot have time to go out and fight, especially with our politically powered criminals. The only way-out seems to be politely refusing to see the patient who does not follow basic mask etiquette. What is the point of explaining to a patient or a relative who wears a mask on their neck, leaving the nose and mouth open?

Many a times the doctor can diagnose and prescribe for common ailments within minutes, but it is customary to listen to the patient, to pacify their anxiety, to explain in detail and address many a fears born of google searches. The more difficult a medical condition, the more frustrating it is to explain it to patients. In every branch of medicine, there indeed are many extremely complicated medical conditions, situations which the most brilliant doctors also must make efforts to grasp.

It took me 3 years of specialty education after completing DM Neurology to understand Multiple Sclerosis or Parkinson’s Disease well enough to treat it, and even after 25 years of practice, neither me nor any of my teachers- some topmost authorities in the world- who spent their life studying these conditions can claim to have understood them fully. There are far more complicated conditions of the brain we must still keep on studying. How can these be explained to everyone from every background in few minutes?

While the medical treatment is the same for the intellectually challenged and endowed, the former takes the cake here because they stop once they trust their doctor, the later rarely can. © Dr. Rajas Deshpande

The Indian Doctor has been long orphaned by all. The pandemic has revealed the cruelty with which doctors are being exploited all over the country: especially the UG and PG students, interns and junior doctors. It is high time that every doctor takes charge of his / her own career, come out of exploiting contracts and services, even go to the courts if necessary, to be relieved of injustice, and start a good clean practice. That way at least one can serve many more patients, earn peace, satisfaction and funds, while also fulfilling the responsibility to safely look after one’s family. Resident doctors should seriously consider a national level petition to the courts of law about the various unfair practices being enforced at present.

We cannot change the clumsy, clueless, perpetually failing yet adamant mismanagers of the situation who unfortunately hold the reigns.

I’ve worked with orphans. They are most self-sufficient, beautiful souls who learn how to survive independently in a big bad world. I have learnt a lot from them, but the best thing they taught me was to not be affected by the false sympathy, artificial display of love, sweet talkers with black agendas and mean exploiters. They taught me that just holding hands without words at difficult times is far more meaningful than any huge boxes of chocolates, gifts, and to wit: thali, diya etc..

The key to wisdom is in silence. Doctors should silently change now.

© Dr. Rajas Deshpande

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Two Shades of Nepotism, and Doctors.


© Dr. Rajas Deshpande

Surgery final exams.Butterflies.
My best friend and me were sweating since last few nights.

My turn, a case of breast cancer. I did well, but obviously it is not possible to answer everything, and there comes the “Sorry Sir, I don’t know” moment, I said it. The kind external examiner smiled at the end, a positive sign. I started on the next short case nearby. My best friend was presenting to the same examiners when I was recording my next case. Poor guy, he had a difficult case and was confusing. He was better than me in surgery, and here he was, not doing well. Just then, his uncle, a senior surgery professor, entered our ward, and our examiners stood up to wish him. They were his students. Our professor wished my friend best luck, and said to the examiners he hoped his nephew did well.

I got enough marks to cross the first class, my friend was far ahead. While I secretly resented that my friend had an advantage, I knew he was a good student, and it did not hurt much. Maybe, if it was an enemy my reactions would have been different. Many examiners in India actually discriminate between an outsider (belonging to non-medical parents) and insider (belonging to doctors, especially from the same institute), or on the basis of caste, language, and even gender.

Gender discrimination and its various shades are nothing new in India and still a taboo to write about, but there are beneficiaries and victims of this anomaly. There was a girl in my college, not very academic, who did ‘impress’ the examiners with her beauty and smile. We saw some male professors being partial to her because she was exceptionally beautiful and had a model-like personality. She always passed with very good grades, got the best ranks, and eventually married a similar rich and handsome guy. Nothing in this story offends me, these are the ways of today’s world, but since centuries probably. I know that most beautiful women also face a reverse discrimination, i.e. even after being the best they are accused of using their looks to get what they want. They are usually above the tendency to reply to such allegations.

A very wise quote mentioned in almost all spiritual texts says “Imagine yourself in their place before you speak about someone”. What would I have done, if my uncle was a Surgery professor, and could ‘push me up’ a little bit? Or, a more difficult question, would I have taken advantage if I was a woman with really good looks? Well, the answers are not very pleasant, and certainly not universal. I wished I had a Godfather in medicine, to guide and protect me. However I do not hate those who have one. Not having a godfather helped me grow better and stronger, and I always found ways to create enough opportunities for myself, to face this reality head-on rather than engage in a blame game about it.

Nepotism and discrimination are not new, in fact it is an ancient tradition in many cultures, like some other questionable traditions. From Kings and Priests to classical singers, people have preferred their own over deserving others. For example, if a wrestler has struggled and won medals, name and fame, he would want his progeny to excel in his own craft, and will do everything possible to help his own son/ daughter. Only those who can say ‘ I will never help my son / daughter / friend to excel in their career, I will never invest for them, never use my goodwill to get them the best life should be able to criticise nepotism in true sense. Nepotism is the naked truth about almost every profession, from politics to mafia. Even genetically (this might need a broader-grasp mind) there are certain things which people inherit an ability to do better. Right from famed watchmakers to singers, dancers, and some artists in fact retain their craft strictly within families, and proudly keep it a secret. So long as they do not prevent someone else from making their craft, or do not stand in the way of others, one cannot blame nepotism. Why should we presume that the son of a great singer cannot be a greater singer if given a chance?

Unless everyone in our society is mature enough to swear not to help their own family and friends and follow that, unless we eliminate nepotism by laws that apply to everyone, we cannot selectively blame one profession or other about it. While we evolve away from it, we must also accept that near and dear ones will always be the favoured ones as a human tendency, with rare exceptions. If a woman is rich enough, she can buy a Mercedes for her daughter, and her neighbour has no case crying nepotism because their kid was denied a Merc. However, if the neighbouring child’s toy is snatched, then alone there can (and should) be an argument. A true anti-nepotism sentiment should be to help every hungry and homeless kid we see on the roads, as they need food and home more than our overfed kids do. Is that happening?

Most of the politicians, businessmen, and even doctors who have reached heights in their careers have tried to rope in their own near and dear ones in their field of expertise. That has never prevented outsiders in any field from reaching where they are destined to reach with their hard work. In fact, outsiders are often seen reaching higher and farther than those who get help and support early on. I have very strong feelings about those with money buying out medical undergraduate and postgraduate seats while those without money and just merit having to let their valid claim vanish. What money does when it changes hands is far worse than what nepotism does in any field. There are other vices far worse than nepotism in every profession. Taking advantage of gender, power and connections to disrepute, defame or emotionally torture others are far worse. There’s nothing wrong in helping one’s own, but it should not be at the cost of destroying others. If a doctor has established a great hospital with his life’s blood and sweat, he will obviously want his own child to own it rather than conducting an international survey for researching the most eligible person to run it. I am not at all in favour of Nepotism, but I strongly feel about the misuse of this term by those who openly practice cronyism, favoritism and shoelickism.

To choose a vice that suits one’s immediate cause and ignore one’s own ‘bypasses’ to success, being thankless to those few who made one successful is a creepy tendency. Many who accuse others of having ‘Godfathers’ gladly indulge in other types of ‘push-pull’ tactics for utterly selfish gains. In medicine too, while we gradually become more objective, we should try and also eliminate our own faults before raising fingers at others. Every doctor should be graceful enough to be above short term attention seeking. If we don’t understand good and bad mentalities, who will? The best we can do is to concentrate on the good we can do, while fighting with a smile those who suppress others. We can never forget that there indeed were people who helped us.

Nepotism will create only a transient glitter. The beautiful spirit of eternity is never affected by it.

© Dr. Rajas Deshpande

Change The Medical Scene, India: Article One. Healthcare Failure In India: Problems And Solutions

1: Etiopathogenesis
(c) Dr. Rajas Deshpande

This is my heartfelt attempt towards initiating a change in the Indian healthcare system. We all, even the government, wants it to improve but nobody seems to know where to start.

I appeal the younger generation of doctors to please think deeply about this article in terms of your future, unless you want to face the same humiliation, insecurity, inhuman attitudes, suppression and threats all your life, just because you are divided. I intend to offend no one, my non-Utopian aim is that every patient as well as every doctor should be happy, healthy and satisfied. There indeed are more good than bad doctors in India, but guess who dominates the scene.

In this series of articles I have tried to first identify the basic problems, and will propose probable answers in my later articles. Before we analyse outsiders, let us first take an honest look at ourselves.

Problems Within Medical Community:

  1. We have many class differences between doctors. This is the most prominent cause of non-unity of doctors. These class differences may be summarised as (a): Intellectual: some doctors are far more intelligent and skilful than others. (b): Cultural: some doctors know the best ways to behave and speak with patients, others have an arrogant, ill-mannered, abusive and sometimes filthy, inviting a bad reputation. (c): Academic/ Clinical: some doctors are trained at extremely good institutes, some put in gigantic self-study efforts, and therefore are academically and / or clinically better even if their medical degree is the same. (d): Financial: some need financial support and critical effort to survive through medical courses, fighting till in their thirties to settle down, while for some others, financially it’s a cakewalk.
  2. Shameful tendency amongst doctors, of discrimination based upon State, Caste, Region, Religion, Academic Institute, City, Financial Status or Political party, generating an “Insider-Outsider” culture. This has also resulted in many hospitals employing doctors from a particular religion or socio-cultural/ financial status even if better candidates are available. Few honourable exceptions.
  3. Jealousy, Insecurity and Envy: There are successful and struggling doctors in every branch. The shameful tendency of some established doctors to suppress and disallow juniors in their institutes is well known. Most wise institutes now employ two or more competing masters in every branch and fire up their egos against each other, to have them fight tooth and nails. Guess who profits and who bleeds. The comic tragedy is that even very brilliant doctors fall prey to such tactics. © Dr. Rajas Deshpande.
  4. Financial desperation: Juniors who come from poorer backgrounds, in spite of better abilities, have no money to invest, make their own hospitals, and must work at bigger hospitals under such competing seniors, and the only way they are allowed to survive is by getting better numbers. This results in a very hostile, bitter work culture.
  5. Killing Humanity: The entire medical community is guilty of perpetually ignoring, intimidating, suppressing and blackmailing medical students, especially postgraduate resident doctors. India has probably the worst inhuman treatment for its budding and junior doctors, with no one interested in addressing their problems. They live in most pathetic conditions, often six in a single room. They are inhumanly overworked, with a shameless answer “We did it, now you do it” from their seniors. “No food and No sleep” is nothing to be proud of, it is Torture. Post graduate students and resident doctors are not only FORCED to work far beyond human capacity, they are overtasked with mindless curriculums. The “Slaves” in our history were far better off compared to how the resident doctors are treated today in India.
  6. Extremely low quality medical institutes: Guess who owns and runs these, still churning out valid degree holders.
  7. Nepotism: Where “Premium” students, often children of the powerful, politicians, administrators, doctors, socially prominent are treated differently, groomed specially and airlifted to success while others, however meritorious and efficient, are humiliated and suppressed. © Dr. Rajas Deshpande.
  8. Master-Slave Culture: In every private or Corporate owned hospital, there is an unwritten rule: never cross the Master-Slave boundaries, never ask questions, you are here because we allow you to be. Should you dare to correct someone about policies, ethics, financial irregularities, excess profiteering, you are unceremoniously thrown out, given the title of a rebel, a troublemaker, and your reputation as a doctor is torn beyond redemption. This is the worst for surgeons than physicians, as ‘badmouthing’ / deliberate ill-reputing of a surgeon can ruin their entire career. Unfortunately, it is not only the hospitals, but different classes of doctors mentioned above participate in this mudslinging too. No institute in India has an honest troubleshooting department for doctors. There is no respite, there is no organisation, doctor’s body, government department that protects a doctor thrown out, defamed or harassed by corporates or big hospitals. Very few hospitals are doctor- friendly.
  9. Even in government service, sycophancy is the strictest tradition.
  10. The SP Syndrome: Shoelicking-Postholders are the worst tragedy in healthcare. Even after being qualified doctors, these ‘doctors’ have learnt the quick-ladder culture to sit in a medical administrative chair. They know which side to please, and are seldom seen working in the interest of either the doctors or the profession. They have but one agenda: strengthening their chair-bum glue. They are found almost everywhere in healthcare, and many enjoy the administrative superiority and control over better qualified and even senior doctors. There are rare honourable exceptions who try and balance the hospital and doctor’s sides. However, those involved in policy making are rarely in direct contact with the patients, have rarely had a reputation / experience of good medical practice, and are happy with hypothetical speeches sweetened for their powerful masters. Senior doctors have never stood up for an unfairly fired or colleague, and often our own community disowns a doctor harassed by healthcare giants or government. Thousands of excellent doctors have either left the country or live in dark anonymity just because there was no Godfather for them. This is a major cause of policy failures and pathetic research in Indian healthcare, inspite of having some of the best medical brains upon earth.
  11. The only thing that helps a good doctor is long-term goodwill generated over years, where patients spread a good word about their relief from that doctor. Against this is pitched the permission to hospitals for self-advertising, which often misleads the society.
  12. Once a doctor starts a hospital, there are so many taxes / overheads that he / she must shoulder, so much paperwork, that it is difficult to concentrate upon patients alone. Add innumerable laws, restrictions, rules that make it impossible to sustain over long term. Bribes are a stark reality wherever rules, restrictions are involved. This is why many doctors have closed down smaller hospitals.
  13. While doctors are only allowed to charge their (mostly) limited fees, almost everyone else in the profession earns a lot more profit, often unjust. From rooms, service, nursing, gloves, catheters, to procedures, from canteen to labs to radiology to pharmacy, the hospital and pharmas earn profits everywhere (this is acceptable in proportion of the investment). The one paid least in the final bill is the doctor / surgeon, who usually earns a piddly sum in spite of being the most important factor in the chain. The doctor is also primarily responsible medico-legally for every case. Patients are upset with the doctor even after saving their lives because the bill is fat, not knowing that most doctors have no say in hospital billings. © Dr. Rajas Deshpande.
  14. The Corruption: There is no denying the fact that some doctors participate in various “unethical” means of earning via “commissions”. While all corruption is wrong, this is an extremely hot and debatable issue, where many questions are unanswered. For example, if a doctor owns a hospital and a lab and a pharmacy, he can profit under all three headings, but if a doctor working with him is also paid from this profit, it is presumed unethical. Our society is too financially biased, and it will never accept the necessity of profits in healthcare. However, the same society or its government has no answers to what a good ethical doctor should do if there are financial emergencies like this pandemic where his / her income is near nil. Hence the doctor is left to ensure his / her own income, with or without patients. Our society will preach doctors a lot of pompous lessons of ethics and compassion, but won’t feed the doctors family if he is in financial trouble due to all the good and free work he does. To completely eliminate “backdoor incomes”, the only way is that the doctor’s fees will shoot up.
  15. Over-smart Attention seekers: This community of doctors will do anything to garner attention. They will make news for being cheapest, they will construct new theories of individual, private research and blabber about them on national / state channels, massage the egos of power, speak against their own colleagues just to get praise from society and media and so much more. They hunt celebrities and powerful to be seen with, always speak the language of “Sweet, Beautiful, Positive” and imply from their wisely framed speech that only they can understand compassion and patient’s feelings while other doctors don’t. These are the usual early birds on TV, who criticise their own professional colleagues whenever there is violence against doctors, preaching about communication, making the society feel that ‘bashing up of junior doctors’ is justified, just because they could not communicate well. They will go to any unscientific extent to fool the public to be in good books of the government and administration, and completely vanish when their profession is suffering. This attention-seeking community has done the worst harm to medicos and the reputation of our noble profession.
  16. Doctor’s Organisations: “………………………………………………………………………………………………………………………………………………………” .

To Be Continued
© Dr. Rajas Deshpande

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© Dr. Rajas Deshpande
“Sir, we are screwed. The Chief Minister and other ministers have closed all doors, they won’t respond. Our careers are in grave danger. Can you please help us?” I frantically spoke.
From the other end of the phone, the Don, Dr. Nitu Mandke answered: “See me at my home at 12 midnight”.
The Maharashtra state resident doctor’s agitation for dignity, national pay parity and better living conditions was on, and I was given the responsibility of coordinating and being the face. We had successfully established a multilevel network.
When students go on a strike anywhere in any field, it is almost always out of desperation, either for dignity or for rebellion against some sort of suppression by the system. Students never rebel for money or power. This raw student power is almost as mighty as the army, and although it falls prey to political misuse sometimes, it has tremendous capacity towards achieving intellectual evolution of the society. The government always treats any unrest as an offence to its ego, and uses everything at its disposal: CID, Police, Administration, Force, Threats, Caste Politics, Cheating and Legal torture to mow down student agitations. Students have no money, no experience and rare political or social backing, and must unite and stand up for themselves. © Dr. Rajas Deshpande

On the fourth day of the strike, a big politico from the ruling alliance came over to our office at Mumbai KEM. There was no telling between him and a mafia goon. The members of student’s central committee: Dr. Sanjay Singh, Dr. Dinesh Kabra, Dr. Narender Sheshadri, Dr. Pramod Giri, Dr. Nilesh Nikam, Dr. Kuldeep, Dr. Vishal Sawant, Dr. Noor, Dr. Shahid, and few others were with me. The politico did not have any scruples using an arrogant, raw and filthy language to threaten that if we do not stop and withdraw the strike, our careers and even life will be in danger. As he was from the ruling party and threatened us in presence of the police, there was nothing we could say.
There are angels everywhere. A senior police officer who was supposed to “keep a constant watch” upon us ‘student leaders’ was quite fatherly. He told us “Do what you must, but don’t declare. Dumb people cannot interpret silence. Stay away from any violence”. © Dr. Rajas Deshpande
Unknown calls kept threats alive. That is when a resident doctor suggested we meet the Don: Dr. Nitu Mandke, the famous heart surgeon who was known to be a fearless, straightforward celebrity doctor.

We went to his home, and waited, hosted by his extremely courteous family. He returned home past midnight. We briefed him the details. He asked a few questions to assess our determination and strength. He asked us to stay united and avoid any misbehaviour during the agitation. To our surprise, he picked up the cellphone and called the Chief Minister’s PA. The CM was fortunately available, and talked to Dr. Mandke. © Dr. Rajas Deshpande

After the call, Dr. Mandke told us: “CM has advised us to meet the Deputy CM tomorrow. Two of you come to Lilavati Hospital tomorrow at 2 PM. I will take you to the DyCM.”.
At Lilavati hospital, Dr. Mandke’s chamber was intimidatingly clean and posh, yet simple. He checked our applications for the CM and corrected them with his beautiful pen. His briefcase had every essential of writing stationary, the mark of a perfect man.

As we waited, I asked him cautiously: “Sir, shall we start?” He replied that he was waiting for someone to carry the bag on his table. I offered that I will carry it. He laughed his thunderous laugh, and looked at us as if we were small puppies. “ Deshpandyaa, that bag has two and a half crore rupees cash for construction of my hospital. A professional bodyguard will carry it. People kill for that. Do you want to carry it?”. I shut up.

In his big car, for the 45 minutes that his bodyguard drove us to the DyCM, I asked Dr. Nitu Mandke questions about what was going through his mind when he was actually operating the Shiv Sena Supremo Mr. Balasaheb Thackeray. Such an enormous pressure it must have been!
“Oh yes, it was stressful. But he is a gentleman, and he had assured my safety. His word is enough”.© Dr. Rajas Deshpande.

That’s when we told him how some politicos had threatened us recently. He laughed and replied something that has been tattooed upon my cortex permanently:
“Rajas, a doctor is a doctor and king of lives forever. Politicos come and go. Idiots misbehave with others when the have any post or power, in any field. You should not budge. It is pathetic to see doctors licking shoes of those in power, under various pretexts. It is up to you to maintain your dignity and pride. That is the true luxury, everyone cannot afford it. So long as you do the right thing, fear nothing. The few crores in that bag is nothing compared to how I feel about myself”.

We entered the VIP zone and bungalow. His car was not stopped anywhere. The DyCM offered us tea, and gave us a patient listening.
“These junior doctors and students are my boys, our own boys, they will look after the health of our people tomorrow. You must help them” Dr. Mandke insisted. The DyCM assured he will. The spell was broken, talks resumed.
Many twists and turns later, one of the most memorable strikes was called off.

A year later, I saw a white Lexus car in our KEM campus at Mumbai. Fond of cars and having never touched a Lexus, I went to see it from a close distance. Just as I tried to touch it, the driver’s window rolled down, and I heard “Deshpandyaa, open the door and come in. Do you like my new car?”
And I sat besides the King of proud men, one of the most proficient Cardiac Surgeons, Dr. Nitu Mandke, in his Lexus. The feeling is unforgettable, not only for the Lexus, but for his simplicity, love and affection for a ‘nobody’, a junior doctor like myself!

Needless to say, then onwards, I have guarded my dignity and pride as a doctor more than any other possession I have. That took away many opportunities and huge finances, still I am doing quite well by God’s grace, and Dr. Mandke’s blessings.
How I feel about myself is more precious than anything I can earn. The luxury of pride is mine.
© Dr. Rajas Deshpande

Dedicated to all students, resident doctors, proud people in every field, student unions and their apolitical fearless leaders.
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Gulabo Sitabo Review: A Feast Of Class


© Dr. Rajas Deshpande

When you want trivial and mundane, you hit the streets, but when you want class, you dress up first and look for the best place you can afford to go to.
To grasp the intonations of various emotions, the prosody of dialogue and the language of the eyes, the depth of thoughts behind the imagery on the screen is a rare feast for the fortunate to enjoy. Steve Jobs taught the world what it should want, rather than catering to what it wanted. Similarly Indian cinema has started moving away from the traditional, more often to loudly shock the audience, but at some other rare times to surprise them with a classic.
Gulabo Sitabo is such a surprise. I couldn’t help but write this, out of my field.

Once during my MD Medicine days, I broke down and confided to my professor Dr. P. Y. Mulay that I am not able to digest the helpless inability to end the incessant suffering, the flow of patients is never ending, it continues in spite of whatever we do. He asked me about my icons. Of course one name among many (Einstein, Sant Dnyaneshwar, Mahatma Gandhi, Stephen Hawking, etc.) was Amitabh Bachchan, he had taught my generation the pride of being upright and the passion to achieve especially against odds.
My professor smiled and told me: “Have you seen that movie where he has a tumour and gets a convulsion? He has convulsed actually as a patient would! It is not easy, one has to observe, immerse oneself in the details. People may think it was just another bit of acting, but even medically his convulsion was nearly perfect. His body language is as perfect as his pronunciation and diction. This needs immense work. One has to accept a lot of pain to achieve whatever one sets out to achieve, that pain and suffering on the way are in fact the part of achievement. Only when you cross this negativity, you will be able to save lives, to end suffering of many. Those words changed my attitude forever.

Now, after about two decades, I got a chance to watch Mr. Amitabh Bachchan’s movie today on its day of release. The legend has grown beyond itself. His voice, his demeanour and his eyes make one realise how far away he has come from the iconic screen image(s) he had made for himself, to perform Mirza. He not only embodies, but appears to be enjoying every bit of being this mischievous old man.
One must imagine the difficulty in maintaining the doubly crooked curvature of Mirza’s (Mr. Bachchan’s character) back, the tilt on one side, the difference between movements of two legs while walking, the postural twist of neck and the difficulty of holding this all together while the face shows a spectrum of every emotion of an expressive old man. This tall man has, all through the movie, bent forward in lower back and then to speak to other characters, has had to turn his neck up. Try doing that (at your own risk)! The wet hoarseness in his voice and the breathless pauses between angry sentences are not only consistent, they underline his oneness with this role. Even the giddiness and falls are portrayed excellently, exactly as they happen in this age group. As he crosses all the bounds of expectations and anticipation, you start to understand why Mr. Amitabh Bachchan is beyond reviews. He probably enjoys acting far more than our opinions about it. Zen! He proves yet again in this film that he is far above any actor in commercial as well as non commercial/ art films in Indian cinema.

Mr. Ayushmann Khurana has played his confident yet frustrated simpleton so naturally that those who have come from poor families will readily identify with the defiant stance of a young man forced by compulsions of life without much money. Very talented and never dramatic.
Mirza’s wife, Begum, played by Mrs. Farrukh Jafar impressed with her nonchalant dialogue delivery.
Everyone else, especially Srishti Shrivastava has done their job really well, complimenting the major duo.

A word for the director Mr. Shoojit Sircar: this movie reflects a very courageous and strong will to overcome the superficial, glazed culture of fast paced but meaningless, noisy filmy clutter catering to a jaded social mindset. Instead, this is a classy feast for those who long for the art called drama, acting and visual expression with infinite colours, sounds, words, beats and silences, enhancing the effect of every moment, and meaningfully so. Not everyone dares break the cliches of dancing to the tunes of times (public), a rare few make a mark upon it.

This film is not for those who want fast and furious, item songs, or loud dramatic expressions of normal. Like I said earlier, dress up for class, open your faculties of perception of the subtle. If you understand the beauty of depth of an effort, the intensity of something so simple as an old man’s love for his possessions, you will thoroughly enjoy this movie.

I am not qualified to review or rate this movie. I am entitled only to express my gratitude for an extremely pleasant feeling of “not all is lost to cheap drama” that this film gave me. After the long lockdown and perpetual hospital stress, this film also reminded me how beautiful past can be, compared to the old age we will all meet one day. We need to reboot our perceptions or the world around us, and redefine our definitions of happiness and possessions. And yes, we need to learn also that we are still amongst icons who work hard to ride their passions, to rise to every challenge and win over it, defying all odds.

Waiting for your next hit, Mr. Bachchan, Sir!

Thank You!

© Dr. Rajas Deshpande

Amitabh Bachchan

“It seems this hospital is distributing death to the patients”

“Aisa Lag Raha Hai Ki Ye Hospital Marijon Ko Maut Baant Raha Hai”

A leading and brilliant Indian TV anchor has framed this sentence. There are over a million deaths all over the world, covid hospitals are burdened up with dead bodies in almost all countries, and the whole medical fraternity is on the frontline, all Indian hospitals have cooperated with whatever demands were made by the government. Still, the news anchor obviously implies that the hospital is ‘handing out’ death in such cases.

It is NOT the doctor’s duty to shift patients and dead bodies, still they are doing this wherever there’s no staff. But if you expect that the docs leave critical patients to die and please the TV cameras, it will never happen, our ethics are supreme.

He didn’t say that:

:Virus is distributing death
:Those responsible for inadequate healthcare are distributing death
Or
:Irresponsible people who don’t follow rules are distributing death

He just blamed the hospital like a Judge.
Media Judge.

We have few questions:
Why didn’t the journalist/ reporter who was shooting this case and crying that the patient didn’t have enough clothes give this patient his own clothes?
Why didn’t he shift the patient to other hospital which had beds?
Did the reporter take written consent from the patient to shoot him naked?
Did the reporter call helpline to attend this patient? What was the government’s response?

And lastly, is this happening only in certain states?

Please stop making TRP business out of dying patients. Why aren’t administrators stopping the interference with healthcare in hospital?

हॉस्पिटल मरीजो को मौत नहीं बांट रहा, कोरोना मौत बांट रहा है, और आप जैसे रिपोर्टर उस मौत का तमाशा बनाकर पैसे कमा रहे हो. सवाल उनसे किजिये जो इन हालात के लिये जिम्मेदार हैं. डॉक्टर और हॉस्पिटल्स अपना अपना काम कर रहे हैं. आदरणीय प्रधानमंत्री की सूचना का आप भी पालन किजीये, और कोरोना योद्धाओं के खिलाफ़ जहर फैलाना बंद किजीये.

(No hospital is distributing deaths, but corona virus is, and people like you are making money by exploiting their deaths for earning money by dramatising everything. If you dare, ask questions to the right people. Doctors and hospitals are working to full capacity to serve patients and the nation. You must first learn to respect the words of Hon’ble PM, and not spread lies against medical frontline warriors.)

Stop your poisonous blah.

© Dr. Rajas Deshpande

We are suffering, India!


© Dr. Rajas Deshpande

After witnessing hundreds of careless, maskless and even purposeless (sitting by roadside) people today, I don’t know how many more weeks it will take for the pandemic to go. The longer it takes, the longer will all of us who work for patients have to use excessive precautions that include an extremely uncomfortable get up. When you use such masks in closed hospital environments, in few hours your head aches, you start feeling suffocated, giddy, hot and tired. You cannot just remove everything and buzz off in two hours like many officials or politicos do after meetings/ TV bytes (many of whom btw don’t even know how to properly use even simple face masks).
I bet no one other than doctors or nurses can wear a proper covid gear for 8-12 hours for days in a row while being among patients. Even to take phone calls, drink a sip of water or have a desperate morsel of food after hours of work is a dangerous circus because this get up comes with a lot of precautions. When this happens because others are irresponsible, it is time to stand up for oneself.
Every doctor, every nurse is suffering this torture every day, since months, thanks to both sides. On one side are those in administration unable to control careless, arrogant, irresponsible people all over the country, and are therefore exerting all their angry pressures upon doctors and hospitals, trying to impress public by ceaselessly speaking against these frontline warriors. On the other side are irate, fearful, frustrated and poor and middle class patients and relatives who vent all their anger upon healthcare workers, because none of the “TV Star” faces claiming to be on their side on TV is actually reachable in real life for them. Have you seen a rich or powerful patient ‘suffering’ in this pandemic?
The ever irresponsible Indian media is also creating a havoc greater than the pandemic by spreading poison against healthcare set-ups, and an entirely new crop of ‘social workers’ looking for loopholes, blackmail material, tiniest mistakes to make viral news/ videos against doctors and hospitals. This is their moment of awaited glory: exploiting a rotten situation. It is surprising that while many doctors / interns and nurses have been served notices and have faced suspensions for speaking out the truth, no action is taken against false information deliberately being spread by either media or those who are making videos in and around hospitals during lockdowns.
We are suffering, India, and the careless, irresponsible attitude of our people is causing many deaths as well as extreme torture to all healthcare workers. Many doctors and nurses have been infected, many have died, and many are on the verge of a breakdown. Some have started thinking about quitting.
We are proud to serve, to risk our lives, for every patient from every religion, every state, rich or poor, but we can not continue to die for stupid, egoistic crowds who do not care if others die even when that is avoidable. That is indirect murder, and everyone irresponsible during this pandemic- not wearing masks, not following social distancing, not obeying healthcare guidelines should be charged with criminal offences.
In the 25 years of my career in this glorious profession, I have seen worst of the worst, including bird flu, swine flu epidemics, natural disasters and thousands of helpless bleeding patients lying around. I have met violent relatives face to face, restarted dead hearts and worked under gunpoint. I have dealt with highest and lowest social cadres of people in society. I’ve met hundreds of brilliant students and insisted that they practice in India. But for the first time ever, this pandemic has created a doubt in my mind about the mindsets and perceptions about doctors in India.
I am not sure if I should advise anyone to live an unprotected life without respect, forced by everyone’s whims and caged by society’s expectations after sacrificing so much to become a doctor. There are so many other ways to show our love for our country. Best way currently appears to be only speaking, sm-posting and shouting about one’s love for their country. You always see rich businessmen and celebrities with highest ministers and those who run various governments, but never the greatest Indian doctors. So we medicos must not be enough patriots to shine with the biggest administrators of our land. That says a lot. We should prefer other ways to show our love for India. There are anyways many non-medicos everywhere who think they can run Indian healthcare very well. Let them handle, they don’t seem to need good doctors or nurses.
Think, my beloved India.
Your Doctors and Nurses are Suffering.
Jai Hind!
© Dr. Rajas Deshpande

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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