Tag Archives: Stress

“Is The Diagnosis Wrong, Doctor?”

“Is The Diagnosis Wrong, Doctor?”
© Dr. Rajas Deshpande

“Doctor, there is no improvement at all” said the angry husband, throwing the case-file upon my table.

Well this is not an extraordinary sentence for any doctor, one must be prepared to openly deal with this. I had been quite polite and well mannered with them, there was no reason he had to cross that line. I could understand though. When they pay my fees, they expect some result or satisfaction.

While teaching my students, I have always insisted that if the patient / relative says that there is no improvement or change with the prescribed medicine, one must first consider the possibility of a wrong diagnosis, a missed condition or a misinterpreted finding. Doctors are humans, and do commit mistakes, or misinterpret findings. This is normal, and happens with every doctor. Medicine is far more complicated than most people think they know. A good doctor knows this and learns, while all the time keeping patients safe, but a doctor with ego kills his own practice, and may cause harm to the patient.

I asked them to sit down and reassessed the case in detail. A 28 years old female. Headache, giddiness, imbalance, palpitations, breathlessness. Lack of sleep and bouts of crying. Past and family medical history not contributory. Physical examination completely normal. MRI of brain normal, Vitamin B12 and D levels low. I had started vitamin supplements, anti-anxiety medicines and an SOS for headache.

She told me all her earlier complaints had improved, but now she had a severe backache. I told the patient that I was trying my best to understand her condition, and to resolve her problem, but her findings and complaints didn’t match. She looked at her husband, and asked him “May I speak frankly to the doctor?”.

Openly agitated, the husband sarcastically offered to wait outside if she needed privacy. However he stood glued to the chair as if he knew her answer. © Dr. Rajas Deshpande

The patient thought for a moment, told him it’s ok he can wait inside, then started to talk. She revealed that she was the only child of her affluent parents, had passed engineering, but now had to quit job and stay at home to raise children. They lived in an extended family, with grand in-laws, in laws and an elder brother, his wife and two children. This patient was the ‘last in the line’ to take orders, all others being senior to her. Her husband and in-laws were perfectionists, and she was tired of their continuous expectations. She had dreamed of making a career too, wanted some free time outside home for herself, but year after year, she didn’t get even a minute for herself. She was tired of it all and there seemed no respite. © Dr. Rajas Deshpande

“I am not averse to hard work, but the continuously condescending and fault-finding attitude makes me feel that I am useless”, she said, and added cautiously: “We were in the same institute and my ranks were always better than him. Look at where I am now” she started crying.

I offered them water and coffee, and waited for her to settle down. The husband became restless and defensive, but his tone was far lower. “I understand her problem, doctor, but what can I do? I cannot leave my family. My work pressures are quite high too, the IT industry is going through a bad phase”.

“I can assure you that she has no neurological problem now’ I replied, “she should improve with lifestyle changes, counseling for the family, and adequate free time for herself. I will refer you to a good counselor” I told them.

The husband laughed. “I can understand, but my parents will not. We will see what best we can do for her”. A bitter tone in his voice didn’t escape me.

‘Sir, she told us what bothered her, and must not be held guilty for trying to speak her mind. It will only help identify and treat the problem better. Please see a counselor together and avoid discussing this at home right now” I requested the husband. © Dr. Rajas Deshpande

There are many reasons why a patient does not improve. Untreatable medical conditions, depression, seeing the wrong specialist are the most common reasons, but there also are patients who want medical leave,those who want to avoid work, who want attention, so will keep on complaining of false symptoms. They do not improve with drug treatment.
On the other hand there are many who keep on taking the wrong medicines for years, those who self-medicate, do atrocious / injudicious dieting and exercises, yoga that doesn’t suit them, and do not follow the doctor’s instructions about abstinence, who keep on indulging salt, sweet, oil, alcohol, tobacco and other drugs freely available in India. © Dr. Rajas Deshpande

A doctor remains a lifelong medical student. A doctor who thinks he / she is always correct is most dangerous. It is not uncommon to meet doctors who are angry / upset with the patient / colleagues when their diagnosis, treatment is questioned. The first thought of a doctor when the patient does not respond positively should be to consider a misdiagnosis, reevaluate the case in more detail, reassure the patient, and obtain a second opinion if necessary. All this done, one must look into other possibilities, with an approach to resolve the issue rather than trying to shove down the patient’s throat their own faults.
We all go through bad patches in life, doctors and patients. If the child is wrong, the parents correct them still with love. A doctor’s attitude should be similar, with due care to also protect themselves. If not the doctor, who will understand the patient whose family refuses to understand them? In so many ways, especially in the Indian society, the doctor must don the role of an elder brother/ sister. Although patronising is legally discouraged in medical practice, and should be refrained from in cases where trust is questionable, one can make exceptions for some cases that need reassurance where the family fails to do so.

The nobility of our profession also lies in reassuring the patients that they are well cared for by their doctor, through the thick and thin of their life.
© Dr. Rajas Deshpande

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The Angry Husband Pandemic

The Angry Husband Pandemic

© Dr. Rajas Deshpande

“She can’t tell properly. I will tell” said the husband when I asked the patient what were her complaints. Right from the name, it was him who had answered all the questions for her.

“Does she have a speech problem?” I asked him.

“No” he replied, then the wife started telling her complaints.

The list was typical of stress related complaints: chronic aches and pains, sleep problems, lack of interest, tiredness, giddiness: a picture also frighteningly common among the youth today.

“What do you think is the main reason for your stress?” I asked, after I found that her examination was normal. The husband offered to wait outside, and she said yes.

Once he was out, the lady regained her composure, took in a deep breath, and folded her hands. “Doc, please don’t tell all this to him. I am terrified. My husband is a very angry person, and reacts very aggressively to small mistakes or whatever is against his wish. He was not this angry earlier, but he is under a lot of work pressure himself, so whenever he comes home, I think I have to accept this anger because he has no other place to vent his feelings. Even when he calls, he snaps at the smallest of things, scolds and insults me. On weekends he wants to be left alone and if at all I try to interact he has outbursts of anger. Earlier I thought that this was the beginning phase of his career, so I tolerated. But now my whole life revolves around this fear of his reactions. He treats other women very formally and mannerfully, but treats me like dirt”. © Dr. Rajas Deshpande

She wasn’t alone. The phenomenon of wife being intimidated by anger of her husband is one of the most common relationship statuses in India. Even when 70 or 80 year old couples visit, the wife usually requests the doctor to advise her life partner of over 50 years to control his anger. Superiority and validity of anger of a man over a woman is so commonly accepted in India, that if some husband treats his wife equal, questions are raised as to his being “man-enough”. Paradox: I know of a wife who told her husband in their terminal fight before divorce: “May be you didn’t know how to handle a woman. Maybe you should have slapped and kicked me and treated me like my father treated my mom. They never had fights, because he knew how to shut her up”.

The implications of applying the Global western culture to an orthodox society are many, and mostly disastrous where human relationships are concerned. While some women proudly boast about the anger and domination of their husbands, and how ‘secure’ they feel about this ‘manliness’ that controls them, only a few realise how far away from true gender equality we all are. Growing up with “Princesses and Damsels in Distress” being rescued by “Knights In Shining Armours”, we have probably conditioned our minds too much to notice whether the Knight treated the Princess well in the “Happily Ever After”.

Let us not even talk about the “he-works-and-earns-so-naturally-tired-and-angry” type, or the “Highly-praises-his-wife-in-public-but-treats-her-like-dirt-at-home” type. The blind acceptance of what earlier generations considered normalcy and words in lieu of actions are both crimes we are all equally guilty of. © Dr. Rajas Deshpande

Implications of this angry husband? A woman who spends her life never growing up being herself, stays a slave to his whimsical outbursts of love playing a hide-and seek with humiliation and anger. Some do this while working and raising children, while some others do it sacrificing the high education and training they have taken, in the name of making a family.

Making a family also means happiness and freedom of thought, speech and action for a woman, responsibility sharing and respect towards the feelings of each other, but this is yet to dawn in many societies, where the bread winner automatically becomes the master and the remaining family members his slave. © Dr. Rajas Deshpande

To be just, one must also mention that there indeed are women counterparts of this phenomenon, where the anger outbursts of a woman hold the entire family for an emotional ransom, where the husband and kids never can feel ‘at home’ in the one where she dwells. But fortunately this is rare.

There also are rare pleasures of meeting some brilliant couples who have mannerful and respectful attitude towards each other (not a show). They hold hands, stay together, and laugh genuinely, whether in public or at home. Those are the definitions of love. An occasional tiff may be unavoidable, but there’s rarely anything that cannot be resolved when the two in a relationship know the correct balance between words and silence. © Dr. Rajas Deshpande

Sometimes some diplomatic men boast with too many chests about their success and achievements, while mentioning in their speeches how their wife was their strength and how she is an ‘equal partner’ in their success, how they could succeed because ‘she looked after the family and kids’, just looking at the wife’s face tells volumes about the reality. My stupid mind is sometimes tempted to ask “Did she choose that or was her duty taken for granted?”.

As I counselled the couple, I realised that so many times we cannot fight deep rooted socio-cultural notions of gender inequality. In the age of rabid egos where there are more break ups than patch ups, where we know more words than feelings, where winning verbal argument is considered a superior ability to healing actions, it is becoming perpetually difficult to imagine that marital relationships will evolve any further unless immediate steps are taken to educate children right from school about the correct interpretation of gender equality and the incorrectness of what is being accepted as normalcy: “Anger Outbursts” under the pretext of being stressed or busy.

For anger or the presumption that it is justified against one’s life partner as a ‘soul venting’ mechanism are both unhealthy for everyone involved: a disease that has now become a pandemic.

© Dr. Rajas Deshpande

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The Braveheart Orthopaedic Surgeon

The Braveheart Orthopaedic Surgeon
© Dr. Rajas Deshpande

dp-final

The stunned auditorium was hijacked by shame. Nearly a thousand paralysed audience helplessly watched the ongoing horrific drama.

It was the annual day function, the only colourful evening in the year that the whole staff, the Dean, all teachers, resident doctors and students from all batches come together in the medical college. Extraordinary talents that the doctors otherwise have to sacrifice for lack of time: Singing, Acting, Music etc. resurface this one night. I was still in my first year.

Midway through, one resident doctor climbed upon the stage. He was a strong leader, a good student when sober, and had a strong political support, hence usually had his way around everyone. He was excessively drunk. He took charge of the microphone. Few of his friends, some also drunk, were guarding the doors.

“Our Dean is a drunkard. He is also corrupt, he takes bribe from everyone for everything. He is having an affair with this professor of XYZ department. I order the dean to come here on the stage and apologise after I slap him”.

This was beyond anyone’s imagination. One of the teachers requested the drunken offender to please come off stage, but received a flurry of obscene abuses. There was a silence that prayed for relief from this situation.

Dr. Devendrasingh Paliwal got up from the audience.
“Chal, bahot ho gaya drama. Main aa raha hun. Karle kya karega. This is not the place for your allegations. Get down”. Devendra was always known for his physical fitness, and had an intimidating personality. Straightforward and kind, he had almost no enemies.

He went to the stage, grabbed the mic from the offending drunk, handed it over to the MC, and brought down the drunken resident. Within a moment some others joined him to avoid the impending scuffle. The dean and many teachers felt the relief of a lifetime.

Those who anticipated fun at the cost of misery to others were of course disappointed, but at the beginning of my medical career I learnt one of the most valuable lessons of my life: It takes one man to be courageous, not a herd. If you have guts to get up and protest the wrong, there is a fair chance you will succeed. A good man’s fear is the bad man’s strength.

That night at 2 AM, after the programme I went with my friends to the hotel near the railway station for tea. Too much excitement prevailed. Devendra was sitting with his friends at a nearby table. I went to him and introduced myself. He smiled as if nothing special had happened, shook hands and told me “Kisike baap se bhi kabhi nahi darne ka (never ever be scared of anyone).”

We became good friends, we also shared a common mess. Studying at night and going to the railway station (6 kilometres away) for a tea break at 3 AM was also common, and Devendra often asked others to race him to run back those 6 kms after the tea. I can proudly say that I reached second, although a good two minutes after him!

He became an orthopaedic surgeon and started his own hospital, but his ‘Gene’ of fighting injustice and standing up for the good never left him. Stress and anger can be a big hindrance for a doctor, especially a surgeon, so he decided to drown his ‘stress-anger’ into exercise. Always a fitness icon himself, even today he does two hours of cycling and an hour of gymming. “It helps me concentrate better during my practice and surgery, and also keeps me totally fit” he says.

Few years ago, a doctor was arrested in a typical example of a hyperreactive populist system. This was illegal, but many a times the system gets away with the illegal more fluently than the citizen. Dr. Devendrasingh Paliwal was the president of the local IMA (Indian Medical Association) chapter. He took the system, police and politicos “Head On” as was his nature always. The city’s hospitals shut down. This enraged the politicos but encouraged the medical fraternity to unite like never before, and the doctor, wrongfully in police custody for 8 days, was released!

Dr. Devendra then worked to straighten out the relations with the system, and formulated a “Modus Operandi” involving the police and local politicians to protect the interests of both patients and doctors so that goons and petty politicos do not blackmail either. If only all the IMA chapters follow this lead (and I must also mention the excellent IMA unity and extraordinary leadership in Goa: Dr. Sam Arawattigi, and Kalyan: Dr. Prashant Patil), half the irregularities and injustice against doctors and patients will disappear.

“I have always kept friendship, professional courtesies and Humanity above my medical practice” Devendra says, “I take it for granted that it is my duty to treat free those who cannot pay”.

It is pathetic today to see many brilliant doctors working in perpetual fear under those who exploit them, by choice or in desperation, accepting humiliating and patient-unfriendly working conditions.. People like Dr. Devendrasingh Paliwal are a hope our profession can look upto.

All other things may change, but the value of fitness, courage in one’s heart and a kind nature that compels one to help others are some things which will never change their place as the best three human virtues.

Medical careers are drenched with excess hard work, stress and anxiety. The one training that the doctors in making must inculcate from the beginning is that of physical and mental fitness. Doctors leading a stressful life and always having to present a ‘pleasant face’ to the patients and colleagues, either suffer their negativity alone or pour it out upon their family. Daily physical exercise is an excellent remedy of many frustrations that accompany medical practice. Dr. Devendrasingh Paliwal not only sets an example by doing this, he goes way beyond his duties to bail out others from difficult situations: medical, surgical and social.

I consider myself fortunate that I met this fearless braveheart fitness icon who infused the right “mantras” of courage and fitness into me at the beginning of my medical career!
Much obliged, Dr. Devendrasingh Paliwal!
© Dr. Rajas Deshpande

The Morphine That Killed a Hospital

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Female Foeticide versus Lifelong Socio-cultural Sadism?

 © Dr. Rajas Deshpande

Whenever female foeticide is discussed, many self-crowned intellectuals run the horses of their pseudo-western philosophy against the entire medical profession. Some irresponsible media asks opinions of the very same majority people for whom our desi government has to run billion dollar campaigns, educating them to shit in the toilet. Might as well ask them the solutions for global warming, terrorism and corruption!

What does our society do once a female child is born (again with the help of doctors)? 

Daughter, Sister, Wife and Mother: almost every female around us (except probably a girlfriend) is taken advantage of, ordered around, made to compromise, told that she must accept the limitations of being a woman, and in general made to live an enslaved and dependant life, under sweet names of love, responsibility, security and a “bad world for women out there”. Who makes this bad world?

In many cultures, the girl child is fed poorly: typically the ghee and sweets and “costlier” food goes to the male child, especially in big poor families. Even the rich and educated are seen having many daughters in a hope to have a male child, and after having one, spending far more on that male child. The girl child has little freedom to dress by choice and play, and is forced to believe from pre-adolescence that kitchen and bedroom are her workplaces for life. Many parents are averse to the idea of their girl child going to parlours or theaters and opting for friends, hobbies or even hairstyles of her choice.

Many parents do not spend upon the education of a female child, the “prime investment” goes in educating the male child even when the female child is smarter, intelligent and hard working.  A girl wanting to pursue higher studies is mentally raped by umpteen relatives who pressurise her parents into shame if she is not “married away” before 25 years of age. (RAMP syndrome: “Relatives Affected with Marriage Psychosis). The dreams of a female child are killed every moment, almost all her active life.  Most men in all fields opt that their wives “look after the kids and home” even if equally educated or better in some cases. While some recent generations encourage equality, this is only urban. A girl is trained to think and say “ I enjoy staying at home and looking after the family as this is what a woman is supposed to do. It is okay for the husband to come home tired or drunk, hit me if angry, and in general to take me perpetually for granted”.

Let a grown up girl walk on any street in India and watch our “manly” public’s eyes following her. You will understand how many of them truly respect women. Let a woman grow socially or at work, and observe the comments of her colleagues about her character. Let a woman decide to marry for love, and there are open decrees to kill her. In a country which runs local trains with one out of ten coaches for women, and reserves four out of twenty seats for ‘ladies’ in a bus, how many people really care for equality of a female foetus and it’s life? In a country where women have to be elected by reserving electorates across male-dominant cultures, who will enforce respect of a poor girl child?

In a society which wakes up to graphic contents of rapes and murders of females aged few months to upto seventy years, how many will stand up actually when a female is being raped or murdered? It is easy to shoot hate content against an educated, civil, non-violent community of doctors. It is easy to blame an entire profession for the faults of a few greedy doctors. Do these “pseudoactivists” have enough courage to stand up against their own female-enslaving culture? Do they have courage to treat their own wives, sisters and daughters at par with men in their own family/ community?

 On every street in every metropolis, hundreds of children – girls and boys- are made to beg naked, dancing, cleaning cars and ever hungry. Where are all the activists who fight for the agony of unborn female foetus? What are your plans for the already born female children begging insecure across the country on every street? Also, one wonders about their views on “male foeticide”, a common abortion. How come male child murders are forgiven? Some of these “pseudoactivists” are like typical orthodox husbands, who flirt with their female colleagues at work talking about freedom, but take an offence when their wife talks to other men.

Female foeticide is ugly, bad blot on our society. It must end. But please stop pinning the entire blame on the medical profession. The facts mentioned above are enough proof that even without the doctor being involved, our society continues to be extremely unjust and cruel to women. Introspect. The female foetuses must be saved. But after their birth they must also be nurtured, loved, respected, treated with genuine equality and given equal socio-cultural freedom. Do these activists have guts to fight for that? There should be a precondition for every “activist” of this cause to adopt at least one girl child, and look after her proper food and education giving her complete freedom.

Activism for females should not stop once they are born.

PS: The radiologists and gynaecologists / obstetricians have a lot more practice beyond and unrelated to abortions, and are far more human in caring for women than most of the society. None of the doctors starves without this “abortion business” as claimed by some activists and media. In a country where there is huge shortage of expert doctors, it is ridiculous that they have been made the easy targets for everyone’s mudslinging.  

Jai Hind.

(c) Dr. Rajas Deshpande

 

Take a Break, Doctor!

“Are you going to Switzerland, Doctor?” asked this business-class patient with a pregnant smile upon his face.
When I told him I was on leave the next week, he thought what most patients naturally think about doctors: “Every doctor gets free luxury trips to coveted destinations sponsored by pharma industry”.
I did not explain to him that my mother had a surgery planned.
Everybody needs a leave, a break, a vacation. Sometimes for problems, illnesses etc. in family. Sometimes a cut off from the routine and mundane. Sometimes to find oneself, sometimes to lose oneself. Sometimes to run away from it all, sometimes to meet life.
A doctor cannot. Wonder why?
There are scheduled follow-ups, complicated cases, people on dangerous prescriptions, admitted patients all the year round, from which one cannot detach completely. Even when on leave, a doctor in-charge who cares about patients prefers to be somehow reachable, albeit via assistant or hospital or email.

Imagine watching a beautiful sunset or being in the arms of your beloved at the dawn, and receiving calls about critical cases, complications or prescription renewals. The moment and the life in it dies instantly.

Many specialists in fact get maximum patient communication via email, whatsapp, sms or calls on Saturdays and Sundays, thinking that the doctor will be free. The doctor, catching up with the missed life among family and children gets worst irritable on the weekends. His cellphone, kept ‘ON’ for the admitted critical cases becomes a mass communication device on weekends.

When a teacher visited recently, he asked what only a parent will ask: “Do you find time for yourself?”.
When one becomes a doctor, they almost always (rare exceptions) sacrifice any other talent they may have, like singing, music, writing, sports, research etc. Seeking solace only in patient happiness (in most cases) or financial success or fame (in some), a doctor then becomes a “Medical Practice Machine” for his / her own happiness. This is the death of the non-doctor individual in a doctor.
© Dr. Rajas Deshpande
Hence the thought: Take a break, doctor.
Many students ask in curiosity to their favorite teachers: What would you have preferred to become if not a doctor / a neurologist etc. (Formula 1 Racer, Singer, Running an infant daycare, Connoisseur of love and peace, Professor of poetry, Philosopher, Vagabond, Scientist, Monk… so many things I wanted to be have stayed within, the smoke sometimes sizzles at midnight.)

In any field when you achieve excellence, it is always at the cost of many sacrifices, especially your chances and wish of doing well in other fields. But about the doctor, the concept has a caveat: that it is no more as rewarding as it was few years ago. A patient becoming a customer has hurt both ends, and this appears irreversible. Now that this is a professional activity, successful recovery is just “buying the treatment” for most. Thankfulness sinks in the bills. So even in a great recovery, good treatment, survival and cure of a patient, the doctor is “just doing his / her job, and my insurance is paying for it” is the usual attitude.
Only the few doctors who “enjoy” the process of clinical evaluation, correct diagnosis and good treatment response or surgery can find hidden solace in this process, also passing it on to newer generations. Others run frustrated from degree to degree, hospital to hospital, or patient after patient. Add conference after conference for some. For the nonclinical and paraclinical specialties, it has become a humiliating task to apply to the business oriented set-ups and keep shifting base in search of career.

Of all the professionals, doctors are the only ones who can never get “meaningful” vacations. Even the tiny time they are on leave is polluted by interference. This practice is more so in India, where individual practice culture and “salary-less” pay structures in most big hospitals precludes the possibility of “handing over the charge” to another doctor while one can enjoy a break. This is more so as one climbs higher in a specialty, as equivalent skills become rarer. A doctor on leave anywhere in the world MUST make arrangement for someone else to attend patients in his / her absence. Why only a doctor? With millions of court cases pending, why not everyone in the judiciary? Why not everyone in all departments in the police and government, where “Sahab is on leave, come back after few weeks” is the standard answer? Why doesn’t every other department dealing with public tasks work 24 / 7 as responsibly too?

And the irony of all this is that most of the society thinks it is for “earning more via illegal means” that every doctor is busy!

There are many hidden assets within every person. Doctors should not “cage” themselves in medical practice. They must learn also to “switch off” being a doctor for atleast a few weeks every year and be a “Normal Human Being” who can stop thinking of death and disease 24/7. They should breathe in the fresh air of being oneself, work upon their own good health, family’s expectations and inner desires to “catch on with life one day”.

The scariest fact: that as general life expectancy is increasing, the life expectancy, stress morbidity and mortality among medical professionals is on a decline. Starting from 12th standard where medical entrance has a “killing” competition, the highest levels of stress in a doctor’s life NEVER go down.

Sacrificing life is not worth it, Doctor. One can definitely be a better doctor with lesser stress.

Catch Up! Take a break!
© Dr. Rajas Deshpande

The Mystique

I desperately wanted to get admission to the DM Neurology course, one of the toughest known. The entrance for only 6 available seats in India then was attended by many hundred doctors who had passed their MD. The results came on a stormy rainy evening, there was a chance: I intensified my prayers.

The interviews left me stranded on the high edge: I was first on the waiting list for Neurology. I returned with a heavy heart to Aurangabad, and joined a private medical college as a lecturer, just to buy time. I started preparing for the next entrance, to be held a year later. The feeling of “not having what you want” is the worst in the world. You know it, I don’t have to explain!

A loner, I sank further into studies, and my calendar was full of studying, teaching and attending my toddler son. I was posted in a new unit, I was told the new boss would be a little “surprising”.
I met Dr. C. S. Shah, professor of medicine next morning. He had a Roger-Moorish mocking expression perpetually upon his smiling face. An excellent clinician himself, he had his own mysterious style of behaviour and speech, and the best part of it was he was completely unconcerned what people thought of him. Still more enviable, he didn’t think at all about them.

“Why are you stressed?” He asked one day after the rounds, as we had a light OPD. I told him I desperately wanted to get into DM Neurology course, but was waiting because there were only 6 seats in the country then. He asked “So what? Study all the Neurology you want and practice it… who is going to stop you?” “But sir, people look at the degree” I replied .
“That is why you will always be stressed. People.” He laughed at me.

“Give it up” he said.
“What?” the dumb me.
“Your desire to do DM Neurology. Give it up” he replied with his trademark mysterious smile.
If it was anyone else, I would have lost my mind. But this was a person I respected.
“I won’t be at peace with myself sir” I replied.
“Are you at peace with yourself now? Have you ever tried giving up what you desperately want just because your arrogant mind wishes it?” he asked me.
I had never. I remembered my favourite quote from Einstein’s book “Ideas and Opinions”: “Man can indeed do what he wants, but he cannot will what he wants”: profound words by Schopenhauer!

I was not prepared to. This was one of my fondest wish: to attain the highest in Neurology education, and DM was an essential step for later plans.

Once we spoke about prayers, I told him my efforts and failures about meditation and “Kundalini Jagruti”. One of my early mentors Dr. P. D. Purandare had encouraged me to read J. Krishnamurty, and I had attempted “feeling one with eternity” for many times, without success.
“Because you are not prepared” Dr. C.S Shah answered immediately.
“For feeling one with all, you cannot have a selfish intention that can harm anyone else. You eat killed animals, how will any animal feel one with you? If you take what belongs to others, if you want to be better than everyone else by showing them down, why will they feel one with you? Inner peace has a price: you cannot hurt or deceive anyone” he added.
It was difficult to follow this in a competitive world where the ability to cleverly deceive others is considered smartness, and to diplomatically market that ability has become the gold standard for most businesses. Honesty and loyalty are considered weaknesses in a world that faces the worst addiction humanity knows yet: money.

But the divinity of good is that it seeps into your soul, whether you like it or not, and even the bad ultimately knows to respect the good. I gradually started realising what a grand difference it makes to myself, to not harm others by even a word, by making choices based upon honesty and trust.

Dr. Shah often told me: “Give up your desire.. it kills you…you will get whatever you want only if you pursue it with a neutral interest, with a readiness to let it go. The more you run after something, the more difficult it will get for you. Nothing is more important than your peace of mind. Don’t sell it for anything else in life”.

He took me to the Ramakrishna math (monastery), where he had found his inner peace. It was such a joy to let the silence soak your being, a flood of realisations that woke me up to what life had to offer and how my stubborn wishes had suffocated my own possible futures. To let go is not always weakness, it is also a sign of higher maturity. A loser or a coward lets go for fear but a winner lets go for a better life.
There, in complete silence, I made a decision that a million words and thoughts had been unable to make: I wanted to move ahead, and even my best dream couldn’t be an obstacle in the path for a good tomorrow. Dreams were not meant to stop my life.

I resigned and went to Nanded, joined one of the best hospitals there and started working with a cardiologist who wanted to pursue a social career. He offered me to take over his hospital.

On 7th January 1999, my birthday, I signed a contract with him. I had also finished a religious book as planned, and my parents were very happy about all this.

On 8th January, I received a telegram:
“You are selected for D.M. Neurology at KEM hospital and Seth G.S. Medical college Mumbai. Please report immediately”.

I called Dr. C. S. Shah sir, and told him I got DM after ‘giving it up’.

He laughed.

“Now give up your dream of a happy life” he said.

© Dr. Rajas Deshpande

Lifehacks for the Doctor

Lifehacks for the Doctor
With interview of a renowned Cardiologist.
© Dr. Rajas Deshpande

Lifehack:
a strategy or technique adopted in order to manage one’s time and daily activities in a more efficient way.

Are you talented, hardworking, hurried, bitter, artificial, irritable, insecure, obsessive, egoistic, money-minded, dissatisfied and longing for a better life? Yes? Then you must be a successful Doctor!

While medical practice is of paramount and sacred importance, the duties as a spouse and parent are absolute too, there is no replacement for you there (Well, in most cases!). If your “Kick” of being completely swept away by the needs of your practice and competition drowns your own personality and the requirements of your family, you may be a overindulging doctor who is a terrible parent or spouse. Only your family will carry you in their arms few years from now, no one else. Rethink how you treat them today.
Are you really earning “For Them” or for your own super-ego, for overcoming the ever widening valley which converts every luxury into a necessity you must have? The justified feeling that “If I have learnt so much and am so talented, work so hard, I must earn real good”. Has money / affluence become your self-assessment criteria? If so, you may be no different than an attention seeking, beautiful, very very attractive but dumb individual. You trade health, family and life for money.

Calm agility of mind and body are hallmarks of a doctor, and too many tasks, irritability, bitterness, insecurity and lack of satisfaction are making this impossible.

Let us identify how we can reduce stress and improve the quality of life. The only life we have.
1. Separate work and family cellphones. Switch off the work phone outside work hours, except on emergency day. Provide all your patients with casualty / emergency contacts, and only your assistant should be able to reach you on your personal number.
2. Hire and train assistants when feasible, they may assist you with secondary/ nonclinical tasks, paperwork etc.
3. Take a big picture look at your day / time correlation, you will be surprised:
Work (8-10 hours),
Commuting (1 hour),
Sleep (7 hours),
Kids (1 hour) till they are 18.
Spouse (dedicated 1 hour: you married for togetherness all life, right?),
Communication / emails / Internet (1 hour), and
‘Self’ time (1 hour)
Total = 20-22 hours.

You will still have 2-4 hours left for cooking / housekeeping / etc. (to be done by both if both are working). If we expect the society to be modern, we must also give up the traditional “wife at home however educated or smart” and “husband rules” attitude. Family is equal responsibilities to be shared with mutual agreement.

If only one partner is working, it is easier to arrange schedules. If both are working, one may prefer non-clinical / paraclinical duties till kids can take care of themselves. Singles are anyways happier till a certain age!

It is extremely essential to disconnect from the work to be completely with your kids / spouse. Strictly avoid talking about workplace at home, especially do not take your stress to bed.
Switching off cellphone at night is a big step in the evolution of a Doctor’s peace of mind.

You can practice far better with a calm and healthy mind. Hence the necessity of good sleep and self time.

4: Find an activity that makes you feel calm and happy. Don’t need to explain this to anyone, don’t need to feel guilty, this is therapeutic. This must be done alone for an hour everyday , with all communications switched off. Some suggestions:
Music: Listening, Composing, Singing, Learning
Writing, Reading, Painting
Gardening, Watering plants (magically calming effect).
Swimming, Cycling, Dancing, Gymming, Yoga
Long walks / drives if good, uncrowded roads nearby.

One of my senior colleagues Dr. Jagdish Hiremath (Director of the Ruby Hall CathLab) is one of the busiest and renowned Cardiologists in the town, and never skips a smile when a colleague crosses him. Always appears at peace with himself and others. I asked him how he manages such a stressful life of a successful interventional cardiologist. As we talked, I realised his answers are worth what every doctor must think about:

Dr. JSH: “I prefer to be in the present 100%, whether with patient or otherwise. I concentrate upon the task in front of me and blank out all else, so I can do justice to that task. When I am with a patient or in cathlab, my cellphones are diverted to my assistants or receptionist, and I am not disturbed. This helps me, and the patient also feels happy about it. My assistants filter out unnecessary calls and pass on the genuine ones to me as a message, I call and talk to them on my way home”.

Me: “Newcomers, especially superspecialists, face the dilemma: that cut-practice or referral practice is the only way they can start, as no one offers any salary till you have a good patient-base. It is almost impossible for the beginners to start in a decent place without submitting to the existing pay structures”.

Dr. JSH: “Yes that is a shortcoming in our system. But then, the concepts of ethics, morals are quite twisted in medicine today. We must never compromise in doing the best for the patient. But then, others should not decide or dictate how the medical charging systems work: neither insurance people, nor media, community or anyone else. Because they never understand / acknowledge the importance of talent and skill”.

Yes, I thought: who else will allow other professions/ government, society or insurance companies to decide the value of their services? Will they allow others to dictate how they use / share their charges? It is only the doctors who have allowed this, and it is high time everyone else shuts up about this and doctors redefine the charging structures.

Me: “Sir, medical education has become “Earning PG” oriented. MBBS doctors do not get good teachers, and are not clinically well groomed. They are smarter and have better net-knowledge, but not good clinicians. They have become “MCQ Doctors”.

Dr. JSH: “I have always said that MBBS should be ‘the making of a doctor’, and not only stepping stone for PG. We need better institutes, better teaching. A doctor must grow as a human being lifelong, and it must start at this level. Even the PGs are exploited too much. Their teachers should understand that they are no more traditional ‘students’ in college, they are grown up married doctors with families, and must be treated like employees rather than servants”.

Feeling a sense of having learnt something invaluable, I thanked him and left.

There’s this “Becoming a Man (or Woman)” of every Doctor: when they start treating independently and confidently. Then comes the phase of an “All Out” effort to increase practice: extreme self neglect and hardwork, running from one hospital to another. Then one day they wake up to the reality.

All the stories of Morals and Ethics taught and expected of a Doctor are like the things that parents tell their kids not to do, while doing these themselves.

The Indian Doctor’s Enlightenment (approximate latency 5-7 years in practice) comes packed in bitterness and depression towards the very society he / she serves. They realise that the society has lost trust and respect towards us, even the recognition of the extreme education and hardwork doctors have to perpetually live in. An educated patient expects global standard healthcare at Indian rates. The uneducated look upon the doctor as a bandit.

So if you have become the typical successful doctor “Hurried, bitter, artificial, irritable, insecure, obsessive, egoistic, money-minded, dissatisfied and longing for a better life”, it is time for a reboot. No medical bodies stand by or defend doctors. So we must learn and try to sort out this mess ourselves.

For life is change, and wisdom lies in the wish for a better life.
It is high time Doctors learn to take care of themselves.
Wishing all Doctors best of health and a beautiful, rewarding life of success and satisfaction.

© Dr. Rajas Deshpande
(This is Part II of “Delusions, Doc?)

Special Thanks
Dr. Jagdish Hiremath,
Director Cathlab Ruby Hall Clinic

Cure This Headache

Cure This Headache
© Dr. Rajas Deshpande
This young woman in early thirties complained of severe headaches. She was accompanied by a caring but frustrated husband, and two sweet kids. One withdrawn and cranky while the other one was hyperactive.
“These headaches started only after shifting to this city 5 years ago” she said. They were from a state far away.
“I am usually fine on holidays, but on almost all other days I wake up feeling sick, without energy, and even a small factor like bright light, loud noise or reading brings on the headache. It then becomes so severe that I have to sleep or take pain killers. I can’t sleep every day, so I take this painkiller daily. Even small stress at work makes me very irritable, and when I return home I have no energy left to do anything. We have started fighting a lot” she said looking at her husband with wet eyes. “I know he is tired of my headaches, but what can I do? We have seen so many doctors in so many places”.
“She used to be very happy when we married, doc” said the husband, “I feel this is a totally different girl now. I do everything I can to help her, but I have work pressure too”.
Nuclear family. Both working 6/7 days. Both on highly responsible posts. Long hours. Changing shifts too.  Kids attended by maids when not in a day care. Their parents on both sides far away.  They have had two kids with a very short interval between them, so their “growing up” is almost together.
“Is it possible that one of you change the job?” I ask this very cautiously, almost knowing the answer.
“No, Doc, our current jobs have excellent prospects and incomes too” said the husband.
“Can you change the timings, so you get an hour ‘s rest without having to attend any tasks?”
“I can’t change the timing. I don’t think I am stressed.  My husband helps me a lot by cooking and looking after the kids. It’s a daily affair now. If these headaches are gone, I will be all right”.
The caring husband who was until now attending both the kids, especially the hyperactive one, said “I have suggested her that she can take a break, but she wants to continue as she thinks she will get bored at home”. He threatened the hyperactive one, now climbing upon my table, with his hand.
I explain that the habit of taking painkillers may itself be worsening the headaches, in addition to the “dual” stress at work and home. All said and done, a woman usually attends two jobs when she works. I also enquired if they can have their parents stay with them alternately, so things will be better arranged at home.
“They don’t get along well with us, doc. My parents irk him and I don’t get along well with his parents too. We have had a love marriage”.
“Sometimes I feel like ending my life” she started crying.
Her examination was completely normal.
As I wrote the notes, I wondered how many of these things were correctable. Nobody wants “Gyaan /Philosophy” or counselling. No amount of medicines were going to take away the basic problem: lifestyle without rest or peace, and no time for love. What happens to a relationship where there is no more “Gelling”of the husband and wife, of parents and kids because they don’t get time to be together?
One of my Yoga teachers, Mr. Mohandas (at the Kaivalyadham Center on Marine Drive Mumbai) always told me: When you mix the “sample curd” and milk, it will not all become curd immediately. It has to stand for some time before the mixture forms new curd. Any relationship that has to mature into something meaningful will require quality time spent together, both with and without the kids. This time has to be separate from merely eating or sleeping together, or travelling for work.
Fast friends who fall in love and marry end up in tangled fights after becoming too busy, sucked up in the work and family routine so much that they become strangers again. Everything for a good life is at their footstep, but life itself has taken a vacation for lack of time. Bodies change, and so do minds. Too much company becomes an irritating nag. Need for personal space is disputed if at all recognised. Meditation is not truly possible when chores keep knocking your door.
As I advised her some medicines and Yoga, I could not help but suggest her that they both need to rearrange priorities in life.
It is not my place and these are not the times that one can “politically correctly” suggest the right options: but kids growing up neglected because both parents are either working or tired when at home is certainly not a healthy option. Lifestyle choices should not take childhoods for granted.
In Canada, they have a law: that one must have one separate bedroom for each kid above three years.
In India, we desperately need this: that at least one parent / grandparent must spend few dedicated hours with kids every day, quality time without being exhausted or irritable.
I wished the mother well via my prescription, but my heart was with those two kids.
For what those two kids were unknowingly suffering is beyond our society’s conscience to deal with, and maturity to logically talk about.
© Dr. Rajas Deshpande

The Critical Diagnosis of the Indian Doctors

The Critical Diagnosis of the Indian Doctors: Doctor’s day special.

This article is also a test of how our society tolerates truth.

Recently read a flash news about Eminent Doctors taking cuts / referral fees. There cannot be any justification. But if a whole system based upon corruption, a whole society facing inflation expects only one of its components to be sane, it’s insanity. Hence these thoughts.

I apologise in advance if this hurts some feelings. This isn’t a placebo though.

For the “Nautanki” people who appear so shocked to hear about corruption in the Medical field, here’s the naked truth:

There is corruption in every aspect of every field including religion, law and judiciary, government, politics, police, press, military, film industry, YOUR FIELD, and also medicine, as the doctor is a part of this very same society, not from Mars. There is corruption in every aspect of medical field: referring a patient, lab tests, CT/MRI, Surgeries, Cross referrals, almost everything.

But as in every field, there are people who do it by choice, there are some who have to be a part of the system to survive in India, and some who refuse to be a part of it all, facing many other problems including a perpetually low income.

Think Simple: why would a person with highest of merit, hardest of hard work, tendency for helping others want to become corrupt? Not by choice. No one becomes a doctor for greed (Someone might attempt, but these people drop out in the first six months or a year: Those not dedicated to a hard life cannot endure medical education in India).

Every doctor wants to do good to his patient and also live a decent life. After a lifelong meritorious career, why should he be expected to toil in villages / rural areas without any rewards for it? Why should he not want his kids to go to the best schools? Why should he not want a decent lifestyle? Why should one give up a lucrative career in the west and return to the homeland feeling patriotic, to just be told that in your own country you are doomed to a life of sacrifices just because the society expects so?

“Someone who wants money should not become a doctor” said a dropout actor who is seen doing all immoral things (from peeing openly in a garden for press in real life to cruel crimes and revengeful murders on film: while running a show to change India to an ideal country.. I hope he and his family only use Indian things, medicines etc.). Why?

Why should a doctor not want money for a decent life? Why should he endure the humiliation of so many non-meritorious people from his class livin in luxury because they chose not to be  a doctor, while he chose the noble profession?

Listening day-in and day-out to patient’s problems, tears, cries, allegations, threats, and expectations, not ever having a peaceful sleep for a week at a stretch, not eating in time, not having enough time for family, why should a Doctor NOT want to earn well?

We are not supposed to refuse a case in emergency. Do the Judiciary or Police or Politicians do that?

We are fined crores for medical negligence. What if the Judge is wrong? What if the police are wrong? What if the politician is wrong? What do they pay even when proven wrong? Why the presumption that the negligent doctor’s intention was bad? Negligence is possible in all fields (reactors/ bridges/ buildings/ food/ trains/ public transport), can cost life in many, how come the doctor alone pays in crores for a life that he was attempting to save, while in all other cases the motive was profit, not saving life…?

How come the judges decide the amount of fine? In a recent case, the fine was in crores. If the patient had survived, would the court have ordered the same payment for the doctors? Doctors  save millions of lives. Some through heroic / exceptional efforts, without thinking of rewards. If a young patient is saved, shall we charge according to all the income he can make all his remaining future? Than why this criteria for fines?

World has become a global village. People travel to the developed world often. Highly specialised doctors in India are expected to be at par with their western counterparts. They often are, because half the world travels to India for medical advice.

But the Indian community is yet to awaken to the Doctor’s fees. An average specialist in the developed world charges between 10,000 to 30,000 INR for the first consult. Appointments are very difficult to get. They don’t work out of 8 am -4 pm slots except in emergencies (some honourable exceptions).  And yet they get so many benefits from the hospitals they work at, and also from the government. THEY SEE NO FREE PATIENTS. Most doctors live in luxury in the western world.

An Indian doctor on an average charges 300 rupees for an OPD patient. Sees many free patients (almost 40-50%) everyday. Continuously has to be occupied with:

  1. Patient’s health and benefit
  2. Relative’s expectations, their anger (many think that every patient must get well irrespective of his / her health status). Many hold the doctor responsible for their illness / failure to improve/ complications.
  3. Continuous suspicion: Many patients think Doctors are out to loot! Every investigation is with an intention to get more profit out of the patient. They want the best, but like “sabji”, they want to bargain.
  4. There is also a widespread belief that pharma industry is actually serving the doctors, not patients.
  5. Google searchers who think they know better medicine just because of what they recently read about a tiny drop in the ocean of medicine. They eat up a lot of time, but don’t want to pay for that additional time.
  6. The very relatives who shout at the doctor seldom know what medicines the patient is taking: it is all supposed to be the doc’s responsibility.
  7. So many Toms, Dicks and Harrys coming over and threatening: this is everyday nuisance in ALL casualties in India. There is no sensible Director in Bollywood to have realised a Doctor’s plight while working under threat in casualty. Everyone loves the populist “Doctor-Threatening” hero!

Then the seemingly innocent weapon (The secret bleeding wound in many a Doctor’s heart!!)

“But Doctor, You are like God / Next to God. The whole society respects you”

That respect is divine for us, that respect and the satisfaction of doing something godly by saving lives, helping people live better lives alone keeps us from going on and not quitting the profession for better incomes. Don’t you think we had the options of making more money had we used our talents elsewhere, especially in today’s IT world?

But that respect does not substitute for our children’s fees. Not for our rents, electricity, travel ANY expense. Almost all doctors and their family members end up paying full bills for themselves at the very hospitals that they work in… some minor exceptions. Everywhere a doctor goes, he pays the same money that any other citizen. There isn’t a separate queue for a doctor anywhere in any office just because he / she has patients waiting. There is no pension. There is no security. I can show you some highly successful (in patient care) ethical doctors who can’t pay for their own treatment TODAY!! If a doctor is sick, his / her income is zero as long as he does not work: No one cares if he has treated hundreds for free.

The respect does not substitute for the stress a doctor bears: of years of listening to and attending pain and tragedy, years of sleepless life, fasting days, lost precious time with dear ones.. as with anyone else, the DOCTOR ALSO HAS ONLY ONE LIFE… WHICH HE CHOOSES TO SPEND HELPING OTHERS.. is it a crime to be living well for such a person?

As for the other side:

There are corrupt doctors, corrupt practises. But please understand, a single doctor did not create them, nor did a group plan them These developed over time as the system evolved.

Like in every field, there are greedy among doctors. They ruin the reputation. But a single doctor cannot do anything. Those who try to change the system are boycott, thrown away, maligned.  There are some continuously fighting this.

Every doctor cannot afford to start a hospital of his own. He has to choose a specialty hospital which has all the facilities to practice his specialty. These come at a price. I appeal the people who feel bad about investigation prices to just enquire the rates of the machines/ skills/ licences/ manpower/ maintenance required to make these facilities available. The government makes it compulsory to attend many of its employees free / at subsidized rates, and never pays.. who will pay for them?

So hospitals have their systems. A single doctor cannot change them.

The Medical councils do not have any protocol / system to protect a doctor who faces vindictive attitude from hospitals if he / she wants to argue. Many specialists DO NOT RETURN TO INDIA OR HAVE ALREADY LEFT INDIA AFTER RETURNING due to this one reason.

Doctors who want to run their own hospitals face same bribery, same licencing scams, same corrupt government practices that any other business does. The rates are probably higher, and the regulations stricter.

Doctors are a weak vote bank., hence not on priority of any party. It is more practical for the politicians to openly criticise the doctor / profession in hope of gaining public sympathy / attention. No one wants to attend to their problems, which are many.

The medical council never protected any doctor against court cases or hospital victimising them for fighting against corruption. The regulations made are ancient, primitive. When a whole medical system is corrupt in almost every step, they have taken the approach of superficial actions against individual cases: typically populist. The medical councils KNOW every aspect of corruption, but have opted to fit in some screws where the whole building needs extensive repairs. One’s degree and education of fifteen years becomes meaningless in the eyes of medical council just because there is delay in renewal of licences. How can rules be applied only partially in a system? While many people practice without degrees or knowledge, the councils choose to target the qualified for not renewing their licences: a process that involves acquiring CME points, the money for most such events, travel etc comes from pharmaceuticals, the patient pays: they do not have the online option of CME / licence renewal like most western countries, even in this advanced age! So a doctor is expected to leave his town and practice, get involved in events sponsored by pharmaceuticals, travel with help from pharma companies, stay in hotels with their money so as to renew his licence. But not online. And there is no compulsion that he has to attend the event for his specialty. So a Neurologist could attend a gynaecology event just for CME points and its ok for the renewal!! One can easily get such CME credits without attending the event!  There has to be an online option, or a rethinking of this whole business.

The whole Mediclaim business in India is a fraud: they don’t pay for

  1. OPD consultation / investigations of a patient.
  2. Patients with genuine illness, but without injectables or surgery.
  3. When they do not understand the diagnosis or the fact that some cases do not have a proper diagnosis.
  4. Emergency / Critical care / Specialist charges etc.
  5. Even when they pay, it is their choice how much.

This results in many a wrong practices.

So in a mediclaim case, no one benefits except the company: Patients, Hospitals, Doctors all lose. Still, the Medical councils do not want to do anything. In fact, they don’t have a say.

Add to these:

Incessant calls / emails/ wtsapp messages for any enquiries that pop up in the patient’s or relatives (usually the cousin in America) mind at any time of the day or night: and bitter words to follow if reply is delayed. (That doctor has advised so so… what is your opinion?… I just read on google about stem cell therapy to improve my anger… what say? Etc. etc.).

Then there are sons and daughters who stay in US / UK etc., but leave their parents back in India. They expect the same care but at a low price, and also a daily update by the treating doctor. NO WESTERN DOCTOR GIVES OUT HIS CELLPHONE or EMAIL ID  TO PATIENTS, THEY KNOW THIS, but they talk from there as if fron the top of a mountain..They don’t want to come and attend their dying parents, but vent out this guilt in form of anger towards the treating doctor: Do everything doctor, don’t worry about the money.. I am unable to come to attend my MOM because of business meetings/ no tickets / kid’s exams etc. I lose my patience here often.

If a Judge / lawyer is ever reading this article, Your Honours, please consider these when you next fine crores to a doctor (even if insured, he has to pay huge:

A doctor should not be held negligent if

  1. The patient does not follow advice as written
  2. Patient continues to drink / smoke / eat tobacco/ does anything that the doctor has prohibited.
  3. Does not follow up as directed (most patients miss their follow up dates: doctors are supposed to jump from illness to illness).
  4. Does not show the same care towards his own life that the doctor is expected to take.
  5. Has not given all correct information about himself / herself / his/ her illness
  6. Hidden some information from the treating doctor.
  7. Has lost treatment details.
  8. Self medication / cross consultation without knowledge of the earlier doctor, resulting in multiple medications.
  9. Has had unknown allergies / reactions in the past.

There should be a doctor’s board for each specialty which opines about every particular medicolegal case before the court makes its final decision.

I always wanted to be a good doctor, like most other colleagues I know. I have always heard the courts of justice demand that one speaks the truth.  Here it is. Hope I am not punished. I am not always correct, I am sure some of my friends will correct me. I will keep learning too.

A warning. When the whole medical system becomes non corrupt, patients will end up paying far higher consultation / surgical fees than what is paid now. This is inevitable. Add the legalities to everything, and many specialists will become non-affordable / non available to most. The many many who get free treatment now will be denied that.

Or the next generations will see less and less specialists opting to settle in India.

I love my profession. I Love my country. I love my patients too.

But I also deserve a good life. It is time I stop thinking I am God because the society has presumed so.

May God confer best of health upon all humanity.  May I always do good to my patient.

© Dr. Rajas Deshpande