Can Anyone Solve The Mystery of Atmaram’s Courtroom Death?
©️Dr. Rajas Deshpande
A hungry poor man named Atmaram went to a big hotel, had a nice big meal, and told he had no money to pay. He was beaten up and handed over to the police. He was released after a warning and a slap.
Next day he filled up petrol in his bike, and said he couldn’t pay. He was again beaten up, handed over to the police. Then he went to the medical shop, bought medicines and mineral water, ate the medicine, drank water from the bottle, and again said he couldn’t pay. He was now jailed for a week.
Next week his house was damaged by heavy rains, so he went and requested to be allowed to sleep in the house of the chief minister. He was arrested again, thrashed up.
As angry Atmaram shouted at the police, he was beaten up by them, another crime was added to his offences. In the court, Atmaram insulted the lawyers and judges and accused them of accepting bribes and charging too much. The judge punished him extra for his behaviour. Atmaram was angry and threw his shoe at the judge. His punishment was extended.
“You must respect the authority “ the court said.
“But I am poor, I need free food and petrol and medicines. I need sympathy too” Atmaram argued.
“You should have begged and applied for favours and eaten in places that provide charity meals. Petrol, however essential, has the same price for everyone. You can sleep on the footpath, and above all, you are not allowed rudeness and violence because you are poor and needy” The court said.©️Dr. Rajas Deshpande
When released from the jail, Atmaram drank a lot of desi alcohol, had an accident and fractured many bones. He went to the best private hospital, got operated and refused to pay his bills that crossed one lac rupees. When the hospital insisted, the operating doctors were beaten up by Atmaran’s relatives, the hospital was vandalised, the police arrested the doctor who saved Atmaram’s life, the government closed down the hospital, while the media and the society kept villainising the entire medical profession.
The headlines next day reported the sympathy expressed uniformly by wag addicted tongues: some said the entire profession was tainted, some blamed the greed of the doctors, even some doctors desperate for attention shed crocodile tears about the ethics in this profession. ©️Dr. Rajas Deshpande
In the courtroom, during the trial, Atmaram sat facing the doctor, still heavily bandaged.
The hon’ble judge, kind but surrounded by security, told the doctor accused of negligence and malpractice in the court: “You as a doctor carry more responsibility for ethical behaviour upon your shoulders. You should never turn away the poor”.
The doctor, defending himself, asked “but Milord, doesn’t our constitution insist on equality? Why do you yourself or ministers get security but not the doctor? Why isn’t everyone supposed to stick to ethics in every profession including politics, police and judiciary? Why are others exempt? How do you explain beating up of doctors while also saying that the society treated them like gods?”.
There were no answers. The kind court asked if the doctor had to say anything else in his own defence.
The doctor said
“Yes Milord, but the real answers will hurt:
Jealousy against medical professionals across society and many other professions is a reality. Why else will anyone who couldn’t qualify to become a doctor try and teach the qualified doctors what they should do?”©️Dr. Rajas Deshpande
“A culture of exploitation of non-votebank groups
and a complete failure of government healthcare with no one accepting responsibility is well known to everyone, but even judges have no courage to suo motu question this and correct it, even when they see the poor dying”. ©️Dr. Rajas Deshpande
“In a country with never ending poverty, how much free can a healthcare facility provide? For how long? This is already forcing closure of hospitals and exodus of good doctors out of the country.”©️Dr. Rajas Deshpande
“Milord, can you assure that every doctor will get his/ her fees as per his service to every patient, and if the patient can’t pay, that much charge will be exempted from the income tax of that doctor? How else do you except a doctor to meet his needs and dreams? Just because there are millions of poor patients, is the doctor’s life and hard work taken for granted? If there has to be financial sacrifice, why not have everyone contribute to it by creating a national health tax fund for treatment of poor patients? Why healthcare is subsidised only at the cost of a doctor?”
Just at this point, Atmaram, who sat in front of the judge, collapsed unconscious, almost blue black.
The shocked judge requested the doctor to examine him.
“He is no more” said the doctor.
“What could have happened ?” asked the kind but sweating judge.
The doctor told the court about three possible reasons. Two of them were scientific and medical: a sudden cardiac event or a large blood clot in the lungs common after fractures and trauma.
The third non-medical, unscientific cause made the Judge seriously ponder.©️Dr. Rajas Deshpande
“Will this court be now closed down, Milord? Will your efficiency be questioned, will you allow the relatives to attack you and understand their sad situation at the cost of your murder?”
“I understand what you mean” said the kind judge.
Needless to say, the doctor was released without a blame.
Can anyone please solve the mystery of the third non medical, unscientific possible cause of Atmaram’s death?
(C) Dr. Rajas Deshpande
Please share unedited
New Medical Criminals
© Dr. Rajas Deshpande
“Doctor, Will My Dad Survive?” asked the anxious son.
“Very unlikely, we are trying our best though” said the desperate doc.
The highly qualified son had brought his father late night on a Friday, over 24 hours after he had developed a paralysis. Patient’s blood pressure was high, and heart status was fluctuating. An urgent MRI was advised.
“I will get the MRI done outside, I have a friend who gives me concession” said the son, and returned with an MRI after three hours, it did show a big clot in the patient’s brain. The son had insisted upon admission in the ward instead of a critical care unit, saying that his father “did not appear critical” to him and his family. “You want to admit in ICU because that will increase the bills. I know” he had bluntly told the doctor. The doctor had asked him to sign the refusal to admit in critical care, then sent the patient to the ward. Routine treatment for stroke and blood pressure was started, and tests sent.
“I will also get the medicines from outside the hospital, I have a pharmacist friend who gives me concession” he had told the doctor. © Dr. Rajas Deshpande
Early next morning, the father developed chest pain, and the cardiologist advised immediate stenting, as he was developing a block in the heart. . The son had insisted on using the cheapest stent. Although the angioplasty went well, the patient developed a bleeding in the brain, a complication known in stroke cases. He became unconscious. As the bleeding caused increased swelling and pressure upon the brain, a neurosurgeon was called in to decompress the brain (take off a small portion of the skull bone, to relieve pressure upon the brain). The surgery is usually safe, but the condition in which it is done is usually ultra-critical, thus risk to life is high. The son asked for a guarantee for a good outcome, and was explained that there cannot be any guarantees in medicine. He then refused the surgery, saying “I have read that surgeries are done without necessity by scaring the patient”.
Within hours, the patient’s brain swelling increased to the level of almost a certain fatal outcome. In the evening the son said he was willing for the decompression surgery, it was almost too late. The Neurosurgeon still operated him late night to make a last attempt to save life. After the surgery, the father was shifted to the recovery room. © Dr. Rajas Deshpande
It was here that the son had asked the doctor: “Will my father survive, doctor?”.
The doctor politely replied: “Sir, you have all the reports, you know what is his medical condition, so you can now google search and also ask your political leaders through their famous apps what will be the outcome, what is the next step”.
“But you are the treating doctor, you know better. You are like God for us” said the desperate son.
The doctor uttered the only two words that the doctor would want to use after hearing this:
Every Tom, Dick and Harry in the government and in the Media has become a critic of the extremely overburdened Indian medical profession made up of some of the best doctors in the world. Those who cannot run their own govt. hospitals well, cannot provide quality heatlthcare to the taxpayer, those who have corruption seeping through almost every office they own, those in whose authority (read govt. hospitals) hundreds of patients die helpless without care, compassion or treatment, those who suspend peons, ward boys, nurses and doctors for deaths that result from inadequacies like lack of essential facilities at hospitals owned by the govt., are out telling the world how Indian medical practitioners are corrupt, instead of praising how they shoulder what the govt. fails to recognize as its own responsibility: healthcare for the majority.
There are bad doctors, bad diagnostic centers, and bad pharma companies, protected by politicians and working on ‘lowest quality-lowest price’ principle. There indeed are “profit sharing set ups”. Among these, if a good doctor / specialist advises the patient to go to a particular doctor or lab or choose a particular brand, the patient automatically presumes that that the doctor is looking for extra money. So most doctors now tell the patient to “go wherever they want” for specialist consultation or tests. © Dr. Rajas Deshpande
When I must refer a patient to someone, the only thought in my mind is to offer the patient the best: because the patient’s trust is most important for me. This is how most doctors think, every doctor wants to make a good reputation, which is impossible without also good outcomes. I need to be able to discuss and be comfortable with that specialist, so we can plan best for the patient. If a suspicion about financial misappropriation looms over everything that a doctor does, it is difficult for any doctor to work. There must be accountability, but for both: the treatment and the doctor’s time, energy and skill. The doctor must be able to choose the best for the patient and the patient should have more trust in the doctor than the rumors. .
The last person who should play with trust and faith in other professions is a politician.
The patient did not survive. Neither the leaders who spoke lose and caused paranoia to affect the outcome, or the son who delayed admission, the pharmacy that sold cheapest drugs, nor the family that refused a life saving surgery had any blemish upon their reputation.
It was easier for all of them to blame the doctors who tried hardest for the patient.
© Dr. Rajas Deshpande
Thank You Dr Nusli Ichaporia for the technical assistance.
Please share unedited
Ban the Entire Medical Profession!
© Dr. Rajas Deshpande
We were always much entertained by a very famous surgeon who would just sit all dressed up in the operation theater. As the worried relatives kept praying in the waiting room, the patient was operated by some other experienced and skilled doctors employed by this ‘famous’ doctor. He would just sit watching TV in his private room within the operation theater, till the surgery was over. Then, he would come out with a benevolent smile, pretend that he was too exhausted, and tell the relatives “that was an extraordinary case. We had almost lost your patient. I had to make a great effort, use all my dedication, knowledge and experience, but finally I could save him. You are very lucky”. Needless to say, the relatives would touch his feet, overwhelmed by emotion, little knowing that this surgeon has not even touched their patient. Bills floated swollen. The patient or the relatives never knew who actually saved that life. In our education to be doctors, we also learnt “what not to do” from such doctors!
With a recent speech in London, I was reminded of this.
It was very unfortunate that the Hon’ble Prime Minister of our own country spoke quite demeaning about the entire Indian medical profession in a foreign country. Nearly one third doctors in the developed world are from India, leaving India because it offers them no good opportunity, compensation or even basic security. The PM seems to disown the patriotic doctors who try to survive in and serve India. Where is the love for India? Does one demonstrate it by showing everyone else in the country down?© Dr. Rajas Deshpande
Let me at the outset clarify that there are some corrupt doctors, some get favours from pharma, and some participate in malpractice. The government always had rights and law in their hand to act against such doctors. The hubs of corruption evolve when the government allows medical seats to be bought for the meritless rich. Our govt. allows crores of sales of medical seats.
We wish our PM also spoke about how many political leaders in this country own medical colleges and what is the actual income that they generate by sales of UG / PG medical seats? Like the prices of all drugs and stents, why not reduce the price of medical seats too?
He said that Indian doctors “do not travel to Singapore to see poor patients”. Was he serving the poor Indian farmers in London? How many poor farmers or labourers accompanied the PM or his delegations on any of his foreign trips? For a PM who has extensively travelled the world, to criticise highly educated doctors for traveling abroad is so unbecoming! Doctors interact with experts from other countries for learning, continuing medical education, and just because Indian politics has screwed the nation into poverty, doctors cannot stop that interaction which is a standard learning process all the world over. Just as Indian politicians who go abroad for treatment to Singapore and London etc. don’t go there to have fun, doctors too do not go for just fun but for a grand purpose: to bring in new knowledge and skills to Indian people.
Then he said that he “enquired” about stents and found that doctors were “”duping” / deceiving all patients into buying costly stents. The PM has himself said in many speeches that he is not educated much, any medical discussion needs high standards of education, scientific proofs and statistics. I am sure that the right people / departments / doctors were consulted by the PM before taking such decisions. Why did he then say “I found out and changed this” rather than “our medical experts / team did this” ? Under the privacy laws no one will know what stents go into which class of people, but from what the doctors see, most politicians and high placed officers opt for “the best and imported”. © Dr. Rajas Deshpande
We wish that the PM, on his next foreign trip on an international platform, also speaks about the state of the government-run hospitals, the federal funding for healthcare, the quality of healthcare provided at rural and primary healthcare centers all across India, the gross inadequacy of staff and the absence of specialists, ICUs, Operation Theatres, in almost all government-run hospitals.
We also wish the PM speaks on an international platform about the state of hostels for undergraduate and postgraduate medical students in India, where they have to live about 4-6 people in a small single room, while the huge luxurious premises for various govt. officers and ministers lie vacant most of the time.© Dr. Rajas Deshpande
We wish the PM also speaks about the good doctors (all his recent speeches imply that there are no good doctors in India), extraordinary medical achievements of Indian doctors, about those who serve in rural India while facing humungous difficulties, those who bring medical tourism to India, those who run so many charity hospitals, those who bring world class healthcare to Indian patients, those grassroot doctors and paramedics who effectively carry out the govt’s schemes all year round by hard work, including polio and other vaccinations, mother-child care etc. without “just once posing” for the media?\
Even under various govt. health schemes, the poorer class patients go to cheaper general wards, while a senior officer from the same office will receive premium class healthcare at a private hospital. This “class-discrimination” in healthcare by govt is not justified. Wish the PM spoke about this too.
Will the PM also speak about the doctors/ health department officials and ministers who help him bring good changes in Indian Healthcare? If the entire modern medicine profession was so bad, why doesn’t the PM ban it completely and provide healthcare with different Babas and Gurus so rampant with powerful blessings today?
We so much wish that the PM speaks on an international platform how he justifies brutal violence against doctors all over India.
India deserves far better healthcare. But that starts with the facilities for majority: at the level of government-run hospitals, healthcare facilities all over India, reachable for the common man, affordable equally to all classes. © Dr. Rajas Deshpande
Unless all the government hospitals provide high quality free healthcare to all without discrimination, unless all the problems that the govt can resolve in a day by sanctioning adequate staff and funds for government-run healthcare are sorted out, it is futile to just increase the gap between the doctor and patient by blanket-defamation and maligning of the private healthcare on public platforms, especially international. Incidentally, our private hospitals also cater to millions of poor and the very ministers who run the country.
I have nothing personal against any political leader or party, I am hopeful of good changes happening in Indian healthcare. But I feel compelled to speak about the other side, the good doctors who are the pride of our country. I must defend the good in my profession, because I love it just as I love my patients, just as I love my India.
© Dr. Rajas Deshpande
The Colour Of Blessings
© Dr Rajas Deshpande
Carefully calculating the dose and mixing it with the intravenous fluid with precision, I told the kind old lady: “I am starting the medicine drip now. If you feel anything unpleasant, please tell me.”
Through her pain, she smiled in reply. Her son, my lecturer Dr. SK, stood beside us and reassured her too. He had to leave for the OPD, there already was a rush today. “Please take care of her and call me if you feel anything is wrong” he said and left.
Dr. SK’s mom was advised chemotherapy of a cancer. It was quite difficult to calculate its doses and prepare the right concentration for the intravenous drip. Just a month ago, my guide Dr. Pradeep (PY) Muley had taught me how to accurately prepare and administer it, so when Dr. SK’s mom was admitted, he requested me to do it for her too.
The drip started. After a few hours, I noticed that her urine bag needed emptying. The ‘mausi’ supposed to do it was already out for some work. Any resident doctor in India naturally replaces whoever is absent. So I wore gloves, requested a bucket from the nurse, and emptied the urobag into it. Just as I carried the bucket with urine towards the ward bathrooms, Dr. SK returned, and offered to carry it himself, but I told him it was okay and went on to keep the bucket near the bathroom where the ‘mausi’ would later clean it. © Dr Rajas Deshpande
Once the drip was over, Dr. SK invited me for a tea at a small stall outside the campus. He appeared disturbed. He said awkwardly: “Listen, please don’t misunderstand, but when I saw you carrying my mother’s urine in the bucket, I was amazed. You are a Brahmin, right? When you were away, my mom even scolded me why I allowed you to do it, she felt it was embarrassing, as we hail from the Bahujan community. I am myself a leader of our association, as you already know”.
I knew it, to be honest. His was a feared name in most circles.He was a kindly but aggressive leader of their community, but always ready to help anyone from any caste or religion, to stand by anyone oppressed, especially from the poor and discriminated backgrounds.
“I didn’t think of it Sir! She is a patient, besides that she’s your mother, and I am your student, it is my duty to do whatever is necessary. Otherwise too, my parents have always insisted that I never entertain any such differences”. I replied. © Dr Rajas Deshpande
“That’s okay, but I admit my prejudice about you has changed,” he said. “If you ever face any trouble, consider me your elder brother and let me know if I can do anything for you”. What an honest, courageous admission! Unless every Indian who thinks he / she is superior or different than any other Indian actually faces the hateful racist in the West who ill-treats them both as “browns or blacks”, they will never understand the pain of discrimination!
As fate would have it, in a few months, I had an argument with a professor about some posting. The professor then called me and said “So long as I am an examiner, don’t expect to pass your MD exams.”
I was quite worried. My parents were waiting for me to finish PG and finally start life near them, I already had a few months old son, and our financial status wasn’t robust. I could not afford to waste six months. © Dr Rajas Deshpande
I went to Dr. SK. He asked all details. Then he came with me to the threatening professor. He first asked me to apologise to the professor for having argued, which I did. Then he told the professor: “Rajas is my younger brother. Please don’t threaten him ever. Pass him if he deserves, fail him if he performs poor. But don’t fail him if he performs well. I will ask other examiners”.
The professor then told me that he had threatened me “in a fit of rage”, and it was all over.
With the grace of God, good teachers and hard work, I did pass my MD in first attempt. When I went to touch his feet, Dr. SK took me to his mom, who showered her loving blessings upon me once again, and gifted me a Hundred rupee note from her secret pouch. © Dr Rajas Deshpande
Like most other students, I’ve had friends from all social folds at all times in school and colleges. I had excellent relations with the leaders of Dr. Babasaheb Ambedkar Association, and twice in my life they have jumped in to help me in my fight against injustice when everyone else had refused. I love the most fierce weapon of all that Dr. Babasaheb Ambedkar himself carried: the fountain pen!
No amount of fights will ever resolve any problems between any two communities, the only way forward is to respectfully walk together and find solutions. Fortunately, no doctor, even in India, thinks about any patient in the terms of their religion or caste. (© Dr Rajas Deshpande). Just like the Judge in the court premises, humanity is the single supreme authority in any medical premises. Blood or heart, brain or breathing are not exclusive to any religion or community. Just like the bigger brain, a bigger heart is also the sign of evolution.
I so much wish that the black clouds of disharmony between different communities are forever gone. The only hope is that our students can open any doors and break any walls, so long as they do not grow up into egoistic stiffs. © Dr Rajas Deshpande
I am proud to belong to the medical cult of those who never entertain any discrimination. A patient’s blessing has no coloured flags attached! Even outside my profession, I deeply believe that the very God I pray exists in every single human being I meet. If at all anyone asks me, I am happy to say that:
My religion, my caste and my duty as a doctor are all one: Humanity first!
© Dr Rajas Deshpande
Please Share Unedited
The Bleeding Curse of an Extraordinary Doctor
© Dr. Rajas Deshpande
“I cannot sleep well, I cannot forget what happened” said the doctor who had come to consult. I was shattered myself. My usual poise was blown to pieces listening to what this mountain of sacrifice was telling me.
As Dr. Anil Dadarao Waghmare told me about his past, I was in frightful tears.
Son of a humble education officer, he had joined MBBS on merit basis, and completed it in time. He wanted to honour the government bond for two reasons: he had an inner desire to serve rural areas in India where medical care was not available, but he also had no other source of income and had no money for investment. This is the common story of most doctors graduating in India.
He joined as a medical officer and was soon posted in a very remote tribal area, where he went beyond his duty to help the illiterate poor tribals. He worked 24/7, attended all their problems like deliveries, poisonings, snake bites etc., but also went to visit homes of those who could not reach him. He offered his designated vehicle as an ambulance whenever someone was to be taken to a higher rural hospital. His wife and children accompanying him sacrificed normal life. Two of their kids went to the local primary school, the quality of education was extremely poor but they had no option. The third child was only 9 months old. This youngest daughter was often looked after by a 12 year old girl who lived next door, and helped Dr. Anil’s wife with her chores.
One day, Dr. Anil’s wife received a phone call. The lady caller who spoke in local dialect told her that this youngest 9 month old daughter was in her possession, and threatened to kill her if a certain amount was not paid immediately. By the time they could arrange anything, the infant was found dead by suffocation. The 12 years old girl who looked after the child was found dead in a local well after three days, a huge stone tied to her body.
The murderers were soon arrested: the lady confessed to the crime, assisted by her parents, for want of money.
All the three: the murderer lady and her family were being treated by Dr. Anil for over a year, as free patients.
Dr. Anil was transferred elsewhere, and decided to still continue serving the rural population. He has now joined a postgraduate course, but he wants to keep working in rural areas.
“No one cares about a doctor’s life, family or especially security. The situation is worst in the rural areas, where illiteracy, superstition, witchcraft, murders and rapes are commonplace. Local politics is at its worst” says Dr. Anil, “I was ready to sacrifice every pleasure in life to serve rural population, I even compelled my family to sacrifice, but I did not deserve this punishment. This pain is beyond description, sometimes I feel whether my decision to go to such unsafe place with family was correct. This bleeding curse kills me every moment”.
Thank you, those who keep saying that our society considers doctors ‘like Gods’!
While air conditioned hypocrites advise doctors to go and serve in the rural areas, no one will look at the big picture: there are no facilities, but worse, there is no security. You are left at the mercy of local criminals, often politicians.
Film stars, directors, politicians and many judges will never notice this kind of a story, just as they won’t ever comment about the sickest lowly traditions in their own individual profession. Communities ripe with rapists and murderers, and onlookers who film rapes or murders rather than trying to stop them, expect the best brains to work for their healthcare at meagre salaries.
There is nothing wrong with a short term bond for service in rural areas, but while signing such a bond or joining such areas, the doctors should also ask the government a written guarantee of security. This should be the part of the bond. If security can be provided to every TDH in politics, filmdom or to even the lowest ranks in the judiciary, even some criminals, it can definitely be extended to the doctors serving in rural areas. A doctor who feels threatened cannot work and in fact should not continue to work unless adequate security is provided to him / her and family.
Dr. Anil Dadarao Waghmare, you deserve the highest medal any doctor can ever get: because you showed this selfish society how big a doctor’s heart can be, by continuing to serve in rural India. From now on when the loudmouth foghorns in politics and administration try to malign our profession, or try to cover the gaping deficits in basic facilities at rural level by pointing fingers at the doctors, we can tell them your story.
As for the loss of your 9 month old daughter murdered by your own patient, I stand up in tearful, shameful regret of the state of affairs of Indian Rural Doctors.
© Dr. Rajas Deshpande
It is high time the doctors unite to take a strong stand against aggressive attitudes of society, against stupid policies and being taken for granted and spoken against by uneducated loudmouths.
This story should reach every blabbering idiot who has no doctor in the family and keeps on expecting all doctors to be servants of this society. To those among doctors who try to impress faceless media or administrators by continually talking negative about our own colleagues, this story should serve as an eye opener.
Thank you, Dr. Anil Waghmare for the courage and permission to share this story.
The Medical Secret Service: Unknown Angels
© Dr. Rajas Deshpande
“Hullo, Vishwa? Please consider this an emergency. One of my rural patients is here, she is on XXX brand of tablets, she has finished the dose, needs more immediately for another three months. She cannot get them. She has to return by an evening bus. Can you do something?” I was in a hurry, between patients.
“Yes, Sir, I will arrange within a few hours” Vishwa said, and indeed, within two hours, the nearest medical shop called, saying that the medicine was available for the patient at a discount.
That evening I called to thank Vishwa, only to be shocked.
“Sir, you were in a hurry today morning so I didn’t tell, I had a heart attack last night, and an angioplasty was done. I am ok now.” said the 30 year old to me.
Like the thousands of his community, the Medical Representatives, he is immensely contributing to the healthcare industry, unrecognized and unacknowledged. © Dr. Rajas Deshpande
“”What is your job? Just passing on bribes to the doctors? My cousin said to me, Sir, and I did not reply. You should not argue with the one who has poison in his heart. People look down upon us, but they will never understand what we do” said a 60 year old man who had spent life as a medical representative, now a national manager. “We have no choice of judgment, our job is to be the link between the doctor and the company, and to make sure our medicine is available” he said.
Millions of busy doctors, overloaded with their work, have no clue how many pharma companies exist, what medicines they make, what medicines are newly launched, what is the brand name or price etc. It is not practically possible to read the whole new drug launch book every month. This community of medical representatives alone is the link between the pharma companies and the doctors, updating us about various new drug launches in India, their availability etc. They also arrange for academic events so necessary for the doctors and medical students. © Dr. Rajas Deshpande
“Some Doctors are very good and treat us respectfully” said Janvi, who has spent over 20 years in this profession, “but some expect favours from the companies, in the form of tours, dinners and other things. Sometimes, I have had an occasional trespassing of moral lines by some doctor, but that was rare. One needs to be able to take care of one’s dignity and self -respect. Especially Indian women face a lot of difficulty and gender bias when making a career, at all levels.” she said.
“The pressure for women in this industry is immense, and like any careerist woman, I faced a lot of presumptive hate too. If a woman, and especially good looking, is successful, our society already has made its judgment as to the reasons of her success. Most Indian men do not tolerate the idea of a woman succeeding ahead of them. Of course, one must clearly set priorities as to whether one wants to make a career or family, and if both, where the compromises will be, because both are full time jobs at least for any woman. Most doctors have treated me well though, and most doctors also want to do good for their patients”. © Dr. Rajas Deshpande
In my 20 years of career as a doctor, I have never come across a Medical Representative who turned down my request to help a patient: lacs of rupees worth of medicines I have asked them to arrange free for my patients, and they have arranged without a question. Thousands of poor patients receive free / discounted costly medicines, injectables, even stents etc., thanks to the generous efforts of this community and their companies. Thousands of medical camps are arranged all over India, where patients get free check ups from doctors and free medicines by pharmas, arranged by the Medical Representatives, but there is seldom any recognition of this service.
Unlike in most other professions, this community helps out its members without bringing in the competition, and in a recent event, when a regional manager suffered a critical head injury, MRs from different companies collected funds to pay for his bills.
Very few people notice how cruelly difficult the life of a medical representative is. They have to meet a certain number of doctors every day. They often stand for uncertain hours and have days longer than 18 hours, as some doctors finish their OPDs long after midnight. Family life is screwed. They are also responsible for making available the stocks of their brand medicine at different medical shops, and have to bargain with everyone: the stockist, distributor, hospitals, and sometimes the medical shops for making their brand available. The final sale figures are their assessment at every month-end. To achieve targets is essential in pharma industry as in any business, to survive. It is the Medical representatives community that faces the brunt on both sides: company pressure and the medical profession.
Unfortunately, our hate-bespectacled society cannot see anything beyond its suspicions: that all companies offer bribes and all doctors take them, that all doctors deliberately prescribe costlier medicine to earn cuts, and that the whole medical service is driven by money. This is somewhat like a suspicious husband who has a very beautiful and loyal wife, but cannot be happy with her because of his own paranoia. © Dr. Rajas Deshpande
I know many doctors who do not ask for any personal favours from the pharma, do not accept gifts, and pass on all the benefits to their patients. But I do not know any mention of gratefulness for such doctors anywhere. Without the medical representatives playing their part well, the medical profession will be quite helpless.
This article is to salute the thousands of medical representatives who work hard day and night, live an extremely compromised life, and still contribute to the service by medical profession, making life easy for millions of patients.
© Dr. Rajas Deshpande
If a medical representative has helped you / your patient, please share this article.
Beyond Fear: The Lady Who Defeated Brain Cancer
© Dr. Rajas Deshpande About a year ago, a young man came with the MRI reports of his 64 year old mother, Mrs. Vijayalakshmi, who was then in Bijapur. She had developed paralysis on the right side of her body, could not speak, and was losing her consciousness fast. The MRI looked bad, a big tumour was compressing much of the left side of her brain. It looked cancerous, and needed immediate surgery as a life saving option. Otherwise the tumor could damage the heart / blood pressure and respiratory control centres in the lower part of her brain, that risked life. The situation could turn into an emergency anytime now. The family was devastated. They brought her to Pune. She was sinking fast. Required investigations were done, and we explained the facts to the family. The surgery could risk life or also cause permanent disability, including permanent loss of speech. Her husband, Mr. Venkat Babladi was always by her side, with his hands folded, and had only one thing always to say every time any doctor visited her: “Please save her doctor, do everything possible”. She was operated. Her husband, son Mr. Anand Babladi, and his wife all stayed in the hospital, taking turns to attend her. The tumor was sent for analysis. On the third day, the report brought the bad news: it was a type of cancer called primary central nervous system lymphoma. These tumors have a high death risk, with or without treatment, especially after the age of 60. “Tell us doctor, where can we do the best treatment for her? We want to do everything” her husband and family kept on telling us. She was still in critical care, but had started now to speak a few words. Our oncologist Dr. Minish Jain and his assistant Dr. Yuvraj Rangam took over, and started high dose chemotherapy. She developed many complications, some related to the medicines, but her family always stood firm. Every day, her husband sat by her, holding her hand, and telling her that she was going to recover, that he will ensure all was well. Her son and daughter in law arranged for all expenses and logistics, not by staying away and sending money, but by attending her every day after their respective jobs. After few days she was discharged with advice to continue chemotherapy. Unfortunately, Mrs. Vijayalakshmi had a fall while walking at home, and fractured her hip, she had to be operated. Her chemotherapy had to be stopped. It was resumed after she recovered from the fracture. Then in few weeks, radiation therapy was started. As a rare complication, she developed life threatening brain swelling, and had to be shifted to critical care unit. She lost her speech again. Her husband, who was now on the verge of an emotional collapse, met us outside her room and with tearful eyes, asked only one question daily: “She will be ok na, doctor?” Medical treatment is mostly standard all over the world, but the affection and care of one’s family is not. Hundreds of doctors treat thousands of such patients, many patients get cured of cancers and other dreadful diseases, a simple statistic that is never made public by those who perpetually talk against medical professionals. Equally unrecognised is the fact that a caring family makes a huge difference in the patient’s recovery, this has become very rare now. After a year, we repeated her scans recently, and told her the ultimate medical good news: she had defeated brain cancer! Her scans did not show any tumor activity at all. She comes smiling to the OPD now, her husband holds her hand on one side, and son on another. The most beautiful gift she gave me this time is that she learned two new Hindi words specially for me, because everytime I saw her I asked her how she was, and could not understand her answer. This time, her husband poked her, then she smiled and said “Achcha hai”. Those two words were the winning roar of a simple, middleclass woman against a dreadful killer disease! © Dr. Rajas Deshpande PS: Thank you, Babladi family for the kind permission to share facts. Please share unedited.
“Do you want a broken leg, Doctor?”
© Dr. Rajas Deshpande
Three days after he suffered a paralysis, after having tried Voo Doo, Herbal and some other medicines, an old man of 80 was shifted to a big private hospital once he became comatose. The three sons accompanying him didn’t even touch the comatose patient, they didn’t even care about whether he was covered properly or not.
His Blood Pressure was too high, and he turned out to have a bleeding in the brain, untreated till this moment. His brain was swollen badly.
Every private hospital has free mandatory beds for poor patients. This family was asked about their preference and eligibility. © Dr. Rajas Deshpande
“We will pay everything. Don’t worry about the money. He should get the best room and facilities” his son said. They signed the necessary documents about knowing the critical condition of the patient, charging schedules, willingness to pay etc.
Then the sons came to me and said “We don’t care about the money, doctor, but he should get completely cured”.
This was expected, experience teaches a doctor about relatives as much as about patients.
“He is 80 years old and critical. At this stage I cannot guarantee anything. Complete recovery looks impossible, partial recovery may be hoped for if he responds well to standard treatment” I replied.
“But we will pay anything you want” the younger son said.
I involved the PRO, a lady who had far better patience than myself dealing with attitude and arrogance. Explained them once again, and left after the patient was shifted to our Neuro Intensive Care Unit. © Dr. Rajas Deshpande
The patient improved in five days. Started to speak a few relevant words. Out of danger, shifted to Deluxe Room as requested. The only person who ever attended the patient was a 15 year old grandson, mostly the patient was left alone.
The sons had by then submitted some documents claiming a BPL “Below Poverty Line” status, but those were found to be false. A fake letter in the name of charity commissioner was also attempted. The hospital PRO reminded the patient’s sons about the pending bills regularly.
It became clear that none of the three sons who earned well themselves wanted to pay for their father’s treatment. They had continuous fights amongst themselves, the only thing they agreed upon was not wanting their father. The request “He must get completely cured” was not because they wanted his health, but because no one wanted to take home a disabled father to care for years.
The hospital took a stern stand. The bills had exceeded two lacs rupees, nothing was paid. This indeed was burglary with blackmail.
After repeatedly asking to meet the patient’s sons for another three days who did not pick up the hospital calls, I told the attending boy very carefully to please remind his parents to settle the pending bills, also reminding him that nothing in the treatment will wait or change because of bills.
In two hours I received a call. It was a local Municipal Councilor.
“Doctor, do you want a broken leg? Are you a doctor or a businessman? How can you speak about money to a small boy? Just keep on treating. We will do something about the bills through our MLA. If you speak about bills again, remember, there will be news about your hospital on every channel”.
Do I have time, energy to waste, filing a police complaint? Will it be any use at all? © Dr. Rajas Deshpande
In no other industry, not even in govt. offices, will anyone be given anything on credit: even for a paper worth five rupees. Even the poorest of the poor cannot get free food or travel in private industry. But the entire private medical care is expected to go on working in ‘credit’ mode, for everyone who claims to be poor. Emergency is understood, and no hospital or doctor thinks about money in case of emergency. But once emergency is over, those who cannot afford a private hospital should go to a government hospital. A private hospital needs too much investment per bed, and anyone who questions this can please sponsor one bed in any ICU for a poor patient, see for themselves what the actuals cost.
Who will even address this Burglary and Blackmail that happens everyday in every private hospital in India?
There should be an online portal by government / police for doctors and hospitals to report patients dumped by family, families who refuse to pay, those who use threats and intimidation anonymously. Then the ‘other side’ of this story will be clear.
© Dr. Rajas Deshpande
Stop This Anesthesia
© Dr. Rajas Deshpande
“Why so Doctor? Why cannot my child be like others?” asked the angry mother.
Just as I started to reply her, the patient: a 23 year old boy, went into a flurry of jerks. His body stiffened up, his eyes rolled up, and his face turned blue. He was already on the examination bed. Me and my student tried to support him there. We activated the code blue, just in case.
But the fit stopped. The boy came to, gradually. The nurse cleaned the bloody froth from his mouth. Heart rate and BP were normal now. Patient remained confused.
The mother, silently sobbing while patting his head, showed me the many large scars upon his face, head, and elsewhere. “He falls down many times every day and often injures himself. Can you imagine, doctor, what a mother’s heart feels to see her child bleeding every day?” © Dr. Rajas Deshpande
It was a case of hypoxic brain damage. The child was born in a village, the labour was prolonged and they could not reach a bigger hospital in time. If they had facilities, the child would have been normal today. Since birth, the child had had mild mental retardation and convulsions resistant to many medicines, They refused a surgery. I tried to counsel them. In many cases, we can control fits with a good combination of different medicines. But that takes time over a few months.
“We are farmers, doctor. We cannot stay home all day, we need to work to earn. The medicines are all so costly. I can sell everything to treat my son. But please tell me this will stop” the father’s voice was quivering.
It is easy to expect a doctor to detach himself emotionally from the patient, but then it is also like denying the patient empathy and understanding so crucial to their wellbeing.
“I will try my best, and I feel we can control the fits with medicines. Also, I can arrange for free medicines for your son whenever you cannot buy them. Never worry about my fees, I will be happy to treat him free. But make sure that his doses are never missed.” My teachers spoke through me.
“What after my death? Who will care for him? Who will bring him medicines? Who will ensure he takes them?” said the hefty man, and broke down. The proud feel it most difficult to declare their agonies. He tried to hide his face. The father and the mother sobbed on either side of the patient, who wasn’t yet alert enough to grasp it. © Dr. Rajas Deshpande
“There are some help communities and groups for epilepsy patients. We will enroll him into one. They will arrange for his medicines. I will also introduce you to some pharma companies who will give him free medicines as required”.
Then, pausing to realize the unasked question, I replied “And after me too, my students, colleagues or most doctors I know will never decline to treat him free. You just have to show them this note” .
I made a small note of such a request. I have never known any of my students or colleagues refuse to see a deserving patient free.
The tension in the room was melting. The parents had stopped sobbing. A possibility of hope and reassurance destroys the worst of darkness. The father folded his hands in gratitude, but couldn’t speak. The patient had a glass of water and they left.
But my mind was on fire again. Who’s guilty here?
Shall we blame fate for the blatant failures of a system? © Dr. Rajas Deshpande
Why didn’t their village have facilities to ensure good delivery? Why wasn’t it possible for them to reach bigger hospital in time? Who is responsible for millions of children who develop lifelong preventable illnesses just because of a cruel lack of healthcare infrastructure? Patients with heart attacks and strokes and cancers die everywhere everyday, unable to afford treatment or to reach hospitals in time.
In a country that needs serious improvement in almost every area of healthcare infrastructure, the whole focus is being directed at the repeated exams for doctor’s requalification.
Do we need it at all in a country that is grappling with critical shortage of doctors, and where we are promoting every other pathy to allopathy with a six month training? We need many care homes, support systems for patients who cannot afford medicines. Many more ambulances. Many more hospitals in remote areas, Many more qualified doctors to work there while being able to afford a dignified life.
But the only decisions being made are about more exams for truly qualified doctors: why? This tranquilizer to divert attention from the main issues that need correction is the worst treatment possible for Indian Healthcare. © Dr. Rajas Deshpande
Doctors are never defined by the examinations that they pass, being a doctor is far more than passing qualifying examinations. But who will educate those who never bothered to pass any dignified exams?
Just before inducing the anesthesia, the patient is told “You will feel sleepy now. Everything is ok. Take a deep breath”. With complete faith, the patient goes unconscious. It is the doctors who ensure he / she returns safe. Some rare unfortunate patients never know that they will never wake up, because there are things a doctor cannot control.
That unfortunate patient is just like the Indian Society today.
How qualified are the healthcare policy decision makers?
© Dr. Rajas Deshpande
Please share unedited. Let the society know what is critically essential.