Tag Archives: violence against doctors

The Secret Illness Of Doctors

© Dr. Rajas Deshpande

She threw the file upon my table.

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

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The Harassed Patriot

(c) Dr. Rajas Deshpande

“Sir Can I come to meet you this Wednesday? I am in Delhi right now, I will be coming to Pune on Tuesday to see my parents” Dr. Aman asked. He sounded different from his usual jovial self. I was with a patient.

“Sure! Everything alright with you?” I asked hesitantly.

“I will come and see you sir, I want to tell you something”.

I finished my OPD and went to the cafetaria, feeling nostalgic. Dr. Aman was a brilliant student from one of my earliest batches. You know, when you have just passed out Neurology DM, and you are a teacher to those 3-4 years younger to you. It’s a guarded friendly relation more than a teacher-student one. (c) Dr. Rajas Deshpande

His parents were uneducated, his father ran a grocery shop in a small town. Aman had mostly stayed in charity hostels almost all his school and college days. He had maintained a high merit but also a very polite behavior, enabling him to get support from his teachers. I met him first during his last year of MBBS, I was in the last year of my MD Medicine. We became friends because both of us were night owls, preferring to study late in peace. The city bus-stand was about two miles away from the hostel, and we went there together to snack and have tea etc. early morning at 4 AM, after having studied till then. We did not discuss anything academic, we were more into Richard Bach and Ayn Rand stuff. (c) Dr. Rajas Deshpande

Once during that 4 AM walk to the bus stand, he said “I want to do the best for my country, Dr. Rajas. My dream is to open a hospital where all poor patients can get the best treatment completely free. Not the ‘charity’class cheap and superficial treatment, but the best treatment that there can be anywhere upon earth”.

“I agree, I want to do something similar too, but where will the funds come from? World class treatment will mean world class doctors, staff, technology, set-up and even world class medicines. Who will sponsor it all?”I asked. This thought crosses the mind of almost every medical student while studying medicine, because there’s no one else other than medical students and resident doctors who witnesses the real health-related suffering of the poor. All the rants of socialists, politicos and other famous preachers die when they actually have to help from their own pockets to treat the poor. Every Indian doctor does it daily, without advertising.

Dr. Aman spoke as if thinking aloud: “Yes, I know it is difficult. But I was thinking that I will urge our society, lawmakers and others to fund my hospital for the poor by using the funds donated by people for greater purposes. The taxpayer should have a choice to directly deposit tax in a fund meant exclusively for healthcare for the poor. Highest donations in India are made for religious purposes, to various religious places. What best use for these billions than to start a free hospital? Will any God of any religion not be happy if those donations are used for the poor patient’s treatment?” he innocently asked. (c) Dr. Rajas Deshpande

That thought never left me.

After my MD I went to Mumbai for DM, and Aman came there in a year for his MD. We caught up occasionally at night in the famous tea stall opposite KEM Hospital. Dr. Aman earned himself the best reputation that a doctor needs: hardworking, studious, and very well behaved with the patients. He was already handsome enogh to be envied by his colleagues, but kindness, compassion and genius gave him an edge above others in everything. When I left Mumbai to go to Canada, he was still studying there. Upon my return, I came to know that Dr. Aman has joined a government hospital near Delhi. We almost lost contact. Then this call. (c) Dr. Rajas Deshpande

He came on Wednesday as planned. I was shocked, his handsome face had a large raw scar.

“What happened?”I asked.

“Two weeks ago, I was in the casualty, when a young lady was brought in unconscious and gasping. She was frothing at mouth, had many bruises on her body. Her husband and two others accompanying him were drunk , incoherent. There was a smell of insecticide, so I started treatment accordingly. There were no ventilators available at our hospital, we have requested the government many times but were told there were no funds. We were trying our best, but within minutes she passed away. As it was a suspected poisoning, a postmortem was necessary. We advised so, but the relatives declined. I explained them many times that a postmortem is legally necessary. Then they called a corporator, who came with his goons. One of them attacked me with a knife. The nurses tried to restrain him, but he attacked them too. Four of us were injured by the time that police arrived. They did the postmortem, the report says that lady was killed”

“That I could have survived, Dr. Rajas. But the next day we were told to withdraw police compaints which we had made against the attacker with knife and the corporator. The administration refused to stand by us”. Dr. Aman was now charged, angry and almost tearful. (c) Dr. Rajas Deshpande

“I don’t want to work here! Many times over now, I have realised that people do not want good doctors, they want chained, frightened slaves who cater to their illegal, immoral demands. I wanted to serve mother India” he now sobbed “but apparently mother India does not want the likes of me now. Last three years I had received many offers from UK and many other countries, but I had proudly declined. Now I have accepted an offer from Oman. They are paying me twenty times what I am earning here, with a two-month paid annual vacation, free housing and food. I feel bad, I don’t want to go, yet I do not want to work here now. I came to you because I have faith in your advice, you are like my elder brother. Please tell me what I should do”.

After thinking a lot, I told him: “You should do what ensures your peace of mind. You can help Indian patients from anywhere in the world, or you can help them from within India”. I did not want to force him to stay back in India, because I was sincerely afraid about his safety

Dr. Aman left the country yesterday, like thousands of brilliant doctors in last twenty years. I feel as if a part of me died when he told me his decision, and the only thing I could say to him was : “I understand. To do good to others, you must first be safe, alive and at peace with yourself. Take care”.

(c) Dr. Rajas Deshpande

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Doctors from various states are welcome to translate this article in local language without changes, and post it with their name along with the original author credit. This will help us spread the message.

I am also translating this to Marathi.

Mob IQ Versus Indian Doctors

© Dr. Rajas Deshpande

Woke up with a bad headache one morning, probably a sudden change in weather. Felt lethargic, did not want to get out of the bed. It was raining heavy, a perfect day to stay in bed and snack with a book and a huge black coffee. But the usual inhibition of a doctor: that many patients will have travelled only to see me worried me. Another important fact that I still depend directly upon my daily work, that ‘No work’ translates into ‘Zero income’ for me like for every doctor, made it more difficult. Just then the cellphone rang.

“Can you see the patient in ICU urgently?” my colleague called, “The relatives are quite powerful people. Very troublesome”.

If it was only to help the patient, I would get up from my grave, but even for a million rupees, today I was not in a mood to balance wits and swordfight my knowledge with an over-expectant crowd whose only qualification to ask me questions was that their patient was serious and I was expected to be compassionate and courteous. But then, I could feel from his voice that my colleague was exasperated. “Okay, I will see him in an hour” I said. Two hot black coffees masked the headache (please don’t try this at home) and pumped some fuel into my blood.©️ Dr. Rajas Deshpande.

I noticed a huge crowd outside ICU. I went in and examined the patient. Indeed critical, a case of stroke. Educated young man, stressful job, smoker, high blood pressure, was given medicines to control it, but did his own “gossip research”, stopped medicines, some atrocious diet, some herbals and one morning suddenly had bleeding in the brain. A story that is a routine now.

I called in the relatives, expecting two, but about 15 people walked in. Few of them had the most deadly dress upon earth: stiff white linen with gold necklaces. As I explained them with two other senior Consultants, questions poured in. If it is plain curiosity and worry about the patient, one can be compassionate, but this was more like police grilling criminals. At the end of every sentence highlighting critical situation of the patient, came the same question: “But he will become normal again no? Do anything you want, we want him to recover”.

It was like throwing a stone at the sky, it never lands there!©️ Dr. Rajas Deshpande.

Where do these people come from? How can so many people wait with the sick patient? At one end we have labourers whose families must work to pay for their treatment in even government hospitals, at the other we have doctors who must work every day without any benefit for future. The whole spectrum is otherwise dominated by these crowds. What is the source of earning for these people in crowds? If these men in hundreds are here all day looking well fed and complacent, who is working for them and their families? Is India rich enough that people can do away with work?

Crowds with patients, with leaders, shouting and vandalising, mobbing.. who is sponsoring their livelihoods? Or is it that we have authentically become a country of slave mobs that entirely depend upon their leadership to feed them? Are we encouraging poverty and dependence to the extent that this makes it easier to control a majority?

Everyone who is working hard and earning, paying taxes is being implied to be not only a fool but a villain. It has become fashionable to be poor and become a mob. Then a majority vote bank, forgiven by those in power, you can choose to break and mend laws as per your wish, still get sympathy. Poverty plus majority together can control anything in India. Beggars everywhere is Indian specialty. Not surprising then that any political party or government promising ‘free’ stuff, subsidised stuff and schemes to look after generations and generations of poor youth at the cost of taxes paid by working class will not only encourage such ‘poor mobs’ to become lethargic, expectant, unproductive slaves, but also provide them with enough time to divert their youthful energy towards the temptations of violence thrown by the powerful. All this at the cost of taxes paid by every hardworking profession who cannot even afford a holiday!©️ Dr. Rajas Deshpande.

While other professions escape the brunt of such free-monger mobs, medical professionals suffer the worst, not only because of over expectations of impractical charity, violence and vandalism, but because of the interference with treatment, duress, and most importantly the time they have to spend answering and explaining repeatedly to those who refuse to understand. Some are incapable intellectually to grasp complicated medical situations. How much time will a judge, IAS officer, minister or police officer spend with arrogant crowd explaining the same thing? Will they go on forever till the other person understands? If a doctor does not wait till the crowd understands, he / she is supposed to have not communicated effectively. Is an uneducated, illiterate, stubborn relative’s understanding and grasp a doctor’s responsibility? It is unfair waste of time. To expect every doctor to satisfy a mob of illiterates or even non-grasping literates is itself an indication of our social immaturity.

Time has come now for doctors to take a firm stand: that we will speak to only two relatives, who have signed and accepted the responsibility of patient’s medical care and expenses, that we will reply every question only once, and explain once if necessary, that whatever we say will be first written then video recorded so there is no later ambiguity or common tomfoolery of lying. Informing and explaining once is indeed a doctor’s duty, but satisfying the relatives cannot be a doctor’s responsibility. No doctor can afford that kind of time and patience. Any further cross-questioning by relatives should be a paid service consultation based upon time. ©️ Dr. Rajas Deshpande.

Our patience, compassion and understanding is not for being taken undue advantage of.

Happy Doctor’s Day!

Jai Hind!

©️ Dr. Rajas Deshpande

“Dev Borem Korum” (Thank You)

(c) Dr. Rajas Deshpande

As the plane landed, I called up the driver who was scheduled to pick me up from Goa airport.

“Hullo, Mr. Clement? I’m Dr. Rajas”

“Haan daktar. Tu aaya kya? Bahar nikalke miss call de mai ayega” (Have you arrived? Come out and give me a missed call, I will come there”) . He would have said the same sentence to the President as well. Goans are least hung up on artificial flowery language, they are the friendliest lot as a society. It was after a year, that the same Clement said to me: “Tere liye apun jaan bhi dega parwa nai” (“I can give my life away for you without any hassles”), when I thanked him for something.

Goa has some excellent Neurologists, and my visiting is actually redundant. Yet somehow, maybe because they keep quite busy, or sometimes patients seek a second opinion, I have been seeing a good number of patients every visit. In the very first visit, after I saw an elderly lady and explained her the treatment, she bowed and said “Dev Borem Korum Doctor”. That means “Thank You Doctor”.

Then I pleasantly noticed: irrespective of what was the diagnosis, what treatment was given, whether there was treatment for the patient’s condition or not, whether the patient improved or not, almost every patient said either “Dev Borem Korum” (Thank You) or “God Bless You Doctor”. Even if surgery was advised, even if there were side effects of medicines, even if the outcome was not as expected in rare cases, the “Thank You”and “God Bless You” never changed. It had nothing to do with any particular social class. The rich, the poor, the educated as well as the uneducated, people from every religion, every age group said it. It is a part of that culture: the Goan culture.

Late one night after the OPD, when we were driving on a beautiful long empty Goa road near the beach, I mentioned this fact to my friend Dr. Samuel (God Bless Him for the exotic dinners he takes me to!), he stopped his car and looked quite affected. “I wondered whether anyone else had noticed that. It feels so beautiful! When the patient is grateful and brings you blessings, you automatically feel responsible to do the best for them. Money never matters in that relationship. We must never take patient’s kindness for granted. So many of them actually say Thank You, God Bless you, but sometimes we are too preoccupied with work, anger, ego and other things to reciprocate and encourage that kindness”.

I told him about my late Professor Dr. Sorab Bhabha, who stood up and greeted every time a patient entered or left his cabin. The onus of initiating a good doctor-patient relationship primarily lies upon the doctor, and it is extremely essential to follow the best of manners and etiquette, kindest of language when dealing with patients.

A very sweet girl who followed up for epilepsy recently told me that she visited me not only for medical purpose but because she was inspired by the way I appear calm and composed, the fact that I never raised my voice and always spoke compassionately with everyone. I had to tell her the truth. “Thank you mam, but I am quite short tempered outside the hospital. Even the junior doctors working with me sometimes find me intimidating. But I have to change when I am with a patient. I don’t think that any patient comes to me because I am any better than anyone else in the profession. I prefer to think that they choose me because they trust I can solve their problem. Will you be rude to someone seeking your help? Then how can I get angry with a patient? Every patient coming to me has that hidden trust, which I must justify. Only rarely, if the patient misbehaves or says something insulting, do I lose my calm.”.

“That’s what I like. So humble!” she had to have the last word!

Yes! The day I bring my ego inside the hospital, I will no more be a good doctor. Even the most illiterate patient understands when the doctor is being rude or artificial. Only when it is genuine, the patient will feel the warmth of my compassion and care. It has nothing to do with sweet talking or a show of affection. The only way to do this is to actually incorporate it within one’s depths so that it becomes one’s originality. Kindness and compassion must be the original, genuine qualities of every doctor who expects gratitude from each one of his patients. It does work in most cases.

After dinner, Dr. Sam took me with two other friends to the beach and we silently stared at the luminous moon for a long time. The music of those waves matched the dance of that moonlight upon the ocean. Just as one can feel the glow of the moonlight upon one’s skin, I could feel those numerous blessings keeping my soul warm and happy.

(c) Dr. Rajas Deshpande

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The Remedy of Trust

© Dr. Rajas Deshpande

I entered the ICU in a torn and angry frame of mind. An old patient had had fluctuations in heart rate and blood pressure all night, and was on the thin line between life and death. Irregular heart beats had clotted his blood and he had developed a paralysis.

I had had a terrible argument with family that morning, and had left home without a breakfast, thinking that I will catch up in the canteen if hungry. The traffic on the way was as usual bad, it further worsened my mood. Messages kept pouring in: pending bills and health enquiries that were an attempt to avoid a proper consultation. One can ignore, but sometimes ignoring is stressful too!© Dr. Rajas Deshpande

As I entered the hospital, I was told about some machine not working. The technician had commented that it was beyond repair now. New one would cost over 30 lacs minimum, and this machine was required on a daily basis. My head started pounding. Another loan now, another recovery period!

As I passed the billing counter, an imposing rogue with a group stopped me. “Sir, the bill is too high, do something”. It was an open threat worded technically as a request. The relatives who folded hands to save the patient till yesterday were standing behind that rogue, looking unconcerned, not even happy that the patient was alive and being discharged after a life threatening illness. I sent them to the charity cell.

I entered the ICU, staring into my cellphone where angry messages of argument kept pouring in, a dear friend was upset that I was not available to see his relatives in another hospital immediately. © Dr. Rajas Deshpande

The old patient was sleeping. A glance at the monitor revealed that the patient’s BP was now stable. His heart rate was regular too. What a relief!

The patient’s wife got up, she was in her 80s. Fair, all white hair, and the confidence of culture upon her face, she smiled through her wrinkles and troubles. The Kumkum on her forehead was bright and fresh. She wore a torn saree, and had no ornaments except a thin thread with black beads that made her Mangalsutra. She was bending forward due to age.

She then said “He spoke to me this morning. He is feeling better than yesterday. I know he is old, but please give him the best treatment. We have been together since childhood.” Her eyes became wet.© Dr. Rajas Deshpande

Then she made an attempt to touch my feet, something that woke me up with a shock. A tingling feeling ran through my body. I held her hand and reassured her that it was ok, and returned the gesture by touching her feet too. I told her I will try my best, and that her husband appeared out of danger at that moment.

She gently prodded the patient: “Look, our doctor is here. He says you are getting better. Do you recognize our doctor? Say Namaskar to him”.

Confused for a moment, the old man stared first at his wife, then at me.

He then tried to lift both hands, but only one went up, which he raised to his forehead and whispered “Namaskar”.

The old couple, the age of my parents, was saying Namaskar to me and touching my feet, although I was many decades younger to them, because I was a Doctor. They never knew me until two days ago, but had trusted everything I said. They did not question my ability or intention. I like to be professional, but that should never compromise my manners.

I switched off my cellphone.© Dr. Rajas Deshpande

I suddenly felt ashamed of the mood that I was in. They did not deserve it. Their complete faith was to me the best return and reward of my efforts of so many years to become a good doctor. No amount of money ‘thrown at me’ by those who think of ‘buying my services’ would actually be my interest or aim. This was.

I smiled at the old lady, and told her that should she have any concerns, she can ask the staff to call me anytime, I would be glad to come over. Then, to repay her for bringing my smile back, I wrote on the billing sheet: “No charges for me in this case”.© Dr. Rajas Deshpande

When I walked out of the ICU, I was feeling proud and smiling. The faith of this patient and his wife had cured me of my bad mood too. I was prepared again to forget my personal woes, to take over the faithless hundreds, still do them good, in an attempt to reach out to the really deserving faithful, who knew their doctor would only do them good. That is the essence of my profession, my education, and my intention.

A patient who trusts a doctor earns for himself the best in that doctor. Always. Although we do not expect it to be understood by everyone.

© Dr. Rajas Deshpande

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That Order To “Stop Saving Life”..

(c) Dr. Rajas Deshpande

“Arrest! Sir… Code Blue!” the nurse shouted. The casualty was full, all eight beds had serious patients, and their relatives waited near them. Every second matters.

“Everyone out” my co-intern shouted. Some moved out, some stayed. Two other interns were already attending similar patients, two of us ran to the arrested patient. The nurse had already started the chest massage. I gave patient the position for inserting the breathing tube, as my co-intern Dr. Ajoy took over the cardiac massage. The senior medical officer, Dr. Hazare, experienced with a lot of medical wisdom, stood near the bed. He calmly gave orders for the last-attempt medicines in such emergencies.

The chest massage to save lives is rather forceful, its force has to reach the heart. The chest wall has to be pumped down 2-2.5 inches with every compression, and this has to be real fast: over 100 times a minute. It looks very traumatic, but it is useless if not done exactly like this. It is quite a disturbing scene for the relatives. The patient’s son kept on shouting “Don’t hurt him” loudly. The medical officer repeatedly asked him and the five relatives around the patient to leave. They refused.

The Medical Officer Dr. Hazare then asked us to stop the CPR. (c) Dr. Rajas Deshpande

We were baffled. How could one stop the life saving CPR?

The patient who had arrested was from a nearby slum, father of a local goon out on bail, like most goons in India. He (the patient) was in his late fifties, a chronic alcoholic and smoker, with severe liver damage. He’d had excess alcohol on the prior night. That morning, he had had a convulsion, and was brought to the casualty after many hours of delay . An arrogant, drunk, politically supported crowd posing as relatives accompanied him, a common nuisance in almost every Indian hospital.

We continued the CPR. Dr. Hazare went out.

After a direct injection of adrenaline into the heart through the chest, the patient’s heart restarted, and he started to gasp, making some movements. We quickly shifted him to the ICU. The proud feeling of saving a life gripped us. There was no time for celebration, but Dr. Ajoy kept whistling on the way for our midnight tea.

Later that night, Dr. Hazare called us. He was angry, yet calm and smiling, an ability that only the most evolved souls can have.

“Listen, we are in India. Most of the people around us are not only uneducated and ignorant, they are also quite violent and paranoid. Emotional dramas are considered a normalcy. There’s a tendency to shift the blame of delayed treatment and bad outcomes on to the doctors. You were risking your life. If the patient’s heart had not restarted, the relatives could have blamed you, even hurt you”.

“But Sir, they saw that we were desperately trying to save the patient’s life” I argued.

“YOU think so. They don’t know anything about the CPR. They refused to go out. You saw how arrogant they are. These things work only when the outcome is good. If the outcome is bad, the doctor is automatically held guilty. I told you, we are in India. People like to think that doctors are wrong, whatever you do. ” Dr. Hazare said. (c) Dr. Rajas Deshpande

We didn’t think he was right. Still, we respected him for his wisdom, so we just apologised and went on to deal with the casualty again. It was a busy night, still a very negative feeling about what Dr. Hazare had said kept shadowing my thoughts. How could such a senior doctor ask someone to stop CPR?

Dr. Ajoy went to his room at 5 AM and returned by 7 AM to relieve me. I went home at 7 AM, had a quick bath and breakfast, to return at 9 AM.

The casualty was all devastated, ruins were seen all around. Many doctors were rushing in and out. All beds were empty except one.

Dr. Ajoy was on that casualty bed, unconscious, intubated and with blood soaked bandages on his head. He had many cuts on his entire body. Our colleagues were trying to push intravenous fluids fast into his veins. Dr. Anirudh, another intern with us, told me even as he could not stop crying: “That patient we had resuscitated yesterday evening… he had another cardiac arrest in the ICU this morning… his relatives came down and attacked Ajoy. They said that the patient died because of the forceful CPR. They stabbed Ajay and hit his head with iron rods. Dr. Hazare came and tried to rescue Ajoy, they even attacked him. We were waiting for you. Do you have his parent’s contact?”.

In a state of shock, I could not speak. I reached out for my bag, got my diary and called Dr. Ajoy’s father in Calcutta.

“Why?” Dr. Ajoy’s shocked father asked when I told him Ajoy was attacked, injured and serious. How could the father of a thin built, cute, brilliant scholar ever understand that people could brutally attack his child for trying to save their loved one?

I had no answers. Dr. Hazare’s sentences kept ringing in my brain, I could not utter them. (c) Dr. Rajas Deshpande

Eventually, Dr. Ajoy recovered. He is now in the UK. His father came over last week, for a check-up. While leaving, he kept his gracious hand upon my head and said with immense love: “Save many lives beta, but take care of yourself first. I still cannot sleep well due to what happened”.

That night, I stared at the sky, and kept thinking: Actually, this is why no doctor ever sleeps well in India. Saving lives comes with the inherent risk of losing one’s own, and this happens only in our beloved motherland.

(c) Dr. Rajas Deshpande

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Religion? Caste? Race? Nationality?

Religion? Caste? Race? Nationality?
No, I cannot think about that.
A Bullet has shattered the skull, damaged half the brain of this young person of 22 years.
A surgeon has put together the pieces of skull, a fragment of metal is still seen deep inside the brain. This person has a whole future of decades to tackle with a severe disability. As doctors, we only think: what best can be done to repair the brain, how best to resettle the patient in their future life, how to help them overcome their disability.
”Shoot, Kill, Hunt, Enemy, Revenge” are not the words any true doctor in this world can ever like!
We can never think about the race, caste, religion or nationality of any human being. Because a Doctor is always above any sort of discrimination. © DR. RAJAS DESHPANDE
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Slaughtering The Precious

(c) Dr. Rajas Deshpande.

At the casualty door she started shouting at me even before I went in. “We don’t want any tests. We don’t want to admit him in any critical care unit. Keep him in the general ward you have, we are now financially exhausted. Give basic medicines only “. Mrs. Julie, the patient’s daughter, went on:”We have already signed palliative care form”.

“Let me see the patient first “ I said and went in.

The resident doctor had earlier told me that the patient, an old man, was conscious, speaking quite well, aware of his illness. He was intermittently getting unconscious for a few minutes. He had high grade fever. He had lung cancer, and a brain scan a few days prior had revealed that that he had a secondary in the brain too. He had just completed his chemotherapy. The resident doctor had already started medicine for fits just now.

As I examined him, the jovial Mr. Shaw smiled back and told me that he was feeling a little giddy and tired, otherwise he had no complaints. He could even stand and walk without support. His blood pressure was normal, but the heart rate was quite high due to the fever.

“I think you have probably developed seizures due to the secondary in brain. There seems to be some infection too, we will run some tests and start antibiotics” I told him.(c) Dr. Rajas Deshpande.

“When will I feel better, doctor?” He asked, “I want to be home and spend every possible day of my remaining time with my grandchildren. I want to also finish a book I am writing. I am told I have only a few months left. How much time do I have? Six months? Four atleast?” he asked, still smiling. Only doctors know what a smiling face with a crying heart actually looks like. “Every passing moment is extremely precious for me, doc! Please cure me fast” he said.

I assured him that if the tests showed nothing serious, he could go home once fever subsided, but the fits needed long term treatment. While we were having this talk he suddenly stiffened and his body developed jerky movements, then he became unconscious.

Ordering the emergency injections for fits, I told the casualty doctor to shift him to the critical care unit.

Coming out, I explained this to the angry daughter.

“Doc, we don’t want to treat him in any ICU. We also do not want any tests now. Please give him tablets instead of injections, we want to take him home as soon as his fever goes down” she replied.

This has become very common now, relatives of elderly people admitting them in hospitals, but refusing to do any tests, use injectable / costly medicines or shifting to critical care units. A doctor cannot refuse patients in such a condition, and it is an extremely painful, stressful situation to not be able to correctly investigate, treat a patient because relatives are unwilling. Ninety Nine percent of the times, money is the only reason. There are many charity, low cost and even good government hospitals, but the relatives also want the “show”of having admitted the patient at some posh hospital. Beyond a certain level, Private

hospitals cannot go on funding tests and treatments of hundreds of such patients even on a compassionate basis, because the poverty in India is never ending.

Compassion is the most abused entity in India.(c) Dr. Rajas Deshpande.

I told her that even if they had signed for palliative care, his current condition was treatable, his fever and fits caused him distress and could be treated, but she staunchly refused to let us send any tests. We started with oral medicines after a lot of deliberation, keeping fingers crossed that he responds. He did.

On the third day, Mr. Shaw walked out of the hospital with his patent smile.

Just next week, his daughter returned to the OPD: “Doc, dad passed away two days ago. After going home he had fever again, but we decided to manage him at home. Somehow he could not get through this time. I have come to get your signature on these bills from his last medicines, we want to get reimbursed”.

“Was he seen by a doctor at home?” I asked her.

“No doc, we gave him the same medicines that he was earlier given for fever. We also searched online and ordered them. But in a way we also feel he is now relieved of all his troubles” she said, hushing up the topic.

I signed the papers, a duty and an obligation.

In every hospital, every day, we see parents rushing, crying, selling everything they have, urging doctors to save their children on one side, and grown up children urging doctors to hasten up the deaths of their parents on the other . Many sweet, politically correct and legally blurred terms are now available for masking these murders.

A patient with a terminal illness may himself sign for “non-aggressive / palliative” care (meaning pain relief, superficial / minor treatment without aggressive effort to save or maintain life), or if the patient is not in a good mental condition to sign such a consent, the relatives may sign so. However, in India where children mostly are responsible for the medical bills of the elderly, they flatly refuse to treat even treatable, reversible conditions citing “öld age” as a reason. Even in case of patients with terminal illness, to presume that someone is immediately unfit to live, or fit to die is like saying it is okay to terminate their life at someone else’s wish. This is cruel, unethical, immoral, and should stand supported in no courts of law.

However, these murders are a daily routine in India, and law has tied the hands of treating doctors and hospitals as one cannot investigate or treat a patient when the relatives haven’t given a consent. An evolution in the fraternity as well as in this society is necessary if a change is expected.(c) Dr. Rajas Deshpande.

Otherwise, when we all will eventually be old, however much we want to live on for a few more days, one day someone will decide that we don’t deserve to continue to live, without ever wanting to know what we wished.

(c) Dr. Rajas Deshpande

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Doctor Abuse: A Medical Specialty

© Dr. Rajas Deshpande

Using the doctor’s private cell / social media accounts for free consultation, second opinion and opinion about investigations. Stalking to send reports, messages whenever online. These are now getting on the nerves of many doctors. I have completely stopped replying to any medical messages on social media / whatsapp.

Relatives, family and friends seeking free medical consultations on holidays, weekends. Directly coming home for a free consultation on holidays (On one unfortunate Sunday morning, back when I was naïve, one neighbour with a Luxury car came home and discussed his old age problems for two hours, reviewed his wife’s reports, then keeping 100 rupees on my table, said “Actually in my childhood doctors would charge only two rupees for consultation, but now it has all become costly”). I have now completely stopped this, refusing politely to see anyone without appointment, except in a true medical emergency.

Expressing Anger, Bitterness, Distrust and Sarcasm towards the doctor for diagnosis (especially incurable), for advising surgery, admission or costlier treatment options (the rich are unhappy with costly medicines, the poor usually do not complain). © Dr. Rajas Deshpande. I have now started to explain in the second consult, after finalizing diagnosis, what to expect, what not to expect.

Expecting the doctor to replace the lost bonds in family because the children do not want to spend time or efforts for their parents (‘you tell him, you spend some time counseling him’). I have started to refer such patients to qualified counsellors.

Taking an advantage of compassion and kindness to save money (Cannot bring patient to hospital, patient is too old, I am too weak to travel, we are out of station etc.). A general rule is that one must be treated, especially in emergency, only after a thorough examination by a doctor. I am now refusing to be emotionally blackmailed.

Seeking free consultations: relatives, friends, classmates, staff, other doctors, watchmen, maids, neighbors, drivers: there’s an unending list who the doctors are expected to see free. Add to these political leaders, VVIPs, government officials, administrative staff etc. Sometimes the doctor voluntarily waives off charges as respect, and some of the above actually request to pay themselves, but most expect a free consultation and in fact argue about it. I have made my own rules about treating only the deserving poor free, and those who need it. I refer them to the right center for help.

Multiple free consultations. This is a paradox: that many who get free consults / treatments usually think it is “not correct or adequate”, take a paid consult somewhere, and then come back knowing that the best was already being done for them. Such patients, when they know t is free, come every week even if they are told to follow up after three months. I have now started specifyinfg that the free consultation in a non-emergency is only once in three months.

Many patients book multiple appointments on the same / consecutive days and then do not bother to cancel the unused slots. This results in heavy losses for the doctor. Some patients call multiple times to book appointments and finally do not turn up, never bothering to inform. I have started to make a list of such patients.

Lying. Many patients / relatives lie about why they did not follow up in time, why they did not take treatment, why they did not do the advised tests, about multiple treatments at the same time, about their condition being an emergency etc.. Many a times parents are abused by their children, and multiple lies are told about why basic care was being denied to the patient. The doctor is supposed to cover up and compensate for the lack of care and compassion at home. © Dr. Rajas Deshpande. I have decided not to cover-up, and to refer them to a family counsellor.

Unnecessary information: Many patients do a lot of unnecessary tests and expect the doctor to “just have a look” at those even when normal. Few understand that time is the most precious commodity for a doctor, (most efficient doctors run late because of unnecessary discussions) and when one seeks opinion, it should be a targeted exercise to resolve the immediate concern. For regular check-ups, one must prefer to visit their regular general practitioner. I have started to refuse to see tests I have not advised, if they are normal.

“Resolve all my life’s problems”: many patients, when they find the doctor caring and compassionate, expect him / her to resolve all the issues pertaining to their old age, relationship issues and spend a lot of time “listening to the sad stories” about their life, and their opinion / rants about them. While in some cases it is necessary to wholly understand the patient’s mind, this is primarily an issue to be addressed by a psychiatrist and a counsellor.

A patient in distress is often not in a position to understand the doctor’s expectations and the nitty-gritty of manners and etiquette, and while still being caring and compassionate, we doctors must learn to politely decline such abuse in the kindest words possible. Once educated, most patients follow the instructions well.

Happy Doctoring!

© Dr. Rajas Deshpande

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Doctor Arrested. Patient Died. Who’s Guilty?

(c) Dr. Rajas Deshpande

“Doctor arrested. Patient died due to a wrong surgery”.

The black headline was shining. There was a file photo of the accused doctor, and angry, crying relatives. Sad and angry, I read through the news that did not affect me directly, yet knowing that every patient who read that news will go further away from their doctor. The already delicate and dying bond will die a little more.

Is it enough to punish this doctor?

Who all is guilty here?

The parents who forced him to become a doctor because they couldn’t?

The corrupt educational boards which allowed leaking papers and increasing marks so the student could get a medical admission? (c) Dr. Rajas Deshpande

The politicians who made it possible for even the undeserving, low-aptitude students (which has nothing to do with one’s caste or religion: it’s more to do with money and power) to become doctors and play with patient’s lives?

The governments who allowed the “Medical Business” by establishment of substandard medical colleges owned by the rich and powerful, to sell medical degrees? The managements of such substandard institutes who chose the “low”quality teachers who agreed to work at low salaries and tolerate all humiliation? The teachers who didn’t care how their student was trained? (c) Dr. Rajas Deshpande

The medical councils which ignored the ‘temporary’arrangements made by such substandard institutes to just ‘Pass the Inspection’, never providing students with adequate education or experience?

The medical policy makers who made theoretical, mcq-type education more important than clinical training?

The offices of law which ignored the repeated applications and complaints of good students from such institutions about incompleteness of educational facilities?

The Universities that allow ‘manipulation’ of medical exam passing under influence of money or power?

Or the politics of allowing cross-specialty practice without adequate training, the ‘jump-over to any pathy’ decisions to please vote banks?

Or the corporate hospitals who prefer such “substandard” doctors because they can work at lowest payments? Aggressive and “market oriented” junior doctors are preferred by many commercial-headed hospitals over those with best academics and clinical knowledge. (c) Dr. Rajas Deshpande

It is indeed a reality that some doctors cannot speak a straight sentence, some cannot spell medicine names correctly, some treat even what is not their qualification skill, and some substitute knowledge with style, overconfidence and sweet talking. At various stages in their career, there are teachers who have tried to correct them, but in these unfortunate times of “pleasing one and all” including students, it is quite difficult to ‘mentally’ train a doctor to be good and perfect.

If only the doctor mentioned above is punished, leaving all others above without correction, then it will be a classic example of example of medical negligence and injustice. It will be like treating only the heart attack without treating the blood pressure and diabetes which cause that heart attack. We know the outcome in such cases.

(c) Dr. Rajas Deshpande

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