Tag Archives: violence against doctors

The Story of a Deadly Brain Aneurysm..“Doc, was the treatment delayed?”

The Story of a Deadly Brain Aneurysm..
“Doc, was the treatment delayed?”

© Dr. Rajas Deshpande

“Doc, was the treatment delayed?”
The angry husband, Mr. Mane asked in a calm voice but the accompanying relatives had a menacing look upon their faces.

The patient, his wife Mrs. Sujata 35 years old, was brought unconscious two days ago, in a comatose state, at about midnight. I was out of city, so my colleague Neurologist rushed to the hospital and started treatment. We were constantly in touch, within an hour Sujata’s scans were completed, and she was shifted to a critical care unit. She had large bleeding in the brain, and was already beyond a possibility of surgical treatment.

About five years ago, she was diagnosed with an aneurysm in the brain. It is a defect in a blood vessel which balloons out as its walls become thinner and may rupture suddenly, causing either instant death or bleeding in the brain, many a times huge. This diagnosis needs immediate treatment, the right words that describe its risk are: “This is like sitting on a time bomb, not knowing when it is set to explode “.

Many patients do not have much symptoms besides headaches or minor neurological issues usually found on examination by a neurological expert. There are many NeuroIntervention specialists in India since last two decades, who can reach the balloon via a catheter/ tube and close the balloon/ aneurysm so the risk is eliminated and patient cured. Sometimes neurosurgeons are required to operate if the aneurysm has a wide base, and close the connection between the balloon and the artery from which it arises, by an open surgery. © Dr. Rajas Deshpande

Five years ago, we had informed all this to Mr. Mane and Mrs. Sujata. Like many educated patients nowadays, they obtained multiple opinions. Almost all doctors had told them what we had told. However one retired allopathic doctor, now quite old, and one non-allopathic practitioner told them “It is not necessary to do the surgery. Doctors these days advise unnecessary costly treatments”. They started some vitamins and health boosters. © Dr. Rajas Deshpande

The couple decided to wait. The came for follow up once after two years, we told them it was better to operate, but they said “We met our neighbour doctor, he is very senior, and he said that there’s no danger in waiting. I think he knows, see, nothing has happened in two years.. we are happy as it is!”

After that they did not follow up. They had even stopped allopathic medicines. They had come now, when she was beyond any possibility of rescue.

When after a day we told the family that she was brain dead, they asked the question above: “Was her treatment delayed?”.

After explaining to them that everything was done faster than even the best centers in America would have done, they calmed down.

Out of curiosity I asked Mr. Mane: “What did your neighbouring Doc say, the one who had advised to not operate her?”

“Oh, he was very kind. He said nature is cruel and anything can happen anytime to anyone. He arranged for an ambulance too for us.”.

Mrs. Mane didn’t make it, we all felt very sad that a young life that could have survived was lost to a wrong advice. Many doctors who do not specialise in certain complicated and advanced branches of medicine often try to please the patient by giving them an advice that attempts to impress the patient by saying what they want to hear.

It is true that sometimes surgeries are wrongly advised and performed, hence the social confusion about trust. There’s only one way out- explaining the patients and giving them credible websites to refer to, referring them to another specialist who is qualified in that branch. Some trust-less patients will still pay with their health and life. © Dr. Rajas Deshpande

If such cases go to the courts of law, challenging the speed and/ or efficiency of treatment, the honourable courts should consider delays and decisions at every step beginning from the day of onset of symptoms, the delays in visiting doctor, specialist, performing advised tests, obtaining another opinion if advised and getting the prescribed treatment in time. Just holding the doctors and hospitals responsible for not being able to rescue the patient at the last stage is not justified.

Leave aside a few wrong ones, but most surgeons only advise a surgery after deeply thinking about all possibilities, risks and outcomes. Sometimes even when the outcome is uncertain, they must operate. At such times their reputation and career is at a stake, because every mistake is nowadays amplified into a media blast. Still they think about what’s the best for the patients, and try to do their best. Surgeries and procedures, even the costliest, are the cheapest in India since last thirty years- surgeon’s fees are still lowest in all branches, and if we consider the medicolegal and media risk and a violent mobs backed by some politicos, actually the doctor is at a high risk during every major surgery. © Dr. Rajas Deshpande

A doctor is not a merchant or politician to sweet talk to the patient and give them a pleasant but wrong advice and jeopardise their future just to “retain the customer“. This is a noble profession where sometimes strongly worded and unpleasant solutions are essential to save the patient. To expect all the patients and relatives to understand complicated medical concepts and treatments (which takes even brilliant doctors years to grasp) is comical.

We sincerely hope that our society recognises the huge stress every doctor goes through, every day, trying to do their best for patients.
We also wish that the law, politicians and media note that it is often the delays before admission that kill the patients than those after.

© Dr. Rajas Deshpande

Please share unedited.

Who Is Guilty Here?A Typical Indian Case


© Dr. Rajas Deshpande

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

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

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

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

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

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

© Dr. Rajas Deshpande

Standing Ovation, Doctors with Hemlock

Standing Ovation, Doctors with Hemlock
© Dr. Rajas Deshpande

It is not new that the world has chosen to torture and kill the right and good. From Socrates to Mahatma Gandhi, the speakers of truth and advocates of good have been punished by a majority addicted to the illusions of both. Socrates, who was declared guilty and awarded death by drinking poison hemlock, had a chance to escape. He chose not to. ‘A true philosopher is not afraid of death’ he said. He chose to drink the poison.

At this very moment, thousands of young doctors all over India have chosen not to run away from the deadly virus: because they believe in the ultimate sacrifice: for saving the life of millions. They are the true heroes of India. If a soldier dies, the whole nation rises to salute the sacrifice. Nearly 400 doctors die, and our administrators said they did not have information about it in the parliament. © Dr. Rajas Deshpande

Digital India, where there wasn’t a day without messages about Aadhar cards, PAN linking, etc., and so many other messages reached everyone, yet unable to know tell how many doctors died. We can tell exactly how many patients were positive, how many tests were done, how many discharged or recovered, but we cannot tell how many doctors died while treating them. Shame!

Thousands of junior / PG doctors, interns and medical officers are being forced to work not only against their wish, but against all fair constitutional rights. They are being threatened and punished even after overworking. Their salaries have been cut, some have not been paid for months now. Everyday, patients too are frantically searching for good covid care beds.

Hospitals are overflowing, no beds available in some places, many centers are closing down because of lack of resources, but what we really need now is an IPL. We don’t have money to pay the doctors, create more healthcare resources for thousands of dying patients, but we can definitely watch cricket and forget all that. There’s nothing wrong with sports or entertainment, but is this the right time? Will the IPL profits be used for creating more hospitals? All through the economic crisis, I was amazed by the perpetual news of few Indians getting higher on the list of the richest in the world. I do believe that they are good at whatever they do. However, what was most ironical was that yesterday I read the news of people urging one of India’s richest businessman to buy the Man-U team. Mind you, people did not want a hospital for the dying poor, people did not ask the billionaire to pay the unpaid covid warriors, they asked him for buying a football team!

Add to this the new law about Violence against healthcare workers “During pandemic”. How can this be best described? “No murders, crimes, corruption during summer months”? Or “No stupid talking between 10 AM and 10.30 AM”?© Dr. Rajas Deshpande

The point is, dear Covid warrior doctors, please understand that the society does not want you, it only wants your free service without offering either respect or remuneration. The government has not even responded to our petition about human rights for doctors who have been slogging, carrying the pandemic burden on their shoulders as everyone else hogs the credit of recovering patients. Postgrad medical students have been denied education in their own branch for over six months now. They have been denied leave, permission to meet sick parents, or even a quarantine after exposure that is followed world over. They also face extremely hostile relatives and goons every day in hospitals. Many doctors who died just as they started their careers, are not even acknowledged! Just as every responsible institution in the country has taken precautions to safeguard itself from the virus, working online, just as the parliament is mulling over whether to cut short the monsoon session as some members were positive, no one wants to think about those actually dying every day facing covid patients: our doctors.

I have never felt so frustrated about the future of doctors in India. I have carried a proud torch of being an Indian medico and am blessed to have a great connection with most present generations of brilliant doctors, but I haven’t slept peacefully last few months knowing that my juniors, students are left to die in the pandemic. Every effort being made is quashed or falls on deaf ears.

I can only say to every doctor in the covid ward right now: humanity will always be grateful to you for drinking this poison hemlock just like Socrates did: bravely and in service of truth and good. If Mahatma Gandhi was alive today, he won’t have published his own achievements, instead, he would have made the country realize how indebted it is to your sacrifice. I believe in the power of one. Mobs never achieve anything. Each one of you out there is a hero saving lives, even when your own countrymen seem to have forgotten and abandoned you.

My Standing Ovation to every doctor working right now anywhere in the world, especially in India.

© Dr. Rajas Deshpande

Picture Courtesy: By Walter Crane The story of Greece : told to boys and girls (191-?) by Macgregor, Mary, Public Domain, https://commons.wikimedia.org/w/index.php?curid=32804549

Orphaned Doctor, Change and Future

Orphaned Doctor, Change and Future

© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

© Dr. Rajas Deshpande

Please Share Unedited.

#covid19, #pandemic, #India

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

1: Etiopathogenesis
(c) Dr. Rajas Deshpande

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

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

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

Problems Within Medical Community:

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

To Be Continued
© Dr. Rajas Deshpande

Please Share Unedited


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

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

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

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

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

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

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

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

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

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

Dedicated to all students, resident doctors, proud people in every field, student unions and their apolitical fearless leaders.
Please share unedited.

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

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

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

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

He didn’t say that:

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

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

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

And lastly, is this happening only in certain states?

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

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

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

Stop your poisonous blah.

© Dr. Rajas Deshpande

We are suffering, India!


© Dr. Rajas Deshpande

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

The Last Bullet For Indian Private Healthcare


© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jai Hind

© Dr. Rajas Deshpande

Please share unedited

Suspend All Doctors, Cancel Their Registrations…


© Dr. Rajas Deshpande

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

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

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

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

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

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

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

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

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

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

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

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

Please Share Unedited.