Why I think doctors deserve the money they make.....

Here's a well written piece by one of my junior colleagues.....  Sriniket. Good job, dude!
(Edited for this blog by yours truly)


     Doctor bashing seems to be the trend today. Everywhere I go, I get to hear a medical horror story about how some satanic medical practitioner had the balls to ask for 500 bucks after giving a measly injection or scribbling gibberish on a paper with his name on after asking some idiotic questions like "what did you eat on that day?"; " is it a throbbing pain or a bounding pain"(like one can make that out!) and of course the biggest sacrilege of them all "that bloody quack had the audacity to tell me where to get my xray /usg/ blood work, he must be getting a commission..... all doctors are just white coated pimps!"
         

It has been just more than a year since I have qualified to become a practicing physician but already people look at  me as if I am Ambani or at least a Birla in waiting who will very soon be driving around in a BMW bought by money which apparently we get by looting the pained, already much taxed masses. Let me make it clear at the outset when I graduated from my institute I didn't get anything other than all my SSC and HSC documents and threatening words from the office that very soon I will have become a medical officer in the govt. public health centre nearby where i will spend the rest of my days giving out malaria pills and pain killer injections to 'tatya , bandya aajibai and others' (no disrespect implied). I was told in most cases by my own batch mates we will get a princely salary of 25k. WOW!!!! I wonder which other 24 year old gets that much money at that age and then the answer came" every moron who ever graduated from college with any lame ass degree gets more than that! In fact most people who didn't bother with graduation get that". Independent sources tell me rickshaw-wallahs in Thane get more dough than that. Why should I ask for more? ALL I EVER DID WAS GET A GOOD RANK IN A HYPER COMPETITIVE EXAM AT THE THRESHOLD OF ADULTHOOD. I only gave 4 sets of freakishly subjective examinations in which my fortunes can be decided in the end by what I wore to the exam hall, my caste, my language skills, my relations with the college departments and MAYBE  by my knowledge and I haven't even begun ranting about my experiences with post graduate entrance exams!
            Let me be very clear i have nothing against any of my friends who are into any other stream, good for you guys you had the good fortune to steer away from this field by design or by accident! I am sure all of you are doing great now and you all deserve every dollar, every euro ,every pound and every rupee(for the few that still live here) that you make. Nor will i trivialize for a moment the troubles you people go through in your graduate lives. My problem here is on a whole  different level . I want to know why does the layman have a problem with a medico earning big money . of course we as medical students are also to blame here. My 66 months in Kolhapur taught me that many students are not comfortable with this idea and their ideas of success in this world come across as rather weak and limited in scope  (again a personal opinion with no disrespect implied whatsoever)  while i don't believe even for a moment that a fat pay is worth losing one's good name , I believe it's reasonable to expect reasonable remuneration for your skills , abilities , aptitude and work.
       

  Let's get the numbers straight. My information about branches other than medical and engineering is painfully limited, but i am sure that won't be a issue here. There are 18 government medical colleges in Maharashtra and around 20 private ones. Engineering- I think there were 639 in Mumbai-Thane region..... there were 620 last week and it will probably hit 700 by the end of this month. Aspirants for both fields give the same exams almost with the obvious variation being Bio and Math. Because of the sheer numbers even if i consider there are 20 great colleges in this state) that will come to a figure of at least 5000 people who end up with good quality peers , teachers , facilities and by extension good prospects. and these guys wont even be close to the best in the country. The best guys are studying in the IITs, NITs and BITS. All together this comes to around another 20 thousand students with excellent prospects. My basic point is you can expect to be Maharashtra rank 3000 and still graduate from a very good institute. What happens in the medical side of the entrance is that in Maharashtra unless your rank is within 500 you have a steep climb ahead. All those people who say all government colleges are the same and they are all good are DELUDED! The reasons are many and I won't get into them...... this write up is already too long. Somewhere around rank 700 rank you have three choices- pick up below average (read baaaad) college or take up a BDS (dentistry) seat which are even fewer and third option is give up, pick up an engineering seat which is always there or give another attempt!
My point here is that at rank 700, a medical graduate is probably studying in a very bad place where he is deprived of many facilities and opportunities. These guys are all mostly very good students,  toppers in their respective schools, cream of the milk pot that is the PCB stream. These guys are now stuck in very mediocre places for a very long time and that has an effect.. ...believe me it does!  These people are those who are within 1 percent of the state.  Even if they come out unscathed still with the fire in the belly to tackle the big monster that is PG entrances what will it lead too! Again if I consider only the popular PG choices which is about 8-10 subjects..... each has not more than 20 seats in our state....maybe 30. And again this includes the who's who of crap such as Nanded, Akola, Yavatmal and Ambejogai! To complicate matters further there are about an equal number of people arriving at the starting line from the private colleges which have hundreds of seats but all off which are auctioned to the highest bidder! People put their life savings to get their children into these courses....for what?...... private colleges where there are no patients and government colleges where there are no facilities and almost no teachers.
                 So once again, there is a cohort formed by 1 percent of the population and among these only 2 percent can move to the next level! Now you go and do the math! I am sure this is the equivalent of doing your engineering from the BIG SEVEN IITs and then wanting to get into one of the IIMs! These are the odds the very best off the PCM stream have.....each and every medical student has to go through the same odds to get even the most pathetic seat in the worst possible college. If I talk about the odds of doing the medical equivalent of a IIT + IIM. the odds get mind numbingly small!
              We as a society are so used to throwing money , " ooh he is a consultant , he did his B.E from VJTI and MBA from IIM-A ' he should obviously get 40 lakhs per annum, he deserves it!!!" What is the salary that a surgeon passing from KEM can expect.. I will be damned if it's more than 40-50 thousand and he is still not done with his studies, mind you ! And that's the best possible outcome! The guy is 28-29 years old, he hasn't slept properly for the last 4 years at least! He has cleared India's second most difficult exam (IAS tops the chart obviously) with  flying colours and he has sacrificed his whole youth. He basically smells of phenyl ! Also bear in mind that Infosys and TCS are not waiting around to hire this guy. His only option is to stick with a government seat if the decision he took as an 18 year old has to make any financial sense in the long term. When this guy finally turns 35 and decides I need to start enjoying the good things in life and enter private practice, he comes upon people saying "If you wanted to make money, you shouldn't have become a doctor(thank you very much Aamir! I am sure the next batch of people who believe you and stick to dialysis for years thinking transplant is a luxury and not a necessity in renal failure will remember you in their prayers as they hurtle towards their painful and inevitable ends!)".
             

So my appeal to all my non-medical friends.....never question a doctor's fees if you are satisfied with the outcome. You are paying remuneration for the struggles and sacrifices he makes in his youth. You are paying for the fact that he depended on his parents for basic living expenses well into his late twenties and in spite of being among the best in the state he gets treated like something that fell off a garbage truck! As for my medico friends- let's stop selling ourselves short, we are an elite bunch and it's time people realize it! Expecting to get good money for the efforts is not a bad thing. And let's be frank......the pay for interns , residents even super-specialist residents is pathetic. Let's change our outlook!
                    -DR. SRINIKET RAGHAVAN


PS: Check out this blog too..... http://doccartoon.blogspot.in/

My tryst with CANCER

Another day, another case.
This blog-post speaks of a man's "need"..... a need to get "diagnosed" first and then the need to get treated and the need to lead a normal healthy life..... Alas! That was not to be ! Read on.......
This patient's case is slightly peculiar because he presented with varying symptoms. I was supposed to present his case, but never got the chance to.....

The Violet Ribbon- "Support Hodgkin's Lymphoma Awareness"

This man was a poor construction-site worker from a remote village, and came to our hospital with complaints of swelling in the neck, fever, weakness, breathlessness, facial puffiness, abdominal complaints and various other non-specific complaints. He was admitted to our hospital 4 months ago to undergo a biopsy but backed out, for reasons best known to him.
Since I examined this patient in detail, I knew his clinical history..... he had multiple shotty lymph nodes all over his body (basically, a generalised lymphadenopathy). My provisional diagnosis for the case read: "Multiple enlarged lymph nodes due to ???Hodgkin's Lymphoma (possibly stage III B) with a severe degree of anemia and anasarca"
Now when I say, a severe degree of anemia.....his "Hemoglobin" levels were 3.2 gm/dl (normal level for an adult male as per Indian standards: between 12-16 gm/dl). Multiple transfusions later, he developed a cardiac overload, which he did recover from. Ideally concentrating on his primary disease, he should have undergone a "biopsy of his neck lymph nodes", but he was scared (?) of this procedure and even though I explained to him that it was a "harmless" procedure, he wasn't convinced. The patient's brother was basically running from pillar to post, just to get a "certain" diagnosis for this patient. My professors suspected a form of "Lymphoma", but a confirmatory test was required in the form of a biopsy, so that he could be referred to a centre offering "Specialised Cancer treatment" (since those facilities were unavailable at my teaching hospital). Since the patient was unwilling to get any form of procedure done on him (while his relatives were more than willing), he was asked to get "discharged". He actually did !!!
Around 2 months later, I was enjoying a "mini"-party with some close friends and just outside the venue..... this patient's brother spots me, and actually recognises me, and then addresses me as "Dr." (I was just a final year student then, but such "occasions" actually give you such a "HIGH"). I remember this patient well and I asked the relative how my patient was doing. I was in for a shock now.....
My patient had expired a week ago...... he developed a severe anaemia again and was admitted to the Rural Hospital in his village. But this time, no amount of transfusions or symptomatic treatment could help him...... his lymphoma, I guess, turned too aggressive......he died from a cardio-pulmonary arrest due to an extremely severe degree of anaemia ( I was told, his Hemoglobin was just 1.7 gm/dl !!! ).
So that party turned out to be exactly the opposite- a cause for celebration..... turned into a cause for mourning !!!
Patient deaths wouldn't affect me so often (more on that on another blog-post), but what happened here shouldn't have happened and in fact, shouldn't happen to anyone...... this man died for the lack of a diagnosis, a fear of the unknown and basically, according to me, his own foolishness (for lack of a better word).
But as my internship progressed and as my rural postings came to an end, I realised that this man's case was not an isolated instance. In fact, in the villages of India, thousands of such deaths go "undiagnosed" !
And we talk about "HEALTH FOR ALL" !!! Wow !

Strange encounters with the "alcoholic" kind !

So, a long-due act was recently passed in the state of Maharashtra. The Maharashtra Medicare Service Persons and Medicare Service Institution (Prevention of Violence and Damage or Loss to Property) Act, 2010 was passed by the Maharashtra Assembly on the 9th of April this year. What this means is that, any individual (or group, for that matter) found attacking any doctor or medicare personnel, will attract a (minimum) fine of Rs. 50,000 and imprisonment for three years and it will now be considered a non-bailable offence.

You might be wondering what the aforementioned tidbit has to do with the title of this post??? Read on.....
This happened during my Internship.....when I was posted to the Dept. of Internal Medicine. As I've (tirelessly!) mentioned earlier about the workload at this district hospital I trained at(because of the paucity of residents.....Interns work like Residents- read "bakras").....I'm not gonna delve into details (for your benefit). This was peak season for admissions (hospital-admissions, mind you) and I was handed over the Male Medical Ward as per my rotating internship programme. There were around 27 patients under my care (and only me, alone!!!) during this period. We were required to see the patients on admission, write their case-history, medicine orders (everyday that they were admitted there, that too twice a day), do blood collections and other minor procedures (like catheterization), etc etc. (hope you get the hint). All this and 27 patients to top it all, sure took its toll on me. And one day, I missed out on seeing one of the patients. After our rounds (with the Senior Consultants), I realised my folly. So, that evening I went and apologised to the aforementioned patient. Fortunately, the relatives were very understanding. As I was about to leave, I heard someone abuse me....(specifically using the word "doctor", and I was the only doc around). I didn't heed....but then the abuses went on and on....and all the patients and relatives in the ward (mind you, this was a general ward) were aghast. I turned back and went to see what the problem was. Believe you me, this patient looked like he was hardly in his senses (diagnosed with "Alcohol-Withdrawal Syndrome") and he wasn't under my care (as in, he was admitted under another Unit), so I began to walk away. But the abuses didn't stop, and now this degrading attitude of his, really began to piss me off.....after all I hadn't spent the past four and a half years studying Medicine, to listen to people like him, abuse doctors like us!!! So I asked him what his problem was, sternly. He actually had the audacity to hit me....though I ducked at the right moment and was spared of his wrath (unlike "first time in labour"). Taken aback, I called the security guard on duty.....but this delirious man wasn't in a mood to give up and went on about how "you doctors" don't give a damn about poor patients....how that patient suffered (which was absolutely untrue) and the like. All this while, his poor wife was a silent bystander to this drama and now even she tried to "console" him. But I really don't know what strength "ALCOHOL" gives people.....three security guards later and his wife holding onto him couldn't stop this guy's attempt to pounce on me. I really didn't understand the reason for his wrath against medicare personnel in general. A few seconds later, the patient's doc (Resident Doc of that particular Unit) came in. He ordered for some tranquilizers. Two shots of Diazepam didn't do the trick. Finally after a lot of attempts to pacify him and a lot of violence on the part of the Resident Doc (yup, have to do that at times), Chlorpromazine and Phenargan, both potent drugs.....did the trick. He conked off. Further probing revealed that his wife was used to this drama at home and often wound up getting beaten up. And yet, she supported her husband.....I was at a loss for words. The next day, this patient was discharged (Against Medical Advice- DAMA).....and it seems he couldn't remember anything about this "interesting" incident !!! Woah....!!!

And so this is one particular "breed of patients" we see on a regular basis at Government Hospitals..... this man hadn't realized the damage that alcohol had done to his brain, liver, kidneys, heart and virtually every organ in his body.....I hope you do, before its too late. . . . . !
P.S.: And on similar lines (as my previous "labour story"), this "man" visited me again when I was in the Surgery OPD.....with his kids having multiple abrasions and contusions, saying they had fallen while playing.....whether they had really fallen or were "made to fall" is an entirely different story.
Sordid state of affairs, I must say. . . . . !

GOLDEN YEARS at my ALMA MATER

Continuing the series on Videos......this one also has something to do with Internship.....and a whole lot more !!!
In sharp contrast to the video posted before, this one's more about the good times at my medical college......a sort of collage of photographs (and memories attached to them) with some soothing Bollywood Music in the background.
NOTE: Please excuse the gross spelling and grammatical errors in the video......coz even though I feature in it, I haven't edited it !!!
Watch, and share some of those memories with me. . . . . .

GELCO: INTERNSHIP UNCUT

This video I'm posting, is created around the life of a Medical Intern (portrayed in a very humorous light). The characters, situations and locations shown in the video are not fictitious.
Although the work that I've done during my internship, in my college-attached District Hospital is nothing like how its portrayed here (as in, it wasn't limited to blood collection, catheters etc.....but much much, much more); the video does give one, a perspective on the trials and tribulations, the red-tape and juz plain BS that an Intern deals with.......just to get that oh-so-coveted "COMPLETION" and his hard earned "measly" stipend !!!
Watch.....and you shall be enlightened (and entertained) !!!
It's not easy becoming a DOCTOR in this country.....thats all I can say !!!