© Dr. Rajas Deshpande
The angry relatives entered my cabin, and threw a file upon my table.
“Doctor, our patient’s kidney function has gone worse because of the injection used in MRI” the patient’s daughter said, quite loudly, pointing a finger at me. The way she spoke spiked my anger, I was already tired: two of my critical patients were fluctuating, I was worried about them, had had a bad day already. I am short tempered. © Dr. Rajas Deshpande
This was a tricky situation, and every expression, every word mattered. One wrong step, and my career and reputation would be open for politicians and media to criticise, for the government and law to give me sermons of compassion and ruthless punishments based upon assumptions. Right and wrong is immaterial in India, so long as there is sensational populist material.
“Patience. You don’t have to react” said my inside Buddha.
I requested the family to sit down. “Please let me see all the papers” I asked.
The elderly patient with diabetes, high BP and kidney failure had seen me more than 6 weeks ago. She had symptoms which can be caused by blockages in the blood vessels of lower brain. Any accident in this area can be dangerous, sometimes fatal. There often are no clues from external examination. Such “Paralysis warnings” are called ‘TIA’s (Transient Ischemic Attacks). The only way to know if the blood vessels are blocked is to do an Angiogram of the brain. © Dr. Rajas Deshpande
The dye / contrast injection used for some radiological tests may cause kidney damage. However, the MRI angiogram does not usually require such a dye. Moreover, if at all a dye is required for an MRI study, the clinician and radiologists update the patient, take a consent, and check renal functions.
I checked the papers in detail. No such dye / injection was used during the MRI. The papers clearly mentioned so. In fact, as the patient was being investigated, even I had not prescribed her anything new. I showed this to the daughter.© Dr. Rajas Deshpande
“We don’t know. Our family doctor XYZ told us that because of the dye given in MRI, her kidney functions have worsened and she has become critical.” The daughter said, again in an accusative tone.
The name she uttered was a big name, a very senior doctor who was in practice over 50 years. I wasn't surprised.
“Has he given you anything in writing?” I asked.
“No” she replied.
I showed her also that according to the reports the patient had gone critical because of urinary infection that had spread to her blood, not because of kidney functions alone.
“Oh! Then why did Dr. XYZ tell so to us? He gave us an impression that you were grossly wrong, and this was entirely due to the MRI”.
I had the right answer. There are many doctors who use this tactic: especially the ones who are threatened by competition or those who are just plain jealous of any attention that any other doctor gets. Not that they have any less success, practice or income, but they cannot help belittling others in an attempt to prove their own superiority. © Dr. Rajas Deshpande
In this case, the senior doctor wasn’t even aware that MRI Angiogram does not require a dye. He had chosen to loosely malign another doctor.
Doctors indeed develop a certain ego and superiority, thanks to years of hard work and merit and never realize when it turns harmful. Then these tactics begin: sarcastic smiles and remarks about other doctor’s diagnosis or approach, loosely commenting that tests or treatments were wrong or unnecessary, telling the chamchas / junior doctors (in front of the patient) how the earlier doctor was wrong, pretending to know beyond one’s specialty (taking advantage of one’s age), and in general speaking low of other doctors: this instantly gains the trust and goodwill of most patients who are not aware of such ‘games’. Then they can be manipulated as wanted. © Dr. Rajas Deshpande
These “gaming doctors” often speak to impress upon the patients that only they are the sane torchbearers of this profession, all others are corrupt. It is these doctors who have caused so much more damage to the medical profession and the image of medical professionals than media and politicians. Especially in today’s times, these doctors should introspect what damage they are inflicting upon future generations by fueling distrust. To gain a repute amongst the media and those in power, such doctors lick many a dirty shoes and empty many a gold bags, begging for titles and rewards that again unfortunately impress our illiterate and poor majority. They are often supposed to be the faces of the profession in the eyes of our society. There definitely are some honourable exceptions, but rare.
Such “disreputable” doctors must be openly confronted by the IMA, and they should be made aware that medical ethics dictate that one should not malign / criticise a colleague. In case one thinks that there indeed was a mistake, he / she should call up the concerned colleague and clarify, obtain a second opinion, and if it is a medicolegal matter, forward it to the medical council, taking precautions to protect the colleague’s reputation from unnecessary damage. One must remember that there is no doctor who is always correct, we all commit mistakes. Those who pretend to be free of mistakes are probably the worst doctors we can have. © Dr. Rajas Deshpande. No one ever grew bigger by showing someone else’s faults, mistakes or inferiority.
Even patients must also be aware of such tactics: it is the sign of a “low-morality” bad doctor, who criticizes other doctors or their approach / diagnosis. This is not allowed in our noble profession. The right approach of complaining to the right authority must be strictly followed. Those who have survived using such dirty tricks cannot be changed, but at least the newer generations must imbibe a healthy professional culture.
A good doctor is never made of other bad doctors. © Dr. Rajas Deshpande
© Dr. Rajas Deshpande
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