13 January, 2013


Hi all,

Every time i sit to write something on my blog i think of my experiences with my patients.. Later on i started to wonder what patients might be thinking about doctors. i wanted some patient to just come forward and tell or rather write.. This was made possible after i joined Indiblogger. Indiblogger gave me a chance to see thousands of bloggers all over india.. I was surprised to see the number of bloggers in india.. I started attaching my posts and while working on Indiblogger i came across various blogs, different topics, different ways of looking at life... The experience was thrilling! Thanks Indiblogger! 
We, Doctors generally see that patients above 60 years are depressed about something or the other. They generally isolate themselves... But here in indiblogger i came across a beautiful , well written blog  My clutter,My life.  i was amazed to see that this blog is being well managed by a senior citizen by name  Pattu Raj from Hyderabad. i found that she was a fun loving and cheerful senior citizen ( very rarely do we come across such great people) . I made up my mind and requested her to write a guest post for my blog which she graciously accepted. 
The next surprise was in store for me was the way she has dealt the subject. I had requested to write on "What patients feel about Doctors"  She managed to give me a beautiful post. The points in the post were beautifully handled. At the end of the post i really started to feel that something should be done to streamline medical profession. So here comes My interactions with Doctors by Mrs.Pattu raj


Visiting doctors used to be nightmare. In childhood, it was Ayurveda powders and Municipal Hospitals. Mostly Ayurveda, an old Doc having hair on his ears, and a scowl. His powders were all same color , but it healed I suppose.

Moving to a big city brought me face to face with young doctor experience. Younger formative years had a romantic view of medical personnel, their lives full of lofty service, inspiring me to join the profession. That did not materialise, I was scared of Zoology, a compulsory one to master those days for medical admissions, thus generating an unattainable glamour.

But when I went for a medical examination before a new job, the lady doctor( who did not even had a MBBS) with an unpleasant face performed some examinations, without me realising that she was shaming me . It was a thorn in the mind for many years. Another bold co-worker had the courage to object to such rude behaviours and got the examination stopped for all lady employees. A very bad experience indeed. Later I understood how her husband being on our office rolls, is the leverage for her to be on our office payroll. Way of the world we thought.

Her husband was a law unto himself. He would prescribe the same red tonic and Anacin for any ailment. In fact his tonic was so good ( alcohol content), which went by the name cough syrup, a favourite with many male employees who used to fill bottles, by posing as phlegmatic. We ladies stayed clear of him except when he would grudgingly give fitness certificate before joining duty from sick leave.

We also had a young doctor practicing near our home, in a garage. He was a kind person, and used to slowly explain, if asked. My dad used to accompany us, so he would talk to him. We did not have much interaction, but I remember he made us aware of penicillin and resistance. Antibiotics were slowly making appearances, but Doctors were not prescribing them easily.

The shock of motherhood, wailing baby, brought me face to face with paediatricians. A very kind and sweet doctor was recommended, who patiently explained what it is to take care of baby ( No knowledge of Spock at that time). For years we consulted him, and now heard that his son has taken over the practice.

Later , moving into our home in a newly developing area brought us in contact with an young Doctor . The rapport was admirable, we English speaking patients, young , he wanting to have a name and develop practice. We all grew together and he would simply write medicines which we would swallow get well, and recommend him to all and sundry. The area developed into a centre of its own. Our Doctor too prospered, increased his fees on the gold rate, and we did not mind. We were getting good care. He would come for old age care, answer calls, and he was good.

Years passed by, while Antibiotic was the norm of the decades for every illness, a new company product would be prescribed. Internet, medical articles in popular magazines, friendly advice from Overseas friends who were also doctors gave some insight into use of medications in India.

The doubts started creeping. Why so many medications?- a nagging question . The Doctor would give some convincing answers to calm us. As the years passed, we noticed that he would prescribe certain company medications, and insist that we use the pharmacy he suggests. We also knew he was charging more than other doctors. Still with due respect to his age, and experience ( it is 30 years and more). He went for some training certified programmes and started calling himself this specialist, that specialist. He is authoritative, therefore most of the patients are afraid of him.

He never thought patient should be informed about the medications that he prescribed or he needs them to understand the side effects. He hardly will communicate, and simply wave away the questions.

All our associations with him for decades, did not cut ice with him , one day. When I had a severe pain, writhing, at midnight, we did not know what was wrong, he refused to come home pleading he was too sleepy and we should look for someone else. That was a slap in the face. But we let it pass.

We also started noticing that he was prescribing too many medications for small illnesses. When we asked him he would forcefully say something or change the topic. We were getting more knowledge of medicines from the Internet. Over a period of time , we started rechecking the medications and find out whether it is really necessary to take so many antibiotics for one illness. He would slyly insist we need to buy medicines only form the pharmacist he recommends, and do pathological tests in places he would point out! We understood.. the game. However he was our GP and that was that.

There was another young man practicing, not so suave as the other one, but was willing to charge much less, a son of soil, attracting lot of clients. Initially he was fine, but over the years, a chance encounter with him showed his true face.

Three years back, when I was brimming with pride about my health staying in good stead despite 6 decades on the age front, a sudden onslaught of body heat, toe tingling, sore, tiredness, and fatigue urgently called for consultations., in the absence of GP. Surprisingly this doctor was grumpy and looked bored. My BP was very high. A big shock, to me and husband. My mind racing to the hectic months I had at home due to sever home cleanings, a strain of trips undertaken and guests care. I was ticking in my mind to stop alla dn take rest and be back to normal soon. The doctor was writing down sugar test, which made me exclaim, I never had this sugar problem so far! He smiled crookedly and announced," Where BP is the Sugar is sure to follow"!.

That remark was a jolt to my pride and senses. Is this the way doctors break news to patients about possible problems? Where are ethics, I was seething with confusion and frustration. I am sure my BP went a few notches in those moments. Meanwhile, the blood sugar test was conformed the high Blood Glucose levels.

Needless to say, I never went back to the said Doctor, to save my pride, and avoid his leering smile of I told you so.

We had another family friend, who is also a doctor and who was also a Type 1 Diabetic. He was consulted urgently and he prescribed some medicines. He advised use of sugar free, and less use of sugary stuff, and less rice, but otherwise continue living normally , with walks whenever possible. The problem was he was not living the city , he was also prone to high irritability which he concealed. I was not comfortable consulting him at all. He would direct my husband to inform me about my problems and solutions , which I was unhappy. I am the patient , why tell the husband?

The GP was back and I consulted him with the reading. He made some sympathetic noises and said, do not worry, I will look after you!. How comfortable I felt. He gave medications and I followed them reverently. The blood glucose level was in manageable levels, and I was back to near normal for a few weeks. Once again some complaints cropped up and I sought the GP's help. He increased doses, and forgot about me. I was very disturbed. Why are the doctors not explaining the side effects of medications? The long term consequences of Type 2 diabetes, meal plans?

That drove to the Internet Where I found similar questions posed by Type 2 sufferers all over the world. I found that one common medication does not go well for all patients. In the west, the Doctors are required to explain to the patients about the medications, side effects and about the illness.

I was at sea. My GP would not be open to discussions at all. He would brush aside everything saying 'oh' and change the topic. I was gaining the impression that he was prescribing remedies that would add to his collection and the pharma companies and diagnostic centres. I also gathered similar opinions from his other patients, who knew him since decades. That he was fond of over drugging., sometimes at the cost of the patient.

But we had fewer choices. He is nearer to the house. His timings are very good. We only need to needle him to get information. We know he over drugs us, now we are cautious.

Another incident reduced my trust in doctors. GP simply increased my dose of Diabetic medicine doubling the dosage. The first day, the effect was mild. Next day, I could not even get out of bed. I was utterly weak with nightmares in my sleep through 24 hours. My alarmed family checked the Internet and found that it could have been overdose. We called the doctor on phone since I could not move out of bed. He simply dismissed it by saying " ok revert back to your smaller dose"!

The experience of shoddy treatments, the careless dismissal of patients, the over drugging, all made me lose faith in today's GPs. Now I am more careful when I get prescriptions. I buy from reputed outlets, and look for all the side effect before popping them up. Meanwhile, I think of all those patients who flock to the Clinics, gullible, without any knowledge of side effects to their bodies, and despite medications , their deteriorating health . Sad.

I learnt a lot about Type 2, what I should do, and how to go about my diet. I bought books, found out about home testing blood glucose levels, buy my strips and keep a watch.

I feel for those who get attracted by big Diabetic camps, sign boards proclaiming doctors as " Diabetologists' mushrooming all over the country. Is it really ethical practice? Do the experts really give suitable wholesome knowledge for the chronic ailment and measures to curb, with suitable advices? I wonder.

A lot needs to be improved in patient care and communication between doctor and patients in India. The ignoring of patients requests for details, and the shoddy way the drugs are prescribed , tests conducted , leads to patient losing confidence in the doctor. Different patients perceive differently, but ultimately they are the ones to bear the brunt of medications. In major illness, the patient or their relative needs to be explained , certain facts of the illness and medications prescribed. Those well-educated patients who have idea of illness and medications are able to understand side effects and make choices while getting treated.

Out of fear of being critical some patients may not even say anything to the doctor, even though they have observed side effects and , have stopped taking the drugs. In such a scenario the doctor will continue to prescribe similar drugs and the patient will continue to suffer. Not having a channel of sound communication with the doctor , usually results in overdose and more side effects affecting the patients, In India, doctors largely lacks this patient communications skills.

Finally Wikipedia says:

"A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. For most physicians, the establishment of good rapport with a patient is important. Some medical specialties, such as psychiatry and family medicine, emphasize the physician-patient relationship more than others, such aspathology or radiology.

The quality of the patient-physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice. In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician"


  1. I remember the story I've heard somewhere. It is about a doctor who received a will left by one of his patients. It was a old trunk. He opened the trunk and to his chagrin found out that it contained his prescriptions to this particular patient from the 20 odd years that he was family physician to him. And a letter that he never used his prescriptions to buy any medicine. I can vouch the fact that many a time, the medicines are too many for a patient to take. And most of the times useless. I wish we learn how to prescribe with discernment and wisdom.

  2. hi jk
    i totally agree with you... but to be on the constructive side lets see what leads to such a bad scenario... i feel its because we dont have standardized guidelines. all we have is american and uk guidelines which dont work on our patients. so most of the enthusiastic physicians end up overdosing....

  3. Pattu has done a very honest post here--thanks to both of you.

    Today more than ever a materialistic yard-stick is employed to gauge a person's value,so everybody is out to make a fast buck.

  4. Dr.Riyaz, I take the liberty of replying on comments.

    JK:- Amazing anecdote.Smart patient?:-)

    Indu Chibber :Thanks Induji. In this materialist world, I am still looking for honest dealings, and am surprised many a times when I find it! It reinforces faith.

    1. feel free to comment madam...

      thats beauty of life we somehow manage to find good ones too....

  5. This is a problem with some of the doctors I met and more than the medicine the words come from doctors does better treatment.

    1. i totally agree with you jeevan.. medicines 50% and doctor 50%

  6. quite a detailed study of the scenario... but a physician may justify that he's a human being too which makes him... well leave his justification for now, may be I would blog that sometime in my blog :)
    Cheers for good health and health for ALL!

    Anunoy Samanta


  7. I have only had good experiences with my doctors in India. So much so that I actually went back to India to deliver my second baby. The only problem - the exhausting looooooong waits before we got to see the doc. Isn't there anything you can do about the third rate medical practitioners you've described? Go to someone else?

  8. i totally agree with this post. i let my doctors write the medicine, then come home and check the effects on the net. other patients are my biggest source of knowledge. Not doctors. half the time, doctors dont even know abt some of the stuff that other patients talk abt on the net. And yes, they overprescribe. yes, they ask for unnecessary tests and diagnostics. IN big hospitals, they have well estabished sales targets - they have revenue per patient targets, which is not on consultation fee, but on the no. of tests they get each patient to do. so their prescription is not a function of what the patient needs, its a function of what they patient can pay and what their target is. likewise, expensive drugs are prescribed when cheap ones will do. today, an apex body in India has directed doctors to prescribe only generic drugs not brand names. but the step will not stay .docs make far too much money off pharma companies to comply.

    Medical malpractice is an extablished fact in India.

  9. As a doctor, I want to zealously defend my kind and my profession but I know its naive to assume that everyone in our profession plays by the rules or ethics.
    But I can also genuinely say that I have seen the opposite also - docs who selflessly work for endless and constant hours on pitiable salaries just to see the patients in their wards get better... I see doctors go daily to remote villages daily to identify at risk blind patients and bring them back, do their cataract surgeries for free and then return them back to their village in 24 hours.

    I know some docs will overprescribe and perform excessive tests but thats where the patient gets a handle of the doctor as well. In some cases, the patient complains when the tests come back normal... instead of being relieved, they fight over excessive testing.. but those same tests help identify disease forms at early stages in 1000s of patients with a similar history every day just in India.

    Where there are bad experiences, there are good too. I get to see both sides daily - it comes down to individual doctors in the end, not the profession as a whole.

    1. that's true... it is the patient who has to decide if the doc's protocol is agreeable or not... you CANNOT blame the whole profession for the mistakes committed by few.... think of it practically!! you find black sheep in every profession so medicine is no exception.... some people tell that they will check drug side effects on internet..... do you think learning medicine is so easy? i can bet and say that you will not take one tablet in your life if you go through the side effects of each drug.. one small example is that everybody takes paracetamol, do you know it can affect your liver and kill you in matter of hours?
      you think websites come down from heaven?
      how do you know that every detail given in website is true?

      some people say they don't take tablets as per prescription and take only less number..... ha ha!! really think you are fooling us?? no!! You are fooling yourself.... Antibiotics taken in less dose and less number of days leads to resistance ... so next time simple antibiotics don't work!! you and up paying 750 rupees per dose and blame the doctor for that also...

      somebody here was talking about using costly drugs when cheap drugs are available.... please remember one thing.. as the cost comes down the purity of the drug also comes down.. recently all of you would have read article about chalk powder being sold as low cost pills... with so many medico legal issues we also would like to save our skin by prescribing standard medicines from standard pharma companies so that the company takes up quality control every now and then avoiding counterfeit drugs...

      finally some people takes advise from friends ( Non- medicos) ... feel like Rolling on The Floor and Laughing.... boss Your friends may be experts in their fields but not docs.. he/she has seen only one patient (self) but we have seen thousands of your friends... so beware before you make such irrelevant foolish statements.....

      sorry if i have been Harsh!!! BITTER PILL IS FOR PATIENTS TOO!!

    2. this reminded me of a few things : when we we interns, an article came in Times of India of how random testing of generic drugs sold to people showed contamination with insect bits and rat feces... surprisingly, back then noone seemed to care. Now because people find the price difference between generic and standard pharmaceutical companies which take all precautions, they demand the latter at the former's price.

      If the people of India want drugs to be cheaper and hospital rates slashed, argue with those in charge of your health care : the government, not the doctor. The doctor doesnt decide the rate printed on the drug. Instead of choosing to fight over dividing states into smaller states or whether somebody's comment is blasphemous, look at what matters - the health of the public.

      I have seen people bring their child blue and cold to my ICU at 2am after keeping him at home while he was dying because their seniors told them that it was an inauspicious time to leave the house at night and that 'Devi' would save the child... can i ask who should i blame for this ? shall I blame a family or a community or a caste or a religion ? Won't you all call me silly then ?

      No doctor in his right mind can say that all docs in India are pure of perfect... but branding all docs with the same taint of some people is not the answer.
      If you want to go by internet prescribing, be our guest... as Dr Riyaz said, all the best finding a single drug which doesnt have side effects... or knowing drug interactions...or the role of resistance... or the side effects of taking the wrong drugs due to similar sounding names.

  10. Now this time I visit many website and found many information but I think this is very important information all of us.I will sharing this information some other people.Thanks for published this information…

    what is diabetes

  11. Very nice post by Mrs.Pattu Raj. AT present definition of Doctor has changed lot. Some people think them God and some devil, it is just matter of how their patient is treated.


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