Physician, heal thyself

A new kind of mafia

The profession of a Doctor is quite respectful if one sees it in that perspective. Doctors in Pakistan are respected highly for their humanitarian profession. Lately this well-respected profession has come under harsh criticism due to the occurrence of different mishaps. One after another report has defamed the whole organisation. Doctors, who were once seen as life-saving paragons, are now deemed incapable of any humanity. We’re all quite aware that this sudden swing in attitude is entirely wrong and we’re conveying a very damaging visage about our nation being one that is biased & one which has an unstable attitude toward matters. The media is playing a major negative role as well by accepting & not trying to dismantle both accounts of a very complex story. Complaints by patients of irresponsible attitude from doctors carry weight & the medical community should take notice of the elements behind it. But being a doctor in the Government or Private sector is no pleasant walk in the park. So, let’s analyse some of the major variables that come into play during a doctor-patient relation.

According to a good friend of mine, there are rarely any serious charges against private practicing doctors. The reason behind this is that they are not supervised at all by any Government dept., whatsoever, and even the EDO (Executive District Officer) is only limited to Government hospitals. Doctors serving at Govt hospitals face serious consequences on even minor mistakes. But Govt hospitals are short of facilitation which can be given to patients. To be a little more specific, Govt hospitals in Pakistan are not providing the basic health facilities & responsibilities mentioned in the “Devolved Health Services Practitioners” Manual both Vol. 1 & 2. The Minimum Services Delivery Standards (MSDS) have two principal objectives, first they provide a common set of requirements applicable to whole health care system & second, they provide a framework for continuous improvement in overall quality of health. It seems that both of these objectives are waiting to be applied.

Facts & figures kept by the Health Dept. have been distorted to such an extent that they are unable to even provide the Mortality rate. It saddens my heart to reveal that in our country, the maternal mortality rate (MMR) is approximately 500 deaths per 100,000 births. It is highest in Balochistan at 673. One of the major reasons for this high maternal mortality rate is malnutrition, which affects 34% of all pregnant women in Pakistan. Around 48% of lactating mothers living in rural areas have a calorie intake of 70% less than the recommended level.

The standard list of medical equipment given by the Govt for RHC (Rural Health Centre) states that a total of 212 equipment’s & 93 medicines need to be available at all times. It also renders compulsory the use of gloves & round-the-clock availability of oxygen cylinder. Both are usually unavailable. The official human resource (staff) of DHQ Hospital for the 250-400 beds hospital is 20 specialists, 84 Medical officers (General Physicians), 2 dental surgeons, a nursing staff of 86, 52 paramedics & 201 other hospital related staff. Still, patients are unable to get proper treatment from our Govt hospitals, there are persistent complaints by patients about Govt doctors that they do not diagnose them properly or advise them to come to their private clinics in the evening. Registrars who set appointment for patients or commonly known as ‘Parchi givers’ humiliate patients in rural areas. Another depressing situation takes birth from the outpour of amateur and reckless medical interns, who usually learn by continuously practicing on our deprived class which leads to the ubiquitous cases the likes of which we read in newspapers of surgical instruments or towels left in the abdomens of the patient after the surgery. Drug inspectors are another cause of dysfunction. According to pharmacy owners, out of the 100 medicines taken by drug inspectors, a measly 10 makes it to the laboratory for quality check & assurance. Usually they either sell them to another medical store at a lesser price or exchange them for some vitamins or supplements.

Internationally medicines are recognised by their Generic name, which is a medical term described in brackets under the medicine name or at the back of the pack. In Pakistan, medicines constituting of identical ingredients are sold at varying prices. Another dilemma is that Multinational companies are giving medicine at wholesale rate to our neighboring country, India, whereas the same medicines are almost 300% pricier for us. This is solely due to the sky-high Govt taxes & duties.

Govt doctors express their grief related to lack of funds and facilities and being over-worked. They are under incessant pressure from political workers to register false cases & prioritise their patients. If they don’t succumb, they are usually posted to a faraway district or get suspended in a false inquiry. I think the Govt should at least ensure that doctors are not politicised in any way.

There was a time when Private hospitals were preferred by the common man because of their undivided attention & sincerity towards their patients but it’s a fact that this reputation is long lost. There are two main categories of private hospitals. First are the common hospitals that are supervised by two or three doctors & which usually provide ample services at a reasonable fee. The second type is the private hospitals that are run by senior doctors, surgeons or specialists who have established a monopoly of sorts in this profession over time. PMDC, whose main objective is to keep check & balance over doctors, is also under their influence because most of the PMDC office bearers are supervising these multi-operation hospitals. Their fee ranges from some Rs.1000 to Rs. 2500. To have to pay such high price for receiving medical facility that is every individual’s basic right is utterly unacceptable. Most private hospitals have rooms that are more expensive than a three or four-star hotels. All renowned private hospitals in Pakistan have patient bed starting from minimum Rs. 8000 basic with joint beds to Rs. 23000 VIP beds per night charges. To think how traumatising, it would be for the family of the patient who is already in such situation. Its common practice among doctors of these hospitals to make the stay as long as possible for the patient as they are also given commission on this basis.

The common Public has the view that doctors rob them in such a tactful way that they cannot grasp or question them because they are not familiar with the medical terms that they use. So, virtually, we have no idea what’s happening around us or what sort of treatment we’re being subjected to. Subsequently, there’s the role of medical firms & their hired medical representatives (reps). They are the one pulling the strings. When we see, some young white collared individual carrying an ordinary bag, we can’t even fathom that almost every bag has an offer so highly tempting that it’s truly hard to refuse. This white-collar bribe is presented to the doctors who recommend the firm’s medicine.

Another point that worries me is the unregistered labs operating in the country. Patients have to take multiple medical tests from numerous labs, just to verify results because often, the same tests procure different results. Govt should see into this problem & register all labs which are operating independently or are affiliated with a hospital. Private hospitals should also be compelled to register so that people can be assured of the degrees & experience of the doctors on duty. Registering private hospitals will definitely pose a positive impact, the fear of check & balance will improve the conditions & attitudes of doctors toward their patients.

Another predicament is that of DHMS (Diploma in Homeo medicines) & Hakeem’s. They may or may not be diploma holders who practice medical treatment from medicines claimed to be made usually in Germany. But amazingly, Germany has dropped this practice of HMS long ago. They come with the label of Dr. ‘initial’ and are found in large quantities in remote areas of Pakistan. About ninety percent of these medicines consist of steroids that give temporary relief but leave extensive effects on liver, kidney and even blood. Locals have no alternatives, because they offer cheap medicines at hardly 50 or 80 rupees which includes the fees. There is no supervision on these often-harmful practitioners. This practice leads to diseases on the scale of minor epidemics. HIV & Cancer are the most common & vital diseases that have spread due to home based private operation theaters built by these people. Re-use of the injections, gloves, cutting equipment & especially dental equipment has caused devastating effects but still PMDC or Govt is doing nothing because their families gets the best treatment in Pakistan and abroad.

Of course, this doesn’t mean that all doctors should be sent to the gallows. There are good people too – respected & honored on all forums. My colleague & fellow journalist, who is a very well known & senior producer in a national TV channel, mentioned a very interesting bit. He said that every parent has a priority that his son or daughter becomes a doctor or an engineer but the consequence of this priority has emerged as the drawback that there is now a surplus of doctors in our country. While it costs about 12 to 14 lakhs for a simple MBBS, further specialisation requires a hefty amount. Consequently, problems occur when these fresh doctors are pressurised by the social taboos or norms of our society that dictate that it is absolutely mandatory that they acquire the three ‘B’s that have become the merits of respect in our lop-sided society. Big car, big house & big bank balance. To fulfill these corrupting aspirations, doctors, like any other person, take inappropriate steps, resulting in utter degradation of this respectable job. Another point my friend mentioned was that Govt is not taking any steps to sponsor medical education. Students belonging to average families who get high grades in medical studies usually borrow money from banks which they have to repay right after completion of house job. Thus, the fear of a recovery team coming & knocking at their door makes them lean towards unconventional means, or the alternative is to apply for a job abroad rather than working for their own country. Doctors are humans too.

While discussing my concern over the topic, I asked the opinion of two students of a prestigious university. The replies were, “Doctors have formulated this profession into a money-making mill” and “Actually the main problem lies with the prayer said by the doctors. Whenever they pray for the improvement of their clinics or hospitals, more people fall sick. It’s really simple, if you get what I’m saying!”

Every profession has a moral duty to abide by; such is the case of a doctor who takes oath to protect life by all means. To tell you the truth, we expect doctors to be no less than angels because of their profession, when we go to them, we trust them with the most precious thing given to us in this world: our lives. And in return we expect only one thing – a promise not to break this trust.