Lessons from the NHS

• Cultivating a certain temperament in professionals

It’s an unpopular opinion among the Pakistani medical community, but I’ll say it anyway.

The person who walks into your clinic is not a professional patient. He is not being accompanied by a professional attendant. Neither of them went to a special training colleges to learn how to be good patients or attendants; how to approach a doctor, how to cooperate with a physical examination, how to say ‘Aaaah’ properly when the doctor comes up to one with a tongue depressor.

Within that clinic room, there is just one professional and that’s you: the doctor. You are there to manage the patient; the patient is not there to manage your temper and emotions. It’s irrelevant if the patient misbehaved first. It doesn’t matter that you’ve had a busy day, running around the ward examining patients and taking blood samples. It doesn’t even matter if the patient is non-compliant with the medical advice and prescription you gave him; it’s his body, he does whatever he wants with it.

You’re a patient in pain. You’re distressed. You are permitted to not be at your best behaviour. It’s your doctor’s job to soothe your pain; to manage your distress with medication, speech, or a hot cup of chai

What matters is the way you deal with the situation, as a medical professional fully aware of the code of ethics to which you’re bound.

This is a concept that many medical professionals in Pakistan, sadly, do not know. Unrestrained classism plays a role. The well-paid consultant considers it a personal affront when the lowly patient refuses the medical prescription, and says he’d rather go to a pir instead. The specialist feels annoyed when the patient bashfully admits that he cannot afford the medicine he’s been prescribed. His poverty, ignorance, and unscientific ideas do not justify the consultant’s misbehaviour. No, you cannot berate your ‘jahil’ (uneducated) patient; he has not had the privilege of receiving the education you’ve attained.

Working for the NHS, I overhead my team manager say that you can teach employees skills and competency, but you can’t teach them values. Knowing the correct dose of antibiotic to be given to a patient with kidney failure, is not what makes you a good doctor. You can Google that information in fifteen seconds, or look it up on an app in half that time.

The NHS demands a certain temperament from its professionals. You must be polite. You must respect one’s autonomy. You’re expected to advise one on his health problems, but you must be prepared to submit to one’s agency over one’s own body. This is not a vertical relationship between a guru and his disciple; it’s a horizontal partnership between two adults to achieve a certain goal.

You must respect his confidentiality, and that involves more than just avoiding deliberate dissemination of patient’s personal medical data. I was once at an educational meeting with a junior doctor presenting a particularly complex medical case to a room full of medical professionals. Four minutes into the presentation, one of the doctors rose from his chair and walked out of the conference saying, “I think this patient is my neighbour. I’m going to step out!”.

This is a particularly impressive display of good values, considering that the case itself was anonymised. Although the patient’s name and other identifiable details had been meticulously erased and left out of the discussion, there was apparently enough detail in it for the doctor to suspect that the patient could be his own neighbour.

These aren’t just anecdotes. This is a well-organised system that has built itself over decades of trial and error, with the assumption that ‘private’ medical care is not an option. The NHS is presently under a great deal of political and financial strain, with widespread protests against funding cuts. Despite the sheer heartlessness and heinousness at display at the higher office, there is a general acceptance of the fact that nobody should be allowed to profit from your cancer and your disability. The private sector is about private profits, not collective welfare.

But we are easily tempted to look closer at how an individual doctor treats an individual patient, and the difference between what we find in Pakistan and the UK is absolutely striking. Even private medical practitioners in Pakistan cannot hold a candle to the compassionate service offered by doctors in the NHS. It’s not simply a matter of facilities and equipment (even at the NHS, I recall plenty of light infighting among wards over skin stickers for ECG); but the way a doctor is trained to see his patient.

You’re a patient in pain. You’re distressed. You are permitted to not be at your best behaviour. It’s your doctor’s job to soothe your pain; to manage your distress with medication, speech, or a hot cup of chai if necessary. You mustn’t settle for the privilege of having a doctor touch you with his stethoscope.

Expect your doctor to make you feel better.