Doctors, where art thou?

Published: May 6, 2012

The doctor to patient ratio is a mere 1:1436 – that means, a single doctor caters to the medical worries of approximately1500 people.

Pakistan has a count of ‘athara crore awaam’ (thank you, dear politicians, for continuously repeating this in the television talk shows) while the doctor/patient ratio was a mere 1:1,800 in 2010 – that means a single doctor catered to the medical woes of 1,800 people, and the situation has not seen much improvement ever since.

The constitution of Pakistan clearly describes that the state has a responsibility,

“To provide basic necessities of life, such as, food, clothing, housing, education and medical relief, for all citizens, irrespective of sex, caste, creed or race.”

But where does the problem lie?

It lies in the fact that there are many people like Dr Shahista Wahidi, and our very own Dr Firdous Ashiq Awan.

According to a list of The International Institute of Medical Education, there are 33 medical schools in Pakistan, capacitating hundreds of individuals to make a difference in a nation that is besotted by a range of health issues. And the government spends approximately Rs500, 000 to Rs700, 000 annually, on a student enrolled in government funded medical schools.

In turn, some of these individuals show their gratitude by bidding farewell to the profession. This is especially true of the fairer sex, because out of the 70%-75% female enrolment in medical schools, only 10%-15% end up practising, which portrays a waste of funds given by a government that is already plagued by a plethora of problems, including dismal levels of corruption.

While it is understandable that the working conditions provided by many hospitals are not favourable for females to work in, but many also choose to leave the profession for more lucrative career options.

Eventually, who silently suffers and sits crammed in waiting rooms that reek of death and gloom?

Athara crore awaam.

It is time to take drastic and calculated steps to take control of this predicament, before the issue spirals out of control – just like our economy.

All medical students should be made to sign a bond with the state, pledging to employ a certain number of practicing years. Failure to do so should result in them paying off subsidies that are granted by the government in the first place.

Another dissuading factor would be to revoke their degrees if the number of years guaranteed are not fulfilled.

A major deterring factor in a female doctor’s professional growth is the worry of leaving her child in safe hands when at work. This dilemma should be countered by establishing day care centres in all the hospitals, and the threshold of their quality should be such that the children’s psychological, academic and physical development is ensured in an effectual environment.

Provision of flexible working hours should be morphed into a certainty, allowing females – especially married ones – to work on timings that are workable and conducive for them to maintain a balance between their personal and professional obligations.

Courses on ethics and morality should be introduced in the MBBS programs in a quest to instil a sense of responsibility in all the potential doctors. If nothing else works, calls of their conscience would be enough to awaken the entrusted sense of duty.

Unless a “carrot and stick” approach is adopted and the Ministry of Health comes up with workable solutions to counter this detrimental practice, the ‘athara crore awaam’ will remain stuck in this perpetually vicious cycle and the government will keep wasting its scarce and desperately needed resources.

 Read more by Sabeer here.

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Sabeer.Lodhi

Sabeer Lodhi

A rebellious misfit who likes to say it as it is, he also works as a freelance writer and tweets as @sabeerlodhi (twitter.com/sabeerlodhi)

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • http://pakistani-edu.blogspot.com Usman Shahid

    One more thing should be assured that doctors should be hanged if he/she found guilty of negligence and killing of patients. They should not be allowed to say “it was the will of Allah and not their negligence”. Recommend

  • http://blogs.tribune.com.pk/author/430/faraz-talat/ Faraz Talat

    Medical students are required to study medical ethics and morals. It’s covered under “behavioural science”, which has become an important component of medical training.

    That aside, I agree with the problem of female med students. Those who waste government resources just because a MBBS degree improves their chances of finding good rishtas. And those who terminate their careers as soon as they start having kids. It’s ridiculous.Recommend

  • Ash

    And you actually think this will work ?
    ”Another dissuading factor would be to revoke their degrees if the number of years guaranteed are not fulfilled” This really gave me a good laugh!
    ”This is especially true of the fairer sex, because out of the 70%-75% female enrolment in medical schools, only 10%-15% end up practicing”
    Would you mind quoting your reference please ? Or these are your own facts ?Recommend

  • Parvez

    Very well written. You have identified the problem and supplied a remedy. Now all that is needed is to try have it implemented.
    If you had provided statistics of how much the government spends on health and how does it compare with other spending and how is this money distributed, it would have given a clearer picture. Recommend

  • Umair

    I have observed that there is some problem with doctors during their house job period. Either it is due to long working hours or not studying ethics course in MBBS but there is some problem with young doctors. I understand sometimes it is difficult to tackle certain type of ppl but this temporary behavior should not become part of personality. I salute female doctors working in night shifts. I don’t know about survival of patients but make up on their faces always survive.

    @ Author:
    Please write something about nurses as well.Recommend

  • Zeeshan Ummaid Ali

    Buddy, first of all Ethics and Morality are already included in the MBBS education system of Pakistan as “Behavior sciences”. You should read that sometime. I recommend you buy the book Mowadat H Rana’s Behavior sciences at any medical book store.

    Secondly, Pakistani government dosent want to change things. I am just not blaming the government for no reason. I got reasons.
    Let me introduce myself. I am a foreign medical graduate who came to Pakistan in mid 2011 thinking that I could bring some changes here. But its been one whole year since I graduated my 6 year M.D., these PMDC (Pakistan Medical and Dental Council) have not been able to take my exam, register my degree and determine my eligibility to work here.

    Every country has a registration process for taking medical graduates from abroad. India has one, UK has one and the rest of the world has one. PAKISTAN HAS 3 NOW!! FROM THIS YEAR for which I have to pay 3 times more examination fee (equal to ~40,000rs) than last year and waste so much time that i had not imagined. Other countries have already assessed 2 and more medical batches and yet we are still waiting. (india MCI EXAM 2, UK PLAB EXAM more than 3)

    Its seems that Pakistan Medical Council wants us to go away. And I , inshallah, will fulfill their desire by going back outside where I came from. Its the people who make a country and despite what encouraging stuff you write about this country everyone knows that this is a place of losers and stabbers. So accept it and work to make it better.

    What i gained from Pakistan is that I have been mugged twice having my cell phone and wallet taken by some Paki dude pointing a gun towards me nothing more.

    This year has been a very challenging year of my life as for this examination you can even BRIBE THIS GOVERNMENT INSTITUTION 7 to 12 lac rupees in order to get the registration. I surely don’t want to do that, its HARAAM, but some do. This is the reality of your medical system. Where there are beggars in disguise of doctors. Where instead of giving opportunities to foreign medical graduates (which are only a handful ~1000) they make them wait and wait so they get fed up and leave the country.

    I even cannot continue a life here, forget about the sick people. In a country where doctors go on strike and watch hundreds of thousands die. THIS IS PAKISTAN. THIS IS YOUR PAKISTAN. JEEVAY JEEVAY PAKISTAN for the rich and the ones in power.

    By the way if you ask I do have e-mailed many people in media about the corruption in medical council here. But too bad, you guys cant even help. No worries, ill leave the place anyway. Recommend

  • MED student

    All medical students should be made to sign a bond with the state, pledging to employ a certain number of practicing years. Failure to do so should result in them paying off subsidies that are granted by the government in the first place.

    All politicians should be made to sign a bond with the state.pledging to keep their wealth for number of years in country failure to do so should result in them surrendering all of their wealth made from this country.Recommend

  • Ashar

    As I have been told by one of my friends who is an oncologist working in Canade, there are about 25 thousand Pakistani doctors working in US and Canada, all surely specialists. Most of them wants to come to Pakistan provided we provide them the environment that they need to work in, and that is not the matter of wages since most of them have earned a lot already. Something they need is security, respect and proper placing in the Hospitals with required facilities.

    As for the blame of neglegence that has been made a point in the above article, it is the politician who is behind this and the main cause is nepotism.Recommend

  • Bilal

    a course on ethics?? sign a bond?? in PAKISTAN?
    AHAHAHAHAHAHAHHAHAHAHAHAHAHAHAHA im sorry i thought u were being sarcastic.

    @zeeshan i feel bad for u dude, im glad u wont stay in pakistan, this country and its people dont deserve honest and qualified people.Recommend

  • http://blogs.tribune.com.pk/author/944/sabeer-lodhi/ Sabeer Lodhi
  • Zafar

    @Usman Shahid: Doctors wouldn’t live through their 2nd year of training if your idea was implemented. But there does need to be accountability.Recommend

  • sars

    Speaking as someone practising medicine for more than a decade let me assure you hardly any doctor kills patients out of negligence, no matter what the daily press would have you believe.
    Doctors in Pakistan are generally have the odds against them especially if we talk about government hospitals which are generally short of funds and the sheer volume does not allow for competent care. This blame should be partly put on the government but also on the hospitals themselves for misusing whatever resources they have. Its unfair to blame a (usually junior) doctor for lack of essential lifesaving equipment. A difficult attitude from often armed attendants also makes things worse, even in the best hospitals.
    Private hospitals generally perform better due to availabliity of more resources and better trained personnel,so there is more accountability.
    At the training level, no matter how many doctors you produce if 90% stay in cities as is the current case , how will healthcare in towns and villages improve? the answer is either have some allocated seats for these areas and ensure that after training these doctors move back. Also there should be a mandatory at least six month rotation of graduates from all medical colleges in these areas. Recommend

  • Doctors are Negligent

    @sars:
    “Speaking as someone practising medicine for more than a decade let me assure you hardly any doctor kills patients out of negligence, no matter what the daily press would have you believe.”

    Let me assure you that doctors are involved in acts of negligence on a DAILY basis. My father went into coma for five years and then passed away, only because of a junior doctor’s negligence who left the operation theater after giving him anesthesia..and there was no one to recover him when he had a reaction with the local anesthesia. The lack of resources has got nothing to do with this. It is a case of utter negligence of both the junior and senior doctors who killed a patient with local anesthesia only because they were not present in the OT. and while my father was in hospital, I almost daily saw cases of negligence by doctors. For instance operating left eye instead of the right one, etc. The private hospitals are not efficient because of the resources, they are efficient because the doctors over there are minting money and they can’t afford to lose their reputation and hence, the money they are minting. I believe every tom, dick and harry should not be allowed to become a doctor and only people with real passion to serve humanity and the passion for hard work and sincerity to learn should be allowed to work. Recommend

  • Faisal

    Our preventive medicine is very poor and whole focus is on treatment. Infections, heart disease, some cancers and STDs are all preventable if few simple principles are followed but there is a shocking lack of awareness and poor political will for the same. Our govt hospitals, at least in Lahore r doing a really good job keeping in few resources and work-loads. Its important to remember that good mistake-proof medical care requires tons of money, both in training of staff and infrastructure, something the country cannot finance. Recommend

  • Atif

    ” Where does the problem lie”. The author wrongly answers this question by saying it lies in a deficiency of doctors. There is a deficiency of quality hospitals to employ those doctors as many are unemployed. There is a more acute deficiency of nursing staff and their training facilities. More patients die because of poor nursing care rather than mistakes by docs. Further, there is no coherent disaster response, no emergency medical care in the bulk of the country leading to loss of life. Last but not the least, there is no community medicine, no health awareness and most preventable diseases wreak havoc.
    PS: greed in the pharma sector ensures costly alternates of cheaper medicines are available while the cheaper medicines r not. The regulators definitely make a lot of money here. There is corruption among doctors and malpractice to make money, commissions to advise tests, unnecessary surgery and so on.
    The problem is very complex and while I appreciate this kid’s effort, ET should have hired a professional rather then this gentlemen or any ordinary doctor to discuss the medical delivery system or the lack of it in our country.Recommend

  • http://blogs.tribune.com.pk/author/944/sabeer-lodhi/ Sabeer Lodhi

    @Atif:

    I absolutely agree there are all these problems that you highlighted but if you read the introductory paragraph, it gives a gist of what the article is going to talk about. It is solely aiming at doctors who do not practice.Recommend

  • haroon

    lol @ the title!Recommend

  • bp

    Please, have a little respect for those who become proper doctors and call these ones you refer to in your article as ‘medical doctors’. Thank you.Recommend

  • elementary

    @Author :Issue is largely political and can only be addressed with more gobal healthcare reforms.Lack of will ,resources and planning in Healthcare are at the root of it.
    However I will strongly disagree with some of your suggestions ,such as making medical students sign bonds, making them study morality ,carrot and stick, etc etc.With due respect these are myopic measures that can only make things worse.
    University education is not free in most developed countries and should not be free in pakistan either;it can be subsidised for underpriviliged but should not be at governmetn’s expense entirely.Recommend

  • Ali S

    As a medical student, I fully agree with you. One aspect you forgot to cover is the number of very talented government college MBBS grads who are eager to land a residency abroad right after getting their MBBS degrees. Ideally, even those who intend to practice abroad right after MBBS should be accepted only to private medical colleges – government funding for medical graduates is meant to be spent on serving the local population of Pakistan. Nowhere else in the world is becoming a doctor this convenient.Recommend