Doctors in Pakistan: Sumbal, only the peptic ulcer wali bibi, not a person with feelings

Published: February 19, 2014
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Our patients trust us enough to submit to the most uncomfortable and embarrassing examination procedures we can subject them to.

Her doctor thought she was an open mouth for him to dunk pills into. Instead, she turned out to be a person with thoughts, feelings and questions that were all left unaddressed.

As part of Pakistan’s tightly-knit community of doctors, it is common for us to share our horror stories about non-compliant, abusive patients with laughable misconceptions about drugs and bodily functions. We softly giggle at them mistaking left-sided abdominal pains for appendicitis, when the appendix is in fact on the right side.

And the unspoken conclusion drawn each time is that a patient is too uninformed to be trusted with his own medical decisions. Thus the standard operating procedure in Pakistan is for the doctor to hijack the patient’s body and do unto it whatever he thinks is best.

In a recent blog post, one mentions a woman complaining about her nephew’s chest being assaulted by doctors – a manoeuvre that turned out to be life-saving CPR.

Was it not incumbent for the doctors to explain to the attendant the kind of procedure they were conducting? Or at least do so later at the first available opportunity? If someone walks up to you and starts pounding your chest, wouldn’t you ask,

“Pardon me for being so nosy, good sir, but what on holy earth do you think you’re doing to me?”

Rather, they acted as if the adult guardian had entirely surrendered the child’s anatomy to the doctors, to do with it whatever pleases them – no questions asked.

But there were questions to be asked and the family left the hospital believing that their child had been attacked when, in truth, the doctors had probably saved his life. This dictatorial approach cost the concerned doctor his rapport with his patient, even if the procedure he performed was fully justified.

Something similar happened to Sumbal, an uneducated young woman not dissimilar to countless others who walk into our clinics each year. She requested an ultrasound for upper abdominal pain. That being an unnecessary test in the given case, the doctor sternly brushed her off with a prescription for anti-ulcer drugs.

Outside the doctor’s office, her eyes welled up with frustration. It wasn’t, I expect, because the doctor was rude but because of how incredibly small he made her feel; making it obvious that her feelings were irrelevant before his medical degree and that she should simply put a capsule in her mouth and zip it.

Inside the office, she wasn’t Sumbal; she was the peptic-ulcer-walibibi, and treated precisely as such.

She had questions.

Wasn’t the ultrasound a superior therapeutic tool?

Was the medication ‘hot’ or ‘cold?

Would it affect her reproductive cycle?

All questions were based on the horribly flawed understanding of the drugs and diagnostic procedures, but it was the doctor’s job to clear them up and send her home, at least, partly satisfied. This is where the subject of Behavioural Science he grudgingly studied in medical college had to be practically applied.

I doubt this patient took those Proton-Pump Inhibitor (PPI) capsules. She probably chucked the prescription out and went back to whatever traditional remedies she had been using.

Outside our community of doctors, an average Pakistani mumbles about greedy, incompetent doctors who don’t really care about their patients. Within our community, we decry foolish patients too uneducated to comprehend the wisdom of our ways; those hating us for not having the divine authority to defy death in all cases.

Who’s really to blame?

I turn the finger at myself, not because I’m greedy or incompetent, but because I’ve done a lousy job convincing my patients about how my decisions benefit them. I’m part of a system that not only bestows little value to the art of keeping patients satisfied and compliant but is also so congested that it leaves me little time to provide each patient the attention he or she deserves.

Our patients trust and respect us enough to submit to the most uncomfortable and embarrassing examination procedures we can subject them to.

The least they have is a right to be informed of what’s being done to their bodies.

Faraz Talat

Faraz Talat

A medical doctor and bubble-wrap enthusiast from Rawalpindi, who writes mostly about science and social politics (and bubble-wrap). He tweets @FarazTalat (twitter.com/FarazTalat)

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