Diary of a Young Doctor(part 3)

(published in The Friday Times on 29th June, 2012)

Diary of a Young Doctor III

"Please guide us, doctor. We have come back because the local dispenser [quack] refused to administer the injection you wrote for our son, saying it is too 'heavy'." 

I was busy making the 'discharge form' of a patient when that couple came towards me and said those lines. Their teenage son had been discharged yesterday upon their request, and I had prescribed an injection that he needed every day for the next week. The couple said they would get their son the shot through a dispenser in their locality. And they were back the very next day.
A doctor can, just by clicking on the computer screen, get free medicines for needy patients


This is not a unique situation. Apart from managing patients feigning abdominal pain in the emergency ward and waking up during the "on call" nights after every hour to change a transfusion bag, this is what young doctors do in "routine". A routine day comprises duty of about 6 hours, from 8 in the morning to 2 in the afternoon. We start the day by checking patients on the beds allotted to us and by writing down the DPNs (Daytime Patient Notes). This is followed by a survey of our work and additional examination by our immediate seniors, the Medical Officers. After that, there is the ward round by any one of the designated consultants/specialists. During the round, the consultants listen to the medical history of patients from house officers or medical officers and look through the investigations carried out previously. Then, according to the situation of the patient, investigations or different drugs are advised which are added later to the charts by House Officers.

If the patient is newly admitted and can't buy medications on their own, there are two ways of getting them free medicine. There is a list of medications that are provided to our wards every day by the hospital. They include most of the commonly required drugs, and a doctor can, just by clicking on the computer screen, get free medicines for needy patients. Another way is through the Medical Superintendent (MS) of the hospital. For that, the patients' file has to be signed by the MS himself, which is not a hard thing to do. Then there is the problem of urgent investigations. For that, house officers have to counsel the attendants and sometimes have to get involved themselves to get those tasks done through the emergency department. At times, the bureaucracy of it all can get in the way and frustrate patients.
I have seen patients who think they are not being treated fairly threaten the doctors by mentioning political figures or members of the bureaucracy


As in the rest of Pakistan, a patient is likely to get sufficient attention (which mostly means more than normal) if they know someone in the hospital hierarchy. This doesn't mean that doctors don't care for their patients; it's just that we find it difficult to divert our energies where they are not required.

This 'protocol' business can turn ugly. Many a times I have seen patients who think they are not being treated fairly threaten the doctors by mentioning political figures or members of the bureaucracy. It happens particularly frequently in the hospital where I work because we have to deal with all kinds of government employees and their kith and kin. According to one of my seniors, even if the gardener of CM house brings a patient to the hospital, he expects to get 'protocol' equal to that of the CM himself.

Hospitals are great places, not only for learning medicine but also for learning about the different shades of life. I would like to mention some of the most interesting cases I have seen in my brief clinical career.

The fiancee with the headache before her FA exams brought to the emergency by her very concerned fiance, the CA student who had not eaten anything for a month due to some kind of love affair; the 65 year-old woman patient who insisted on smoking despite the disease in her lungs; the helpless relatives of a 70 year-old woman who had to get dialysis but couldn't find the hospital where it was urgently available; the 50 year-old woman with tuberculosis of the meninges (brain coverings) and an untiringly colorful vocabulary; the madrasa student who sat for his Dars e Nizami exam while he was admitted in the hospital; the women loudly reciting Quranic verses around a very sick patient and freaking out the doctors; a 15 year-old boy spending most of his time around his ailing mother in the ward and running around taking her samples for laboratories; the young patients (mostly girls) with acid/bleach intake for suicide purposes and the attitude of their families towards them; and all those patients who are never satisfied when they are prescribed pills and demand injections and drip infusions just to feel medical; and all the drug mules who are accompanied by police or custom officials and deny any wrongdoing until the last minute.

There are also issues among various departments in the hospital that cause unnecessary delays in diagnosis and treatment of patients. The Radiology and Pathology departments provide services to all the rest of the Hospital, and are indispensable in the management of patients. If the same tests are to be done from private labs, the cost is not affordable for most of our patients, who belong to the lowest strata of the society economically.

I would also like to mention that there are almost no holidays for young doctors during their house jobs. In the department where I work, we only get 2 holidays in a month, both Sundays. Apart from that, we only get one emergency leave per month.