Doctors Strike: The Aftermath

Doctors’ Strike: The Aftermath



It has been two months since one of the largest strike by doctors shook the province of Punjab. It all started with the closure of Outdoor Patient Departments (OPDs) in all major hospitals across the province as a gesture to protest against the attitude of the Government of Punjab in provision of a better service structure for Doctors. It was a move designed to be of minimal impact because only ‘stable’ patients visit OPDs and there was no threat to patients’ lives. Last year similar protests by doctors led to a commitment by the Chief Minister to provide a new service structure and committees were formed to pave the way for formulating an acceptable formula. The closure of OPDs happened after one year of useless meetings with the representatives of Punjab government.

Last year, government was unable to control doctors and the chaos led to loss of many precious lives and ended with a truce. This time around, Khwaja Salman Rafiq (brother of Saad Rafiq and Special Assistant to Chief Minister on matters of Health) was designated the responsibility to ‘deal’ with the situation. Punjab Government started giving half-page advertisements in all major newspapers stating it had already done too much for the doctors and that doctors were essentially getting too big for their own boots. An estimated Rs. 1.6 million per day was given to newspapers and Rs. 450 million of public money was spent on advertising by ‘Khadim e Aala’s government. In addition, Essential Services Act was enforced by the govt, making it mandatory for doctors to do their OPD duties or else receive legal proceedings.

On 1^st July, 2012(after 21 days of OPD closure), a police raid was conducted at Doctors’ Hostel, Services hospital Lahore, resulting in arrest of numerous doctors. The same night, hundreds of other doctors were arrested from their homes. There was another raid at Doctors’ Hostel, King Edward Medical College on the night of 2^nd July. A total of 360 doctors were kept in Jails including Kot Lakhpat, Attock and Mianwali for four days. As a result of all this, emergency services were withdrawn from all major hospitals and any negotiations were made subject to release of all the doctors.

I want to recount some of the ‘stunts’ pulled out by the government during all this, apart from ‘Advertisement’ money from the public exchequer.  

1. ‘Medical Martial Law’:

As a ‘contingency’ plan during the closure of OPDs, Punjab government requested help of Army Medical Corps (AMC) to decrease patient overload. This was an unprecedented act of desperateness and expediency shown by the big-wigs of Punjab Government. This ‘experiment’ did not work out though. It failed miserably. Senior Doctors said it on record that the Army doctors were not trained to deal with such situations. Additionally, those doctors were paid Rs 2000 per hour of duty and special police contingents were employed outside hospitals where the Army doctors worked. For comparison, government of Punjab was paying Rs 800 per day to junior doctors and Rs 1400 per day to seniors whose places the Army doctors took for few days.
There were reports of those Army doctors misbehaving with the senior doctors and the ‘flexible’ duty hours practiced by our 'Jarri Jawans'. At the start of the Strike, Zaid Hamid's Baloongra's alleged that YDA punjab is actually “NGO funded Young Animal Association” and they work for money, not for saving lives. The 'Brave' Army Doctors that came 'to the rescue' didn't work for free though. This is the characteristic selective Amnesia practiced by Qibla Zaid Hamid and his followers.  For the Record, only 200 Army Doctors were deployed.!!!

2. The PCO Doctors

During the strike by Junior Doctors, Government hired around 500 new doctors (in place of around 5000 doctors) on ad-hoc basis. Those individuals are known these days as ‘PCO doctors’. They mostly include foreign graduates (who can’t normally get jobs at Government Hospitals as per orders of Chief Minister) and people who could not get job in ordinary circumstances. Some people, who had not practiced medicine for more than 10 years, joined the service just to get a paid Job. Chief Minister Punjab is fond of parroting the mantra of ‘Merit’ but these blatantly out-of-merit inductions did not gain his attention. All these people were hired against the rules and on ‘paid seats’ while more than 50% doctors work in government sector without getting any pay.

3. The legal Front

Apart from hundreds of doctors arrested without any justification, four doctors from Mayo Hospital were charged with Murder of a child that died in the Pediatrics Ward on the night of 1^st July, 2012. The Strike was also challenged in court and it resulted in involvement of Lahore High Court in the matter. The court ordered to release all doctors who were arrested without any legal reason and granted bail to the four doctors alleged to be involved in the Murder. It was further ordered that matters pertaining to Service Structure should be solved amicably by the Punjab Government.

4. Lies and Damn Lies
Throughout the strikes, there was a continuous propaganda mongering done against the ‘Cream of Nation’. Government Officials lied on Television programs and press-conferences about doctors being greedy, selfish, hooligans etc. The entire Advertisements campaign consisted of Jacked up figures that were used to fool people.

The Aftermath

On 2^nd August, one month after the strike, a follow-up meeting was called up by Young Doctors Association in Services Hospital Lahore. Dr. Amir Bandesha, member of the committee delibrating the future service structure, explained at length about the proposed changes to the existing structure and the points on which a consensus had been reached between Punjab Govt and YDAP. ‘PCO Doctors’ are still working in the hospitals despite resumption of services by young doctors and it is the demand of YDAP to transfer them to DHQs and RHCs.  After the meeting of general council of Young Doctors Association on 29^th August, 2012, province-wide protests were held on 5^th of September to exert further pressure on the Govt to solve our problems. Committees have failed to provide us any relief and even the Lahore High Court has been unable to enforce the writ of law. Another Protest/Dharna is planned for 19^th September and a March to the CM Punjab House after that. Is another showdown between doctors and State on the way?

Brain Drain-1

(Published in The Friday Times on 14-09-2012)

33,703 candidates appeared in the entry test for medical colleges in Punjab last year, competing for 5,271 seats in 40 public and private medical and dental colleges. Nearly 3,500 seats are available in 15 medical and 3 dental colleges in the public sector, while 1,850 seats are available in private medical and dental colleges. This suggests that the top 3,000 candidates would be able to secure admission in the public sector and around 2,000 more will get admission in Private Medical Institutes.

These figures raise the question: What about the rest of the 28,000 students who passed FSc (Pre-Medical) with more than 60% marks but were deemed not good enough to get admission into a medical college, either due to merit or financial issues, as Private Medical Colleges charge almost half a million rupees every year only in tuition fee? 

As the saying goes: where there is a will, there is a way. And that's another way of saying that students who want to become doctors should make use of opportunities to study medicine abroad.

Medical education in developed countries such as USA,UK, Australia and Canada is much more expensive than in Pakistan, so the options for most Pakistani students are either China or the ex-Soviet states such as Kazakhstan or Kyrgyzstan. Medical Education in these countries is imparted in English, so there's no worry about language barriers. Browse through any English or Urdu daily in Pakistan and you'll see advertisements for institutes in these countries. 

This trend of going abroad to get a degree in medicine started in the 1990s when Central Asian colleges became a destination for students who lacked good marks. It should be pointed out that the minimum eligibility criteria for the Medical Colleges Admission Test (MCAT) is 60% marks in FSc. Initially, students with marks as low as 35-40% were able to secure admissions in Central Asian colleges. It was a dream come true, a shortcut bypassing the system in Pakistan. Chinese medical institutes offering medical courses in English started in the last decade.

At present, around 2,000 Pakistanis are studying medicine in various medical schools across Kyrgyzstan. According to the United Nations, a July 2006 survey of medical students at nine institutions in Kyrgyzstan rated their level of knowledge between 2 and 2.6 on a five-point scale. In China, there are 6  medical colleges and 1 dental college recognized by the Pakistan Medical and Dental Council (PMDC). Each of these medical schools has around 150-200 Pakistani students per session. Nine hundred Pakistani medical students are presently studying medicine in Cuba on scholarships awarded by the Cuban government after the 2005 earthquake. But PMDC does not recognize Cuba's medical colleges and the living conditions of our students there are pathetic. Around 100 Pakistani students are studying medicine in Bangladesh. Vulnerable students are duped into some of these places with fancy titles like 'WHO Recognized Medical Institute'. The fact remains that WHO (World Health Organization) "has no authority to grant any form of recognition or accreditation to schools of medicine or other training institutions. Such a procedure remains the exclusive prerogative of the national government concerned." (This is WHO's own clarification.) The Pakistani state has done little to stall this "business". Pakistan's embassies in the respective countries do not own the students if they face any difficulties regarding the whole process. In Cuba, students live 15 Kilometres away from the city in which their college is located. In China, many universities which are not officially recognized enroll students using paid agents in Pakistan. Every admission gets the agent a fixed amount of money and the unsuspecting student can't get out of this maze easily. The big problem facing Pakistan's health system is the influx of these Foreign Educated Doctors and their integration into the system. These medical graduates are not at par with their counterparts from Pakistan-based institutes and that creates a chasm in their ability levels. In almost all the foreign universities, clinical training, the backbone of undergraduate programs, is seriously lacking because of obvious language constraints. You can teach students in English but you can't teach them all the required nuances of the local language in such a short period of time. Without the necessary knowledge of the local language, how can anyone get a good medical history from a patient? (Around 70% of clinical diagnoses are based on a patient's medical history.)  PMDC has made it compulsory for all international medical graduates to pass a specially designed test to practice medicine in Pakistan. This is the only intervention done on a governmental level for these doctors. A lot of those who can't pass the test end up working for private hospitals, as they can't get jobs in the public sector. This alternate pathway for medical education is going to flood Pakistan with a lot of substandard doctors very soon.

Diary of a young doctor(part 6)

(Published in The Friday Times on 17th August, 2012)

Medical Science, like other disciplines of science, is a constantly evolving subject. New discoveries are being made, new ways to treat and look at diseases are being researched and newer drugs are being introduced on a daily basis. But the medical profession in Pakistan is lagging far behind the rest of the word in innovation and research. Very little, if any, research is being done by public sector hospitals and medical colleges. Apart from the Aga Khan University and Shaukat Khanam Hospital, there are no recognizable research centers in the country. Due to this issue, most of the books we consult during MBBS are written by Western or Indian authors.
It may come as a surprise to the reader that doctors in Pakistan are required to do research as part of their curriculum, both at the undergraduate and post-graduate levels. The ground realities, though, are very different. Very few of the "researches" done by Pakistani authors are published in international publications. On the undergraduate level, the research is mostly very basic and does not require much critical thinking, nor is it up to an international standard. The Community Medicine departments (responsible for overseeing research) ask students to choose from a particular list of topics on which research can be done. No funding is provided for the purposes of research. Students usually take shortcuts just to fulfill the academic requirement, and the matter is over after the final exams.
On the post-graduate level, where research is an important tool in the rest of the world, Pakistani doctors do not spend enough time on research topics. Most of the topics are re-hashed versions of the same old 'traditional' things. A grand sum of Rs 2,200 can get you a good synopsis on your chosen topic. Plagiarism is not thoroughly checked, so liberties can be taken in that regard. I questioned some of the senior doctors about this trend and they pointed out a few factors responsible for this problem.

The foremost issue is financial. Most post-graduates do not have job security and often have to work at multiple hospitals. In addition, they do not get any kind of funding for the sake of research. In such conditions, all they do is look for shortcuts to fulfill the academic requirement. In Shaukat Khanam Hospital, doctors are paid handsome salaries and have job security, resulting in some serious research work being done there. The proposed Service Structure that was the demand of doctors during their recent strikes is a much-needed step as it would at least provide job security, if not lavish pays.

The second most important reason for lack of research is the absence of critical thinking from our curricula. Research is borne out of questions about persisting problems and requires finding solutions to problems. We, on the other hand, learn and see throughout our academic life that 'he/she who crams the most, achieves the maximum marks'. From nursery school all the way to the final year of MBBS, we learn how to rote-learn particular texts and then regurgitate them in our exams. Questions are discouraged at almost every level and many teachers think it a disgrace if they do not know the answer to a student's question. In addition, there are almost no research societies working in medical colleges. The only one that I encountered was a small society working out of Punjab Medical College, Faisalabad.

The third factor in this regard is the lack of teachers and instructors who can guide students about research. This problem is present both in medical schools and in the College of Physicians and Surgeons, the premier body that awards specialization degrees in Pakistan. In many cases, the supervisors for research are not well-versed in the art of evaluating a research paper as it is very different from an examination paper.

Despite all these problems and glitches, there are still some success stories. Pakistani doctors, particularly surgeons, have developed many indigenous solutions to the problems they have faced over the years. The need of the hour is to promote critical thinking and research among the medical community so that Pakistani doctors can compete on an even keel with their international colleagues.

Diary of a Young Doctor(part 5)

(published in The Friday Times on 27th July, 2012)


"I am really thankful to you doctor sahiba, you saved my daughters' life today," said the mother of a young woman to one of my female colleagues.

The very next day, another attendant had this to say,

"You doctors are murderers. You don't know how it feels when your loved ones die. You have killed our young brother. We will never forgive you."
Both of the above-mentioned statements reflect a common misconception in our society, that doctors are supposed to be messiahs who save lives. I may have to face the wrath of some of my fellow professionals for saying it out loud, but this can't be farther from the truth. During the five years of medical school, followed by countless years of medical training, all we learn are a set number of protocols to follow. There is no subject or even a chapter dedicated in any of our books on 'How to Save a Life' (excuse me for the reference to a song with the same name by the band The Fray). The main problem with this assumption is the immense responsibility it places on the shoulders of the attending physician/surgeon. Doctors, in general, safeguard the best interests of their patients but having the mantle of 'saviour' placed on their shoulders is more than a little unfair.
As a result of the 'messiah' label, doctors become the automatic fall guys when a tragedy occurs. Doctors are obliged to do their best, regardless of the expected results, and when their efforts fail, the first impulse of the attendants is to blame the doctor for the demise of their loved one. I am not saying that medical science is guesswork; but why is the medical profession considered a "calling from God"? It is high time we learned to differentiate between a profession and a calling from God. Doctors are "working" in hospitals. They aren't on a divine mission to save everyone who comes their way. They provide a service and in return expect to get paid for it. (And we know how that's gone done in our country.)
When doctors announced a strike to demand for a better service structure, the widespread reaction was that doctors should be philanthropists who put others before themselves and don't ask for a compensation package in return for the time they have invested.
To quote the columnist Ayaz Amir: "The young doctors' strike was not about doctors versus ailing and suffering humanity. In the Islamic Republic suffering humanity is a handy cliche, readily invoked to score a political point and as readily consigned to the upper layers of forgotten memory when the need passes. If anything, this strike was doctors versus a hidebound bureaucracy, one of the most ossified bureaucracies in the lands which can claim descent from the British Raj."

During the strike by doctors, one of the major objections was that doctors were supposed to provide health services in any condition, as they have taken an oath to do so. Let me make it absolutely clear that in the original Hippocratic Oath that was formulated around the year 425 BC, there is no provision that makes it mandatory for a doctor to provide health services to anyone who wants them. In the revised Hippocratic Oath, constituted by the British Medical Association, one of the points declares: "I will do my best to help anyone in medical need, in emergencies. I will make every effort to ensure the rights of all patients are respected."
Similarly, according to PM&DC (Pakistan Medical and Dental Council) Ordinance of 16th July 2011, Section 9, Sub-Section 2 (a) : "A medical or dental practitioner shall be free to choose whom to serve, with whom to associate and lay the timings and place of professional services to be provided."

While Sub Section 2(b) reads: "A medical or dental practitioner shall not be bound to treat each and every person asking his/her services."
In my opinion, one of the underlying causes of outrage against doctors during the strikes was the "messiah" proposition. How can someone who is supposed to "save lives" go on strike? As a nation, we are prone to miracles and magical rescues; we are always hoping for some messiah to come and save us from the "mess" we are in. This messiah complex has in the past led to acquiescence to dictators and demagogues. We, as a nation, need to mature and start believing in processes and institutions, not saviours. Bottom Line: Doctors are not messiahs; they are ordinary professionals doing the best that they can.

Reflections from Pakistan India Social Media Mela 2012

(an abridged version published by Express Tribune Blogs on 16th July, 2012)

Question: What is the one common thing between a writer from Mumbai, a Journalist from Delhi, a famous film maker from India and a Junior doctor from Lahore?

Answer: The fact that all of them loved hearing Iqbal Bano(it was actually Meesha Shafi, as pointed out later by Jugal Mody) sing 'Dasht e Tanhai main' on the radio, at wee hours in the morning while waiting to get CNG at a gas station in Karachi. 

For me, that one moment captured the spirit of Pakistan India Social Media Mela 2012. No wonder the slogan of the event said, “Faasla Na Rakhen, Pyar ho Jaanay Dain’(Translation: Overcome distances, Let love happen)

Organized in Karachi by PeaceNiche, in collaboration with the United States Consulates in Lahore, Islamabad and Karachi, it was supposed to be a gathering of social media enthusiasts from India and Pakistan. This being Pakistan, the criticism leveled at the event started much before the event itself. It was an invite-only affair and most people who were invited were recommended by other people. Participants from Lahore and Islamabad were sponsored by U.S Consulates in Lahore, Islamabad and Karachi for their travel and accommodation.

It was my first visit to Karachi and I was really excited by this opportunity. I boarded the plane from Lahore airport on the evening of 12th July, along with the rest of participants from Lahore. The visit was not only an opportunity to interact with new people but also to get a respite from the hectic schedule at the hospital. During the flight, I had a good, long chat with my seat mate whom I discovered to be a fellow participant. I got some flak after the plane landed, from assorted uncles who were unfortunate enough to have gotten seats around us. The first thing that I noticed after landing in Karachi was the wind. We were transported to Avari hotel and allotted rooms. When I reached my designated room, I had to pinch myself to judge if I was not dreaming. The rooms were spacious, comfortable and had attached baths separated by glass walls.

We were offered BBQ dinner at the top floor of the hotel. That was where we first met fellow participants from India including Onir, Karuna John, Jugal Mody, Venket Ananth, Sabbah Haji, Annie Zaidi, Raheel Khurshid and Sanjay Rajoura. I immediately struck cordial notes with one of them because of me being a vegetarian. Later, I took part in an interesting discussion about Marxism, Class Struggle and Pakistan Movement taking place at an adjacent table.

The next two days were one of the best that I've had.  Despite being an adopted Lahori, I didn't miss Lahore for a moment. I wouldn't have met many of favorite people at one place if I had not come to the mela, including Nadeem F Paracha (one of my mentors), Ali Chishti, Marvi Sirmed, Beena Sarwar, Mohsin Sayeed, Muhammed Hanif, Faiza S Khan, Musharraf Ali Farooqi, Declan Walsh, Amir Mughal, Murtaza Solangi, Hassaan Belal a.k.a mighty, Sana Saleem, Ali Arqam, Zebunnisa Burki and the wonderful people from across the border. At the start of first day's session (around 9 a.m. which was an inconvenience for many people) Senator Rehman Malik, usually at the receiving end of mockery by social media people, was generously praised for urgent attention to the visa problems faced by guests from India.

The sessions were mostly insightful and informative but I personally enjoyed the off-session activities where I got the chance to interact with some amazing people.

Some of the memorable sessions dealt with online activism, role of social media in education sector, use of non-profit for non-profit organizations, online activism, Pakistan-India relations, ‘Slactivism’, impact of party politics on Social Media, Internet Censorship, Cyber-Bullying and Twitter as the new Newsroom. 
 I was a panelist at the session 'Fight Club:Rise of the Troll' alongside Bina Shah, who had come fully prepared with research, Mohsin Sayeed, star of our show and a delightful presence throughout the mela, Raza Rumi and Rab Nawaz, editor of the magazine Laaltain and member of Khudi Pakistan. Some sessions were, indeed, boring but that is how things work usually. Due to my involvment in the recent doctors' strikes, I had plenty of questions to answer. I was branded 'the revolutionary doctor' by Sher Ali, an Express Tribune reporter and 'Hartaali doctor' was my nick name. After the first day, the event was declared open to everybody because of the quips about elitism and exclusion.

There was a Qawalli session after first days’ proceedings and it featured Fareed Ayaz and Abu Muhammad, the best Qawwals in Asia. They enthralled the crowd with their renditions from Sufi poetry.
There was a standup comedy act on the second day by Sanjay Rajoura and he left the audience rolling on the ground with his observational comedy about Facebook albums, Indian Cricket and some social peculiarities. He received a standing ovation at the end.

Contrary to popular expectations, the event did NOT offer a solution to the Kashmir Problem, brought an end to killing of Shias and Hazaras in Pakistan, decreased the level of radicalism in Pakistan or ended the hostility between Pakistan and India. Kashmir was mentioned, but only as a barter for Coke Studio by Sanjay in his stand up act. The issue of persecution of minorities was discussed in detail and panelists included members from Ahmedi, Hazara and Christian communities. It was a social media event, not a Track 2 diplomat meeting. There were many Hazara participants there as well, which was encouraging. It was not a kitty party and for the record, only two women were actually wearing Sari(Even if they were, Whats wrong with that?), so over-generalizations have to be avoided.

 It was a unique coming together of people who know each other mostly by twitter names and such events should take place at least once a year. It was a tremendous effort by Sabeen Mahmood and her team at PeaceNiche, and I would like to thank and congratulate the team at PeaceNiche and the U.S Consulate staff for their co-operation and hospitality. I would also thank my new friends from Karachi and India, for their love and company. I left the event with a heavy heart, new friends and acquaintances and countless good memories.  

A big shout out to my new friends
Faizan Lakhani, FurSid, Aroosa Shaukat, Sheru, Tuba, Shiraz Hassan, Osama, Faheem(@smokenfog), Yasser Latif Hamdani, Shahab(@UncleFu), Rab Nawaz, Sara Muzzammil,  Awais Aftab, Bilal Tanweer, Salman Lateef and Zeeshan Haider. 

Diary of a young doctor (Part 4)

(published in The Friday Times on 13th July, 2012)

Pay Up
"Please give me some money, I'm hungry and don't have any money to buy food," said the beggar.

"I wish I could, my friend, but I earn less than you do," was my reply. And I was not bluffing. 

There is a simple basic rule that governs almost all professions in the world: you work and that earns you money. There are strings attached to this simple fact according to diferent fields but the basic notion remains the same. Soldiers claim to fight for the country, police officers risk their lives for maintaing law and order, public servants work (or at least they are supposed to work) to provide services to their countrymen. At the end of the day, however, they all get paid for it. From the highest offices of the country to the lowest, from generals to chowkidars, from CEOs to clerks, the maidservants that work in houses, sewage workers, technicians, sales boys, they all get paid for doing their job. But in present-day Pakistan we are making one big exception to this rule: doctors.

I have chronicled the lives of young doctors and have described the trials and tribulations associated with their job. It is hard to believe that despite all this hard work, most doctors working in public sector hospitals are not paid. Imagine a person with 17 years of education, working 28 days a month, doing 30 hr/48 hr duties, and earning a grand total of zero rupees per month. 

Imagine a life with no pay, no job security and no health insurance (given that we deal routinely with HIV positive and Hepatitis C infected patients). All that keeps us going are the 'thank yous' of patients and a hope that someday, things will be better. 

After the doctors' protests last year, pays were increased. This does not mean that everyone is getting that pay. In the department where I work, there are 28 people working as House Officers and around 30 as Medical Officers/Post Graduate Trainees (PGRs). Out of 28 House Officers, only 8 are on the paid seats while the remaining 20 are working on 'honorary' basis (there is not much honor involved; it is a euphemism). Similarly, out of 30 Medical Officers, only 15 are getting paid. The situation is similar or worse in other departments and hospitals across Punjab. People working on honorary seats perform equal duties, do everything as others do, the only difference is that they are not paid for doing that work. This is a unique and frankly disgusting way of treating a professional, and there is no precedent for it anywhere in the world. Apart from interns at offices, everyone gets paid for their jobs. At times, even the Senior Registrars, after 10 years of medical training, have to work on honorary basis. 

There is an inside story to this practice. Theoratically, the seats in wards of teaching hospitals are preferably given to the graduates of the institute that the hospital is attached to. This results in unequality at times because graduates of other institutes opt for institutes in bigger cities. In the case of Punjab, graduates from all over the province prefer to do their clinical training in either Lahore, Multan or Rawalpindi. There is also the issue of non-residents. If a resident of Lahore got admission in Rawalpindi Medical College or Nishtar Medical College, he/she would prefer to complete his/her post-graduate training in the native town. Due to this shuffling, there are more candidates for less seats and departments employ different people on honorary basis. The merit list for giving a job for post graduate training starts from graduates of the same institute. Second on the list are graduates of other government institutes and lastly, the graduates of private medical colleges, including the ones in China and Russia.

There are ways that people bypass the merit system, because in Pakistan there is a single key for every lock: Sifarish. If you have the requisite Sifarish, you can bypass the merit and get a paid seat in your desired department. 

To cope with the economic pressure due to lack of any pay, doctors from public hospitals look for jobs in the private sector which forms 80% of our health sector. As a result, most of the unpaid (and in some cases, even the paid ones) do jobs at private hospitals in the evenings and in public hospitals in the morning. After living for more than 25 years on the largesse of your parents, if you still do not earn anything on your own, it reflects poorly on you. Also, during post-graduation, a lot of doctors are tied in the knot of marriage and it is difficult to ask your parents for sustenance of another person while you earn nothing. I personally know some people who delayed their marriages because they did not have the means to support a new member of the family. In some other cases, the young doctors were the only source of income for their families and had to wait till completion of their post graduation to marry. 

This system of 'honorary' jobs should end as it is nothing but a kind of slavery.

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.