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An academic, a researcher and writer.

Wednesday, 12 October 2011

Doctors, ethics and materialism

Written in 2007

In a letter to THE NEWS titled ‘ Honourable crime’ one, Lt.Zaheer Abbas from Peshawar had the following observations about our honourable doctors and the way they serve the ‘dukhi insaniat’: “Peshawar is a city which serves as a headquarter for the NWFP, FATA and some other remote areas situated near it. Peshawar thus has the largest number of patients as compared to other cities of Pakistan. The normal practice which is carried out in Peshawar is that the doctors do not see the patients properly in the hospitals, in the morning session, where they have to offer their consultation free of cost because they are serving in a government hospital, rather they give them their cards and tell them to visit them in their clinics in the evening. In the evening if you visit Dabgari garden, a place that is almost completely occupied by private hospitals and clinics, you will find patients in huge queues in front of the doctors' clinics. Normally the consultation fee of a doctor is 500 rupees but this varies from doctor to doctor. The alarming thing is that more than 90 per cent of these patients belong to very poor families and these doctors barely examine them for more than a few minutes at a time.

"The question is why are they charging such high consultancy fees/charges for such brief examinations and that too from such poor people with whom you cannot help but sympathise. They travel from far-flung areas in their ailing states, are poverty stricken, equally ignorant of their malaise and its treatment, not to mention their helplessness against these doctors who are supposed to have taken the Hippocratic Oath and are meant to serve humanity selflessly. What would happen if they take Rs50 or Rs100 instead of Rs500? Instead of making Rs50, 000 a day they will make Rs10, 000 a day, which still means Rs300, 000 a month. Isn't this amount enough for them and their families' luxurious lifestyles? When their private clinics were banned and a new practice was introduced in the combined military hospital, according to which half of the fees would go to the doctors and half to the hospitals, all the doctors put up resignations in protest. Why can't they afford to give half of their fees to government hospitals, which serve the poorest people of our poor nation? I request the authorities concerned to take steps in this regard.” The letter seems to be a voice from the hearts of those who can feel the miseries of the ailing helpless multitude of this hapless land of the pure, and who have the ears to listen to the cries of agony that come from those who suffer in helplessness and die in hopelessness. But let us see how those to whom the letter was primarily addressed, think .

In response to this letters were published from doctors in the same newspaper. One letter coming from a doctor in Rawalpindi has the following to say: “ this is with regard to Lt Zaheer Abbass' letter 'Honourable crime'. The sympathy of the young reader for the ailing poor community in the suburbs of Peshawar was indeed genuine and worthy of appreciation. However his biased opinion regarding doctors' fee was all the more obvious. Soon after reading his letter I went to a car mechanic who charged me Rs250 for merely washing the radiator, Rs380 for tuning the engine and Rs300 for repairing the choke. I must add that nothing new was fitted into the car only repair was done. While I drove back home I stopped by a tire repair shop where a small kid in his teens who spent only15 minutes on my car tyres and handed me a bill worth Rs180. I would like to mention over here that those doctors who charge Rs500 as fee have spent 30 years of their lives studying and have at least 10 years of strenuous work experience. The young reader should refrain from making vivid calculations about how much a doctor earns and should spend time donating to charities.”

The first thing that comes to mind while going through the good doctor’s response is that he is (unintentionally?), comparing a human being with a machine (a car). An ailing human being, unfortunately, is dealt with by most of the doctors, as a machine, which is out of order and can be fixed in the way a machine is fixed. Hence the mechanical behaviour when an ailing person comes to a doctor for cure. The doctor also laments the ‘small kid in his teens’ charging him Rs.180 in just fifteen minutes of work on his car tyres! Dear doctor as a highly educated citizen (cream of the society to be precise) as a doctor is supposed to be, why don’t you object to ‘a small kid in his teens’ working in a tyre repair shop, instead of objecting to his ‘heavy’ charges? But the most telling part of the doctor’s reply is the one where he justifies the heavy fees of doctors by weighing it against the years of hard work done by them and the money they have spent on becoming doctors. This reflects what is in the mind of our doctors while they are at work in the hospitals or in their clinics: you are here to get back multiple times what you have invested in becoming a doctor i.e. time and money. In the end the doctor has a good piece of advice for the ‘young reader’, which he should pay heed to as it has come from a doctor!

There is a response to the same letter from another doctor. This one from one doctor from Peshawar, who writes, “This letter is in response to Lt Zaheer Abbas letter 'Honourable crime’. I agree with Lt Abbas' concern that doctors have been butchering the poor and have been violating the Hippocratic Oath. But if we put it in perspective, I think Lt Abbas will realise that among all the honourable criminals, doctors still are still quite low on the list.

"The doctors working in the government sector, despite negligence and inadequate work still work at least three to four times more than all those sitting in public offices such as the GPO or WAPDA, secretariat who puff more cigarette hours and tea hours than work. Five to six times more than an average military officer and 10 times more than the average bureaucrat who have more time to read newspaper and entertain guests than the military and civil service he/she is entrusted. Highest on the list are the politicians who are the least responsible, most corrupt and most incompetent. Doctors are also the least paid by government standards compared to teachers, bureaucrats, and other salaried staff for the amount of work hours they put in, the teaching they do (to produce more doctors), the research papers they churn out yearly, the amount of study they have done to become doctors and the amount of study they have to do to remain updated (even if you take the least updated doctor).

"Doctors take the least vacations. They are also the least supported and most attacked by government and least garnished with government based luxuries. Per capita professionals, they also pay the highest taxes. In short they are the country's single strongest building block. They can work independently of any government-based structure. The average salary of the highest grade doctor is in the order of 20,000 where as principals and other high grade teachers especially of IT who have studied less than half and worked almost half the amount of hours get salaries nowadays around 100,000 per month. These are rough and probably humble figures and approximations but I will be surprised if I am terribly mistaken. It is just a pity that many doctors have taken things too far and when they can like Lt Abbas said, earn a reasonably handsome amount with honesty, they still go ahead and violate the nobility of their own profession.”

The good doctor does not seem to be terribly mistaken when he compares his profession with other professions in terms of the hard work involved, the number of hours in work and the hard labour required for becoming and remaining in the field of medicine. But he is mistaken when he compares this noblest of professions to others in terms of the monetary benefits involved or when you get solace from the fact that doctors are still quite low on the list of ‘the honourable criminals’.

Now before looking into what is wrong with the way doctors are prepared in our medical colleges, I would like to share a few personal anecdotes regarding the mechanical and materialistic behaviour of our doctors. Sometimes back a friend of mine had some minor surgical problem. The doctor after examining the patient told him that he had to undergo a minor operation. The ‘operation’ lasted for five minutes, which did not need even stitches and the doctor charged him Rs.3000. After a month the problem resurged. When the doctor was consulted again, he told the patient, ‘I charge for this Rs.4000 but as you are an old ‘Gahak’(customer), I’ll charge you Rs.3500. Just look at the word ‘Gahak’ for a patient and everything is clear.

In another incident this writer was standing in a bicycle shop, when one person introducing himself as a doctor wanted to buy a bicycle for his son. An old ailing person coming to know that this person was a doctor came closer and said, “Doctor sahib, I am suffering from some heart disease, can you please help me out?”. The doctor replied, “Chacha I myself suffered from the same problem, I went to the USA to have an operation. This disease has no cure for in Pakistan, if you want to cure it you have to go to the USA”. The old man smiled helplessly and said, “I don’t have the means to go to the USA”. To this the good doctor replied, “then you should wait for your time to come to an end in this world!” Just imagine what should be the feelings of a person who talks to a doctor in the hope of some relief and hears from him to prepare himself for death! And then quite recently newspapers carried the story of a ‘Gurda chor’ doctor, who robbed a young poor boy of ten years of his kidney, when the latter’s father brought him to the private clinic of the doctor for an operation that the doctor had proposed, to cure him of some pain in his body. The doctor reportedly charged the poor man a good sum of Rs.20, 000, for curing his child (robbing him of his kidney as a matter of fact)!

Now the most important question is why our medical colleges produce only medical money making machines? This indicates that this highly mechanical and materialistic attitude of the doctors has something to do with the flawed system of their training and education. As a novice in the field of medical education, I had to take into account the opinion of those who are directly related with medical education to know the reason for its failure to produce good human beings besides good doctors. After some discussion with quite a few people I came to the conclusion that medical colleges need to include some subjects in their syllabi besides those subjects, which prepare good physicians and surgeons.

A good physician or surgeon is of very little use unless first of all he/she is a good human being who can feel like humans and who can treat humans the way they should be not just like machines. Keeping this query in mind I asked Prof.Dr.Sirajuddin, a former principal Khyber Medical College, Peshawar and who is also a well-known educationist as to the reasons contributing to the extremely materialistic and mechanical behaviour of doctors. I would like to share with the reader some extracts from his reply to my email. He said, “You have raised a very pertinent question regarding the materialistic conduct of doctors these days. I agree and condemn this attitude on every forum. Such behavior is part of the overall deterioration in social values of the society, the foundation of which has been laid in the rotten basic education. Teachers who used to be role models for students have not remained the same. In the most receptive years of education in young age there is absolutely no attention to the Affective Domain of education. Cheating, fraud, lies, dishonesty, disobedience, selfishness, lack of regard for others’ rights, violence & injustice are common practices in the schools & colleges of Pakistan. Students carry the same hardened attitudes to professional colleges and practical life that comes out in the shape of corruption, deteriorating law & order and materialistic approach in all walks of life.

There is no shortcut remedy to this state of affairs except by reforming the basic education for which no government is prepared. All the governments are dominated by the feudal lords and the rich who do not wish to rectify this situation so that they can comfortably continue their exploitation of the ignorant society. The religious group of politicians has also failed miserably. However people like you should not loose hope & continue your efforts to bring a healthy change in education.”

This email is indicative of the fact that like our overall education system, which is predominantly materialistic in nature, and which aims at producing graduates who do not have much care for basic human values, medical education too severely lacks this extremely vital aspect of the process of education, which results in the phenomenon of mass production of skilled individuals who are good at earning money but who lack in basic human feelings and emotions for the uplift of humanity, who have very little regard for human life which is the ultimate aim of their profession and who can at times act in the most barbaric manner for the simple reason of enriching themselves even at the cost of precious human lives. This surely indicates that syllabi of our medical colleges, as of course of the entire education system need to be revamped in a manner in order to make them more humanized. One suggestion is that doctors-to-be do not merely need medical ethics, something very restricted and very technical in nature but general ethics because only then can they be good doctors. It is bizarre to think of creating good doctors before making them good human beings. Inclusion of ethics and other humanitarian subjects in the medical colleges’ syllabi will be of great worth in this regard.

The existing system of education in our medical colleges produce doctors who are skilled technicians and scientists but who lack in understanding and appreciating higher human values like kindness, love, sacrifice and a missionary zeal to serve their fellow human beings.

Preparing our doctors as good scientists will not do as, “Science cannot discover values, because facts have no values: facts just are. Science can learn how best to heal a man, or how best to torture him: such facts exist whether we know them or not, whether we wish them or not, and in themselves are just facts of physiology, not values. Whether such research is good or evil has meaning only within the context of our values: and determining the proper values for human beings is the task of philosophy, not science.”

So why not a bit of philosophy, psychology and ethics in the syllabi of our medical colleges and universities?

P.S: This not to tar all doctors with the same brush. There are amazingly great doctors who are there to help their patients with a premium on service rather than money. One is not sure if such doctors are in majority but they really make a difference. The society in general has great respect for such self-less servers of humanity.

Email: ilyasjans@yahoo.com

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