Shaken to the core after witnessing the worst form of violation of the Hippocratic Oath, I kept wondering why the government and other policymakers of Pakistan heed no attention to the rise in the cases of medical negligence in the country. The well-known case of Imanae Malik, a three-year-old girl, who died in 2009 after her doctor administered a lethal dose of anaesthesia, also made no headway and disappeared after a while.
Dr Rahim*, a doctor who has been in the medical profession for the past 25 years and previously, owned a private hospital narrated his experience by saying, “it is all about money these days. Doctors tend to entertain more and more patients every day because that way they can earn more. They run their private clinics and misguide patients.”
“I remember a case of a 19 year-old-boy who was diagnosed with appendicitis and was operated. The doctor even showed him a specimen of his appendix for authenticity after the surgery; however, recurring pain in the boy’s abdomen led his family to consult another doctor, whose diagnosis confirmed colorectal cancer. Moreover, lab reports also revealed that the boy’s appendix was intact, which proves that the doctor only operated on the boy because he wanted more fees,” he added.
The fact that medicine remains one of the most underpaid professions in Pakistan, so much so that a Resident Medical Officer (RMO) gets Rs 8,000 to Rs 10,000 per month for services, can be possibly attributed to this materialistic mindset of doctors. They, who are considered the epitome of humanity and are known to carry the responsibility for alleviating people’s miseries, should not let money drive them.
We all hear about tampered medical and pathological reports, primarily because perhaps it is more ‘lucrative’ to remove a spleen or appendix than to prescribe medicines.
Medical negligence and incorrect diagnosis, which ideally should be considered equivalent to attempted murder, have become a norm in Pakistan because there is no accountability. We hear about cases of medical negligence and the plight of the victims but what we do not hear is the news regarding the fate of the culprit who has either been involved in malpractice or is found guilty of medical negligence. Termination from employment by the government and medical associations is the highest form of punishment for these culprits, without any mention of suspending their license to practice.
Medical negligence, however, is not always deliberate. In government hospitals evidently the constant flow of patients is one of the most important factors behind medical negligence.
Whilst talking to another doctor who works at the Abbasi Shaheed Hospital in Karachi, I came to know that flocks of patients wait outside the outpatient department (OPD) and surgical wards, which is why doctors are always in a rush to attend and discharge as many patients as possible.
“Leaving cotton packs inside human bodies after surgical procedures is not uncommon in government hospitals and generally these mistakes occur because doctors cater to a huge queue lined up for treatment,” said the doctor on condition of anonymity.
“The government should either deploy more qualified doctors or should construct more state-owned hospitals to resolve this issue,” she added.
Regulations and governance framework, setting a ceiling of maximum patients that a doctor can see in a day, among other measures can resolve issues of unintentional medical negligence.
The most underreported and unknown cases of medical negligence take place in pediatric and neonatal wards.
A speech therapist, who works for children with disabilities, said on condition of anonymity that, “it would not be unwise to say that an extremely high percentage of disabilities that Pakistani children face is either because of an inaccurate diagnosis or medical negligence.”
“Many a times, a child is diagnosed with common jaundice, whereas it is later revealed that the child had Kernicterus or Bronze Baby syndrome. I have personally counselled and treated many children who are completely deaf because they were diagnosed with common jaundice when they actually had Kernicterus,” she added.
Kernicterus is a form of excessive jaundice which can cause irreversible brain damage if the patient is not given photo-therapy or the blood is not exchanged, within the early hours of the birth. All it takes is one wrong diagnosis and screening test to deprive a child of a vigorous and healthy life.
Whether we attribute the failings of our doctors and medical system to a lack of conscience, drive to make more money or inappropriate training, it is essential to understand that policies and punishment for non-compliant doctors are the only way to address the issues pertaining to medical negligence.
It is difficult to say when and how the negligent doctors will be reprimanded, however, unless the culprits are identified and extreme judicial precedents are set, we will continue to read traumatising stories about ‘medical killings’.
*Identity concealed due to security reason.