There are doctors who are tarnishing the image of what was once the noblest of all professions
These days, a number of doctors, not to mention medical institutions, seem to be damaging the reputation of their profession. To gauge the verity of the observation, the following examples may suffice:
Case A: A patient whose long bones have been fractured is operated upon by a known orthopaedic surgeon in Karachi. The operation is a success. The patient recovers exceedingly well. He again undergoes a procedure in order to get the metallic plates that were used during the operation removed from his body. The plates are removed. But the next day, after sterilization, they are used in a surgery performed on another patient. The hospital management charges both patients a hefty amount for using the plates. They are not told that the plates had been re-used. The hospital, surgeons and the anaesthetists all earn a good amount of money.
Case B: A very famous physician has a special arrangement with a gastroenterologist, because of which all his patients with abdominal pain and burning sensation are referred to him for gastroscopy. Routine gastroscopies performed by the gastroenterologist costs quite a bit of money, and 30 per cent of the fee is paid to the family physician. Patients are not screened for hepatitis B, C and HIV. The gastroenterologist has no separate instrument for patients suffering from the above-mentioned diseases. Nobody knows how safe the procedure is.
Case C: A famous laser therapy centre is functioning in the city of Karachi to treat patients with ophthalmological problems. Eye specialists and other doctors are paid Rs2,500 for referring patients to this centre. Patients who require or don’t require laser treatment are treated here on a regular basis. The commission is paid regularly to the doctors who send patients here. The use of laser without any such requirement can be a dangerous practice.
Case D: A centre is providing diagnostic services for quite some time in Karachi. All kinds of blood and urine tests are performed here and the centre has arrangements for the MRI and CT scan investigations too. General practitioners, physicians, surgeons and gynaecologists send their patients here. For each investigation the laboratory pays commission to the doctors who refer patients to this centre. The system is very efficient. In the last week of the month referral doctors received cash in envelops with the detailed statements of their patients. The business is flourishing by leaps and bounds. All sort of patients undergo tests at the centre which they may not require at all.
Case E: Many surgeons have an arrangement with some physicians practising in different parts of the city for performing surgery. For each surgery, the family physician is paid a certain percentage of the surgeon’s fee. Apendix, breast, gallbladder, tonsil, and uterus are removed whether surgery is imperative. Referring physicians and surgeons argue that because of this practice patients get good health-care. “If we will not operate upon them, someone else will, who may be dangerous.”
Case F: At a private hospital, patients have to go through a set of investigations with or without having any symptoms of diseases. Patients are charged for these investigations. They are never told that some of the investigations are done for the sake of research work, of which the hospital is a part. Patients wrongly believe that they are “well-investigated” and the hospital is paid for these investigations.
Case G: At another private hospital, patients are charged for investigations which are never performed. Computer print-outs with normal values are enclosed with the patient’s chart. The hospital charges hefty amounts from the patient’s employer (company). They justify the practice by arguing that the money is not paid by the patient himself.
Case H: A pregnant patient is operated upon at a government hospital by a junior doctor at night. The patient is profusely bleeding. A senior professor is informed about the situation, but she refuses to attend to the patient. Desperate doctors call a general surgeon who comes and the patient is saved after the transfusion of 22 units of blood and hysterectomy. The next day, the junior doctor is harassed by the professor and is told that “every day so many women die and nothing would have happened if this one also died”. The professor is angry because the junior doctor had called a general surgeon for help when she refused to come. A big number of poor patients suffer because of acts like these.
Case I: It is a routine thing for many doctors working at government hospitals to relocate patients from a government centre to their private clinics for further management. It is also a practice to operate upon private patients at government hospitals and charge a hefty fee. This is being practised by senior professors as well as junior medical officers.
Case J: Doctors working as family physicians and consultants at hospitals are also involved in having certain unethical arrangements with pharmaceutical companies for financial benefits. On prescribing certain drugs for their patients and achieving the target, these companies organize leisure trips to foreign countries for doctors’ families.
These are few examples from Karachi. The situation is not very different in other cities of Pakistan. In fact, these practices are common in all provinces of Pakistan. There are some general practitioners, surgeons, physicians, diagnostic centres and hospitals that are not involved in such heinous practices, but unfortunately their number is decreasing.
On the other hand, people involved in such practices give a different argument in favour of their activities. Obviously, they do not agree with the notion that they are involved in any kind of criminal or unethical practice.
In a society where money has become the most important thing and everything is purchasable, this kind of practice becomes a routine one and is accepted generally. In addition to that, medical colleges do not teach medical ethics and young medical students have no role model to follow as their faculty members are also part and parcel of this system.
In the prescribed medical courses, ethics is not included as a subject. Faculty members hardly teach medical ethics and talk about high moral standards while teaching. Neither is there an organized system of ethical audit at the majority of government and private hospitals.
Students are also exposed to an environment where faculty members use expensive fleshy cars and show off a lifestyle like that of celebrities. The doctor who is involved in a heavy private practice appears to garner more respect. He charges a fee which is very high and is least bothered about poor patients in his ward. Students also observe that part-time faculty members create such a situation in their ward that patients usually leave the hospital and start visiting them at their private set-up.
As young doctors students face a world where values are based on the money-generating power. Doctors with good family background usually try to leave the country and never want to come back. A very small number of doctors stay in the country and try to conduct their lives in an ethical manner. Usually, they are considered failed doctors as they don’t have the money to show off. Others get involved in these kinds of activities with or without local or foreign qualifications.
The other factor which aids these kinds of activities is illiteracy, ignorance and apathy among the masses. Then there is a ‘conspiracy of silence’ among the doctors who support and protect each other in their illegal and immoral practices.
The Pakistan Medical and Dental Council (PMDC) is very slow in dealing with complaints of patients regarding doctors’ misconduct. In such a situation, doctors find it easy to carry on with their unethical practices.
The absence of a PROBONO group is another factor. Good lawyers and other social activists are not ready to help the poor who cannot pay their fee to fight cases against rich doctors.
There is a need to organize medical education and medical practice on ethical grounds. In this regard, the PMDC has to play its role. All doctors should understand that they just can’t ignore, exploit, and abuse their patients at any cost and at any level. If the profession wants to enjoy the respect it once had, doctors need to adhere to high moral and ethical values.
These days, a number of doctors, not to mention medical institutions, seem to be damaging the reputation of their profession. To gauge the verity of the observation, the following examples may suffice:
