Pakistanis – Please trust your doctors

During a recent experience the writer noticed something very interesting and, maybe, alarming too.

A patient was admitted to a well reputed hospital in Karachi for a major surgery.  The surgery went well but due to the age of the patient some minor issues needed follow-up which were being looked at and were treated.  The doctors treating the patients are also well experienced and have a good reputation.  The patient had a concerned grandson who also happened to be a specialist in the same field with a very well reputed hospital in Canada.  Naturally the grandson was closely monitoring the treatment of his grandfather being done in Karachi, remotely though.  So, he will periodically talk to his grandfather to get his condition/input and would review reports of all tests recommended/conducted and medicines/treatments prescribed by doctors in Karachi. 

Effectively the patient was being treated by doctor in Karachi but was being closely monitored, passively though, by another doctor in Canada.

The above brought up a key difference in approach which was initially based on the above experience but was also confirmed and substantiated by other doctors in Pakistan thru personal interviews by the writer.

Doctors in Pakistan:

• Start, or continue, treatment without first figuring out the potential cause, even when the time is available to investigate the issue.
• Start treatment with heavy strong medicines and doses from the get-go, even when the need of such heavy/strong doses is not warranted at the time.
• Prescribe antibiotics, steroids and/or food supplements (vitamins) more frequently than needed.
• Do not prescribe lab tests as frequently as generally needed.
• Tend to rely more on their experience rather than the lab reports.

Of course, all the above is not good for the patients in the long run.

Medical and healthcare is a field where most professionals are passionate about what they do.  For them patient care is the most important thing in the world, and they go miles to ensure their patients get completely well, and soon.  The above observations do not go with the good intentions doctors generally have so before jumping to any quick conclusions the writer wanted to first validate his observations and, if found true, wanted to know the rationale for doing so.  Hence the writer approached a few doctors in various areas of expertise and asked them to explain the above.  The results of the discussions were even more interesting.  According to them it was patients, not doctors, to blame.  It is patients’ psyche of need of a quick fix rather than anything else.

The way doctors explained to me is that Patients do not have the patience to allow them enough time or effort doctor to figure out things.   Patients expect the doctors to hit the bull’s eye blindly.  So just from the description, symptoms visible signs the doctors should not only, with 100 percent accuracy, figure out what the issue is but also prescribe a magic pill that makes the patient walk normally from next day.  A doctor who “wastes” time in figuring out things with the lab tests is not considered a good doctor and will not see the same patient again. 

As happens in any other field, investigation takes time.  It starts from a higher level and continues narrowing down on things till the actual root cause or causes can be determined.  Similarly, a doctor is not a magician.  He/she needs time to investigate things which also include gathering additional information through various lab tests, to narrow down initial assessments to be more certain.  Patients neither have this patience and understanding, nor do they want to.  No matter what, if the patient and/or their attendants do not see any improvements in one a day or two, doctor gets failed, “If he/she were a qualified/knowledgeable, experienced doctor medicine should work right away.  Getting the tests done means, the doctor is not confident of his/her assessment, and is “anaari.  They would move on to the next one, who gets quick results.

Patients also do not favor getting tests done.  Before prescribing a medicine, if a doctor prescribes a test, patients think that the doctor is wasting their time and money.  Also, that the doctor is not knowledgeable (anaari).  If the doctor were knowledgeable and experienced, he/she would not need any tests for treatment.  Like an old hakeem sahib who would prescribe medicine just by feeling the pulse.  Patients think that doctors get so many tests done just to earn more money him/herself; and to bilge money out of them as he/she gets commission for each test prescribed.

Realistically thinking doctors are human too.   In Pakistan, it takes somewhere from 18-25 years of very hard work and discipline studies, and tons of money, to become a qualified medical doctor.  Most healthcare professionals, doctors included, join this field as they want to serve humanity.  At the same time, they want to make enough money too, to provide a respectable life for their family.   With patients above psyche, and by following a practice of being as conclusive as possible before prescribing a specific medicine for curing something, the doctors, and their families, would die of hunger as they would be out of business in days.  So, very unwillingly, doctors surrender to their patients’ expectations and prescribe strong medicines and antibiotics at the first go without properly trying to collect enough data about the root cause and addressing the same.  It is not something they want to or should be doing but they are almost compelled to.

So, patients and their attendants should always realize that:

• Human bodies and systems are way more complex than they think.
• Doctors are knowledgeable but are not magicians to know everything from the get-go.
• While being similar, each human body may act and respond differently in similar circumstances.
• One symptom may be due to 10 different reasons, so prescribing stronger medicines without proper investigation is not good for them.
• Consistent and repeated use of Quick effects medicines are generally not good for their bodies.
• Lighter medicines at the beginning and stronger medicines later are in their own favor.
• Lab tests are absolutely necessary to conclusively determine the root cause of an issue and to prescribe the most suitable medicine.
• The primary objective of all doctors, and other healthcare professionals, is looking after patients’ well being, not making money.

I don’t think it’s fair for doctors to put the blame on patients for lacking patience, or being demanding, or having unrealistic expectations. Of course, this is wrong, but the medical institution cannot expect patients to be all-knowing.  What needs to happen is education (like this essay) from the medical field to educate patients on these things.  Also, for doctors to unify in their approach to frivolous management. Doctors need to say no and educate.  If patients go to another doctor, that doctor too needs to say no, and educate. It needs to be a universal approach. This is difficult and can only come from broader institutions such as the Ministry of Health, the College of Physicians and Surgeons and Pakistan Medical Association. It is important for them to demand and ensure physicians are practicing correctly, and to educate patients.

Further, doctors should also realize that:

• Most of their patients may not be highly educated, or not educated at all, so they need to explain things to their patients in extra detail and with extreme simplicity to make them understand.
• People’s perceptions about medical illnesses are very different and so are the expectations.
• In a lot of cases, they do have the liberty to make a call and should do so to avoid quick fixes.
• Should establish, agree to and strictly follow some standard protocols of treating patients.

All to say, blame cannot be squarely put onto patients. It is equally wrong of doctors as well, and ultimately, it’s an improper system that’s led to the situation in Pakistan, that we all need to help improve.

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Babar Saeed

bsaeed@yahoo.com

July 10, 2023