At least once a year, I have to write something to defend doctors. First, we must remember that doctors are human beings and not messiahs. They have families, financial obligations, children that want the latest cell phones and computer games, spouses that want vacations and a decent lifestyle and of course they want to be able to save something for the rainy day and for the marriages of their daughters. In short they are exactly like lawyers, accountants, engineers, and other professionals. Like everybody else, they work to make enough money to fulfil as many of the needs as they can. And like other professionals, they provide their professional services in the best way possible.

Having lived and worked with doctors for most of my life (both of my parents were doctors), I can say without any hesitation that I have never seen a doctor do something deliberately that could cause harm to a patient. Human beings, however knowledgeable and sincere they might be, can and will make mistakes. All that I have said so far does not under any circumstances justify mistakes made due to a lack of appropriate knowledge or inadequate diligence.

Most people in Pakistan when they think about medical care still think of it as care by a physician. The idea that persists is of the family doctor who examines a patient and writes out a prescription or even mixes his own medicines and gives them to the patient. My father as a general practitioner (GP) in Lahore practiced that sort of medicine for 40 years. His clinic provided 90 per cent of the medical care needed by most patients. Blood tests or X-Rays were rarely ordered and diagnoses were made based on examination and a ‘history’ of the problem provided by the patient. Most often when the patient was sent to the hospital it either was for surgery or if the patient needed prolonged medical care.

But modern medicine is much more than that. Today, it is all about laboratory tests, complex investigations and complicated treatments. At least that is so in the private sector. In the public sector, the available care is extremely variable. For instance, by creating specialised cardiac centres and ignoring our big teaching hospitals, patients in need of treatment for heart problems will often be ignored in most of these hospitals and have to go to the nearest cardiac centre that might be miles away or even in another city.

The first healthcare person a patient meets is usually the local doctor and from here the problem starts. In rural and semi-rural areas and even in big cities, many of these first level medical care providers are non-qualified ‘quacks’. Most of the ‘patients’ that end up being treated by these quacks like a vast majority of Pakistanis are not too well-educated and have very limited financial wherewithal. So, in the minds of a majority of people in this country that unqualified person posing as a doctor is for all practical purposes a real doctor.

If these ordinary Pakistanis end up in a government-run facility, they might get to see a qualified doctor but even so the doctor has little capability to provide adequate medical care. In public sector hospitals facilities are limited. Tests that might be needed are rarely available. Even if the infrastructure for things like X-Rays and blood tests are available, the machines are usually out of order or essential parts of the testing equipment is missing. As far as medicines are concerned, less said the better.

In the public sector, two major problems effect the reputations of the doctors that work there. First is what I have described above. Even the best and most empathic doctors are unable to provide reasonable medical care because of lack of facilities and medicines available to them. The second reason is a bit more complicated. Because of extremely poor pay scales for doctors in the public sector, most of these doctors have to work in the private sector also (private practice) to make a living income. As such some doctors working in public hospitals will divert patients to their private clinic for treatment. This is unfortunate and such doctors are rightfully though to be dishonest.

Whatever the problems of healthcare for the poor might be, most of the complaints about improper treatment and bad doctors come from people that have the money to seek care in private hospitals and from doctors in private practice. Here it is always interesting to see that those that have the money to pay for reasonably adequate medical care still go shopping for doctors or hospitals that charge the least. They then forget the basic principle that governs a market place: You get what you pay for. In the open market when a doctor or a clinic charges less than the competition, there is a reason for that. And like anything else, the more you pay for a particular service; chances are the better service you will get.

Most complaints that are discussed in the press or in letters to editors are generated in the situations where even after what a patient or the family thinks is an exorbitant fee, the service provided falls short of expectations. The problem we as doctors have is that our shortcomings or mistakes lead to loss of life or else disability. And as I have said above, doctors can make mistakes also. But more importantly sometimes medical treatments or surgical procedures done even most carefully and appropriately will end in an ‘unfortunate’ outcome. As an example, even after heart surgery in the best cardiac hospitals in the world, a certain number of patients will have complications that might lead to death.

From my perspective one of the major problems I see among even the most honest and hardworking doctors in Pakistan is the lack of a mandatory system of continuing medical education. In the United States, for instance, every physician requires a state license to practice medicine. These licenses are renewed every two years. To get a license renewed, physicians have to provide proof that in the previous two years they have attended at least two hundred hours of medical education that has been approved by the American Medical Association. As far as medical specialists are concerned, most specialties require that specialists must retake their specialty examinations (boards) every ten years.

I strongly believe that most young doctors start out honest and wish to practice the best medicine they can. But in time they might lose some of that idealism. The one thing that helps to keep most physicians honest and weed out the dishonest and the incompetent ones is a system of medical malpractice. In the US, if a physician has been sued for malpractice too often, he or she will lose malpractice insurance and with it the ability to practice medicine.

For a country like Pakistan that cannot even get rid of the thousands of non-qualified people that masquerade as doctors, to expect that any of the above changes within medicine can ever happen is impossible to even think about.