A majority of the complaints received at the Punjab Healthcare Commission (PHC) relates to the behaviour of doctors and other medical and administrative staff of a Healthcare Establishment (HCE). A general complaint is that doctors are rude and easily get irritated. Another resentment is that in the event of a crisis, doctors and other staff members instead of consoling the relatives or attendants treat them like pariah. About the complaint management system at the hospitals, the regular grievance is of cold shoulder given to the complainants. Experts, in fact, think that presently, it is the behaviour of the medical staff at the hospitals----both public and private-----that has caused this prestigious profession to lose its credibility and integrity in Pakistan.

If the PHC is unable to bring about improvement in the way doctors behave at an HCE, the purpose of the Commission’s existence would remain half-achieved. Development and enforcement of Minimum Service Delivery Standards (MSDS), is a system improvement approach towards quality enhancement. It’s a mechanical thing. Going beyond, however, is another factor without which, an HCE may not be able to bring about attitudinal change towards ‘care’. A machine can be operated using manuals, interacting with human being-----patients----- according to specifications is not possible. Where patients are treated like machines, it does not come without sacrificing the basic human element----compassion----which is absolutely important to achieve optimal quality, especially in the field of medicine.

The purpose of medical schooling is to teach how to save lives. Every era used its own dynamic to keep people from losing life. The advancement in medical and social sciences brought in lifestyle concepts such as sanitation, hygiene and cleanliness, that not only improved quality of life but also lengthened the average life expectancy. Many fatal diseases, such as cancer and even HIV/AIDS are managed if not cured to help patients live a life free of pain and as close to their normal routine as possible. Today people are not supposed to die at the onslaught of any disease. There are many options and many cures. Scientific advances and the latest successful drugs and procedures have made death, the ultimate decider, come in a more dignified manner. In the midst of all these good news, an enigma has emerged though, taking a toll on all the good work. Kindness and compassion have declined in doctors with increasing responsibilities and overexposure to technology.

Doctors have been perhaps confident that they would act compassionately when the need arises. A reverse, however, has been observed to this self-expectant behaviour. Because compassion like any other behaviour pattern is developed over time. It is therefore that the National Health Services in England had embraced the concept that CARE has to be redesigned to the needs of the twenty-first century. According to a Tibetan Buddhist teacher and meditator, Chokyi Nyima Rinpoche, “Compassion lies within each of us and emerges after removing the stumbling blocks of greed, anger and ignorance.” New findings have also revealed that compassion promotes competence. It is imperative therefore to understand the dynamics that play into making a human being---in our case the medical staff-----become a true caregiver. Taken for granted kindness can get lost in the smog of routine checkups, sufferings, deaths, complicated machines and the strenuous life at an HCE.

Take a route down to Pakistan’s hospitals. We find inadequate facilities spread across the vicinities of large hospitals. This spectacle may not be visible in posh, cultured and upscale clinics. In rural areas, we have still a long way to go in terms of managing a sufficient supply of doctors, proper medical staff and medicines. Lack of facilities notwithstanding, it is the compassion stifling milieu in HCEs that has eclipsed the physician-patient relationship. Being a two-way street, when doctors and other medical staff at the hospital stopped being caring, people lost trust in treatment.

The Punjab Healthcare Commission does not have the mandate to regulate doctors but can create a realisation in them about the effects of their attitude on the overall performance of the HCE. It is pertinent to note that PHC only entertains complaints that have been vetted by the concerned HCE.

Ninety per cent of the time, HCEs fail to satisfy their patients in case of grievances. In fact, many cases accentuate in intensity and ferocity because of the behaviour of the doctors and the administrative staff during crises. Of course, in an HCE, any emergency would mostly involve human beings, which also means emotions can run high and suffering can look intolerable. In such situation losing patience is normal. But unfortunately our people also resort to verbal and physical abuses because of the social system, where illiteracy and lack of trust in doctors justifies becoming rude and uncivilised. In any case, however, the responsibility to keep the atmosphere relaxed lies with the doctors and their staff. Many complainants at the PHC had said that they would not have come to the Commission had doctors empathised with them and behaved accordingly.

If we place the medical industry in Pakistan under the spotlight of what Chokyi Nyima Rinpoche said, we may reach the conclusion that the walls of anger, greed and ignorance had made the practitioner of such a noble profession to become compassionless.


The writer is a freelance journalist based in Lahore.