By Dr. Zeeshan Khan
The Hippocratic Oath requires a new physician to swear, by a number of healing gods, to uphold specific ethical standards. These include the principles of medical confidentiality and non-maleficence.
“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm”. A statement, which certainly encompasses the rights of a patient in critical condition fighting for his or her life.
Nishwa, a young girl, who was administered a wrong injection at Karachi’s Darul Sehat Hospital, passed away a week ago and the hospital has only been fined five lac rupees.
Accused, Sobia, had filled the injections without a label and gave it to male nurse Agha Moeez. On April 14, a nine-month-old girl had been allegedly paralysed after being administered a ‘wrong injection’ by ‘untrained nursing staff’ at Karachi’s Darul Sehat Hospital.
Provincial government and state could even plan to send Nishwa abroad for treatment but nothing was done. Qaiser Ali, Nishwa’s father said that he would approach every forum to seek justice for his daughter so that others did not fall prey to such malpractices.
There is no working regulatory framework that governs the health sector in Pakistan. Here, the markets are incomplete and have large information asymmetries (where it is not clear if what is being prescribed is in the patient’s best interest), therefore, the need for regulation is vital. Otherwise, the temptation to take patients for a ride becomes too much. Even if some doctors and hospitals do not indulge in unethical or illegal practices, it becomes impossible to differentiate between these and the less scrupulous ones. Word of mouth is not enough to make clear distinctions.
But there is more to it than that. When each specialist is visited, they order a panel of tests to be done before they will even start talking of treatment. Hospitalisation is sometimes the only option left if you want a team of doctors to examine the patient holistically. But even that is not easy. Getting admitted into a private hospital is costly and even there you are placed under the care of a particular doctor. It may not be easy to get other specialists to come and visit.
More importantly, even if they do, they still diagnose and prescribe in isolation. There is no primary doctor who coordinates with other specialists or looks at issues of medicinal interactions, the effects of one treatment on another, and so on. It comes down to the patient themselves or to the family of the patient to coordinate between doctors. But they have no way of knowing medicinal or treatment interactions.
In Pakistan the public is constantly made aware of the mistakes made by doctors and care providers.
Our Judicial institutions are also quick to dispense justice which will allow for a remedy against malpractice. Usually hospitals have strong internal peer group-based quality audit systems.
The strength of each of the checks including governments imposing strong external quality assurance audits on hospitals, medical practices and doctors, make the health care system standardized.
Nonetheless, almost all checks and regulatory structures are in place in most societies. In some places we even have insurance companies and other intermediaries coming in on behalf of the patients. We have none of these in Pakistan. It is no wonder medical markets are lucrative in Pakistan but provide, on the whole, terrible service to the people.
A medical research study in US has shown that 30% of all deaths in US happen because of a medical mistake or negligence somewhere during patient’s lives. The most important thing is not the doctor. It is to have a very well-funded, well organized and very centralized form of health care. Oath does not improve health care. It is the system that does (eg. see Scandinavian health models). In Pakistan a junior doctor in public sector works like a donkey. Many of which are under equipped and overburdened.
Being a developing country, Pakistan has always struggled with health issues. In 2015, Pakistan was ranked 149th out of 179 countries in 2015 on the Maternal Mortality Ratio Index. According to UNICEF, despite significant improvements over the past two decades, Pakistan ranks towards the bottom among other countries when it comes to infant and neonatal mortality.
There is need to keep democratic institutions strong. The three tier approach should be switched with a four tier approach, with the 4th pillar being preventive Healthcare. This is a very wide branch but if launched, could do wonders in our Healthcare system. Furthermore, a procedure for proper investigation for such cases should be set and punishment should be applied accordingly. Moreover, every person of medical field must have defined duties whether he is a doctor, pharmacist or any other paramedical staff.
The opinions in this article are of the writer only and do not represent the views of The Weekly Pakistan.
Dr.Zeeshan Khan is a writer, analyst, doctor, educationist, Human Activist, Blogger, certified trainer, and Poet. He is a motivational speaker, Cultural-cum-Political Analyst and regular contributor to the Op-Ed pages of different newspapers. He is a doctor at CMH and also alumnus Of LUMS.