Promotions over patients?
Writing somewhere in the late 5th Century BC, Hippocrates (widely regarded as the father of modern medicine) penned down an oath in Ionic Greek. Known, forever after as the Hippocratic Oath, it is a pledge that every doctor takes to practice medicine ethically, honestly, and (most importantly) to never turn away a patient without treatment or advice.
In Pakistan, however, the young doctors who are protesting in the streets, leaving the sick at the mercy of… well, no one… clearly did not take this oath. Or even if they did, they mistook the Hippocratic Oath for ‘Hypocritical oath’ instead.
The facts, in case you haven’t been following, are rather sad: this is the third time, in the recent past, that the young doctors across Punjab have announced a strike and boycotted hospitals. Initially, their contention was to have an increase in their salaries (fair enough). The provincial government, faced with the anguish of the patients (who are their constituents) acceded to the demands of Young Doctors Association (YDA). As a result, whereas the monthly salary of a common BS-17 grade official is Rs 30,000 per months, the salary of a BS-17 grade doctor was increased by 100% to Rs 60,000. While this is not comparable to the salary standards in the West, but for a cash-strapped country this increase was significant (to say the least). And with it, the government and the people, asserted their belief in the importance of the education, talent and service that the doctors render in an ailing society. However, the YDA’s demands did not stop here. This time the protest involves the more esoteric demand of reforming and restructuring the service cadre of government doctors. And having tasted success as a result of their earlier protests, these young doctors seem confident in their belief that if they could just prolong the strike for long enough, causing enough inconvenience (and loss of life) to the patients, the government and the people will have no choice but to surrender to their demands once again.
What a way to hold a gun to society’s head.
To give perspective to this issue, it needs to be understood that doctors in Pakistan can be broadly bifurcated into two categories: government doctors, and private practitioners. While there is some overlap among doctors who are government employees during the day and run their own private practice in the evenings, for the most part, this bifurcation is a useful tool to assess the problem at hand.
With regards to private doctors, the issue is rather straightforward. A person who, having gone through the long and rigorous process of becoming a doctor, may choose to practice medicine in his/her individual capacity, or become associated with a non-governmental clinic or hospital. The equation: patients, out of their own choice, come to see this doctor and the doctor in turn is free charge whatever fee he/she chooses. It is simple demand and supply. There is no cadre of promotions (except the increase in fee), and no structure of the job (except for hard work). This doctor is not out on the streets protesting because it is a waste of time. Every minute that this doctor is not in the clinic is a rupee wasted in real terms.
The problem rests squarely in the sphere of government doctors. These are individuals who (also having gone through the same rigorous process as the private-practice doctors) have chosen to join government service under the ministry of health. Let me reemphasize: chosen to do so! What might be the reasons behind this choice are irrelevant. But as a result of this choice, the government doctor is assigned a bureaucratic grade, gets a government salary irrespective of how many patients he/she treats, is promoted from time to time and retires with a pension. In essence, this doctor wears two hats – a government servant, and a doctor – and therefore has double the responsibility (to the government and to his/her profession). And having been employed a government servant, this doctor is assigned the critical responsibility of treating (poor) patients in rural parts of Pakistan, or in the government hospitals in urban centres (where the poorest of our society go in search of affordable medical treatment).
Sadly, this government doctor has, for a while now, been unhappy with the salary scale and service structure. And to address these grievances, this doctor has decided to take to the streets, leaving the patients at the stretcher in the meanwhile.
From a purely legal perspective, this doctor is in violation of his/her responsibilities as a government employee. Government service entails following all lawful directions of the government. More specifically, to the extent of doctors, nurses, emergency work personnel and law enforcement, The Punjab Essential Services Act, 1958 mandates that these professionals will not “disobey any lawful order given in the course of such employment, or attempt to persuade any person to disobey any such order”. The spectrum of penalties includes dismissal from service, fine, and even imprisonment. Given the fact that these doctors chose to join government service, they cannot be allowed to fall outside the fold of law in terms of their employment.
Perhaps more important, however, is the moral obligation at stake here. The requirements of Hippocratic Oath, even if one has never cared to read it, seep through the medical profession. How can an individual deny saving the life of an elderly woman on a hospital bed, on the pretext that the structure of his/her job should be ‘improved’ before an ounce of morphine is prescribed? Where is a moral argument in contesting the speed of one’s promotion in the job (which is all that is at stake here, since the salaries have already been increased) at the cost of letting a child suffer from pneumonia? And if this the deprecated state of an individual’s morality and compassion, how can such an individual be trusted with a stethoscope or a surgeon’s knife?
The writer is a lawyer based in Lahore. He has a Masters in Constitutional Law from Harvard Law School. He can be reached at: firstname.lastname@example.org