Features
WHY ARE DOCTORS LOSING THEIR RESPECT?
SOUTH ASIA
By Dr Shershah Syed
(Illustration by Samiah Bilal)
Doctors and patients have a life-long relationship. People need doctors when they become sick. Doctors treat them till they get better or they die, depending on the severity of the illness, complications of their ailment, or in the case of failure of treatment and intervention. In the majority of cases, patients and their families are always thankful to doctors and their medical teams.
The medical profession enjoys this unique relationship where you get paid for services and at the same time are treated like a god or goddess. After treatment, patients often like to have a long-term relationship with doctors and expect that their doctor would join them on their happy or tragic occasions. Hence, doctors and family physicians, in particular, enjoy a special and respectable status in the community. I know many doctors whose names are very popular in the community and many of their patients have named their children after these doctors.
Despite the need and necessity of doctors in the community, there have been some situations where the general public has been not too pleased with those in the medical profession, particularly doctors. These are situations when we come across news of doctors being verbally abused, becoming victims of violence, and their clinics being attacked and doctors even being tortured and killed by patients or patients’ families.
Unfortunately, during the current Covid-19 crisis, this type of situation seems to be getting worse. Patients and the public seem to have lost their traditional confidence and trust in doctors. Rumours are rife that doctors are killing patients, wrongly diagnosing Covid-19 and even selling human organs to make money.
However, this kind of a situation doesn’t happen overnight. Doctors have lost their respect and status in the community because of their own actions and deeds. They have chosen to and worked hard to destroy the respect of their profession, and their esteem, in the hearts and mind of people.
With a rise in the number of reported incidences of medical practitioners being abused and physically attacked by patients and their families, it is time for, doctors to look inward.
It happened gradually and steadily when doctors became more interested in wealth, power and fame. To achieve these goals, they compromised their professional duties, and, perhaps, did not act with sympathy and empathy when it was required of them to do so.
Some doctors became involved in taking commissions, a practice in which a doctor expects a commission after referring a patient to a surgeon or physician. There are surgeons and physicians who charge hefty fees from patients in a country where almost 50 percent of the people are living below the poverty line. Doctors also demand commission from medical stores, pathology laboratories and diagnostic centres, particularly those with CT scan and MRI facilities. That doctors stoop that low to make money is neither acceptable nor permissible.
The moral and ethical integrity of physicians has deteriorated in the last few decades. In medical colleges, professor, who work as part-time faculty, hardly have time to teach and train medical students as they are extremely busy in their private practice. Among their patients and paramedics in hospitals, they are known as butchers — for extorting high medical fees for consultations and surgeries.
We are producing technician-dependent surgeons and physicians who are guided by pharmaceutical-industry representatives who are partners in medical crime. There are enough examples of physicians who prescribe multiple types of antibiotics with different kind of vitamins and painkillers to patients. It would be very embarrassing for the profession to reproduce these prescriptions here. These prescriptions of multiple drug therapy have no scientific basis, nor pharmacological justification, and doctors, who make such prescription are nothing but glorified quacks with postgraduate diplomas and appointments as faculty members at public or private medical colleges. They are only prescribing unnecessary medicines for the benefit of some unethical pharmaceutical corporate agendas.
In a system where people think that the more medicine a doctor prescribes, the better he is, the ignorance and illiteracy of the public remains a blessing for this kind of clinical practice. In fact, this is worse than quackery, as quacks at least are not expensive and they spend time to talk to patients kindly and answer every query patiently, whereas these doctors have no time for patients’ questions.
In many hospitals, renowned surgeons cannot operate as they have no skills and neither do they know how to deal with complications in surgical procedures. Behind the flashy glass walls of the operation theatre, they have experienced operation-theatre technicians in their team to perform surgeries on their behalf. At some stage, when patients learn about this, they lose their confidence and trust for these surgeons and hospitals, and it is definitely a violation of trust.
Many doctors own hospitals built on amenity plots given by the government on extremely cheap rates. The majority of these hospitals are ruthless business centres, charging enormous amounts of fees and providing substandard services. Often, patients and their relatives are lied to and no internal audit system exists, simply so that unethical medical practices can be easily and smoothly carried out.
In the past few decades, many private hospital owners have established medical colleges without fulfilling the basic criteria of the Pakistan Medical and Dental Council (PMDC) and, hence, these medical colleges are producing doctors who are good for nothing. These doctors are glorified MBBS quacks, with minimal knowledge and skills. They have no ethical considerations and hence believe it is their right to make money because they have themselves paid enormous tuition fees to study at these medical colleges.
A large number of doctors do not hesitate to travel and stay in five-star hotels at the expense of pharmaceutical companies. Many pharmaceutical companies bribe doctors, on a personal basis to boost the sales of their medicine. Unfortunately, people are unable to differentiate between good, ethical doctors and bad, unethical and criminal, medical practitioners.
Many MBBS doctors have joined the civil services, politics and the electronic media as TV anchors. It’s very unfortunate that ‘qualified’ MBBS doctors are serving as members of the bureaucracy in ministries of industry, agriculture, excise, taxation, police, etc. They use the title of doctor with their name. The majority of them conduct themselves in the same manner as the average, traditional, unhelpful government official.
No doctor who has gone into politics has created a good impression by being caring of humanity. They behave in the same fashion as other politicians in the country, who serve their political masters and work against the interests of the masses. They get involved in corruption as do their non-medical counterparts. The education and training in medical colleges has failed to make them good doctors or good people, and neither has the hospital environment inculcated empathy in them. When they studied in medical colleges and worked in government hospitals, they must have had first-hand experience of the common man’s misery and the degradation of poor people. But when they decide to become politicians, they acquire attributes of lying, misconduct, nepotism, incompetence as well as a bad reputation, despite the title of doctor prefixed to their names.
As television anchors, these doctors fail to produce shows with substance. Instead they often promote ignorance, intolerance, religious fanaticism and non-scientific thinking. In media, they have the opportunity to help unfortunate patients needing a voice for their cause, but they fail to highlight the plight of dying pregnant women, the misery of poor diabetic patients who have no place in our healthcare system, or of the masses with chronic diseases who are exploited by qualified doctors and quacks. These doctor-anchors also become a part of the corrupt system of exploitation.
Recently, a doctor became a victim of the callousness of her fellow doctors. A female physician in Hyderabad died in her third pregnancy because of the failure of her obstetrician and an unhelpful healthcare system. Another competent general surgeon in Lahore died because of the callous attitude of surgeons.
Meanwhile, hundreds of doctors and health workers, on duty to save the lives of Covid-19 patients, are dying by getting infected in hospitals, but their services are not recognised.
The medical profession should review the practice of medicine and the unethical conduct of doctors. Every doctor should question his or her practice and try to understand why people have begun to hate doctors and why they have lost respect for health providers.
When PMDC and institutes, such as the College of Physicians and Surgeons, are least bothered about these issues, like-minded doctors must show that they will not be a part of this silent conspiracy.
(The writer is the former Secretary General of the Pakistan Medical Association)
The perceptive commentator seeking to make some sense of social and economic developments within most Southern countries today has no choice but to revisit, as it were, that classic on post-colonial societies, ‘The Wretched of the Earth’ by Frantz Fanon. Decades after the South’s initial decolonization experience this work by the Algerian political scientist of repute remains profoundly relevant.
The fact that the Algeria of today is seeking accountability from its former colonizer, France, for the injustices visited on it during the decades of colonial rule enhances the value and continuing topicality of Frantz’s thinking and findings. The fact that the majority of the people of most decolonized states are continuing to be disempowered and deprived of development should doubly underline the significance of ‘The Wretched of the Earth’ as a landmark in the discourse on Southern questions. The world would be erring badly if it dismisses this evergreen on decolonization and its pains as in any way outdated.
Developments in contemporary China help to throw into relief some of the internal ‘structural deficiencies’ that have come to characterize most Southern societies in current times. However, these and many more ‘structural faults’ came to the attention of the likes of Fanon decades back.
It is with considerable reservations on their truthfulness that a commentator would need to read reports from the US’ Office of the Director of National Intelligence (ODNI) on developments in China, but one cannot approach with the same skepticism revelations on China by well-known media institutions such as Bloomberg News.
While an ODNI report quoted in this newspaper on March 25th, 2025, elaborated on the vast wealth believed to have been amassed by China’s contemporary rulers and their families over the years, Bloomberg News in a more studied manner said in 2012, among other things, on the same subject that, ‘Xi’s extended family had amassed assets totaling approximately $376 million, encompassing investments in sectors like rare earth minerals and real estate. However, no direct links were established between these assets and Xi or his immediate family.’
Such processes that are said to have taken hold in China in post- Mao times in particular are more or less true of most former colonies of the South. A clear case in point is Sri Lanka. More than 75 years into ‘independence’ the latter is yet to bring to book those sections of its ruling class that have grown enormously rich on ill-gotten gains. It seems that, as matters stand, these sections would never be held accountable for their unbounded financial avarice.
The mentioned processes of exploitation of a country’s wealth, explain in considerable measure, the continuing underdevelopment of the South. However, Fanon foresaw all these ills and more about the South long ago. In ‘The Wretched of the Earth’ he speaks insightfully about the ruling classes of the decolonized world, who, having got into the boots of the departing colonizers, left no stone unturned to appropriate the wealth of their countries by devious means and thereby grow into the stratum described as ‘the stinking rich.’
This is another dimension to the process referred to as ‘the development of underdevelopment.’ The process could also be described as ‘How the Other Half Dies’. The latter is the title of another evergreen piece of research of the seventies on the South’s development debacles by reputed researcher Susan George.
Now that the Non-aligned Movement is receiving some attention locally it would be apt to revisit as it were these development debacles that are continuing to bedevil the South. Among other things, NAM emerged as a voice of the world’s poor. In fact in the seventies it was referred to as ‘The trade union of the poor.’ Accordingly, it had a strong developmental focus.
Besides the traditional aims of NAM, such as the need for the South to keep an ‘equidistance’ between the superpowers in the conduct of its affairs, the ruling strata of developing countries were also expected to deliver to their peoples equitable development. This was a foremost dimension in the liberation of the South. That is, economic growth needed to be accompanied by re-distributive justice. In the absence of these key conditions no development could be said to have occurred.
Basing ourselves on these yardsticks of development, it could be said that Southern rulers have failed their peoples right through these decades of decolonization. Those countries which have claimed to be socialistic or centrally planned should come in for the harshest criticism. Accordingly, a central aim of NAM has gone largely unachieved.
It does not follow from the foregoing that NAM has failed completely. It is just that those who have been charged with achieving NAM’s central aims have allowed the Movement to go into decline. All evidence points to the fact that they have allowed themselves to be carried away by the elusive charms of the market economy, which three decades ago, came to be favoured over central planning as an essential of development by the South’s ruling strata.
However, now with the returning to power in the US of Donald Trump and the political Right, the affairs of the South could, in a sense, be described as having come full circle. The downgrading of USAID, for instance, and the consequent scaling down of numerous forms of assistance to the South could be expected to aggravate the development ills of the hemisphere. For instance, the latter would need to brace for stepped-up unemployment, poverty and social discontent.
The South could be said to have arrived at a juncture where it would need to seek ways of collectively advancing its best interests once again with little or no dependence on external assistance. Now is the time for Southern organizations such as NAM to come to the forefront of the affairs of the South. Sheer necessity should compel the hemisphere to think and act collectively.
Accordingly, the possibility of South-South cooperation should be explored anew and the relevant institutional and policy framework needs to be created to take on the relevant challenges.
It is not the case that these challenges ceased to exist over the past few decades. Rather it is a case of these obligations being ignored by the South’s ruling strata in the belief that externally imposed solutions to the South’s development questions would prove successful. Besides, these classes were governed by self- interest.
It is pressure by the people that would enable their rulers to see the error of their ways. An obligation is cast on social democratic forces or the Centre-Left to come to center stage and take on this challenge of raising the political awareness of the people.
On the morning of 21 March, 2025, a Chinese-built K-8 jet trainer aircraft of the Sri Lanka Air Force (SLAF) crashed at Wariyapola. Fortunately, the two pilots ejected from the aircraft and parachuted down to safety.
A team of seven has been appointed to investigate the accident. Their task is to find the ‘cause behind the cause’, or the root cause. Ejecting from an aircraft usually has physical and psychological repercussions. The crew involved in the crash are the best witnesses, and they must be well rested and ready for the accident inquiry. It is vital that a non-punitive atmosphere must prevail. If the pilots believe that they are under threat of punishment, they will try to withhold vital information and not reveal the truth behind what happened, prompting their decision to abandon the stricken aircraft. In the interest of fairness, the crew must have a professional colleague to represent them at the Inquiry.
2000 years ago, the Roman philosopher Cicero said that “To err is human.” Alexander Pope said, “To err is human. To forgive, divine.” Yet in a Royal Air Force (RAF) hangar in the UK Force (RAF) hangs a sign declaring: “To err is human. To forgive is not RAF policy” These are the two extremes.
Over the years, behavioural scientists have observed that errors and intelligence are two sides of the same coin. In other words, an intelligent human being is liable to make errors. They went on to label these acts of omission and commission as ‘Slips, Lapses, Mistakes and Violations’.
To illustrate the point in a motoring context, if one was restricted to driving at a speed limit of 100 kph along an expressway and the speed crept up to 120 kph, then it is a ‘Slip’ on one’s part. If you forgot to fasten the seatbelt, it is a ‘Lapse’. While driving along a two-lane road, if a driver thinks in his/her judgement that the way is clear and tries to overtake slower traffic on the road, using the opposite lane, then encounters unanticipated opposite traffic and is forced to get back to the correct lane, that is a ‘Mistake’. Finally, if a double line is crossed while overtaking, while aware that the law is being broken, that is labelled as a ‘Violation’. In theory, all of the above could be applied to flying as well.
In the mid-Seventies, Elwyn Edwards and Frank Hawkins proposed that good interaction between Software (paperwork), Hardware (the aircraft and other machines), Liveware (human element) and the (working) environment are the essentials in safe flight operations. Labelled the ‘SHELL’ concept, it was adopted by the International Civil Aviation Organisation. (ICAO). (See Diagram 01)
In diagram 01, two ‘L’s depict the ‘Liveware’, inside and outside an aircraft flightdeck. The ‘L’ at the centre is the pilot in command (PIC), who should know his/her strengths and weaknesses, know the same of his/her crew, aircraft, and their mission, and, above all, be continuously evaluating the risks.
Finally, Prof. James Reason proposed the Swiss Cheese Theory of Accident Causation. (See Diagram 02)
From this diagram we see that built in defences in a system are like slices of Swiss cheese. There are pre-existing holes at random which, unfortunately, may align and allow the crew at the ‘sharp end’ to carry out a procedure unchecked.
Although it is easy and self-satisfying to blame a crew, or an individual, at an official accident investigation, what should be asked, instead, is why or how the system failed them? Furthermore, a ‘just culture’ must prevail.
The PIC and crew are the last line of defence in air safety and accident prevention. (See Diagram 3)
A daily newspaper reported that it is now left to be seen whether the crash on 21 March was due to mechanical failure or pilot error. Why is it that when a judge makes a wrong judgement it is termed ‘Miscarriage of Justice’ or when a Surgeon loses a patient on the operating table it is ‘Surgical Misadventure’, but when a pilot makes an honest error, it is called ‘Pilot Error’? I believe it should be termed ‘Human Condition’.
Even before the accident investigation had started, on 23 March, 2025, Minister of Civil Aviation, Bimal Ratnayake, went on record saying that the Ministry of Defence had told him the accident was due to an ‘athweradda’ (error). This kind of premature declaration is a definite ‘no-no’ and breach of protocol. The Minister should not be pre-empting the accident enquiry’s findings and commenting on a subject not under his purview. Everyone concerned should wait for the accident report from the SLAF expert panel before commenting.
God bless the PIC and crew!
– Ad Astrian
Yes, it’s happening tomorrow, Friday (28th), and Saturday (29th,) and what makes this scene extra special is that you don’t need to rush and pack your travelling bags and fork out a tidy sum for your airfare to Thailand.
The Thai Street Food Festival, taking place at Siam Nivasa, 43, Dr. CWW Kannangara Mawatha, Colombo 7, will not only give you a taste of Thai delicacies but also Thai culture, Thai music, and Thai dancing.
This event is being organised by the Thai Community, in Sri Lanka, in collaboration with the Royal Thai Embassy in Colombo.
The Thai Community has been very active and they make every effort to promote Amazing Thailand, to Sri Lankans, in every possible way they can.
Regarding the happening, taking place tomorrow, and on Saturday, they say they are thrilled to give Sri Lankans the vibrant Thai Street Food Festival.
Explaining how Thai souvenirs are turned out
I’m told that his event is part of a series of activities, put together by the Royal Thai Embassy, to commemorate 70 years of diplomatic relations between Thailand and Sri Lanka.
At the Thai Street Food Festival, starting at 5.00 pm., you could immerse yourself in lively Thai culture, savour delicious Thai dishes, prepared by Colombo’s top-notch restaurants, enjoy live music, captivate dance performances, and explore Thai Community members offering a feast of food and beverages … all connected with Amazing Thailand.
Some of the EXCO members of the Thai Community, in Sri Lanka,
with the Ambassador for Thailand
I’m sure most of my readers would have been to Thailand (I’ve been there 24 times) and experienced what Amazing Thailand has to offer visitors … cultural richness, culinary delights and unique experiences.
Well, if you haven’t been to Thailand, as yet, this is the opportunity for you to experience a little bit of Thailand … right here in Colombo; and for those who have experienced the real Thailand, the Thai Street Food Festival will bring back those happy times … all over again!
Remember, ENTRANCE IS FREE.
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