By~ Romesa Qaiser Khan.
"Yeh tum larkiyon ne medicine seekh ke kya karna hai? Abhi kuch salon main sari ghar beth jao gi. Choro ward, mazaay karo."
"USMLE karke tum sab ne bahir bhaag jana hai, phir baray humanitarians banay phirtay ho"
"Kemcolian ho, kemcolians saari dunya main chaaye huay hain aur tumhain yeh bhi nahi ata"
Sooner or later, every one of us comes to encounter this blatant tanay-baazi at least once in our three years of clinical medicine, or if things get very real, within the first two years of basic sciences as well. The universal lamentation of the fact that we don't have enough doctors, our doctors are incompetent, our doctors are selfish- these aren't just limited to senior physicians but often come from our patients and are echoed by society too.
And if we're completely honest, it DOES seem to be true. More than half of our batches are made up of girls, inevitably many of those girls ending up settling down and getting married even before house job (after all as they say, medical main rishta na kiya, to phir kya jiya?) leaving a net deficit of practicing physicians before a class has even graduated. Of the rest, the ones resourceful enough or lucky enough to be able to give the high life a shot will start touring amreeka for electives and uploading airport selfies well before their final year result is announced. But what about the rest? The idealists, the patriots, the resigned- the ones who, are either left behind by circumstances or better yet, choose to stay out of a sense of duty and obligation and honor? How are they rewarded for being unselfish?
Answer: They're not. Five years of scoring well below par, not due to a lack of effort or because of being dumb, and well below other private universities, the new graduates have to go through the circus of attaining a paid house-job in their specialty of choice based on the merit-caste system, striving for a pay that is less than the pocket expenses many of them received monthly during their academic years. Some of them will not succeed and will settle for being unpaid. Others will make a meager 5k in army hospitals and console themselves with the catechisms of "serving humanity".
The conditions for all of them will be uniformly gory. 24 hour-36 hour calls on alternate days in sweltering heat and without provisions. No protection against potentially infectious diseases and unhygienic conditions that will honestly make you wonder why a hospital would even qualify as a hospital and not a bio-hazard hub for catching all diseases that you would never have caught otherwise. Listening to thundering tirades on your incompetence from PGs and running the risk of being potentially mobbed by your patients. Living in constant fear of ill maintained walls collapsing on top of you or the potholes in sidewalks breaking your legs (no exaggerations here: many a one has been injured in the doctor's rooms of many government hospitals by tiles falling from walls on them as they sleep)
After this mandatory year of hell, rinse and repeat. Forget that MBBS is in itself a degree- specialization is mandatory if you intend to earn more than pocket change. Training slots for part-1 won't be available. Government jobs won't be in your reach without "approach". Someone with a foreign degree will beat you to them if they are. Foreign countries won't accept more IMGs because of saturation-your visa clearance won't come through anyway. All the while your friends in other fields like CA will be getting settled and you'll still be struggling- struggling with your immense patient load and trying to do the serve humanity while your hospital isn't even able to afford the basic necessities like medicines and more beds, thanks to budget cuts. And if finally, being sick and tired of all this, you raise your voice and strike, you'll be labelled selfish and ungrateful and a traitor to your profession. And you'll come full circle to face all those tanaas yet again.
When all is said and done, what does a country where a health budget of only 0.8% faces further cuts every year, where it is perfectly legitimate for parliamentarians of a minor province like KPK to raise their own salary by 500% yet paint doctors as greedy for asking for a 25k salary, where the ratio is 300 patients to a doctor per day with patients beating up those same doctors as an added bonus sometimes, have to offer those who don't abandon it? Our people don't just want doctors to be messiahs- we want messiahs on sale. We want it to be okay for us to be selfish and comfortable but expect unencumbered service from doctors 24/7. We wouldn't expect an architect, an engineer, a teacher or even a laborer to work without pay, job security or limited workload but when it comes to doctors everything's an exception because after all, they're messiahs- not humans.
Can one then honestly blame the ones who choose to put themselves first? Because they already know no one else will?
But those who return after 10 years abroad to lecture students not to do the exact same thing? Those who have the power to make conditions better for their own students but won't? Those who push the very stereotype that if a girl works after marriage she can't be your son's wife? Those who won't bother imparting knowledge but expect student prodigies? Maybe not.
The only ones who you have an absolute obligation to however are your patients. They have a right on you because they place everything they have in you and they trust you with the biggest responsibility in the world- their lives. And the answer then becomes this: even in a country as dysfunctional as our own (or even more so because of this) has the satisfaction of saving millions of lives to offer. All that hardship, all that injustice, can find solace in one thing and one thing only- knowing that you're the difference between someone's life and death. Your bank balance, your fatigue, your sacrifices- everything pales in comparison to the immense unseen rewards you earn by alleviating the suffering of just one person. No government, no professor, none other than God can grant you that. And for every doctor that has struggled or is struggling, this is the anchor that keeps them attached here despite all the injustices they face- something everyone else should be grateful for and appreciate instead of judging or demanding more from them. Like all humans, they have their limitations but they try so much harder than everyone else to overcome those yet they're still the ones bearing the brunt of society's displeasure.
Medicine is one of the most revered professions in the entire world- and one of the hardest. Practicing medicine is a choice. Everyone makes their own- and it doesn't have to be according to anyone else's expectations.
Some can begin that path and not finish it. Some can be forced onto that path and abandon it at the first opportunity they have of exercising free will. Some can take the easy one and some will do what's right.
The end message for everyone who is, or is becoming a doctor is this- do what is right by your patients. If you're not coming into this field prepared that you'll lose a lot and not necessarily gain much, if your only mission is life is not to serve humanity- then maybe this isn't the path for you. Being a doctor is about making life better for others and prioritizing them over yourself, even if no one appreciates you or treats you fairly. Everything else, marriage and career prospects, power and respect, is secondary and happens along the way. Striking for a pay raise doesn't justify letting your patients die without medical attention. Being understaffed and underfunded shouldn't weaken or defeat your resolve to create a better world. And it is finding this balance between humanity and self that is essential to be a good physician.
If you're doing medicine just to get a good rishta or because you want to live abroad, you're cheating yourself and all the people who put their life and faith in your hands- because the thing is, these aren't exclusive concepts. Having a family doesn't mean you can't practice. Treating an American patient is the same as treating a Pakistani one. You can do whatever you want, wherever you want and have no guilt on your conscience, as long as you're fulfilling the one thing you've sworn to do on your honor- serve people in sickness and in health, and work as God's reflection.