Pakistan's healthcare system is very over-loaded. Everyone has to approach a private practitioner at one time or another. Most of us have had the bitter experience of waiting for hours or days for a doctor, despite having an appointment. And even calling a clinic and receiving an appointment for several months after.
This report is to analyse this painful and widespread phenomenon that seems to be more frequent nowadays. The complaints are widespread that a new doctor had to be approached in the midst of a treatment, emergency patients were not catered, patients waited outside while the "safarshi" were being checked, or the guests had a prolonged chit chat with the doctors.
In the waiting room of a renowned eye specialist, we can see some forty to fifty tired faces. Some of the patients are quite old and sagging, and would be thankful if their turn came within the next few hours.
"I went to a skin doctor, who wasn't even a qualified dermatologist but kept me waiting for hours. Later, I realised that many other patients had the same appointment time as I did," said Zubaria Masood.
Another patient in a different clinic said, "Sometimes, if a fellow patient enters first, we have to be kept waiting, otherwise it is usually not more than half an hour."
According to an approximation, the doctor to patient ratio is 1254 patients to one. Dentists are perhaps the most in demand while in Pakistan, for every 20,839 patients, we have one dentist. Dr. Zafar Iqbal, a dentist in Saadat Hospital, Lahore believes there are two or three reasons for this. Hence the major reason behind the delayed appointments is this shortage of doctors. The demand is much higher than the supply, hence the waiting rooms are always choked.
"When doctors start an hour late, everyone has to wait," says Dr. Iqbal. "Patients also get entangled with guests or traffic. Many arrive without an appointment, just because the doctor is friendly to them."
Many of the doctors run clinics, work for the government, teach, hold administrative positions in colleges and perform managerial tasks there. The system is taxed further by the flood disaster which requires doctors to move to disaster-struck areas. Meetings with the ministers and other administrative affairs also make the matters worse. Since every doctor has to thrive in the same society, their favours to VIPs and politicians, relatives, sitting ministers are usually acceptable.
"The only time I went to see an ENT specialist; I had to wait for three hours," said Noman Siddiqui. "The only reason I waited for the doctor who was busy at home with his guests, was that I had paid the doctor's fee in advance."
Dr. Rubina Felix, a gynecologist believes that poor time management lies at both ends. "Patients believe since they have paid the doctor's fee, they can go at their own leisure. Ten to fifteen minutes are not taken into account. It is medical ethic to see emergencies first. When this happens, we need to communicate why the delays happen."
More then 50 percent of the doctors have private practices, according to the Health Ministry. There are neither enough government jobs nor good pay-scales in the government sector to accommodate these private practitioners Furthermore, the population of the country is growing at 2 percent a year, but the number of hospitals and health professionals is not. No big hospitals have been added to the major cities in the last one decade. According to a Ministry of Health report, less than a thousand hospitals are operating across the country. It is no surprise that private practice is so common. And again, no revelation that doctors are over-worked and keep you waiting for hours at a stretch. There is hardly a threat of losing patients with this much demand.
Since the population is rising, new medical facilities are promised by the Health Ministry each year. But like most government promises, these never materialise. The major factor being, that less than one percent of the government budget is allocated to health. This vacuum in government healthcare gives room for private practices to bloom.
Even in one of the best private hospitals, patients can have an appointment at eight in the morning, but be operated by four in the afternoon.
"My wife and I, both old, have almost ten different specialists to deal with now," says an aging Mehmood Ahmed. "Some are absent on long vacations in Europe, others don't meet without a reference. The worst was the eye-specialist who kept me waiting for months and eventually misoperated my glaucoma that was fixed by another doctor."
The fact of the matter is that private healthcare remains as unregulated as many other sectors. Doctors need to devise a mechanism where they can minimise the delay in case of appointments, especially in their private clinics. They can allocate an extra half hour, either before or after the given appointments, for their friends and relatives. They should politely inform the patients in case they have to attend to an emergency. And lastly, they must ask their secretaries who manage appointments to be a little more professional.
This piece was first published in The News.
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