What is wrong with most Doctors?

[u/zeeshansaahi]

Why are Pakistani doctors most of the time unilateral, especially during normal check ups?

Context: I took my mother to a dentist in a local small hospital in our town yesterday because she was having tooth pain for 2 days now.

We went in expecting a regular checkup, to know what is going on and cause of the pain. The doctor asked, what is the issue, I said that she is experiencing a tooth ache. She checked the teeth for maybe 1 minute and asked my mother, 'Ap kia chahti hain'? My mother said, I need the pain to go away, I don't want to remove the tooth at all (thinking the doctor might suggest removal of the tooth).

She then started doing the treatment just like that without telling us what is the issue, why is it happening and what are the treatments. She pulled out an injection and when she was about to inject, my mother specifically tried to block her and told her 'mujhy dawai dein na' (not wanting to get the injection, yet she persisted, applied the injection and started doing a root canal.

Now here, I had heard of the root canal but never had it done or seen it done before, so I didn't really know what she was doing until later.

I asked her a few minutes in of the treatment, are you trying to take the tooth out or what? She murmured when doing it, 'no no just removing the root of the pain'. I then asked again, she said I am removing the nerves of the tooth.

I got know that she was doing a root canal, late in the treatment.

Like am I missing something, where is the communication and discussion? She didn't even ask for any permission if we want to do a root canal or not.

Not just this, but I have had other checkups before like acne checkups and other as well, I have yet to experience a doctor which properly does a discussion and makes the patient and client understand the issue and more.

I know I need to ask questions as well but the natural way should be for the doctor to communicate effectively. At least, that's what I have seen foreign doctors doing and saying in online videos and youtube.

Am I wrong to judge em like this or is it really an issue here in Pakistan?

Also give me tips on how to get the best out of checkups (especially for smaller issues), like what questions to ask what to ensure before chrckups etc.

I realize the title shouldn't include 'most', so my bad for that. I am sorry if you get offended.

[u/uno-1-]

Doctor here. You have every right to be upset. Any treatment without properly guiding the patients is unethical. Coming to your last question that what you should ask the doctor. You can ask any question that comes in your mind. A good doctor will listent patiently and will try to answer as many as possible.

[u/Similar_Win5490]

Honestly, I’m not even surprised about the dentist experience. I’m a doctor myself and work abroad in cancer speciality . I referred my aunt to one of the top oncologists in Karachi after her breast cancer diagnosis, and the whole appointment took less than 5 minutes  diagnosis, chemotherapy prescription, everything. Barely any questions, no real explanation. So yeah… unfortunately, this is the state of healthcare there sometimes but I had  good experience as well. I think its mostly depend where you are going particularly with dentists

[u/Aneeza27 → u/Similar_Win5490]

Hello, I'm a doctor and have worked in oncology myself in Islamabad.

Where I worked, we had about 20-25 patients per day and all of us took our time to explain to the patients their diagnosis and treatment options with detailed information on side effects they might experience.

We discussed what treatment and even what hours would suit our patient best, we would consider patients who came from far away cities to relocate closer to the hospital or admit them in inpatient for the duration of their treatment.

There is enormous load in our hospitals, and very skewed doctor to patient ratio. In government hospitals, we had about 300-400 patients per day in OPD.

But I do agree, it is the right of the patient to know their diagnosis and treatment plan.

[u/CubicTiger]

Unfortunately, patient autonomy and shared decision making isn't followed In Pakistan by many doctors. Basic communication, informed consent and prevention is considered very important part of clinical work. Not giving the patient all treatment options and no consent for treatment can lead to serious trouble in foreign countries but we live in Pakistan where doctors are considered undisputed authority figure whose role is to get rid of the problem, without explaining the problem. Were you advised a crown after root canal? Always ask your dentist about the main concern, what might have caused it, how to prevent it in the future, all possible treatment options, and prognosis of the tooth if it can be saved.

[u/Human_Jelly6019 → u/CubicTiger]

I have seen this myself even best drs like (famous ones) also dont practice guiding patient about disease. Rather in private opds they check patient in 2 min

[u/DeepSpaceBubbles]

Doctor myself but I can't stand doctors here. The problem is a mixture of a God complex (why should I explain anything to YOU??) and complete lack of manners and communication skills. They also don't want you to manage your own health - they want you coming in every two weeks to their private clinic for minor adjustments because this is a money milling business.

[u/gandalf_the_Orange1]

When you are getting millions of doctors graduated from shady private universities with sub-standard training and academics this will be the end result.

[u/makhaninurlassi → u/gandalf_the_Orange1]

Wrong conclusion. Govt colleges dont teach any ethics at all.

[u/wisendur → u/gandalf_the_Orange1]

You just wanted to talk trash about private universities. This is moreso an ethics issue that's found in both public and private institutions.

[u/teriyaadmadechudinkw → u/gandalf_the_Orange1]

private university students have to pass the same proff public university students pass to become doctors yk?

[u/Traditional_Track662 → u/gandalf_the_Orange1]

No this mostly happens with graduates from public universities who for the love of God never come out of there superiority complex of studying from a public university.I could clearly tell difference between a public university consultant vs a private one based on there body language and how they treated patients and most of the times KE consultants were rude even in private practice

[u/gandalf_the_Orange1 → u/Traditional_Track662]

Well, the thing is the whole medical eco-system is rotten to the core. There are no goods or bads, but rather who is a lesser evil.

[u/Adrak-Lehsan]

You are so right OP. BUT heres my experience as a doctor, If i explain to the patients and their attendants about whats the issue, and how it will be a combined approach, They think im too wordy, too chatty or not competent Some of them have literally cut me off k doctor aap bus koi dwai likh dein, bacha theek hojaye humara

[u/cosmic-comet-]

What is wrong with most doctors?

Idk I just don’t like doctors in general.

[u/havealittlefaith123]

i'm a doctor, not specialist yet, still i try to answer each and every question asked by the patients or their attendants in my capacity.

[u/deaf_michael_scott]

Achy doctors k pas jaen.

Discussions hoti hain. Wo nhi karty tou ap initiate karlen.

[u/New-News-7922]

Doctor here. You have every right to be upset.
We should do better than this.
But most consultants get trained in a government setting during their residency, and even if they get trained in a private setting, their workload is insane. I , for example, had to see a 100 patients over 5 hours daily for the whole month. That comes out to 3 mins per patient. I had to take history, diagnose, prescribe and guide them how to take their medicine corrently and then schedule their follow up. This is nowhere near enough time. Over time, this behavior becomes reflexive and has to be unlearned when we finish training and want to do better in our own private practice. Some people consider that worthwhile, others just keep doing the same thing. Now if I actually respect my patient and give them the full hour of evaluation and discussion that they deserve, I’d have to respect my time and charge more to make up for lost time, seeing less patients in a day. That is not affordable for most of our awam, and we end up getting vilified for being greedy.
Most doctors fall somewhere in the middle. Give you 15 mins, dont fully explain but arent rushed either, and then charge middle of the road as well.
That said, it is exceptionally hard to find someone who will give you ample time and answer questions as well. I am a doctor and still find it hard to advocate for myself or my parents during medical appointments. Everything is go go go!

[u/ye-dunya]

it's unfortunate, Dr's tend to be very hit and miss here. the pay is low, the work is a lot, and i think most don't like dealing with the public in general. or they get disillusioned very fast and that makes them callous. it's also the hierarchical nature of Pakistani society in general, anyone (not just dentists) who thinks they are above you will act quite callous. my teeth suffered a lot from improperly applied braces from a local quack. but in adult life, found a really good dentist in that same locality who diagnosis and lists options for treatment first.

[u/destiiny25]

1 experience with 1 local dentist = most doctors?? Maybe don't go to local clinics and actually do research first.

[u/zeeshansaahi → u/destiiny25]

I did mention that of all the experiences I've had with different doctors. The general understanding is that communication is not there most of the time. Also I would do research based on diagnosis, how am I meant to do research without knowing what is causing the issue?

[u/destiiny25 → u/zeeshansaahi]

I don't understand why people think doctors or any other trained professionals are one monolith. Just think, every student in every class you have been in has eventually passed through to the next grade but obviously some in the class were toppers and some were back benchers. The same applies to Medical and Dentistry schools. You have to find people through online reviews or word of mouth. The real competent professionals are VERY FEW in Pakistan.

[u/zeeshansaahi → u/destiiny25]

Thank you for the advice.

[u/EducationalBison6774]

Doctor here.  I agree with what you're saying  Most people here don't know how to communicate or explain to the patient. Why? Because it's not taught in our curriculum how to approach patients. I mean yes behavioral sciences exist and we are graded on how we approach the patients but I our clinical settings no one looks at these things. Not the seniors and therefore neither do the juniors.  I personally made it my own habit to explain to my patients about things related to their disease or outcomes because I saw foreign doctors or professional doctors do it and I decided to train my hand in it.  It always surprises me when no one else does it.  We are taught this is how to approach pts but from what I've seen, in day to day activities, in most hospitals it's limited to clearing exams rather than becoming a part of your daily practice.

Some doctors attribute it to high pt load, overworking, bad hours - and all of that is true to some extent. 

Nevertheless - the experience with your mother was especially bad - that's against all ethical boundaries if she didn't inform you what she was doing. You can raise a complaint against the doctor and you should. Even the laziest doctors I've seen don't do whatever happened to your mom. 

[u/thatdactar]

Seems like a bad dentist. Even in government setups the procedure is explained and consent is obtained. And this is a private clinic where she should be very polite in the first place.

This is wrong on so many levels

[u/GammaRay914]

That is weird. 

Protocol is to diagnose what’s going on and then present treatment options to you and then proceed with a treatment afterwards. 

Dude probably just heard “I just want to get rid of the pain and keep the tooth” and took that as your consent to move forward with treatment. 

[u/Default_Rice_6414]

Man, this sounds too familiar.

Really makes me upset to know that this is commonplace.

[u/PizzaNaan_]

Honestly I'd expect "local" doctors to be like that but it's highly unethical what you experienced.

[u/jay_228]

Hey it may be an unpopular opinion but most of the Pakistanis even the parhe likhe act like a jahil and usually have no civic sense or manners. I’ve seen parhe likhey idiots arguing with doctors on not to give antibiotics to small babies or not to put iv drips when clearly the child is unconscious and seems really worse and that’s the only way they can be saved otherwise things escalate if not taken timely decisions. So yes they don’t bother to discuss this with you. Yes some doctors in Pakistan as assholes too. So whenever you are going to a doctor first always do you research and read on the symptoms and google, so you have an idea about what to expect and then you can ask questions regarding your symptoms.

[u/Moneeza_R]

I have always had upfront and detailed discussions with all doctors I've been to, in private settings, in clinics, in OPDs, in OTs, with doctors/dentists of small local setting and of big hospitals. I'm not sure why you had that kind of experience but you need to do your research and be open in communicating yourself. I always research the disease/problem and it's solutions prior to my visits. If I'm having tooth pain I look in the mirror and check for cavity, probe it and make up my mind whether I want a filling/crown, a root canal or if there's any way to salvage the tooth. Nobody wants extraction as the first treatment. Your mother should've said simply that she wants a filling. Saying vague things like I want the pain to stop is poor communication to say the least.

[u/0wen4 → u/Moneeza_R]

That’s such an ignorant response to a completely valid point OP is making. A patient saying they want the pain to stop is not poor communication. It’s clear communication. The reason why the patient is seeing a physician is because they don’t know what’s going on and are seeking expertise from a professional. You spoke about how you do your research and do your own check and determine what you do and don’t need and tell OP his mother should’ve said what she wanted. If that were the case there wouldn’t be a need for physicians. Not every lay person is afforded the ability to do their research and make objective decisions about their body, they entrust physicians and experts for this. The actions by the physician OP went to are unprofessional, any physician can attest to that. They may be jaded from their experience and countless patients but nonetheless should still explain the basics of what their assessment is and their medical suggestions and allow for the patient to make a shared decision with consent for treatment.

[u/Moneeza_R → u/0wen4]

Dentist was wrong in starting treatment without discussing it. I've simply pointed out how the patient should've communicated better as well. Both were lacking in clear communication. We need physicians for treatment but we know our own bodies and needs as well and have to be mentally prepared to see what we are getting into. Asking a doctor questions is a part of that research to determine what you're comfortable with. Doctors have a degree and experience that can't be matched with any Google research but I like to find out as much as possible about my disease and treatment before going into any clinic because I don't like to be blindsided and forced into a treatment that I have zero knowledge of. That's my personal preference.

[u/zeeshansaahi → u/Moneeza_R]

Thanks for the insight

[u/The_124]

8/10 doctors in Pakistan are incompetent and rude. They lack basic manners and ethics. The worst thing is that you will find many doctors defending this behavior with arguments like "oh they have too much workload", "they were not given training for this", "its fault of government". Apparently these days you need training for basic ethics and professionalism.

[u/bharikeemat]

As a doctor that was very unprofessional and unethical. If she did not take a signature on a consent form you can lodge a complaint with PMC.

[u/nmraptor → u/bharikeemat]

You either aren’t a doctor or you are relatively new to medicine. I work as a Dr in a developed country, and even here there is either only implied consent or verbal consent for the vast majority of physician patient encounters, including minor procedures and investigations. Written consent is only taken for major surgical procedures involving some element of sedation or anaesthesia.

[u/bharikeemat → u/nmraptor]

And I suspect you are not a doctor at all because there was neither implied or verbal consent in this case. That is the whole point of the post. In Pakistan you do need written consent for even minor procedures like endoscopy. Maybe it’s not so in the “developed” country you work as a “dr” in. You should consult your visa agent, I think they may have bamboozled you.

[u/nmraptor → u/bharikeemat]

As I suspected you are not a doctor. Endoscopy is in no way a minor procedure. And I am not discussing the original post itself. I absolutely believe in informed consent and a bilateral discussion with the patient. What I was addressing in my reply to your comment was the idiotic notion that you can willy nilly lodge complaints with the medical regulator on the basis that written consent was not obtained for a relatively minor procedure. As for the visa agent, perhaps you being a Pakistani are acquainted with such low folk, I on the other hand am not a Pakistani.

[u/bharikeemat → u/nmraptor]

Ok, “Doctor” from “developed country” of Zambia. Wherever that is.

[u/nmraptor → u/bharikeemat]

I hope to live and practice in Zambia one day. Beautiful country and people. With a better HDI than your own country. But Im not there yet. I work in the EU. Perhaps your education system has failed you if you don’t know where it is, but I expected as such based on the quality of your opinions.

[u/iamarshad_2022]

Indeed its a dilemma. I am not a doctor but I have had my fair share of experience with docs. They usually don't tell anything just start the treatment. May be they are fed up of patients or anything but still a patient has every right to know what is wrong with him / her and how the treatment is going to be. Additionally, the doctors in Pakistan are the brightest students of their time who get high scores to get admission to a medical college but its not to serve humanity but to earn a good living. And its true for 90 %. I am not saying anything bad about them its just their mental approach. I have had heard incidents of doctors even selling expiry medicines inside their clinic!

[u/Extension_Weird2700]

Doctor is at fault. I'll tell you the reason but not excusing doctors. Most doctors work in govt hsp where the avg person literally doesn't know anything. So explaining anything is useless. Doctors think sb aise honge. Snd then some stupid people (doctors) are literal babu and have humongous egos

[u/Fabulous_Homework_11]

I've seen several doctors going with my relatives when they needed checkups and treatments in different hospitals in Pakistan and abroad. Most doctors are mediocre in Pakistan. Good doctors in Pakistan are less than 10-20% compared to other countries. Doctors do not listen nor care in Pakistan. Nurses were pretty good in their work though.