“Patients often come to me frustrated about unavailable beds, high costs of tests and medications, billing disputes, cleaning issues, and malfunctioning air conditioning. Many assume I have control over these matters, but in reality, these are hospital-level decisions,” says nephrologist Dr. Najia Hameed.
In a society like Pakistan’s, doctors hold a revered place and are seen as prestigious figures, often regarded as miracle workers. However, when things go wrong — whether due to excessive fees, lack of available beds, poor services, or administrative negligence — this respect quickly turns to resentment. Many times, doctors become the target of public frustration, even though the root causes often lie in systemic issues within hospital administration rather than the actions of individual medical practitioners.
In Pakistan, the public perception of doctors is shaped by a culture of both admiration and blame. This duality often creates confusion about the doctor’s role and responsibilities. In many communities, especially among the lower-middle and middle classes, people believe that doctors oversee and manage not only patient care but also hospital staffing and maintenance.
Low levels of healthcare literacy further amplify the misunderstanding. According to the research Assessment of Health Literacy in the Adult Population of Karachi, only 3.5% of the population possesses adequate healthcare literacy, while 82.6% have limited healthcare literacy. Additionally, a survey conducted by the Pakistan Medical Association (PMA) found that over 65% of patients did not understand the difference between clinical responsibilities and administrative duties. When a hospital fails to meet expectations, patients often direct their frustration toward the doctor — who is their immediate point of contact — making them the easiest target for blame.
Misplaced blame
“Doctors are expected to answer for everything, even changing the sheets, which is actually the staff’s responsibility. Yet, we end up having to address it as well,” says a house officer at a government hospital. “Patients shout at us, accusing us of giving them beds with infected sheets, and when we ask the staff to change them, we’re told that the sheets are out of stock,” the house officer adds.
“If there’s an issue with hygiene or a shortage of bed sheets, we’re always the ones who are blamed, and patients or their families end up taking us to court,” says Dua Azhar.
Maintaining hygiene and cleanliness in hospitals falls under the administration’s responsibilities. However, the staff often taunts doctors in a light-hearted manner, saying, “You don’t even keep the hospital clean.” Azhar shares, “We’ve gotten used to these light-hearted taunts, and they don’t bother us anymore.”
The administration is also responsible for ensuring that lab tests are available in the hospital’s laboratory. “There are many tests that are unavailable in the hospital’s lab but are critical for patient treatment. When we ask patients to go to an outside lab, they get frustrated with the doctor,” says Azhar.
When it comes to the shortage of beds, especially in government hospitals, it’s an ongoing issue. “In emergencies, this challenge comes up daily. We are doctors, and our primary responsibility is to take care of patients, diagnose, and treat them. However, we are expected to manage everything, from arranging beds to changing their sheets. And somehow, we end up doing it,” sighs Azhar.
“Attendants often misbehave and use foul language, but it has become internalised. We’ve gotten used to it,” says Azhar.
“One thing I’ve observed is the lack of unity among the staff. They don’t even provide us with proper equipment and medications. Whenever we ask for something at night, they always tell us, ‘Come back in the morning,’ or that there’s a shortage of supplies.”
Suffering inefficiencies
“Around six or seven years ago, I was admitted to a private hospital after getting burned. I was shouting in pain, but no one was there to help. The doctor on duty kept saying another doctor would come and examine me,” sighs Ansaar Mahar, a student at Hamdard University. “When I went for follow-up bandages, the staff handled my injury so roughly. They were always in a rush, saying they had to look after other patients as well,” Mahar adds.
It is the responsibility of the hospital’s administration to set and regulate fees. “I was in a private hospital in Sukkur with my teammate. We were there for a performance when suddenly my teammate developed a high fever. We took her to the hospital, and the first aid was fine, but they charged us excessive fees,” says Mahar. “On top of that, they prescribed medicines that were only available at their own pharmacy, insisting we buy them from there, even though they were really expensive.”
This situation is not isolated. Many people complain about overpriced medicines and often mention that a particular medicine is unavailable at local pharmacies, yet it mysteriously appears in the hospital’s own pharmacy. This occurs because most people don’t know the alternatives to specific medications. If people were more educated about their options, they wouldn’t have to suffer or pay extra for medicines.
Unfortunately, the administrative sector in many Pakistani hospitals is plagued by inefficiency, corruption, and lack of accountability. Patients often mistakenly associate high medical costs with the doctors themselves. However, in the private sector, billing structures are determined by administrative policies, not by the doctors who provide care. Despite this, it is the doctor who bears the brunt of the anger when a patient is charged an unaffordable sum.
A system in crisis
Public hospitals in Pakistan are plagued by a chronic shortage of beds due to underfunding and overcrowding. The World Health Organisation (WHO) recommends a doctor-to-bed ratio of 1:1, but many hospitals in Pakistan fail to meet this standard. When patients are unable to secure a bed, it’s often the doctor who bears the brunt of the blame, even though the real issue lies with hospital management and resource allocation.
“We face this all the time — dealing with a shortage of beds and facing misbehavior from patients and attendees because of it,” says Dr. Mohsin Shah, a resident in orthopedic surgery. He recalls an incident that occurred due to a lack of available beds: “Once we ran out of beds and asked patients to wait for a while. They lost their temper and even verbally and physically abused the doctor.”
Staff and facility issues are also prevalent. “Even the staff shows us attitude,” complained a house officer. In public hospitals, staff is often poorly trained, and due to mismanagement and a shortage of personnel, they become overburdened and frustrated. Incidents of misbehavior by hospital staff or the unavailability of critical facilities like labs or diagnostic centers are clear administrative failures. “Yet, doctors are seen as representatives of the system and become victims of attendees’ frustration,” adds Azhar.
High treatment costs and skyrocketing bills are among the core issues faced by patients. However, instead of addressing these concerns with hospital administration, patients often direct their frustration toward doctors.
“Patients and their families sometimes assume that I decide the charges, and I can see their frustration,” says Dr. Hameed. “They start begging, and I try to explain, as gently as possible, that the fees are set by the hospital, not by the doctors. If needed, I direct them to the billing department so they can get proper assistance.”
Another tactic employed by some hospital administrations is gaslighting patients. When complaints arise, administrators may downplay the legitimacy of patient concerns or suggest that the issue was a result of the patient’s misunderstanding. This redirection of blame confuses patients and reinforces the misconception that doctors are at fault.
In some cases, patients are told that doctors are “busy” or “not performing well” to cover up administrative shortcomings, such as scheduling errors or a lack of staff. This not only deflects attention from the real problems but also damages the trust between doctors and patients, leading to a breakdown in communication and the quality of care.
Clarifying responsibilities
To clear up the confusion, it is essential to highlight the responsibilities and roles of hospital administration. Hospital administrators are responsible for the logistical, financial, and operational functions of healthcare facilities. This includes setting and regulating fees (in private sectors), hiring and managing staff, maintaining hospital infrastructure, allocating resources such as beds and medical equipment, and implementing patient care policies.
One of the more insidious outcomes of administrative failures is the exploitation of doctors. Many young physicians work under grueling conditions with limited resources. A report by the Young Doctors Association (YDA) found that 80% of junior doctors in public hospitals work shifts exceeding 12 hours, often without adequate support staff or functioning equipment. When issues arise, hospital management often deflects blame onto doctors to avoid scrutiny.
For example, in cases of delayed surgeries or misdiagnoses caused by faulty equipment, it is easier for administrators to accuse a doctor of negligence than to address the underlying systemic failures. This not only demoralises doctors but also creates an environment where they are constantly on the defensive.
The path forward
To address these issues, a multi-pronged approach is necessary. Educating the public about the distinct roles of doctors and hospital administrators is key to mitigating misplaced blame. Health literacy programs should be introduced in schools and communities to explain how hospitals operate and clarify the responsibilities of various healthcare workers.
It is also crucial to implement stricter oversight and accountability mechanisms for hospital administrations. This includes transparent billing, proper allocation of resources, and regular audits to curb corruption and inefficiencies. Strengthening these mechanisms will ensure that administrative failures are identified and addressed promptly, rather than being deflected onto doctors.
Ensuring that doctors have the necessary resources, support staff, and infrastructure to perform their duties is vital. This can help prevent situations where doctors are unfairly blamed for systemic shortcomings. Additionally, protecting doctors from administrative scapegoating through legal and professional safeguards is essential to preserve their ability to provide quality care without fear of unjust reprisal.
Establishing independent patient advocacy groups is another important step. These groups can assist patients in navigating the healthcare system and lodging complaints appropriately. They can also hold hospital administrations accountable for systemic failures, ensuring that patient concerns are addressed properly.
The healthcare crisis in Pakistan is complex, and while doctors are often the face of the system, they are not always the source of its failures. Mismanagement, corruption, and inefficiency within hospital administrations contribute significantly to patient dissatisfaction. By shifting the focus from blaming doctors to holding administrations accountable, we can pave the way for a more equitable and effective healthcare system. Only through awareness, education, and systemic reform can we ensure that patients receive the care they deserve and doctors receive the respect they have earned. It’s time to recognise who is really responsible and demand accountability where it truly belongs.
Syeda Maleeha Kiran is a freelance journalist and mass communications student
All facts and information are the sole responsibility of the author (Tribune)