Fear Over Healing: Pakistan’s Doctors Driven to Defensive Medicine
Pakistan's healthcare system faces a breakdown as doctors adopt defensive medicine due to harassment, violence, and criminal charges.
The healthcare landscape in Pakistan is reaching a breaking point as medical professionals find themselves trapped between their duty to save lives and the fear of criminal prosecution. A surge in harassment, physical violence, and legal aggression is pushing physicians toward defensive medicine, a dangerous trend where doctors avoid high-risk patients and critical procedures to protect themselves from legal repercussions.
A Climate of Fear and Violence
Medical associations have sounded a loud alarm, warning that the country's already fragile healthcare infrastructure is on the verge of a total collapse. The current environment is characterized by a disturbing rise in attacks on healthcare workers and the aggressive use of the legal system to penalize clinical outcomes.
Recent incidents have highlighted the severity of the crisis, including:
- The alleged assault of a female doctor in Lahore.
- The registration of First Information Reports (FIRs) against 27 doctors at the Liaquat University Hospital in Hyderabad.
- Legal actions initiated against medical staff at the Dr Ruth Pfau Civil Hospital in Karachi.
Criminalizing Medical Practice
The Pakistan Medical Association (PMA) has described the situation as "alarming," noting that medical practice is increasingly being treated as a criminal activity. Dr. Abdul Ghafoor Shoro of the PMA revealed that physicians, surgeons, and trainees are now facing grave charges, including murder-related counts under Sections 302 and 322 of the Pakistan Penal Code.
Beyond criminal charges, doctors are being hit with substantial compensation claims following adverse clinical outcomes. In some extreme cases, non-bailable arrest warrants have reportedly been issued against entire hospital departments, sweeping up everyone from postgraduate trainees to senior professors and department heads.
The Bypass of Medical Review
A major point of contention for the PMA is the way medical negligence complaints are handled. Instead of these cases being referred to independent medical review boards or healthcare commissions for specialist assessment, authorities are frequently referring them directly to criminal courts.
This bypass exposes doctors to immediate police raids and detention. Dr. Shoro emphasized that this is particularly unfair given that many of these professionals are working in severely under-resourced hospitals where the lack of equipment and staff already complicates patient care.
The Rise of Defensive Medicine
The psychological toll of public humiliation and administrative harassment is leading to a systemic shift in how care is delivered. To avoid the risk of prison or financial ruin, doctors are adopting "defensive medicine." This manifests in several dangerous ways:
- Avoidance of Critical Cases: Hesitation to admit critically ill patients who have a low probability of survival.
- Avoiding Risky Procedures: Shying away from complex surgeries or life-saving interventions that carry a risk of failure.
- Delayed Treatment: Prioritizing legal safety over urgent medical needs.
The PMA warns that this shift will ultimately place patients' lives at greater risk, weakening emergency services and delaying essential treatments.
A Looming Brain Drain
The pressure is not only affecting the quality of care but also the availability of doctors. The combination of psychological stress and professional insecurity is prompting both seasoned specialists and young, ambitious doctors to consider leaving clinical practice entirely or migrating abroad in search of safer working environments.