Hiding behind ambiguity!

By Dr. Muhammad Hafizullah

“I am a government servant,” Karim Baksh, a forty years old patient, responds to my query regarding the occupation. "What is your job?" I reiterate my question. "Sir, I am a regular government servant!" he refuses to divulge any further information. "I understand you are a bona fide government official and I have no question about that; but what I am really interested to know is as to what do you actually do?" I rephrase my question. "I am working in secretariat," he concedes. "Government servant can be a chief secretary or a naib qasid: I am neither interested in your grade nor in your department. I want to assess the physical and intellectual demands of your job in view of your ailing heart!" I expand on the subject. And only then, he unveils that he is an office clerk in finance department - essentially a sedentary job which may involve long hours but no physical running around. In view of his heart problem, he could continue to work and accomplish without much fret.

"I am a labourer and work by hours," informs a thirty years old patient while answering questions. "Well, we are all labourers and we all work by hours and are paid accordingly," I inform him. I look at his dress and examine his well preserved hands devoid of any callosities and add, "by the way your hands belie your claim of any physical hard work."

He looks at his hands unbelievingly and confesses, "Yes I am not the classical physical labourer but I have to earn my livelihood the hard way."

And I wonder how many people in this world are born with silver spoon and do not have to work! "As a matter of fact I work in an office dealing with cellular phones!" he reveals the well kept secret. I was only interested to evaluate whether he could pay for his treatment as he required change of his heart valve and if his job is not very demanding then we could delay the operation by year or so.

"What does your husband do?" we ask our female patients in routine. "He is a poor man," some women reply. "But what does he actually do?" I persist, as this particular lady required an angiogram with possible angioplasty, which entailed a considerable amount of money.

Her social condition did not appear too good and I was considering the possibility of offering her the choices of Zakat, Baitul Mall or free treatment based on entitlement.

"He hardly earns any money and we find it very difficult to meet both ends," she explains her status. "Madame, you have my sympathies but I need to find out what exactly he does so that I can arrange some help for you," I tried explaining to her. "My husband is illiterate and who would give a good job to an illiterate poor man?" she fields a counter question.

"Madame, I am not here to offer your husband a job but I want to help you! If you could please tell me about his job or allow him to speak and explain," as I evaluate her apparently decently dressed and well mannered husband with probing looks. "Sir, I am working in a university and I am entitled for reimbursement," the gentleman submitted and that solved the issue.

Very few patients volunteer the required information with succinct details. Doctors are not tax men to assess the income. When we ask about the job, our prime concern is the nature of job - especially the physical and psychological aspects of it.

A patient with heart failure and poor effort tolerance cannot work as an insurance agent or a medial representative — jobs requiring extensive travelling and walking around. A gentleman who has sustained a heart attack cannot perform in an active job for a month.

A patient with advanced disease cannot do manual work or serve in an active job. Patients requiring drugs for weak heart should not serve in hilly places especially when it entails climbing uphill. Similarly such patients cannot undertake jobs requiring tough work like carrying heavy items or working in the farm.

Our next main concern is about the affordability of the treatment. In the developed countries, a doctor's main concern is to prescribe evidence-based treatment as most patients have some support programme and they do not have to pay from their pocket.

Here we do not have the luxury either in the hospital or in outpatients to write a prescription or suggest a treatment plan and then walk away.

More often than not we have to work with patients and their families and look for different options. Quite frequently this takes more time than the actual treatment. Filling in the forms and verification take a long time.

We, as a nation, thrive on ambiguity. Ask someone about the age and the person goes into a trance as if he has been asked to solve the theory of relativity. Quite frequently they come back with a stereotype response - mothers do not grow older than forty five and fathers never cross fifty-five.

All females submit the same answer that they answered about age ten years ago! Most middle aged men will hang around forty for ten to twenty years. When questioned about education, unless the person has PhD or Masters under his belt, the response is vague.

May be those, who are not properly educated, try to gain some academic height in the guise of nonchalant attitude. Regardless of literacy, most of us have no well-shaped opinion about most of the affairs except politics and medicine. Though people hold strong opinions in religious affairs, when questioned for references and evidence, most have no legs to stand on.

Our education system thrives on rota learning. Most examinations still have long essay questions, where format is more important than real data.

As against that, short multiple choice questions put a student on spot and have to be answered with accurate knowledge. Short answer question format, also, encourages answering the crux without the props of linguistics.

Accurate information is asked and brief precise answers are expected -no beating about the bush. In oral examinations, similarly, structured viva rewards accurate answers to a set of predesigned questions.

The questions are not drafted by a single person rather a group of experts utilise collective wisdom to arrive at consensus. References are asked for, whenever desired, to support the answers.

This system of education should be introduced from kindergarten and developed accordingly. This inculcates the habit of enquiry, research and forming of opinion on evidence. This provides a solid base for the nation to build a strong foundation for future progress.