By Dr. Fiaz Maqbool Fazili
The recent anguish expressed by Madam Sakin Yatoo (MOH) during her Gemba walks—her onsite surprise visits—should serve as a seismic shock to our collective professional conscience. To find only 30-40% of doctors present at their duties is not merely an administrative failure; it is a profound betrayal of the Hippocratic Oath we have all sworn to uphold. While it is convenient and commonplace to point fingers at the “system”—lamenting infrastructural gaps and bureaucratic inertia—we must now turn that critical gaze inward. The state of our public healthcare is a mirror reflecting our own ethical decay, and the image is deeply disquieting.
The public’s complaints are not born in a vacuum. They observe a stark dichotomy in our behaviour. In our private clinics, we are often paragons of patience and empathy. Yet, the same patient, when encountered in a state-run hospital, is met with indifference, haste, and at times, outright neglect. Why does the colour of the building dictate the colour of our compassion? This Jekyll and Hyde existence erodes the very foundation of trust upon which the doctor-patient relationship is built. The patient is left wondering: who is the real doctor? This trust is shattered further by the pervasive perception, often validated by reality, that the medical fraternity is viewed through the tainted prism of “commission agents.” Though the dedicated majority suffer due to the bad name brought by a few dishonest practitioners, whispers and now open accusations suggest collaborations with brokers for unindicated tests, medications, and even surgical interventions. When news channels report that a significant percentage of surgeries in the country are unnecessary, manipulated by conflict of interest, we cannot simply dismiss it as media sensationalism. It is no longer surprising—caesarean sections and hysterectomies are often being performed by practitioners who neither belong to the relevant specialty nor possess the required qualifications or certification to conduct such procedures. This alarming practice, though widespread, reflects a serious breach of medical ethics, patient safety, and professional accountability. We must look into our own operating theatres and prescription pads. The race for riches is now tragically morphing into a race for cheap publicity, where a trivial procedure is hyped on social media to anoint oneself a “world-acclaimed” expert, with little regard for the actual metrics of quality, safety, and standards of practice.
Where are the safeguards? The process of credentialing and privileging—determining who is qualified to perform which complex procedure—is either meagre or invisible. There are no maintained logbooks for trainees or even for senior consultants. There are no clear guidelines on who can do what intervention. We allow professionals to handle human organs and lives without rigorous, ongoing competency tests or skill assessments. Is it any wonder then that adverse events, sentinel events, and preventable mortality occur? Our response to these tragedies is an age-old ritual: an inquiry is ordered, a report is awaited, and with time, the urgency dies down. The root causes, the concerns, the systemic gaps are buried in bureaucratic limbo, only to resurface in the next tragedy.
Consider the emergency department, where minutes matter. The ideal medical ritual of “early assessment, prompt diagnosis, and immediate treatment” remains a distant dream in many of our institutions. We speak of advanced concepts like MEWS (Modified Early Warning Score) and PEWS (Paediatric Early Warning Score) to identify deteriorating patients, and the need for a Rapid Resuscitation Team (RRT) or a “code blue” team. In our context, however, thinking of an RRT is like thinking of rockets and drones to deliver medication to inaccessible areas—a futuristic fantasy. How can we even think of forming a Rapid Response Team (RRT) or ensuring compliance when, shockingly, many tertiary-care teaching hospitals still lack a designated Code Blue team? Even the most basic policies and procedures for emergency response remain unimplemented. This reflects a deep apathy toward patient safety and institutional accountability. The Code Blue concept—introduced globally in the 1950s to enable prompt, coordinated action during cardiac or respiratory arrest—was meant to save lives through readiness and teamwork. Yet, decades later, many of our hospitals still struggle to move beyond paper protocols to real-time, practiced preparedness. Where are the seniors when a junior doctor in the overwhelmed emergency department is struggling? By the time they arrive at the point of care, it is often too late.
Every patient presenting to the Emergency Department must be evaluated using standardized triage tools such as the Canadian Triage and Acuity Scale (CTAS) or equivalent emergency assessment systems. The evaluation should determine the patient’s acuity, define the required response within a set timeline, and be closely monitored and supervised to ensure adherence to these clinical guidelines. Compliance must not remain theoretical—it must be demonstrated through real-time performance and audit. To achieve this, Lean Six Sigma training should be made mandatory for all hospital CEOs and healthcare executives, ensuring that leadership fully understands process improvement, waste management, patient flow, and quality metrics.
This failure of leadership and accountability extends to the very foundations of hospital administration. How many of our state-run hospitals, particularly our tertiary care teaching institutions, are accredited by a national body like the NABH? The answer is tragically few. There is no independent, third-party assessment to tell us, “Your hospital is doing well based on established healthcare standards and Key Performance Indicators (KPIs).” Data scrutiny is missing. What to write, how to write, and who can write in patient records remains anarchic. A case sheet sought through RTI often reveals unidentifiable scrawls—a mere signature without a name, code, stamp, or designation. How can we ensure accountability or conduct a meaningful audit when we cannot even identify who provided care?
The question then demands an answer: how can we bring change? The first step is for us, the medical community, to acknowledge our complicity. We must reclaim our professional integrity from the corrosive influences of commercialism and apathy. Hospital administrations must be empowered and compelled to enforce strict credentialing, maintain transparent logbooks, and implement robust clinical audit systems. The National Medical Commission must move beyond its difficulties to ensure that re-registration is contingent on proven continuing medical education and competency assessment, not just a formality.
But above all, we must rekindle the spirit of our oath. A patient walking into an Emergency Department should be guaranteed care based on the merit of their disease, not the power of their sifarish or recommendation. We must build a system we can trust, and that begins with becoming professionals whom the public can trust. The state can provide the infrastructure, but it cannot infuse the integrity. That is our sacred duty. It is time we stopped blaming the state and started healing ourselves. The patient is waiting, and their right to safe, ethical, and compassionate care is non-negotiable.
In Kashmir, the once-rare attitude of resignation has now become a norm. The casual shrug of “chalta hai” — once an exception — has evolved into a collective philosophy. It reflects not patience but paralysis; not tolerance but quiet surrender. The real question, therefore, is where we draw the line—between enduring and enabling, between living consciously and merely existing. Concern is not a luxury; it is a civic and moral necessity. The day we stop feeling disturbed by decay around us is the day we cease to be alive in spirit.
(Author is a certified professional in healthcare quality, a clinical auditor, and an expert in healthcare policy analysis, standards, and system improvement).
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