The Social Contract – Story of a Pakistani medical student


In Pakistan, medicine is one of the most sought after profession. Admission to a medical college is highly competitive, like in other parts of the world. Back in the days, a lot of material had yet to be deciphered. Hooray, we wished that it would remain unexplored until we’re out of school, so we wouldn’t have to study that too.

It was the same with Fermat’s last theorem and the Riemann hypothesis in Mathematics, cloning animals in biology, and lots of stuff in physics and chemistry were yet to be discovered when I was in school

However, it was too late for some things like the structure of the DNA; it had already been revealed, the secret of the nuclear bomb cracked. We had to study the former, but luckily, as it was an anti-national or anti-something to teach young students how to make a bomb, the latter was not on the curriculum. A good student got a 63% and a brilliant one scored 72. Anyone who pushed more than that either had his papers re-checked or was immediately made full professor.

And everyone was guaranteed college admission. My nostalgia was provoked by a decision by the education committee where the cut off mark for admission was 98%. If you finished your schooling with less than a perfect score, you need not apply. Either we have been creating geniuses in the years since I left school, or high school students have been taking a test designed for nursery school kids. For example, what letter follows ‘C’ in the alphabet?

I took up the contract along with many students aspiring to become doctors and sat in a Medical Colleges Admission Test (MCAT). Students who failed to qualify for public medical colleges settled for admission in private settings. Once admitted, we followed a detailed curriculum over the next five years appearing for yearly/semester university examination. Success in the final examination granted a degree of MBBS and following registration with Pakistan Medical and Dental Council (PMDC), the graduates were eligible to practice medicine in Pakistan.

The race began with trying to ensure that wherever the students spend their five years of education at either government or private sector; the final product of the dyads is essentially the same. Another argument lies on the student population entering medical school with backgrounds of Pakistani education system (HSC), British (A-Level) and a combination of both with performances in medical college examinations in various years.

Now what leads to an idealistic interest in public service? The heterogeneous foundation of this anticipation ranges from living the family legacies, intimate contact with the suffering, to set them apart from the common run, or simply, going with the flow. Doctor is one of the most common career choices yet a small percentage enters medical school. Some students abandon medicine because they are told they lack talent; others because they cannot endure the panorama of seven to nine years of education. There are more of others, because they are lured in to multiple academic interests and still others-a significant group – ‘I don’t think I am among them’.

In the course of social contract, the medical student is less likely to be aware of his own feelings. A decrease in empathic concern including feeling less humanistic and balancing personal life with professional is my personal experience and concern as well. Thereby, despite the potentially serious consequences of a burnout, few interventions exist to combat this problem. Assuming a more partial authority, confronting various aspects of the human condition daily, experiencing substantial vagueness to prevent errors, difficulties in fitting in with the social norms and expectations of the dominant culture of a medical school etc. are only a few glitches a student is challenged with.

Just when our attempts to retain human sensitivity in the modern world weren’t ample, the abuse rooted in medical education took its toll. Despite numerous declarations by the academics, it has shown little amelioration. Therefore, both personal and professional factors appear to contribute to student burnout. Seen from this point of view, this fact should be a subject of research and recognition by medical schools, so they can channel their energies and practice in order to prepare student for the psychological and physical hazards of their vocation in effort to strengthen students’ sensitivity and social responsibility.

Young students who readily embrace “The Social Contract” experience high levels of pressure during education and training years. The pressure ranges from the large body of clinical knowledge to master and absenteeism, increased competition and demands, inadequate support of health professionals and professional misconduct, financial indebtedness, cultural and minority issues, scarcity of leisure time, poor-self-care etc.

This may leave students feeling emotionally exhausted and contemptuous. So the next Nobel should go to the genius who can perform this crucial housekeeping of our brains – removing the totally useless so there’s room for totally useful; the Medical Schools. Medical schools must train aspiring students to evaluate their personal health and determine its influence on their practice. Another important assessment is support groups for students challenged with personal or professional life events and increase in the humanistic approach in the work force.

Furthermore, medicine’s Social Contract is the profession which receives a variety of public support; thereby schools now encourage their students to complete service work either voluntary or elective. Nevertheless, such a reflective practice may make this kind of learning more fruitful and stable. Thereby, the schools have double function aiming at technical competence and strengthening mental performance.

I think the weighing of the centuries (and the burden of the world) is not upon the old and the ageing. Not if you are a Pakistani Medical Student!

About the author: Eman A. Khaled is a medical student from Sir Syed College of Medical Sciences, Karachi, Pakistan. Her profound interest in Public Health led to active contribution to Best medical Center research. She has volunteered duties at various hospitals, Pakistan Red Crescent Society and the Rotaract Club of Karachi.

Article source AFP

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