Professional jealousy is a fact of the Pakistani way of life. Out of 170 million people, how many real professionals are there? The majority of our population is illiterate and the problem is made all the more vulgar with the addition of the ‘educated illiterates’ out there. It is well known that the crème de la crème, after FSc or A-levels, joins engineering universities or medical colleges, and those who cannot get merit-based admissions (and want to rule with a stick in hand) join the civil services. I know many who, after the completion of their professional training, left and joined the civil services because they decided in favour of early power gain. It is unfortunate that the strings of power in almost all professional (and political) institutions are in the hands of those who know the least about the business they are overseeing. In the medical profession, it is a sorry fact that governments have come and gone but they have not been able to give a viable service structure to the doctors who are holding the fragile threads of the healthcare system together despite massive ethical corruption. The changes introduced by the government are on personalised intuition or according to what suits those in charge the best. Autonomy in the healthcare sector was introduced with gung ho and gusto in the late 1990s but was cut down to size when the government changed. Where doctors are concerned, there are senior physicians and surgeons occupying higher positions who tend to forget the merit-derived promotional capabilities of those who wait in the wings when they have lacklustre offspring queuing up to become the nation’s future generation of healers. In the past, some draconian rules prohibited capable doctors from practicing privately. Even now, junior doctors are thought of as little better than note-taking servants who should not speak. The clever bureaucracy in the administrative wing of many hospitals ensures the employment of incapable favourites as seniors who then proceed to dictate their nothing rules and ‘training’ to the mute juniors. If a junior possesses the gall to progress and cross lines of careful control to qualify as a specialist, he is pulled back so as not to stand at par with the designated seniors. However, there are exceptions: when a well-connected or agenda serving doctor makes his way into these wards of tortured unprofessionalism, he/she will quickly be absorbed into the system and regularised. Others, who base their lives and vocations on professional ethics and fastidious principles, see the back of all too many hands. Many ways have been devised in the recent past to halt the career progression of these junior, qualified (to become consultant) doctors, which include ad hoc appointments, own pay scale (pays that do not justify the interim use of a medical professional at a higher post) and dubious current charge. From time to time, these policies are reviewed in the interest of only God knows who and junior doctors working in the specialist cadre are pulled back to the general cadre. The poor fellows, who spent a good chunk of their early lives studying to excel in the noble field of medicine, are either again divided to the benefit of their seniors or they do not raise their voices. A lot of them become frustrated and leave the country. Who loses in this political-professional game? Only the people who actually go to government hospitals and expect legitimate medical advice. They are, once again, left to the mercy of poorly administered health facilities, subjecting themselves to the quacks that are a dime a dozen. I wonder why the chief minister pays surprise visits to catch these unqualified people playing with the lives of the poor. Why are laws not in place to check this blatant disregard for public health? If there is a law, why is it not implemented? A weakly educated population that is worried about its job security and running a kitchen on hyper-inflated prices becomes a win-win situation for the power-enjoying minority that rules the majority. When you preoccupy the masses with basic inanities, no one is going to raise their voice against injustice. Between making ends meet and cradling a dysfunctional national psyche, the masses just do not have the time. Promotions are never performance based; seniors are asked about their thoughts concerning candidate hopefuls in the form of the Annual Confidential Report (ACR). The ruling class also asks itself: which doctor is most useful to our particular agenda? Who can be easily moulded and who has principles? The West has come out of this personal bias. Their criteria are performance-based with the usefulness of the doctor for his institution always kept in mind. They regularly monitor their punctuality, work, competence and relations with patients and their own colleagues. They do not victimise the individual in case something goes wrong; rather inquiries are directed to find out the reasons behind any professional lapse and recommendations are made on how to rectify it. If someone is found in a compromising position, he is given a chance to clarify and improve himself. This is how systems are made — not by a few people but by all the stakeholders. We are losing our educated people. There is a brain drain that is directed towards the US, UK, Australia and even Saudi Arabia and the Middle East. They are leaving because of malicious manoeuvres that aim to discredit professionalism because of insecure leaders in the vocational realm. This must be addressed, lest even our political leaders will one day also have to make do with medical quacks. The writer is a physician based in Lahore and can be reached at mimranhkhan@hotmail.com