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The Social Contract – Story of a Pakistani Medical Student

Submitted by on August 22, 2012 – 5:16 AM 7 Comments

In Pakistan, medicine is one of the most sought after profession. Admission to 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, 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 5 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 5 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 to 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 the 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 the student for the psychological and physical hazards of his 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 medical research. She has volunteered duties at various hospitals, Pakistan Red Crescent Society and the Rotaract Club of Karachi. She can be contacted at [email protected].


About this article: This article is competing for the JPMS International Medical Writing Contest 2012 for the theme: Medical Education


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  • Waqar Hassan

    Well i have a lot reservations with the article posted above. I am a med student and i agree that at certain point the med student undergoes some degree of pressure but making it look like a giant problem is totally wrong. The article is filled with that much hatred that to me it looked as if the article was the consequence of tremendous frustrations because the author had failed some semester or had a year back.

  • EmanA

    you mean HELD back?

    Waqar, you need to work on your reading and social ethics.

    not my story, it’s my experience. My word is full of support to the students who
    will relate to the article. Moreover, the amendments I suggested to be made in
    the system depict encouragement of new boundaries and livelihood of the rising

    since this is a word competition not a debate, I don’t need to strain pros and
    cons, just humor and word power!

  • Nauman Hashmani

    I like the general essence of your article but where you say someone should do a “housekeeping” of our brains is something i disagree with. Nobody should be able to get rid of the “useless” as you say because the brain keeps information that a person think is somehow useful. See every experience and every task a person does makes him or her the person they are today; medical knowledge isnt the only thing that makes a man who he is.

    Now I like how you said that both the professors and the personal life account to a student burnout. This is severely lacking in today’s Pakistani medical school. Not many professors are willing to help the students and alot of them do for their own personal gain; theres no “service” so to speak that genuinely helps a student. Now don’t get me wrong there are professors who help but there needs to be a system that aids students because today you have to make it on your own and I believe a university is in place because it needs to help you.
    Thirdly you said in your opening paragraph that “back in the days a lot had yet to be deciphered”. I still think a lot is yet to be deciphered. I mean we haven’t gained eternal knowledge just yet and these discoveries are natural progressions. Our kids will probably learn more in their high school than we did; thats the point of research, something we also severely lack.
    I like your article and its well presented!

    • EmanA


      The point where I mentioned the housekeeping
      was candidly disclosed and so were the discoveries of perpetuity…I began with
      humorous direction where the sessions between a student and a teacher were only
      confined to knowing the name of the street next to one’s house.

      I explicitly
      aim to change the existing entities of the system rather than bringing a


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  • Ali

    Being a member of the general public and not medical students. I have a say here:

    We have more doctors on the road protesting than we need in hospitals. We have lineups in emergency wards. We think that surgeons wear a mask to loot patients. We have loads of people below the poverty line and too few hospitals to treat the poor.

    In such a struggling country like Pakistan, one feels hurt to see that the medical profession is becoming too commercial to be what it intended to be.

    Commercial hurdles, necessary nature of medicine and ethical objectivity of doctors. Put them together and you are reminded of praying to God.

    I’m not accusing doctors of anything here. Infact I can understand how difficult it is for doctors to practice in such environments. Where a doctor must work eighteen hours a day and seven days a week and if they cannot, they’ll have to console themselves to this and get out of the profession.

    The social contract in my opinion is not that social and is resulting to be too unethical as well!

    God help us all!

    • EmanA

      Ali, one of the prime focus while writing the contract opinion was adopting the profession for multiple reasons and not being the core “save people” kind of mode. Moreover, I too highlighted and wish to implement the ethical education among students in addition to the subject. Restoration of student sensitivity and social concern combined with regard for the humanity is important once granted entry into this profession. Wide protests and predictive associations put forward their requests while several wait along corridors un-attended.