Living and working in the UK compared to Pakistan
A lot of people ask me why I came to the UK. Some Pakistani doctors ask me what it is like and what the core differences are.
Let me tell you one thing - no place is perfect. You have to compromise on one thing or another.
I came to the UK because:
1. I wanted to get training in the best health care system in the world. I still believe that the NHS is the best and most"humane" system - where there is no profit. Every person (British citizens and people on work visas) are treated for free- which may cost thousands of pounds elsewhere.
2. My parents were (and still are) independent and self caring. They come to the UK regularly and have long term visit visas.
3. My sister is also working in the NHS (she came 1 year after I did).
Racism and Humanity
I am not going to discuss this however I feel that the UK is more humane and less racist than Pakistan.
Family
This is also a major factor. It is very difficult to manage for some of us whose families are back home and are unable to travel (because of age or disease). Some of us do get home sick and have to go home frequently. Leaving home can be hard for some too - as they may be saying their last goodbyes. This makes living in the UK even more difficult.
Let me tell you one thing - no place is perfect. You have to compromise on one thing or another.
I came to the UK because:
1. I wanted to get training in the best health care system in the world. I still believe that the NHS is the best and most"humane" system - where there is no profit. Every person (British citizens and people on work visas) are treated for free- which may cost thousands of pounds elsewhere.
2. My parents were (and still are) independent and self caring. They come to the UK regularly and have long term visit visas.
3. My sister is also working in the NHS (she came 1 year after I did).
Here are some of the differences:
Skills
In Pakistan, when I was working as a house officer, I was doing lumbar punctures, pleural taps with proper supervision initially and then independently. I was very good at these and had done loads. However the methods are different in our home country. We may be more skilled but the aseptic techniques are not followed.
So even though I was well versed in these procedures, I had to start all over again here. Now I am well versed in the skills I learnt back home done under national and local NHS guidance.
So even though I was well versed in these procedures, I had to start all over again here. Now I am well versed in the skills I learnt back home done under national and local NHS guidance.
Teaching
Unfortunately, the teaching back home was slightly different. Here it is based on bed side teaching during ward rounds, CPD lectures, e-modules and simulation sessions with dummies under supervision (This is an example: http://www.yorksandhumberdeanery.nhs.uk/medicine/core_medical_training/simulation_training/ascme_(acute_simulated_core_medical_emergencies)/
At home it was mainly bedside teaching.
I gave presentations and taught medical students back home and I do those here too.
I find the teaching here better as you can actually implement the latest guidance you learn in your clinical practice.
Training
In Pakistan, I worked as a house officer and then started my post graduate training.
I felt that I had more hands on experience back home but my knowledge and ability to apply that knowledge to my clinical practice was limited. As I saw a variety of cases, I gained a lot of experience.
I feel that the training for foundation year doctors in the UK is more supervised and more structured. They have a syllabus and a portfolio which they have to tick off by the end of their training.
In the UK, there is a simple rules for procedures: learn, observe, do under supervision, do independently and then teach.
In the UK, there is a simple rules for procedures: learn, observe, do under supervision, do independently and then teach.
Exams
Since I am working in a medical specialty, I will limit this discussion to what I have experienced.
The Pakistani post graduate exams (especially FCPS-1) are slightly different than the MRCP exams.
I found FCPS 1 very difficult - I had to cram topics which had no clinical relevance whatsoever. It took me 3 months to prepare for this and it was the toughest exam (and at the same time, the least clinically relevant exam) I have given. Kindly do bear in mind that I gave it in 2014 so (hopefully) the syllabus would have changed by now.
I found FCPS 1 very difficult - I had to cram topics which had no clinical relevance whatsoever. It took me 3 months to prepare for this and it was the toughest exam (and at the same time, the least clinically relevant exam) I have given. Kindly do bear in mind that I gave it in 2014 so (hopefully) the syllabus would have changed by now.
After FCPS 1, we have a OSCE type example known as intermediate module and then FCPS 2- both of which are more clinically relevant.
MRCP 1 and 2 are more clinically relevant which required more conceptual preparation rather than cramming and I feel that I become a better and more knowledgeable doctor after giving these exams.
Curriculum
As mentioned above, in Pakistan we do not have a set curriculum. We do have an "e-logbook" but many doctors there do not use it properly as there is no proper check and balance. It is a requirement to complete training so most end up filling it in the last few months of their training.
In the UK, we use our e-portfolios regularly. We add on certificates, reflect on events, get assessments done and follow the curriculum set by it. We are checked regularly (once every 3 months) and are informed to work more on it.
Supervisors.
We have supervisors in both countries. However their approach is very different. In the UK, your supervisor is your friend, guide and mentor. My supervisors have given me excellent advice over the last few years and they have helped me in a lot of projects.
In Pakistan, the supervisors are usually very strict therefore we cannot be very open with them about concerns we have. Of course, there are some excellent supervisors in Pakistan who have trained people to become one of the best doctors in that region without any foreign exposure.
Hierarchy
In the UK, we are on friendlier terms with our seniors. We call our registrars by their first names and our consultants by Dr/Mr(last name). We are very open about everything with them. I have personally discussed my problems in the workplace with them and they have helped me a lot. Some consultants are so friendly that they ask us to call them by their first name. I remember my consultant took me for coffee and gave me excellent advice about career progression and life in general.
In Pakistan, you refer to everyone who is senior to you as "sir" or "ma'am". They are the authority and everyone is scared of them. Some do take full advantage of their authority, such as post graduate trainees making their house officers do their duties (thus over burdening them and affecting the standard of health care provision ). I clearly remember some personal incidences in my one year internship back home in which a consultant shouted at me (and everyone else on multiple occasions) during a ward round.
The pay
This should not be a concern, but if you are in a situation like I was in then it is a concern.
I worked as an honorary house officer (i.e. I was not paid for the whole year) and honorary post graduate resident ( for 3 months after which I resigned). However now things have improved and they do pay junior doctors - although it is not enough to be financially independent which is why most doctors in Pakistan either do a second job or they live with their parents.
In the UK, we are on friendlier terms with our seniors. We call our registrars by their first names and our consultants by Dr/Mr(last name). We are very open about everything with them. I have personally discussed my problems in the workplace with them and they have helped me a lot. Some consultants are so friendly that they ask us to call them by their first name. I remember my consultant took me for coffee and gave me excellent advice about career progression and life in general.
In Pakistan, you refer to everyone who is senior to you as "sir" or "ma'am". They are the authority and everyone is scared of them. Some do take full advantage of their authority, such as post graduate trainees making their house officers do their duties (thus over burdening them and affecting the standard of health care provision ). I clearly remember some personal incidences in my one year internship back home in which a consultant shouted at me (and everyone else on multiple occasions) during a ward round.
The pay
This should not be a concern, but if you are in a situation like I was in then it is a concern.
I worked as an honorary house officer (i.e. I was not paid for the whole year) and honorary post graduate resident ( for 3 months after which I resigned). However now things have improved and they do pay junior doctors - although it is not enough to be financially independent which is why most doctors in Pakistan either do a second job or they live with their parents.
In the UK, we have a strict criteria as mentioned here:
http://omarsguidelines.blogspot.co.uk/2017/08/our-payslips.html
http://omarsguidelines.blogspot.co.uk/2017/08/our-payslips.html
You are paid according to the post you are working on- not a penny less. You can earn more by doing extra shifts and that too has a certain pay (which varies from trust to trust but there is a minimum limit).
Career progression
Compared to the UK, career progression is "easier" in Pakistan. You give your FCPS 1 exam, get a post graduate training post and work in it till you pass your FCPS 2. Then you become a registrar- You can either continue in the same place as a registrar in a sub specialty or change your hospital.
Compared to the UK, career progression is "easier" in Pakistan. You give your FCPS 1 exam, get a post graduate training post and work in it till you pass your FCPS 2. Then you become a registrar- You can either continue in the same place as a registrar in a sub specialty or change your hospital.
In the UK, we generally start our careers as non trainee SHOs, then we apply for core medical training posts which is via national recruitment (or bypass this by completing MRCP), then ST3 registrar posts and then consultant posts.
So we have to change our jobs thrice. With changing our job (which is usually in a different city), we have to change our visas and accommodation as well.
However, like everything else this looks hard but is not very difficult if you are in the system.
General Practitioners
In the UK, GPs are the core physicians of all patients. They have their clinics which they run with other colleagues. They manage patients in the non acute setting and then consider referring to ED, AMU O/P clinics, other specialty clinics if they are concerned. GP training is a full specialty and initially doctors work in ED, surgical and medical specialties, then start working in GP practices.
In Pakistan there is no such thing as GPs. The medical consultants usually manage such non acute (and acute) patients.
However family medicine is being introduced in some hospitals.
In the UK, GPs are the core physicians of all patients. They have their clinics which they run with other colleagues. They manage patients in the non acute setting and then consider referring to ED, AMU O/P clinics, other specialty clinics if they are concerned. GP training is a full specialty and initially doctors work in ED, surgical and medical specialties, then start working in GP practices.
In Pakistan there is no such thing as GPs. The medical consultants usually manage such non acute (and acute) patients.
However family medicine is being introduced in some hospitals.
Quack doctors.
Although Pakistan has a medical council, it does not have very strict rules against quack doctors and spiritual healers- who are in abundance particularly in rural areas. These "professionals" cause more harm than good and usually such patients end up in a critical state in hospitals when nothing can be done.
In the UK, the GMC is a very strict and vigilant authority.
Although Pakistan has a medical council, it does not have very strict rules against quack doctors and spiritual healers- who are in abundance particularly in rural areas. These "professionals" cause more harm than good and usually such patients end up in a critical state in hospitals when nothing can be done.
In the UK, the GMC is a very strict and vigilant authority.
Specialty nurses.
In the UK, we have specialty nurses for almost every chronic disease. IBD nurses, incontinence nurses, heart failure nurses, respiratory nurses, parkinsons nurses, midwives etc. This eases the burden off the doctors and they can focus on managing ward patients, etc. These nurses are excellent and as a junior doctor, I have learnt a lot from them.
There is no such thing in Pakistan.
The MDT approach.
In the UK, we have a MDT approach as explained in this blog post:
http://omarsguidelines.blogspot.co.uk/2017/05/guideline-for-junior-doctors-working-in.html
This does not exist in Pakistan.
In the UK, we have specialty nurses for almost every chronic disease. IBD nurses, incontinence nurses, heart failure nurses, respiratory nurses, parkinsons nurses, midwives etc. This eases the burden off the doctors and they can focus on managing ward patients, etc. These nurses are excellent and as a junior doctor, I have learnt a lot from them.
There is no such thing in Pakistan.
The MDT approach.
In the UK, we have a MDT approach as explained in this blog post:
http://omarsguidelines.blogspot.co.uk/2017/05/guideline-for-junior-doctors-working-in.html
This does not exist in Pakistan.
Computerized system.
In the UK, all GP records, patients investigations, discharge summaries, etc are computerized. We enter the hospital number and get all of the records.
In Pakistan, we hand a hand written discharge summary to the patients which they never bring on re-admission.
Occupational and physio therapists.
If a patient is fit for discharge from a medical point of view but has not been cleared by the aforementioned teams, the patient cannot go home. OTs and PTs are therefore a vital part of the MDT.
We do not have such a thing in Pakistan. There are a few physiotherapists who are available privately.
Management of the sick patient.
In the UK, we have CRASH calls, EWS calls and we have an escalation plan for such patients.
In Pakistan, we do not have any bleeps or any other sort of media. So if a patient crashes, the on call team is called by the nursing staff and there is no critical care support unless they are called.
In the UK, all GP records, patients investigations, discharge summaries, etc are computerized. We enter the hospital number and get all of the records.
In Pakistan, we hand a hand written discharge summary to the patients which they never bring on re-admission.
Occupational and physio therapists.
If a patient is fit for discharge from a medical point of view but has not been cleared by the aforementioned teams, the patient cannot go home. OTs and PTs are therefore a vital part of the MDT.
We do not have such a thing in Pakistan. There are a few physiotherapists who are available privately.
Management of the sick patient.
In the UK, we have CRASH calls, EWS calls and we have an escalation plan for such patients.
In Pakistan, we do not have any bleeps or any other sort of media. So if a patient crashes, the on call team is called by the nursing staff and there is no critical care support unless they are called.
Escalation plans
In the UK, when a sick patient is admitted to hospital and if they have multiple co morbidites, are frail, a DNAR form is signed. At times, GPs also do this if the patient wishes to or if the GP finds it appropriate. This way such patients (and their relatives) do not go through the agony of CPR and intubation and they are allowed to pass away "naturally and peacefully" when the time comes.
In the UK, when a sick patient is admitted to hospital and if they have multiple co morbidites, are frail, a DNAR form is signed. At times, GPs also do this if the patient wishes to or if the GP finds it appropriate. This way such patients (and their relatives) do not go through the agony of CPR and intubation and they are allowed to pass away "naturally and peacefully" when the time comes.
In Pakistan, some hospitals have DNAR forms however it is not implemented nationally like the UK. Most patients undergo CPR unless the relatives ask us to stop.
Palliative medicine
In the UK, when a patient is very poorly, aggressive treatment has not worked and they are deteriorating rapidly, the family is involved and after agreement, all active treatment is stopped and they are put on "end of life care". They are started on medications subcutaneously to relax them (these medicines DO NOT hasten their death and are therefore NOT assisted suicide). This way they pass peacefully and not in pain. Some patients are transferred to Hospices which are special centers which deal with such cases.
They have rooms where they can spend time with their loved ones and is more peaceful than a busy hospital.
In Pakistan, there is no such thing as palliative medicine or hospice care. The relatives often get aggressive that why have the doctors not treated their loved ones.
In the UK, when a patient is very poorly, aggressive treatment has not worked and they are deteriorating rapidly, the family is involved and after agreement, all active treatment is stopped and they are put on "end of life care". They are started on medications subcutaneously to relax them (these medicines DO NOT hasten their death and are therefore NOT assisted suicide). This way they pass peacefully and not in pain. Some patients are transferred to Hospices which are special centers which deal with such cases.
They have rooms where they can spend time with their loved ones and is more peaceful than a busy hospital.
In Pakistan, there is no such thing as palliative medicine or hospice care. The relatives often get aggressive that why have the doctors not treated their loved ones.
Check and balance
In the UK, we have morbidity and mortality meetings. The consultants in charge go through a patient's notes if there is any concern about management of a patient and the responsible doctor is then held accountable.
We have annual appraisals for this very reason too - to ensure that the doctors are working at a certain level set by the GMC. It is compulsory for junior doctors and consultants have to go through this.
In the UK, we have morbidity and mortality meetings. The consultants in charge go through a patient's notes if there is any concern about management of a patient and the responsible doctor is then held accountable.
We have annual appraisals for this very reason too - to ensure that the doctors are working at a certain level set by the GMC. It is compulsory for junior doctors and consultants have to go through this.
In Pakistan, there are morbidity and mortality meetings but the system is not as robust as in the UK - therefore people may not know what mistakes they are making and hence it may be difficult for them to learn. Sometimes in medical negligence, doctors responsible for the care of such cases can get away through personal contacts.
The patient is first
In the UK, patient care is always the priority. We have a Patient Experience Team (PALS) which deals with any complaints patients have - This may be against a HCA, nurse, junior doctor, registrar or consultant. Usually the consultant in charge goes through the notes and then holds the person responsible.
The patient is first
In the UK, patient care is always the priority. We have a Patient Experience Team (PALS) which deals with any complaints patients have - This may be against a HCA, nurse, junior doctor, registrar or consultant. Usually the consultant in charge goes through the notes and then holds the person responsible.
This way, there is always a certain standard of patient care provided.
In Pakistan, it varies from doctor to doctor and from hospital to hospital.
In Pakistan, it varies from doctor to doctor and from hospital to hospital.
Timings
In the UK, doctors either start at 8 or 9 AM and finish at 5 or 530 PM. If they are not on call, they go home.
In Pakistan, doctors especially consultants come to hospital at 8 or 9 AM, work till 3 PM (this is the official finishing time), come home, eat, nap and then go to their private clinics and work there from 6 PM to 11 PM (some overenthusiastic consultants work till 1 AM).
On call
In Pakistan, the on call rota is made by registrars and usually a set pattern is followed. Usually doctors have 12 hours or even 30 hour shifts.
When I was doing my house job, I used to come to the ward at 9 AM and stay there till 3 PM the following day.
In the UK, the European Time Directive is followed which means that doctors showed have adequate rest (at least 8 hours after a 12 hour shift).
http://www.hse.gov.uk/contact/faqs/workingtimedirective.htm
In Pakistan, doctors especially consultants come to hospital at 8 or 9 AM, work till 3 PM (this is the official finishing time), come home, eat, nap and then go to their private clinics and work there from 6 PM to 11 PM (some overenthusiastic consultants work till 1 AM).
On call
In Pakistan, the on call rota is made by registrars and usually a set pattern is followed. Usually doctors have 12 hours or even 30 hour shifts.
When I was doing my house job, I used to come to the ward at 9 AM and stay there till 3 PM the following day.
In the UK, the European Time Directive is followed which means that doctors showed have adequate rest (at least 8 hours after a 12 hour shift).
http://www.hse.gov.uk/contact/faqs/workingtimedirective.htm
ED departments
In Pakistan, the ED department is run by the medical teams. Usually hospitals have 4 or 5 medical wards and each ward has a team of 20 to 30 doctors ( including house officers and post graduate trainees). These ward teams have a rota and they are asked to do 12 hour shifts in ED.
In the UK, the ED departments are a whole specialty (known as emergency medicine). They are trained to deal with emergencies and they have their own training as well (with trained consultants, registrars and core ACCS trainees).
In the UK, the ED departments are a whole specialty (known as emergency medicine). They are trained to deal with emergencies and they have their own training as well (with trained consultants, registrars and core ACCS trainees).
The on call teams
In Pakistan usually, on a medical ward the on call team (i.e. the team after 3 PM) consists of 1 or 2 house officers and 1 post graduate trainee. There is a registrar available on the phone (who does not stay in hospital).
The ED on calls are described above.
In the UK, we have a whole team which has to be there at all times. This varies from trust to trust.
PS: This is typical team for the weekend
Bigger trusts
- 1 Consultant for the wards (goes home at 9 PM - available on the phone)
- One registrar for the wards
- 2 SHOs for the wards
- 1 or 2 foundation doctors for the wards
In Pakistan usually, on a medical ward the on call team (i.e. the team after 3 PM) consists of 1 or 2 house officers and 1 post graduate trainee. There is a registrar available on the phone (who does not stay in hospital).
The ED on calls are described above.
In the UK, we have a whole team which has to be there at all times. This varies from trust to trust.
PS: This is typical team for the weekend
Bigger trusts
- 1 Consultant for the wards (goes home at 9 PM - available on the phone)
- One registrar for the wards
- 2 SHOs for the wards
- 1 or 2 foundation doctors for the wards
-1 Consultant for post taking clerked patients (goes home at 9 PM - available on the phone)
- 1 registrar for clerking ED patients
- 2 SHOs for clerking
- 1 or 2 foundation doctors for clerking
Smaller trusts
- 1 registrar for clerking ED patients
- 2 SHOs for clerking
- 1 or 2 foundation doctors for clerking
Smaller trusts
-1 Consultant for post taking clerked patients (goes home at 9 PM - available on the phone)
- One registrar for the ward and clerking
- 1 SHO for clerking
- One registrar for the ward and clerking
- 1 SHO for clerking
- 1 foundation doctor
- 1 Consultant for the wards (goes home at 9 PM - available on the phone)
- 1 SHO for wards
- 1 foundation doctor for wards
Locums
In the UK, there has to be a set number of doctors covering the wards and on call rota. If there is understaffing, the HR asks for extra help - They send emails to internal staff and external agencies to help them. These doctors are paid.
- 1 SHO for wards
- 1 foundation doctor for wards
Locums
In the UK, there has to be a set number of doctors covering the wards and on call rota. If there is understaffing, the HR asks for extra help - They send emails to internal staff and external agencies to help them. These doctors are paid.
There is no such thing in Pakistan.
Consultants
In the UK, the consultants are very dedicated towards the care of the patients admitted in the NHS. They take full responsibility of their ward and ensure that all health professionals working there learn the maximum and are not overworked.
It varies in Pakistan from consultant to consultant and their working hours vary- some are very dedicated- They come at 730 AM, teach their juniors, do full ward rounds, make plans for all patients, do specialty based procedures, do a mini ward round and then leave at 3 PM. However some consultants come at 11 AM, have tea, scold a few juniors and leave at 1 PM. Some do not bother to show up at all. 34
Stress
This is a very subjective thing. Personally, despite having no pay I did not feel stressed back home because I had a family to support me. However some people may not have this luxury. The other stress in Pakistan is the lack of support when things go wrong such as relatives beating doctors when a patient who was terminal on admission, etc. The other issue is overburdening (as mentioned above).
Similarly, in the UK International Medical Graduates may be stressed initially but once they settle in, they manage well. However here, they have different sort of stresses. They worry about family back home or they may not settle well if they are not outspoken.
It varies in Pakistan from consultant to consultant and their working hours vary- some are very dedicated- They come at 730 AM, teach their juniors, do full ward rounds, make plans for all patients, do specialty based procedures, do a mini ward round and then leave at 3 PM. However some consultants come at 11 AM, have tea, scold a few juniors and leave at 1 PM. Some do not bother to show up at all. 34
Stress
This is a very subjective thing. Personally, despite having no pay I did not feel stressed back home because I had a family to support me. However some people may not have this luxury. The other stress in Pakistan is the lack of support when things go wrong such as relatives beating doctors when a patient who was terminal on admission, etc. The other issue is overburdening (as mentioned above).
Similarly, in the UK International Medical Graduates may be stressed initially but once they settle in, they manage well. However here, they have different sort of stresses. They worry about family back home or they may not settle well if they are not outspoken.
Personally, I have found life in the UK less stressful.
Funding of hospitals
In Pakistan, building roads and giving contracts to companies owned by government officials is the priority. They would prefer buying bullet proof cars in dozens rather than spending that amount on hospitals and education. As a result, the government run hospitals are in a very bad shape. Most affording people prefer private hospitals.
In the UK, the NHS is as good as any privately run hospital in the world with all sorts of clever technology. And all of this is for free.
In Pakistan, building roads and giving contracts to companies owned by government officials is the priority. They would prefer buying bullet proof cars in dozens rather than spending that amount on hospitals and education. As a result, the government run hospitals are in a very bad shape. Most affording people prefer private hospitals.
In the UK, the NHS is as good as any privately run hospital in the world with all sorts of clever technology. And all of this is for free.
Improvement
In the UK, it is mandatory for a junior doctor to do projects (such as audits) to improve the standard of care - This may be in the form of making handovers, ensuring patients are discharged on time, get medications on time, etc. These are also discussed with their supervisors and are pointed out during appraisals.
In the UK, it is mandatory for a junior doctor to do projects (such as audits) to improve the standard of care - This may be in the form of making handovers, ensuring patients are discharged on time, get medications on time, etc. These are also discussed with their supervisors and are pointed out during appraisals.
However in Pakistan, there is no trend for such things and often people who suggest changing the system are looked down upon and ridiculed by their seniors. As mentioned above, there are exceptions and some seniors are very open to ideas and have made world class wards even in government funded hospitals (And in my opinion, these are the true heroes of Pakistan).
Legal issues
In the UK, some doctors may face legal action if they have done something wrong.
It has been discussed in detail here:
http://omarsguidelines.blogspot.co.uk/2017/08/indemnity-insurance-for-imgs.html
In Pakistan, relatives very rarely sue doctors. Instead their way of "justice" is to beat the doctor up even if it is not "justified"
Guidelines
In the NHS, there are strict guidelines for everything- such as antibiotics, investigations and management of pulmonary embolism, etc.
In Pakistan, although every doctor has read these guidelines, these are rarely practiced- especially when it comes to antibiotics. I remember that when I was working as a house officer, every patient who was admitted would receive a STAT dose of IV ceftriaxone. We treated all gastroenteritis patients with IV ciprofloxacin and IV metronidazole. Blood cultures were rarely done.
Pharmaceutical companies
In Pakistan, some pharmaceutical companies fund development of wards in government hospitals. Some also sponsor trips of senior doctors (with families) abroad. In return, they ensure that the doctor prescribes their company's medication.
In the UK, we hardly see pharmaceutical companies. And whenever we do see them, it is usually at a teaching session where they tell us about their medication which is very educational. They show the latest research.
In the UK, if any doctor does take funding from pharmaceutical companies, (s)he has to declare any competing interests if they present anything or publish a research.
Medical students
Like in Pakistan, medical students start going to the hospitals from 3rd year. However they have a more active role in wards. They have lists of things to do (like cannulation, doing capacity assessments, etc) and have a log book which junior doctors and consultants sign. They shadow junior doctors and help in making discharge summaries. They clerk patients in final year (which is under supervision) and also help junior doctors in their ward jobs (that too, under supervision). They are supported by their supervisor who may be a specialty nurse or a doctor who helps them achieve everything in their log book.
They rotate in different wards till final year and by the end of their final year, they are ready to work in the NHS as they have been exposed to the system since 3rd year. They can ask consultants any questions and they are regularly assessed in a formal and casual environment.
In Pakistan, it depends on the medical student on how much they want to learn however they are limited on what they are allowed to do and do not have log books like UK medical students do.
Privileges for students/doctors whose parents are doctors.
In Pakistan, if your parents are doctors you will easily sail through everything. You will pass your vivas because the examiners might know your parents and will also "ensure" that you pass on their regards to your parents after the viva. If they do not like your parents for some reason (which is also common), they will fail you or make your life in medical school hell.
In the UK, everyone is treated equally. No one knows your background. We are all treated equally without any prejudice. People get assessed on the basis of their knowledge and skills rather than what position their father is in.
Again, this may not be true for some colleges in Pakistan and some teachers there are excellent.
Support
In Pakistan, the best people to support you is your family. Here, the NHS is your family. If you have any concerns, you can talk to your colleagues, ward clerks, nursing staff, supervisor, programme director if you are in a training post and all of them will go out of their way to support you. I have heard some amazing stories from IMGs who have been supported here (even in personal problems).
Unfortunately, in Pakistan the work place does not provide such support because everything is more of a competition. In the NHS, we work as a team and support each other. It is the opposite in Pakistan - of course, exceptions do exist.
Factual evidence vs Hearsay
In Pakistan, most things are based on hearsay. We all have a cousin whose friend knows about everything and advises us on what car to get, which medical college is the best and we follow his/her advice.
In the UK, everything is based on statistics. There are online reviews for everything and all sorts of information is available on the internet. Unfortunately, as we are used to our cousins friends advice, some of us may get a bit lost in the UK.
In the UK, some doctors may face legal action if they have done something wrong.
It has been discussed in detail here:
http://omarsguidelines.blogspot.co.uk/2017/08/indemnity-insurance-for-imgs.html
In Pakistan, relatives very rarely sue doctors. Instead their way of "justice" is to beat the doctor up even if it is not "justified"
Guidelines
In the NHS, there are strict guidelines for everything- such as antibiotics, investigations and management of pulmonary embolism, etc.
In Pakistan, although every doctor has read these guidelines, these are rarely practiced- especially when it comes to antibiotics. I remember that when I was working as a house officer, every patient who was admitted would receive a STAT dose of IV ceftriaxone. We treated all gastroenteritis patients with IV ciprofloxacin and IV metronidazole. Blood cultures were rarely done.
Pharmaceutical companies
In Pakistan, some pharmaceutical companies fund development of wards in government hospitals. Some also sponsor trips of senior doctors (with families) abroad. In return, they ensure that the doctor prescribes their company's medication.
In the UK, we hardly see pharmaceutical companies. And whenever we do see them, it is usually at a teaching session where they tell us about their medication which is very educational. They show the latest research.
In the UK, if any doctor does take funding from pharmaceutical companies, (s)he has to declare any competing interests if they present anything or publish a research.
Medical students
Like in Pakistan, medical students start going to the hospitals from 3rd year. However they have a more active role in wards. They have lists of things to do (like cannulation, doing capacity assessments, etc) and have a log book which junior doctors and consultants sign. They shadow junior doctors and help in making discharge summaries. They clerk patients in final year (which is under supervision) and also help junior doctors in their ward jobs (that too, under supervision). They are supported by their supervisor who may be a specialty nurse or a doctor who helps them achieve everything in their log book.
They rotate in different wards till final year and by the end of their final year, they are ready to work in the NHS as they have been exposed to the system since 3rd year. They can ask consultants any questions and they are regularly assessed in a formal and casual environment.
In Pakistan, it depends on the medical student on how much they want to learn however they are limited on what they are allowed to do and do not have log books like UK medical students do.
Privileges for students/doctors whose parents are doctors.
In Pakistan, if your parents are doctors you will easily sail through everything. You will pass your vivas because the examiners might know your parents and will also "ensure" that you pass on their regards to your parents after the viva. If they do not like your parents for some reason (which is also common), they will fail you or make your life in medical school hell.
In the UK, everyone is treated equally. No one knows your background. We are all treated equally without any prejudice. People get assessed on the basis of their knowledge and skills rather than what position their father is in.
Again, this may not be true for some colleges in Pakistan and some teachers there are excellent.
Support
In Pakistan, the best people to support you is your family. Here, the NHS is your family. If you have any concerns, you can talk to your colleagues, ward clerks, nursing staff, supervisor, programme director if you are in a training post and all of them will go out of their way to support you. I have heard some amazing stories from IMGs who have been supported here (even in personal problems).
Unfortunately, in Pakistan the work place does not provide such support because everything is more of a competition. In the NHS, we work as a team and support each other. It is the opposite in Pakistan - of course, exceptions do exist.
Factual evidence vs Hearsay
In Pakistan, most things are based on hearsay. We all have a cousin whose friend knows about everything and advises us on what car to get, which medical college is the best and we follow his/her advice.
In the UK, everything is based on statistics. There are online reviews for everything and all sorts of information is available on the internet. Unfortunately, as we are used to our cousins friends advice, some of us may get a bit lost in the UK.
Now, the other equally important topic:
Life in the UK vs Life in Pakistan.
Life in the UK vs Life in Pakistan.
Financial stability
As discussed above, junior doctors in the UK are more stable financially then what they are back in Pakistan. They have a decent standard of living.
The minimum wage
The minimum wage in the UK is higher than in Pakistan and hence most people have a decent living.
Social class
In Pakistan, unfortunately a majority of the people are living below the poverty line, the "middle class" families struggle and the "upper class" families are filthy rich.
In the UK, there is a middle class and upper class system as well but the majority of people are in the "middle class".
Access to luxuries.
In the UK, any person with a reasonable pay can get a loan and mortgage, buy a decent car and house.
In Pakistan, in order to get a loan, you need to prove to the bank that you will able to afford to pay it back and hence only the people who had land/a reasonable amount of wealth are able to afford this.
Support for the unemployed
There are a lot of benefits for the unemployed in the UK and they are encouraged to earn their own living.
There is no such thing in Pakistan.
Education.
In the UK, education is free till college. The state run schools are very good and the standard of education is reasonable.
In Pakistan, unfortunately the government schools are just like the government hospitals - they are underfunded and a majority of our nation is uneducated as they cannot afford private schools.
As discussed above, junior doctors in the UK are more stable financially then what they are back in Pakistan. They have a decent standard of living.
The minimum wage
The minimum wage in the UK is higher than in Pakistan and hence most people have a decent living.
Social class
In Pakistan, unfortunately a majority of the people are living below the poverty line, the "middle class" families struggle and the "upper class" families are filthy rich.
In the UK, there is a middle class and upper class system as well but the majority of people are in the "middle class".
Access to luxuries.
In the UK, any person with a reasonable pay can get a loan and mortgage, buy a decent car and house.
In Pakistan, in order to get a loan, you need to prove to the bank that you will able to afford to pay it back and hence only the people who had land/a reasonable amount of wealth are able to afford this.
Support for the unemployed
There are a lot of benefits for the unemployed in the UK and they are encouraged to earn their own living.
There is no such thing in Pakistan.
Education.
In the UK, education is free till college. The state run schools are very good and the standard of education is reasonable.
In Pakistan, unfortunately the government schools are just like the government hospitals - they are underfunded and a majority of our nation is uneducated as they cannot afford private schools.
Loneliness
This is a major problem in the UK. You may have all the money and training experience in the world. You may have done loads of publications and research. But if you do not have anyone to share your happiness with then it all seems worthless.
Security
In Pakistan, there are robberies left and right. You cannot walk on the road with your phone out as there are phone snatchers everywhere.
In the UK, there are robberies too. But to a lesser extent. The police is involved and usually they do catch the criminals.
This is a major problem in the UK. You may have all the money and training experience in the world. You may have done loads of publications and research. But if you do not have anyone to share your happiness with then it all seems worthless.
Security
In Pakistan, there are robberies left and right. You cannot walk on the road with your phone out as there are phone snatchers everywhere.
In the UK, there are robberies too. But to a lesser extent. The police is involved and usually they do catch the criminals.
Racism and Humanity
I am not going to discuss this however I feel that the UK is more humane and less racist than Pakistan.
Family
This is also a major factor. It is very difficult to manage for some of us whose families are back home and are unable to travel (because of age or disease). Some of us do get home sick and have to go home frequently. Leaving home can be hard for some too - as they may be saying their last goodbyes. This makes living in the UK even more difficult.
Rules
The rules in the UK are very strict.If you break them, you can face serious consequences no matter how small you think that rule is. In Pakistan, unfortunately people follow this saying a lot: "Rules are meant to be broken".
Corruption
In Pakistan, corruption has infected every institution. The government is corrupt and tries its best to corrupt other people.
In the UK, there is corruption but at a lower level. People are more aware of what is going around and hence the common man does not suffer like in Pakistan because of the greed of the government officials.
Manners
In the UK, people are generally very well mannered. They will queue no matter how rushed they are,on the road they will give way to emergency vehicles, pedestrians and cyclists.
Overall, these simple etiquette make a huge difference in our daily lives. It makes things less stressful.
In Pakistan, I do not remember a single minute on the road where I had not heard a horn. The general rule there is "Might is right" and "Me first".
The rules in the UK are very strict.If you break them, you can face serious consequences no matter how small you think that rule is. In Pakistan, unfortunately people follow this saying a lot: "Rules are meant to be broken".
Corruption
In Pakistan, corruption has infected every institution. The government is corrupt and tries its best to corrupt other people.
In the UK, there is corruption but at a lower level. People are more aware of what is going around and hence the common man does not suffer like in Pakistan because of the greed of the government officials.
Manners
In the UK, people are generally very well mannered. They will queue no matter how rushed they are,on the road they will give way to emergency vehicles, pedestrians and cyclists.
Overall, these simple etiquette make a huge difference in our daily lives. It makes things less stressful.
In Pakistan, I do not remember a single minute on the road where I had not heard a horn. The general rule there is "Might is right" and "Me first".
Utilities
In the UK, gas electricity and water may be more expensive but at least we get it all the time (They are not expensive when you are getting paid here). In Pakistan, I spent half of my time in the dark/with a noisy generator which used to break down every 2 days.
In the UK, gas electricity and water may be more expensive but at least we get it all the time (They are not expensive when you are getting paid here). In Pakistan, I spent half of my time in the dark/with a noisy generator which used to break down every 2 days.
Food
In the UK, making an oven hot chapati may not be available. As Pakistanis, we miss our hot and spicy food. However nowadays there are some very good restaurants where you can satisfy your culinary home sickness, plus cooking is easier because of easy to use ingredients and appliances, as well as ready to eat meals for those who do not know how to cook or are tired or are still in the process of settling in.
So the bottom line is,
In terms of working, UK is still the best. In terms of living standards, UK may still be better but this depends on your personal circumstances. For someone like me, it is a huge improvement.
However this does not mean that Pakistan is a horrible place. We have excellent services.
A lot of Pakistani doctors (who have worked in Pakistan before) are in the NHS and have made a huge difference here as well.
We also have very good hospitals and doctors in Pakistan.
Here are some examples:
A charity run state of the art cancer hospital:
https://shaukatkhanum.org.pk
A charity run hospital:
https://hospitals.aku.edu/Pages/default.aspx
A charity run transplant center:
http://www.siut.org
A charity run dialysis unit in a government hospital:
http://www.goharejaz.com/career/sheikh-ejaz-ahmad-trust/
The worlds biggest charity:
https://edhi.org
https://www.transparenthands.org/top-15-charity-organizations-pakistan/
There are a lot of charity organizations in Pakistan and a lot of people who are trying their best to help people - To be honest, these organizations are the reason why this country is still surviving. It is unbelievable how much effort some people put in to help others. We cannot appreciate it till we actually see this.
In the UK, making an oven hot chapati may not be available. As Pakistanis, we miss our hot and spicy food. However nowadays there are some very good restaurants where you can satisfy your culinary home sickness, plus cooking is easier because of easy to use ingredients and appliances, as well as ready to eat meals for those who do not know how to cook or are tired or are still in the process of settling in.
So the bottom line is,
In terms of working, UK is still the best. In terms of living standards, UK may still be better but this depends on your personal circumstances. For someone like me, it is a huge improvement.
However this does not mean that Pakistan is a horrible place. We have excellent services.
A lot of Pakistani doctors (who have worked in Pakistan before) are in the NHS and have made a huge difference here as well.
We also have very good hospitals and doctors in Pakistan.
Here are some examples:
A charity run state of the art cancer hospital:
https://shaukatkhanum.org.pk
A charity run hospital:
https://hospitals.aku.edu/Pages/default.aspx
A charity run transplant center:
http://www.siut.org
A charity run dialysis unit in a government hospital:
http://www.goharejaz.com/career/sheikh-ejaz-ahmad-trust/
The worlds biggest charity:
https://edhi.org
https://www.transparenthands.org/top-15-charity-organizations-pakistan/
There are a lot of charity organizations in Pakistan and a lot of people who are trying their best to help people - To be honest, these organizations are the reason why this country is still surviving. It is unbelievable how much effort some people put in to help others. We cannot appreciate it till we actually see this.
PS: This is a general post and is not meant to offend anyone. This is my opinion based on my personal experiences and observations.
However it is important to recognize these issues so that we can work towards improving the situation in our home country as well.
However it is important to recognize these issues so that we can work towards improving the situation in our home country as well.
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