`Medicine became distinguished when specialised knowledge was used for the benefit of the patient. It became noble when the needs of the patient held sway over the interests of the practitioner` Rosenberg, 1987 IN Pakistan, discussions about healthcare usually revolve around the number of hospitals, doctors, hospital beds, ventilators, medicines, and health budget. This is important, but there is another crisis that is harder to measure and frequently ignored: the gradual loss of humanity from medicine.

To humanise medicine is not merely to ask doctors to be kinder or improve their bedside manner. It is to recognise that healthcare is, at its core, a relationship between human beings. A sick person is not a diagnosis, a bed number, a laboratory report or a source of revenue. Nor is illness simply a technical problem to be fixed with increasingly sophisticated machines and medicines. People become ill within families, communities and societies. They bring to hospitals not only symptoms, but fear, poverty, uncertainty, grief and hope.

Pakistan`s fragmented health system makes this human connection particularly difficult. At one end are government-run facilities, which are overwhelmed, understaffed and underresourced. At another, there is the fee-for-service private sector, where access depends on one`s ability to pay. In between are charitable hospitals, which provide an invaluable service but cannot compensate for the failures of the national system. The result is that healthcare in Pakistan is a lottery in which the patient`s income determines not only where they receive treatment, but how quickly and with what degree of dignity.

Private healthcare in Pakistan is particularly troubling. More than half of health expenditure is financed through out-of-pocket spending, and a large proportion of this goes to private facilities. The burden falls heavily on households already struggling with inflation. For a wealthy patient, illness may be frightening. For a poor patient, it can be financially catastrophic.

Hence the question of humanising medicine becomes inseparable from the question of justice. There is little humanity in telling a patient that a potentially lifesaving treatment exists but is beyond their means or dignity in a family selling assets or borrowing to pay for treatment. Nor is there compassion in a healthcare systemwhere a consultation may last only a few minutes because the clinician must see a large number of patients to generate revenue.

The dehumanisation of medicine is not caused by individual doctors alone, who are themselves frequently victims of an inhuman system. A doctor in an overcrowded government hospital is expected to see scores of patients, or a nurse is responsible for far more patients than she can reasonably care for. It is easy to accuse healthcare professionals of becoming indifferent. It is harder to acknowledge that chronic exhaustion can turn empathy into a luxury.

A humane healthcare system must therefore care for its carers. Medicine cannot be human-ised by demanding compassion from doctors while denying them reasonable working conditions, professional security and psychological support. Burnout is not an individual weakness to be treated through resilience workshops. It is the consequence of a system that expects healthcare workers to compensate for institutional failure.

A humanised medicine recognises the patient as a participant in decisions about their treatment. It involves explaining illness in language that patients and families can understand, acknowledging uncertainty rather than pretending that medicine has all the answers, and asking not only, `what disease does this person have?` but also, `what has this illness done to this person`s life?` Two people with the same diagnosis may have entirely different needs. A financially welloff person with diabetes may struggle with diet and exercise. Another may be choosing between purchasing insulin and feeding their family.

Prescribing the same medication to both may not constitute the same quality of care.

Humanising medicine requires clinicians to understand the social conditions in which illness occurs poverty, unemployment, poor housing, gender inequality, violence and political instability all enter the consultation room, whether doctors recognise them or not.In Pakistan, the weakness of the government healthcare system has pushed many patients towards the private sector that now dominates a substantial portion of healthcare delivery.

Government services struggle with infrastructure, workforce, and quality challenges. A system dominated by fee-for-service incentives creates an uncomfortable question: what happens when the financial interests of an institution and the needs of a patient do not align? Charitable institutions demonstrate that Pakistanis possess a remarkable capacity for compassion and philanthropy. But charity cannot substitute for the state`s responsibility to ensure equitable access to healthcare. A citizen should not have to depend on the availability of a benefactor for treatment of a common illness.

Healthcare is the state`s responsibility and cannot be based on the assumption that some will pay, some will donate, and the rest will wait.

Ultimately, humanising medicine requires us to return to a simple principle: healthcare is not a commodity like any other. Markets can play a role, charitable organisations can make vital contributions, and private medicine will remain an important part of Pakistan`s healthcare landscape. But there is a need to invest in public healthcare (especially primary care), reduce the financial burden of medicines and tests, regulate private medicine, and build systems in which continuity, communication, and quality matter as much as procedures and profits.

We need hospitals where patients are treated with dignity regardless of their class, doctors who have the time and institutional support to listen, and medical education that values communication and empathy alongside anatomy and pharmacology. Technological sophistication is not the same as humane care. A hospital may possess the latest machines and still treat people without dignity.

At its most fundamental level, medicine begins when one vulnerable human being turns to another for help. Humanising medicine means ensuring that, regardless of wealth or status, the answer is not determined by how much the patient can pay. A civilised healthcare system is not only one with advanced medicine but also one that treats the person who cannot afford to be ill. • The writer is professor ementus of psychiatry at Aga Khan University mmkarticle@gmail.com