Trust is a delicate bond between patient and therapist that distinguishes the treatment process from a mere business transaction. But in recent years, we have seen that this pillar in the Iranian medical environment has been severely damaged, giving way to cynicism and misunderstanding.

What is happening in the crowded corridors of hospitals and waiting rooms of offices today is not just simple friction between individuals; it is a reflection of a deeper, structural crisis. Heavy economic and managerial pressures have both placed the patient in the position of a dissatisfied customer and exhausted the medical staff under the burden of overwhelming expectations and restrictions.

This report is an attempt to hear the voices of those lost in the din of this flawed system. Our goal is not to assign blame, but to shine a light on the darkest corners of this broken relationship; a story of the untold suffering of the people and the hidden pain that has overwhelmed doctors and nurses.

Part One: Patients’ Experience

For a patient who walks into a treatment center with a sore body and a troubled mind, there is nothing more painful than feeling invisible. Patients’ narratives show that, faced with the current system, they feel caught in the cogs of a money-making machine, a machine in which recovery and human dignity have been sacrificed for profit and speed.

– When health becomes a commodity

Many patients feel that they are a “client” or a “money-making opportunity” for the doctor before they are a human being in need of help. This sense of commodification completely destroys trust. For patients, the priority of the medical staff is not to alleviate their pain and suffering, but to fill their quota of visits or to meet their monthly income ceiling.

Minoo, who has been suffering from breast cancer for three years, told the Peace Line: “Doctors think they must earn several million a month and have visited so many patients. They don’t care about the patient getting better, what matters is filling their pockets.”

This view reduces the doctor from a savior to a businessman. Minoo sees the root of this problem in the motivations for entering the medical field, saying: “When they are taught from childhood that they should study medicine to become rich, what can be expected? God forbid someone gets sick and has to beg for money to pay the doctor, change cars, or go on a foreign trip.”

When the logic of the market ruthlessly overshadows medical ethics, the patient even views the doctor’s compassion with suspicion. Sometimes patients assume that “high cost” must equal “too much medicine and complicated treatments,” and when a doctor prescribes too little medicine based on scientific principles or does not write a prescription for a patient, the patient attributes it to incompetence or illiteracy, not professional commitment.

Samira told the Peace Line: “When you go to the doctor and pay a lot of money for visits and tests, you expect him to at least give you good medicine. For example, I went to the doctor myself, and it cost me about 1,200 tomans for the tests, and then the doctor just gave me a pack of pus-drying ointment. I could have bought the same thing from the pharmacy and not spent so much money. I didn’t say anything to the doctor, but I didn’t go to him again. Even if someone wants to go, I advise them not to go, because I didn’t get any results.”

Some doctors also admit that if they do not give a patient medicine, the patient feels that he did not receive the service for the money he paid, which causes his dissatisfaction. Therefore, they prescribe unnecessary medicines or supplements. This can also lead to financial pressure on the patient.

Ali, a 65-year-old doctor, told the monthly magazine Khat-e-Sulh: “Sometimes the patient’s problem is not serious and does not require medical intervention, yet doctors write a prescription for the patient in a customer-oriented manner, usually for vitamins or painkillers. The reason is that a patient who leaves the office empty-handed and without a prescription often thinks that he has been scammed and does not return. Basically, the offices of doctors who incur the highest costs for the patient, both in terms of paraclinical and pharmaceutical costs, are busier and have greater respect and intimacy.”

On the other hand, if the doctor has written a long prescription for a patient with a lot of medications, there is a concern that the doctor may have colluded with the pharmacy or pharmaceutical company to prescribe unnecessary medications. This toxic atmosphere causes the patient to constantly weigh the issue of whether this prescription was for my health or to line someone else’s pocket?

Mehdi told Khat-e-Sulh: “I worked in a pharmacy and saw with my own eyes the struggle between doctors and pharmacists to write prescriptions. Specialist doctors charge huge amounts of money every month from pharmacies to send their prescriptions there and write more medicine than the patient needs.”

– Doctors’ rudeness and inattention

Beyond financial issues, the way a doctor interacts with a patient plays a crucial role in building trust. Many patients describe doctors as arrogant, impatient, and unresponsive. This indifference and indifference can have a devastating effect, especially when the patient is stressed and in pain.

The experience of Hamid, a patient who suffered pulmonary complications after open-heart surgery and was readmitted, illustrates this disconnect between patient and doctor. He says, “My heart surgeon didn’t explain at all, he was very arrogant, and he didn’t talk to the patient or his companion in that way. For example, after the surgery, he didn’t tell me that this procedure had such consequences and complications. After the surgery, we went home, and then the lung problem that is now in the hospital was a complication of the surgery, and we had to come back to the hospital. If we had been a little late or my family had ignored me, something bad could have happened to me.”

Farkhunda, Hamid’s wife, also told the Peace Line: “The surgeon did not involve himself at all and did not even talk to me clearly and precisely after the surgery about the possible complications of the surgery. Of course, I remember that he quickly said things that were not so vulgar that we could understand, nor were we in a good mental state due to the stress of my husband’s surgery to justify it. He was so rude that we did not dare to ask any questions. If the doctor had explained to us very clearly and in simple and understandable language, this might not have happened, or at least we would have been aware of this incident.”

– Medical malpractice and misdiagnosis

Nothing shakes a patient’s trust more than the fear of a doctor making a mistake. Medical malpractice and misdiagnosis, especially when accompanied by denial and irresponsibility, inflict an unhealable wound on the body of public trust.

Saba says: “My appendix burst. The doctor told me it wasn’t an appendix. Go home and come back if you get a fever. I spent thirty-six hours with a burst appendix. Then I went to another hospital and had surgery. After the surgery, the doctor told me I was a few hours away from death.”

Aida, who is also suffering from diabetes, says: “My toe was sore because of my illness, meaning it was more of a crack than a wound. I went to the doctor, and they said we had to remove the infection with surgery. Our wounds heal very slowly, and I was actually afraid of surgery. I went to Mashhad, to a hospital for diabetics, and the doctor there said there was no need for surgery and it would heal with pills and medication. My cracked toe healed well in a week. If I had let the doctor do the surgery, God knows what condition I might be in now.”

Such experiences, when spread by word of mouth, create a general fear of visiting the doctor.

Leila says: “I myself heard from one of my doctor friends that sometimes when we can’t diagnose a patient’s problem, we prescribe all kinds of medications, maybe one of them will work!”

– Short-term visits

The global standard for visits is between 15 and 20 minutes, but domestic statistics and field observations indicate disastrous averages of 4 to 5 minutes in Iran. Short visits make the patient feel unheard and the doctor’s diagnosis hasty.

Anahita, who has been struggling with eczema for a long time, says, “You go to the specialist before you even sit down in the chair, they diagnose you and write you a prescription.”

In such a process, there is no opportunity for empathy and addressing the patient’s concerns, and the patient may not even have the courage to ask questions. “Sometimes I want to ask the doctor to make the appointment longer so I can ask my questions, but I’m embarrassed, to be honest, I’m a little afraid of my doctor,” says Leila.

This fear and embarrassment reflect the extreme power imbalance in the examination room. The doctor is in a position of omniscience and has complete control over the examination. The patient does not have the right to make demands or the courage to express them.

Shahin also tells the Peace Line: “My doctor gives me five hundred thousand tomans for a visit, and the most time he gives me is when he writes the prescription. I took an appointment for about ninety seconds. Then the next patient is pushing behind the door to come in.”

This compressed schedule of visits leaves doctors with insufficient time to carefully review the patient’s case, explain medications, and answer patient questions, which in turn leads to medical errors.

– Group visit

These days, “group visits” have become commonplace in crowded offices and government centers. Patients who are forced to recount their most private pains in the presence of a few strangers experience a feeling of intense humiliation.

Mahtab, a young woman who had a bitter experience visiting a gynecologist, told Peace Line: “He would do the examination behind a partition, but on the other side of the partition, there were several other patients sitting and they could hear everything that each patient was saying to the doctor. I didn’t want everyone to know what was wrong with me.”

This blatant violation of privacy not only calls into question medical ethics, but also causes patients to refrain from expressing their core problems, which directly leads to misdiagnoses and incomplete treatments.

Quotas and the crisis of doctors’ scientific competence

As news about “medical quotas” in the college entrance exam and specialty exams spread, the perception in society has been reinforced that many doctors have relied on their medical chairs not based on scientific merit, but rather on rent and quotas.

Maryam, quoting her daughter, who is a medical student, told the Peace Line about this issue: “My daughter says that doctors are so angry about these quotas. She says that they are making holes in other places or leaving surgical instruments in the patient’s abdomen, especially with laser procedures.”

These stories, whether true or exaggerated, cast doubt on society’s mentality. “People are afraid to show themselves to a novice doctor anymore,” says Solmaz. “These uneducated people want to test their illiteracy and inexperience on patients. Gone are the days when you could trust your education and universities. Now, they let anyone into the medical field.”

According to reports, in some sensitive specialties, such as cardiology, a high percentage of admissions have used the quota. This is why patients today generally prefer to wait in line for hours for old doctors rather than take the risk of visiting young doctors. This distrust traps the patient in an endless cycle of changing doctors and repeating tests.

Part Two: The Lived Experience of Medical Staff

There is another side to the story. Today, Iranian doctors and nurses find themselves caught in a storm of unrealistic expectations, economic pressures, inefficient management structures, and social anger. They believe that society has ignored their sacrifices and focused only on the astronomical incomes of a small group of surgeons.

– Exploitation of residents

Residents in Iran struggle with inhumane working hours (sometimes up to 100 hours per week), meager salaries, and heavy responsibilities.

Pooya, an orthopedic resident, describes her situation this way: “Residents don’t have a chance to scratch their heads at all in the first two years. We sleep every other day, and that’s if we don’t eat extra…. We often feel exhausted and extremely tired. It’s unreasonable to expect kindness from a doctor who hasn’t slept for 36 hours.”

The Iranian education system views residents not as expert students but as cheap labor to fill hospital staffing gaps. In such a draining system, young doctors have no opportunity to learn communication and empathy skills.

The shocking suicide rate among residents, which some sources say is up to five times the national average, is a testament to this psychological strain. The suicides of young doctors like Dr. Parastu Bakhshi and Yasman Shirani highlight the depth of the mental health crisis among those who are the health care providers in society. How can a doctor who is struggling with severe depression and anxiety be a safe haven for a patient?

– Compulsory service plan for doctors

The Physicians and Paramedics Service Plan is a law in Iran that requires medical graduates to serve for a specified period (usually 24 months) in areas designated by the Ministry of Health, which are often underserved and underserved. Until this period is completed, the physician’s degree is not released and he or she is not allowed to practice medicine independently or immigrate.

Although the initial goal of the scheme is to ensure equitable distribution of healthcare services in the country, the way it is implemented places a heavy burden on young doctors. Many doctors on the scheme face long delays (sometimes up to a year) in receiving their allowances and salaries. The amount paid is often disproportionate to their heavy workload.

Tanaz told the monthly magazine Peace Line about this problem: “Our compulsory draft salary is less than that of a simple worker. Two years of hard labor and hardship in the most deprived parts of the country, even with equipment from half a century ago, is truly cruel. It is true that there is a need for doctors in deprived areas, but they are not willing to make going to those areas attractive for doctors by increasing their salaries, so they forcefully send young doctors there.”

Amin says: “There are no more helpless people in this country than doctors. Study, suffer from insomnia and misery, and don’t breathe, and force a few salaries and allowances out of the ministry’s throat, and in the end they’ll send you to a remote place for a project.”

In many deprived medical centers, doctors have to manage critically ill patients with their bare hands. The lack of medicine and equipment causes the patient’s companions to vent their anger on the doctors, which endangers the doctors’ physical and psychological safety.

Amin adds: “One of the honors of our planning and development manager was that in our city, it’s true that they curse and threaten doctors, but they don’t beat them. Because in the neighboring city, they beat a doctor every day. Once, they beat an orthopedic resident so much that his arm was broken.”

The biggest criticism of this plan is that it is mandatory for the release of a certificate. The doctor practically does not have the right to choose his career path, and this feeling of lack of control causes severe burnout in the early years of his professional career, kills the motivation to serve honestly, and turns the doctor into a bitter and hopeless person whose only wish is for the plan to end and escape from that area.

– Violence against medical staff

One of the most bitter experiences for healthcare professionals is encountering blatant violence in the workplace. The patient’s companions, angered by their loved one’s pain and lack of facilities, often blame the healthcare professionals and vent their anger through insults and beatings.

The story of Dr. Mohammad Aboutorabi, an anesthesiologist, who was severely beaten by the companions of a deceased patient and was on the verge of blindness, is a horrific example of this situation. Or a nurse in Arak who was beaten so badly that she fainted because there was no empty bed. In another incident in Yasuj, Dr. Masoud Davoudi, a cardiologist, was murdered by the brother of a deceased patient.

This violence has a direct impact on the behavior of doctors: to protect themselves from potential lawsuits and violence, doctors focus on what is safest for them, rather than on the best treatment. They order unnecessary tests, refuse to admit high-risk patients, and refer patients to other centers. This vicious cycle increases the cost of treatment and further erodes trust.

– The reality of the medical community’s livelihood

While the general perception is that all doctors earn billions in income, the statistical reality shows that only a small percentage of doctors (mainly surgeons and renowned specialists in the private sector) earn such incomes, and the main body of the medical community (general practitioners, young specialists, residents) face serious livelihood problems.

Behzad, a doctor, says: “With the current situation in the country, doctors sometimes perform a procedure for just a few million, and that too will be paid for next year.”

The government’s mandated and unrealistic tariffs have put doctors in a bind. Many doctors believe that keeping tariffs artificially low is the root cause of phenomena such as underpayment. When the government system is inefficient and tariffs do not cover costs, a direct and illegal financial relationship is formed between the doctor and the patient.

Low income compared to high workload and responsibility has greatly increased the motivation for immigration among Iranian doctors. The annual departure of thousands of doctors and nurses from the country not only wastes national capital, but also further limits people’s access to quality services.

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An analysis of the current state of the health system shows that mutual trust between the public and the medical staff, as one of the most important pillars of social capital, has been seriously eroded. This deep rupture in public trust is a direct result of the ineffectiveness of the government, which, instead of playing the role of a supporter and observer, has practically turned the field of treatment into an eroding battlefield between the doctor and the patient by commodifying health and abandoning its responsibilities. In this flawed structure, the patient, instead of receiving competent services, finds himself alone in a ruthless market, and the doctor, instead of having job security, finds himself a tool to compensate for the government’s budgetary and managerial shortcomings.

The government, by adopting irresponsible policies, is the main originator of this conflict; on the one hand, it exploits young doctors with mandatory plans and unrealistic tariffs, and on the other hand, by not covering costs properly and with weak supervision, it places the financial and psychological burden of treatment entirely on the shoulders of the people. The anger and violence that we are witnessing in hospitals today is the natural reaction of a society that, in the absence of an efficient and accountable system, seeks the only way to vent its dissatisfaction in conflict with the final link in the chain, namely the medical staff.

Attempting to restore this trust through moral advice to the public or doctors is misdirecting and covering up the root cause of the crisis. Until the government accepts responsibility for the consequences of its decisions through fundamental reforms, the wall of distrust will continue to grow higher, and the smoke from this managerial fire will be felt most in the eyes of the public health of society.