PAKISTAN MED MATTERS: Bring medicine around —Basharat Shafqat Yusuf

If not for the sake of the profession, then for the millions of patients and thousands of students who would eventually suffer from the dwindling fortunes of medicine in this country, it is time for all concerned to get their act together
Let me say it upfront. Pakistan’s medical profession, today, is acutely mismanaged. Teaching professors, once respected for their services, are now expected to be at the beck and call of political masters. Punjab, home to the best of Pakistan’s teaching medical institutions, leads the downslide.

Doctors are treated appallingly by bureaucrats and politicians. Just recently, there have been embarrassing episodes at some of Lahore’s top hospitals — Mayo Hospital, Lahore General Hospital, and Services Hospital — where medical administrators and professors have been poorly treated and, in some cases, shown the door.

Moreover, the importance successive governments have accorded to medical education can be measured by the manner in which medical institutions are being run in the Punjab. Just take the example of the King Edward Medical College, crème de la crème of the profession. In early 2006, it was upgraded to a university in great haste. Since then it has been without a regular vice chancellor.

Thanks to poor policies, this almost 150-year-old jewel lies in the dust. Matters have come to a point where PMDC (Pakistan Medical and Dental Council) has yet to recognise all postgraduate degrees of KEMU.

The last governor, Lt-Gen (retd) Khalid Maqbool, passed an ordinance to allow non-doctors to become vice chancellor of KEMU. Indeed, it has become a norm to get non-specialists to run the profession. Today, in Punjab, there is hardly any Board of Governors/Management of medical teaching institutions which is headed by a doctor from the teaching cadre. This has only worsened the situation.

Now, the present authorities are reportedly in the midst of a third revision of the Autonomy of Medical Institutions in less than a decade. The task of overseeing the revision has been handed over to a committee headed by an individual that does not belong to the profession.

But KEMU is no exception. The Allama Iqbal Medical College is without a regular Principal since almost three months. In Fatima Jinnah Medical College, where, to my knowledge, the Principal has been appreciated for his initiatives of establishing skill labs and enticing the long lost spirit of authentic research, he is allegedly under the spotlight for not being among the senior-most.

I must also mention that the mannerism of the guardians of our profession today has much to do with the scenario sketched above. During our day, no one could imagine commercialisation of the doctor-patient relationship, neglect of the students, unethical relationships with pharmaceutical companies, and self-aggrandisement by using political back channels to climb up the professional ladder. These practices have become a norm now.

Indeed, just like any other faltering institution, the downward slide initiated by the politicians and bureaucrats has only been hastened by many inside the profession itself.

A few practical suggestions are in order.

Foremost, governments must understand that medicine is a highly specialised profession that requires intricate knowledge of doctor-patient and teacher-student relationships to be managed proficiently. While difficult to comprehend for a bureaucratic mind, running medical institutions has never been about administrative cost calculations and regimented soldier-like order. A move to allow non-specialists to run the show would make matters worse.

Acclaimed professionals known for their honesty and dedication, not for their political contacts, need to be given charge of our medical establishments.

Related to the above, the government needs to comprehend the fact that seniority of medical teachers in the public sector is specialty-based, which often does not match with experience. Given that the entire rationale for seniority-based hierarchy in institutions is experience, it makes no sense for this to be followed for top level appointments in medicine.

Appointments at the level of professors (and higher) should be based on the capability of individuals. After all, the DMG often witnesses such cases; the current Chief Secretary’s appointment in Punjab is a case in point. Of course, if implemented, such a suggestion would need a well-defined, completely transparent selection criterion. Again, the task should be left to those revered within the profession.

Clearly, given the kind of attitude politicians have adopted towards doctors and the policies being followed with regard to medical institutions, it is obvious that those advising them — even though the doctors among them are thorough professionals in their own right — have yet to approach the profession in a constructive spirit.

It would prove highly beneficial if they sought guidance from the stalwarts of our profession. At the cost of being biased, let me spell out some names: Professors Akhter Khan, Kh Sadiq Hassan, Bilquis Fathima, and Rose Madan, just to name a few of the many.

All these individuals carry a wealth of knowledge and experience without benefiting from which the profession may never see its lost glory. And none of these would desire any personal aggrandisement or quid pro quos if asked for guidance.

Such stalwarts are also the only resource the government has if it is to be successful in raising professional and ethical standards of the profession. Virtually the entire medical cadre today has been taught by this illustrious group in one capacity or another. And fortunately, despite all the negatives, the aura of respect and humility for teachers remains intact among our students (although this is changing for the next generation, perhaps a function of the declining teaching standards).

The government and its dedicated group of advisers should convene the profession’s greats and request their services to head institutional boards and lead seminars and workshops on medical professionalism and ethics, a practice the profession has moved away from. Hard-hitting, humiliating antics from the political and bureaucratic enclaves will only create further resentment.

I was born with medicine in my blood. My father, Dr Shujaat Ali was the founder Principal of Fatima Jinnah Medical College, Lahore and held the post for nearly two decades. I myself retired as Principal of the College. My late-husband, son, daughter in law and granddaughter was/are all proud and respected members of the medical teaching profession. My family and I have given a life time of services to medicine; the sheer despondence and apathy among current practitioners makes me wonder if it was all in vain.

If not for the sake of the profession, then for the millions of patients and thousands of students who would eventually suffer from the dwindling fortunes of medicine in this country, it is time for all concerned to get their act together.

The writer retired as Professor of Anatomy and Principal, Fatima Jinnah Medical College in 1982 after serving the Institution for over three decades

Source: Daily Times, 30/6/2008


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