Role of Doctors and Nurses will change in the future medicine-Paul Barach

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Proceedings of Plenary Session-I at ICON 2020
Role of Doctors and Nurses will change 
in the future medicine-Paul Barach
Advances in Technology will create more
problems rather than solve them
We need to bring virtual ethics back
into the fold of medicine - Aisha Malik

KARACHI: Prof. Paul Barach Consultant Anaesthetist and Critical Care Specialist with special interest in Patient Safety from Wayne State University USA was the first speaker in the Plenary Session-1 during the ICON 2020 organized by Indus Health Network here from 17-19, January 2020. The topic of his presentation was “Patient Safety: A new model to engage Healthcare Providers and Managers”. He pointed out that high morbidity and mortality is due to poor quality of care. Pakistan, he said has very high maternal mortality, child mortality. Most of these are due to preventable problems. Adverse events lead to many deaths of patients and we are not addressing the most serious problems. In United States a number of senior healthcare officials were fined because of preventable deaths.

Now accountability of senior executives in hospitals has started. There are system problems. Screening in government hospitals is very bad; staff is not to be blamed. Incorrect priorities doe’s lot of damage. All this calls for engagement of leadership. More money makes the situation worse. Speaking about the future of medicine, Prof. Paul Barach said that the role of doctors and nurses will change. Their jobs will change. Technology will create more problems rather than solve it. There is much for the healthcare professionals to learn from other industries. He highlighted the importance of professional development in health outcome of the patients, high reliability and system performance. We need to talk to the entire healthcare professionals not to the physicians alone. He also pointed out that last year as many as three hundred one doctors committed suicide in United States because of stress under which they have to work. Male surgeons and anesthetists are at greater risk. They have to work for long hours, lack of respect and bad electronic health record system were some of the other reasons. There is ever increasing use of technology in medicine, physicians talk less to the patients. Healthcare staff is unhappy, hence more patients die. Better team performance will lead to better patient survival, better performance and better outcome. He also referred to Lack of attention, focus, lack of ability to focus. He laid emphasis on reliability of processes, appreciation of a system and not individuals. We need to understand the variation in Theory, Knowledge, Psychology and Trust.

Prof. Paul Barach, Dr. Aisha Malik, Prof. Murad Musa and Dr. Naseem Salah Uddin
speaking at the first Plenary Session of ICON 2020 held at Karachi recently.

Continuing Prof. Paul Barach said that we know that most anesthetists and surgeons lie to each other. Speaking about psychological safety, he laid emphasis that healthcare professionals should be able to speak up. At present people are afraid to talk and it will not improve the things. We need to engage all members of the healthcare team. Teaching should be structured. Healthcare professionals need to be trained in leadership skills. Situation needs monitoring. There is an urgent need for mutual support and entrustment, improved communication. Currently in many countires and Pakistan is no exception, physicians do not report adverse drug reactions. In developed world 80% of the ADRs are reported by physicians. We need to give feed back to people. Trust each other; improved communication has resulted in 80% reduction in mortality. He also referred to the changes in management model. He then highlighted the importance of empathy, compassion, kindness, engagement, harmony and joy. It is the clinical operational leadership excellence which makes the difference. Patients and the carers should be encouraged to speak up. Reduced fear will help improve patient safety, he remarked.

Dr. Aisha Malik was the next speaker whose presentation was on “Phronesis in Medical Ethics; Courage and motivation to keep on the track of rightness in decision making”. She pointed out that it is the practical wisdom which leads to sound decision making. We need to understand what the patient and their families want? What hospital can provide? He emphasized the importance of better informed clinical decision making and morality in medicine. Externally improved interventional devices are reducing the doctor patient interaction. She then spoke about theories of well being, mental state, desire fulfillment, objective list, composite happiness, flourishing concept of health, biopsychoanalysis aspects of illness. She laid emphasis on right means use to achieve the right ends. She highlighted the importance of virtual ethics and made a passionate plea to bring virtue ethics back into medicine. Moderation, she stated, is best but we need to know how much information provided to the patient is enough. She then referred to awareness, courage, reflection, motivation which are all integral part of doing good for the patient.


Prof. Murad Moosa from Aga Khan University was the next speaker whose presentation was on “Is your organization ethical”. Speaking about quackery vs ethics, he wondered how they can complement each other. Medicine today, he remarked, has become a big business. Patient has to pay 70-90% of healthcare cost out of their own pockets. Healthcare industry has become a profitable business. He then referred to quality initiatives, JICA standards which all lead to improvement in care. Care not documented is not provided. He urged the healthcare professionals to document whatever they have done. Now over the years patients complaints have increased and we see increasing violence against healthcare professionals and healthcare facilities. Ethics is the missing link.

Prof. Murad Moosa then discussed at length clinical ethics, patient care, financial dealings, operations everything should be ethical. He also referred to conflict of interest in appointments and promotions, taking care of institutional policies, compensation, benefits, moral distress. Business should not be profit driven but value driven. If the organization has business ethics, unethical people become ethical but if ethics are lacking in organization, even ethical persons will indulge in unethical practices. There is a need to sensitize people how to behave. Doing things right, doing it ethically results in right automatically. Talking about infection control, he referred to the importance of hand washing. When it was first practiced, healthcare professionals did not give it too much importance but later studies showed that this simple measure was one of the most effective intervention. Not doing hand washing results in the increased hospital stay of the patients, increase in cost of healthcare but on the other hand by practicing hand washing results in reduction in morbidity and mortality. Healthcare staff must practice hand washing. He laid emphasis on use of disinfectors and value based training of the entire healthcare staff. Ethics, he opined, bring quality, hence it is important to impart ethical values in training of staff.


Healthcare organizations, Prof. Murad Moosa said deal with sick, distress, vulnerable segment of population. Their health and life is at risk. They can be exploited. Hence the importance of core values of the organization. It is the systems and processes which affect decisions and actions. As such ethics education and training is important. Website blogs are also important. We need to ensure system of confidential reporting, ethical leadership. Integrity, he went on to say, flows from top. Everyone in the hospital should be educated in ethics. It is upto the leadership to take up values, ensure culture of ethics and ensure that everyone is committed to ethical organization.

Summing up the session Dr.Naseem Salahuddin said that they were trying to inculcate ethical spirit in their staff and we have made some progress, she remarked.

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