Medical Ethics

This refers to your Off The Record column entitled “DEGREE AND BOASTFULL CHAIN OF LETTERS” published in Pulse International of April 15-30, 2016. Prof Alaf Khan is a gem of a person, excellent teacher, and ethical professional. He strictly follows the British traditions of medicine. As I gather from your column, his wife Prof. Lala Rukh also has all the sterling qualities to make both of them excellent human beings and outstanding professionals.
In the early period of Pakistan our medical teachers followed their teachers’ ethical British traditions. At the King Edward Medical College (KEMC) medical teachers practiced medicine ethically like Prof Amir-ud-Din. Prof Col Sami helped poor patients generously providing medicines and financial help.

At Rawalpindi, General Shaukat Hassan, General Ayub Khan were equally helpful to the patients. At Karachi, Dacca, Peshawar, Multan doctors enjoyed good reputation. Later on situation deteriorated immensely and it became an exception to find ethical doctors like Prof Akhtar Khan and Prof Alaf Khan, Prof Khawaja Saadiq Husain and a few others maintained ethical professional work. It is not common to see consultants checking patients in hundreds, spending only one to two minutes in consultation, charging exorbitantly high fees and indulging in malpractice of sorts- doing costly not-needed procedures, receiving kickbacks from diagnostic centers and pharmaceutical companies. They neglect teaching, making it a part time job while running their own hospitals, diagnostic centers and even selling medicines belonging to the alternate system of medicine. No wonder there is so much deterioration in health care systems of Pakistan. Our country has earned the delirious distinction of having the most death tolls in all the age groups- the highest still births 40 per 100000 births (world average less than 14 per 100000) infant mortality 85/1000 births while Bhuttan 32, Nepal 36, Bangla Desh 40 in one of the shortest life span even amongst the SAARC and also the highest prevalence of both communicable and non-communicable diseases. It is remarkable that Alaf Khan and Lala Rukh sought retirement one year earlier to provide opportunities to their juniors while the tendency in Pakistan is to hang on to the jobs beyond the retirement age by hook or crook. A consultant got his birth date changed and maneuvered three years extension by using unfair means.

I may narrate a good example set by Lt Gen Mahmud ul Hassan former DG Surgery Pak Armed Forces. On his retirement, General Zia-ul- Haq offered him the job of the Principal Army Medical College. He sent his Army Military Secretary to seek General Mahmud ul Hassan’s consent. General Mahmud ul Hassan told the Military Secretary that he had no interest in the administration and his taking over the job of Principal Army Medical College would not be in the interest of the institution-could be disastrous. Although he would also be the practicing professor of surgery and also have large administrative staff headed by a Major General but would not do justice to the institution. On Military Secretary’s request, he gave this in writing. He declined the job which had a lot of prestige, perks, privileges etc. He voluntarily kept teaching at the Army Medical College. He was a superb teacher for both the undergraduates and post graduate students, an outstanding surgeon and a well-known Urdu poet. He also taught clinical applied anatomy- was called Prof Last of Pakistan. Prof R J Last was a leading clinical Anatomist- who had written a famous book on this subject.

When I retired from the Army in 1992, I was also offered the job of Principal Army Medical College, the job which I had performed with enormous success from 1989 to 1991. I told the authorities that my taking over the job will affect my junior’s chance of getting the Principal’s job and also the highest rank of Lt General. I was told that my junior was in lower medical category due to having suffered a heart attack and my takeover would not affect his career. I told the Military Secretary that rules about medical category can be changed and I should be excused. I continued voluntary teaching for over two decades for undergraduates and post graduates. My wife Prof. Khalida Adeeb Khanum Akhtar fully supported my stand.

About the use of titles, countries have their own systems. Armed Forces ranks are allowed by countries for use after retirement. In other countries the word retired after the rank is not used unless there is a specific need.

In Pakistan there is an interesting history as usual based on personalities not principles. After 1947 the same British system was used. It changed during F.M. Ayub Khan’s rule. During political campaigns Air Marshall Asghar Khan was leading a bitter political campaign against Field Marshal. The television announced Air Marshal Asghar Khan. Ayub Khan’s massively inflated ego was hurt that why was ‘Marshal’ used for somebody other than him. He invented the rule to use word retired after the ranks though the person retires not the rank. By this way the word Air Marshal (retd) lost the force of the word Marshal but Ayub Khan renamed his rank to Field Marshal as the Field Marshal’s do not retire technically though they leave the job. TV was further instructed by authorities, Ministry of information to softly utter the word Air Marshal for Asghar Khan followed loudly by the word Retired and then softly Asghar Khan. This is how the word retired was introduced in Pakistan which is not used elsewhere. About the British tradition of using the word M.S. for surgeons instead of doctors I was reading in a journal that many universities in UK have changed M.S. (master of surgery) nomenclature to Doctor of Surgery- the holder of qualification continued to use the word Doctor holding doctorate qualifications.

The most unfortunate situation in this country is that all sorts of qualifications are sold by many bogus companies and institutions like EXACT etc. with impunity. It is high time that such fraudulent organizations are eliminated and ethical systems are introduced and implemented. People use bogus qualifications, using the medicines etc. of the scientific system of medicine immensely harming the patient. When the Govt. does not take any action, the situation is exposed by the foreign agencies as in the case of EXACT scandal. PMDC also does not play a role to protect people’s lives- it only takes action against the legally qualified doctors by issuing notices for demanding registration fees etc. The Govt. and PMDC should stop criminal quackery jeopardizing the lives of innocent people.

Prof. Emeritus Lt. Gen.
Mahmud Ahmad Akhtar
Rawalpindi - Pakistan.

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