Thought Provokers

Dear Shaukat,

Thanks for sending me your latest book, ‘Thought provokers’. Congratulations on the publication of the twentieth book and 9th Volume of “Off the Record” Essays in book form. It covers a variety of topics facing the medical profession. As usual, they are all thought-provoking, highly informative and honest evaluation of what way, how and why we are degenerating and decaying. One may assume, it is the society as a whole of which the medical profession is a true reflection.
Medical education is just a joke with no objectives, goals and standards. Private medical education has turned us to be traders and businessmen concerned only about the personal material gains without any professional considerations, merging trading into profession.
Your selection of subject is very appropriate and timely critical touching on aspects of medical education and practice as well as pharmaceutical industry. It is all an unbiased commentary on the current medical scene which unfortunately does not inspire hope and optimism even in the wide spectrum of our political life. All essays are good, some really excellent. I liked especially:

• ‘Declining interest in acquiring clinical skills and bedside teaching’
• ‘Professional satisfaction and real happiness’
• ‘Prove your credibility, money will run after you’
• ‘Mukhtar Nama’

I would recommend the book to all doctors interested in self-audit. It is beautifully printed on good quality paper. Once again congratulations Shaukat on your marathon performance of bringing out a very interesting book at a modest price.

Ali Muhammad
197-B, EME sector DHA,
Multan Road, Lahore.

I wish to express my gratitude for sending me your latest book titled, “Thought Provokers”. Your contributions to our medical profession are second to none. May Allah keep you in his protection, Ameen.

Dr. Waris Qidwai
The Tajuddin Chatoor
Professor and Chairman
Department of Family Medicine
Aga Khan University, Karachi-74800, Pakistan
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 This is to acknowledge receiving “Thought Provokers” and thank you a lot for remembering me! Although we read with great interest your thought provoking columns in “Off the Record” from time to time in Pulse International, this compilation in Book Form will give an opportunity to read what was missed, or re read what one wants. You have done a wonderful job in keeping the torch of medical journalism alive, and making it so lively..... thought provoking and soul searching. Keep it up. May Allah bless you, Ameen

Prof. Sohail Akhtar
Professor of Medicine, Ziauddin University, Karachi
President PIMA 2014-16

Many thanks for sending me a copy of your latest book “Thought Provokers”. I am a regular reader of Pulse International and also a contributor. I have gone through this book and it is just like revision before the examination of the topics. I had commented on some of these columns when they were published which were included in the Letters to the Editor’s column of your esteemed publication.

In the Preface, you write “Truth Must Be Told”. By now you have authored and published many books highlighting and conveying the Truth. In fact the quest for truth is the sacrosanct objective of life. In the Holy Book the only curse from the Almighty is on those who tell lies “Lanat-ullah alaial Qazabeen”. Unfortunately our Nation lacks whole truth and indulges in half-truths, untruths and lies and lies. This, in my opinion is the route cause of all vices and the cause of our steep national downfall.
I fully support Dr. S. Amir Ali Shah former DG Health in Federal Health Ministry. He was a man with high principles and convictions. Other personalities discussed in the book like Prof. Mahmood Ali Malik is an outstanding one. Prof. Kh. Saadiq Husain is one of the noblest soul among the healthcare professionals in Pakistan, Dr. Amiruddin, Dr. Peerzada, Dr. Baloch and others did a very limited private practice. Col. Ziaullah had Friday for free patients.
In one of your columns you have stated that our doctors did not pay enough attention to editing of biomedical journals. I have discussed this issue in one of my communications. The route cause of this and other problems is the system of private medical practice in vogue in our countries. In one of my addresses at the Staff College, I had termed it the “Cancer” affecting our profession. All over the world including India, teaching doctors are allowed private practice and consultants working in the teaching hospitals are allowed controlled institutional private practice for a limited number of hours for a limited number of days in a week. Our doctors do public service as part timers while they do private medical business practically whole time, many owning hospitals/diagnostic centers etc. They take all sorts of patients some examine even hundreds of patients in a day; spend hardly few minutes on patient consultation which is absolute quackery and cheating. Some of them practice till late in the night hence they have no time to study, teach, do research, publish scientific papers etc. Teaching needs a lot of study without research teaching is barren. To publish or perish is a well known paradigm. Our medical teachers have lust for money though there are a few exceptions. Many of them are multibillionaires, earn hundreds of thousands rupees a day. They have absolute lust for money. This has become our national disease. That is why I called unlimited private practice a cancer destroying the medical profession in Pakistan as well people’s health.
I must say some of our doctors are worse than dacoits/robbers because dacoits loot and rob rich people and leave poor but doctors with few exceptions do not even spare the poor patients. This is tragic. These money maniacs even have no time for their own health and for their own family. Even in Pakistan doctors working at Aga Khan University do well because of the system in place. Most of our doctors do well abroad again because of the system. What we need is an honest ethical system and working environment in our medical institutions and healthcare facilities.
I see many patients from Srinagar and India, relatives of Pakistanis. I find doctors practicing in Srinagar doing ethical and good professional practice. Consultants Fee in Srinagar is Rs. 300/- first visit, second visit is free, charges for third visit are Rs. 200/- Lipid profile lab charges are Rs. 250/- while in Pakistan the patients for the same tests are charged from rupees one thousand to twelve hundred.
Normally I do not talk about myself but here I must mention that I was offered teaching job at AFM College Rawalpindi. My father who was the senior most pathologists at AFIP told me that to do justice to teaching job, “private practice should not be done”. He even volunteered to provide me money if I needed. I opted for non-practice. I had plenty of time to study, to teach, do research work and create publications. I taught medicine to undergraduates as well as postgraduates, taught clinical pharmacology/therapeutics and community medicine to postgraduates. Published four books on Rational Therapeutics second edition in 1951 and won prize from the National Book Foundation published numerous scientific papers besides contributing to the national press on social issues.
After retirement I did limited practice seeing ten to fifteen patients a day. Kept on teaching till recently as Professor Emeritus and keep on publishing. I learnt from my teacher mentor Dr. General Ayub Khan who used to tell patients suffering from ordinary ailments to consult the GP/Family Physician. Give full time to the patients from half an hour to forty five minutes for consultation practice, holistic medicine. The problem in our country is the lust for money, lust for power, no principles and no character etc. This is why the consultants from Sri Lanka and other countries are far ahead of us in sciences, profession, innovations, and inventions. We can only do well if we correct ourselves. We must correct our system of private medical practice. We need radical surgical procedure to eradicate the cancer. Our religion lays stress on honesty and says that if some body takes little quantity of food earned through illegal means his whole Ibadats including prayers go waste.
Lt. Gen.C.K. Hassan (Surgeon General) once told me that when he was 5th Year MBBS student he sought an appointment from the professor of ophthalmology an English Man who gave him an appointment after a week’s time. The professor used to see a limited number of patients on limited number of days in the week. He spent about forty minutes on consultation. When C.K.Hassan enquired about his fee, the Professor told him he does not need to pay. When C K Hassan told him that “Professor you have spent so much time, why you are not taking the Fee”, the Professor replied that one of the principles of his practice was that if he could not help a patient, he would not charge fee, so he refused to take fee.
I feel that the best personality depicted in your Book “Thought Provokers” is your wife Khursheed Akhtar who served the family including her in-Laws with immense devotion, dedication and self lessly. This is true”humanity”. My deepest regards, respects for her as she is a Role Model.

Lt. Gen. (Retd) Mahmud Ahmed Akhtar,
43- Race Course Road,
Rawalpindi. Pakistan.

 I have read your latest book “Thought Provokers” and found it very thought provoking, a commendable effort. Hats off to you for the excellent work produced.

Dr Ambreen Usmani
MBBS, MPhil-Anatomy, MCPS-HPE, PGD-Bioethics
Associate Prof, Anatomy
Dep Director, Med Education
Bahria University Medical and Dental
College Karachi. Pakistan.

 Preserving independence & 

need for reforms in the CPSP

This refers to your recent column on the above mentioned title published in Pulse International of November 1st 2014. You have correctly written that the progress and prosperity of any institution should not be linked with any individual or personality and it should not remain under the grip of a particular group. In Pakistan we have no dearth of praise singers who are all the time crying that the existence of the country and certain institutions was in the hands of an individual. They keep on raising such slogans and are never tired of it. Only God Almighty knows whether the number of these praise singers will eve reduce in Pakistan or not.
As an Examiner I have visited CPSP Karachi many times and stayed at the campus. Where ever I looked, its foundation stone or inauguration was performed by one individual. Once when I entered into the bath room of my room, I was expecting that its commode flush system might have also been inaugurated by the same personality. However, there were no such writings on the toilet seat or water tank. This was a bit disappointing for me. I will request you to keep on your Jihad and make sure that no one considers it as their parental inherited property. To ensure that democratic traditions are followed in CPSP for all times to come is not only a Kare-Khair but also a duty which must be fulfilled.

Prof. Alaf Khan
Richmond, Virginia, USA.

 College of Physicians 

& Surgeons Pakistan

This is with reference to the news of establishing the “Sindh College of Physicians and Surgeons”. In this context it should be kept in mind that this act would not be in the interest of Sindhi doctors and the Sindhi people. It has taken more than fifty years for the College of Physicians and Surgeons (CPSP) of Pakistan to attain an international status and recognition of its postgraduate qualifications with the joint efforts of doctors from all over Pakistan including those from the former East Pakistan, which has now, the Bangladesh College of Physicians and Surgeons. It takes enormous efforts and time to attain recognition of higher qualifications of Medical academic institutions especially when there is stiff competition in the international arena. There have been many ups and downs before achieving the present status for the CPSP. Higher medical qualifications need international recognition for doctors to have jobs in the foreign countries and to get education/training in emerging medical disciplines. Furthermore, there are too many higher medical qualifications including some rare specialties called sub-specialties / super specialties and there are too many faculties of different disciplines of health sciences needing experts which are scarce. CPSP runs too many courses/ workshops for the education / training of postgraduates aspiring for the qualifications which would not be possible for a provincial college. Furthermore a separate college at a provincial level will not be cost-effective – candidates will have to bear a lot of extra-expenses. CPSP has regional centers which cater adequately and efficiently for the regional needs.
The interest of the doctors and the people of the Sindh province is best served by being a part of the CPSP where medical experts from all over the country get together and contribute to advancement of higher medical education / training. Therefore CPSP should be kept intact and its qualifications constantly improved and strengthened to compete with other international institutions and qualifications. It is encouraging to note that the present set up at CPSP has taken the college to new heights. There are some individuals with vested interest who should not be allowed to harm higher medical education and health of the people of Sindh. Higher medical education should not be politicized. The provincial authorities should concentrate on prevention of diseases, promotion of health of their people, improving basic education and university education.

Lt Gen Prof Emeritus Mahmud Ahmad Akhtar
Former Surgeon General /
DGMS (IS), Pak Army.

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