Intellectual dishonesty has now become rampant in the medical profession-Prof. Majeed Chaudhry


Prof. Fazle Elahi Memorial Lecture at Surgicon 2013

Intellectual dishonesty has now become rampant
in the medical profession-Prof. Majeed Chaudhry

Current state of affairs undermines our core values
of Truth, Integrity, Philanthropy and Altruism

KARACHI: Late Prof. Surgeon Fazle Elahi was a legendary figure, monumental personality and upright scrupulously honest person and in order to memorize such a personality I have chosen this topic to talk about intellectual dishonesty which is now rampant in the medical profession. This was stated by Prof. Majeed Chaudhry an eminent surgeon and former President of Society of Surgeons of Pakistan, currently Principal Lahore Medical and Dental College, while speaking at the just concluded Surgicon 2013 held at CPSP campus. Healthcare in Pakistan, he said, leaves much to be desired and we see glaring deficiencies and fragmented delivery of service, high costs and adverse events. This leads to an embarrassment that pervades our profession and also undermines its core values of truth, integrity, philanthropy and altruism. This was an excellent presentation and Prof. Majeed Chaudhry did a commendable job of narrating and listing unethical practices indulged in by the members of the medical profession which must have been an eye opener for many among the audience who do not realize the gravity of the situation as some amongst the healthcare professionals seems to have crossed all limits in their greed for money.

Prof. Abdul Majeed Chaudhry former President of SAARC Surgical
Care Society as well as SSP delivered Prof. Fazle Elahi memorial
lecture during SURGICON 2013 held at CPSP recently. Picture
shows Prof. Naheed Sultan along with Prof. Saleem Khan
presenting him a mementoe on this occasion.

Currently dishonesty, Prof. Majeed Chaudhry said, encompasses any form of profession or academic misconduct. It includes fraud, deceit, cheating, lying, shrinking responsibility, abuse of authority, conflicts of interest and plagiarism, alteration of medical records, forgery, false presentations and knowingly assisting another person in dishonest acts. Speaking about the current scenario, Prof. Majeed Chaudhry said that in our circumstances parents had significant contribution in plantation of dishonesty sapling. Cheating is prevalent in schools and colleges. It is independent of religious or moral attitudes or of the desire to study medicine. A study revealed that at undergraduate level between 27-58% of students cheat at least once in medical school and this also includes dental and nursing students. Another survey showed that 43% of all students at University of Lowa College of Dentistry admitted cheating. The time honoured methods of cheating include copying from another student or from a crib sheet during a test. Having someone else write a paper or complete a homework assignment, plagiarizing, signing an attendance sheet for a classmate besides faking the result of laboratory experiment. It is generally believed that those who cheat at graduate level are likely to be dishonest when providing patient care. Developments in the information technology, Prof. Majeed Chaudhry said, has taken cheating to much higher level. We now hear of cyber plagiarism and immoralities. In Pakistan it started with the use of Walkie talkies during the examination in the 70s but now sky is the limit.

Honesty Prof. Majeed Chaudhry stated is never an issue. The emphasis is on avoiding failure and achieving success. Talking about abuse of medical students, he said that one of the studies reported that 75 students admitted having been humiliated or belittled at one time or the other by house staff, nurses or faculty members. Twelve students were allegedly physically harmed, six by the house officers and six by the clinical faculty. Added to this was various types and degrees o sexual and racial harassment from classmates, house staff and faculty which were common as well. 29% of the students reported that the clinical faculty had threatened them unjustifiably with a bad grade while 5% students claimed that clinical faculty had threatened to run their careers.
Giving further details of intellectual dishonesty in the medical profession Prof. Majeed Chaudhry said that it has crept into letters of recommendation; medial students and House officers obviously seek such letters only form faculty members who are likely to be supportive. What is surprising is the fact that these letters are typically supportive but often to a ridiculous extent overstating the positive aspects but ignore or hide the negative aspects. The situation is no better in the postgraduate medical education where sycophancy and apple (Boot) polishing is quite common. His Masters voice is the decor on the rounds and scratching each others back is not uncommon either.
Giving examples of poor documentation Prof. Majeed Chaudhry said that false reporting of physical findings is almost standard. At places there is no documentation at all. Deceit in recording the operative findings, no documentation of complications occurring during surgery and so on. In fact this list is too long. House Officers and practicing physicians record these false findings because as medical students they have observed the house staff and even some senior staff doing precisely the same thing. It has become a habit with the healthcare professionals to serve one’s self before serving patient. One often hears them asking what is in there for me. Failure to take charge is also noticed because the consultants faced with a busy schedule and fearful of being sued for missing out on something. Doctors order un-necessary tests and prescribe a multitude of drugs hoping thereby to detect and alleviate every conceivable ill. It is also not uncommon on the part of consultants to refer patients to an army of consultants who march and take over, each managing the whole. Fraudulent or inappropriate billings are frequently reported and so is the case with manipulating medical records to concealing complications. There are healthcare facilities which hospitalize patients solely for better reimbursement. Doctors do not hesitate to indulge in self advertisement through interviews, news, stories regarding their foreign trips, un-necessary projection and even distribution of advertisements along with the Sunday newspapers and he also showed some of these clippings. The use of electronic media for self publicity and advertisement is also quite common through purchase of time for medical programmes, comparing TV programmes though one may not have the expertise in that particular field. There are healthcare professionals who present themselves at all functions and also pass on special instructions to the cameramen to focus them properly while covering an event.

Some healthcare professionals suffer from qualification complexes and they use A. Professor on their business cards and if one asks what is meant by A, it is said there are different grades and I am in A grade. One can see big billboards and sign boards on Roads, lamp posts and railway stations. Some have prescription pads with all sort of factious qualifications and membership of dozens of organizations, fake and cover up degrees and self proclamation of expertise in a particular field with the result that there is hardly any space left for writing the prescription and all this is done to befool and hoodwink the patients. Some doctors have come up with innovate ideas of increasing their clientele through arranging dinners without any occasion, dishing out gifts, hosting of Iftar parties, making personalized phone calls and greeting cards to the patients on particular occasions. We have some “Non-operating Surgeons”, some doctors do not mind employing touts, multiplication of figures, mentioning non-existent complications and reporting fantastic results which are better than any in the world. Some are expert in burying the complications and also avoid re-exploration even if it is indicated.

Giving examples of dishonesty in surgical specialty, Prof. Majeed Chaudhry said that one often hears of “ First ever procedure performed in Pakistan”, removal of so many Kg tumour from abdomen, sexual change procedures, painless Haemarrhoidectomy, bloodless procedures and two minute procedures which are all advertised regularly. Patronizing friends and relations irrespective of their competence, referral to certain individual with ulterior motives, expecting some share and referring for CT scan for in growing toe nail can be mentioned just a few.

Referring to intellectual dishonesty in scientific publishing Prof. Majeed Chaudhry talked about cooked up stories and figures, reporting work done by someone else, the objective of the study is in many cases self projection. The study mentions hardly any complication and the study findings overwhelmingly advocate a particular drug and there is projective indulgence in discussion. Some even use fake title and descriptions like renowned surgeon, physician, and national figure an internationally famed personalities etc. Money and prestige seduce some practitioners which allow conflicts of interest to take roots, many physicians go round the country promoting specific drugs or biomedical devices manufactured by the company who sponsors such trips. Those physicians who join the pharmaceutical industry advisory boards, help create industry supported clinical practice. There is no dearth of physicians who are ever ready to affix their names to manuscripts drafted by the industry and finalized by ghost writers. Some doctors do not hesitate to accept substantial company sponsored gifts or all expenses paid trips overseas. The Pharma industry has largely succeeded in altering the physician’s behaviours. By offering subsidy on continuing medical education, and sponsoring CME activities, the companies create an ideal market for their products.

Coming to the field of medical research Prof. Majeed Chaudhry said hat there are ambitious investigators whose quest for fame and glory overshadows whatever integrity they might have. Scientific misconduct is endemic in today’s society. Some people have no contributions at all but their name appears on the authors list of papers. Some of these investigators do not mind multiplying figures and are keen to get their papers published irrespective of their standard and quality. Plagiarism is most common and the only one easily detected and uniformly condemned type of dishonesty in scientific publishing. Peer reviewers of manuscripts could have their own ulterior motives and when these individuals have vested interests in a particular case, they may approve or reject a manuscript simply because it favors or contradicts their own interests. Many manuscripts published in medical journals are in fact written by professional medical writers who are paid by drug companies or in some cases by the journal itself. We have medical teachers busy doing nothing. They delegate their personal responsibilities to their youngsters, their lectures are prepared by others. At times they delegate even delivery of lecture to juniors at the last moment and there appears to be hardly any respect for duty hours.
All the above, Prof. Majeed Chaudhry remarked happens because there are people who are in search of identity. They are keen to get early recognition in the professional circles or they are trying to overwhelm a new place of posting besides quick financial gains but they have no fear of God. After highlighting this long list of unethical practices and intellectually dishonesty indulged in by the medical profession, Prof. Majeed Chaudhry also gave a prescription with certain recommendations which calls for professional societies and associations to caution their members, PM&DC to play vital role, enforcement of existing laws, taking suo-moto action against those violating the code of conduct, formation of vigilance committees at divisional level, exemplary punishment for those found guilty and institutional management committees performing their duties and monitor their staff.
Earlier Prof. Rizwan Azmi read Citation for late Prof. Fazle Elahi who he said had an amazing ability to explain issues in surgery. He had the ability to combine anatomy, pathology and surgery all in one time.

Prof. Manzar Saleem Memorial lecture

Dr. Syed Yousuf Iftikhar from UK delivered Prof. Manzar Saleem Memorial lecture and the title of his presentation was “laparoscopy – candle light to 3D”. He discussed in detail the advantages and the latest advances in this field like less time, less pain, few complications, quick recovery besides historical background and developments in surgery. Prof. Shams Nadeem Alam read the Citation for late Prof. Manzar Saleem and gave details from his college days to his activities in Dow Medical College where he was Secretary of Students Union to his love for medical journalism, editing the Pakistan Journal of Surgery besides being accomplished organizers of surgical conferences. He had a passion for music as well.