Excerpts from Silent Musings by Dr. Alaf Khan


 Excerpts from Silent Musings by Dr. Alaf Khan

Professional ethics, medical profession and bitter realities

I loaned some cash to Dr.  Murad to hire an ultrasound machine and start his private practice in the evenings next door to my office. His service to the patient was efficient, ethical and considerate. Genuinely poor patients were scanned gratis. Friends, relatives, doctors and members of their immediate families were, likewise, accommodated free of charge.  On 8 April 1987, he came to me for advice about a patient referred to him by a gynecologist for pelvic scan.  The gynecologist (Mrs K.J.A.) ran a private maternity home. Her referral note addressed to Dr. Murad was candid and shamelessly blunt. It read as follows:

Dr. Alaf Khan

Dear Dr. Murad Ali.  Season’s greetings to you. In future you will charge all my patients coming to you for investigations half the amount, the other half I shall take in agreement with you. Please send a reply through the bearer of this chit. Thanks.      Mrs. K.J.A., Consultant Gynecologist.

(Patient) Johar.  Amenorrhoea, Primary, 18 years.  o/e  PR.  Negative findings.  Referred to ultrasound unit, Dabgari.  Dr. Murad Ali.  

I told Murad to scan the patient free of charge and give the letter to me. I called on the lady at her maternity home on my way home that evening. This was our first ever encounter in life.  What do you want? she mlurted out as she stepped out to see me.  I showed her the referral note she had written to Murad. What about it?  she asked. Please do not send any patient to Murad,  I gently told her. Dr. Murad is not in the fee-splitting business, I added.  Why should I send patients to you bloody fools if you do not pay commission, was her parting compliment. This was the first and the last time I heard the words Bloody Fool from the lips of a woman decked with MBBS,  DGO,  MRCOG.. 

Professional misconduct, verging on the criminal at times, comes in many guises. Here are two painful examples from my own experience:

A.  Seventy-seven years old Raza Khan had been my close friend since 1972. His cardiologist son was getting married to Prof. Sirajuddin Ahmad’s daughter in a few days in early August 1998.  Invitation cards to the wedding feast had already been distributed.  His responsibilities understandably made him a little tense.  His elder son took him on 28 July 1989 to a psychiatrist in the Peshawar version of  Harley Street.  The man with MBBS-plus-DPM prescribed the following incredible array of antidepressant and antianxiety drugs:  

1. Inj. Clopixol AM  3 times daily.   2. Melleril tabls 100 mg;  twice daily.   3. Kemadrin tabs  Â½ + 1 daily.    4. Rekotnil tabs 3 mg  1+1 daily.    5. Prothiaden tabs 75 mg 1+1 daily.    6. Restoril tabs 15 mg  1+ 1 daily.    7. Epilepsin  tabs 200 mg  1 + 1 daily.    8. Inj Valium  10 mg  I.V. slowly  0 + 1 daily.    9. Serenace  drops  50+50+50 drops daily.    

Stamped three  times along the three borders of the prescription was the emphatic advice that all medicine be continued without interruption (dawaayi ka istimaal musalsal jaari rakhin).

Raza Khan received the first dose of each medicine at the doctor’s clinic. He was so deeply asleep on reaching home that his son had to carry him from the car to the bedroom.  Later in the evening, he was wakened partially with great effort to swallow his second dose of the many drugs.  Effort to wake him up for his dawn prayers were unrewarding.  Raza Khan was dead.  The concerned Messiah carried on his healing art as usual

B. Thirty-eight years old Saidan Gul was a linesman in the electricity department employed in Quetta (Balochistan).  He suffered sudden paralysis of the right half of his body (hemiplegia) with complete loss of speech (global aphasia) on 29 May 2000. His paramedic brother (Muhammad Ayub) took him on  June 3,  2000 to the Professor of Anesthesia at the local medical college. The Professor recorded the following prescription:    

1.  Acupuncture and electrification on all Chinese traditional points on collaterals and related channels, far and local points. 2.  One combined shot of Western medications for relieving of neuronal oedema and superadded infection.  

The administered single shot of Western medications consisted of the following:

Inj. Akatinol + Inj Cavinton + Inj. Galamate + Inj. ACTHAR + Inj. Rocephin 1G + Inj. Solumedrol 160 mg  +  Inj. Furosemide / KCl tabs  +  Tabs Duxil (45)  1+1+1 for 15 days +  Tabs Persantin (45)  1+1+1 for 15 days  +  Tab Disprin one daily +  Tabs (unreadable)  (45)  1+1+1 for 15 days.

There was no mention of Saidan Gul’s Blood Pressure, Blood Sugar or any diseased heart valve that could cause formation of a blood clot that would lead to such brain damage.

One day I read the happy news that our Professor of Anesthesia had been elected a Member of our (not too) famous Medical & Dental Council. God save Trump, the Queen, the Sharifs and the Zardaris.