We must generate local data and strengthen our healthcare system-Prof. Javed Akram


 PIMA Conference-2022

We must generate local data and strengthen
our healthcare system - Prof. Javed Akram

Healthcare professionals should promote positive image
of their institutions and Pakistan - Prof. Shahzad Ali Khan

KARACHI: We need to promote research culture, generate local data, opt for Evidence Based Medicine and enhance Pakistan’s contribution to world medical literature. This was stated by Prof. Javed Akram Vice Chancellor University of Health Sciences who is also President of Pakistan Society of Internal Medicine. He was speaking at the Pakistan Islamic Medical Association conference held at Karachi on June 6th in a session devoted to Healthcare Systems. He was invited as a guest speaker in this session which was chaired by Prof. Ejaz Ahmed Vohra. Other panelists in the session included Prof. Shahzad Ali Khan Vice Chancellor Health Services Academy Islamabad, Mr. Khalid Mahmood Chief Executive of Getz Pharma, Ms. Sara Salman from WHO and Dr. Zakiuddin Ahmed.

Prof. Javed Akram further stated that if we practice Evidence Based Medicine, many pharmaceutical brands will live longer. He suggested that every one of us must adopt EBM. Many antimicrobial agents have now developed resistance and treating Typhoid has also become very expensive because of indiscriminate use of antibiotics. Yet another important issue which Prof. Javed Akram highlighted was the need to identify physician burnout. Studies have showed that in Pakistan, those physicians working in emergency medicine, obstetricians & gynecologists’ besides psychiatrists are at a greater risk of burnout. If one has a Mentor in life to whom one can talk to, it has a protective effect. His advice to everyone present was to adopt new technology otherwise things are moving so fast that those who do not adopt new technology will be out of business.

Prof. Javed Akram

Continuing Prof. Javed Akram said that we have no local database. Physicians should have mastery in information technology. We must participate in Randomized Clinical Trials, initiate RCTs in Pakistan. At present most of the medical representatives who visit physicians just act like a postman, drop some literature or sample and mark their attendance. It would be much better if they take time and then discuss some issues with the physicians. These medical representatives can be used to collect data. During the last few years there has been an enormous increase in publications. Now it is China and not United States which is leading in RCTs as well as publications. Unfortunately Pakistanis contribution of world medical literature was just 0.12%. Evidence Based Medicine is learning by doing. One has to be current and fully abreast with the latest developments in medicine. We need to address patients concerns. Information generated through RCTs and Cochrane Review is the most reliable. Healthcare professionals must prescribe drugs which the patients can afford. It is also important to know what the patients thinks about doctors and says about them in your absence. We must compare alternative outcomes. Almost 40% of diseases do not need any intervention at all. Do nothing just listen to the patient carefully and give him reassurance. They need reassurance that there was nothing serious and every effort should be made to provide him comfort. Look at the prognosis of patient.

Meta-Analysis, Systematic Reviews, Cohort studies, case control studies, clinical case series and opinions generate data. We need to have patient oriented outcome, look at the family. In the developed world Cochrane reviews, clinical findings, DARE, Journal Club, Info POEMS, USPTF, APC Journal Club and numerous such other sources exist. In Pakistan PSIM has taken the initiative to start PSIM Journal Club with Prof. Ejaz Ahmed Vohra as Chairman and Mr. Shaukat Ali Jawaid chief editor of Pakistan Journal of Medical Sciences at Vice Chairman while Prof. Azizur Rehman Editor of PSIM Journal will be other member. We can involve some other members as well and start working. PSIM Foundation, he further stated, has already started Aap Ka Clinic which is a free healthcare facility where consultants see referred patients. First such clinic has started functioning at Lahore; the second will be established at Karachi followed by such clinics at Hyderabad and Multan. Here from consultation to investigations and drugs will be provided free. He urged the Pharma industry and healthcare professionals to help such a cause. Already many Pharma companies are part of this project, he remarked.

He concluded his presentation by stating that we need to avoid or minimize medical errors, reduce cost of treatment, enhance patient’s confidence in the doctors, improve patient outcome and adopt evidence based medicine. PSIM has adopted it and use its logo, he remarked.

Dr. Arshad Taqi President of deceased Pakistan Medical Commission was the next speaker in this session who made his presentation through video link. We in Pakistan, he opined have failed to produce doctors that we needed. Our graduates study just to pass the examination. He highlighted the importance of good communication and said that how the doctors communicate with the patient, colleagues, nurses, paramedics and other members of the healthcare team is extremely important. We need to improve our training. Healthcare systems have their own limitations. We must ensure judicious use of the scarce resources. He laid emphasis on empathy. Doctors often fail to convey the information correctly while communicating with the patient. Doctors need to understand law and needs of the society to earn respect from the society. We need to change the way we teach our undergraduates, postgraduates. We must look if they are capable of and prepared to serve the society. They need to learn how to practice medicine, he added.

Mr. Khalid Mahmood Chief Executive Getz Pharma said that in a country where there is no research culture, evidence based medicine has a critical importance. Those who are active and working in this field despite such unfavorable circumstances deserve to be commended. We need to do and promote indigenous research. We should market research, and promote the research we do. DHQ hospitals, Mr. Khalid Mahmood remarked can be used for data collection. Data integrity should be enhanced. He also talked about data analysis and importance of leadership in healthcare. It is surprising to note that despite the fact that almost 75% of advances in technology, surgical devices were made in USA but even then United States does not enjoy the leadership in healthcare. Metabolic disorders are increasing. We need to develop critical thinking but our children cannot even think. Pakistan has failed to invest in primary healthcare. Every segment of the society has to contribute to strength our economy. We have a trade deficit of fifty to seventy billion which needs to be checked. It is the Pakistani workers who contribute about thirty billion US dollars every year but we have done nothing for these workers, he remarked. We have not built more healthcare facilities with the result that our health system is overloaded. Even anti TB drugs are not available to the poor, vaccination needs to be promoted. We lack leadership in every field, health services was no exception, he remarked.

Dr. Sara Salman from WHO participating in the discussion said that Covid19 pandemic was a challenge and we did convert it into opportunities. Our performance was much better as compared to many other countries. She also talked about Hospital safety initiative by WHO which aims to improve the quality of care. We are working on Universal Health Coverage. Our objective is to provide quality healthcare at the doorstep. Care which is also cost effective. We are also working in patient safety hospital initiative. We have started this project in Sindh province, working with Indus Hospital Health Network, Tabba and twelve other hospitals. We are working with public as well as private healthcare facilities. WHO is also supporting the Lady Health Workers project, she added.

Prof. A. G Billoo opined that there was no dearth of resources for research but our doctors do not know how to write proposals for research grants. How to get funding from different sources?

Prof. Shahzad Ali Khan

Prof. Shahzad Ali Khan in his speech on the occasion said that WHO in 2004 had defined Evidence Based Medicine as information that we get from research and other sources which enables us to make decisions. Meta-Analysis, RCTs are one source. Organizations’ like WHO are other sources. Similarly institutions like NIH, AKU and other medical institutions are other useful sources. Look at how they do things. Follow those institutions. Political evidence, he further stated, was most important. It is the evidence which is based on people and patients perceptions. Unfortunately doctors do not make good opinion leaders. Perceptions are driven by political evidence. Doctors need to project positive image of their own institutions and of Pakistan. But what happens doctors are ever ready to defame their own institutions. Lot of good works is being done in these institutions and many doctors are doing a commendable job. It needs to be projected. Do not create negative perceptions of your institution. Talk to the media and communicate with journalists it will improve their political evidence and ranking as well. Pakistan is facing some challenges and we will overcome them, he remarked.

Prof. Ejaz Ahmed Vohra in his concluding remarks said that people of Pakistan are hard working. What we need is to project our positive image. Health care is a basic human right. We have very poor health indicators. Apart from healthcare, we need to improve sanitation, ensure safe water supply and provide primary healthcare. We do not speak to our patients as we have no time with the result that patient satisfaction is compromised. We need to be mindful of the adverse drug reactions and avoid medical errors.

Earlier Dr. Zakiuddin Ahmed in his introductory remarks referred to challenges and opportunities, patient safety, quality of healthcare and medical errors. Many patients, he said are harmed while they are in hospital. Medical Errors are recognized as the third leading cause of death in United States and this is all preventable. Let us build the systems, physician burnout should be identified. According to reports one physician commits suicide in USA daily. Antibiotics resistance is increasing; health care is becoming more expensive. The fact that the richest country in the world USA does not have the best healthcare shows that there are other things which matter not the finances alone. There is something wrong and we are missing something. Healthcare needs to be safe, timely, effective, and efficient. We need to work for physician’s wellbeing, adopt patient centric healthcare and work as a team, he added.

Inaugural Session

Prof. Muhammad Shoaib Shafi, President CPSP was the chief guest in the Inaugural & COVID appreciation ceremony during the Karachi Con. 2022 organized by Pakistan Islamic Medical Association (PIMA) on June 4th 2022. Speaking on this occasion he pointed out that there is a serious shortage of medical postgraduate training institutions in the interior parts of Sindh, which has no institute for training in the fields of intensive care and emergency medicine. Majority of hospitals in the interior part of Sindh were without senior consultants, forcing patients to come to Karachi for specialized treatment.

Continuing Prof. Shoaib Shafi said that provincial health department has not established a single training institute in the field of intensive care and emergency medicine in interior Sindh. Seventy-seven per cent of the post-graduate medical education training institutions are in Karachi, while only 23pc exist in the rest of the province. In this situation, young doctors have no option, but to come to Karachi for training. Currently twelve institutions of emergency medicine are in the country where 240 trainers are working under 29 supervisors.

Medical education in Baluchistan is in a poor state where only Quetta has all institutions for postgraduate training. Despite our repeated requests, governments in Sindh and Baluchistan are yet to fill the critical gap in medical education, he added. He also informed that in Province of Punjab, Lahore had 42% of medical training institutions while 58pc existed in other parts of Punjab, which mean that training institution existed in each district of the province.

Prof. Shoaib Shafi lauded the efforts of PIMA, for doing excellent work for the betterment of the ailing humanity and education besides organizing awareness programs for medical professionals. Strength of truthfulness is very important and courage should be our top priority so that we can call spade a spade, he concluded.

Prof. Javed Iqbal, former Principal Quaid-e- Azam Medical College Bahawalpur speaking at the occasion said that evidence based practice is extremely important. There is need for inculcating values among medical students, it’s equally important to educate students about the importance of good conduct and positive attitude along with getting professional excellence. He urged the medical profession to avoid unethical relationship with Pharma industry. We can use their help and assistance for research and CME credits financial aspects should not be our core value.

Prof Khalid Masood Gondal Senior Vice President CPSP in his presentation highlighted the progress of CPSP. CPSP, he said, has introduced International scholarship and so far four hundred sixty-two doctors have gone to Ireland for two years training. These candidates are selected by them through online interview and we in Pakistan assist them. Selected doctors are eligible for training in various disciplines of medicine. We have also signed an MOU with Royal College of Physicians London for two years training. Efforts are also going on for academic collaboration with American Council of Continuing Medical Education, he added.

Inaugural session of Karachi CON was dedicated to Late Prof Tahir Shamsi, the pioneer of bone marrow transplant in Pakistan and other Covid-19 heroes. Organizes acknowledged the services of medical staff who worked tirelessly in the pandemic and honored them with shields. The recipients included the heads of Covid-19 wards at various public and private sector hospitals of Karachi which included Indus Hospital, Expo Centre, JPMC, Sindh Infectious Diseases Hospital, and Liaquat National hospital, AKU, Al- Khidmat Hospital, Ruth Pfau Civil Hospital, Ziauddin Hospital and Dow Ojha Campus. Dr. Khubaib Shahid, President Pakistan Islamic Medical Association highlighted the aims and objectives besides various activities of PIMA conducted all over Pakistan

 Neurology Session

Prof. Khalid Sher along with Dr. Syed Ahmed Asif chaired this session while Dr. Irfan Hashmat was the Moderator. Dr. Saba Zaidi, Consultant Neurologist at Liaquat National Hospital, Karachi conducted an interactive session on stroke, it covered its definition, types, diagnosis and management of stroke. She went through different case scenarios in which she discussed young stroke its etiology and management. She talked about acute stroke care in Pakistan and also discussed atrial fibrillation and stroke.

Dr. Shahid Mustafa from AKU discussed special issues in the management of Epilepsy. Common mistakes in management of epilepsy includes not getting MRI especially if a focal onset seizure, new onset after adolescence. Not choosing the correct medicine, Polytherapy/under dosing, incorrectly done and interpreted EEG.

Dr. Abdul Malik presented an overview in Headache and stated that everybody in the World will have experienced a headache at least once in their lifetime. Neuroimaging is not usually warranted in patients with typical headache and a normal neurologic examination. A detailed history and examination constitute the diagnostic gold standard and rarely requires extensive investigation. All headache are not migraine. Two different types of headaches may coexist in a patient and even require prompt diagnosis and management for the therapy to become effective. Lumber puncture is useful for assessing the CSF for blood (subarachnoid hemorrhage) infection and cellular abnormalities like meningitis and encephalitis etc.

Prof. Khalid Sher in his concluding remarks said that if someone is taking anti pain drugs for more than ten days, they must visit neurologist otherwise it will become chronic problem. In a stroke condition one should not control blood pressure at home. It could be dangerous, he added.

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