We need Good Doctors and a Good System where they work-Dr. Ghulam Rasool Mufti


 Healthcare Regulation in South Asia
We need Good Doctors and a Good System
where they work-Dr. Ghulam Rasool Mufti
Over regulation should be avoided as a
Good Doctor can fail in a bad system

LAHORE: Dr. Ghulam Rasool Mufti the visiting guest speaker from UK who is also member of Fitness to Practice Tribunal in UK in his presentation at the International Conference on Medical Updates at Fatima Memorial Hospital highlighted the need for Healthcare Regulation in South Asia. Tracing the history of regulation of healthcare professionals Dr. Mufti pointed out that it was Hammurabi in 1750 BC who was the first one to suggest that doctors should be regulated. He had stated that if a surgeon saved life he should be appreciated and rewarded but if the patient who is operated by him dies, the surgeon’s hands should be cut. It was the Hippocrates who came up with the philosophy that “First Do No Harm”. He further stated that do not do anything unless you are properly trained to do that.

Continuing Dr. Mufti said that UK came up with the idea to strengthen this further by suggesting a regulation that if someone is not qualified, he or she won’t be able to practice. In 1518 College of Physicians was established and later General Medical Council took over the responsibilities and started registration of doctors to practice but it had no other role. Licensing was done by the College and other peers who looked into it. However later three important incidents happened which accelerated the regulation process. First in 1996 one of the urological surgeons perforated the bladder of a patient and also damaged the ureter. One of his colleagues had to redo the surgery on the patient for three hours and ultimately saved the lady. Medical Superintendent of the hospital investigated the case which revealed that there were too many complaints against that surgeon and his speed of doing surgery was his problem. The enquiry further revealed that out of fifty three patients he had operated, twenty nine were dead. The second incident was the Bristol Heart Scandal. It showed that there were too many complaints against two Paediatric cardiac surgeons, Stephen Bolsin and their mortality was too high. Then in 1998 Dr. Shipman became famous as Dr. of Death in Manchester. He used to give injections to elderly people living alone who wanted to die and helped them die. He was charged for murder of fifteen people and sentenced to life imprisonment. He later died in the Jail. There was lot of hue and cry even in the media why the doctors were not being regulated. It was said that GMC was failing and it was protecting the doctors. These things were happening all over the world. It was said that to err is human. Governance was very poor in hospitals and lot of harm was done to the patients while they were hospitalized not only in UK but USA, Australia. The message for regulation of doctors was coming from all over the world. It started a movement and a demand was made for regulation of professionals as well as the healthcare providers. It was then decided that everyone should be regulated and the healthcare professionals had to be disciplined. Then the discussion started who should regulate the doctors, whether it should be the Professionals or the Manager. There was lot of pressure from the media as well. BMA was in favour of self-regulation. State, Media and Public also wanted some sort of regulation. Thus GMC was given the responsibility to regulate the professionals. It came up with the document which stated that the doctors should be knowledgeable, skillful, deliver high quality of care, good communicator, good team player, and act with honesty and integrity. So GMC took over the responsibilities of Medical Education, Registration. It resulted in annual appraisal and re-validation. The appraisal meetings can be challenging. Now over eight thousand doctors are referred to the GMC annually. Some of them are fined and some are suspended. So far action has been taken against two thousand and eight hundred eight doctors.

Dr. Ghulam Rasool Mufti is being presented a memento by Ms. Sameena
at the International Conference organized by FMH on February 27th. Also
seen in the picture are Prof. Yasmin Rashid and Prof. Rakhshanda Rehman.

Later on the debate started whether we were over regulating the doctors. One of the doctors Dr. Bawa was prosecuted for man slaughter and sentenced for two years and then suspended. Her peers said that she was a very good doctor. Enquiries revealed that she was a brilliant doctor working against many odds. Her name was later not erased from the register. It was found that it was the failure of the system and not the doctor. Government said her name should be erased from the register but the GMC went in appeal against the trail stating that their decision should be upheld. There is no point in over regulation. It was highlighted that we need Good Doctors and a Good System where they work. A good doctor can fail in a bad system. Many human beings are dying because of substandard care. In 2009 Care Quality Commission was established with the main objective of making the hospitals accountable. Monitoring and regulation should be started and actions should be taken where things go wrong. The Care Quality Commission (CQC) ensures safe, caring and responsive healthcare professionals. While GMC regulates the professionals, CQC regulates the healthcare providers in UK.

Recently India has also decided that healthcare professionals and healthcare providers needs to be regulated. Professionals and healthcare providers are both interdependent and both needs to be regulated. Poorly trained professionals, doctors can spoil the best system while bad doctors will fail the system. We must listen to our conscience, be honest and try to learn from your mistakes, but we are not honest about it, Dr. Mufti remarked. Let us avoid duplication and wastage of money. Somebody must instill this message in the doctors. We all face problems while in practice but it is not wise to blame the doctors all the time. It could be a system failure. Those who say they have never made a mistake are not speaking the truth. Things do go wrong at times but it is the perception in the society about the doctors which needs to be improved. Such things do happen all over the world. Dr. Mufti suggested that let the doctors reserve half day a month and look at their results, their infection rate, how many patients had to be taken to the operation theater again. How many deaths occurred and how many of them were preventable? Every hospital should start a clinical audit. All complications should be documented. Record the longer stay of the patients and they discuss how it can be shortened and how the system can be improved without naming and blaming. It will lead to lot of improvement and those involved will be careful next time. He reiterated that without the intervention of the conscience, the law cannot govern.

Continuing Dr. Ghulam Rasool Mufti said that the communication between the doctor and patient was very important. Majority of the patients are not satisfied which is due to inadequate communication between the doctor and the patient. Doctors must give time to the patient, listen to their complaints patiently. Most complaints against doctors are due to poor communication. Be careful about the words you use while talking to the patient. Every word you say is important. Try to improve the outcome.

Responding to a question from the audience during the discussion, Dr. Shaukat Ashai remarked that research is not so difficult. You need to involve a statistician from the very beginning. Doctors in Pakistan are sitting on a goldmine of data. It is good methodology and enthusiasm which are important in conducting research. You do not need too much funding and sophisticated equipment, instruments, high rise buildings to carry out research. Good statistician is a must. Mr. Shaukat Ali Jawaid Chief Editor of Pulse International pointed out that doctors in Pakistan waste billions or rupees every year on holding conferences in Five Star hotels many of which has very little scientific programme and mostly these turn out to be social get together. Funding is not a problem in Pakistan what we need is to ensure judicious use of the available resources. National Bioethics Committee had prepared its Guidelines on Physicians interaction with Pharma Trade and Industry which were approved by the federal government as well as by the PM&DC but they are not implemented.