Demise of Clinical Acumen has serious consequences for patient care-Prof. Majeed Chaudhry


 Modern gadgetries are no substitute for good clinical examination

Demise of Clinical Acumen has serious consequences 
for patient care-Prof. Majeed Chaudhry

Highlights the importance of Bedside medicine,
good history and clinical examination

LAHORE: The recent technological developments have taken the toll on clinical training of undergraduates as well as postgraduates with the result that serious lapses are noted every day in patient management. Physicians must always keep in mind the limitations of new developments in technology. This was stated by Prof. Majeed Chaudhry a noted surgeon, eminent medical educationist and Principal of Lahore Medical & Dental College, He was speaking at the recently held 2nd International Medical Conference of Shalamar Medical & Dental College held from February 2-4th 2018.

He supplemented his presentation with a numerous important quotations from eminent medial personalities to highlight the importance of bedside medicine and felt that the importance of bedside medicine, good history and clinical examination in patient management can never be over emphasized. It was world renowned Dr. William Osler who had said that “The good physician treats the disease, the great physician treats the patient who has the disease”. He had also remarked that “Listen to your patient. He is telling you the diagnosis”

Continuing Prof. Majeed Chaudhry said that in the past we imparted wonderful training across the country and Pakistani medical graduates did wonders all over the world. But then something went wrong. We all need to ponder over this and try to find out the causes of this malady and try to find possible solutions. Stressing the importance of practical training, he quoted Benjamin Franklin who had remarked that “Tell me and I forget, teach me and I remember but involve me and I learn”. William Osler also believed that “He who studies medicine without books sails an unchartered sea but he who studies meidicne without patients does not go to the sea at all”. Medicine he believed is” learnt by bedside and not in the classroom. Let not your conception of disease come from words heard in the lecture room or read from books. See and then reason and compare and control but see first”.

Highlighting the major lapses which occur almost every day in healthcare facilities during patient management and the importance of good clinical examination, Prof. Majeed Chaudhry then described a few scenarios which were as under:

In the first scenario, a young House Surgeon presents a case during the emergency round of the professor in Good old days. The patient is a young school teacher who presented in the emergency of Mayo Hospital with a chest intubation for Pneumothorax but with persistent dyspnea. However, on routine clinical examination observed bowl sounds in the chest and diagnosis of diaphragmatic hernia was made. At operation intra thoracic colon was retrieved, colostomy with mucus fistula was established and the patient recovered completely. Moral of the story, Prof. Majeed Chaudhry remarked was that good clinical examination can save lives.

In the second scenario a sixty nine years old retired professor of surgery was diagnosed with aortic stenosis. He flew to USA. Aortic valve replacement was done. He had persistent dyspnea post operatively. Came back after three months, dyspnea persisted. He was investigated and was found to have carcinoma of the left lung with secondaries in all the bones. He succumbed to his disease and died in three months.

The third scenario which Prof. Majeed Chaudhry shared was of a sixty two years old Professor of Surgery who had myocardial ischemia and was flow to USA for CABG. This was done and he returned after couple of weeks. He complained of slight distension of abdomen. Clinical examination showed massive ascites. Further investigations revealed that he had a multifocal Hepatocellular carcinoma with multiple peritoneal secondaries. He succumbed to his disease in four weeks. Herein the moral of the story is that modern gadgetries are no substitute for good clinical examination.

Sharing his thoughts as to what he felt has gone wrong over the last few years Prof. Majeed Chaudhry discussed in detail the student factors, institutional factors and the faculty factor. As regards student factors, he mentioned undue student friendly assessment system, misuse of modern gadgetries, very casual attitude of students and parents, aptitude test as of now is waste of time. Unmanageable number of students in the class coupled with unmatched facilities and very low motivational level of new entrants.

Institutional Factors: This includes unethical practices in the assessments at institutional level, rat race for better results without adequate training, paucity of teaching material in newly established medical institutions. The solution lies in the use of Simulation besides stronger and more efficient log book system for undergraduates and postgraduates alike to solve these problems, he remarked.

Faculty Factors: The role modeling, Prof. Majeed Chaudhry opined has now vanished, holistic approach is not there. We need to have regular feedback about faculty by students. Private practice, he opined was a scourge and he wished that the faculty members were paid enough to live decent life with dignity ensuring that they can meet their expenses.

There are general factors as well which have contributed to the present miserable state of affairs in the field of medical education. One of them, he said, is the use of modern gadgetries, wish for monetary gains, poor work up of the patient besides marketing tactics of the industry. He urged his colleagues that let us continue to play our part and try to redeem the past glory. In the good old days, we had teachers who were different. We produced doctors who did well locally and in the western world. They earned good name and rose to high positions. A large number of these medical graduates are at present working as consultants in the Western World. They were the product of good old days. They commanded respect because of sheer hard work and good basic clinical training. In the past our students were also different. It was very rare for someone to miss lecture and clinical classes. We as students could not imagine missing out indoor teaching or outpatient teaching. Now the number of students is too high. They cannot be accommodated in the classroom. Our priorities are different. He also revealed that while interacting with Principals in a meeting held at University of Health Sciences one of the Principal had remarked that “He was grateful to 175 students who don’t come to attend the classes. If everyone came, where would he accommodate them” and this conveys a lot.

Prof. Majeed Chaudhry wondered that how come we see 100% pass percentage by some of the medical institutions? Do they have some supernatural students who don’t even come to the classes but still everybody passes the examination. What we are doing was just scratching each other’s back. We do not teach, but still we make sure that the students pass in the examination. Introduciton of private medical institutions has not helped to improve the situation. Medical students have very poor clinical exposure and then there is a concept that everything has been paid off by the parents.

Speaking about the postgraduate training in surgery, Prof. Majeed Chaudhry said what kind of stuff we are producing these days? Commitment by both the supervisors and the students is lacking and the end result is that Fellowship can now hardly be termed as an Exit examination. Training leaves a lot to be desired. These days monetary distraction has become the way of life. This is the kind of importance to be a successful practitioner. The healthcare professionals have disrespect for professional ethics and many of them indulge in private practice in surgical infancy while we do not see any good role models as well.

He concluded his presentation by stating that let us all ponder over what has gone wrong all these years? Where is our past glory? Where is the commitment and dedication? Do we need to enhance our commitment to the profession as well as to the Nation? Late Prof. Najmuddin Masood Ansari who served as Professor of Medicine at King Edward Medical College in 1980s used to be absolutely correct in his clinical diagnosis of surgical problems in a medical ward, he added.

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