off record
Shaukat Ali Jawaid

Increased Cesarean 

Section rates & promotion

 of Social Medicine


Prof. Rashid Latif Khan, an eminent obstetrician and gynaecologist of the country who is the pioneer of IVF (Test Tube Baby) in Pakistan was the chief guest at the special session devoted to obstetrics and gynaecology at FAMILYCIN 2013 held at Lahore from January 3-5, 2013. Speaking at the occasion he commended the Family Physicians for their Continuing Medical Education programme and efforts aimed at their Continuous Professional Development. The invited speakers at the session, he opined, have made excellent presentations on different topics in obstetrics and gynaecology practice.
Commenting on some of the presentations he had a word of advice to his professional colleagues based on his own personal experience. Referring to the management of patients with Polycystic Ovary Syndrome (PCOS), Prof.Rashid Latif Khan said that when the mother comes to you with her daughter with hair on her face, obese, the mother is very much worried and anxious. Many questions which comes to her mind are whether after marriage, her daughter will become pregnant or not, what about the hairs on the face and weight gain? The patient and mother both need reassurance and we should not indulge in un-necessary investigations. Do it only if they are going to change your management plan. PCO is mostly a clinical diagnosis, go ahead and treat it. Ultrasound will do the rest of the diagnosis. Read their worried face and make clinical diagnosis.
Prof. Rashid Latif Khan was of the view that we need to promote social medicine. When I came to Lahore from Multan, I was worried. This city had many distinguished gynaecoloigsts like Prof. N. A. Seyal, Prof. Fakhar Zaman and others and I thought it will be very difficult to adjust here. But what I decided was to practice ethical medicine and go by the standard treatment protocols. Telling the secrets of his practice, Prof.Rashid Latif said that when these PCOS patients come to me, I tell the mother and the daughter to look at each other’s face rather than looking at me. I tell the mothers, forget that your daughter has any abnormality and this takes away their 50% of anxiety. There is no single treatment available for PCOS. There are different treatments for different disorders. After marriage, ask the patient to go and consult their doctor if need be. But if you start telling the mother about infertility, diabetes mellitus, overweight, you are not doing any service to patient. The patient will become hypertensive, develop diabetes mellitus and her anxiety level will increase. Do not make the treatment of PCOS expensive. Just reassure the mother and tell them that these problems can be handled and satisfactorily managed in most of the cases.
Talking about cancer cervix, Prof. Rashid Latif Khan said that there was a time that PAP smear was mandatory for every patient over the age of sixty years. I also stated doing Pap smear on every patient but then I realized that we did not have many qualified cytopathologist who can read the reports. We do have good pathologists but not many good cytologists who can read abnormal cytology biopsy. Soon I realized that it was not helping my patients any way so I gave up doing PAP smear because we do not have good cytologists and PAP Smear will not answer the problem. The VIA procedure discussed by Prof. Tasneem Ashraf is a wonderful technique for screening patients for cancer of the cervix. As regards throwing away the forceps advocated by Prof.Shaheena Asif, I will support it to the extents that do forceps delivery only for correct indications. Head of the baby should be fully rotational. Cesarean Section is a lot safer. In more than 50% of the cases, C.Section is compromised to the convenience of the obstetricians and gynaecologists. If you tell the patient and the relatives that you are going to do C.Section at the last minute, relatives become unhappy. Early humiliation, Prof.Rashid Latif Khan opined, is much better than late. Instrumental delivery should be undertaken only by those who are adequately trained, otherwise C.Section will be much safer and many complications of instrumental delivery can be avoided.
As regards Prof. Mahmood Shaukat’s presentation on avoiding litigations, Prof. Rashid Latif’s advice to the healthcare professionals was that “if any thing goes wrong, admit it, patients will be happy. They should not be cheated”. Many a times the paramedics and support staff give wrong information to the patients. Tell the patient and the relatives. Things do go wrong even in expert hands. Honesty is the best policy but if you fail to tell the truth, the patients might go into litigation, he added.{jcomments on}

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