off record
Shaukat Ali Jawaid

surgical procedures 


According to a report published in USA Today last month, there are tens of thousands un-necessary surgeries which are performed every year in United States of America. Their report is based on assessment and looking at government records and medical databases findings.

The report further states that” in fact un-necessary surgeries might account for 10-20% of all the operations performed in some specialties including a wide range of cardiac procedures”. “In the last seven years, over one thousand US doctors are reported to have made payments to settle or close malpractice claims in surgical cases that involved allegations of un-necessary or inappropriate procedures”.
The above revelation has not been made for the first time. Such reports of unethical practices on the part of healthcare professionals in United States are often highlighted by the media and all this is happening in a society where there are too many watchdog, monitoring agencies in addition to strict accountability being carried out by the respective professional specialty organizations of its members. What will be the real state of affairs as regards unethical medical practice in developing Third World countries and other societies where no such monitoring and accountability mechanism is in place, is extremely difficult to imagine. However, it also shows that one can have as many laws as possible but the best and the most effective way to check all such malpractices is to appeal to the conscience of the members of the medical profession. One cannot do much in those cases where the conscience is dead but in those whose conscience is sleeping, one can wake them up and make them realize to uphold the professional ethics and practice ethical medicine.
In Pakistan, the situation is not different than in many other developing countries. While at the government level, no accountability mechanism is in place, the professional specialty organizations have also miserably failed to monitor its members. The result is reported too many un-necessary angiography, endoscopy procedures, surgical procedures being performed by many who are not well trained and competent enough with the result that it leads to serious complications affecting patient safety. Let the conscious members of the medical profession in these professional specialty organizations take up the challenge and at least come up with some system of self monitoring. They can at least register those who they think are adequately trained and competent enough to undertake certain procedures and make this information available on their society’s website. Those who wish to undergo certain procedures can then check up the information on these society websites to be sure that they are being managed by competent people. Mishaps and complications do occur even in the best of the hands but these are exceptions but on the whole it will have a positive impact on patient safety.
Let the respective professional specialty organizations, associations register those who are qualified and experienced to undertake angioplasty and stenting procedures, different endoscopic procedures, bariatric surgery, IVF and other assisted reproductive procedures, total hip replacement and knee replacement surgery, retinal surgery, renal transplants, liver transplant, robotic surgery and so on. It is also important that healthcare professionals know their limitations, do not hesitate to refer the cases if they think the patient can be managed better by some other colleague or do not feel shy in seeking help and assistance of their colleagues if and when required. In some specialties like Oncology, the concept of combined cancer clinics practiced in the developed world has not yet materialized in Pakistan. Shared decision making by the team of consultants including surgeon, clinical oncologist and radiotherapist can improve the ultimate outcome.
We also need to have national databases where information regarding these procedures can be sent which will also help in generation of lot of useful local data which can be extremely helpful in further documentations and publications. We have to make a beginning somewhere. At present every healthcare professional is free to do whatever he or she likes and this should not go on indefinitely. Pakistan Medical and Dental Council is supposed to be monitoring all this but it is itself now paralyzed and has become dysfunctional for the last almost over a year and there is no hope that its affairs will be streamlined and it will start functioning effectively soon.{jcomments on}

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