off record
Shaukat Ali Jawaid

The last wish of a
senior physician


A senior physician who served as Principal of three medical colleges in Pakistan is reported to have expressed his last wish to his family members stating that “Let me die peacefully at home and do not take me to the hospital”. He died many years ago and his family members respected his wish. Was it an expression of lack of confidence and trust by this senior physician in his professional colleagues and healthcare establishments?

Professional ethics demand that while treating patients, the first and foremost objective should be “Do no Harm” but do most of the healthcare professionals practice that? Most often lot of un-necessary interventional procedures, investigations are carried out just to prolong the misery of the patient. During this process, the economic death of the family takes place first followed by the death of the patient. And all these actions are often influenced by the materialistic virus which has infected the healthcare professionals and the healthcare establishments. A vast majority of the doctors, unfortunately, seems to have forgotten the importance of good history taking and physical examination, do not realize the importance of clinical skills and rush for sophisticated, most expensive tests. Advances in modern technology which should have been used judiciously when indicated to help in making and confirming diagnosis is being misused and abused, many a times prolonging the agony and sufferings of the patients.
However, it is heartening to note that some conscious people within the medical profession have started voicing these concerns but it appears the message has not got registered with all the stake holders appropriately. Speaking at the Golden Jubilee Conference of CPSP at Karachi last year, later while inaugurating the Medical Education Conference at Fatima Jinnah Medical College for Women at Lahore, and more recently at the Medical Education Conference on May 20th at Karachi which was part of the CPSP Charter Day Celebrations Prof. Kh. Saadiq Husain talked on all these issues in detail. He also referred to the “CC Virus” the Commercialization and Corruption virus which has infected the medical profession and the healthcare facilities and opined that “excessive use of medical technology has lowered our clinical judgment, adversely affected doctor-patient relationship and ethics. Advances in medical technology should be used judiciously when needed rather than for making money and technology should not rule us”.
I have personally witnessed the awful conditions in many so called Intensive Care Units at various hospitals which are run and managed without any qualified and trained staff, where no infection control policy exists and shifting the patient to such an ICU is a sure prescription for disaster. The patient gets infected, the attending doctors keep on prescribing high potency antimicrobial agents but the ultimate result is disappointing for the patient and their attendants since there is no control, monitoring of these healthcare establishments to ensure quality of care provided. While in cities where the latest medical technology is available, the situation is quite bad, it is much better in small towns and cities where the doctors when they realize that the patient is in a terminal stage, do ask the relatives and attendants to take the patient home and look after them as not much can be done at this stage in the hospital.
More recently Prof. S.Tipu Sultan an eminent critical care physician, former Principal of Dow Medical College while making a presentation at SURGICON 2013 held at CPSP Karachi had stated that “only 20% of hospitals in the city of Karachi have proper Intensive Care Units. Very few of these ICUs, he said are purpose built facilities for teaching and training of staff. Residents are available in 1-2% of these ICUs. High Dependency Units are labeled as ICUs. Only 25% of these ICUs have got proper beds, 40% have working ventilators, only 30% have supporting equipment, just 5-10% have arrangements for in-house drugs delivery otherwise in most cases patients attendants have to arrange the drugs. Very few of these ICUs have trained dedicated doctors and consultant cover. Most patients are under primary care physicians, surgeons and gynaecologists. Most use refurbished equipment and there are no infection control policies”.
In view of the above, the question arises who will monitor all this and ensure accountability, minimum healthcare standards? When will the authorities’ concerned wake up do realize their duties and responsibilities of ensuring patient safety?

Tail Piece: There are worse crimes than burning books. One of them is not reading them-Joseph Brodsky.{jcomments on}

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