off record
Shaukat Ali Jawaid

Standard of General
Practice and elimination

of quackery


Despite the fact that a vast majority of fresh medical graduates settle in general practice, there is no formal standardized training in general practice during their training. The discipline of Family Medicine which has emerged as a major and important specialty overseas is not yet fully developed in Pakistan. It was late Dr. S.H. Naqvi who laid the foundations of the specialty of Family Medicine in Pakistan thus earned respect for the family physicians, general practitioners in the medical profession and the community. Later Dr. Bashir A. Malik and his colleagues in Lahore did a commendable job to promote this specialty that is why Dr. Bashir A.Malik was very much respected not only by the general practitioners but the specialists as well.

There is no unity amongst the family physicians, GPs with the result that there is no national representative organization of family physicians. In Karachi it is the College of Family Medicine which represents the Family Physicians and in Lahore there are two groups, one working as Pakistan Association of Family Physicians headed by Dr. Tariq Mian and the other known as Pakistan Academy of Family Medicine headed by Dr. Iqbal. Both are well organized and hold regular CME programmes for their members besides holding annual conferences. Last month both groups had their annual conferences and one of the important demands which they put to the government was ban on quackery. There can be no two views that the havoc being played by these quacks needs to be checked by an iron hand but have they ever realized why these quacks are flourishing in the country? A critical analysis of the prevailing situation will reveal that the members of the medical profession are also themselves to be blamed for having played a vital role in promotion of quackery because they have made the medical treatment so expensive and beyond the reach of a vast majority of people. Secondly they do not listen to the patients and just rush for writing the prescription. Again most of these prescription do not contain the diagnosis but a list of drugs and at times they even do not tell the patient in detail how they are going to use these medications.
The overall standard of general practice in the country leaves much to be desired. Since there is no mandatory requirements for re-certification to practice medicine something which has been implemented in many countries of the world, many GPs and Family Physicians are least interested in these CME programmes except those in major cities. Secondly such CME programmes are also organized only in big cities only although all the teaching hospitals should have such an arrangement. Not only that, even the District Headquarter Hospital should have some CME programmes for the Family Physicians. This will go a long way in improving the standard of medical practice thus enhancing the level of patient satisfaction as well. To begin with, may be the regulatory authorities should start this re-certification as an option but should be made mandatory after few years, once such Continuing Medical Education(CME) and Continuous Professional Development (CPD) programmes are put in place all over the country. It is extremely important because doctors have to deal with the patients whose lives are in their hands, hence the demands and calling of the profession of medicine are different than any other profession. The physicians have to keep themselves abreast with latest development in medicine within their chosen specialty to practice ethical medicine. DUHS at Karachi has recently initiated eCME programme for the family physicians which is a commendable step and it should be followed by other institutions as well.
CFMP in Karachi and both the Family Physicians groups at Lahore need to be commended that they do organize some Continuing Medical Education programmes for their members. More recently a number of workshops have also been added to their annual conferences. However, there is no justification whatsoever for the medical profession in general and the Family Physicians in particular to hold their conferences at Five Star Hotels. Have they ever realized that the millions of rupees which they collect from the pharmaceutical trade and industry for these conferences inviting them to put up stalls in the pharmaceutical exhibition, sponsor lunches and dinners are all passed on by the industry to the poor patients by way of enhancing the cost of drugs and services they provide. All such academic activities should be organized at the medical institutions which will be quite economical and secondly any financial help assistance from the industry should be utilized purely for capacity building of the GPs, Family Physicians to update their knowledge through CME programmes, Hands on Workshops etc., so that they can practice medicine with confidence. Unfortunately in many cases organizing such medical conferences by the medical profession has become a money making business by a few and they even do not hesitate to coerce, threaten the industry to get funds.
It was heartening to note that one of the speakers at the Family Physicians conference at Lahore had pointed out that now some Family Physicians have started writing diagnoses on their prescriptions. Family Physicians are the doctors of the poor and less privileged class in the society in most cases, hence it does not suit them to hold their conferences in the most expensive Five Star Hotels. One hopes that the conscious physicians among them will reconsider this issue, give it a serious thought and move to some medical institutions for their academic activities. Enhancing their competence and ability to practice medical, upholding professional ethics, re-certification of physicians both family physicians and specialists are essential requirements to improve the practice of medicine. Little more emphasis on improving doctor-patient relationship, communication skills by the healthcare professionals are needed to win the trust and confidence of public so that they are not trapped by the quacks. At the same time, the public also needs to be educated regarding likely and well established complications of certain interventional, surgical procedures and adverse drug reactions which are all well established entities and there is no need to press the panic button. The media in general and electronic media in particular has been on the forefront to lead a malicious campaign against the medical profession by running stories which are nowhere near truth in most cases. Every now and then one sees the breaking news or sticker on the television screen patient died due to doctor’s negligence or wrong administration of medications. Do these people in the media have any professional qualification, knowledge and competence to give their opinion on such incidents within minutes, certainly not? Hence, while professional negligence cannot and should not be tolerated on the part of doctors but medical errors should be seen and dealt with in their own perspective. Like all other professions, if media has certain privileges then it also has certain responsibilities to avoid sensationalism and creating panic in the society by upholding professional ethics while printing or telecasting such health related news, stories. A vast majority of the medical profession works with devotion and dedication in worst circumstances but the positive aspects of their service are seldom recognized by the society, authorities and highlighted by the media.
Professional specialty organization in the medical profession has a responsibility to monitor their members, hold them accountable, all healthcare facilities in public and private sector must put in place some mechanism of investigating and taking actions on patient complaints. It will not only enhance patient satisfaction, improve doctor patient relationship but also help in eliminating the menace of quackery from the country.{jcomments on}

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