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HomeFRONT PAGEMedical Profession must initiate a mechanism of self-monitoring and accountability

Medical Profession must initiate a mechanism of self-monitoring and accountability

Authorities should refrain from humiliating the healthcare professionals and no one should be punished without proper investigations, proof of negligence
Hospital Committees with representation from the civil society can
help resolve many issues and improve services to a great extent

LAHORE: It is high time that the members of the medical profession initiate some mechanism of self-monitoring and accountability to improve medical education and health services. The responsibility lies much more on the leadership, i.e. Deans, Principals, Vice Chancellors and Medical Superintendents of hospitals besides leadership of professional specialty organizations to start monitoring its members. All healthcare facilities should have Hospital Committees with representation from respectable members from the civil society who can look into any complaints, help resolve any disputes, issues and also suggest improvements of services. Above all if all selections, appointments and promotions are also made on merit and there is no political interference, the situation will improve tremendously.

With the revolution in information technology, the public at large is now much more informed, their expectations have increased too much while they are not at all aware of the difficulties, problems faced by the healthcare professionals in discharging their duties. Media which is very fond of sensationalism goes on reporting events without proper investigations which at times creates more problems. It is unfortunate that neither the owners of media, print as well as electronic are interested in acquiring services of knowledgeable people nor the vast majority of those reporting on health issues have any basic knowledge hence they are not capable of analyzing the correct situation, the causes of any mishap but feel pleasure in scandalizing, defaming, humiliating the healthcare professionals and facilities. Millions of people benefit and get cure at public healthcare facilities every day which is never reported and acknowledged but any small mishap at any hospital is highlighted which demoralizes the already overburdened healthcare staff which is again not going to help improve the situation but the public and patients will suffer. Many a times the patients are brought in such a critical condition that it is almost impossible to save them but public does not realize its own responsibilities as to why these patients were brought so late?

When such incidents are highlighted by the media, government authorities wake up and start taking actions which most of the time are improper and not at all justified. If the situation did not improve, the healthcare professionals will never entertain serious cases even in emergency fearing any backlash hence even a few of those who can be saved will not get a chance. The authorities will be well advised to refrain from acting in haste to please public, refrain from humiliating the healthcare professionals and no one should be punished without proper investigations and without any proof of negligence. The recent incident at Sahiwal Teaching Hospital which resulted in the death of over a dozen neonates and infants has neither brought any sympathy to the health care professionals nor helped improve government image and both seems to be at fault.

According to first hand reports which we were able to find out, the fire broke out in a split air-conditioner, there was smoke all around. It is said the infants admitted in the Nursery were immediately shifted to other wards, emergency and put on oxygen but some of them might have suffered due to smoke. The first child died next day and over a dozen deaths were recorded in the next five days. It is also learnt that the nursery has facilities to accommodate about twenty neonates and infants but the number of patients admitted were much more than that. It is also said that figures reveal that there is a very high mortality every month but the question arises, why the hospital administration and the in charge of the unit did not try to find out the reasons for such a high mortality? Did the hospital administration reported the situation to the health department, asked for more facilities? Were the fire extinguishing system in place and functioning and if not why the administration did not look at it in time.

It is a well-known fact that doctors are blamed to be more interested in private practice than discharging their professional duties in government hospitals. Some are found absent even during duty hours; hence the authorities should start introducing biometric attendance. During the past few years’ hundreds of faculty members have got promoted by publishing their manuscripts in sub-standard medical journals many of whom even bought authorship which is so common, hence it is not possible for them to undertake some research work, try to find out reasons for this high mortality, initiate some interventions to check it, bring it to the notice of authorities and put it on record. Medical Superintendents often do not move out of their air-conditioned offices to see what is happening in the healthcare facility under their control. Meagre budget marked for repairs and maintenance is often misused hence it is not uncommon to see such incidents taking place at different healthcare facilities throughout the year.

It is heartening to note that the Punjab Health Secretary is reported to have immediately intervened and tried to defuse the situation. In any case the Principal of the affiliated college in this case Prof. Imran Hassan who is a noted physician, very pious, kind hearted and who has tried to improve the services wherever he served whether it was Ganga Ram Hospital at Lahore or here at Sahiwal Teaching Hospital does not have any direct responsibility for healthcare as he is mostly involved with academics. Even otherwise he enjoys a very good reputation and any action against him is unwarranted and highly uncalled for. Authorities on their end cannot remain silent spectators with so many deaths taking place and they are under pressure to act but they must act with wisdom taking the ground realities into account. They had to initiate some enquiry but the reaction from the junior doctors, nursing staff and the paramedics was uncalled for. They must remember that in such situations, many outside elements with their own political interests try to take advantage of such a situation and make things worse. There was no justification to attack the Chief Minister’s car and attack the police escort as alleged which then naturally reacted which resulted in reportedly injuries to some police personnel as well as healthcare professionals which all could have been avoided had the situation been handled intelligently.

However, according to another report the” PMA has demanded an apology from the Chief Minister and dismissal of the Health Secretary Dr. Ali Jan claiming that he mislead the government, distorting the facts to cover up his own negligence. They have accused the health department of making erratic appointments on the advice of incompetent bureaucracy resulting in gross negligence and mismanagement. The fire they claim broke out due to faulty wiring, hanging wires and poor quality of air-conditioning system which was part of revamping spectacle. The PMA further stated that neither the engineers involved in the revamp work, maintenance and repairs nor departmental parasites nor contractors of communication and works department were held accountable for the Sahiwal episode. Board of Management was nowhere in sight in the investigations by the health department. They also criticized the Punjab Health care Commission who remained a silent spectator in the entire episode”. These are very serious allegations which need a thorough probe by a committee consisting of credible healthcare professionals to find the truth and identify those guilty of any negligence who should not be spared.

Previously all induction for residency training used to be made by the teaching hospitals by a committee drawn from the faculty and a large number of residents used to get the posting in their desired specialty, unit, ward. But when the junior doctors started misbehaving with senior professors, some of them were even locked in rooms and insisted on selections as per lists they were handed over by the junior doctors, they refused and referred the matter to the health department which took away the powers of selection of residents from the faculty. The young doctors must have learnt some lesson from this. In future too any of their undesirable action which is not based on merit, facts and is intended to coerce blackmail the hospital, medical institution administration will go against them and in the end it will be the medical profession which will suffer and it will further strengthen the hands of bureaucracy.

To avoid such unpleasant situation and repeat of such incidents, it is essential that all medical institutions, healthcare facilities should have Committees with representation from the civil society not necessarily the politicians. These committees should meet frequently, look into any issue and help resolve problems. They can also influence the government authorities to improve the existing facilities, generate funding through donations to further equip hospitals and expand facilities. Many such committees are already working in a few hospitals particularly those run and managed by Trusts and a few in the public sector. Every medical institution, healthcare facility should also have a Public Relations Department, focal person to talk to the media to provide any information asked for while all others should refrain from talking to the media.

This will ensure their side of the story is also covered. Every healthcare facility must have regular morbidity and mortality meeting every month, to learn from their mistakes and see if the deaths taking place were preventable and could have been prevented. Such meetings are a routine in the civilized world and some hospitals in Pakistan also practice that. Healthcare professionals in general should also learn how to communicate with public effectively using the media something in which the healthcare professionals are lacking and have so far not given it due importance. Most of the information on social media is also fake, concocted and no one should pay any heed but effective steps should be taken to highlight the good work being done by the healthcare professionals which at present is also lacking. One hopes that the leadership of the medical profession will realize its responsibilities and come up with some self-monitoring, accountability mechanism which will also help improve the image of the profession. SAJ


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