Good for nothing

Dr Rana Jawad Asghar

I remember when I graduated, the first patient who came to my house was a small girl of seven years. At that time, I was yet to start my practice but as they lived near by, they came to seek treatment for the girl. The girl had some really messy wounds on her leg. I prescribed a good antibiotic and some other medicines. Her condition improved in the first few days as weeping wounds started to dry but after finishing the five day antibiotic course, her wound started oozing again with pus. She came back and I changed the antibiotic but the same thing happened again. When I had to change the third antibiotic, I was really worried and like any young physician went all through my medical knowledge and reviewed all the coloured atlases of the diseases I had. I realised that this was not the case of an infected wound but a case of scabies. When she came back again, a simple antiscabies lotion which cost nearly Rs 10 did the trick and she was cured.

I was really embarrassed that I totally failed to recognise a very common problem. I had many classes and the training to pick even the rarest heart murmurs. My Professors in examination loved to ask me about rare syndromes. I was well trained to pick any of these one in hundred thousand conditions but I was not prepared to diagnose a condition which in some areas you could find in 50 out of 100 children. I had only a few classes in dermatology and cases which come to the dermatology ward in a big teaching hospital are really messy ones. You don't see them in your daily practice. I don't have any reservations about the excellent qualification and expertise of our young doctors. They are really very good. They pass USMLE (American Entrance Exam) and PLAB (British Qualifying Exam) in flying colours. They pass the American Board Exams and British MRCP and FRCS with ease. Foreign hospitals don't hesitate to hire these highly qualified professionals.

Their training and education is at par with any good Western medical institution. But here also lies the problem. They are being trained as a doctor/physician of a highly developed country. They are being trained in big state of art teaching hospitals. These hospitals do not cater even less than one per cent of population of this country. They are being trained by the teachers who had their training abroad and now want to reproduce physicians just like they saw in the developed countries. But we cant afford to build these state of art hospitals in every city, at least, for a quite long period. So for whom we are producing these westernised doctors?

We are spending millions of rupees to educate these doctors so that when they graduate, they are so misfit in this environment that there is no avenue for them but to go abroad where they are quite adequately trained. Very few of our professors had any meaningful research. It is still very hard to find any good published papers in reputable international medical journals by them. The whole culture of our medical education is heading for a disaster. Most of our professors never had any time even to prepare for their lectures. They were so busy in their private practices. Many of them were not even abreast with the new developments in their field.

I remember, during our final examinations, one of our external examiners who was at that time the Professor of Medicine (Later, he became Principal of a Medical College in Lahore) was asking questions in a way which were a little difficult to answer. Eventually, it was found that the questions he was asking were from an old book by an Indian author. The book was so old that a lot of things in it had become obsolete. But apparently, he studied that book when he was a student and he still wanted answers, the way that book had described. We left all our latest editions of medical books and memorised all the tables of that old book and did very well in the exams. But e need to change our emphasis. We need to find for whom we are producing these doctors at such high costs. If we want to treat our 99 per cent population, we need to change our medical education drastically.

We need to train our doctors in Family Medicine. (I am not aware of any medical college except the Agha Khan which is providing it as a formal education). It is funny to see that though majority of doctors eventually go to Family Medicine, there is no formal training for it in their whole five years of medical education.

There are no courses on medical ethics for them to take. Apart from some haphazard experiences in their clinical training, there are no communication classes for them. Everything has been static for very long now and it is in the interest of our own health that we seriously review our medical education system now.