Nobody trusts us

There should be a uniform system of training for every specialty and it should be properly supervised

A good friend and a classmate from medical college who is presently on the cardiac surgery faculty of a prestigious New York City University has over the last few years developed an interest in the history of medicine.

This interest has culminated in his desire to pursue a master’s degree in that subject. As he applied, the university asked him for a transcript of his undergraduate degree (MBBS) sent directly from his degree awarding institution (KEMC-KEMU). The e-mail address from which the transcript was sent had to be safe and relatively ‘hack proof’.

As expected, KE officials ignored this request necessitating my intervention by asking a former student of mine now on the teaching faculty at KEMU to help out. The transcript was finally delivered and I suppose my friend can now proceed with his post-graduate work.

For the last couple of decades new graduates from Pakistani medical colleges that came to the United States (US) and applied for medical licences in various states were asked to have their transcripts sent directly from their medical colleges. Original documents that they had with them were not acceptable.

More than 40 years ago when I applied for my New York State medical licence, the original documents I had were accepted without any question. Something has obviously changed since then and not just for Pakistani doctors arriving in the US.

However, I do know for a fact that documents provided by individuals from Pakistan are highly suspect and confirmation is now uniformly sought from the awarding institution. I am sure that the same applies to many other foreign graduates.

Obviously, there must have been previous ‘bad’ experiences that necessitated such caution. Before I talk more about what has happened to Pakistani higher education, perhaps a bit of historical perspective is appropriate.

My late father used to tell us a story he heard from a good friend, a former colleague and a classmate in medical school about a physician who went to the United Kingdom (UK) for post-graduate training. After this physician kept failing in the ‘membership’ (MRCP) exam, my father’s friend advised him to go across the Irish Sea for his post-graduation.

This physician did exactly that, forked out a decent number of pound-sterling and sat for a special MRCP exam. While there, he was asked if he wanted to take any other exam and on enquiry he was offered a diploma in obstetrics and gynaecology (DRCOG). So he returned to Pakistan and was perhaps the only physician with a medical degree (MRCP) and a surgical diploma (DRCOG). On the basis of these qualifications he became a professor of obstetrics and gynaecology.

This story is from the late 1940s and is quite possibly not correct. That said, while I was doing my house job in Mayo Hospital way back in 1971, a newly arrived ‘triple’ FRCS qualified surgeon joined the faculty in King Edward and Mayo Hospital. Rumour had it that he learned how to do surgery from his juniors while he was serving as an assistant professor.

In Pakistani medical institutions, the FRCS and the MRCP qualifications are considered ‘terminal’ or highest academic qualifications. Though Fellowships from the College of Physicians and Surgeons of Pakistan (FCPS) and American Specialty Boards are also up there, as are the, in my opinion the totally worthless MS and MD degrees awarded by medical colleges and universities in Pakistan.

For many decades of the last century, the MRCP-FRCS exams became money-makers for the royal colleges in UK awarding these degrees. Physicians with minimal or dubious training could take these exams after paying a hefty fee a few times and go back to former colonies and become experts. However, none of these oversees ‘fellows’ were accepted within the UK as experts.

The handing out of often meaningless diplomas, memberships and fellowships is a tradition we inherited from our former colonial masters. Since then we have considerably improved on it.

The UK has now changed this system and only awards fellowship degrees to those physicians that undergo a fully approved training programme in a particular specialty. To those that once got an FRCS by paying a fee and taking an exam, they give an MRCS qualification as a prelude to proper training.

The practice of handing out often meaningless diplomas, memberships and fellowships is a tradition we inherited from our former colonial masters. Since then we have improved on it considerably. The reason why all this comes to mind is because of the recent scandal about the national airline having a large number of pilots with licences of dubious veracity.

Obviously, I have no expertise about what goes into getting a pilot’s licence but I do hope that some good will come out of all these PIA problems. However, I do have some experience about training doctors, experience obtained both in the US and in Pakistan.

Having supervised FCPS trainees as well as Master of Surgery (MS) students preparing for cardiac surgery post-graduation, I am entirely convinced that the MS programme should be restricted to those candidates that have completed their Fellowship (FCPS) qualification and want to do research or qualify in a sub-specialty.

Sort of like my friend in the US that I mentioned in the beginning who wants to get a post-graduate degree in medical history. After getting a master’s degree, he could go on to get a PhD. And yes, I know many physicians in the US that have MD and PhDs and are involved in research in their area of specialisation.

The point I am trying to make is that there should be a uniform system of training for every specialty and it should be properly supervised and have some element of uniformity. The same I am sure should be applicable to most other professional qualifications, including pilot licences.

Having worked in the US for more than three decades, I have many a gripe against the medico-legal environment that forces doctors to practice what is called defensive medicine. But that litigious environment also makes sure that certain levels of safety are maintained. Some of that litigiousness might be good for Pakistan.

In Pakistan of course, any bad outcome due to medical malpractice is addressed in only one of two ways. Either family members go on a rampage and beat up doctors responsible or else the doctors are accused of murder. Neither one of these is an appropriate response. With proper malpractice legal system, the quality of medical practice will definitely improve.

Coming now to the problem of improper or ‘dubious’ licences of pilots flying airplanes in the national airline, if something like that had happened in the US, the owner of the airline (the government) that allowed that to happen would have been sued for ‘billions’ of dollars by family members of those that died in the unfortunate plane crash. And each and every court in the US would have accepted that claim.

The prime minister of Pakistan keeps talking about accountability. Clearly more than a few metaphorical heads should roll. But sadly as a society we have lost the basic moral capacity to accept responsibility. Nobody in top positions, present or past, will accept any blame. A few pilots will be fired but those that hired them will never suffer any consequences.

The writer has served as professor and chairman at the department of cardiac surgery, King Edward Medical  University

Nobody trusts us