IN the last 10 years, one thing strongly noticed by me as a doctor is that the merit of clinical practice and competency of doctors is declining drastically. Nowadays, there are many more doctors in Pakistan, and the specialist consultant ratio has also risen drastically, but malpractice with incompetence has risen too much. PMDC has the maximum number of registered doctors today, and CPSP (College of Physicians and Surgeons Pakistan) has the maximum number of specialist consultants with a fellowship from the college. One fact is evident: perfection rests with the Almighty only.
For years, health facilities in certain areas of Pakistan have always been criticized, always blaming the Government for not paying attention. One such strategic location is South Punjab, including Multan and its attached cities and towns. I am a female doctor in the rare field of urology with FCPS training completed at Sharif City Hospital Lahore. Due to personal reasons, just for a year, I was shifted to the bit underdeveloped area of South Punjab, the Layyah city. Quite surprised to see a lot of FCPS consultants in DHQ Hospital Layyah, even FCPS gold medalist cardiologists, but their clinical practice was strange. With so many FCPS gynecologists, CTG facility is rarely available in their private clinics, and monitoring is not done.
It’s appreciable that CT scan facility is available in DHQ Hospital Layyah. As I am from urology and CT scan is readily indicated in urology patients, it’s declared as a fundamental component of our practice according to EUA guidelines. Despite the provision of such a facility, FCPS urologists prefer ultrasound and X-ray KUB over CT KUB, but according to the controller exam CPSP, their FCPS is passed and the degree awarded, so their opinion is valid. Stone density is an important factor in deciding whether to go for ESWL or minimally invasive procedures, apart from stone burden, but stone density can never be evaluated by ultrasound but by CT KUB plain in Hounsfield units. Because these important components of urological practice are not considered by the examination department of CPSP, that’s why urological practice in cities like Multan and Layyah is too demerited.
In general, the role of a radiologist is vital in the medical field, but radiologists in South Punjab are strange. In fact, due to CPSP, South Punjab is yielding incompetent FCPS consultants. I did a diploma in basic ultrasound post-house job, and being in urology, we used to do ultrasound-guided PCN quite often. In Layyah, at a private hospital, I checked a young female patient with a history of urine dribbling and incontinence. On examination, a rare finding of an ectopic female urethral meatus and a variant of female hypospadias found, which is mostly associated with other congenital anomalies. In childhood, the patient had been operated on for urachus in Multan with a birth history of myelomeningocele as well and had been regularly catheterized in Multan, but no one noted ectopic urethral opening causing outflow obstruction.
I did an ultrasound that revealed a thick-walled trabeculated urinary bladder with bilateral hydronephroureter and left severe hydronephroureter with paper-thin cortex but normal creatinine and no active urinary infection. So, I didn’t go for percutaneous nephrostomy and went for a DTPA scan done in Multan with much difficulty revealing a left non-functional kidney. I discussed with my seniors for augmentation cystoplasty and Mitrofanoff and left nephrectomy in a single setting, but before that, I advised MCUG and was back to Islamabad those days but was in direct contact with patient attendants to save the patient with a single functioning kidney from renal failure.
FCPS radiologists of Multan, despite briefing urethral abnormality on a phone call, reported narrowing in the prostatic urethra and didn’t do proper grading of vesicoureteric reflux. Females don’t have a prostate, and an FCPS radiologist should know this. No one is perfect. In fact, perfection rests with the Almighty only. Finally, Alhamdulillah, this patient of Layyah got operated on by my seniors at Sharif City Hospital Lahore with a major surgery for neurogenic bladder augmentation cystoplasty and Mitrofanoff and left nephrectomy in a single setting. Unfortunately, despite so much clinical effort and knowledge and taking FCPS 2 urology written exam with confidence, I had been failed by CPSP examination five consecutive times.
For the last one year, I had been sending MCQ answers with explanations and requesting them for a review of the answer key and MCQ pool, but the examination department is adamant. The examination department of CPSP is failing me unjustly after which I have decided not to take the exam again and go for FRCS, InshaAllah, but highlighting this unjust system and fighting for this is my right. Incompetent FCPS consultants are also unjustly favored by this so-called YDA (Young Doctors Association), which is only promoting incompetency and poor patient care and postgraduate training. At the end, I must say that the FCPS consultants of South Punjab are demeriting the medical field in collaboration with CPSP and the so-called YDA Punjab.
—Email: [email protected]
views expressed are writer’s own.
