Prof Mohammed Idrees Adhi

Prof Mohammed Idrees Adhi recently completed his services as chairman and professor of ophthalmology at the Dow University of Health Sciences and Civil Hospital Karachi. He is the president of the Ophthalmological Society of Pakistan, as well as the Karachi chapter of the Pakistan Medical Association. He is also the chairman of the editorial board of the Journal of Pakistan Medical Association.

What is the difference between medical negligence and medical malpractice?

Medical negligence in simple terms is a case where a medical professional did not use the skills imparted to them during their training in a proper way, thereby causing avoidable harm to their patient. He/she intentionally or unintentionally commits a mistake in the management of his patients that should not have been done.

Malpractice is the failure to do the right thing — where the right thing is defined according to accepted standards of medical care. In simple words, if a medical professional deviates from the accepted norms of patient management and welfare, they are involved in medical malpractice. Human error cannot be termed malpractice if steps are taken with good intention as per evidence based medical practice and standard procedures.

In the face of competing interests and the absence of a comprehensive law against medical malpractice, today’s doctors need to be scholars and researchers too

Can you cite a case of medical negligence?

Without disclosing the identities or the hospital, I came across the case of a child who lost his vision due to negligence of the doctors and staff members of hospital. The child was conceived after 14 years of marriage, and was born premature in the 28th week of pregnancy. He was subsequently kept in the intensive care unit (ICU) for about two months.

But this baby was never examined by eye specialists whilst in the ICU. Nor were the parents given any advice to see the eye specialist to screen for the possibly blinding Retinopathy of Prematurity (ROP) disease that affects the retinae of the baby. And that is what exactly happened.

When the child was about three months old, the parents realised that there was something wrong with his eyes. They then consulted the eye specialists, who diagnosed the baby to have ROP, and by the time I examined the baby, his condition was not treatable. ROP is preventable and treatable when diagnosed in time and that is in the early part of a baby’s stay in the ICU.

This is a clear example of medical negligence; a precious baby was turned blind even though this tragic outcome was avoidable and treatable. The family accepted it as fate and the will of God Almighty, as is the case in most of these cases, but there has to be a system where the doctor and hospital should be held accountable.

“The patients have a right to know their problems and they need to be in the picture throughout the management of their problems. The consent to treatment that a patient signs should be an informed consent.

What are the current ways of regulating medical practice?

In Pakistan today, there are two levels to regulate medical practice. The Pakistan Medical and Dental Council (PMDC) is a regulatory body, and gives doctors their licence to practice (after qualifying a doctor has to register with the PMDC in order to practice). If there is a complaint against a doctor, the PMDC can look into the matter and if the doctor is found guilty of negligence, PMDC takes action against him.

The public has a right to be made aware about the availability of this platform and that the public could reach out to a regulatory body. A medical practitioner cannot practice medicine without a licence from the regulatory body which is the PMDC in our country. This regulatory body has a great responsibility both for implementing the guidelines for the medical professionals as well as for the education and looking after the medical needs of the general public. It is unfortunate that even our regulatory body (the PMDC) is suffering from political issues and the government is not playing its role; the political stakes are very high there.

The second level is at the Pakistan Medical Association (PMA), which is a representative body of doctors working both for the benefit of doctors as well as the patients. But the PMA cannot take any action as it is not a regulatory body like the PMDC. It has an ethical committee and if a complaint is brought to its notice, it checks the case and if it has some weight it can recommend it to the PMDC (or any regulatory body) for action. We (the PMA) cannot take any action but can try to bring medical practitioners morally to a position that doctors who are in the wrong apologise or even pay compensation to the patient.

Are there laws to check medical malpractice in the country?

Till a few years back there was no law and the aggrieved patient or his family had two options — either go for litigation which is a time-consuming and expensive process given the way our justice system works or to take things in their hands and resort to violence.

A consensus emerged some years ago that although there is a regulatory body, the government should form a commission to regularise the functioning of the hospitals, clinics, laboratories and medical facilities functioning in various provinces of the country. The commission must look after the security of medical and paramedical staff and must ensure that the patient’s rights are also taken care of. There should be well-defined standards of care and a mechanism of quality control of health delivery to the common man.

Both the hospital and doctors should be held responsible for a mishap during the management of patients if there was any medical negligence. The health facilities must only do the procedures where proper equipment and skilled personnel are present.

The PMA came up with a plan to make a commission taking on board all stake holders that included all health communities and their sister organisations, health secretary, health minister, law minister, advocate general, etc. and prepared a document, which became Health Commission Act in 2013 after passage from the Sindh Assembly; it was earlier adopted by the Punjab.

It is meant to stop malpractice and define patient’s rights, to safe guard the security of doctors and paramedical staff, for quality control and standardisation of medical practice, hospitals, clinics, laboratories, etc. and would help improve the quality of healthcare services and help eradicate quackery. The commission would educate both doctors and patients in what is right and wrong. It can ask the doctors to explain their position and tell them if it was their fault. It is binding on the doctors to accept the commission’s decision. The commission has to set up protocols for hospitals, laboratories and theatres, and create awareness among the patients about the standards.

For the commission to be effective it is important that it is autonomous and free from government interference. The commission will be a platform for the patients to refer to get their grievances addressed. The commission will question the doctor for not fulfilling the identified standards and hold the doctors responsible and its decision will be binding for the doctors. It will recommend to the PMDC to cancel the doctor’s registration if the doctor is involved in medical malpractice and negligence.

What is the one competency that all modern doctors must have?

Modern medical education stresses a lot on competencies like research and professionalism but one important competency is communication skill. The patients have a right to know their problems and they need to be in the picture throughout the management of their problems. The consent to treatment that a patient signs should be an informed consent.

It is important that the doctor communicates with the patient, to explain the problem, what treatment will be given, what is the success rate of the treatment being given and what complications could arise. If a doctor does not communicate this to the patient he is not doing justice with the patient. These are patient’s rights and if a doctor does not do it he is not doing justice with his own profession.

Today’s doctor has to be a scholar and a researcher as well. These competencies were not given consideration in the past; if a patient comes to me I have to treat him according to today’s evidence-based medical practice. If I am not doing this I am not doing justice with either the patient or with profession, he said.

There is an argument about pharmaceutical companies influencing diagnosis and treatment. Is there any weight to such claims?

Pharmaceutical companies try to influence doctors in different ways — they may sponsor doctors’ foreign trips, furnish his clinic / hospital or send expensive gifts for the family. A doctor has choices when prescribing a medicine and priority in selecting a medicine should be efficacy, but if the doctor is influenced by these tricks and prescribe a medicine which is not as effective as another one available in the market he is not doing justice to the patient and can be called as involved in malpractice.

Has there been any government support in trying to regulate medical practice?

Political leaders should have a vision to visualise peoples’ problems, especially when professionals and their representative body like PMA are pointing them out, and they should come up with solutions.

The doctors have made themselves accountable and have acknowledged the rights of the patients. Now that we have given them a document, they are sitting on it for the last two years, quarrelling over which political party will have control over the commission and which party the commissioner/s should be from.

Published in Dawn, Sunday Magazine, August 30th, 2015

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