Healthcare Landscape in Pakistan – Healthcare Professionals – Asrar Qureshi’s Blog Post 982

Healthcare Landscape in Pakistan – Healthcare Professionals – Asrar Qureshi’s Blog Post 982

Dear Colleagues! This is Asrar Qureshi’s Blog Post 982 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

Credit: Dr Adel

Credit: Funkcinės Terapijos Centras

Credit: Haguy Paulemon

Credit: Mikhail Nilov

Credit: Saulo Leite

Credit: Yan Krukau

A healthcare professional, or healthcare worker is a provider of healthcare treatment and advice based on formal training and experience.

“Health professionals maintain health in humans through the application of the principles and procedures of evidence-based medicine and caring. Health professionals study, diagnose, treat and prevent human illness, injury and other physical and mental impairments in accordance with the needs of the populations they serve. They advise on or apply preventive and curative measures and promote health with the ultimate goal of meeting the health needs and expectations of individuals and populations and improving population health outcomes. They also conduct research and improve or develop concepts, theories and operational methods to advance evidence-based health care. Their duties may include the supervision of other health workers”. [source: WHO]

We shall look at the major categories of Health Care Professionals – HCPs – and the state of affairs in Pakistan.

Physicians

We include all doctors in this group, be they medical specialists, or surgeons, or anaesthetists, or from any super/sub-specialty like cardiology, diabetes, neurology, psychiatry, gastroenterology etc. 

The basic qualification for a physician is MBBS – Bachelor of Medicine Bachelor of Surgery – which is a five-year study program at any recognized medical school, followed by one year of house job. Postgraduate degree is required to get certificate of specialisation. Before this became available in Pakistan, doctors, who could afford, used to go abroad to get the postgraduate qualification. 99% went to UK to get MRCP – Member Royal College of Physicians – or FRCS – Fellow Royal College of Surgeons. Royal Colleges of few other specialties like anaesthesia and psychiatry were also there, and Fellowship was superior to Membership. Then, Pakistan established its own College of Physicians & Surgeons and started offering Membership (MCPS) and Fellowship (FCPS) degrees. 

To promote own degrees, the public service commission rated local degrees higher than the foreign degrees. In a way, it is right also. A postgraduate degree is less a study and more practical training. Foreign postgraduates mostly go there to take exam and get degree but they do not get the opportunity to get hands-on training, which they get here thanks to huge number of patients and lax rules. A physician, after receiving postgraduate degree, can claim to have become a specialist and start charging in thousands of rupees.

Has the availability of plenty of specialised physicians improved the quality of healthcare in specialized areas? Yes and No.

Yes, because due to their focus on one specialty, they are better able to diagnose specific health issues, and can offer targeted treatment. In fact, some specialties, like oncology (cancer), are so specialised in diagnosis and treatment that a general physician cannot handle these patients. Same is true for cardiology, gastroenterology, neurology, but to a lesser extent. Quality of diagnosis and treatment has improved in certain areas.

No, because the patient now may need to go to four different specialists for four problems, which are interrelated, but one specialist will not touch the other area and will simply refer to the other specialist. Each of these specialists will have their own battery of tests and a long prescription. The specialists rarely talk to one another about the cases they refer to one another. The patient not only runs around, but also spends multiples of thousands of rupees and ends up having four treatments instead of one consolidated one. 

Dentists

Dental doctors are less in focus, though it is a very important field and has also added several sub-specialties. From regular tooth extractions and denture-making, the dentists are now heavily engaged (and heavily charging) for cosmetic dentistry, crowns, implants etc. In the specialised areas, their cost is extremely high, and runs in hundreds of thousands of rupees. In making money, dentists are now far ahead of physicians.

Pharmacists

We had discussed the role of pharmacists in blogpost #979 and do not need to repeat it here. The only comment is that pharmacists here have still not received the position which their colleagues in developed countries have.

Nurses

Nursing as an important profession is recognized the world over, though our perception is fundamentally wrong.

A nurse is a trained and licensed healthcare professional who provides compassionate, patient-centred care, is what we consider in a rather limited sense. We see that the nurses in hospitals provide the kind of care which even the patients’ relatives refuse to do. However, this is one part of nurses’ work, albeit a major one.

Nurses are also trained to perform several other functions. They are an integral part of surgical teams in theaters where they assist the surgeons. In fact, surgeons will not be able to function without trained nurses. They assist the anaesthetist in keeping the patients stable. Some nurses are trained to take care of newborn babies in nurseries, some of whom may need extra-special care being born prematurely. Nurses are trained to assist cardiologists, and gastroenterologists during their interventional procedures. In summary, nurses touch every corner of healthcare, including those you may never see. 

In the developed countries, nursing is a very highly paid profession, though not here in Pakistan. Even in terms of their respect and recognition, Pakistan lags by a wide margin. 

Physiotherapists

Physiotherapy has fast come up as a fully-fledged specialty and has made its place in the medical practice. A four-year Bachelor of Science (BS) is now being offered by many medical schools.

A qualified, trained physiotherapist would know what kind of physical exercise/activity should be done by the patients in different conditions, such as after knee replacement, hip replacement, trauma surgery, coronary bypass surgery, painful joints, neurological pains, and so on. Physiotherapists have started charging good amounts – good for them, bad for patients.

Allied Medical Services Providers

In addition to the above, there is a rather long list of healthcare providers, who work in different roles. 

If you visit a diagnostic lab, you will find staff who are trained to do various jobs, from the phlebotomist who takes your blood sample to the person who does CT scan, MRI and what not, are all part of healthcare providers. You do not see them, but there are scores of lab technicians who run your diagnostic tests manually or with machines.

The osteopaths provide footcare to anyone with foot problems. They would advise specialized footwear and exercises. Podiatrists provide footcare to diabetic patients particularly.

X-ray technicians are trained to do imaging. Some of these have upgraded and learn to do various kinds of scans. Dialysis technicians handle patients who come for dialysis, and they often do it independently. 

Administrative staff running the healthcare facilities is also part of the healthcare landscape.

This list is not exhaustive, but it gives you a fair idea of healthcare professionals and providers.

Sum Up

Pakistan has come a long way and has gained much in expertise and facilities. The lacking is not in the physical amenities or expertise, it is in the professional integrity. Plenty of cases happen, reported and unreported, which are due to professional negligence and dishonesty. Work needs to be done in this area.

Concluded.

Disclaimers: Pictures in these blogs are taken from free resources at Pexels, Pixabay, Unsplash, and Google. Credit is given where available. If a copyright claim is lodged, we shall remove the picture with appropriate regrets.

For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intention to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.

References:

https://www.ncbi.nlm.nih.gov/books/NBK298950/

https://www.standardsofcare.org/understanding-care/healthcare-professionals/

https://my.clevelandclinic.org/health/articles/nurse