Accountability: ‘Doctors’ performance should be reported and evaluated’

Ways to improve medical practice in Pakistan were discussed at the AKU

KARACHI: At a lecture held at the Aga Khan University, the director of the adult critical care services department of medicine and surgery, Dr Erfan Hussain, stressed that for better and more professional behaviour by medical professionals, their performance must be reported and evaluated.

He said that to promote an academic environment in the health sector and to promote safety in medical activities, a system should be evolved where the patients report about the performance of physicians.

The lecture was titled 'Changing Healthcare Professionals' Behaviour: Current Paradigms in Decision Making and Implementation.'

Hussain spoke about the theory of diffusion, which examines how, why and at what rate new ideas and technology spread through different cultures. He related this theory to the changing perceptions in the health sector and termed it the most influential theory in the field of knowledge and practice. He also termed the nurses and physicians as 'apex leaders' of the health sector, as most of the decisions are taken by them.

Hussain compared the role of physicians in Pakistan the physicians in the United States. "The US is moving to a pay for performance system now because they know if something goes wrong their licence would be revoked and they would be sued," he remarked. He added that here, in Pakistan, free service to performance still exists as the physicians are still being paid poorly for their services.

Speaking about the action taken if a physician commits any errors, he said the Pakistan Medical and Dental Council, as the sole decision-making body, will take a lot of time to decide the appropriate course of action to be taken.

Stressing the importance of not overlooking the performance of healthcare professionals, Hussain said that at least for the past three years, there has been no work done in Sindh's health sector. "Punjab has taken serious steps towards [improving their] healthcare system and a lot of good work is being done by the provincial government of Punjab," he claimed.

Hussain suggested that patients must be encouraged to send performance reports to the heads of the departments and the heads should forward them to the practitioners and the physicians. "There has to be performance feedback for the system to get better," he said. He also suggested another system to promote an educational paradigm, calling it internal transparency, where the hospital staff, in groups, report performance department wise to the heads of departments.

Replying to a statement that over confidence is a major cause of diagnostic error, Hussain, through a presentation, explained that between five to 15 per cent of diagnostic errors are reported depending on the specialty. His presentation stated that evidence of over confidence is very much seen in the health sector.

Hussain explained that while many physicians accept errors in diagnosis, even today many believe that errors in the diagnosis are made by others, instead of them. He said that in the US, a physician has to spend at least 40 minutes before diagnosing any disease.

Published in The Express Tribune, September 3^rd,  2015.