SURGICON-2010 proceedings-II
Skills, Values and ethics have to be inculcated in our future generation of surgeons - Prof. Majid Chaudhry
Supervisors do not hold regular meetings with trainees and
we need to improve our performance
Esophagectomy for Neoplasia is safe, effective associated with low
mortality and significant morbidity - Dr. Inam Pal

KARACHI: Prof. A. Majid Chaudhry former President Society of Surgeons Pakistan and Principal Fatima Jinnah Medical College Lahore was one of the invited guest speakers at the SURGICON 2010 held at Karachi on January 16-17th 2010. His presentation on January 17th was entitled “Pakistani Surgeons of tomorrow”. He started his presentation by quoting from a Hindu surgeon Sushrata who had described that it is the Union of Medicine and Surgery which constitutes a complete doctor. A good surgeon, Prof. Majid Chaudhry stated should have a desire to learn, must be strong, energetic, courageous, intelligent eyes, pleasant speech, thin lips and thin Teeth. It was William Halsted who, he said, first described the Residency in Surgery. In Pakistan College of Physicians and Surgeons has appointed many supervisors but it will be fair to say that most of us do not hold regular meetings with the trainees and we need to improve our performance.
A surgeon or for that matter a doctor has many roles to perform i.e. as a human being, practitioner, social animal, hero as a teacher and surgeon as a leader. He emphasized the importance of structured training. Skills, Values and ethics have to be inculcated in our future generation of surgeons. A surgeon should take bold decision in the best interest of the patient but in case of impediments, one will be reluctant to take such decisions. Conducive atmosphere is a pre requisite. Over confidence at the youngsters level should be avoided as it can be disastrous. It is important that we as surgeons must know our limitations. At any stage of training one should not be hesitant to ask if one does not know anything. These days due to bad media coverage, confidence of doctors has been shattered. It is the trust between the doctors and the patient which matters and if it is lost, it is very painful but in Pakistan at present things appear to have gone too far if one looks at the current media campaign against the medical profession. Many a times the patients have abused the surgeons but we were trained to be patient and look after the patient. Treat the patient politely. Trust between surgeon and patient should not be broken otherwise it will lead to disasters. We must learn to respect the opinion of others.
Continuing Prof. Majid Chaudhry said that we as Surgeons or for that matter physicians should dress up nicely should have no malice, work within the limits of our competence. Patient’s interest should always be kept supreme. Always aim for height. One should be scholarly dressed and treat patient as individuals. Keep yourself well informed. All the surgical decisions should be for the well being of the patient. He advised the media that it should project good image of the doctors so that the patient confidence is not shattered otherwise at the end of the day it is the patient who will be the losers. As a scientist, it is important for the surgeon to document what you are doing. Be ready to learn always. We all do make mistakes but there is a difference between human error, medical negligence and criminal negligence. At times the pathology is such that one is liable to face complications but remember the intention of the doctor is always good. One should be respectful to one’s colleagues and do not belittle them who are working with very little facilities. What you say to the patient is important for him. Doctors must master communication skills and this is needed to be inculcated in them. One should avoid blaming others for one’s own mistakes.
Referring to Dr. House of UK more commonly known as Dr. Death, Prof. Majid Chaudhry said that people like him are misfits in the medical profession. There are some professionals in practice, mentors, leaders who have personality problems. They should be advised to change their profession. He suggested that we must improve our expertise, practice evidence based medicine, should try to achieve excellence, attain experience, improve our education and also ensure that the trainees have exposure of EBM. We must change the curriculum and change the educational, training strategies. Now new learning situations, opportunities are available and so are the new methods of assessment. Hence, we must re-establish our strategies in the changed circumstances.
During the discussion Mr. Shaukat Ali Jawaid pointed out that though it is painful to see the current malicious campaign against the medical profession and healthcare facilities in the print and electronic media but since the doctors have failed to monitor themselves, some one else will have to do this. How many hospitals, he asked, hold regular mortality meetings and discuss causes of preventable deaths. We have been pointing out that for the last many years that all the professional societies within the profession must monitor its members and work out some accountability mechanism to check unethical practices but no one bothered. The result is the present malicious campaign. Prof. M. Sarwar opined that we must make sure that media projects our side of the story as well while Prof. A. Razzak Shiekh from Hyderabad stated that it is our own colleagues who complain about plagiarism to the Higher Education Commission. Prof. Majid Chaudhry responded by saying that it is important that we do our self accountability and monitor ourselves but one cannot condone plagiarism at any cost.
The second presentation in this session was by Dr. Inam Pal, Associate Professor of Surgery from Aga Khan University Hospital Karachi. He presented a Decades experience at AKUH of surgery for esophageal neoplasm. During 1997 to 2009, they had managed one hundred twenty eight successful resections. In 1997 they had just two cases while in 2009 they had seventeen cases. So far this is the biggest single center case series being presented, he remarked. Their patients included seventy male and fifty eight female between the ages of 24-50 years with mean age of fifty two years. He pointed out that they were getting patients in a younger age group as compared to the developed countries.
Giving further details Dr. Inam Pal said that 67% of the tumors were at the lower one third, 28% in middle one third and 3% at upper one third. Almost 72% of these cases were squamous cell carcinoma and 27% of these patients had comorbids as well. In one hundred twelve patients (87%) we did two stage esophago-gasterectomy, 71% of our patients had hand sewed anastomosis while staples were used in 29% of the cases. About 64% of the cases were in T3 and 27% in T2 stage and 47% of the patients were offered adjuvant treatment. As regards morbidity 7% had anastomosis leaks, 4.5% leaks were in thoracic anastomosis. Nutrition, he said, is very important and so is the sepsis control. Our three cases had positive margins. We had just four deaths in this series which comes to 3%. Cause of death included leaks, sepsis, multiorgan failure, ARDS and pneumonia. He emphasized that one must be careful in patient selection for these surgical procedures and should also be mindful of pulmonary problems. Epidural analgesia is good for the patent as it has fewer complications. Previously we used to discharge these patients after twenty four days but now they are discharged on 12th day as evolution in practice has shorted the hospital stay of the patients. His conclusions were that this surgical procedure is safe and effective associated with low mortality and significant morbidity.