Beyond Stethoscope: Dr. Muhammad Zubair's MBBS to MD in Clinical Pathology in Pakistan (Part - 1)

Thank you. I am Dr.Muhammad Zubair. I am currently working as the Head of Clinical Laboratories at the Multan Institute of Kidney Disease in Pakistan. Our specialized healthcare setting includes a 150-bed hospital where we also perform transplants. To date, we have successfully conducted 50 transplants at our institution. My specialization is in chemical pathology, and I obtained my MBBS from Qaid-e-Azam Medical College, Bahawalpur, Pakistan.

After completing my MBBS, I underwent training at prestigious institutes in Pakistan, including Combined Military Hospital Lahore and Chukdai Lab Lahore, which is one of the leading healthcare labs in the country. In 2019, I earned my FCPS and joined Shalamar Medical and Dental College Lahore as an Assistant Professor of Pathology. At the college, I teach both undergraduate and post-graduate medical students and also serve as an examiner for medical lab technologists from the University of Health Sciences Lahore.

In 2020, I transitioned to Indus Hospital and Health Network, another prominent healthcare setup in Pakistan, which oversees 17 healthcare units across the country. Indus Hospital and Health Network also took over the management of M.I.K.D. (Multan Institute of Kidney Disease). At present, my responsibilities involve overseeing specialized clinical chemistry testing, as well as immunology and transplant testing.

Before proceeding with a transplant for a patient, we conduct specialized testing on both the donor and recipient. This testing includes HLA typing, CDC crossmatch, and analysis of various antigens and antibodies present in the donor and recipient. These tests are crucial because they help us identify any potential cross-reactivity or other compatibility issues between the donor and recipient. Ensuring compatibility is essential to prevent graft rejection in the patient.

Chemical pathology is closely related to medicine, much like other fields of pathology such as histopathology, hematology, virology, and microbiology, which are taught in the 3rd year of medical studies. Chemical pathology involves various types of testing, both routine and specialized.

Routine chemical pathology tests cover organ system functions, including liver function, renal function, glucose levels, and electrolytes. Specialized chemical pathology testing includes assessing hormone levels, such as thyroid and reproductive system hormones (LH, FSH), adrenal cortex hormones, heavy metals, and vitamins. It's a broad spectrum of pathology that plays a crucial role in diagnosis and patient care.

During my general practice at a rural health center, I became interested in chemical pathology. While performing tests on patients, I realized that many of the most common tests were related to this field. I decided to adopt chemical pathology, as it allowed me to combine clinical practice with laboratory work.

Toxicology is also a part of chemical pathology, encompassing various testing areas, such as forensic toxicology and drug toxicology. For transplant patients, we monitor drug levels like cyclosporine and sirolimus through therapeutic drug monitoring.

Chemical pathology covers other aspects too, including newborn screening, proteomics, and metabolomics. It's a vast and recognized field worldwide. In the UK, it's known as chemical pathology, while in the USA, it's referred to as clinical chemistry or clinical biochemistry – all of which refer to the same discipline.

No, a histopathologist looks after that. A histopathologist is responsible for examining tissue samples under a microscope to diagnose diseases and conditions. On the other hand, the chemical pathologist is focused on blood and urine testing, managing and interpreting various tests related to these bodily fluids.

As I mentioned earlier, there are not just a few tests, but a vast array of them. Approximately 70% of the workload in any lab, whether in India or Pakistan, is related to chemical pathology. This includes testing for hormones, tumor markers, routine tests, antigens, antibodies, and the complement system.

No, currently, I am not involved in forensic toxicology because it requires very robust and sophisticated instrumentation for the forensic analysis. You can perform screening tests on regular devices, but for confirmation, you need expensive instruments like GCMS, LCMS, or MS. Diagnostic labs usually cannot afford such costly equipment, so they typically conduct screening tests only. Yes, we can do screening for different types of drugs like cannabinoids and drugs of abuse, but for confirmation, a specialized lab is required. In such cases, a chemical pathologist or scientist will handle the analysis.

I have previously mentioned one aspect of chemical pathology, which is testing. The second aspect is related to instruments, and there is a significant focus on instrumentation. In chemical pathology, we must prioritize examining the instruments, their quality, quality control, and the quality management system. It is a somewhat different aspect, and patient interaction is not as prominent in this field.

When working in the lab, your main task involves reporting the lab results, and you do not have direct patient interaction like using a stethoscope. However, it's essential for students to understand that despite not directly interacting with patients, each sample being tested is crucial as it belongs to a patient. The generated lab report must be accurate and reliable as it impacts patient care and treatment decisions.

Indeed, even though you may not physically see the patients, you play a vital role in their treatment through the correlation of conditions with your lab reports. The diagnostics field, including chemical pathology, is continuously advancing with automation and technological advancements, making it indispensable in the medical landscape. If you have an interest in artificial intelligence or instruments, chemical pathology offers a compelling and exciting career option.

In this field, you get the opportunity to explore both the aspects of disease understanding and instrumentation. It is particularly appealing for those interested in devices and instruments.

Yes, government medical colleges are very affordable, but private medical colleges are quite expensive. This has led to a high demand for medical education. The problem here is that unemployment is very high due to the increase in the number of private medical colleges in Pakistan, leading to a surplus of graduates.

Another reason for the high competition is the desire of students to pursue opportunities abroad, especially in the US. However, there is fierce competition for medical-related opportunities in the US as well, which adds to the challenges for aspiring medical professionals.

It is crucial to raise awareness among students about various fields of medical education beyond MBBS and BDS. Career counseling is essential as well to help students make informed decisions about their future. Depression among students can arise if they invest significant amounts in their education and then face limited job opportunities.

There is a need for early education and exposure during MBBS to guide students toward their desired paths, such as pursuing further education or exams like USMLE.

Regarding healthcare facilities, in Pakistan, there are efforts to provide accessible healthcare through programs like the Sehat Sahulat program. This program aims to offer insurance-based healthcare that is accessible to everyone, providing free surgical procedures and medical services.

While charity hospitals like Shaukat Khanum Memorial Cancer Hospital & Research Centre in Punjab and SIUT Karachi, along with various charitable organizations, are working to provide healthcare services, Pakistan still faces challenges due to its underdeveloped status. Communicable diseases remain prevalent, and the country's high diabetes rate highlights the need for focused efforts in addressing such health concerns.