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Confidence with your patients: An interview with Family Medicine Doctor Fardin Fazl

Dr. Fardin FazlWhat is your professional background?

I’m from Afghanistan. I practice family medicine there, and I’m also the vice president for Afghanistan Medical Association. I’m affiliated with Cure International Hospital, as well as the Firuzkoh Family Health Clinic. Under the Afghanistan Family Medicine Association, we run two teaching hospitals, which both do family medicine residencies, and we have several family clinics all over Kabul, the capital city of Afghanistan.

I work in an urban clinic mainly. The name of the clinic is Firuzkoh Family Health Clinic. It’s supported by a British organization which is called Turquoise Mountain Trust, and it works in the old city of Kabul. Our coverage area is Murad Khani, where about 900 families lives, but we have patients from all over Kabul City and all over Afghanistan.

What are some challenges you face in your daily work?

Afghanistan is one of the top 10 poorest countries in the world, and the health system is not very good there. If you consider maternal health, we have over 300 deaths per 100,000 women. There are other health problems there, and most of the people do not have access to health facilities due to economic security and geographical challenges. For me as a doctor, you know, practicing in a country like Afghanistan has always been challenging.

Practicing as a doctor in a low or middle income country is a challenge. There are a lot of myths, a lot of different beliefs, traditional healers, and complicated cases that need resources and patients can’t afford them. Seeing dying patients in front of you is the worst thing as a physician. Traditional medicine is a challenge for us because people take home remedies, and if they’re not getting well, only then do they present their issue to doctors. You receive the patient at a stage where the patient has developed many complications.

Another problem is malpractice. Most of our physicians are not well trained. As a doctor, it’s very difficult to accept that malpractice exists but to convince the patient is even more difficult. We have to tell them, “The way you are treated is not good,” or “You could have been treated in a better way.”

How has UpToDate helped you in your challenges?

UpToDate has helped me a lot and not only me but also those in my association that have the Better Evidence UpToDate subscription. It has helped all of us to overcome the complexities and challenging situations we face in our practice. It has helped us to improve our knowledge. It has helped us to improve our self-confidence as physicians and helped us build trust between doctors and patients. On occasions where there are lots of complications for the patient, the confidence that UpToDate has given me or my colleagues as physicians helped us to just deal with those most complicated cases and take care of those complications.

The Cure and City Hospitals are teaching hospitals that train doctors in family medicine, and through our association we do oversight of these hospitals. Both hospitals receive the most complicated patients from all over the country. The reason doctors have the courage to deal with those patients properly is UpToDate. Every time you see doctors, they have their smartphones or iPads and are just opening UpToDate. They’ll say, “I have a patient and he has this problem, so I am checking that am I doing the right thing with that patient, what’s next, and how I can just treat the patient well.” 

I greatly appreciate GHDonline for providing us free UTD subscription that has made medical practice easy in  a resource-limited country like Afghanistan. If we are saving lives, the credit directly goes to kind people in GHDonline.

What are some specific instances where you’ve relied on UpToDate?

There are many examples, but I will bring you one example that was also a life lesson for me. In my second year of residency, I had been to a very remote area in a rural district hospital in the south of the country as part of my rural health rotation. One night, when I was on duty, I received a 25-year-old lady who was a nursing mom and complaining of lower abdominal pain. She was treated by a doctor in an outpatient setting with the possible diagnosis of a urinary tract infection 2 days before presenting to us. She was given several antibiotics, but unfortunately, she had not improved.

We retained the patient in emergency room. Although she was stable initially, her vital signs were getting deteriorated gradually each hour. We reevaluated the patient several times. Given her breastfeeding status and that her last baby born was five months ago, we did not think of pregnancy. I went to UpToDate again because UpToDate is my number one reference and my number one resource for reading while I’m dealing with my patients. It taught me that in any child-bearing age woman presenting with acute abdominal pain, pregnancy should be ruled out first in order not to miss the life-threatening condition of ectopic pregnancy. It urged me to reevaluate the patient again and test the patient for pregnancy this time. At that time, we were at a district hospital in a rural area. We did not have access to ultrasound, so I did just a simple urine pregnancy test, and it was positive. Patient was immediately shifted to OT to undergo surgical intervention with most likely diagnosis of ruptured ectopic pregnancy. And, it was really a ruptured ectopic pregnancy. Fortunately, we saved the life of that 25-year-old lady. And that was UpToDate that helped us to make a right decision in a critical time that dark night in a very remote area, on a very young patient who was taking care of three more children and one who was breastfeeding and finally saving a life.

What makes UpToDate special to you?

The good thing about UpToDate is, it’s very simple. It has the tables. It has the algorithms. It has the graphics. When you’re approaching a patient, unlike other medical applications or textbooks, if you’re just looking for something you want and you’re searching it on UpToDate, you can find it easily. Then you can learn how to approach the patient. That helps you and gives you the confidence to just go over any patient and confidently take care of that patient. As a doctor, when you help and treat any of your patients, you feel relaxed and pride and the sense of pride comes to you, but if you save lives, especially a young person who has lots of hope and ambitions to just continue her life, that’s amazing and the happiest moment of your life as a doctor.