Dr Abdul Khaleeq Khan: A Doctor Par Excellence
By Dr Ahmed S. Khan
Dr Abdul Khaleeq Khan, a prominent Pakistani cardiologist of Chicagoland, after a dedicated service of 61 years in the US, the UK, and Pakistan, retired on June 30, 2020.
After graduating from Dow Medical College, Karachi, in 1959 he went to UK, and completed his residency at St. Helen Hospital, and worked at various hospitals on south coast. After passing Member of Royal College of Physicians (MRCP) exam, he returned to Pakistan in 1968, and served as senior Registrar, and Assistant Professor at Dow Medical College, Karachi. In 1973, after he fell victim to Domicile/Quota politics and lost his job, he decided to come to the USA. In Chicago, he was awarded a direct fellowship in Cardiology at Cook Country Hospital. During 41 years of service in Chicagoland, Dr Khan exhibited exceptional professional expertise, and was affiliated with a number of medical institutions including Northwest Community Hospital, St Alexius Medical Center, and Sherman Hospital. He treated his patients with compassion and care in an exemplary manner, he will be missed by his thousands of patients. In the following interview, Dr Khan reflects on various facets of his 61-year career.
Q: Where were you born, and when did you migrate to Pakistan?
A: I was born in Bareilly, UP, and in 1950 we migrated to Pakistan. I was in class nine, and I vividly remember the difficulty I faced in getting into the academic cycle. After arrival I had to study for exam of class nine. My brothers admitted me to a school called Allama Iqbal Islamia High School, located in Saddar. I had only two months to prepare to appear for the class nine exam in August, so I worked hard and passed the exam, and then I passed the matric exam in 1950. After that I passed the inter- science from DJ Science College, but then I faced a challenge; I was not qualified to get admitted into a medical college because I was underage. I was about 16 years old and the minimum age requirement was the age of 17 years at the time of admission or during the first term. So I decided to enroll in BSc and study Microbiology. Finally, I got admitted to Dow Medical College in 1953, and graduated in 1959.
Q: Why did you have to wait until 1950 to migrate to Pakistan?
A: My father had sent my two elder brothers to Pakistan in 1947. After they got government jobs and got settled down in Karachi my father decided that it would be better for our future if I and my other brothers also migrated to Pakistan. So I with my two brothers boarded the train and came to Karachi via Lahore. I am the youngest of seven brothers.
Q: Did your brothers face any resistance in the form of ethnic riots in migrating to Pakistan in 1947?
A: In Bareilly there were no riots, so my brothers did not face any resistance, and they took the train for Lahore. Later, in 1950, we three brothers also came to Pakistan by train to Karachi via Lahore. In Karachi, my elder brother who had a government job was provided official accommodation in Jacob Lines. We all stayed with him.
Q: Where did you go to School in Bareilly? When you came from Bareilly to Karachi, did you see any difference in education standards?
A: I went to Islamia High School in Bareilly, which has now become a college. Well, there was a difference in terms of subjects, in Karachi there were two additional subjects, Urdu and Persian which I never studied before. The other subjects like English, Math and Science were the same.
Q: In Bareilly, did you learn the Devanagari script to write Hindi/Urdu?
A: No I did not learn. Back in those days, there was no difference between Urdu and Hindi in spoken form. The only difference was in the manner they were written. Urdu was written from right to left and Hind from left to right. Muslims and Hindus used to speak just Hinsdustani. But after the creation of Pakistan, they transformed Hindi into a very much Sanskrit-heavy language.
Q: How did you find the educational standard at the Dow Medical College in 1959?
A: It was excellent. We used to have around 100 male and 30 female students in our class. The faculty-to-student ratio was very good. Especially in practical and clinicals, there was a lot of interaction with the faculty. Nowadays, I hear that each class has around 400 to 500 students, and the female students outnumber the male students. Most of the female students after graduation do not practice medicine due to marriage and family issues. This is a waste of talent and resource.
Q: How do you compare the doctors of the 1950s and the later decades?
A: In the 1950s medical graduates were very serious about getting education and enhancing their knowledge-base. Top graduates used to prefer to work with senior professors of medicine and surgery, and others used to opt for Psychiatry and other fields. But when I came back from England in the late-1960s, I discovered that most top graduates opted for casualty for financial gains, and so corruption started to seep into the medical profession.
Q: In your time was there no corruption in medical profession?
A: Absolutely, there was no corruption. Nowadays doctors and staff are manipulating platelet counts of politicians! That is mega corruption. No concept of right and wrong, or Halal and Haram. This shows the decline of moral and ethical values in society.
Q: How did you go to England?
A: After my graduation from Dow, I worked for a year at Jinnah Hospital, and then I went to England for higher education and training.
Q: Where did you work and get training in England?
A: There is a long list; mostly I worked at nice hospitals on the South coast. Besides a regular job, I also studied and prepared for the Member of Royal College of Physician (MRCP) exams. Back then there used to be three prestigious Royal Colleges of Physicians and Surgeons, London, Glasgow, and Edinburgh. First, I passed the MRCP exam for Glosgow and then passed the MRCP exam from London, which was very challenging. MRCP London was deemed to be the highest qualifications. For foreign graduates the pass rate was about 6-10%. The exam was very difficult too. It consisted of face-to-face orals and clinicals with the examiner, and dealing with short and long cases. In the written exam, there was an essay requirement, and no option of multiple choice questions. In order to write an effective essay one has to have subject matter knowledge and strong writing skills. Back then in England the foreign graduates lacked good training, strong knowledge-base, good communication skills and effective interaction with the examiner; in the US there is no interaction with the examiner.
Q: Did you see any differences between Pakistani and British medical systems?
A: Both systems were very similar since we inherited things from the British. Most doctors used to go for training to England and not to US back then. The emphasis was on the clinical approach, in contrast to the US, where before seeing a patient all tests such as lab, X-ray, echo etc. are conducted. Back then everything was clinical. No one knows the art of stethoscope in the US, they go with the reports.
Q: During your stay in Britain, did you observe any other differences between Pakistani and British
practices?
A: As I said, there was a strong emphasis on the clinical approach. At the social level, I found that the society exhibited traits which Muslims should have. Like Maulana Suliman Nadvi had observed that when I went to the West, I found more Islam but not Muslims, and when I went to Muslim countries I saw lots of Muslims but no Islam. I give you an example of simple honesty; one person comes to place near a highway and puts a bundle of newspapers and a box next to it. People come, pick up a copy of the newspaper, and place money in the box. May be it can happen in Saudi Arabia but not in Pakistan.
Q: When did you return to Pakistan from England?
A: After getting all training and passing exams I returned to Pakistan in 1968 and started working as Senior Registrar at the Dow Medical College. After a couple of months, I was promoted to Assistant Professor, the appointment was on ad-hoc basis, which was required to be confirmed by the Public Service Commission. But then Bhutto Sahib imposed the quota system according to which the rural population got 60% share of government jobs and the majority urban population got 40%. We were five Assistant Professors at Dow, two were confirmed by the Commission, and three were not. The two who got confirmed had domiciles from someplace like Tando Adam and rural Sindh. Being from Karachi I unfortunately did not get confirmed. So I got perturbed and very much disappointed and decided to come to the United States.
Q: When and where did you come to the United States?
A: In 1973 I came to Chicago. One of my friends at Cook Country Hospital got me into a direct fellowship in cardiology. I was not required to do any residency. At Cook Country Hospital, Dr Young was the chief of medicine. He wrote a letter on my behalf to the American Board of Medicine stating my previous education and training, and requesting to be allowed to take the boards. Based on that letter they allowed me to take the internal medicine board; everyone else who came to the US was required to do the residency. I was the only one who got the fellowship directly.
Q: After you arrived in the US what was the big difference you observed compared to you experience in Pakistan?
A: In Pakistan I was an Assistant Professor and I used to go on rounds with 10-12 residents with me. Over here, there was a big, big change. Back to ground, very difficult to adjust, here I was an ordinary fellow.
Over here they do not know what MRCP is and you have to take local exams. So I did the internal medicine board.
Q: As you stated that in Pakistan and British systems, there is more clinical approach and in the US there is more testing approach; which is more effective?
A: There should be a balanced approach, too much testing has increased the cost. Too many tests are done without using your brain. That’s why Medicare care has become so expensive. Lots of doctors do not know what kind of tests must be done, particularly the young doctors. Nowadays, doctors do not spend appropriate time with patients. The reason is that you are now a provider, not a doctor. To avoid malpractice doctors also do more testing to protect themselves.
Q: What is the difference in terms of salaries between the US and Britain?
A: In England everyone is an employee of the government, very few private hospitals cater to overseas and Middle East clients. Everyone gets care so people sometimes over-utilize it. Doctors do not have incentives; tests are done on need basis. In Britain, medicine is a social service, a patient does not pay directly for the service rather indirectly via taxes, but sometimes wait time is too long, especially in cases of surgeries. In the US you go in today, and tomorrow you have bypass surgery. In the US there is a fee for service, so doctors can charge what they like; there is incentive for doctors to do more procedures to make more money; that’s why medicine has become more expensive here in the US. But now I see it moving towards social service; in the UK there is no such thing, regardless of how much work they do they will get the same salary.
Q: How is medicine undergoing change?
A: Technology has transformed medicine, there is an excessive use of computers, and a plethora of software programs, nowadays there is too much data entry taking place, as a result nurse and doctors are struggling to feed computers and not spending appropriate time with patients. A doctor’s role has been transformed into a provider on a production line. There are so many regulations to keep up with in addition to keeping abreast with the technological change. Because of this, I see so many senior doctors opting to retire rather than continue in their professions.
Q: How do you see the future of medicine in the US?
A: Future is the same as everyone else has it in Europe and Canada. We are moving towards social medicine. Things are getting out of control, it’s becoming so expensive, people cannot afford it. So they are going towards social medicine.
Q: Are the lobbies not against social medicine?
A: Yes, they are opposing it, there is a strong resistance to social medicine; but people like Bernie Sanders are saying medicine has to be for everybody.
Q: In terms of medical research, how do you compare the US and Europe?
A: There is no comparison. Of course, the medical research in US is far better than Europe and the rest of the world.
Q: What are the challenges to young doctors who are coming to the US from other countries?
A: Nowadays they have to join a group or take a salaried job, it’s becoming difficult to do solo practice.
Q: What is the reason for the decline of solo practice?
A: Government regulation and control is excessive. How expensive are you to insurance company?
Economics and costs are being monitored. Also technological tools have taken over, everything is so computerized there is too much data about you and your patients, there is no more privacy anymore. So solo practice is becoming difficult.
Q: How do you compare doctors from Pakistan, India and Bangladesh?
A: We were as good as anyone else, at least in those days. Nowadays, there are too many unregulated medical colleges; moreover, class size has increased, all this is leading to an adverse impact on standards of education over there.
Q: What were the key challenges you faced after your arrival in the US?
A: The first challenge was that you have to start all over again, you have to take exams again. There was lots of bias against foreign graduates; no doubt about it. There was too much politics in hospitals, certain groups made rules and protocols to exclude you from active participation. In a nutshell, as French president Charles De Gaulle had said that
if you do not do politics, politics will do you. This is so much true in the medical profession too. Some groups were very mean to foreign doctors. So to survive the art of politics was practiced too.
Q: How effective are the associations of foreign doctors?
A: Mostly they are involved in social activities and are not viable platforms for promoting cooperation and collaboration among members. Some college-specific organization are doing good work for their alma maters. Back in 1970s I helped Dow in regard to its lending library acquisitions.
Q: Why has no cure been found so far cancer? Why are more people getting cancer?
A: Lots of research is going on and hopefully a total cure will be found in the coming years. We are living in a very polluted environment, too much exposure to chemicals. One has to watch out the diet and try to eat organic foods and avoid processed foods.
Q: How has the field of cardiology improved during the past 40 or so years?
A: Yes, over the past 40 years the field of cardiology has improved a lot, there has been great progress in the treatment of heart disease. Forty years ago, in case of a heart attack, a patient was given lot of rest, and not many options were available for treatment. Aspirin was the medicine of choice. Nowadays so many options are available to treat heart attack and stroke right after the occurrence of the event.
Q: What is the future of medicine?
A: Genetics is the future. Splicing of genes, and use of STEM cells hold lots of promise in the treatment of an array of diseases.
Q: What advice would you give to a young person who wants to become a doctor?
a: Intention is what makes the difference. If your intention is to make money do not become a doctor, if your intention is to serve humanity, you will be a very successful doctor.
