Friday, August 13, 2010

Inbreeding is a dangerous thing….

Genetic inbreeding has been going on up until now since the first it has been created. With regards to human inbreeding, I personally think that all of us agree that it does more harm. Well, if it’s not, I bet our parents will keep on asking us to marry our cousins without knowing about the consequences. It has not only scientifically proven that it carries genetics diseases, but it also slows human development.

If you accidentally made a silly mistake, people would even sometimes joke around and ask you if your parents are related. In a way, it implies that inbreeding produces a weaker (or slower) generation.

There is a concept of “Faculty Inbreeding” and this is the one that I would like to discuss more. Faculty inbreeding implies that the same student graduated and rejoins the same institution. It reduces the possibility of new ideas that are coming in from external sources, just as genetic inbreeding in which it reduces the possibility of new genes entering in to a population.

Let me simplify this concept for better understanding. A medical student graduated from university X became an intern in University X. He then later joined a specialist training in University X and became a specialist in University X and calling himself a world standard physician.

Try to imagine, a person that only drives a Proton Saga throughout his life, could not possibly commented much regarding Mercedes, BMW, Porsche and etc. This person can brag all he wants regarding proton fuel consumption, price on the road but until he has driven others, he might not know the smoothness, safety and reliability of other cars. If Proton is so good, people would not have bought other cars. There must be reasons behind it and until you have driven it, you might not see the whole picture of what I am saying.

Dr Ogren from University of Minnesota wrote “A high quality graduate training cannot be achieved if such inbreeding of ideas takes place”.

This statement did not surprise me. First, a student from the same institution was obviously has the same experiences and therefore ideas as others. Secondly, this student will always obey their “Master” no matter how old, ancients and disruptive the idea really is. Otherwise we will not have seen patients with unstable intra-abdominal injuries getting a CT Abdomen, patients with moderate to severe head injury getting X-ray cervical (AP, lateral, shoulder pull, swimmer’s view and etc) prior to CT cervical. All these happened and things are still happening because the “Master” is considered right even though he is clearly wrong.

These new inbreeding faculty members would have a narrow horizon. For them, the horizon is set and all that they have to do is just to continue to work as before. No new destination, no new technique, no new management and continue to breed a new generation that follows a very old captain. The worst thing is that they don’t even know what is new and the right thing to do. They act as in they are so smart and rejecting unheard ideas.

Inbreeding faculty members would want someone to stay with them and eventually those who have the same ideas like them (or the one that would not object). In turn, they will try not to hire people who try to introduce and invent new things. These new things might save more lives; transform the department to become more efficient and in turn it makes life worth living. But because it is not understand by these so called “Master”, it could not have been done.

This “Faculty inbreeding” product is very contagious. It can affect hospitals which are nearby and for those who depend on them as a tertiary hospital. Their management will have to alter according to this old, ancients rule prior to sending these patients.

I have always asked my students to compare their lecturers. Which one gives best, compact and informative lecture? Is it the one that inspires them most? Almost all gave me a lecturer who has been to a lot of places with lots of experiences.
Don’t get me wrong, I’m not trying to say that we should not buy proton cars. I’m driving a Proton car myself. After I have owned a Honda, Mercedes (a second hand car of course) and drives many others, I have decided to buy a Proton Saga because of its fuel consumption, cheaper taxes and maintenances. I know I have given-up some aspects in terms of comforts and safety but I try to compensate it by driving it carefully. All I’m saying is that I know what I’m driving rather than bragging that this is the best car ever.

Even Prophet Muhammad (pbuh) himself preaches us to travel to China if necessary. Yet, some of us are feeling so comfortable in their “comfort zone” and rejecting this precious statement.

Once we “The Doctors” have seen other systems, departments, protocols, personnel and etc, then only we would appreciate how much lives that we have truly saved and how much that have died in vain.

7 comments:

Jacknaim said...

salam dr lan.. finally your first article has been published. it's like about one decade of waiting.huhu.

waiting for more to come..

cksheng74 said...

So, is this a shifu problem or a disciples problem ;p? Well, this post is based on the premise that inbreeding is a necessary evil thing, which can be true because of the deleterious traits it may bring. But that is only one side of the story. Inbreeding is also necessary in some livestock when the parental species are of the highest quality. This will prevent "dilutional" effect if this high quality species is mixed with the low quality one. A Harvard wouldn't send his people to some remote unknown university for training only to come back to serve Harvard. Well, this contention is only valid if any University X here in Malaysia is of Harvard quality. Yet, another problem is this: a student is selected to get his first degree in a nice overseas college because of some "selection criteria", which may or may not be based on meritocracy; yet this student is soooo attracted to the foreign country he is sent to, decide to stay there, mate and breed his mixed breed, get a PR, and forgot about his "tanahair" and the taxpayers who painstakingly supported him. Well, how about that? Whereas those who had good grades in secondary education but because of "some criteria" were not chosen and had to struggle at local level. At the end of the day, though inbreeding can be a problem, but the bigger problem is the attitude problem. The Master may be trained overseas, but if he has an attitude problem, and insist all things must be done according to his ways, even though his ways are obsolete, then all subsequent inbred juniors would be doing outdated things. For the heart of the matter is...the matter of the heart.

Dr. Azlan Kamalludin (Landen) said...

This entry simply emphasizing the concept of "Faculty Inbreeding". To avoid this, going overseas is not the only answer. Instead, going to other learning institutes and other hospital will widen the horizon. In HKL, we received about 8 medical students (both local and foreign). I'm personally responsible for their attachment. All off them learned or at least appreciated something new.

And yes Dr cksheng74: The heart matter.
When my patients with unstable intrabdominal bleeding require an urgent laparotomy and yet the surgical team doing abdominal x-ray, ultrasounds, CT scan to please their ancient rule... Sometimes I wonder... where is their heart??...

This is just an opinion....

Jacknaim said...

relly nice input from both of u Dr lan and dr chew.

Dr Lan, i agree with you that we need more exposure on different setting. this is to broaden our horizon as well regarding the differences of management between different hospital setting.

in view of that, i believe that it is not a huge mistake if someone obtaining M.D from USM and get the master in USM too. but, with a condition that, the person also expose himself to the surrounding like committed in doing attachment at other different hosp setting, locally and oversea.

maybe, the faculty should consider to send them to few place as part of training. let say 2-3 months per session. they can be sent to the top hospital and even to the worst place. so that they may have option in chossing the management.

however, i believe that another root problem of why the problem arise is that the student didnt dare to discuss certain management with their senior consultant since some of them are very rigid with their opinion.

Jacknaim said...

""Unstable intrabdominal bleeding require an urgent laparotomy and yet the surgical team doing abdominal x-ray, ultrasounds, CT scan to please their ancient rule""

well, since u mention bout it, i remember that i've to present about radiological evaluation in trauma patient during our radiology session. and the radiologist agree with the point from the latest management

1) abdominal X ray has no rule or very2 little esp in setting without US or CT scan in abdominal trauma..

2) unstable patient with suspected inta ab does not need CT evaluation and may straight go to the OT or may at least have bedside US.

3) FAST is an effective screening tool in evaluating abdominal trauma.

well dr, i guess that fellow didnt familiar with the current management. or maybe he's lacking of experience.. but, i do not know the real situation.

p/s:btw, please verify my info for any mistake..tq

Dr. Azlan Kamalludin (Landen) said...

Dear Jack:..

I agree with your opinion. There is no problem for students from USM wanted to work in USM once they completed their training..
Look at Prof Jafri (neurosurgeon), Prof Nik Hisam (Emergency Physician).. Their names are still heard even after I left USM.. These people learned from others and pour their knowledge back to USM...(Thats why it is important to learn from others!!)

Your comment on intraabdominal injury: The need for emergency laparotomy in an unstable patients is not new. This is a very old rule and I learned it in the year 2000. So, why is it so difficult to understand this simple technique to close the tap?. Wait for my upcoming topic regarding this experience in HKL.

Anonymous said...

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- Laura