Muhammad Ahmed Abdullah.
Are clinical specialities overshadowing primary healthcare in Pakistan?.
Pak J Public Health Jan ;5(3):9-10.
The Chaos theory is the study of nonlinear dynamics, in which seemingly random events are predictable from very simple deterministic equations. According to such mathematical models, it becomes easy to predict events for the future to an extent. In scientic terms, the word chaos does not depict complete disorder, rather a set of predictable variables through specic viewing angles. The social sciences use the word chaos in its literal meaning and hence claim that; "everything in order leads to eventual chaos." The same concept when applied to the versatile branches of science compels us to think that with the ever progressive compartmentalization of different sciences, it is becoming evident that such order might lead to chaos in the end. The human mind has the capacity to engulf, interpret and utilize the immense types and amounts of information; for example, trying to remember Ibn-e-Sina , who was an expert in diverse elds including medicine, philosophy, astronomy, alchemy, geography, geology, psychology, Islamic theology, logic, mathematics and poetry. This singular example is enough to explain the endless potential of the human mind. With the passage of time the knowledge base of all elds of sciences has attained immensity. This stands true for medical sciences, and its sub/super specialties. In Pakistan we have reaped the fruits of advancement in medical knowledge and the development of exclusive subelds of medicine and surgery. We have come a long way from a life expectancy of 57 years in 1951 to almost 65 years in 2012. Yet based on our resource constraints, and inequitable distribution of health care delivery services, one thing comes to mind. Can we afford to place advanced medical services in restricted boxes, while we continue to ignore the issue of primary health care for the masses? Can we make the development of sophisticated specialized hospitals our priority, while the underprivileged many are forced to overcrowd our already overburdened tertiary care facilities, while the primary and secondary care set ups remain underutilized and poor equip with resources? Medical advancements is a success story, to be proud of; yet this strict order, has the potential of leading towards chaos in the end; in which situation a public health expert fails to understand the jargon of the neurologist, or a radiologist is unable to communicate effectively with a psychiatrist. A generalist approach incorporating elds like public health, family medicine, primary health care seems to be the need of the hour, with enhanced focus on prevention rather than cure of complicated conditions through costly interventions. Our policy makers both technical and administrative need to see the darker side of the picture and intervene in a more generalized manner. Improving the primary health care system would obviously reduce the burden the secondary and tertiary tiers of the health system, but for this we need to clearly identify and prioritize our problems. A nal point to ponder are the career paths that we make accessible to the newer lot of health care providers need to be overhauled and adapted according to the needs of Pakistan's marginalized majority.
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