Some time ago, I came across an article on the current strike called by the Nigerian Medical Association (NMA) written by Dr Omobude and posted on Nairaland. I posted that article here and promised to write my rejoinder in due course.
In what follows, I have highlighted the writer's words in blue, italicized words, and then followed up with my own thoughts in black, regular font.
My own contribution viz; "From the comments made by contributors, it seems most people appreciate the fact that medicine is one of the most sensitive (I am trying to avoid the word "most difficult" course of study in our tertiary institution largely because it deals with human life and the uncertainties (one is not sure if he will eventually become a doctor or not), even the best students in first year could be withdrawn the following year. When I was in school, over 400 of us gained admission to study medicine but less than 120 of us who gained admission together graduated. It is also a known fact that after several attempts at entering medical school, most students eventually settle for related courses like Medical Laboratory Sciences, Nursing, Physiotherapy, pharmacy (Note that a good number of students also choose these courses as their first choice course ab initio).
Medicine is recognized globally as a noble profession; a profession that, perhaps like no other, is capable of making the difference between life and death; a profession that brings man as close to God as he can possibly come without donning sacerdotal vestments. It is for this reason that becoming a doctor is an arduous, rigorous task, achieved not necessarily by the most brilliant minds but by the most steadfast and most disciplined ones. By conferring the qualification of MBBS on an individual and calling him a doctor, you are placing your life in his hands. You are saying that you are confident that he possesses the competence to see to your health needs and those of your family, including those of your unborn children and grandchildren. It is therefore an act of faith that you are making, and such an act of faith is not made lightly. It is for this reason that although many are called to study Medicine – including those who call themselves – only few are chosen to bear the name of doctors.
Having stated the above, it is crass injustice for someone who knew from the beginning that he could not study medicine (for reasons best known to him, be it academic challenges, time spent in the training amongst others) to now realize that the name "doctor" is dignifying, and hence, desires to be called doctor (and or consultant) because he works in a tertiary institution and has garnered some years of experience. This is comparable to technologists who refer to themselves as engineers simply because they know how to assemble machines. What matters most is the qualification and not the number of years spent assisting a medical doctor. I support that health care workers can and should aspire to whatever they want and to whatever extent. They can still be called doctors. All they need do is complete a Master’s degree program and a PhD. I know some Nurses who are professors, same with pharmacists. In the USA, in the state of Arizona and some other states, it is an offense to address yourself as "doctor" if you are not a medical doctor without stating your profession immediately ( there should be no room for patients to assume you are a medical doctor when you are not).
Indeed. I support a policy that allows deserving nurses, pharmacists, radiographers, and medical laboratory scientists/technologists to attain the peaks of their respective careers, without prejudice to the primacy of the position of the doctor in the hospital, in terms of protocol, governance, and salary structure. In effect, my position is that a pharmacist who has undergone the requisite post-graduate academic training can be addressed as a lord or even as a god, provided his lordship and godhead, in the context of the hospital environment, only empower him to become a close adviser to the Managing consultant in matters concerning the Consultant’s patient. It need not be emphasized that his purely advisory role means that the managing physician is under no compulsion to act based on his pharmacist’s advice. A situation where an allied health professional (what does that really mean?) attempts to arrogate to himself the power to interfere with a patient’s treatment plan without reference to the managing physician is chaotic, irresponsible, and inconsistent with the demands of the Hippocratic Oath.
Let me emphasize that a doctor will never fight to head a pharmaceutical company. We all knew what we wanted before we wrote UME (JAMB) .... This short cut approach must be rejected. I was in Microbiology 300L when I got admission into 100L medicine, I knew what I wanted. I had classmates who were nurses, medical lab scientist, who wanted to become doctors; they took UME again.
Of course a doctor has no business heading a pharmaceutical company. A doctor has almost no business in that setup, except if he also doubles as a pharmacist. A doctor is a health professional who has been trained to work with patients, to work on patients, and to work for patients. The patient is the centre of the doctor’s universe. The nurses and the pharmacists and radiographers and medical laboratory scientists in the hospital environment are satellites revolving around the doctor, waiting for him to activate any of them as needed, so that they can help out in the care of the patient by using their skills as far as the doctor requires them to use those skills and no more. What has led to this instability is that some nurses, pharmacists, and others have attempted to exit their own orbits and insert themselves into the doctor’s orbit as he revolves around the patient. Unfortunately, even if this move is well-intentioned (and in a minority of cases, I daresay it is), these allied health workers do not have the requisite training that will enable them sustain themselves in their desired orbit. As a result, this arrangement wherein a satellite becomes a planet creates a plethora of problems and solves none.
Remuneration of doctors should not be compared to any other allied health profession. Google is our friend and we can always ask. Is there anywhere in the world where pharmacists, medical lab scientists, nurses and others earn the same remuneration? If there is any, please let me know. It is quite unfortunate to see the pharmacists I once respected stoop so low, finding themselves in the nexus of abhorrent disgruntled elements of disappointed and frustrated persons fighting against not only medical doctors but themselves (because they are reducing the practice of pharmacy to drug dispensing). What happened to industrial pharmacy, what happened to drug formulation and research? I was once envious of a classmate who later became a pharmacist. While I was still doing my internship, she was done with hers (no thanks to our extended academic calendar of 6+X years as against hers of fixed 5 years), she was working in a pharmaceutical company, earning a fat salary, had an official car and a driver. Her remuneration and job description was very good and juicy, but that is her calling not for a medical doctor.
A pharmacist should earn all he is entitled to earn, and not a kobo less, as he discharges his duties in the pharmaceutical company. The pharmacist who works in the hospital however works as an aide to the doctor, and his earnings within that context should reflect the level of his relevance in that setting. Same goes for the nurses (who in my opinion should earn even more than the pharmacists and others because nurses are needed much more often and for much more diverse activities), medical laboratory technologists, radiographers, et cetera.
In every stratum of life, in every team, there is always a leader, one leader, that's why we have only one pope, only one Nigerian president, only one state governor, only one captain and indeed only one chief medical director (who must be a doctor) which must be earned and not gotten through the back door. Note that only doctors have been appointed Director General of WHO since inception, yet we have other health workers who work for WHO. The present Director General, Margaret Chan should be an inspiration to JOHESU members because she was a home economics teacher before going back to school to study medicine.
I already talked about how the patient is the centre of the doctor’s universe. The patient is like the sun. The doctor is like the earth. These “Allied Health Professionals” who comprise the Joint Health Sector Unions (JOHESU) are like the moon(s) that orbit the planet (earth) while the earth (or the doctor) orbits the sun (the patient).
My sincere advise to JOHESU is to lead by example, they should propose an arrangement that gives health workers (apart from medical doctors) equal rights viz; the pharmacy technicians should be allowed to head the pharmacy department, auxiliary nurses and B.Sc. nurses should be paid exactly the same salary and have the same type of promotions (since they can all administer injections and dress wounds), laboratory technicians should be allowed to be the assistant head of a laboratory departments assisting a consultant pathologist. If they can successfully implement the above for 5 to 10 years, and the model works perfectly well, then maybe the federal government can look into their request. Indeed the patient care should be a team work involving the pharmacist, laboratory scientist, nurses with medical doctors at the centre. Any attempt to take the sole responsibility away from the medical doctor will lead to chaos and serious disaster.
I laughed out long, loud, and hard when I read the above paragraph. This paragraph is one of the reasons I decided to write my thoughts on the entire article. It attempts to expose the illogicality of the current position held by JOHESU and maybe the Federal Government wherein an “Allied Health Professional” (who is not a doctor, mind you) can become Chief Medical Director of a hospital. This position is not tenable, any more than it is tenable for a court clerk to be allowed to judge cases at a High Court simply because she has had an unblemished record as a Court Clerk for 20 years!
I must confess, the turn of events in recent years is not encouraging, it has a most negative effect on the already brain drain that has plagued the Nigerian health sector, what they should be fighting for(collectively, doctors inclusive) should be how to increase the slots for residency training, better remuneration and welfare package across board,how to promote research and get scholarships to further enhance skills and build career, cooperate with doctors to ease the admission of their children into medical school so that their desire can come into fruition. I believed in our generation, we must fight together, my friends who are pharmacist, physiotherapist and nurses know we are not the same, their "ogas" should stop the Tom and Jerry display of ignorance and comic. Yes, I respect them, I respect every other health worker, they have their role which must be respected and indeed the best patient outcome is in team work. The reasoning that doctors go on strike in order to increase private patronage is not only myopic but a serious neurological deficit on the part of those who have such reasoning. What will you say when pharmacist and lab scientists go on strike, where do patients buy drugs from( they don't only go on strike, but they frustrate the effort of anyone who choose to deliver care by switching off power generators, hiding surgical instruments, locking up stores amongst others). Yes, most doctors have private hospitals in order to meet the increasing demands in the health sector but pharmacist and others also own pharmacy shops and laboratories, committing the most heinous crimes of consulting, examining and treating patients in their shops which is not designated for such, oh what a lawless nation. Most patients have worsened their clinical condition and indeed died from such crimes. Permit me to call their act genocide of the highest order towards Nigerians.
It is worthy of note that the JOHESU folks, who masterminded this current imbroglio, have consistently turned a blind eye to the real problems bedeviling patients and Nigerian citizens in Nigeria – the hundreds of young women and girls who die every day at the hands of “chemists” and “nurses” and “pharmacists” while trying to take care of a certain OBGYN-related issue, the millions of people who are misdiagnosed as having “severe typhoid” and then saddled with prescriptions featuring the simultaneous administration of amoxicillin and ampicillin, the others who simply complain of pains and are then given 4 different types of NSAIDs at full doses, resulting in an upsurge in the number of bleeding PUD patients that present to us in the Emergency room, the native doctors whose signposts litter our streets and who have a potion that cures all diseases under the sun and even those ones afflicting the sun (of course, the potion cures all diseases by inducing renal failure - dead men do not fall ill). No. JOHESU sees nothing to fight in this. The Federal Government does not see the people who die from all these.
Yet, these Nigerians are victims of a new kind of terror; the kind of terror that has been happening on the streets; the kind of terror that JOHESU is trying to get the Federal Government to unleash on our public hospitals – the terror that I can label the Legalization of Quackery; the establishment of a system wherein a Consultant nurse or Consultant pharmacist can arbitrarily interfere with a doctor's treatment plan, without the doctor's approval - a treatment plan that was arrived at after obtaining a thorough medical history and conducting a comprehensive physical examination (both of which a doctor and no one else is trained to do); the adoption of a policy that converts medical care from a focused enterprise undertaken by a team with a leader to a dangerously haphazard competition among very differently equipped individuals, at the expense of the patient.
This is the kind of injustice that patients and the entire Nigerian citizenry should reject with one voice. This is the kind of terror that should receive condemnation as loud and universal as that given to Boko Haram. It is the responsibility of every doctor to take whatever steps are necessary to defend and protect the lives of his patients. A very necessary first step would be the immediate Delegalization of Quackery in Nigerian Hospitals.
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