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Akunyili and doctors’ competence
By Sam Madugba
Monday, December 3, 2007
Initially, it was a question of doctors being accused of
being it all, knowing it all, doing it all and taking it all
alone. Today, the music tone has changed. Doctors’ competence
is now in doubt in Nigeria. It has got to the extent that
Dora Akunyili, a Professor of Pharmacy and the renowned Director-General
of the National agency for Food and Drug Administration and
Control, (NAFDAC), in a recent international science conference
in Abuja questioned doctor’s competence in disease diagnosis
and drug prescription.
This formed the basis of The Sun editorial of November 16,
2007. Akunyili was specifically worried about doctors’
“general attitude of prescribing without adequate laboratory
tests and proper diagnosis..,” a cliché often
sung by medical laboratory personnel in the past five years
or so.
The only unfortunate thing about Professor Akunyili’s
diatribe is that she is not in a position to know what quality
medical practice is. She is but a pharmacist.
And now that pharmacists have joined laboratory agitators
in questioning the right of doctors to treat their own patients
after nurses had failed in their bid in the 80s to take over
the consulting room, every right-thinking man ought to know
that a crisis is brewing in the health sector and without
the intervention of government in spelling out the responsibilities
of all personnel in the hospital environment, soon an open
confrontation will ensue.
It was Professor ‘Koye Ransome-Kuti, the then Health
Minister of the IBB era that made nurses know that they were
quasi-professionals, trained, just over a period of three
years in schools of nursing manned by their not-so wonderful
fellow nurses just for them to learn how to interprete doctors’
intentions on their patients which they usually pen down for
nurses’ consumption in patients’ folders and the
experiences make a nurse a better nurse and never a doctor.
By the way, the only health professional in the hospital is
the medical doctor. He owns the patient. He makes all diagnoses,
decides what laboratory investigations are necessary and indispensable
for his patient, what drugs to prescribe and how they are
to be administered. That is to say, he is the only person
qualified to write on a patient’s folder. He tells his
assistants – the pharmacist, the laboratory technologist,
the nurse, the radiographer, the little they can do for him
to achieve a holistic objective of getting his patient well.
In teaching hospitals, the doctor’s tag is on each patient’s
bed and nobody can touch a patient without his permission.
So the practice goes globally.
But Nigeria being a country where anything goes, nurses, pharmacists,
and laboratory technicians would want qualified medical practitioners
to queue behind them and very educated ones among them like
Professor Akunyili who ought to know the right thing embarrassingly
support this mad desire.
A professional is that person who can start an action and
bring it to a fruitful conclusion and still is responsible
to himself and for his actions.
In the hospital set-up, the pharmacist (who is actually a
visitor there, his place being in the drug manufacturing factory)
waits for the doctor to prescribe drugs before he dispenses,
the laboratory man waits for the doctor to write out tests
before he collects specimen after which he is duty bound to
send any result he gets back to his boss, the doctor, and
the nurse administers only drugs that the doctor prescribes
and at the duration and frequency he wants.
So, all are quasi-professionals who cannot stand on their
own. But a pharmacist involved in drug manufacturing is a
professional there. He produces the drugs which the doctor
uses. He did not study the science of diseases and treatment.
He should not treat anyone because he does not have the knowledge.
Most times, you send patients to the laboratory. You expect
your results, but they hardly get back to you. Your assistant,
the laboratory hand, with his tacit knowledge of medicine,
usually commandeers the patients and criminally writes drugs
for them in the name of treatment, based on laboratory results
he is not legally or academically qualified to interprete;
hence the drug resistance syndrome in malaria therapy and
antibiotics in Nigeria today.
The science of Medicine and Surgery is a mystery only partly
expounded by the prolonged medical education of young perspicacious
minds, followed by public induction and later, acquisition
of experience. Any doctor you see in the hospital must have
passed the following courses – Anatomy, Physiology,
Biochemistry, Pediatrics, Pathology, Pharmacology, Obstetrics
and Gynecology, Psychiatry, Anesthesiology, Internal Medicine,
Community Medicine, Surgery, even before specialization in
any chosen field.
The doctor’s training givens him the authority and competence
to make accurate diagnoses in about 95% of all diseases that
come his way without reference to the laboratory. So is he
endowed with the ability to treat about 95% of all such diseases.
The remaining 5% is left for laboratory confirmation and specialists
respectively. The problem of treatment failures is that patients
are misled by other competing hospital workers to do everything
to avoid the doctor who they ought to see first.
In factor, doctors are not trained to rely on laboratory results.
There are many diseases than do not even have specific laboratory
diagnoses. Such diseases include, Hypertension, Angina Pectoris,
Cardiac Failure, Peptic Ulcer Disease, the Pneumonias, Appendicitis,
Stroke, Road Traffic Accident, etc. Diagnoses of diseases
are made through careful history taking and clinical examination
on the couch which only a qualified doctor can do. A doctor
may only need to dip his forefinger into a person’s
anus to diagnose certain diseases. Some diseases are even
diagnosed through telephone, just by the doctor hearing you
talk.
Laboratory results are called ancillary by doctors or confirmatory
diagnoses. A doctor who usually has a working diagnosis does
not usually wait to get a laboratory diagnosis before treating
a patient with Acute Malaria, Typhoid fever, Pneumonia, and
Acute Abdominal when delay can lead to a person’s death.
No pharmacist, nurse or laboratory personnel would opt to
treat his wife or children himself. They usually rush to doctors
and fawn upon them, but they want to deceive the public with
pretentious acrimony.
So, it is wrong for anybody, including Professor Akunyili,
to talk what he does not know. Akunyili is a lay person in
the field of medicine. She is not in a position to tell even
a house officer what to do with his patient. At the University
of Nigeria, pharmacists do not come over to Enugu Campus where
Medicine is taught. They usually remain in the Nsukka Campus
jungle and learn their own very important and complimentary
wonder of drug production.
Nigeria is a fast degenerating country. Every facet of national
life, every profession has been eroded, politicized and bastardized.
Medicine is not just a profession. It is a calling and that
is why all practitioners are sworn in with the Holy Bible
or the Koran in their hands at the end of training as they
recite the ancient Hippocratic Oath. Nigeria should not allow
professional agitations, envy, bickering and unnecessary competition
to destroy the global practice of medicine in the country.
A doctor ceases to be a doctor the very day he waits for a
laboratory result to come out before he makes a diagnosis
or commences treatment, or waits for the pharmacist to advise
him on the drug to write for his patient.
The problem of fake drugs in Nigeria is as a result of greedy
pharmacists who collude with drug merchants to produce fake
and adulterated drugs. Doctors only use finished products.
It is not their duty to go on drug trial of Erythromycin or
Amoxicillin, as Professor Akunyili is advocating, to know
if they are fake or genuine while their patients suffer. They
simple go for trusted alternatives which are ever present
in their seminal heads. That is the teaching all over the
world and the decaying Nigeria cannot force doctors to change
this age-long practice.
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