The Nigerian Medical Association (NMA) that called resident doctors in public health facilities out on a nationwide in July had a list of 24 demands but I will limit myself to the most contentious ones. There is no contention, the medical doctor is the head of the clinical team. He/she leads the ward rounds, clinics, surgical operations, multidisciplinary meetings and so on because the ultimate and final responsibility for patient care rests in his/her hands. The headship of the hospital is a different matter. This is an administrative office, which needs not be occupied by a medical doctor. This job is better in the hands of people who have administrative or business management skills. This is the case in countries like the UK, Canada and the US, which heavily influence our health system. Therefore, it is difficult to reason with the NMA why this job should be the exclusive right of medical doctors.
The doctor-patient ratio in Nigeria is dangerously low. In my view, the roles of non-medical professionals such as nurses, physiotherapists, pharmacists etc need to expand to cope with the demands on doctors. It is important that this is done in a safe way by providing the appropriate level of training for these individuals. This is the case in countries such as the UK, Canada and the US where consultant nurses, pharmacists etc, have existed for a few decades now. I do not see any problem with non-medical consultants as long as these individuals are appropriately trained and can practice competently and safely within an agreed framework. These professionals have separate (but complimentary) job descriptions and their roles are not designed to replace or dispense with the services of the doctor. If this arrangement enhances patient care, then where is the problem with it? The NMA needs to demonstrate to the public and to the government how the creation of these non-medical consultant positions will adversely affect patient care, otherwise, its demands will be perceived as obstructing the professional development of JOHESU members, and I don’t think this is helpful to anybody.
The types of hazards and the extent to which healthcare workers are exposed vary considerably and depend on the type of job they do. For instance, psychiatrists are hardly exposed to body fluids and their risks for contracting diseases like HIV and hepatitis are much less than for a theatre scrub nurse. The risk of physical assault by a patient is higher for a psychiatrist than for a surgeon. And because psychiatry nurses spend more time with patients, their risks of assault are arguably higher than those of consultant psychiatrists. The people who work in radiology departments such as radiologists, radiographers, nurses, porters and so on have greater exposure to radioactive materials than everyone else in the hospital. The current health hazard allowance of N5,000 is unconscionable – it needs to increase. However, I think it is imperative to get an independent risk assessor for impartial advice.
Our health system suffers from poor regulation. This is why anyone can open a chemist and dole out antibiotics indiscriminately. It is the reason doctors are scared that consultant pharmacists, nurses and physiotherapists will steal their patients. But it is also the reason why doctors may recommend an operation to a patient where none is necessary just so they can charge more. This is a problem that is in urgent need of attention. I hope that this something both NMA & JOHESU will flag up in the near future.
Another recurrent theme in these debates is the abuse of junior doctors by both medical and non-medical staff, which appears to be endemic. There is a consistent narrative of junior doctors being asked to do other people’s jobs such as collecting blood from blood banks, taking samples to laboratories etc. In extreme cases, these doctors are asked to undertake non-clinical tasks by more senior doctors. This is simply unacceptable! I think it is fair to place the blame for this at the hands of consultants who are supposed to be responsible for junior doctors. But this in itself is not a good argument for blocking JOHESU members from becoming consultants in their specialties or for stopping them from heading hospitals if they have the right qualifications.
I am concerned that the NMA is losing public sympathy. Increasingly, I hear people describe doctors as selfish and heartless. This is very sad and rather unfortunate. They say doctors do not have any motivation to end the strike because patients are forced to pay exorbitant fees to them in their private hospitals. Those patients who cannot afford these fees are left to suffer or die. If the NMA has made any efforts to change this public perception, then these do not appear to have been effective.
Ijabla Raymond, a Nigerian medical doctor based in the UK can be reached via email@example.com.