could the Mods move to the appropriate section.
Thank You.

For a longtime now I have come
across so many articles and
reports in the national dailies
and in online social media on
the rife in the health sector
which centers mainly on the row
between doctors and non-
doctors working in the
healthcare system. Most of
these reports and articles,
mostly lopsided, have one
common denominator,
presenting the Doctor as an
enemy of the people and the
manner of their submissions is
such as to draw undue
sympathy from the
unsuspecting public. But for the
neutral members of the society
who have had cause to have
sufficient contact with the
hospital environment, I’m not
talking of some quasi
journalists, they need not be
told, if there are, who the
Angels and Demons are.
This article is not aimed at
indicting or exonerating any of
the two combatant parties as
both have had a fair share of
the blame, and honestly, the
deplorable state of our
healthcare system is not as a
result of the performance of the
health workers, but it is a
component of an overall failed
system called Nigeria which the
current government is still
trying to salvage amongst other
difficult challenges. Considering
the lines along which the divide
has been made, I shall delve
into an inquest of some of the
key issues at stake, mostly
those that affect the general
public, and this I will do by
placing the Nigerian Doctor on
one side to be reviewed
alongside a few of the
numerous “health professionals”
working in the healthcare
system with due consideration
to the most important person in
the system, the Patient. I shall
concentrate mostly on the
tertiary healthcare institutions
where the bulk of the rivalry is
most felt.
The Patient and the Hospital:
Let us begin from the beginning.
A healthy person falls sick and
needs to regain his health and
function properly. He says to
himself, “I don’t feel well
enough, I need to see a Doctor.
May be I should go to the
hospital tomorrow”. He sets out
of his house with this principal
aim. On getting to the hospital,
he first gets to the reception,
obtains a card at the Out
Patient Department and then
proceeds to see a Doctor
(usually a Medical Officer) if his
condition is one that
necessitates a Specialists
attention, he is then Referred to
another Doctor, the Specialist
(Consultant) for further
treatment. On getting to the
point of referral, the Record
staffs assist him in opening a
folder containing case notes,
and in the process of this, a
Doctor (Consultant) is assigned
to him. The entire processes of
obtaining a card and folder have
no direct effect on the patient’s
condition but helps ensure
proper documentation and
recording within the hospital.
He is then directed to the
designated Specialist or
Consultant Clinic where he is
received by a Nurse who does
further documentation and
records his vital signs which
may or may not be repeated by
the Doctor. Then the patient
enters the clinic to see the
Doctor, his primary aim for
coming to the hospital ab initio.
The Patient, the Doctor and
Other Health Workers:
The Doctor begins by taking a
complete history of the patient
which includes his current
complaints, previous health
challenges, living condition,
social habits, family history,
drug history, financial capacity,
religious and cultural beliefs,
and then proceeds to do a
complete physical examination
of his entire body system, at the
end of which the Doctor would
have verified the patients
complaints and identify any
other problems unknown to the
patient, before arriving at a
Provisional Diagnosis. He then
counsels the patient, draws up
a treatment plan, which is to be
strictly adhered to provided the
patient is within the hospital
environment, and automatically
takes full responsibility for any
problems encountered along the
line. He finally schedules him
for a follow-up visit to ascertain
his response to treatment. This
process of history taking creates
a personal relationship between
the Patient and the Doctor and
this is where the confidence of a
patient on the Healthcare
system of a Nation is built; the
Doctor-Patient Relationship.
The treatment plan of the
Patient, drawn by the Doctor,
may or may not include; the
investigations (or tests) both
laboratory or radiological to be
carried out, the drugs to be
dispensed and the appropriate
prescription, the additional care
to be rendered outside the basic
nursing care and the treatment
orders to be followed, some of
which he does himself (or via
his subordinate Doctors) and
others by the Nurses. There is
no stereotyped outline of what
must be done for every patient;
investigations to be carried out,
treatment to be administered or
drugs to be prescribed lies
solely at the discretion of the
Patient and his Doctor.
Apart from the Nurses, all other
“Health Professionals” come
into patient care when the
Doctor’s plan involves them.
Clearly, a patient has no
business with the Radiographer
if the Doctor’s plan does not
involve radiography, neither
does he have any business with
the Pharmacist if the patient
does not require any drugs, of
course, not every patients
require drugs. Therefore, it is
safe to assert that if Patient
Care is the sole interest of
everybody in the Health sector,
then the Doctor takes the
Central stage in this service to
Patients and must carry the
Nurses along at every point in
time, and together they look out
for any other “Health
Professional” that should be
roped into patient care. Why
then should the Doctor take the
Central stage? Very simple. He
has been trained thoroughly to
do so. Invariably, the Doctor is
naturally the undisputed leader
of the Health team and only two
classes of people can challenge
this standing; the criminal
minded ones pursing their
selfish interests and the dim-
wits incapable of any logical
reasoning.
On the Headship of the
Hospital:
Over time, the functional head
of the tertiary hospital setting
has been the office of the Chief
Medical Director, CMD, and part
of the Act establishing the
hospitals specified that this
position be held by a Medical
Doctor. However, there has
recently been a loud cry from
other “Health Professionals”
under the auspices of the Joint
Health Workers Union (JOHESU)
for the chance to also partake in
the “enjoyment” of this office, as
if to say it is a political office, a
“National Cake” which should be
shared equally to everyone in
the scene, whereas, it is the
most sensitive of all positions in
the hospital setting, one with
huge implications on the health
of patients. The Medical Doctors
on the other hand, insist that
the office of the Chief Medical
Director and the headship in
general, of the Hospitals is their
exclusive reserve.
How true is this claim by the
Doctors? Again, it is very simple.
Healthcare is all about patient
care, and in rendering care to
the patient who is the main
focus of everyone, the Doctor is
the arrow head. He brings
together the activities of all in
the health care delivery system
to bear fruit in the health of the
patient. He has a broad-based
and yet in-depth medical
knowledge that enables him to
function as a leader in patient
management and take
responsibility for the outcome.
It is then indeed a funny
ideology to expect the Doctor to
maintain leadership of Patient
Management and then cede the
leadership of the Hospital
Management to a Non-Doctor.
Right thinking people would
agree that whoever takes the
blame should take the lead.
Leadership is about
responsibility, and Doctors
embrace such responsibility
mainly as it involves lives which
they have sworn an oath to
protect.
Furthermore, JOHESU, a body
comprising of other “health
professionals”, support staffs
and in fact all in the Hospital
setting except Doctors, claim to
be equal and allied to Medicine.
But my question is, how is the
clerical staff allied to Medicine?
How can a support staff head
the core members of the
organization? Also, why should
a “profession” that is “allied” to
Medicine surmount Medicine?
Can a Non-Lawyer become the
Attorney General of the
Federation? Why isn’t the office
of the Vice-Chancellor made
open to every staff in the
University system since ASUU
and NASUU both consist of
“professionals”? How would
ceding hospital leadership to
JOHESU improve the health
indices of our country? These
are people that do not deal
directly with patients, people
that do not really understand
the agony of patients which
Doctors do. The saddest part is
the extent they can go to press
home their irrational demands.
We have a documented
occurrence of how they turned
off power supply to the
Intensive Care Unit during a
JOHESU orchestrated strike
action in a southeastern
Teaching Hospital leading to
death of patients on life
support. This was an attempt to
frustrate the Doctors’ effort to
keep hospital services running
while they were “striking”. How
can people who have displayed
this level of irresponsibility be
allowed to head the Health
sector? Again, God forbid!
It is a common saying that
Doctors are “proud”, and I
insist, they have very just
reasons to be, and when it
comes to arrogance, the
patients can tell who amongst
Doctors and Nurses are more
approachable. Doctors are a
selected class of elites and
comprise the best brains of the
society. Yes, the entry
requirements into the
profession and the medical
training ensure that only the
bests emerge as Doctors. As
such, the government has to
understand that any
arrangement that sees a Non-
Doctor in a sensitive position to
head Doctors in any Health
related issue would be met with
fierce resistance and the never
ending tussle it will ensue will
have detrimental effects on our
nation’s healthcare delivery. In
the interest of peace and
decorum, the Federal
Government have to dig in and
ensure that the status quo is
been maintained. The ear that
will hear needs not be the size
of a raffia palm.
On conferment of Consultancy
on other “Health Professionals”:
A Consultant (Medical) is the
title for a senior hospital-based
physician or surgeon who has
completed all of his/her
specialist (Residency) training
and has been placed on the
specialist register (Fellow) in
their chosen specialty. This level
of Doctor joins the Civil service
as a Consultant and
automatically leads a team of
Doctors comprising Residents,
Medical Officers and House
Officers who train under him.
Currently, there has been an
outcry by JOHESU to also be
awarded Honorary Consultancy
based on the fact that Doctors
are been appointed as
Consultants, why not they too.
The concession of the
government to this particular
demand has led to the entire
hospital going berserk in some
centers. This was done against
the warning of the Nigerian
Medical Association that the
introduction of such “alien”
practices would be detrimental
to the lives of patients and the
results are showing.
At the Nnamdi Azikiwe
University Teaching Hospitals, it
is been said that a “Consultant
Pharmacist” invaded the wards
with his team, cancelling
patients prescriptions and also
demanded that a Consultant
Cardiologist remove a key drug
in an inpatient prescription, on
grounds that the drug has some
known adverse effects. Another
report have it that in Abuja
University Teaching Hospital,
the Ante-Natal Clinic was
invaded by Nurses who decided
to consult patients and make
prescriptions, of which the
Doctors left the clinic and the
Patients were confused. Patients
who sought to see their Doctors
were told that there was a
“Consultant Nurse” who does
whatever a Consultant does.
Also, in University College
Hospital, Ibadan, stories had it
that a Consultant Plastic
Surgeon was barred from
reviewing the surgical wound he
created post-operatively
because a “Consultant Nurse”
had reviewed the wound earlier
and was satisfied with her
findings.
Let us address one of these
occurrences. It is grave
ignorance for a Pharmacist to
tamper with a drug prescription
simply because he has looked
through his drug formulary and
have identified a known adverse
effect of the drug when he/she
has no knowledge of the
processes involved in the
making of diagnosis and
prescriptions. Patient
management is highly
individualized. To make a
prescription, the Doctors put
many things into consideration
viz; patient’s history and
examination, financial cost of
the drug, benefits against the
risk of using the drug, other
drugs to be administered etc.
Sometimes the side effect of a
drug is the desired effect
needed in one patient but would
remain a serious adverse effect
in another patient. But no, the
Pharmacist didn’t think in that
line before cancelling
prescriptions. I am not saying
every doctor’s prescription is
infallible. No. But if a
pharmacist wishes to express
concern over a patient’s
prescription, he should discuss
with the Doctor to sort out their
concerns.
This whole consultancy for non-
doctors arose as a result of
their quest to have better
remuneration. I am not
opposed to better remuneration
for other health workers, but
looking for cheap means to it at
the expense of the lives of
patients is grossly unacceptable.
Why would you want to be a
Specialist (Consultant) when you
have no specialty, or you have a
specialty in an area whose
service is not needed? Even if a
non-doctor must be a
consultant that does not
automatically make him/her a
Doctor. We all know how to
become a Doctor and age is no
barrier.
If non-doctors must immutably
be made consultants, their
duties and jurisdictions must be
clearly spelt out and understood
by all involved. A Consultant
Nurse should be confined to
Nursing Practice and she will be
expected to enhance it, not to
invade Medical Practice. She
must ensure that the
management plan of a Doctor is
properly carried out, even if he
is a House Officer.
Unfortunately, the idea of non-
doctor consultant emanates
from the desire of these other
“health Professionals” for
position and better pay than the
desire to meet any specific
needs. For instance, a ward
Nurse that does her duties
properly becomes a Consultant,
what extra services and
improvement does that bring to
nursing care? The fact that
there exist non-doctor
consultants in a few foreign
countries does not explain why
the government should channel
huge sums of money into the
payment of honorarium to
consultants that add nothing to
the existing system but chaos.
The NMA have identified these
unhealthy health policies and
should do all it can to prevent it
from killing Nigerians.

By,
Basil, C. B. – M.B.B.S (Nigeria),
Department of Clinical
Chemistry and Metabolic
Medicine,
Benue State University Teaching
Hospital.

On relativity of Wages:
Another very important object
of discord is the demand by
JOHESU for a unified salary
scheme for everyone in the
health sector and that will see a
close approximation of the
eventual earnings of all in the
sector. What else can be sillier?
Need I remind us that in every
organization there is usually an
established strata. Even in
heaven, there are Angels and
Arch angels, and the angels are
content with their positions and
would not want to usurp the
duties of the Arch angels either.
People cannot obtain different
qualifications, different
expertise, subserve different
needs and end up earning
similar pay. No. That cannot
happen. Why would a non-
specialist insist on being paid
specialists allowance? Why
would a Non-doctor terrorize
the government because he
wants to be paid like Doctors?
Where in the world is that
obtainable? Relativity is
sacrosanct and must be
reflected both on the basic
salaries and all allowances.
Granted. Doctors are few. Very
very few. The World Health
Organisiation recommends that
a Doctor should consult not
more than seven patients in a
clinic session and should pay
maximum attention to their
needs, but our environment see
us in a situation where a Doctor
consults over 40 patients in one
clinic session, yet, he is
underpaid compared to his
colleagues even in nearby
Ghana. There are less than
30,000 Doctors currently
practicing in Nigeria subserving
over 170 million Nigerians, and
there is a dire need for more,
but that will not push the
Medical schools to take in
everybody and churn out
unqualified people as Doctors,
neither will the Nigerian Doctor
allow a Non-Doctor to tamper
with the lives of patients.
Doctors swore an oath to
preserve lives and the NMA
must see to it that the lives of
Nigerians are safeguarded. If
the Hippocratic Oath is to be
taken serious, then the NMA
must win this battle.
More often than not, we are
clear on the knowledge that it is
injustice to treat equal people
unequally, but it fails to come to
our minds that, it is graver
injustice to treat unequal people
equally. This is not pride, it is a
statement of fact. Doctors and
Non-doctors in the Health
sector are not equal and they
cannot be treated as equal.
There is a reason why some
students work harder than
others to become Doctors.
Some sat for JAMB several times
to achieve that, although many
fail to do so and even some do
fail out of medical school and
end up as “other Health
Professionals”. To eventually
anticipate to be rewarded
equally with those who
triumphed where you failed is
simply madness. The
government must see to it that
relativity is maintained. For if a
Nurse or Pharmacist consults
patient, not regarding quality of
the consult, earns equally with a
Doctor and even get a chance to
head the Doctor, why then
would one need to work harder
to become a Doctor when he
can easily become a
Pharmacist? Tampering with
relativity is a conscious attempt
at breeding mediocrity, again at
the expense of lives. If the
Nurses and Pharmacists accept
to be paid equally with the Lab
“Scientist” and Janitors, it’s their
own cup of tea, but paying
Doctors and Non-doctors
equally? God forbid!
On the Physiotherapists’
demand to make first contact
with Patients:
According to Prof. K. E. Obidike,
there are three reasons why
patients go to see Doctors.
Firstly, is to ascertain the
causes of their complaints and
resolve them. Secondly, is to
identify any other health
problems unknown to the
patient, and again, resolve them
timely, and finally, to have a
baseline documentation of the
patient as a reference for
subsequent health issues. The
second reason especially,
answers the question as to why
a Physiotherapist cannot make
first contact with patients.
Medicine is holistic, and the
initial assessment of a patient
takes the entire body system
into account not just the
presenting complaints.
Therefore, Physiotherapists
should remain Physiotherapists
and should come into action
when consulted. Simple.
On adoption of Foreign
Healthcare Structure:
The fundamental idea behind
the establishment of Tertiary
Healthcare centers (Teaching
Hospitals) in Nigeria was
primarily for training of Medical
Practitioners, Research, and
provision of specialized
healthcare at very affordable
rate. It is not a business
venture, and if this aims and
objectives are to be met, then
the hospital must be made to
operate under the very Act that
established it. Comparing our
Healthcare practices with that
of foreign nations without a
review of the aim and objectives
viz-a-viz that of our country is
practically insane. Granted, a
few hospitals in Canada are
headed by Non-Doctors, and
there are few Non-Doctor
Consultants with well-defined
jurisdictions in a few foreign
countries, but that does not in
any way directly improve their
health indices. After all, high
quality health care is still not
affordable for a large
proportion of Americans despite
their very potent health
insurance system.
Our very first interest should be
to assist the government, which
some members of the health
sector have chosen to distract,
to ensure there is affordable
healthcare services to all its
citizenry, seek ways of
improving the training of the
medical personnel and carry out
Research programs that will
elevate the quality of healthcare
delivery in our own nation. Yes.
We can go abroad and observe
what obtains from there, but
instead of disrupting order in
the already existing system, by
trying to blindly implement it
over here, we can see how best
to fit a few of them into our
system and get the best out of
it. The Government should
concentrate on policies that will
better the lives of the larger
population of Nigerians, not
those that pacify some
disgruntled group of individuals
fighting for position and their
own other personal interests.
There are many other issues
that do not only need
Government attention, but also
its speedy response. Some of
these areas include: the
appointment of Directors in the
hospitals which distorts the
chain of command in the
hospitals, induces anarchy and
expose patients to conflicting
treatment and management
directives; the passage of the
National Health Bill, and
extension of Universal Health
Coverage to cover 100%
Nigerians and not 30% as
currently prescribed by the
National Health Insurance
Scheme; the appointment of the
office of the Surgeon General of
the Federation alongside many
other pressing needs. These are
health issues of paramount
importance and the Government
cannot afford to be lackadaisical
about them. No. Not this time.
My Recommendations:
First of all, JOHESU is an
amorphous body comprising of
different entities with varying
agitations, concerns,
qualifications, expertise, and
eligibility status and should not
be confronted in that front by
the government. Our
government has to recognize
the various constituents
independently and verify their
individual complaints as some
parts of it have no moral
standee to withdraw its services
because of the unmet demands
of another. For instance, The
Medical and Health Workers
Union (MHWU) comprising of
Clerks, Messengers, Record
Officers, Admin staffs, Janitors,
Engineers, Security etc., an
association of different people
with absolutely no training in
any Health related courses
should not dare to aspire for
headship positions in the
hospital let alone been
prevented from doing so. We do
not have to give reasons why
they should not. Therefore, the
five different associations and
unions under JOHESU should be
made to make their specific
submissions independent of one
another for clarity.
Secondly, the Nigerian Labour
Congress and Trade Union
Congress should look beyond
Unionism and focus on the
ultimate goal of everybody in
the health sector which is
adequate Health care for the
Nation. They should relinquish
their parochial stand in the
dispute between JOHESU and
NMA, and as well desist from all
forms of hooliganism and
attempt to bully the
Government and NMA on this
matter.
Finally, the Government should
resist all attempts to coerce it
into yielding to the demands of
one party in the dispute when
the matter is still in court.
There should be absolute regard
for the Rule of Law. And all
previous “concessions” should
be stalled, and pending till a
decisive ruling by the court.
We can go on and on to address
so many other issues in the
health sector that require
attention but I have decided to
throw light at just some parts
of it before the Doctors under
the auspices of the Nigerian
Medical Association, an
association of all certified
Medical Doctors practicing in
Nigeria down their tools as
proposed come July 1st, 2014.
Before the health of the nation
would be thrown into the hands
of Non-Doctors in the Health
sector that usually prefer the
exclusive services of Doctors
when they and their loved ones
take ill. Before the general
public begin to lash out on
Doctors and blame them for
lives lost as a result of the
forthcoming massive industrial
action. The onus lie on the
general public to call out on the
Government to resolve these
life threatening issues before
the Doctors take to this hurtful
last resort of theirs.
God bless Nigeria.
By,
Basil, C. B. – M.B.B.S (Nigeria),
Department of Clinical
Chemistry and Metabolic
Medicine,
Benue State University Teaching
Hospital.

When two elephants fight the grass suffer. To me i have always seen most doctors as wicked and greedy people who are ready to sign people death warrant because of increament in salary. As for those nurses on skimpy gown, i have nothing to say.