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.
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.

After downloading ur lecture notes here, pls justify these.

Why would physicians stop other health professionals from becomming consultants and directors in their own field, eg physiotherapist becoming a consultant physiotherapist etc.

Why would the nigerian physicians stop other health profesionals from becoming directors even if they have PHD and has spent several years in service?

Why shld nigerian physicians insist that other health professionals shld not move from level 10 to 12 as obtainable in every other government parastatel, but should go through level 11 as a way stagnating others.
I am really disapointed and ashamed of nigeria physicians. They have allowed their selfish ego to becloud their sense of truth.
After downloading this your lecture notes given to you by your achaic and outdated lectures,
I will advise you to do a little reseach on international best practises in hospital administration.
Also check if other health professionals become consultants in other countries, eg UK, USA at least these are countries we emulate from in most things.

pls burst that primitive egocentric menterlity that has left Africa behind every other continent on earth.

@ OP, CEO
can you go tru these, by an outsider.

http://feathersproject./2013/08/27/health-workers-strike-nigerians-are-dying-by-fejiro-oliver/

Please read this before JOHESU brain washes you and make doctors enemies of the general public.
Who is greedy: JOHESU or NMA
FACTS ABOUT HOSPITAL MGT BY Archibong F. |
Medical World Nigeria - MWN
http://www.medicalworldnigeria.com/2014/07/
facts-about-hospital-mgt-by-archibong-f#
.U7LVJRPtu6s.facebook

iiiyyyk: After downloading ur lecture notes here, pls justify these.

Why would physicians stop other health professionals from becomming consultants and directors in their own field, eg physiotherapist becoming a consultant physiotherapist etc.

Why would the nigerian physicians stop other health profesionals from becoming directors even if they have PHD and has spent several years in service?

Why shld nigerian physicians insist that other health professionals shld not move from level 10 to 12 as obtainable in every other government parastatel, but should go through level 11 as a way stagnating others.

Please convince me on the above points
Thank yon.

You can read the following article for clarifications on why Directors should not be allowed in hospital settings.

NMA Strike And Crises In The Health Sector - Health - Nairaland

https://www.nairaland.com/1798239/nma-strike-crises-health-sector#24440675