RE:THE MASTERS AND THEIR SLAVES

After reading through the article by one Alli John Adeolu (and his likes), Chief Medical Laboratory Scientist of God knows where, I couldn't help but punched my keyboard in response to his distortion of facts. There will have been no need for a reply if it were only for his low quality unreferenced write up. NMA raised 24 demands, but for reasons best known to him, he decided to chose only 4.

I think there is no need for me to respond to the jaundiced compazimibraun: The only disagreement I have with this write is the fact tha, he doesn't understand why the Doctors want to be incharge. If doctors don't manage the hospitals as chief Medical directors(cmd) how does he want them to raise money for the political ambitions and plans of owning big churches? The Doctor needs to have a budget and award contracts to make money and become a Senator, Governor, House member and General Overseer. Check the Nigerian senate and various churches and private hospitals and u wll understand what am talking about.arison of Doctors to either our colonialists/imperialists or Boko Haram, that will be too childish. If one finds it difficult to differentiate civility from primitiveness and started comparing Nigerian Doctors with murderous groups, then I guess it is a waste of intellectual calorie to try to reply.

Chief, doctors are not superior to other health workers because the former spent 6 years in undergraduate school, sam sam. Professional superiority arises because of competitive knowledge advantage and nothing else. Even if you extend the study of medical laboratory science to 10 years, its certificate cannot be equivalent to that of MBBS because the curriculum differs, their roles differ. It is not a matter of theology; belief or unbelief.

The FMOH of Nigeria doesn't have directories, but rather directorates and they are 8 and not at least 5 and they are not all headed by Doctors. According to Presidential Committee on a Harmonious Work Relationship Amongst Health Workers and Amongst Professional Groups in the Health Sector chaired by Hon. Justice Bello A. Gusau, "By its approved structure, the Federal Ministry of Health has eight Departments, namely: Department of Human Resources; Department of Finance & Accounts; Department of Planning, Research & Statistics; Department of Procurement; Department of Hospital Services; Department of Public Health; Department of Family Health and the Department of Food & Drugs Services. Of the four Professional Departments, three are headed by medical practitioners while one is headed by a health professional who is not a medical practitioner." Do you propose a JOHESU to head Hospital Services, Public Health or Family Health?

Yes the CMD and the CMAC are doctors, but you failed to mention the latter is a director of clinical services representing all the clinical departments with a single vote just like the director of administration, director of Nursing etc. The CMD is a Doctor because the law says so, you can always go to court if you are not happy about that. No, Doctor mustn't head medical lab scientist, but a Doctor must head clinical laboratory. If you decide to open your private lab, no Doctor will lord over you, but then he won't use your results.

Truth is Doctors don't hate you guys to have increase in salary, but their must be relativity otherwise what is the essence of adding quality to patient care? Wages are paid based on intellectual input here on earth, I don't know of other planets. No Sir, thats incorrect, Doctors do not earn a minimum of N250,000 in Federal Institutions and a very senior consultant N500,000. Either you didn't see the circular or you are distorting it. Wouldn't it have been easier to just reproduce it here and compare CONMESS and CONHESS, to see who is cheating who?

I want to believe even a junior staff knows salary is divided in to basic salary and allowances. Federal Ministry of Education pays lecturer-Doctors basic salary while Federal Ministry of Health pays them call and specialist allowances. Does that constitute double salary? You see, don't dabble in to something you have no knowledge of. Have you ever read the responsibility of a Consultant? Do you imagine the fellowship is just for his immediate environment and his services not required in the periphery? Please check the geographical radius a consultant is suppose to rotates.

Since you are not a constitutional lawyer, why don't you allow a competent court of law interprets what medically qualified means. Shikenan. You insinuated medically qualified applies to you, thats delusional. Read the act for the appointment of CMD again or get a translation.

You carelessly define the word consultant without a single reference in the hope the gullible and lazy populace wont crosscheck. Both Advanced learners English dictionary and Merriam Webster dictionary have two similar definitions for the word. As per the latter thus;

1. A person who gives professional advice or services to companies for a fee.
2. A hospital Doctor of the highest rank who is an expert in a particular area of medicine.

Let me attempt to explain one demand called consultant/specialist in clinical practice. In summary all doctors have the basic undergraduate degree called MBBS (Bachelor of Medicine, Bachelor of Surgery); which of cos currently is a misnomer since the course covers many specialties apart from the traditional Medicine and Surgery. In those days doctors were either physicians or Barbers (Surgeons). Now after the basic degree, you can divide doctors broadly in to two; Medical Officers and Consultants/Specialists. In between you have House Officers/interns and Residents (Specialists in training). To be a specialist, requires an average of 6 years in an accredited health institutions. Ours is not the traditional PhD cos of the complexity of human diseases and the need for clinical knowledge. Thus it is a unique training combining theory and clinical skills at the same time. Example, one cannot have a PhD in Neurology, in fact its impossible cos of the numerous neurological conditions afflicting human populace ranging from infectious, inflammatory, degenerative, neoplastic, traumatic, metabolic etc with further subdivisions. Another example, one will attempt to have PhD in a degenerative disease called Dementia. I say attempt cos its not even practicable due to its numerous unrelated causes. To be a Neurologist, one must be drilled first in all medical specialties for at least 24 months and then in human neurological clinical conditions in the remaining time including a thesis in one of the entity. The other arm is Medical Officer who chose not to specialize rather improve themselves either through academic degrees or just progressed through conventional civil service. The hierarchy is thus in descending order; Consultant > Residents > Medical Officers > House Officers in terms of professionalism and quality of patient care. Specialists are suppose to see complicated cases or those with potentials to cause complications and or cases requiring advance care; there is no need for a consultant to see controlled uncomplicated Hypertension or Diabetes Mellitus, uncomplicated Malaria, Typhoid, Pulmonary Tuberculosis etc. Now is it fair to compare a medical consultant with someone who did 3 year diploma course with 1-2 year post basic studies or even that with academic PhD? In the tertiary hospital, a Consultant is the final refined touch of any patient management. He owns the patient, leads the unit, teaches medical students and mentor residents. So if someone say has an MSc in Iron deficiency anaemia and PhD in Hemoglobinopathies (assuming not just theoretical academic degrees), will he then be appointed as a Senior Resident and Consultant Hematologist respectively? What if someone present with Hemophilia or Leukemia? Ok I hear you say no big deal, there are others that will specialize in those areas. That is correct, but how many consultants are you going to have in hematology, 1000? Thus in a hospital you will need like 500,000 consultants to manage just one centre! This of course is not practicable and that is why medical postgraduate training is very different and unique. It may interest you to know Medical Officers whatever their qualifications or years of experience are not candidates for CMD in the tertiary institution or even the secondary centers in the presence of a consultant. Again the position of a consultant itself has legal implications when it comes to litigation, autopsy or as expert witness. Patient care is under the consultant playing the central role not because of anything but for his strategic knowledge advantage. There is no need for a consultant to be in the primary health centres. So if the FG appoints other health workers as medical consultants, imagine the confusion. What role will they play, what value will they add to patient care? Let me elaborate on this, a lab scientist will insist a patient to use an antimicrobial drug based on laboratory drug sensitivity pattern irrespective of clinical outcome whereas a Consultant Medical Microbiologist or Physician will not so long the patient is responding to the initial empirical drug treatment even if the pathogen showed antimicrobial resistance on the plate. Another example is physician will not treat as emergency isolated case of hyperkalemia without cardiovascular examination and ECG even if scientist suggested such. Chest pain with rise in cardiac enzymes doesn't necessarily mean Myocardial Infarction.

There is an old age rivalry between Doctors and other health workers that can be traced right from undergraduate level. You may not have noticed it or probably studied outside the country, but it was there. Not only among them but surprisingly even among lawyers. There is this childish debate about who is learned. This gradually turned in to envy and now dangerously in to enmity. Just read their comments, articles or interviews, you can't possibly missed the unmistakable deep seated frustration and hatred. People have no qualms spreading falsehood among unsuspecting populace just for financial gains. The funniest thing is that those people bring their family and relatives to see Doctors (they never entrust such burden on their colleagues) and the elite promoting the discord all have Personal Physicians. Am not aware of personal this or personal that, but then I know very little. Again when you go to the private clinic and NGOs, everybody conforms to ethics, isn't it a wonder? Why then do we have confusion only in the tertiary health institutions? Everything is about money. Ok suppose one of them is appointed a consultant, what will be his job description, what input will he make in patient care? Some even want to be appointed directors at grade level 17, imagine. As a Doctor with MBBS my entry point is grade level 12 and 15 as a specialist, imagine how many directors a teaching hospital will have in the next 6 years or so. What will happen to other civil servants who have reached level 17 but not yet directors? What will happen to other workers with same qualifications who are not even suppose to reach directorate level?

You seem to be fascinated with USA and UK model of health system where you were eager to emphasize the qualification of hospital CEOs. Yes they do have non Doctors as ministers of health, but you failed to say they equally have office of the Surgeon General and Chief Medical Officer as well. Ironically you are not that keen to borrow their leaf on privatization of hospitals because of cost, but in actuality it is the fear of loosing your fight. Why not go all the way and clone their system here? You have to understand theirs is a capitalist economy and thus putting a non Doctor up there doesn't mean anything. A Doctor will always put patient first in his policy, obviously this is against the fundamental of capitalism.


Ibrahim Toli
doctoli@gmail.com

http://www.medicalworldnigeria.com/2014/07/the-masters-and-their-slaves-by-alli-john-adeolu#.U7nDg2W9KSM

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