Beneli,
Actually, a few Private hospitals are already doing postgraduate training, all they did was to meet up with the PG colleges requirements and were accredited. Eye Foundation in Lagos does residency in Opthalmology and I am sure their residents will be much better trained that residents where I work. They definitely are much better equiped than any govt hospital that I am aware off.
EKO hospital also has a residency programme in General Medical Practice. At the last board meeting of my PG faculty, National Post Grad Medical college, it was already being discussed. The issue of private PG training. The truth is that some private hospitals are miles ahead in their specialty than any goverment hospital and may actually give better quality of training to residents.
im in a hurry so pardon my spelling mistakes.

hello, senior colleagues, i just inducted from Ibadan, and am due for internship, please can you help a young colleague out with information, thank you, God bless

gmyguy:

hello, senior colleagues, i just inducted from Ibadan, and am due for internship, please can you help a young colleague out with information, thank you, God bless

What information do you want?

beneli:

What information do you want?

i wud like to know private hospitals in lagos state that have good internship programmes. thank you

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@beneli
Pls i need to ask you some few questions.what would you think i patient dat presented with 5yr hx of neck pain,feeling of heavyness in d head associated with feeling of collections in the occipital scalp.there has being a mild alteration in the sleeping pattern.and pt beliefs symptoms worsen if he didn't sleep b4 12:am.he has the believe that he has being afflicted with a serious illness and thinks is problem can only be solve by divine intervention from an highly experience doctor or a priest.there has being a great limitation in his functionality for d past 5yrs.pt has being on antidepressant(TCA) for some time which he say brings mild symptomatic relief only to become refractive to treatment.pls i will like you to comment on your view about this and the current trend in the mgt.tnx

^^^^

Let’s break it down point by point.

1. 5 year hx of neck pain, feeling of heaviness in the head, associated with feeling of collection in the occipital scalp(?)
2. Mild alteration in sleeping pattern. Belief that if he doesn’t sleep before 12am he has been afflicted with serious illness; believes the problem can only be solved by divine intervention from an highly experienced doctor or a priest
3. Limitation in his functionality for the past 5 years
4. On antidepressants (TCA) which brings mild symptomatic relief, only to become refractive to treatment.
5. Current trend in the mgt.

Some questions we need to clarify-

1. How did it all start? Were there any clear precipitants or did it develop insidiously?
2. Has the neck pain and feeling of heaviness been progressively getting worse over the past 5 years?
3. Are there any neurological signs associated with these complaints (weakness in specific parts of the body;  visual disturbances; dyspraxia etc)
4. Are his beliefs about being afflicted with ‘serious illness’ delusional in intensity-in other words are they unshakeable in spite of all contrary evidence?-i’ll help out here. Most people back home would share the same belief! So if he continues to hold on to the beliefs in spite of all investigations to rule out a space occupying lesion for instance, such as a CT-scan, then you could add ‘Over valued ideas’ to his symptomatology, given that culturally we believe in divine intervention and that sort of thing. That, however, doesn’t change much. People can have overvalued ideas even if they have serious illnesses!
5. What functions exactly are limited?

The approach to management is to move from the most simple to the more complex:

i) Use physical examination (including neurological examinations and cranial nerve exams) to rule out lesions in the neck region; then carry out basic blood investigations (check for inflammatory markers etc); doing a radiology (X-ray of the neck region) should be a must; ideally a CT-scan/MRI of the head to exclude space-occupying lesions etc should be included. You wouldn’t be forgiven if you don’t recommend it here (UK), but one can understand financial considerations back home.
ii) Based on the findings, you would make your formulation-neurological vs non-neurological (psychological). If there are no findings then you could work on the hypothesis that the patient suffers a Somatoform (pain) disorder, with hypochondriasis.
iii) Somatoform disorders are usually difficult to treat with medication alone. The approach should be Cognitive-Behaviour based psychological intervention, which will challenge his reasons for believing that he has a ‘serious illness’. Selective serotonin re-uptake Inhibitors (SSRI) are the medications of choice, but I can understand the rationale for a TCA, like Nortryptiline, especially if the concern is that the patient has Neuropathic pain.

I hope the above is helpful

@beneli
tnx,for d detailed and well layed out answer.For d few questions you asked-
1)the condition started in his second year in the university.
2)symptom has not being worsning or progressive.
3)pt has a clear insight that his feelings are abnormal and may be psychological in nature.
4)their has being a great reduction in his academic performances.
Although i've being thinking in the direction of hypochodriasis,i just need to make a confirmation of d differential.One more thing pls,how likely is an hypochondriac to respond to tmt?or do most of them live with symptoms for the rest of their life.

^^^

Your Questions:

1. How likely is a hypochondriac to respond to treatment?

The response to treatment depends factors such as the ones below:

i) What are the co-morbidities?- A lot of people who suffer from Somatoform disorders generally are known to have a high level of co-morbid conditions such as Generalised Anxiety Disorder, Depression, Anxious Personality Disorders etc. The intensity hypochondriacal preoccupation may be delusional (in other words psychotic) etc.

ii) What treatment is offered?-Like you rightfully mentioned there is need to be clear about the diagnosis. Is this actually a Somatoform Disorder with Hypochondriasis? Is this a monodelusional psychotic disorder? Are there any neurological explanations for the presentation-in other words have we excluded the differential diagnoses?

Generally, the mantra for treatment of such disorders is to approach it ‘holistically’, in other words tick the biological, psychological and social interventions boxes.:

Biological-be clear about the medication. If there are no psychotic co-morbities then your anti-depressant (TCA, SSRI’s etc) should suffice. If there are elements of delusional interpretations of his experiences, a trial of low dose antipsychotic would not be out of place. But in this case the patient has insight, so it wouldn’t be necessary for him.

Psychological-the psychological intervention of choice would be CBT. In the absence of CBT, psycho-education would suffice. This will involve explaining to the patient in detail about his illness, why he feels the way he does (e.g. an increased cognitive and sensory awareness of his body functions that otherwise he would not have paid attention to if he were not ill), allaying fears about dying from it etc.

Social-this is to look at the exacerbating and maintaining social factors.  You mentioned that it started when he was in his second year in University. Perhaps understanding the particular social stressors he is under will allow you to offer appropriate advice.

The objective of treatment should really be to increase the patient’s ability to cope with the symptoms, rather than to eliminate the symptoms completely

2. Do most live with symptoms for the rest of their life?

I can’t give you any evidence-based figures, regarding prognosis and outcome, but it is estimated that up to 2/3 continue to live with the symptoms. They however learn to cope with it. Like i mentioned above, the objective of your intervention should really be to make him to cope better. If he happens to be among the 1/3 whose symptoms disappear then that’s an added bonus.

I hope that's useful.

^^^

I have responded to your question but for whatever reason it's not reflecting here! The moderator may have to intervene here, otherwise you may just have to click on my name and read the penultimate post. I have clicked on the notify button and hope the MOD will act on it.

Best regards.

Tnx one more time

Watz going on here?this thread is at a GCS of 4.

Glasgow Coma Scale of 4, lol.

^^^

Thank God it's at least rousable!

Anyways, I am curious about what guys think are the reasons why the compensation culture (as it applies to health) has not yet kicked off given the pervasive dissatisfaction with the services available.

My questions are:
1. Why are Doctors/Hospitals not being sued in Nigeria?
2. Are Doctors routinely insured in Nigeria? i.e. is there a requirement for Doctors to get insured against bad practice etc?

I'd like to hear what guys think about this. Question 1 is open to everybody, Doctors and non doctors alike.

Thanks.

I think the reasons why doctors are not sued in Nigeria is because most nigerians are ignorant of their rights and the legal system. And fortunately also,the Nigerian Medical Association effectively support and protect doctors in the case of a serious medicolegal issue.

zerocool:

I think the reasons why doctors are not sued in Nigeria is because most nigerians are ignorant of their rights and the legal system. And fortunately also,the Nigerian Medical Association effectively support and protect doctors in the case of a serious medicolegal issue.

Thanks for your response Zerocool. I wonder if you'd be able to clarify some further issues:

1. Are there Doctors not covered by the NMA or is membership with them mandatory for all doctors practicing in Nigeria?
2. What constitutes a serious medicolegal issue or can the NMA offer support in all cases involving litigation?
3. If there is litigation, leading to a requirement to pay compensation, who pays-the NMA or the concerned Doctor?

beneli:

Thanks for your response Zerocool. I wonder if you'd be able to clarify some further issues:

1. Are there Doctors not covered by the NMA or is membership with them mandatory for all doctors practicing in Nigeria?
2. What constitutes a serious medicolegal issue or can the NMA offer support in all cases involving litigation?
3. If there is litigation, leading to a requirement to pay compensation, who pays-the NMA or the concerned Doctor?

1- All medical students at accredited Nigerian universities offering medicine as a course are expected to write the NMA exam in their final year before they can graduate as a doctor,so that automatically makes them a member of the NMA and qualifies examinees for a medical license to practise in Nigeria. 2- A medicolegal issue in Nigeria is the same as other parts of the world especially same as in the UK, e.g negligence, abortion etc. Here in Nigeria, you hardly ever hear of doctors go to jail or license revoked for such because of the reasons i mentioned in my last post. 3- The doctor concerned pays the compensation required.

zerocool:

1- All medical students at accredited Nigerian universities offering medicine as a course are expected to write the NMA exam in their final year before they can graduate as a doctor,so that automatically makes them a member of the NMA and qualifies examinees for a medical license to practise in Nigeria. 2- A medicolegal issue in Nigeria is the same as other parts of the world especially same as in the UK, e.g negligence, abortion etc. Here in Nigeria, you hardly ever hear of doctors go to jail or license revoked for such because of the reasons i mentioned in my last post. 3- The doctor concerned pays the compensation required.

Thanks Zerocool.

I can't remember having registered with the NMA while practicing in Nigeria. On returning to Nigeria after my basic medical qualification, I had to sit the exam for Foriegn trained Doctors, following which I was registered with the Nigerian Medical and Dental Council and then recieved my license to practice. So, I thought the Nigerian Medical and Dental Council were the ones that facilitate the medical licensing exams, and not the NMA. In the UK, the equivalence of the NMA is the British Medical Association (BMA), membership of which is not mandatory. There are different organisations appart from the BMA which provide support in the event of litigation, but they don't make it mandatory that you join. Each have their different Membership fees and other packages, which entitles you to advise, legal representation etc in the event that you find yourself liable to litigation from aggrieved patients.

I had actually asked about SERIOUS medico-legal issues but i understand what you mean.

The culture of litigation has indirect advantages for Health service delivery as it encourages the health providers and Doctors to strive towards evidence-based good clinical practice. In a society where it doesn't happen, then anything goes, unfortunately. For the patient, it's empowering perhaps to the irritation of the health providers, but you can't hold back the clock! I see this culture of litigation and patient empowerment soon creeping into Nigeria-sooner than most people realise-as the middle class grows. With that culture will come organisations that provide training in evidence-based practice, clinical governance, medico-legal work etc.

Do guys see this as a welcome development or not?

Pls i need information on hospital(federal or state)that are recruiting intern for now or soonest.tnx

hello, can someone please tell me what is the average cost of dialysis in the u.k per session and also renal transplant ASAP? thanks

^^^

The average cost of dialysis is £30,000 per patient per year.
http://www.kidney.org.uk/campaigns/Transplantation/ukt-press-dec03.html

Each session will cost about £230
http://www.privatehealth.co.uk/hospitaltreatment/find-a-treatment/dialysis-treatment/bmi-healthcare/

The cost of a kidney transplant would be in the region of £20,000 per patient per transplant.

If you are thinking of accessing these interventions privately, then below are the contact details of people you may wish to contact:

The London Independent Hospital
Renal Dialysis Unit
1 Beaumont Sq
Stepney Green, London, E1 4NL

Tel: 0800 656 9606
Fax: 020 7780 2416
Email: dialysis_lih@bmihealthcare.co.uk
Web site: www.bmihealthcare.co.uk


Good luck!

DOCTORS WHAT DO YOU SAY;

Specialist nurses paid higher salaries than family doctors!.
According to a news flash,doctors no longer enjoy bumper salary read more;

Primary care doctors were offered an average base
salary of $173,000 in 2009 compared to an average base
salary of $189,000 offered to certified nurse anesthetists,
or CRNAs, according to the latest numbers from
Merritt Hawkins & Associates,
a physician recruiting and consulting firm
.
Read  the full story at www.eclatcareer..com

]

Whatever medical Doctor goes through in Nigeria, they are better placed in term of salaries than Pharmacist. Pharmacist went through more stress for their training than medical Doctors, this is an open truth. Pharmacists are the least respected amongst the three major member of the medical family, namely, Medical Doctors, Pharmacist and Nurses. Nigerian Pharmacists were over trained but under utilized. The law that governs Pharmaceuticals practice in Nigeria is so weak that practicing Pharmacists are not earning salaries that can sustain them. Those in Hospital practice earn far less than their other two colleagues mentioned earlier (this could be objective or subjective). Those in community practice are not smiling to their banks, with Patient Medicine Dealers, faith healers, laying claims to higher percentage of their would be clients. The worse of the practicing field is those in the marketing, their rate of job changing is so high for most a times, they couldn’t meet-up with either sales or collection target. Only few are in the industrial sectors that are a little bit better than their colleagues in other sectors. Several Pharmacists had abandoned the profession for something better. I desire to be rich and I know practicing the profession in Nigeria would not offered me what I wanted, I went back to school, to study Law, I am very comfortable with the practice.

Any Pharmacist who desire to practice outside of Nigeria could do so, though the process is somehow cumbersome, but the result of its success is fulfilling. UNITED Kingdom will be the best option, paparticularlyoung graduates, while US is equally good their modus operandi would be very difficult for any one from Nigeria without immigrant status to get into. Australia, Canada and New Zealand other places I will recommend to young Pharmacist who may desire making what I desire.

Fisay u say pharmacist's went tru more stress than doctors in medical school? Dats so untrue! Y r u peddlin untruths? Abeg delete dat fabu from ur post

Afrodoc, you may disagree with me, it is your right. I guess you possibly did not pay more attention to this fact or possibly you did not compared the stress of training Pharmacist in Nigeria and stress of training Medical Doctors in Nigeria. Nevertheless, that is not the issue here, like I said, it is subjective. We are all in the same boat.

Fisay:

Those in community practice are not smiling to their banks, with Patient Medicine Dealers, faith healers, laying claims to higher percentage of their would be clients.

As Fisay rightly noted; we're all in the same boat, when it comes to that overhanging sense of having been abandoned by the government etc etc, and especially when it comes to the difficulties experienced as a result of the activities of the patent medical dealers and the faith healers! Both engage in some very worrying practices and one wonders why they are allowed to continue in these dodgy 'practices', without adequate regulation. The truth is that Doctors and Pharmacists short change themselves by not ensuring that there is better regulation in the health services industry. The way things are everybody (doctors, pharmacists and the service-users) suffers! 

@ Fisay, I don't agree with you though, that Pharmacists went through more stress in their training! The experience of 'stress'-as you highlighted-is, at the end of the day, a very subjective thing!

I don't know when this re-curing fight for supremacy between doctors and pharmacist is going to end. Unfortunately we are all looking up to government to pay us. As I keep saying if government would do its main job which is regulation of health services and provision of a healthy framework for health insurance, we all wouldn't be comparing our salaries. We would be out there being creative and working our butts off(pardon my language) to make our dough.
Unfortunately for other health workers in Nigeria, a lot of medical care still revolves around the doctors. The patient needs to be seen and examined by a doctor to get a diagnosis which then generates investigations and prescriptions and nursing care. Until the doctors services become less important in the scheme of things he will keep getting paid higher.
As for the nurse anaesthetist earning more than some doctors, the truth is that the service they are rendering is seen as more important hence the pay.Its the basic laws of demand and supply.

@FISAY: You are wrong with ur viewpoint and claim that pharmacy students go through more stress than medical students. Using my school as an example, 1, compare the length of study for both. 2, during exams, pharmacy students just write MCQ, theory and maybe perform practicals but med students write MCQ, theory, do viva voce, husky, short and long cases. During clinical yrs of studies, medical students do call duties overnight while pharmacy students don't. These are just to mention a few.

@fisay
Atleast be sincere with ur self.

zerocool:

@FISAY: You are wrong with your viewpoint and claim that pharmacy students go through more stress than medical students. Using my school as an example, 1, compare the length of study for both. 2, during exams, pharmacy students just write MCQ, theory and maybe perform practicals but med students write MCQ, theory, do viva voce, husky, short and long cases. During clinical yrs of studies, medical students do call duties overnight while pharmacy students don't. These are just to mention a few.

ABSOLUTELY

It is very sad hearing that someone thinks that pharmacists undergo more stressful training compared to doctors. Soon, we will be hearing that Nurses are better trained than Doctors.
A person's perception of training is very subjective, but despite that fact one can't jump to the conclusion that one training is more stressful than the other. Both trainings have got merits. But looking at the curriculum and courses taken by both professions, it is more cubersome to be a doctor.
I also want to clarify that there is no such thing as three major members of the medical family (Doctors, Pharmacists and Nurses). All healthcare professions have got its own importance and they are meant to work hand in hand. For example, a person who has got a chronic back pain will need the combination of the following people to work together: Doctor, Nurse, Pharmacist, Laboratory/Clinical Scientist, Radiographer and a Physiotherapist.
I will also like to point out that the Doctor is always the head of the medical team. He learns a bit of every branch of medicine. He is also known as 'Jack of all trade, Master of none'. Remember, we once had a Surgeon General in the our beloved country.
The only reason why the Doctor's profession is sometimes abused by people is basically because of the low income the Doctor gets.
I was forced to leave the country to seek greener pasture in another country because I was earning N60k per month as at 2007. Things may have change now in Nigeria, but each time I look at my payslip in my country of abode, I smile and say to myself 'it is not yet time to go home'.
I will also like to make a clarification that if Nigeria's health system is redefined and all issues are addressed, a great number of healthcare professionals may decide to come back home.