reindeer:

The whole essence of a hospital is the doctor-patient relationship.
Poeple walk into a hospital to see doctors and get their problems addressed.
Other health workers are in support roles to help the doctor achieve his desired result for the patient.
[b]The problem is peoople lose sight of this fact in Nigeria and that's what leads to unneccessary rivalry.[/b]People should be proud to be what they are and stop trying to compete with doctors, its an inferiority complex.

I have to second this. This is the same mentality that has led to the demise of Polytechnics in NIgeria. They were always competing with Universiites, now we have no vocational skills and no technical professionals. The university and the polytechnic graduates have now become uselesss while we look for welders and other artisans from other countries!

I understand the OP's frustrations with this issue but a Pharmacist or Nurse becoming the medical director will not solve your issues. There are other ways to address these issue and the Doctors need to be magnanimous too, this winner takes all mentality in the management of our affairs is not helping us.

@OP:It is very funny that you want people's opinions from this thread despite your already prejudiced and myopic view point to the extent that you even used abusive,uncouth and irresponsible languages against opinions that are contrary to your jaundiced view.I thought you need opinions and not impose your own.
There is no place for comparison here as stated by reasonable and unbiased Nigerians.For your information,doctors have maintained dignified mutism for so long despite barrages of orchestrated attacks from paramedics because an Albino does not need to announce his/her presence in the market place and because we are too busy saving lives to be struggling for supremacy in the health sector but things are going to change and you shall go back and bury your head in shame.It is unfortunate that we have a 'government of anything goes' in Nigeria and the society is so lawless.I think the question you should ask yourself is 'What is the global best practice over this matter?'
If you want to head hospitals,please write JAMB that you failed earlier again and go to medical school.

Must a jugde be a lawyer? Why can't other paralegal professionals aspire to become a jugde. Why can't the accountant general or auditor general be a medical doctor. How can a pharmacist be a medical director? We are talking about people that don't even attend ward round in a hospital? What do they know about laboratory? To put it correctly, doctors are the only health professionals that do postings in every medical field while in school. From pharmacology to pathology to microbiology to medicine to surgery. There is no aspect of medicine that doctors didn't touch. A doctor can effectively man the laboratory wtot any problem infact doctors can specialise in lab medicine. They can specialise in pharmacology. They know a bit about every aspect of hospital section if not more especially wen they specialise in that field. Worldwide a doctor is the head of any medical team according to WHO. Even if the doctor qualified yesterday and the pharmacist has been qualified for donkey years if they find themselves together as a team in any medical mission the doctor is the head. Even NYSC camp doctors head the clinic. If you want to head medical team go to medical school and stop looking for cheap blackmail on a forum

God bless you[b] helpee[/b].During the last failed strike embarked upon by the Lab Technicians nationwide over their desire not to be under doctors,most Teaching hospital functioned maximally as doctors were mobilized to the laboratories to fill in the gap.I personally ran the automated machine in the blood bank of my centre for Full Blood Count and Grouping and Cross matching of blood for emergency cases.Infact,there is a court case in Kogi state now because when these irresponsible people realized that their strike did not paralyze the hospital as intended,they assaulted the doctors working in the lab and policemen were called into the centre.
In the history of medical practice,doctors were the ones carrying out all these investigations in the side labs of hospital but to lessen the job burden for professionalism,lab technicians were trained to man the labs and now they want to take over.

medical doctors hav led our health sector over the years and guess wot they achieved? Bottom table ratings in d world health care chart!
As much as i know, there is a hospital management course in other countries. In a country where even trained proffesional management personal fail in proper management of institutions due to nigerian factors, doctors who have little or no exposure to management trainings shouldnt be left in totally in charge.
I think we need a serious selfless review of our health system to achieve and help our people. All that matter to our doctors is to sit tops n demand bumper salaries at intervals from govt,while they expect worship praise from d average low esteem and ignorant nigerian.
Their mates abroad are researchn and moving on,forming research teams with every other colleague in the healthcare field,even outsider lyk engineers to enhance medicine, but here, a first degree physician in orthodox 1985 medicine knowledge walks around the hospital and thinks about how he wil ride his health colleagues he shud be working with,jst to show a baseless superiority.
Maybe one day we wud get to seperate the hospital depts into differently located health units just to achieve selfish desires.
I pity 4 our health system and our so called 'doctors'

thr they go, exposing their sheer ignorance, 4 how long did u do medical microbiology and haematology at graduatn to knw how to run a blood bank and haemat tests 100%?
Thats wot we expect from a mediocre system!

There was a time in this country when medical directors were administrators. There was a lot of squabbles. While I agree the office of the CMD is mostly administrative, they administer on managing the resources that would ultimately affect the lives of patients.

It is all in the training really. Most other professionals are trained to SUPPORT the doctor in managing a patient. The doctor is trained to LEAD the team to treat the patient. If other health professionals desire to be MDs, wont it be a waste of their training as well?

Should administrators do the job? Not yet? Especially not the kinds we have now. No expertise in health management. I am not talking of getting a masters degree in which your assignments were done for you and you paid a hungry graduate to write your thesis.

i think in order to really address this issue one must identify what the role.duties and function of a CMD are.

the title is a common and historical one in many government hospitals in nigeria.

in the UK the more usual title is Medical Director so they drop the "Chief" (TRUST NAIJA) we wont do that.
in England the person occupying this role is a member of the Board of the hospital and provides leadership to doctors and advice to the board on "medical" matters. there is a Chief Executive who is rarely a doctor and quite often has a nursing background.
there is also on the board a "Director of Nursing" who performs a similar role to the medical director as relates to nursing matters.
eg workforce strategy,planning,discipline , legislation etc.
the role of the chief executive is very different and there is some evidence that one person should not combine both roles in some situations.


in Nigeria the CMD  combines medical director function with chief executive functions but this is not necessary or found everywhere and tends to bring about conflict.

the CE does not even have to be a health professional
as such the real question is not who should be CMD but should there be a CMD.
there are so many different kinds of hospital Teaching,General,Specialist e.g Orthopedic,Psychiatric in Nigeria they tend to adopt a blanket management structure but this is not necessarily right in all cases.
there are many cases of Nurse led Organizations in the UK and the skies have not fallen though there was tension in the early days.
in summary  CMD is an anachronism that is no longer relevant in modern hospital management
i am guessing that a lot of doctors who are in naija are on this blog. if you ever go abroad e.g the UK or US you will need to unlearn that attitude FAST

actually non-lawyers can become judges in the US supreme court.
better not to assert in ignorance

Please HAVE A LOOK at this

http://well.blogs.nytimes.com/2011/07/07/should-hospitals-be-run-by-doctors/
i post this not as evidence as it proves nothing really but just for interest

no,it must be a bricklayer

reindeer:

The whole essence of a hospital is the doctor-patient relationship.
Poeple walk into a hospital to see doctors and get their problems addressed.
Other health workers are in support roles to help the doctor achieve his desired result for the patient.
The problem is peoople lose sight of this fact in Nigeria and that's what leads to unneccessary rivalry.
People should be proud to be what they are and stop trying to compete with doctors, its an inferiority complex.

maybe in nigeria

but that is not true everywhere any more
there are dozens of chronic conditions for which the only interventions are supportive  and rarely involve doctors.
that model of medicine is so 1970s. modern medicine is  different these days

there are so many other therapists in a modern hospital who do stuff doctors are not trained to do.

I think anyone taking up the position of CMD should have a lot of experience in the Medical field and also possess some form of Health Management training.

With that said, Doctors are sort of generalists in the any Hospital. A doctor knows the job of a Pharmacist, a Nurse, a Radiologist, and so on. But every other person working in a hospital is sort of specialized in a specific field.

A Doctor can replace a pharmacist or nurse (cause they know the generalities of their work) but neither of these people can replace a Doctor.

That's why Health Care Centres don't handle complex cases in the absence of a Doctor.

I'm not a Doctor BTW.

a doctor CANNOT replace a Pharmacist or other professional maybe a native doctor in a village hospital  NOT in modern medicine.
but there is no part of the training of a doctor that equips them to handle or dispense drugs some doctors do not even know the colour of some tablets they prescribe !!
BUT even if they can what has that got to do with being the chief executive of a hospital many doctors do not know the difference between a balance sheet and a profit and loss account
what is more important is man management as well as resource management. a good chief executive does not have to know everything but he must know the LIMITS of his knowledge and how to build a team that complements him adequately and be able to delegate effectively

in fact he might have been the chief executive of Guinness in his last appointment it would not make much difference

aribisala0:

actually non-lawyers can become judges in the US supreme court.
better not to assert in ignorance

Please HAVE A LOOK at this

http://well.blogs.nytimes.com/2011/07/07/should-hospitals-be-run-by-doctors/
i post this not as evidence as it proves nothing really but just for interest

I hope you did assert the bold portion in ignorance. I was a lil confused to how a non-lawyer sit a justice in SCOTUS.

@Iolo,

In the U.S., doctor cannot replace a pharmacist, pharmacist make their drugs and dispense these drugs. Doctors on the other hand prescribe these medications based on the dosage. In fact, pharmacist are more like than not make changes/alter to the doctors prescription if these drugs are strongly controlled medications like narcotics. The pharmacist are trained on the areas of drugs dosage (manufacture and dispensation), doctors just prescribe it,  A pharmacist is more likely than not to tell you the cause and effect of a drug reaction than a doctor is, so sorry, doctors are not and cannot replace pharmacist. Again, just my opinion,

OP if you want to head your own unit, well become the Pharmaceutical Director i.e. if they have one, just like you have medical director, nursing director, etc in a hospital.

Nawa o, not dis argument again,

aribisala0:

maybe in nigeria

but that is not true everywhere any more
there are dozens of chronic conditions for which the only interventions are supportive  and rarely involve doctors.
that model of medicine is so 1970s. modern medicine is  different these days

there are so many other therapists in a modern hospital who do stuff doctors are not trained to do.

You're making assumptions here. Most of those chronic cases have been seen by the hospital doctors and referred for community care, this frees up the doctor to take up more complex cases. An example is cystic fibrosis in the UK, the care is mostly in the community and so for many other cases, but these people have peoriodic hospital reviews(3, 6monthly or yearly) where they may see the doctor or the specialist nurse who is trained by the doctors in the hospital to handle just that particular ailment.
People need to stop feeling inferior and be proud of their professions. wanting ''our own'' to be in 'power' won't help anything. It is the same mentality we apply in politics wanting the president to be from our zone and what has that acheieved for anyone in any zone for that matter?
The whole thing boils down to people not knowing the limits of their knowledge and an unneccesary ego trip. You don't see such wrangling in the UK because the salaries are fixed based on experience, years of study and level of responsibility.

all over the doctor is the head, so whats the fuss all about

manny4life:


I hope you did assert the bold portion in ignorance. I was a lil confused to how a non-lawyer sit a justice in SCOTUS.

@Iolo,

In the U.S., doctor cannot replace a pharmacist, pharmacist make their drugs and dispense these drugs. Doctors on the other hand prescribe these medications based on the dosage. In fact, pharmacist are more like than not make changes/alter to the doctors prescription if these drugs are strongly controlled medications like narcotics. The pharmacist are trained on the areas of drugs dosage (manufacture and dispensation), doctors just prescribe it,  A pharmacist is more likely than not to tell you the cause and effect of a drug reaction than a doctor is, so sorry, doctors are not and cannot replace pharmacist. Again, just my opinion,

OP if you want to head your own unit, well become the Pharmaceutical Director i.e. if they have one, just like you have medical director, nursing director, etc in a hospital.

i think if someone asserts that then it behoves you to check rather than ask in foolishness whether they are ignorant. i chose my words very,verydeliberately. there is no constitutional or statutory requirement that supreme court judges in the US are lawyers

sartorius:

all over the doctor is the head, so whats the fuss all about

MUST AN AIRLINE BOSS BE A PILOT?
OR THE CHIEF EXECUTIVE OF A FOOTBALL CLUB BE AN EX_PLAYER
please do not talk ignorantly .head of what?
i am a doctor for almost 20 years and there is nothing in a doctor's training that prepares him to handle a budget. nothing. anyone with suitable experience can be the chief executive of a hospital or healthcare organization. in the the US more often than not it is Not a doctor who is the chief executive which is what a CMD is as distinct from medical/clinical director which is a different role

reindeer:

[b]You're making assumptions here. [/b]Most of those chronic cases have been seen by the hospital doctors and referred for community care, this frees up the doctor to take up more complex cases. An example is cystic fibrosis in the UK, the care is mostly in the community and so for many other cases, but these people have peoriodic hospital reviews(3, 6monthly or yearly) where they may see the doctor or the specialist nurse who is trained by the doctors in the hospital to handle just that particular ailment.
People need to stop feeling inferior and be proud of their professions. wanting ''our own'' to be in 'power' won't help anything. It is the same mentality we apply in politics wanting the president to be from our zone and what has that acheieved for anyone in any zone for that matter?
The whole thing boils down to people not knowing the limits of their knowledge and an unneccesary ego trip. You don't see such wrangling in the UK because the salaries are fixed based on experience, years of study and level of responsibility.

i am not making assumptions.
i am a doctor and have been for a long time. there are nurse consultants with their own case loads as there are consultant psychologists,speech therapists, physiotherapists and all that. at any rate those are technical issues nothing to do with management which is a different discipline requiring a different set of skills.
community services still are part of the NHS and must be managed.No? that means planned,budgeted for,admistered and given logistic support which entails contracts etc that is what the role of a CMD (chief executive is) very little to do with medicine and more to do with operations management,financial management,strategy,HR etc
if you know anything about the uk as you are pretending to tell us how many chief executives of NHS trusts are doctors or health professionals. the number of health professionals in this role is small and of those MOST have a background in nursing. please spare us details like cystic fibrosis and all of that. it is not relevant to who should be a CMD(chief executive)

the backbiting and competition within the health sector can be annoying. anyways i agree with u. there is nothing in a doctor's training that prepares him to handle a budget. same goes for pharmacist and other health workers. Individual  vary with their administrative capacity, US aint nigeria.

aribisala0:

i am not making assumptions.
i am a doctor and have been for a long time. there are nurse consultants with their own case loads as there are consultant psychologists,speech therapists, physiotherapists and all that. at any rate those are technical issues nothing to do with management which is a different discipline requiring a different set of skills.
community services still are part of the NHS and must be managed.No? that means planned,budgeted for,admistered and given logistic support which entails contracts etc that is what the role of a CMD (chief executive is) very little to do with medicine and more to do with operations management,financial management,strategy,HR etc
if you know anything about the uk as you are pretending to tell us how many chief executives of NHS trusts are doctors or health professionals. the number of health professionals in this role is small and of those MOST have a background in nursing. please spare us details like cystic fibrosis and all of that. it is not relevant to who should be a CMD(chief executive)

I refuse to resort to crass attitude like saying people pretend to be what they're not.
You mentioned community care and i only gave you an example, you can take or discard it, that's your take.
All community cared for folks still have clinic appointments no?
I am yet to meet a nurse consultant in the UK, there are many nurse specialists who essentially have support roles for the targeted care of specific illnesses.
The Overall responsibility for the patient lies with a consultant(they are registered to a consultant, either they are cared for in the community or not)
Until Nigeria develops a robust system with good community support like in these developed climes, it will be foolhardy to want to appoint chief executives like in the NHS.
Coming to the NHS i hope you realise they are divided into trusts and the hospitals are just an arm of the whole healthcare set up in the trust. They all have a MEDICAL DIRECTOR responsible for the medical aspect of the hospital work, then a chief executive for the whole trust.You wouldn't know that anyway. Tell me what else hospitals in Nigeria do apart from the medical part?Are they involved in buying healthcare for the citizens?
The chief medical directors are doctors who still have patients and still see them, they remain connected to the sharp end and can make better decisions. You will be surprised to know that many medical directors in the NHS still see their patients regularly and they still do their admin job well.

reindeer:


I refuse to resort to crass attitude like saying people pretend to be what they're not.
You mentioned community care and i only gave you an example, you can take or discard it, that's your take.
All community cared for folks still have clinic appointments no?
I am yet to meet a nurse consultant in the UK, there are many nurse specialists who essentially have support roles for the targeted care of specific illnesses.
The Overall responsibility for the patient lies with a consultant(they are registered to a consultant, either they are cared for in the community or not)
Until Nigeria develops a robust system with good community support like in these developed climes, it will be foolhardy to want to appoint chief executives like in the NHS.
Coming to the NHS i hope you realise they are divided into trusts and the hospitals are just an arm of the whole healthcare set up in the trust. They all have a MEDICAL DIRECTOR responsible for the medical aspect of the hospital work, then a chief executive for the whole trust.You wouldn't know that anyway. Tell me what else hospitals in Nigeria do apart from the medical part?Are they involved in buying healthcare for the citizens?
The chief medical directors are doctors who still have patients and still see them, they remain connected to the sharp end and can make better decisions. You will be surprised to know that many medical directors in the NHS still see their patients regularly and they still do their admin job well.

patient care and service management are related but separate entities. your discourse on patient care is informative but not really relevant.

that you are yet to meet a nurse consultant means what? since when did your personal experience become a measure of reality?
in orthopaedics,psychiatry ,rheumatology and other specialties there are many patients who are referred by their GPs, have hospital encounters with INDEPENDENT practitioners and return back to their GPs without a doctor coming into the loop AT ALL. these are not "Support roles" as you call them.so your claim about "OVERALL RESPONSIBILTY" is an anachronism that does not reflect the multi disciplinary thinking that prevails in many specialties.
at any rate it is not relevant.

yes the pilot is in charge of the plane in the air does that mean

PILOTS SHOULD RUN THE AIRLINE?

So does Nigeria have ''airlines'' now or just ''airplanes''?

Tks reindeer, the Uk system is different from ours, so comparison is faulty. the nursing union here also proposed to have their consultants too without a framework or binding law.

do not forget that many of us trained and worked in nigeria. in nigeria we have management structures that have not changed from the 60s but are no longer useful. many medical students are indoctrinated with this we are the head attitude without realising that there is a difference between patient management and system management

ARD would resist it, its not true that the management structure hasnt changed, it has been evolving and the natonal health bill that has yet to be assented to by Mr president also addresses some issues. We know how much Relativity would have been distorted in nigeria. The current laws of the land support the status quo. maybe a bill changing the management structure and composition should be sent to the national assembly, I would rather channel energy in making sure we provide care to our patient at all levels. what works in the Uk doesnt work in germany.

Please Mr. Chookodi, let doctors run the hospital for now.Last time i checked u needed an MBA even as a medical doctor to become a CMD(well i'm certain of my own hospital)

Dude, you are so funny, this rivalry is everywhere, well, if the Pharmacist is actually a Pharmacologist or a Clinical Pharmacologist, why not, actually, the country's health sector is in shambles solely because the Health Minister is not a Doctor!!! And the so called Professionals dishing out Health Policies are incompetent in the health field. Will an Air hostess fight for the right to be a Pilot and the Passengers sit still, simply because she has been flying for 20 years or the Doctor's maid who has been sitting with the Consultant for 20 years during his consultations insist on seeing her own Patients? the answer is ''yes'', in a place called Nigeria!!!

sofa-dj:

Please Mr. Chookodi, let doctors run the hospital for now.Last time i checked u needed an MBA even as a medical doctor to become a CMD(well i'm certain of my own hospital)

where did you check? please be quiet and stop misinforming the public.
clearly you have not got a clue about this subject

gmyguy:

Dude, you are so funny, this rivalry is everywhere, well, if the Pharmacist is actually a Pharmacologist or a Clinical Pharmacologist, why not, actually, the country's health sector is in shambles solely because the Health Minister is not a Doctor!!! And the so called Professionals dishing out Health Policies are incompetent in the health field. Will an Air hostess fight for the right to be a Pilot and the Passengers sit still, simply because she has been flying for 20 years or the Doctor's maid who has been sitting with the Consultant for 20 years during his consultations insist on seeing her own Patients? the answer is ''yes'', in a place called Nigeria!!!

i think your analogy is wrong flying an aircraft is different from running an airline.
performing surgery and running a hospital are completely different jobs.

you do not need medical training to run a hospital just as you do not need a pilots licence to run an airline.

aribisala0:

i think if someone asserts that then it behoves you to check rather than ask  in foolishness whether they are ignorant. i chose my words very,verydeliberately. there is no constitutional or statutory requirement that supreme court judges in the US are lawyers

In your bid to sound smart and intelligent, you sound really STUPID obviously. Where did I mention about statutory requirement and the constitution bullshit and nonsense you're saying here now? In fact was the thread about lawyers and judges and Supreme Court. I had to ask if you're ignorant because ain't no need to check anything, non-lawyers CANNOT and DO NOT make Supreme Court Justices, period. If you chose your words very deliberately, so did I reply "very deliberately" you should have realized that no one is asking for all that rubbish you put up there.

Oh btw, there are NO Constitutional requirement, but the Constitution empowers Congress to create legislation or make collective decisions that result in de facto requirements one of which may include education and obviously practical experience. So to the bullshit you wrote though no one asked you, non-lawyer CANNOT and DO NOT make Justices of SCOTUS.

manny4life:


In your bid to sound smart and intelligent, you sound really silly obviously. Where did I mention about statutory requirement and the constitution bullshit and nonsense you're saying here now? In fact was the thread about lawyers and judges and Supreme Court. I had to ask if you're ignorant because ain't no need to check anything, non-lawyers CANNOT and DO NOT make Supreme Court Justices, period. If you chose your words very deliberately, so did I reply "very deliberately" you should have realized that no one is asking for all that rubbish you put up there.

Oh btw, there are NO Constitutional requirement, but the Constitution empowers Congress to create legislation or make collective decisions that result in de facto requirements one of which may include education and obviously practical experience. So to the bullshit you wrote though no one asked you, non-lawyer CANNOT and DO NOT make Justices of SCOTUS.

i said "Actually non-lawyers can become judges of the US supreme court"
you are free to disagree with that providing evidence. but you chose to say i spoke from ignorance .

and so i put you straight there is NOTHING in US law or constitution stopping it. in some countries there is a requirement in statute that judges are lawyers or members of the bar. this is not of statutory force in the US.
in some jurisdictions judges are elected.
to paraphrase you

using your logic

BLACK WOMEN CANNOT AND DO NOT BECOME US PRESIDENT

there is nothing in US CONSTITUTION stopping a woman or black person becoming president because those events are rare or have not happened does NOT mean they are PROHIBITED.
that is my point. if you do not understand english blame your parents do not come here barking like a rabid dog . legislation means statute i covered that already.BERK!! you and your parents should go and jump under a trailer
instead of making a fool of yourself go to the supreme court website
http://www.supremecourt.gov/faq.aspx#faqgi2
http://en.wikipedia.org/wiki/Robert_H._Jackson
and see what they have to say