An incisive article by Ibrahim Toli

After reading through the article by Alli John Adeolu, Chief
Medical Laboratory Scientist of God knows where, I
couldn't help but punch 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
comparison 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 said 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 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
allowance. 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 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 shows
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.
By Ibrahim Toli

dalhat14: An incisive article by Ibrahim Toli

After reading through the article by Alli John Adeolu, Chief
Medical Laboratory Scientist of God knows where, I
couldn't help but punch 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
comparison 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 said 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 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
allowance. 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 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 shows
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.
By Ibrahim Toli

well said.

FF

This is the scrap u called article ,lengthy but empty . You are very bias.

This is the scrap u called article ,lengthy but empty . You are very bias. ,