I feel compelled to write on
this subject because of its
seriousness and the dearth of
objective analyses on our social
media. It is an emotive subject
for both NMA and JOHESU
members, and I can understand why punches
fly around, but both parties must rise above
petty and emotional considerations if we are to
find a way forward. For clarification purposes,
the NMA represents medical doctors whilst
JOHESU is a union of all health workers who are
not doctors.
The NMA has a list of 24 demands but I will limit
myself to the most contentious ones. At this
stage, it is probably best that I introduce myself.
I am medical doctor of Nigerian heritage
practising in the UK.
WHO SHOULD HEAD THE HOSPITAL
There is no contention – the medical doctor is
the head of the clinical team. He/she leads the
ward rounds, clinics, surgical operations,
multidisciplinary meetings and so on because
the ultimate and final responsibility for patient
care rests in his/her hands.
The headship of the hospital is a different
matter. This is an administrative office, which
needs not be occupied by a medical doctor. This
job is better in the hands of people who have
administrative or business management skills.
This is the case in countries like the UK, Canada
and the US, which heavily influence our health
system. Therefore, it is difficult to reason with
the NMA why this job should be the exclusive
right of medical doctors.
NON-MEDICAL CONSULTANTS
The doctor-patient ratio in Nigeria is dangerously
low. In my view, the roles of non-medical
professionals such as nurses, physiotherapists,
pharmacists etc need to expand to cope with
the demands on doctors. It is important that
this is done in a safe way by providing the
appropriate level of training for these
individuals. This is the case in countries such as
the UK, Canada and the US where consultant
nurses, pharmacists etc have existed for a few
decades now. I do not see any problem with
non-medical consultants as long as these
individuals are appropriately trained and can
practise both competently and safely within an
agreed framework. These professionals have
separate (but complimentary) job descriptions
and their roles are not designed to replace or
dispense with the services of the doctor. If this
arrangement enhances patient care, then where
is the problem with it? The NMA needs to
demonstrate to the public and to the
government how the creation of these non-
medical consultant positions will adversely affect
patient care, otherwise, its demands will be
perceived as obstructing the professional
development of JOHESU members, and I don’t
think this is helpful to anybody.
HAZARD ALLOWANCE
The types of hazard and the level to which
healthcare workers are exposed vary
considerably and depend on the type of job they
do. For instance, psychiatrists are hardly
exposed to body fluids and their risks for
contracting diseases like HIV and hepatitis are
much less than for a theatre scrub nurse. The
risk of physical assault by a patient is higher for
a psychiatrist than for a surgeon. And because
psychiatry nurses spend more time with
patients, their risks of assault are arguably
higher than those of consultant psychiatrists.
The people who work in radiology departments
such as radiologists, radiographers, nurses,
porters and so on have greater exposure to
radioactive materials than everyone else in the
hospital.
The current health hazard allowance of N5,000
is unconscionable – it needs to increase.
However, I think it is imperative to get an
independent risk assessor for impartial advice.
MISCELLANEOUS
I have read far too many emotional arguments
on these issues and very little of an objective
discourse. It is important that I draw your
attention to a few of these.
What has become obvious is the lack of
understanding of the concept of teamwork.
There is a pervasive notion among doctors that
the other healthcare workers are there to serve
them. JOHESU members think that doctors have
become too conceited for their own good and
are determined to put them in their “places”.
The most important person in the hospital is the
patient – it is not the doctor, nurse, pharmacist
or laboratory scientist or anyone else. Every
team member is important and must be
respected, including the people who do the least
clinical jobs like cleaning. I don’t imagine that
any hospital will remain open for longer than a
week if its cleaners went on strike and dirt was
allowed to accumulate to the point where it
constitutes a health risk.
I have heard so many anecdotal accounts of
nurses not joining doctors on ward rounds or
pharmacists altering prescriptions without first
discussing these with the prescribing doctors or
laboratory scientist slapping doctors; and these
accounts are being given as reasons why doctors
must continue to head hospitals. These are
disciplinary matters, which should be managed
according to existing procedures. These excuses
are emotional and should not be used to block
the professional development of others.
The other reason I have heard doctors give for
not wanting our non-medical colleagues to bear
the "consultant" title is the fear that patients will
confuse them or anybody else in a white-coat
for a doctor and give such people an excuse for
autonomous practice. This reason is not good
enough because this problem can be solved by
wearing names badges and/or colour coded
uniforms. Also health professionals should
introduce themselves to patients at the start of
consultations. But more significantly, this can be
an issue of regulation - any one found to be
(criminally) practising over and beyond their job
description, competence level or professional
registration becomes liable to disciplinary
procedures.
Our health system suffers from poor regulation.
This is why anyone can open a chemist and dole
out antibiotics indiscriminately. It is the reason
doctors are scared that consultant pharmacists,
nurses and physiotherapists will steal their
patients. But it is also the reason why doctors
may recommend an operation to a patient
where none is necessary just so they can charge
more. This is a problem that is in urgent need of
attention. I hope that this something both NMA
& JOHESU will flag up in the near future.
Another recurrent theme in these debates is the
abuse of junior doctors by both medical and
non-medical staff, which appears to be
endemic. There is a consistent narrative of
junior doctors being asked to do other people’s
jobs such as collecting blood from blood banks,
taking samples to laboratories etc. In extreme
cases, these doctors are asked to undertake
non-clinical tasks by more senior doctors. This is
simply unacceptable! I think it is fair to place
the blame for this at the hands of consultants
who are supposed to be responsible for junior
doctors. But this in itself is not a good argument
for blocking JOHESU members from becoming
consultants in their specialties or for stopping
them from heading hospitals if they have the
right qualifications.
I am concerned that the NMA is losing public
sympathy. Increasingly, I hear people describe
doctors as selfish and heartless. This is very sad
and rather unfortunate. They say doctors do not
have any motivation to end the strike because
patients are forced to pay exorbitant fees to
them in their private hospitals. Those patients
who cannot afford these fees are left to suffer
or die. If the NMA has made any efforts to
change this public perception, then these do not
appear to have been effective.
CONCLUSION
The current strategy (i.e., recurrent strikes) is
not working. Over the last decade or two, the
NMA and non-medical health workers (more
recently represented by JOHESU) have taken
turns to go on strikes. Perhaps, it is time for
both parties to sit together, talk to each other
and resolve these contentious issues once and
for all. It’s pointless for the government to enter
into agreements with one party knowing fully
well that the other party will ask for a reversal
of those agreements.
I think the time has come to incorporate Ethics,
Teamwork and Communications into
undergraduate curricula. The various online
comments I have read from medical and non-
medical colleagues show that whilst many easily
mouth off "team work", a practical
understanding of what this means is lacking.
Disciplinary procedures are there for a reason.
They must be followed when necessary.
Although I practise abroad, I should point out
that this strike affects me too. My family and
friends all live in Nigeria. And who says I am not
planning to come home to practise?
Lastly, we must all be mindful of our own
mortality. Most of us will be ill someday. And
when this happens, the only thing that will
matter to us is to be looked after by caring and
competent health-workers regardless of their
individual specialisation. We can create that
environment if we forget our individual egos and
work as a team.

www.medicalworldnigeria.com/2014/08/revisiting-the-nma-strike-the-candid-opinion-of-a-uk-based-doctor/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+medicalworldnigeria/VRlb+(Latest+Medical+Vacancy,+News+and+Events)#

in summary

Best way to end this animosity

Just your Opinion though.