Been following different posts here about the incompetence of Nigerian doctors etc etc

This post is going to step on many toes so if you are easily offended OR IF YOU DON'T LIKE LONG POSTS, you should go no further.
Public perception of Nigerian doctors is probably at its lowest since independence and we’re regularly hung out to dry. This is perhaps a result of the increased health consciousness of many Nigerians which can only be a good thing. As you will find out however, most of these criticisms are unjustified. This negative perception is likely due to a lack of understanding of how medical practice works among the general populace and rather than an outright defence of doctors or health workers in general, I’ll try to do more of an enlightenment. And what better place to start than from the beginning.

Nigerian medical training has its flaws but it is safe to say it gives one of the best professional trainings in Nigeria. Unlike other courses like engineering where graduates complain of little to no practical experience, medical students in Nigeria spend a minimum of 3 years in the hospital. This is the clinical stage of their training.

The average graduate graduate from a Nigerian medical school can hold his own anywhere in the world and the easy adaptation of Nigerian doctors in overseas countries is evidence of that. However, that is not to say our medical training is perfect. Far from it. There is a lot that can be done to improve medical training in Nigeria. An awful lot. An indepth analysis of medical training in Nigeria will reveal a box of cankerworms, especially the conditions in which the students have to learn.

That being said, Nigerian medical schools churn out well trained and competent doctors on the average. But then, the system is not foolproof. A few “quacks” might still wiggle their way through but that is the exception rather than the rule.
If the deplorable conditions of the health system was limited to institutions of learning, it would have been manageable but the working conditions are even worse. The World Health Organization, WHO recommends a doctor-patient ratio of 1:600 but several sources put the ratio in Nigeria at about 1:30,000 and this will only worsen as more doctors flock abroad in search of a better life. It is not uncommon to hear people narrate stories of how an emergency was brought to the hospital and they didn’t receive medical attention for up to an hour. Most hospitals in Nigeria are grossly understaffed and generally overwhelmed. It is difficult to extract optimum performance from workers in such conditions.

As part of my internship program after medical school, I spent six months at the state hospital in Oyo town. It was an eye opening experience. I was nearly drained of all the enthusiasm I graduated from school with. We operated on patients with rechargeable lamps because of non existent power supply and unavailability of generator fuel. I donated blood for an accident victim because the blood bank had run out of blood. Despite all these, we get queries and extensions for little mistakes. Contrary to what most people think, there is a system that punishes health workers for misconduct and/or incompetence. That at least works.

From experience, I can confidently say that Nigerian hospitals save more lives than are lost. I won’t say the percentage of lives lost is insignificant because every life is important. However when the average person loses someone to what looks like medical incompetence or negligence, there is this temptation to make sweeping generalizations. I will be the first person to admit that there are incompetent doctors.

There are bad eggs in every profession. But really, they are in the minority. The blanket of quackery that is thrown over everybody is not deserved. The funny thing is that many of these quacks are not even doctors to start with. I see some referrals and I know that someone who spent a minimum of six years in medical school could not have written that. The number of people who masquerade as doctors in Nigeria is simply mind boggling. In the words of Agu of Beast of No Nation fame, “I saw terrible things” in Oyo town. Laboratory scientists running private hospitals and treating patients, scrub nurses performing major surgeries. I had heard of these things but I thought they only happened up north(apologies to my northern friends). I’m not trying to belittle other health workers. Afterall, I’ll probably embarrass myself trying to do their job. But when someone masquerades as a doctor and does a myomectomy that a gynecologist goes through five years of residency training to learn, you can only imagine the outcome. I once walked in on a “doctor” that came to give my dad home consultation. Turned out he was a laboratory scientist in UCH.

On the other hand, you can’t really blame these people for trying to cut corners to make ends meet. It is the fault of the medical authorities. Organizations like the Medical and Dental Council, MDCN and the Nigerian Medical Association, NMA are too busy fleecing doctors by increasing licensing fees yearly and fighting for increased renumeration instead of regulating the activities of hospitals in Nigeria.

Another blame is is commonly ascribed to Nigerian doctors is misdiagnosis. Misdiagnosis is actually real and it occurs everywhere in the world. The reason is that medicine like every other science, is always evolving and is prone to imperfections. In the US, only cancer and heart diseases account for more in-hospital deaths than misdiagnosis. It is not peculiar to Nigeria.

However, what most people on the street see as misdiagnosis is not what really obtains.
Doctors are not magicians. We rely on questioning and clinical examination to make a diagnosis. Most of the time however, this is rarely enough because different diseases present with symptoms which are similar and overlap each other. History taking and examination helps you to arrive at a provisional diagnosis, or multiple differential diagnoses. This is where laboratory investigations come into play. They help to clinch the diagnosis. However, apart from the basic investigations, most people cannot afford investigations required. Doctors then have to make do with their provisional diagnosis. The absence of a functioning health insurance scheme is mostly to blame. Patients bear the brunt of everything. Claims of free health care in Oyo state for example is just propaganda by the government. The only thing you don’t pay for is the bed you sleep on. You pay for everything. Gloves, syringes and needles, plasters and even fuel sometimes. Even in emergency situations. There are no emergency kits in government hospitals in Oyo state. That is a fact. A cranial CT scan costs about 45,000 naira. We all know what the minimum wage is. A son of a farmer falls from a tree and hits his head. How do you order a CT scan when he can’t even afford to buy drugs? You have to rely on the symptoms and manage accordingly. Most hypertensives in Nigeria can’t afford a chest Xray not to talk of an ECG.

Sometimes when you order these tests, the patient even thinks you want to scam him or her.
Imagine a patient who is being treated bases on a working diagnosis of tuberculosis because he cannot afford required investigations. A rich son in law comes into the picture, flies him abroad and tests carried out reveal he has lung cancer. Both doctors know these diseases mimic each other but the layman will go to town with stories of how Nigerian doctors cannot diagnose cancer. You’d be surprised at how uncanny the resemblance between congestive heart failure and an asthmatic attack is. Little wonder doctors sometimes use the term “cardiac asthma”.
It is also important to note that even if a patient does all the avalanche of tests, diagnosis can sometimes be tricky. Because of the variation in symptoms at different stages of a disease, the diagnosis might only be clinched as the disease progresses and in some instances, it might even change. Case in point ovarian cancer. Early symptoms are usually vague, sometimes absent and unlike cervical cancer, there are still no accurate screening techniques for early diagnosis of ovarian cancer worldwide. Hence the late diagnosis in most cases.

This is not to say that Nigerian doctors don’t misdiagnose patients. Poor record keeping is a bane of our society as a whole but misdiagnosed cases probably occur more often in Nigeria than in the West. If you suspect that your doctor doesn’t know what he is doing, please run far away or better still, seek a second opinion. Some doctors are very clueless. But the notion that Nigerian doctors don’t know jack can’t be farther from the truth. If it were true, doctors won’t be migrating in droves to places where the threat of litigation is very real.
The reason why Nigerian doctors get the lion share of the blame for an ailing health care system is not far fetched though. Many Nigerians need a scapegoat when something goes wrong.

There must always be a villain. Perhaps it’s a coping mechanism for grief or maybe it helps us to achieve closure.

You can’t curse the system neither can you slander the poor insurance scheme. So the doctor has to fill the gap. He is the focal point. The pillar that represents Shaytan that we stone on pilgrimage.

This post is not meant to exonerate Nigerian doctors from all misdeeds or paint them as saintly. Far from it, doctors in Nigeria have a lot to improve upon, particularly in the area of professionalism and relationship with patients.

Many doctors have a poor attitude towards work because of the less than ideal working conditions and because they know the check and balance system can be easily circumvented.

Overall though, doctors in Nigeria give their best despite the prevailing circumstances and they deserve better than the short thrift they get from the public. Afterall, it is teachers that get their reward in heaven.
*drops mic*

source : https://thedreamreaper./2016/08/28/in-defence-of-nigerian-doctors/

Nice writeup.

I doff my hat. Nice one