₦airaland Forum

aribisala0:
I am not talking about payment codes but diagnostic codes specifically ICD 10 codes of the WHO
So do not try to change the subject
The ICD 10 codes are not designed for payments they are designed for the whole world to have internationally standard criteria for diagnoses. It just happens that countries like the US use them for payment
Ignorantly you claimed doctors never use them. I schooled you and you are talking rubbish about payment codes

No that is not the issue.

The diagnostic code for headache is R51 , you claimed it is not a diagnosis, I schooled you and you continue wriggling like a condemned point and kill fish

Lol funny.

Well you have not made one clinical application, all you are saying is just theory. Things you can google. You are not talking like one with clinical experience.


Most symptoms have a diagnostic code. Because as i clearly said if a symptom like headache is a presenting complaint it is the duty of the doctor or clinician to eliminate all other possible scenarios. A HEADACHE is not one that you want to mis diagnose. What if you diagnose a headache and it is eventually found to be a small growing tumour. That is the sole reason why in clinical practise it is commonly treated as a symptom but oga you can be arguing.


You can put your own signature to headache as a sole diagnosis. Mind you with the way panadol is readily available over the counter, if a patient who is likely a worker leaves work and drives, walks, takes public transport or whatever and presents to your clinic and waits the line and tells you all I am there for is a headache that is a RED FLAG for further investigation because that headache should not be taken for granted.

Don't kill patients with misdiagnosis. Oga UK. That patient can leave your practise and passout or even worse.

That is where clinic experience is different from theory and book and reciting code.


But you can treat your nursing or clinical patients as you want.

aribisala0:
You claim to be a doctor .I do not believe you.
I do not have to repeat myself like a retard. I have already said what needs to be said about Hierarchy. If you want more schooling ask questions
You said no doctor will talk about codes I said that doctors talk about codes in the USA with EVERY SINGLE patient you are here spewing more rubbish. Codes are crucial not only for payment but epidemiology. That is the only way that we can say how many cases of appendicitis or breast cancer were treated in a certain period in a specific hospital in order to talk about incidence or prevalence and that is fed to the WHO which studies trends world wide. You are ignorant of all this and proud of it

You are a joker lol. I think I know your problem. You are fixated on your own theoretical ideologies and trying to make sense of medical coding. I just told you what a payment code is and what it was primarily created for, i never said it was the only thing. And you are talking about epidemiology lol. Or you want to teach me that too lol. Mr Nurse. When I say no doctor will focus on coding, I mean clinically it can hinder diagnosis and that is because there is a lot of controversy in the coding diagnostic system. If you are in the system you will know. And that is why the USA health care system has a lot of downfall. Look Oga Nurse that is my Fathers age mate lool I am going to sleep.

aribisala0:
You are clearly frustrated. did I even tell you I went to primary school?
This is an anonymous forum any idiot can claim to be anything,I prefer anonymity so let us pretend I am a BOT or computer program . That should not stop the debate. Stick to the issue
You are the one with ego claiming to be this and that.You claim to be a doctor and all other kinds of stories . Who asked you your biography?
I made a comment and you foolishly came on to say
"Headache is not a diagnosis"
I educated you and you are talking about mandate. Mandate ko June 12 ni.
Imagine the nonsense you are saying that no doctor will talk about codes?
How do doctors get paid in the USA without diagnostic codes?

Let us discuss issues without all these fake personal claims that cannot be verified

Illiterate. Mr. UK. So UK is your achievement Ode. And I don't need to claim. You are the one talking about codes. A diagnostic related tariff is payment based. It was created so diagnosis can be used to make payments for health insurance. It is not one that determines how you should diagnose a patient clinically.

See all what you are saying can be googled. If you want to know if I went to CMUL or to UCL ask anyone who did. At least it was you that said you know it VERY WELL Lol. Even the word mandate will let you know what year I was there.

I guess you are no longer talking about medical hierarchy anymore. To you everything is ego. Mr. Ego. Lol

aribisala0:
What has that got to do with the issues we were debating .Do you admit that you have lost the debate?
Is mandate the issue now?
You say you are a doctor .Where is your certificate. I do not believe you. Or your knowledge of mandate is how you prove you are a doctor?

What debate. Mr. Anxiety lol.

aribisala0:
I am not here to play stupid games with you or to prove anything. I am not that insecure.
However I will answer that . I have never heard of Mandate. What does that prove? I am your fathers mate not yours
Let us stick to issues . You are more comfortable with the personal
I do not want to know you and I particularly do not want to be known. I crave anonymity
Show us your photograph and certificate to prove you are a doctor because I do not believe you

You are a joker. Aburo ode. You say you know CMUL and don't know mandate. Even Professors know. Foolish man. Getout.

aribisala0:
lol
You are small and insecure. You do not really believe in yourself
Who or what you are is not relevant .Invoking that show you have lost the debate.
Any fool can come online to claim to be this and that?
It remains an anonymous forum
I do not believe you are a doctor until I see your certificate with your photograph

Lol Mr. UK. You say you know CMUL. There is a place called mandate. It has existed for years. What is it. Lol let's probe you.

aribisala0:
I would rather give you a job.
Do not talk like a fool. The fact that we are online together does not make us coevals
The tail is very far from the head. Go and help your family

Haha. Next time be a doctor. Your hate will kill you. Foolish thing. Just my surname alone will help your generations. Ask seun at least seun knows me.

Mr. UK lol

I noticed your foul mouth from the beginning. Illiterate.

aribisala0:
Are you not small?

Help me come to Australia? You talk very foolishly.
Don't you have family members? Help them
I do not believe you are a doctor, maybe a dropout

Lol yes. If you are medical let me help you come here. Abi you don't know UK doctors are influxing here on the daily lol.

aribisala0:
All your claims are unverifiable and therefore foolish. I do not believe you are a doctor. It maybe that you dropped out or never even were admitted
You won't stay in UK for free but claim you stayed here for 9 years?

Guy leave the biography and personal stuff.
Stick to the issues and bridle your ego
Salary money comes from somewhere. Ultimately across industries this is the customer. The PAYING customer. The money does not drop from the sky so of course demand and supply determine wages.
If you do not know that you do not know anything
Ronaldo earns more because his shirts sell more. That is where the money comes from
In Cuba they have a very high supply of doctors and wages are LOW
Many footballers earn more than their bosses and this is equally true for doctors. Salary does not reflect hierarchy. Within the NHS doctors report to people who may be earning half their salary

Lol joker. You are clearly a disgrunted lab scientist or something. You say you know CMUL. What year were you?? Which medical school did you go. Where are you in the UK? I will expose you lol. At least I know many docs in the UK. Just tell us where you work let us probe you. You don't need to tell us your name.

aribisala0:
Well that is quite weak and petty from you but again predictable. Why should I be bitter ? The reality is you have lost the ideas debate. So you resort to the personal like you did the other day talking about my English. I will not indulge you by talking about myself simply because if I did I will lose anonymity but so far your English has not been at a standard to justify that remark and anyone following this thread can tell that we do not write English at the same level. All your offerings have been littered by regrettable solecisms
I do not know what you mean by "position" , or salary being a measure of position. Salary is not about position but about DEMAND AND SUPPLY. Salary is not a moral construct but an economic one.
That is why Brain surgeons earn more than Paediatricians or Psychiatrists
Is the Prime Minister of Britain the highest paid government employee

How is that relevant to any of the things we were talking about. It just reinforces what I have said all along about your toxic Nigerian orientation.
I am happy to debate you on issues because I know I am more articulate than you can ever be
You are the one that is bitter You were in "my UK for 9 years" what did you achieve? Did you get on the Specialist Register ? You should have achieved that in 9 years so that makes you a failure and you ran away if we are to believe your tales that indeed you are a doctor.
Guy learn to shun pettiness in debate and stick to issues. No one asked you to render your inconsequential biography
.

Lol you are laughable. UK? I won't stay there if it is free. And yes I am a member of the royal college. And I am same in Australia. You don't know me and neither do I know you. You have exposed many things so saying you want to remain anonymous is laughable. Mr. UK.

UK that is dead. If you are medical let me help you come to AUSTRALIA.

Speaking about personal characteristics, I think you should read your summons and irrelevants. Mechanic Lol.

You are clearly bitter. But I understand. You will now say WHO allows a doctor to be imprisoned.

And salary? You are just full of theory. Demand and supply. Lol. Are you a learner?

Salary globally is used as a reward. Why do you get higher salary when promoted. And I clearly said amongst other things.

Abi MR. UK why are you there??

aribisala0:
Globally the go to standard of Diagnosis is the WHO standard which is the ICD 10 now 11.
In the US you will not get paid if you do not write an ICD 10/11 diagnosis. Payment is for each diagnosis you treat and that is the gold standard for collecting epidemiologic data
Pathologic diagnosis is not the basis of diagnosis in clinical practice
Not in Psychiatry; schizophrenia, Anxiety ,ADHD PTSD
Tell us what pathologic diagnosis exist for
Epilepsy ? Asthma , Type 2 Diabetes, Essential Hypertension
Stammering , Bedwetting and the dozens of other Idiopathic conditions that we know
Everything you are saying is what a Nigerian trained doctor with a Nigerian mentality would say.
The fundamental problem you have is no grounding in Epistemology and a failure to recognize the limits of what you know
Millions of people go into hospital all over the world daily and have NO contact whatsoever with a doctor. You talk from the limits of your exposure
Do you know what Ambulance crews do, the training they have? In their narrow area they have training, experience and expertise beyond what 99% of doctors have.
Doctors are not the most trained or most experienced in every aspect of health care that is nonsense.
In many chronic and terminal palliative care situations what patients need is just care or palliation NOT treatment per se. Doctors have very little experience in providing non-intervention care and many lack the bedside manner, in Nigeria many are just nasty to patients. So when you say if you are ill who do you go to hospital to see you expose your Nigerian mentality. It depends on the illness.
One of the commonest chronic conditions is back pain. In the absence of surgery what do doctors have to offer? The mainstay is physiotherapy
There are so many types of illnesses that take people to hospital many do not require input from a doctor. People go to see physiotherapists, speech therapists, Occupational therapists , nurses who are independent practitioners for a range of issues with no medical input
You say there is a hierarchy with doctors at the top or at least that is what you imply. More Nigerian nonsense I have seen a hierarchy where Clinical leads are Consultant Nurses and or Consultant Psychologists in the UK. It all depends on the clinical scenarios.
A specialist doctor does not have a HIGHER role than a non specialist doctor he has an ADVISORY role.
Sometimes more than one specialist may be involved who then is HIGHER. ?? I wonder how it is possible to cram so much nonsense into one post
It all comes down to the TOXIC ORIENTATION that Nigerian doctors have that
"DOCTORS ARE THE HEAD OF THE MEDICAL TEAM" Sometimes yes but not always.
Many people study medicine in Nigeria not because they care about people or patients but because they are smart enough to score high in JAMB and this is manifest in their attitude
There are dozens of chronic conditions that have no cure and for which doctors have few interventions other professions provide support and palliation .In your mind that is LOWER.

There really is nothing like HIGHER training ACROSS professions. I do not understand how a pilot can say he is higher trained that a truck driver. They do very different jobs ,none is higher or lower. A specialist doctor is not higher than a GP. They are different
An auto mechanic is not superior to a panel beater. Everyone has his area. When you say most trained most experienced. Who is the judge of that? By what metrics?
Healthcare provision is not the territory of doctors. It is the territory of all professionals and the message is many professionals do not recognize the supremacy of doctors across board rather everyone has his area of competence and who leads depends on the specific needs of each patient

It is actually because it exists that you are so bitter about it. Is it sometimes abused yes. And it is not a Nigerian thing. At least I was in that your UK for 9 years. Oga leave this matter to those who are affected. But I feel your bitterness though. Abi in your UK there who has the highest salary structure in nurses, doctors etc. At least salary can be a measurement of position. Not the only one but it is a valid measurement of who is higher in a team, before you now lecture me again lol. Good night. I await your response.

aribisala0:
Globally the go to standard of Diagnosis is the WHO standard which is the ICD 10 now 11.
In the US you will not get paid if you do not write an ICD 10/11 diagnosis. Payment is for each diagnosis you treat and that is the gold standard for collecting epidemiologic data
Pathologic diagnosis is not the basis of diagnosis in clinical practice
Not in Psychiatry; schizophrenia, Anxiety ,ADHD PTSD
Tell us what pathologic diagnosis exist for
Epilepsy ? Asthma , Type 2 Diabetes, Essential Hypertension
Stammering , Bedwetting and the dozens of other Idiopathic conditions that we know
Everything you are saying is what a Nigerian trained doctor with a Nigerian mentality would say.
The fundamental problem you have is no grounding in Epistemology and a failure to recognize the limits of what you know
Millions of people go into hospital all over the world daily and have NO contact whatsoever with a doctor. You talk from the limits of your exposure
Do you know what Ambulance crews do, the training they have? In their narrow area they have training, experience and expertise beyond what 99% of doctors have.
Doctors are not the most trained or most experienced in every aspect of health care that is nonsense.
In many chronic and terminal palliative care situations what patients need is just care or palliation NOT treatment per se. Doctors have very little experience in providing non-intervention care and many lack the bedside manner, in Nigeria many are just nasty to patients. So when you say if you are ill who do you go to hospital to see you expose your Nigerian mentality. It depends on the illness.
One of the commonest chronic conditions is back pain. In the absence of surgery what do doctors have to offer? The mainstay is physiotherapy
There are so many types of illnesses that take people to hospital many do not require input from a doctor. People go to see physiotherapists, speech therapists, Occupational therapists , nurses who are independent practitioners for a range of issues with no medical input
You say there is a hierarchy with doctors at the top or at least that is what you imply. More Nigerian nonsense I have seen a hierarchy where Clinical leads are Consultant Nurses and or Consultant Psychologists in the UK. It all depends on the clinical scenarios.
A specialist doctor does not have a HIGHER role than a non specialist doctor he has an ADVISORY role.
Sometimes more than one specialist may be involved who then is HIGHER. ?? I wonder how it is possible to cram so much nonsense into one post
It all comes down to the TOXIC ORIENTATION that Nigerian doctors have that
"DOCTORS ARE THE HEAD OF THE MEDICAL TEAM" Sometimes yes but not always.
Many people study medicine in Nigeria not because they care about people or patients but because they are smart enough to score high in JAMB and this is manifest in their attitude
There are dozens of chronic conditions that have no cure and for which doctors have few interventions other professions provide support and palliation .In your mind that is LOWER.

There really is nothing like HIGHER training ACROSS professions. I do not understand how a pilot can say he is higher trained that a truck driver. They do very different jobs ,none is higher or lower. A specialist doctor is not higher than a GP. They are different
An auto mechanic is not superior to a panel beater. Everyone has his area. When you say most trained most experienced. Who is the judge of that? By what metrics?
Healthcare provision is not the territory of doctors. It is the territory of all professionals and the message is many professionals do not recognize the supremacy of doctors across board rather everyone has his area of competence and who leads depends on the specific needs of each patient

Once again a whole lot of nothing.

So let me address briefly two things you have mentioned the most.

1. Diagnosis
2. Medical Hierarchy

Diagnosis - Since you want a lecture and you have googled non invasive health treatment modalities I will give you the simple input of what Diagnosis entails. As mentioned before there is not one standard to care. Nobody ever said that. Generally in health care you have pathologic illnesses and psychological illnesses, not to mention a few. When you diagnose a holistic approach is always used. It is your basic understanding of clinical application that keeps you repeating the same thing out of context of what I said. I will give you a scenario. A definitive diagnosis is one that is usually pathology based. If you have a metastatic melanoma for example anywhere in the world you go, as long as they are trained doctors there, under investigations specific cells associated with that pathology has to be detected to categorically give a definitive diagnosis.

Now to your take, again if you go through what I said and somehow have an understanding of my very basic English, I mentioned that there are other diagnostic modalities. What you are saying is equivalent to telling a child how to recite a nursery rhyme. Maybe you do not realise you are talking to a trained doc. In Nigeria that you hate, your self acclaimed UK and other countries Nigerian doctors go there and excel.

Let us keep remaining faceless.


When it comes to cases like anxiety, depression, stammering and all the other broad conditions you are referring to, we can spend a year analysing differential diagnosis for those. Because when there is no specific pathologic parameter
you need to use other approaches. E.g a wider approach of diagnosis exists for psychological cases and other related cases. Every doctor knows that. In the plastic surgery field BDD is a big psychological concern that needs a multiapproach. We see it everyday. And those are best managed with a multi specialist team as recommended.

Again using a basic case you will understand, covid; irrespective of your all loving psychological, stammering, cold, back pain etc and all other irrelevant jargon you mentioned in the context of what was not said, the only way you can say someone has covid is you look under the scope and the causative pathogens are identified. No other way. That is definitive. I am not talking about broad, note writing, diagnosis.

And when it comes to Hierarchy. Again your understanding of that word is clouded by bias, bitterness and lack of understanding. I clearly said a health team, and you are there mentioning what is irrelevant. Even in your UK. Is an SHO higher than a consultant. Nurses have been included in the debate because of their close relationship with doctors. Why is the title Dr. protected. The way the health profession is structured is changing no one doubts that but that process still recognises a structure of clinical knowledge. Get a clinical team organogram and let us see who heads most teams. And there is a reason for this. Keep talking theory.

You mentioned covid the doctors who first reported it are two Chinese doctors, however official or unofficial it was, as they are no more. But that is a topic for another day.

Once again hierarchy is not a derogatory term. It signifies structure. Even a simple ward has hierarchy. Even the nurses you are shouting about have a hierarchy. You noticed I did not mention any other health profession per se, that is because the nursing role was primarily created to support doctors. Or should we now start with the genesis of Medicine? However I understand that, that role is changing and they are becoming more independent.

Hierarchy doesnt mean anyone is better. Nigerian mentality. Does it exist. Yes.

How do you differential diagnose and proceed to a definitive diagnosis. I bet you don't know the difference in practise. Psychology is another aspect entirely and I am not a psychologist so I do not know their diagnosis modalities.

So you telling me other approaches to diagnosis is laughable. As though it is something new. And there is a health hierarchy. I didn't create it. What is being done about it is a different matter but it exists.

aribisala0:
I am sorry but you are speaking an outdated language
There is no medical hierarchy everywhere , There is nothing like that in the UK. Every professional is independent of the other though it may be different in surgical disciplines
You say the first health professional to call COVID out were doctors. I do not know and i wonder where you got that from.

It is such a bizarre claim and says a lot about your psychology and need to be on top. Why does that matter? What is your point with that? Of course we simply have no way of checking that claim
Maybe in surgery there is a hierarchy but like I said your thinking is outdated
Diagnosis is something you need to go an sit down and spend a whole day studying because virtually everything you are saying about diagnosis is just not right.
You will need to unlearn a lot of what you think you know
Are you even familiar with the concept of functional diagnoses?
Pathology is a very different effort from diagnostication
There are dozens of diagnoses for which there is no known pathology and where rather what is recognized is just a syndrome or constellation of symptoms and or signs with no known underlying pathology. There are categorical and dimensional approaches to diagnostication
Once again I am not a nurse. But in the UK no one needs to signature what Advanced Nurse Practitioners or other health professional do

Your ideas are so backward I really do not know where to start but that notion of hierarchy , subordination and so on is just nonsense.
It is also clear that you have little understanding of psychiatry? How many pathologies are established as causative in psychosis, depression etc
Chronic fatigue, Essential Hypertension , Conversion disorders and even epilepsy
Surgeons tend to have a concrete perspective of the world but even at that there are many diagnoses without known pathology.
So your idea that pathologic based diagnosis is the core of diagnosis may be true in surgery but not across the range of Medicine.

There is plenty that we just do not know what causes it or see consistent pathology but still make diagnosis and asthma/epilepsy/hypetension are good examples. Also we see diagnosis for Diabetes based on a sign not pathology

I am sorry Oga. But you have just said a whole lot of nothing. Not replying you as such I am simply making a passing statement. Globally pathologic diagnosis is still the go to standard used to diagnose.

Because there is a gold standard does not mean it is the only standard. I am not here to lecture you.

My point is simple, the level of training you receive determines the medical care responsibility you are entrusted with. Maybe you want to argue that. The higher your level of training the higher your role. It is simple. And that is why a specialist has a higher role than a non specialist doctor in a health team. It is not about ego or insubordination.

When you are ill, who do you go to the hospital to see. I am not demeaning any profession and i never will. We are all colleages. Is there a delegation of duties, yes. Is there a hierarchy; yes. It exists not because of ego as you have severally and erroneously pointed at but to ensure lives are entrusted to the most trained and most experienced and to ensure a smooth running of any health facility or team. Without a hierarchy everyone will just do whatever they want.

You are however entitled to your own opinion.

aribisala0:
Allegedly
Doctors and nurses have been slapping each other for decades in Nigeria did not start today
It probably would not have triggered your visceral response if a doctor had imprisoned a nurse

Diagnosis is Not or at least no longer a "MEDICAL PRESERVE" you need to wake up to that reality
There are social diagnoses, psychological , Educational diagnoses etc so that model that many Nigeria doctors trained with based on pathology is out of date. That continues to reflect in what you are saying
Doctors are not the only ones who diagnose and there are diagnoses that doctors are not trained to make.

It is not my appreciation. It is the WHO which is World Health Organization Not World Medical Organization

Digest that
Interesting you mention COVID

Anyone with the right equipment and 2 hours training can diagnose COVID it has little to do with being a doctor

Well before covid was diagnosed, symptoms were treated. The first health professionals to call it out were doctors. As with most pandemics. Once a diagnosis was established everything else followed including vaccines, management modalities etc. However that is a digress.

Pathologic based diagnosis is still the core of any diagnosis. Even with covid you take a swap and pathogens must detected to diagnose, you cannot be diagnosed at positive, just because you have all the symptoms.

Other diagnostic modalities can come into play, social etc you mentioned. These can be used to understand whatever pathology you are dealing with.

And again I am referring to a scope of training, even with softwares etc someone with adequate training and qualifications needs to signature the diagnosis of whoever you are treating.

Doctors are limited within their own speciality or training. As I mentioned previously. I don't think anyone understands this more than doctors. So no one said doctors do it all. The point is there is a medical hierarchy and this applies globally. Dr. Fauci and fore runners of the covid eradication are doctors. Where I work all team leaders are doctors. The clinical head is a doctor. In a standard health facility this applies. Anything outside this is just your opinion that's not representative of this fact. Name any hospital globally where this does not apply. I mean in term of clinical not administrative.

But again so you do not say I am being biased because I am one, as stated, everyone in the medical team is important and has a vital role to play. Good night.

aribisala0:
Does it make you feell better as aperson to put people down because they are "nurses" . Anyway I am not a nurse and it does not really matter what you or I claim to be Any fool can come online and claim to be anything .Let the issues and ideas speak for themselves
Leave whoo you are claiming to be out of it.It is not relevant or verifiable. You have always believed that headache is a symptom and not a diagnosis but you are WRONG
There are so many other conditions like that
e.g
Anxiety
Depression

Stick to issues
You are the one that is in the dark about "treatment" because you have an undergraduate mentality.
Even untrained people can offer first aid and that is treatment
Sports physios give treatment and make diagnosis on the football field everyday of the week
Also treatment does not even have to conform to the Western Medical model
I want to believe you are familiar with the concept of interrater reliability
How often do doctors agree on diagnosis
Computer software apps are making diagnosis so you need to understand better what diagnostication is all about
I already told you that nursed DO DIAGNOSE and if as you CLAIMED you have been in the UK you would know that they do so I am inclined to believe you are a liar

Once again let us put words where they are necessary. If you followed this trend you will see that a nurse imprisoning a doctor started the trend. You may or may not be a nurse. I was doubting that you are hence asking for your education status. These are not claims. For a while we have not had a trend on here specific to medics, now I know about 10 colleages following this. I am still nameless and faceless as this is the point of a forum. Also a forum is a place where opinions are aired. From our trend your narration went south very quickly and I responded.

Again I think you and I have a different appreciation of diagnosis. The whole medical profession is based on the training, experience and ability to diagnose. Without it you cannot treat, monitor or even alert of an outbreak. A symptom is different. Covid symptoms existed for almost 7 months before it was diagnosed. So let us stick to the topic of the trend. Are the ARD even still on strike on this same issue.

aribisala0:
Are you a horseman? How long have you been riding Mr English
I, as a matter of principle, do not talk about my biography but I know CMUL quite well from when Babanginda was in power by which time you might not even have been born. You should have the courage of your knowledge . You said something about Nurses writing diagnoses and when called out you started talking about English
So is it your belief that only doctors make/write diagnoses? Yes or no?

As a matter of fact I was already a fellow when I left Nigeria. So add 7 years of undergraduate, another 5 years of post graduate not to mention nysc, and the two years I was doing geology in OSU as it was called then before jamb finally smiled on us to enter this medicine. I think I was clearly born and maybe even almost on my way to university then. After all babangida era is not that long ago I still remember yaba under bridge and free transport and fun fare when God rescued us from those shackles.

No no and no. Not only doctors can. Other health professionals can in their own role. But while I stand to be corrected I am not totally sure about if Nurses in Nigeria can. But hearing from Debola et al, I am beginning to have a different orientation now. It seems to be largely widened in terms of diagnostic function and treatment scope from my last knowledge.

aribisala0:
You need to change your toxic attitude if you have any plans of working successfully outside Nigeria.
Be humble
Especially when you are not as knowledgeable as you want to think.
What you do not know is multiple what you know AND

You yo not know that you do not know but think you know it all

Wow lool. See ehn, I graduated and left Nigeria is 2011. See this man oh lol. Nairaland and thinking everyone is faceless. I have lived and practised in the UK and now in Australia. I went to the College of Medicine, University of Lagos, UCL and I have a Royal College of Surgeons fellowship in Australia. I was attracted to the topic because I did my housemanship in Ife. That is all. Now back to the topic at hand. And the unfortunate event that unfolded between the doctor and matron.

aribisala0:
what is dolor?

You are embarrassing yourself guy.
I apologize for my English
I hope that gives you a face saving exit
Halitosis is a diagnosis
Jaundice is a diagnosis
Homelessness is a diagnosis
Failed exams is a diagnosis

You are just a little boy in this game

Lol your reasoning is as epileptic as you are typing. Firstly you are the big boy. Lol big boy nurse.

Then I think you are clearly in the dark about what it is to actually treat a patient. And you have no training for that so I totally understand that.

Diagnosing is not a theoretical function. Even with specific symptoms you may not reach a diagnosis until all investigations are exhausted. I guess that is why nurses don't diagnose. You can treat a symptom and as a matter of fact that's what most doctors will do first, to manage the ailment.

Keep talking theory.

aribisala0:
I will not educate you for free.
Headache is a symptom of some conditions it can also be a diagnosis
Anxiety is a symptom it can also be a diagnosis
High blood pressure is a sign of some conditions it can also be a diagnosis
Ditto Fever

To go far never stop learning. Keep an open mind
You are not as knowledgeable as you think you are

Go and read what I said. As I said English may actually be your problem. A nurse what education do you have. Enlighten us. A diagnosis is derived from symptoms, and in specific cases a symptom can be a sole diagnosis. Also I am not referring to differentials. Headache is a too broad a term to be a diagnosis in actual practise.

aribisala0:
You education level is obvious from how you talk.
I have no intention to be biographical with you
ICD 10 (Now 11) if the World Health Organization List of Diagnoses in medicine. Do not try to bluff your way out of that one.
I baited you and you fell for it very predictably showing YOUR LEVEL
Headache is a diagnosis .........period
The simple truth is YOU DID NOT KNOW THAT

Now you do and you should say

Thank you to me for teaching you what you did not know

You said "real practice"

Yes in real practice ICD 10 codes are recorded in hospitals and even used FOR BILLING in the USA
That is how epidemiological data from Hospitals are gathered
You are sounding very backward
Whether or not an ache is associated with the head is a Pathology question not a diagnostication issue
However that is a false claim
Headaches can be classed like many other conditions as "Not otherwise Specified".

You clearly have no medical knowledge. Ache is not a pathology. It is a symptom. I am not even conversing with you. Your English is not even at par. I would rather continue to converse with the debola individual she is making a lot more sense than you.

aribisala0:
You education level is obvious from how you talk.
I have no intention to be biographical with you
ICD 10 (Now 11) if the World Health Organization List of Diagnoses in medicine. Do not try to bluff your way out of that one.
I baited you and you fell for it very predictably showing YOUR LEVEL
Headache is a diagnosis .........period
The simple truth is YOU DID NOT KNOW THAT

Now you do and you should say

Thank you to me for teaching you what you did not know

You said "real practice"

Yes in real practice ICD 10 codes are recorded in hospitals and even used FOR BILLING in the USA
That is how epidemiological data from Hospitals are gathered
You are sounding very backward

You educated me that a symptom can be a diagnosis. Great. Lol. Instead of listing codes give a case scenario and let's here your coding theory in practise. How do you apply it. Educate us.

debola27:
You see what I'm talking about? You're too conceited to actually know that saving lives is a collaborative effort of health professionals, not just the work of a doctor. And you still don't understand the job of Nurses from your statement.
Primary headaches can actually happen without any underlying disease, so if after all investigations and you don't find any underlying condition, will you cook up another diagnosis asides what is wrong with the patient which is just headache?

I actually said that on purpose. It does not mean literal terms. We all write notes, 60 percent of health care is writing notes. There is nothing wrong with that. About the headache we can spend 100 years explaining all the different sinarios that can cause a headache. It is a symptom. When you diagnosis and it happens to be something else you can be in big trouble. So it is professionally acceptable and more appropriate to list it as a symptom and treat by elimination.

debola27:
Do you know that if a doctor commits an error in prescription or dosage and the Nurse serves the medication ignorantly and something happens to the patient, it is the Nurse that is most likely to face litigation because she is meant to have adequate knowledge to know if there is an error in a prescription or a dosage. Does that mean the Nurse is in charge?

A nurse will face no litigation for prescription. You may face one for administering what a doctor prescribed if for example you give a wrong dosage. So yes.

aribisala0:
Lol
I was expecting this and wrote what I wrote deliberately because many Nigerian trained doctors spout this same ignorance
You are predictable
Your problem is you do not know and do not know that you do not know but think you know it all


The WHO has a list of diagnosis that it recognizes with specific codes in it publication ICD-10 and its latest version ICD-11
The ICD 10 code for headache is R51

Educate yourself

Anyway that is not the issue so let us not major in minors

The point for me is your statement about "writing diagnosis" and your apparent belief that nurses cannot diagnose or that only doctors can. That is ignorant and wrong

Once again Headache is a diagnosis and there are MANY types of headache recognized as diagnoses

So now let me educate you. But before I do can we know what level of education you have. Secondly referring to WHO coding. Coding is a guide to deduce a diagnosis. Every symptom is coded because a symptom can become a diagnosis.

So you read a book code and suddenly think you know diagnosis. Funny. If you actually are in practise you will understand that there is no ache that can be associated to the 'head'.

It has to originate from somewhere. You need to investigate the source of that ache and come up with a proper diagnosis.

That is what separates you who take directions and write notes, from people who actually save lives in practical reality. Remember strict scopes of practise is to ensure lives are in safe hands.

Go and diagnose headaches to your patients. Write it and sign it and let me see. Lol.

You don't know anything about practise. Telling me WHO coding theory lol. I am talking about real actual practise and what you have deal with. Do you know the level of investigation it entails to conclusively say headache is a diagnosis. You need to rule out every single differential. In practise that is almost impossible. It is either due to congestion, tension, nerves etc.

The only time head ache can be a diagnosis is when there is no associated factors and in practise that is almost impossible. Go and be reciting codes for patients. It is like you are fresh out of school.

aribisala0:
My point is doctors LIKE nurses are limited in their scope of practice. I am referring to your post below . It is left to you to clarify what you mean by "strict level" of care and if or how that is different for doctors or Nurses.
My point is everyone has their professional limits subject to regulation by their professional bodies
I really do not understand what you are talking about with your emphasis on "diagnosis"
I am telling you in the UK that nurses operate as independent practitioners and prescribers either as Advance Nurse Practitioners or Nurse Consultants. That means they Diagnose and treat without ANY medical input whatsoever They are INDEPENDENT CLINICIANS . So you alone know what you mean with this outdated idea of writing down diagnosis. By law you cannot issue a prescription without a diagnosis so even Paracetamol for Headache implies a diagnosis of "Headache"
An abscess or boil is a diagnosis so also is ringworm, which nurses diagnose and treat in Nigeria.
Nurses in the UK diagnose and treat ADHD, Depression, Anxiety and some Consultant Nurses Admit patients to hospital under their care with ZERO INPUT from doctors. Clearly this is beyond your orientation and exposure.




The implication from your words was that this strict level of care was peculiar to nurses otherwise what is the point of mentioning it. A paediatrician has no business treating adults or going beyond what he is accredited for

Headache is not a diagnosis.

debola27:
This is not about hate, this is for doctors to understand that other health professionals are their colleagues not their surbodinates. I don't know why that is hard to understand

Umm everyone has subordinates oo. Do you know in the west people would rather not be the one in charge, it is the person in charge that faces the most litigation. Even various doctors are subordinates to others colleages. Nurses are dear colleagues.

debola27:
you really have a lot to learn. A Nurse can own a clinic and employ doctors to work for him or her. And even though CMDs of hospitals have been doctors for a while, other health professionals have been questioning that arrangement of why the doctor alone can be a CMD. And we aren't even talking about CMDs right now. We are talking about the health professionals that patients meet when they get to a PHC. You don't need to get so worked up. A Nurse does not work under a doctor. They work together. And talking about Nursing schools and Universities, Nurses that graduate from schools of Nursing already have a Registered Nursing certificate. They still go back to the university to spend an extra four years after the three years in Nursing school to get a BNSc so they can be at par with their colleagues the world over.
However, Whether it is just school of Nursing a Nurse attends, he or she is still not under a doctor. Each professional is trained to do different things and they have different bosses. You need to understand that

Debola debola lol. You are actually the first person I am communicating with on nairaland. And what an interesting conversation. Well we learn everyday but can a nurse register a clinic in Nigeria. I need to investigate that one. In 2011 when I left Nigeria only a doctor can register a clinic or health facility. Even a pharmacist needs a doctor to partner with to open a hospital. Just as a doctor needs to partner with a pharmacist to open a pharmacy even if that pharmacy is located in your clinic. Give facts do not give hear says. I know for a fact that a nurse cannot be the sole proprietor of a clinic or health center. Also do you belong to MDCN. Because that is the body that regulates and monitors health clinics etc.

debola27:
I don't know what you mean by note writing, and I don't think I said Nurses make medical diagnosis in secondary or tertiary health centres. Nurses have their own Nursing diagnosis that they make in the wards and that is used to take care of patients. This may probably be the first time you're hearing about Nursing diagnosis. You can browse about Nursing diagnosis and NANDA for more information.
As far às I know, TBAs do not work in formal primary health centres. They may be a part of primary health care, but they have their own centres where clients go to meet them. Some PHCs actually have just community health workers, and even these people also treat ailments. Every Registered Nurse has a formal education, whether they attended school of Nursing or the university. I think you mean that the Nursing body is pushing for more registered nurses to have a bachelor's degree.

Sorry but this is where we draw the line. As far as I am concerned the so called nursing school system is part of the reason you have a problem with respect and recognisation. Which one is nursing school or university. What degree is nursing school. Please I won't converse with anyone who does not at least have a bachelors. Also educate yourself a primary health system is not run by nurses. It is still a health care system headed by a doctor. Who is the cmd of health centers. Who is the head of any clinic. So why not as a nurse go and set up a clinic and call it primary health center only. Excuse me but the more you converse the more you are making no sense. A nurse works under a doctor. And to state further in the health team hierarchy where there is a pharmacist, physiotherapist, psychologists and so on, if they work as a team the medical doctor heads. Even a nurse practitioner needs to have a doctor on record to refer to at all times. So this hate please get over it. It is only in Nigeria nurses want sit shoulder to shoulder with doctors. Where i work we have a doctors lounge and then a common lounge. A nurse not dare come sit there. But there is still respect across board. No one is saying nurses have no role, they do and a very important one.

debola27:
When i say health centres, i mean primary health centres. TBAs are not put in primary health centres as far as I know. The least person to attend to people in a PHC is the community health worker. And when you talk about complete treatment, it depends on what you mean. Nurses in PHC take care of ailments and child births then send patients home afterwards. I think that qualifies as complete treatment. They do not need a doctor for that. If any complication occurs, the patient is sent to a secondary or tertiary health centre where they are cared for by specialists. Nurses in secondary or tertiary centres do not prescribe for patients because that is the job of the doctor there. Nurses have their jobs, doctors have theirs. The only problem is when doctors feel the work of the Nurse is only limited to taking vital signs. And Nurse practitioners do not have 'doctor level training'. They have trainings that correspond with the standard level of care they are to give as Nurse practitioners.

Also when you talk about child birth in PHCs, I stand to be corrected, but I do not think a nurse who is not a mid wife can lead that team. That, as far as I am concerned is where the TBAs come in. You will be surprised how trained the certified traditional birth attendants are in delivering babies.

aribisala0:
Doctors do not have unlimited scope of practice so in that regard they are not different from Nurses.
A Psychiatrist cannot perform surgery etc
You claim that NOWHERE IN THE CAN A NURSE PERFORM COMPLETE TREATMENT
I do not know what or how you define "complete treatment" what does that mean?
In the UK there are Advance Nurse Practitioners and Nurse Consultants that practise independently of doctor TOTALLY running independent clinics and their own caseloads doing MORE than BASIC CARE and providing SPECIALIST INTERVENTIONS without medical supervision including PRESCRIBING specialist drugs which General Practitioner doctors CANNOT prescribe and offering specialist advice to GPs

Many Nigerian doctors run into trouble in the UK when they arrive with this outdated mentality

Dear Colleage. There is no where did I mention that doctors have unlimited scope of practise. As a matter of fact having a specific role in the health team is what I mentioned. As a specialist myself insurance firms would not even cover you for treatment beyond your scope of practise. So when you talk about nurses diagnosing; I ask who signs the case note of that patient confirming the diagnosis and treatment plan. And who signs the drug regimen for the patient. I do not mean signing when a delegated task is given. Kindly post an attachment where a nurse signs a patients case note for a diagnosis.

debola27:
When i say health centres, i mean primary health centres. TBAs are not put in primary health centres as far as I know. The least person to attend to people in a PHC is the community health worker. And when you talk about complete treatment, it depends on what you mean. Nurses in PHC take care of ailments and child births then send patients home afterwards. I think that qualifies as complete treatment. They do not need a doctor for that. If any complication occurs, the patient is sent to a secondary or tertiary health centre where they are cared for by specialists. Nurses in secondary or tertiary centres do not prescribe for patients because that is the job of the doctor there. Nurses have their jobs, doctors have theirs. The only problem is when doctors feel the work of the Nurse is only limited to taking vital signs. And Nurse practitioners do not have 'doctor level training'. They have trainings that correspond with the standard level of care they are to give as Nurse practitioners.

A traditional birth attendant is a part of the primary health care team, especially in a rural setting. Many primary health centers do not even have Nurses. I do not know if apprenticeship qualifies as nursing. I think the drive to ensure every nurse has formal education is being pushed by the nursing body in Nigeria, there are still many nurses who have no bachelors. Also when I say a nurse practitioner has doctor level training I mean they are trained to diagnose. If you call note writing as diagnosing then you clearly do not understand what that word means. Nurses in Nigeria do not diagnose. Period.

debola27:
Like I already said, everyone has their duties assigned to them. Health centres usually have only community health/public health nurses attend to patients there, and no sanction occurs. In standard hospitals, Nurses also clerk patients to have a baseline knowledge on the patients they are to take care of. Thats why we have Nurses notes. They treat with drugs prescribed by the doctor, support a lot and post monitor the patient. The Nurse stays the most with the patient. Maybe because most of you doctors are used to private hospital settings, you're not really familiar with the duties of the Nurse.

Are you a nurse? And what level of nursing education do you have. I do not say it to spite you just out of curiosity. It seems you have a misunderstanding of how a health facility works. When you say health centres do you mean PHCs or be specific. A primary health center is usually a sub health facility in very remote areas with no resident doctor. A nurse or even TBA is put to stand in and attend to very basic care. At least we don't want patients dieing. No where in the world can a nurse perform complete treatment of a patient so get your facts right. I do not mean your notes of recording vital signs etc. Even Nurse practitioners in the western world that have doctor level training have a strict limit of care. You can perform basic care but there will always be a doctor or a pharmacist that can be called upon. I have worked in LUTH for many years so I know perfectly how hospital systems run. Once again nairaland is faceless but there are real people behind these accounts. At this point I rest on this case. As I said every member of the health team is vital and important, but roles on what to do are specific, and it commensurates with the level of training you receive and the need to ensure lives are in safe hands.