₦airaland Forum

stine b: I should be askinng you that question. Apparently you know only about CT scan hence your refferennce to it as the most complex in Radiography Practice, which I disputed and Introduced MRI. and PET scans to you.Thank God for me and google that has added knowledge of MRI and PET scan to your brain. Sink this Ito your memory "Positron Emitron Tomography scan is done by Radiographers"

....... quackery everywhere! o Lord. oga what training do our diagnostic radiographers have to carry out PET scans? I hope you know its extra training? did I ever mention ct and MRI as the latest modalities in town?? please don't overstate your importance.stick to what you can do.as far as nuclear medicine goes your job description is the same - imaging!
you are nothing special.let's leave PET and pet-ct alone for a minute.even the common MRI machine many of you can't operate.many of you can't acquire flow sensitive images, DWI or PWIs yet you all feel like alpha and omega. its a pity really.

how is it possible for a resident to earn cumulative salaries of pharma nurses and lab techs for gods sake? why these type of lies just to get public sympathy? na wa o. johesu really know how to play dirty.

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eaglechild: WHEN THE NURSE WANTS TO BE CALLED A 'DOCTOR'.


NASHVILLE — With pain in her right ear, Sue Cassidy went to a clinic. The doctor, wearing a white lab coat with a stethoscope in one pocket, introduced herself.



"Hi, i am Dr. Patti McCarver and i'm your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine.

It was something that will become increasingly routine for patients: a someone who is not a physician using the title of doctor.

Dr. McCarver calls herself a doctor because she returned to school to earn a doctorate last year, one of thousands of nurses doing the same recently. Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title “doctor,” but also the money, power and prestige that often comes with it.

As more nurses, pharmacists and physical therapists claim this honorific, physicians are fighting back. For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines.

Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.

But many physicians are suspicious and say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point?

Dr. Roland Goertz, the board chairman of the American Academy of Family Physicians, says that physicians are worried that losing control over “doctor,” a word that has defined their profession for centuries, will be followed by the loss of control over the profession itself. He said that patients could be confused about the roles of various health professionals who all call themselves doctors.

“There is real concern that the use of the word ‘doctor’ will not be clear to patients,” he said.

So physicians and their allies are pushing legislative efforts to restrict who gets to use the title of doctor. A bill proposed in the New York State Senate would bar nurses from advertising themselves as doctors, no matter their degree. A law proposed in Congress would bar people from misrepresenting their education or license to practice. And laws already in effect in Arizona, Delaware and other states forbid nurses, pharmacists and others to use the title “doctor” unless they immediately identify their profession.

The deeper battle is over who gets to treat patients first. Pharmacists, physical therapists and nurses largely play secondary roles to physicians, since patients tend to go to them only after a prescription, a referral or instructions from a physician. By requiring doctorates of new entrants, leaders of the pharmacy and physical therapy professions hope their members will be able to treat patients directly and thereby get a larger share of money spent on patient care.

As demand for health care services has grown, physicians have stopped serving as the sole gatekeepers for their patients’ entry into the system. So physicians must increasingly share their patients — not only with one another but also with other professions. Teamwork is the new mantra of medicine, and nurse practitioners and physician assistants (sometimes known as midlevels or physician extenders) have become increasingly important care providers, particularly in rural areas.

But while all physician organizations support the idea of teamwork, not all physicians are willing to surrender the traditional understanding that they should be the ones to lead the team. Their training is so extensive, physicians argue, that they alone should diagnose illnesses. Nurses respond that they are perfectly capable of recognizing a vast majority of patient problems, and they have the studies to prove it. The battle over the title “doctor” is in many ways a proxy for this larger struggle.

For patients, the struggle has brought an increasing array of professionals trained to deal with their day-to-day health woes, but also at times confusion over who is responsible for their care and what sort of training they have.
[b]
Six to eight years of collegiate and graduate education generally earn pharmacists, physical therapists and nurses the right to call themselves “doctors,” compared with nearly twice that many years of training for most physicians. [/b]For decades, a bachelor’s degree was all that was required to become a pharmacist. That changed in 2004 when a doctorate replaced the bachelor’s degree as the minimum needed to practice. Physical therapists once needed only bachelor’s degrees, too, but the profession will require doctorates of all students by 2015 — the same year that nursing leaders intend to require doctorates of all those becoming nurse practitioners.

Dr. Kathleen Potempa, dean of the University of Michigan School of Nursing and the president of the American Association of Colleges of Nursing, said that the profession’s new doctoral degree, called the doctor of nursing practice, was simply about remaining current. “Knowledge is exploding, and the doctor of nursing practice degree evolved out of a grass-roots recognition that we need to continuously improve our curriculum,” she said.

Last year, 153 nursing schools gave doctor of nursing practice degrees to 7,037 nurses, compared with four schools that gave the degrees to 170 nurses in 2004, when the association of nursing schools voted to embrace the new degree. In 2008, there were 375,794 nurses with master’s degrees and 28,369 with doctorates, according to a recent government survey.

Dr. Potempa said that nurses with master’s degrees were every bit as capable of treating patients as those with doctorates.

Nursing is filled with multiple specialties requiring varying levels of education, from a high school equivalency degree for nursing assistants to a master’s degree for nurse practitioners. Those wishing to become nurse anesthetists will soon be required to earn doctorates, but otherwise there are presently no practical or clinical differences between nurses who earn master’s degrees and those who get doctorates.

Nurse practitioners must generally graduate from college and take an additional 12 to 16 months of classes, which include months of treating patients for both mild and serious illnesses in clinics and hospitals under the watchful eyes of instructors. Those earning doctorates must generally take a further four semesters or 12 to 16 months of additional classes.

While instruction at each school varies, Dr. McCarver took classes in statistics, epidemiology and health care economics to earn her doctor of nursing practice degree. These additional classes, at Vanderbilt University, did not delve into how to treat specific illnesses, but taught Dr. McCarver the scientific and economic underpinnings of the care she was already providing and how they fit into the nation’s health care system. Studies have shown that nurses with master’s level training offer care in many primary care settings that is as good as and sometimes better than care given by physicians, who generally have far more extensive training. And patients often express higher satisfaction with care delivered by nurses, studies show. Physicians say they are better at recognizing rare problems, something studies have trouble measuring.

The benefits to patients of nurses receiving doctorates is unclear, since there is no evidence that nurses with doctoral degrees provide better care than those with master’s degrees do.

Given the proven effectiveness of nurses with master’s degrees, even some nursing leaders have asked why nurses should be required to get doctorates.

“If it ain’t broke, why fix it?” asked Dr. Afaf I. Meleis, dean of the University of Pennsylvania School of Nursing.

Some health care economists say the push for clinical doctorates across health professions could be misguided. They argue that anything requiring students to spend more time and money getting trained will invariably result in longer waits and increased costs for patients, because fewer students will meet the increased requirements and those who do will eventually demand higher compensation.

“Everyone’s talking about improving patients’ access to care, bending the cost curve and creating team-based care,” said Erin Fraher, an assistant professor of surgery and family medicine at the University of North Carolina School of Medicine. “Where’s the evidence that moving to doctorates in pharmacy, physical therapy and nursing achieves any of these?”

[b]Depending on their area of specialty, nurse practitioners earn a median salary of $86,000 to $90,000 annually, according to the Medical Group Management Association — a bit less than half of what primary care physicians earn. [/b]Nurses with doctorates generally earn the same salaries as those with master’s degrees since insurers pay the same rates to both. Physician groups fear that the real reason behind the creation of the doctor of nursing practice degree is to persuade more state legislatures to grant nurses the right to treat patients without supervision from doctors.

[b]Twenty-three states allow nurses to practice without a physician’s supervision or collaboration, and most are in the mountain West and northern New England, areas that have trouble attracting enough physicians. [/b]Nursing groups have lobbied for years to increase that number. “This degree is just another step toward independent practice,” said Louis J. Goodman, chief executive of the Texas Medical Association.

Not true, Dr. Potempa said — the new degree simply ensures that nurses stay competent. “It’s not like a group of us woke up one day to create a degree as a way to compete with another profession,” she said. “Nurses are very proud of the fact that they’re nurses, and if nurses had wanted to be doctors, they would have gone to medical school.”http://www.nytimes.com/2011/10/02/health/policy/02docs.html?pagewanted=all&_r=0

When the Nurse Wants to Be Called ‘Doctor’







We must be careful not to allow unwholesome practices that are now a thorn in the flesh of even developed healthcare systems in the world rear up its ugly head.

Many states in the US are now passing laws that limit what non doctors can do or titles they can bear.
Trying to undo what was unwittingly done.

We on the other hand must nip it in the bud.

sane nations are already seeing the future and the problems this will cause. they are already checkmating it

Slimchy09: In my opinion...NMA demands is just a truckload of crap. Its nt even patient-focussed...just adminstrative battle between them and JOHESU. So, its the patient that will suffer in this whole brouhaha...and they are jus too greedy to see that.

For starters...what the heck is a Surgeon General of the Federatn and hw does it better the lives of patients...if nt that its simply a political position and one more bragging claim over other health professionals

Secondly, why are the fighting to head over all the units in the hospital. Imagine a doctor that just graduated and did masters in maybe...say Nursing, would come and be the Chief Nursing Officer in a unit that has matrons with over 25years experience...imagine the disparity.

I think the major reason why there is so much decay in the health sector is because all the units have always been headed by medical consultants that are ill-trained for the field they are heading. Let the Nurses, lab scientists other health workers man their own unit if they are duly qualified to do so.

NMA cant survive on their own and neither can JOHESU. What is a doctor without a lab test result...NATIVE DOCTOR.

They should stop all this admistrative war and put aside all ego to work together for the benefit of the patients...which is their primary purpose of being health workers.

very shallow reasoning based yet again on sentiments. why don't you go through the demands of nma and critically analyse each one no matter how obnoxious they may be. study them then come and ask us sensible questions.

stine b: I am trying to fanthom if you are a medical officer or House officer maybe even a 2nd MB drop out. For a start,I want to introduce my self as a proud Medical Imaging Specialist A.K.A Radiographer I wish to inform you that as far as my practice of Radiography is concerned,We have trained Radiographers who report Tomograms(CT scan Images, MRI Images, Mamograms and Radiographs(Not picture as you call it). I have worked in Australia,UAE and Grenada before returning home to set up my private diagnostic centre where we run X-ray, Ultrasound,ECGand Laboratory Test. We didn't engage any Doctor in our practice because there are not needed. We have been precise and succesful with our test procedures without any complain from anywhere. It will suffice you to note that I take the X-ray exposure and report the Radiographs afterward with my name and Qualifications written and stamed there in. Same thing goes for general and specialised Ultrasound scan procedures(You can see that I have no need for a RADIOLOGIST,who after graduating from Medical school,decides to come and idle in my field of Radiography because of Lack of Job)
Furthermore, I employed a Medical Laboratory Scientist to oversee our Laboratory and he is very copetent in that line without the involvement of any socalled Pathologist. There is a pharmacy outfit beside us where we Reffer patients to buy their medications if need be, especially in Swab M/C/S etc.The good news is that patients get well after diagnosis and take prescribed medications from the pharmacist. We only refer a case that is worth Refferable to selected Hospitals that understand what Team work or division of labor means so that they can also do the needful. For your information Student Dr. Phantom,Nigerians are getting more exposed to know that you musnt go to the Hospital and see a Doctor to be well. 70% of our patients walk into our diagnostic outfit to give their complains.From our vast clinical knowledge based on experience and reading, we clerk them and carry out investigations where needed and where were see an issue we refer them to pharmacy for drugs or to a Hospital for care.
All the points you have been raising in this thread are only applicable in Government Health Institutions where you have your peers as Directors hence JOHESU petition and outcry to put an end to this anomaly.Government researched and constructively reasoned with JOHESU by accepting to implement our plea and a certain unrecognized Association in Nigeria Trade Unionism called NMA is striking against another mans career progression. All this anomalies in the health sector is what made me to reject an appointment from OAU Teaching Hospital Ife, after my Internship because I didn't want to be restrained from progressing in my career. I never regretted my decision to turn down the offer, because I have made so much money both abroad and in my private practice in Nigeria, A thing that I can only dream of probably after Retiring from the current Healthcare Institutions if I had taken their offer. Infact we need a change in this Rotten sector Instigated by a group of practitioners(NMA) that has little knowledge in Management.
In summary, I heard you said Doctors can do other professional duties. With all sense of seriousness I disagree with you. The day I catch any socalled Doctor Touching an X-ray,CT,Mammo,MRI or even an ultrasound machine,talkless of operating them, I'll so sue them using Decree No. 42 of Federation an act that empowers only Radiographers to run diagosis with those modalities.
Infact Dr. Phantom or whatever you call yourself, I openly challenge you on Clinicals let's see who knows it better.
Go to College of Medical Science University of Calabar and hear how student Radiographers beat Medical students in a quiz organised by the College provost for Anatomy courses (Neuro, Embryology,Gross,Histology etc)
Most of us chosed Radiography as First and 2nd Choice during our Jamb, because we wanted to be Radiographers(Eyes or Oracle of Medicine) Can you beat that? Cheers bro.

you can't write English.pray tell, why should I take you seriously? I shudder at the thought of someone like you reporting a CT film.lord have mercy! what language do you write in? pidgin?

Joenz: Another pathological lie typical of the lying egomaniac Nigerian physicians.whrever u practice in Nigeria,hw can u say med students n physicians pay for patients' tests MOST times,dnt u guys av conscience at all?And then to ur example,so cos d second test confirms ur suspesion of anaemia,u then load d patient with all sorts of heamatinics and supplement without caring to know wat d root cause is.let's assume d issue abt renal disorder leading to inadequate production of heamopoietin,then u continue loading ur patient with blood,patient suffers citrate toxicity n dies after massive blood tranfusion.This is exactly why u will b in jail in a sane society cos d will b thoroughly investigated n actsof incompetence or negligence severely punished!

as usual you have missed his point and already spinning a story around the little medicine you know.

barcanista: True...doctors don't av d luxury of "rest" like their professional colleagues. The issue now is that the Johesu did not tell us that the Office of Chief Nursing and co officers exist.
I am sure no doctor will entertain a situation where the offices of, Chief Nursing Officer and Chief Pharmacist are ALL occupied by a Nurse. It is so unacceptable and immoral for others to fight for the post of CMD when they have provisions for their own Chiefs.
Johesu should plssss tell us the whole situation of things. At the same time the Meds/NMA should strenthen their PR dept so as to gv the public the necessary informationn on what is going on and also tackle misleading information.

Honestly, NMA's public rating is going low these days....


However, strike is not the best when it comes to dispute resolution.

our PR is zero I tell you.that's why we struggle in situations like these.we need to properly explain to the public.johesu knows we are lacking in our PR dept and have used that to their advantage.

in the radiology department of UPTH,there is 1 MRI machine,1CT machine and 1 functioning ultrasound machine. the mammography machine has packed up.the digital xray machine is dead. they have been using the mobile xray machine used for patients who cannot be moved.the mobile machine is not built to handle lots of patients. in UPTH they xray not less than 50 patients a day.the mobile machine will soon pack up cos of the load.

the MRI machine is a 0.2 Tesla machine. (that figure is an indication of the strength of the machine and quality of images you get.the higher the Tesla, the better)
abroad they have gone up to 7tesla and more.in Ghana ,the least they have us 2 or 3 Tesla. in India they don't have less than 3 Tesla machines. the images gotten with 3 Tesla machine are so beautiful. you see tiny blood vessels well defined. a friend of mine went to India and told them we had a 0.2 Tesla machine at UPTH.they looked at him like he fell from the moon.a brand new MRI is about 300million naira
the ultrasound machine at UPTH is a new one but get this....it was acquired under a PPP arrangement. can you beat that? a state of the art ultrasound machine is at the most 20million naira.can't our government afford 50 of those?the machine came without a transvaginal prove meaning we can't properly assess the ovaries in an infertile woman.
the main x ray machine is dead so we have drastically reduced patient load and can't carry out contrast studies like HSG ,MCUG and IVU.

the CT machine is not wonderful.we can't do angiographic procedures.the injector never worked since the unit was installed.
the mammography machine is dead.we can't screen elderly women for breat cancers.
no dedicated generator for the department so poor power supply has ruined many of the machines and many times power has gone off in the middle of examinations ruining our images.
all these machines were acquired from vamed under obj in 2005.nothing has changed since then.
it is the same story in other depts. sometimes no reagents or fake reagents in the lab. no drugs in the pharmacy.no sterile packs for surgeons. no water or electricity for patients. are doctors magicians? we are seriously hampered YET we try our best.it is seriously disheartening when Nigerians crucify and call us all sorts when their leaders are robbing them blind.

tunsmart: @bumfem,you really don't need to be too dogmatic about this,links were posted by the respondent to clarify and define the respective roles of the consultants in those other fields,stating clearly that they are not hospital based.The best you can do is to take the king king route and use the stupid tywin lannister quote.If you are so sure that consultant nurses work in hospitals abroad.Post your links,and we discuss from there,stop your insulting display of ignorance right in front of corrections.

my brother don't expect any sensible argument from him.its all emotions. I've said it before...this struggle is just to embarrass the doctors pure and simple.

till date Nigerian medical graduates compete favourably anywhere in the world. go and check the pass rates of our graduates in USMLE & PLAB. after the Indians, the Nigerians are not far off. I know a boy four classes below me in medical school who left without doing the NYSC and in 3 -4 years became an " attending " in paediatrics.medical graduates leave the country everyday and compete well. that tells you something is fundamentally wrong in Nigeria and we all know what is. until Nigerians address the root cause we are not moving an inch forward. if we kill all the Nigerian doctors today and import american, British and Indian doctors,we will still have our abysmal and shameful health indices.don't be decieved. in the US,certain specialties are kept for their people e.g cardiothoracic, neurosurgery e.t.c. I don't know why but it makes no sense to me.you can't blame that on foreign qualifications.even Ben Carson a black american trained doctor had to surmount lots of obstacles before he could carry out paediatric surgeries.

saxywale: Doctors don't get poached again as the profession is heavily regulated except the poster is referring to countries like Uganda or CAR. In a country like Canada, they find regulated degrees not even as valuable as the paper they are written on especially when it's from a 3rd world country. Even doctors from almighty India would spend at least 5 years retraining to prove their worth before being allowed to touch a patient.
If it was that easy, all Nigerian doctors would have left Nigeria for better pay abroad.

note:I am not taking sides in this argument. I have a doctor as sister, a registered nurse as sister and pharmacist as wife.

this is false. those countries have NEVER REALLY POACHED our graduates.even in the 70s and 80s.what you actually mean to say is that its MORE DIFFICULT THESE DAYS TO GET PLACEMENTS ABROAD. that is not necessarily due to our qualifications but might be because of tighter or stricter IMMIGRATION policies. this issue is multifactorial

YourHealthlabs: Disprove what i said with facts. Stop allowing your lecturers deceive you.

If you touch an American patient with your Nigerian Mbbs, oga you'll go to JAIL. Try it

oga what are you saying? as a foreign graduate you must write the licensing exams of the countries in which you want to practice. of course I can't work in the US UK OR Australia without USMLE,PLAB OR AMC. this applies almost everywhere except Trinidad and Tobago where I can practice with my MBBS. your earlier statement implied that a Nigerian doctor who has passed the exams of those countries can't practice in those places WHICH IS FALSE.

lab technologists -> lab scientists
radiographers -> medical imaging scientists

we all see through the charade.all we see are lazy people trying to get what they couldn't get through the front door from the backdoor.

olrotimi: and u dnt think d advanced first aid kept u living til u got to india? BTW, who do u meet in india, uk, us, germany when u go thr? Its still we naija docs, making waves in a better working environment where we are respectd

you might have to get a pencil and paper and draw pictures for him.

YourHealthlabs: Sorry your last paragraph is another common fallacy you guys sold to the unsuspecting public.

A Nigerian-trained mbbs doctor won't be allowed touch an American patient. Never!. Even U.S medical Interns and Resident Docs are not allowed to treat patients, that's why they are paid far lower that Pharmacists, Nurses and Scientists in the States. Go check the relativity. American lives are too precious.

Now statistically, In the U.S the chances of a foreign-trained doctor passing MCAT and practicing in the U.S is a paltry 3% and that includes Britons, Indians, Italians, Nigerians, Filipinos and the rest of the world....all sharing a paltry 3%!. 97% is for U.S-trained Docs.

My uncle is a Nigerian-born US-trained doc practicing in the U.S.
Many Nigerian-born docs practicing there are US-trained. Nigerian-trained docs are only fit to be phlebotomists and lab specimen collectors in the U.S until they more training and try passing MCAT.

Please let endeavour to tell the world the truth.

were you able to keep a straight face while typing the above lie?? na wa o! the heights you ll go to.....lol

barcanista: u nigerian docs are bringing the medical profession to an unprecedented all time low!


Btw: even wen we go to see you in the hospital, all you do is ask few questions (and give some advanced first aid) before exporting us to india for "proper" treatment!

as if you could even afford to go to Ghana if your life depended on it....lol.

.......did naira land also lose its moderators along with its data?

olrotimi: I still dont understand all these hoof hoof about we doctors, soo loved yet soo hated. Unfortunately the common man wldnt understand the genesis of the conflict in the health sector. Visit the average lab in teachn hospitals & you'd be shocked abt the incompetence of the technicians (i desist from calling them scientists cos thrz nthng scientific abt their operation). We often times go back to discuss the veracity of the results they gv us which doesnt tally with clinical diagnosis, u'd b shockd to the marrow how hollow an explanation they'd offer. Its commön knowledge that if therz a diagnostic dilema, we take our samples to private laboratories which are directly supervised by doctors .......these are the people who want to be consultants. Consultants of the very chemicals they are confused about?

my brother the thing tire me wahali. I blame we doctors.we left these insults for long.we were busy reading books while they were getting bolder and edging us out.look at where too much jacking has lead us.serves us right.

ssultana: Perhaps if your post made more sense,i"d have a reply.....but as it is,nahhhhh

you are trying to hard to educate someone who has thrown away reason and is arguing on emotions. you will make no headway.

otokx: Medically qualified is not the same thing as medically fit.

People should call a spade a spade. Lab technologist were usually hnd holders then an amorphous and strange B.tech was given by universities to the same lab technologists and dubbed science lab tech.

Now they are calling themselves lab scientists dropping the tech to distinguish themselves fron lab tech but we all know their history. One went to apply for Masters in Microbiology and was told his starting point is post graduate diploma and he took offence.

A man will always be a man and head of the home, the woman will say she is head of the kitchen but it will end in laughter.

I nominate this for best post of the thread....

citizenisb: may we pray that evil BH does not strike again in Abuja before all you rats ranting understand the importance of doctors in your lives.

doctors are the best paid in the States because they value life and if we are so incompetent why do Nigerian trained doctors get frequently poached to work in the US and UK health sectors

somebody should please answer this very important question.

nathanomochi: well said @phantom,that's more than a comprehensive review.

bless you sir.

MissMeiya: I heard about this yesterday when I found out my uncle is ill. The doctor told him they were preparing to go on strike, so he couldn't help him, but prescribed some medication instead. I almost cried. If anything happens to my uncle, my grandmother will just slump. I'm so scared and angry and upset.

so sorry love, but the situation truly can't be helped.its a pity indeed.

obi4eze: I expected you to address the issue at hand. Doctors are afraid that if we begin to train consultants in other fields, there would be real competition and we could expose their inadequacies. We are not asking to be Consultant Surgeons or Gynaecologists. We want to have Consultant Haematologists, Physiotherapists and so on but they don't want and instead of focusing on doing their jobs, they want to trample on other professionals' scheme of service thus violating the constitution.
We respect them a lot but they should also respect themselves and stop asking for what they cannot have.

funny post.expose whose inadequacies doctors

Consultants and Chief Medical Officers in other Government Hospitals in the Developed World (International best practices/standards).

We do not need to travel far and wide to know what is happening in other parts of the world because the world has become a global village, all thanks to information technology.
The conflict in Nigeria health sector has tugged me to search for what is obtainable on the key warring issues in other developed countries. Ideally the Nigeria Health system format is supposed to be compared with that of the Britain(not the American’s) since Nigeria adopted and is using the British educational/health systems; however reference has been made on American health system in this write up, for obvious reason. I deliberately sourced for all information from current and popular international encyclopedia and/or professional websites not hosted by medical doctors.

Medical/hospital Consultant
The term or title “consultant” is coined from consultation. It is wise to see the standard definitions of medical consultation; which are:
Medical consultation is a formal meeting with a medical doctor for discussion or the seeking of advice….{ www.en.m.wikipedia.org/consultation(medical)}.
It is also defined as a procedure whereby, on request by one Physician, another Physician reviews a patient’s medical history, examines the patient and makes recommendation as to care and treatment….. ( www.medical dictionary.freedictionary.com/medical consultation).

In the UK, Republic of Ireland and parts of the commonwealth countries Medical Consultant is the title of a senior hospital-based physician or surgeon who has completed all of his/her specialist training….. {www. en.m.wikipedia.org/consultant (medicine) , www.medical dictionary.thefreedictionary.com/consultant(medicine), www.gapmedics.co.uk/difference between consultant and a doctor in a hospital }

Consultant Pharmacist
In America Pharmacists are broadly grouped into two:
1. Health system pharmacist
2. Consultant pharmacist
The health system pharmacist is hospital-based pharmacist that provides care to patient on healthcare team. They undergo residency training but are not awarded the title of consultant….(www.asph.org).

Consultant Pharmacists are pharmacist that work as private pharmacist for individual elderly persons or is employed to work in old people homes(institute) to enhance quality of care for all old persons. They are non-hospital staff and do not undergo residency training but write preparation/recertification examinations. They are also called senior care pharmacist… (www.ascp.com).

In USA Consultant Nurse is a registered nurse who uses expertise as a healthcare provider and specialized training to consult on medical related legal case. They assist attorneys in reading medical records and understanding medical terminology and healthcare issues to achieve the best results for their client. They are non-hospital staff….( www.en.m.wikipedia.org/nurse consultant)

Chief Medical Director (Office)
This title is used in many countries for the senior government official designated as head of medical services, usually at the national level. He advices and leads a team of medical experts on matters of importance. { www.en.m.wikipedia.org/chief medical officer, medical dictionary.thefreedictionary.com/chief medical officer, www.ehow.com/chief medical officer, www. gov.uk/government/people/sally-davies}

Surgeon General
In the United States and many areas of the British Commonwealth, this title refers to a physician commissioned by government and entrusted with the public health responsibilities.
In Uk Surgeon General is the senior medical officer of the British Armed Forces… ( www.en.m.wikipedia/surgeon general UK/USA).

Hospital Chief Executive Officer is the highest management position within a hospital in the capitalist countries. He or she is expected to have masters in business Administration, masters in healthcare Administration etc….( in Nigeria such a position is designated as Director of Administration in Teaching Hospitals)……www.degreetree.com/how to become a hospital ceo.

Health Care Professionals are divided into two broad groups:
1. Core Healthcare Professionals
2. Support (Allied) Healthcare Professionals
The core professionals are doctors, nurses and pharmacists….others, except these three, are allied professionals…… (www.wikipedia.org/allied health professions)

continuation....

On adoption of Foreign Healthcare Structure:
The fundamental idea behind the establishment of Tertiary Healthcare centers (Teaching Hospitals) in Nigeria was primarily for training of Medical Practitioners, Research, and provision of specialized healthcare at very affordable rate. It is not a business venture, and if this aims and objectives are to be met, then the hospital must be made to operate under the very Act that established it. Comparing our Healthcare practices with that of foreign nations without a review of the aim and objectives viz-a-viz that of our country is practically insane. Granted, a few hospitals in Canada are headed by Non-Doctors, and there are few Non-Doctor Consultants with well-defined jurisdictions in a few foreign countries, but that does not in any way directly improve their health indices. After all, high quality health care is still not affordable for a large proportion of Americans despite their very potent health insurance system.
Our very first interest should be to assist the government, which some members of the health sector have chosen to distract, to ensure there is affordable healthcare services to all its citizenry, seek ways of improving the training of the medical personnel and carry out Research programs that will elevate the quality of healthcare delivery in our own nation. Yes. We can go abroad and observe what obtains from there, but instead of disrupting order in the already existing system, by trying to blindly implement it over here, we can see how best to fit a few of them into our system and get the best out of it. The Government should concentrate on policies that will better the lives of the larger population of Nigerians, not those that pacify some disgruntled group of individuals fighting for position and their own other personal interests.
There are many other issues that do not only need Government attention, but also its speedy response. Some of these areas include: the appointment of Directors in the hospitals which distorts the chain of command in the hospitals, induces anarchy and expose patients to conflicting treatment and management directives; the passage of the National Health Bill, and extension of Universal Health Coverage to cover 100% Nigerians and not 30% as currently prescribed by the National Health Insurance Scheme; the appointment of the office of the Surgeon General of the Federation alongside many other pressing needs. These are health issues of paramount importance and the Government cannot afford to be lackadaisical about them. No. Not this time.
My Recommendations:
First of all, JOHESU is an amorphous body comprising of different entities with varying agitations, concerns, qualifications, expertise, and eligibility status and should not be confronted in that front by the government. Our government has to recognize the various constituents independently and verify their individual complaints as some parts of it have no moral standee to withdraw its services because of the unmet demands of another. For instance, The Medical and Health Workers Union (MHWU) comprising of Clerks, Messengers, Record Officers, Admin staffs, Janitors, Engineers, Security etc., an association of different people with absolutely no training in any Health related courses should not dare to aspire for headship positions in the hospital let alone been prevented from doing so. We do not have to give reasons why they should not. Therefore, the five different associations and unions under JOHESU should be made to make their specific submissions independent of one

Secondly, the Nigerian Labour Congress and Trade Union Congress should look beyond Unionism and focus on the ultimate goal of everybody in the health sector which is adequate Health care for the Nation. They should relinquish their parochial stand in the dispute between JOHESU and NMA, and as well desist from all forms of hooliganism and attempt to bully the Government and NMA on this matter.
Finally, the Government should resist all attempts to coerce it into yielding to the demands of one party in the dispute when the matter is still in court. There should be absolute regard for the Rule of Law. And all previous “concessions” should be stalled, and pending till a decisive ruling by the court.
We can go on and on to address so many other issues in the health sector that require attention but I have decided to throw light at just some parts of it before the Doctors under the auspices of the Nigerian Medical Association, an association of all certified Medical Doctors practicing in Nigeria down their tools as proposed come July 1st, 2014. Before the health of the nation would be thrown into the hands of Non-Doctors in the Health sector that usually prefer the exclusive services of Doctors when they and their loved ones take ill. Before the general public begin to lash out on Doctors and blame them for lives lost as a result of the forthcoming massive industrial action. The onus lie on the general public to call out on the Government to resolve these life threatening issues before the Doctors take to this hurtful last resort of theirs.
God bless Nigeria.

the above article i copied from a friend. its a long article but i implore you to read and digest it so you can get the salient issues and make an informed opinion.thanks and god bless


the 3 or 4 paragraphs that i bolded in the article(with the heading "on confernment of consultancy on other health professionals") is NMAs grouse with the issue of consultancy. the NMA has no business with what the other health professionals want to call themselves BUT IT BECOMES OUR BUSINESS WHEN IT BEGINS TO AFFECT PATIENT MANAGEMENT AND MAKE NO MISTAKES ABOUT IT,IT WILL!! believe it or not,the NMA is the only party in this drama that cares about the patients. when you make every chidi,kunle and adamu consultant in the health sector,YOU ARE BREEDING CONFUSION. NMA has vowed to resist it in the interest of nigerians.this struggle looks superficial to the average nigerian but we doctors are are already seeing the FUTURE,one that will be full of anarchy. we implore the general public to think deeply before they JUDGE & KILL us..

these same nigerians screaming 'CRUCIFY THE DOCTORS" will be the same people to turn around tomorrow and blame us for allowing this confusion to stand.as usual no one will point a finger at the governemnt. we are too docile for that. i beg every 'right-thinking" nigerian to support the NMA in this struggle. you will NOT regret it. but if you think johesu have a case and that NMA is pursuing trivial things,no wahala.

On adoption of Foreign Healthcare Structure:
The fundamental idea behind the establishment of Tertiary Healthcare centers (Teaching Hospitals) in Nigeria was primarily for training of Medical Practitioners, Research, and provision of specialized healthcare at very affordable rate. It is not a business venture, and if this aims and objectives are to be met, then the hospital must be made to operate under the very Act that established it. Comparing our Healthcare practices with that of foreign nations without a review of the aim and objectives viz-a-viz that of our country is practically insane. Granted, a few hospitals in Canada are headed by Non-Doctors, and there are few Non-Doctor Consultants with well-defined jurisdictions in a few foreign countries, but that does not in any way directly improve their health indices. After all, high quality health care is still not affordable for a large proportion of Americans despite their very potent health insurance system.
Our very first interest should be to assist the government, which some members of the health sector have chosen to distract, to ensure there is affordable healthcare services to all its citizenry, seek ways of improving the training of the medical personnel and carry out Research programs that will elevate the quality of healthcare delivery in our own nation. Yes. We can go abroad and observe what obtains from there, but instead of disrupting order in the already existing system, by trying to blindly implement it over here, we can see how best to fit a few of them into our system and get the best out of it. The Government should concentrate on policies that will better the lives of the larger population of Nigerians, not those that pacify some disgruntled group of individuals fighting for position and their own other personal interests.
There are many other issues that do not only need Government attention, but also its speedy response. Some of these areas include: the appointment of Directors in the hospitals which distorts the chain of command in the hospitals, induces anarchy and expose patients to conflicting treatment and management directives; the passage of the National Health Bill, and extension of Universal Health Coverage to cover 100% Nigerians and not 30% as currently prescribed by the National Health Insurance Scheme; the appointment of the office of the Surgeon General of the Federation alongside many other pressing needs. These are health issues of paramount importance and the Government cannot afford to be lackadaisical about them. No. Not this time.
My Recommendations:
First of all, JOHESU is an amorphous body comprising of different entities with varying agitations, concerns, qualifications, expertise, and eligibility status and should not be confronted in that front by the government. Our government has to recognize the various constituents independently and verify their individual complaints as some parts of it have no moral standee to withdraw its services because of the unmet demands of another. For instance, The Medical and Health Workers Union (MHWU) comprising of Clerks, Messengers, Record Officers, Admin staffs, Janitors, Engineers, Security etc., an association of different people with absolutely no training in any Health related courses should not dare to aspire for headship positions in the hospital let alone been prevented from doing so. We do not have to give reasons why they should not. Therefore, the five different associations and unions under JOHESU should be made to make their specific submissions independent of one another for clarity.
Secondly, the Nigerian Labour Congress and Trade Union Congress should look beyond Unionism and focus on the ultimate goal of everybody in the health sector which is adequate Health care for the Nation. They should relinquish their parochial stand in the dispute between JOHESU and NMA, and as well desist from all forms of hooliganism and attempt to bully the Government and NMA on this matter.
Finally, the Government should resist all attempts to coerce it into yielding to the demands of one party in the dispute when the matter is still in court. There should be absolute regard for the Rule of Law. And all previous “concessions” should be stalled, and pending till a decisive ruling by the court.
We can go on and on to address so many other issues in the health sector that require attention but I have decided to throw light at just some parts of it before the Doctors under the auspices of the Nigerian Medical Association, an association of all certified Medical Doctors practicing in Nigeria down their tools as proposed come July 1st, 2014. Before the health of the nation would be thrown into the hands of Non-Doctors in the Health sector that usually prefer the exclusive services of Doctors when they and their loved ones take ill. Before the general public begin to lash out on Doctors and blame them for lives lost as a result of the forthcoming massive industrial action. The onus lie on the general public to call out on the Government to resolve these life threatening issues before the Doctors take to this hurtful last resort of theirs.
God bless Nigeria.

THE TROUBLE WITH THE NIGERIAN HEALTH SECTOR
For a longtime now I have come across so many articles and reports in the national dailies and in online social media on the rife in the health sector which centers mainly on the row between doctors and non-doctors working in the healthcare system. Most of these reports and articles, mostly lopsided, have one common denominator, presenting the Doctor as an enemy of the people and the manner of their submissions is such as to draw undue sympathy from the unsuspecting public. But for the neutral members of the society who have had cause to have sufficient contact with the hospital environment, I’m not talking of some quasi journalists, they need not be told, if there are, who the Angels and Demons are.
This article is not aimed at indicting or exonerating any of the two combatant parties as both have had a fair share of the blame, and honestly, the deplorable state of our healthcare system is not as a result of the performance of the health workers, but it is a component of an overall failed system called Nigeria which the current government is still trying to salvage amongst other difficult challenges. Considering the lines along which the divide has been made, I shall delve into an inquest of some of the key issues at stake, mostly those that affect the general public, and this I will do by placing the Nigerian Doctor on one side to be reviewed alongside a few of the numerous “health professionals” working in the healthcare system with due consideration to the most important person in the system, the Patient. I shall concentrate mostly on the tertiary healthcare institutions where the bulk of the rivalry is most felt.
The Patient and the Hospital:
Let us begin from the beginning. A healthy person falls sick and needs to regain his health and function properly. He says to himself, “I don’t feel well enough, I need to see a Doctor. May be I should go to the hospital tomorrow”. He sets out of his house with this principal aim. On getting to the hospital, he first gets to the reception, obtains a card at the Out Patient Department and then proceeds to see a Doctor (usually a Medical Officer) if his condition is one that necessitates a Specialists attention, he is then Referred to another Doctor, the Specialist (Consultant) for further treatment. On getting to the point of referral, the Record staff assist him in opening a folder containing case notes, and in the process of this, a Doctor (Consultant) is assigned to him. The entire process of obtaining a card and folder have no direct effect on the patient’s condition but help ensure proper documentation and recording within the hospital. He is then directed to the designated Specialist or Consultant Clinic where he is received by a Nurse who does further documentation and records his vital signs which may or may not be repeated by the Doctor. Then the patient enters the clinic to see the Doctor, his primary aim for coming to the hospital ab initio.
The Patient, the Doctor and Other Health Workers:
The Doctor begins by taking a complete history of the patient which includes his current complaints, previous health challenges, living condition, social habits, family history, drug history, financial capacity, religious and cultural beliefs, and then proceeds to do a complete physical examination of his entire body system, at the end of which the Doctor would have verified the patients complaints and identified any other problems unknown to the patient, before arriving at a Provisional Diagnosis. He then counsels the patient, draws up a treatment plan, which is to be strictly adhered to provided the patient is within the hospital environment, and automatically takes full responsibility for any problems encountered along the line. He finally schedules him for a follow-up visit to ascertain his response to treatment. This process of history taking creates a personal relationship between the Patient and the Doctor and this is where the confidence of a patient on the Healthcare system of a Nation is built; the Doctor-Patient Relationship.
The treatment plan of the Patient, drawn by the Doctor, may or may not include; the investigations (or tests) both laboratory or radiological to be carried out, the drugs to be dispensed and the appropriate prescription, the additional care to be rendered outside the basic nursing care and the treatment orders to be followed, some of which he does himself (or via his subordinate Doctors) and others by the Nurses. There is no stereotyped outline of what must be done for every patient; investigations to be carried out, treatment to be administered or drugs to be prescribed lies solely at the discretion of the Patient and his Doctor.
Apart from the Nurses, all other “Health Professionals” come into patient care when the Doctor’s plan involves them. Clearly, a patient has no business with the Radiographer if the Doctor’s plan does not involve radiography, neither does he have any business with the Pharmacist if the patient does not require any drugs, of course, not every patient require drugs. Therefore, it is safe to assert that if Patient Care is the sole interest of everybody in the Health sector, then the Doctor takes the Central stage in this service to Patients and must carry the Nurses along at every point in time, and together they look out for any other “Health Professional” that should be roped into patient care. Why then should the Doctor take the Central stage? Very simple. He has been trained thoroughly to do so. Invariably, the Doctor is naturally the undisputed leader of the Health team and only two classes of people can challenge this standing; the criminal minded ones pursing their selfish interests and the dim-wits incapable of any logical reasoning.
On the Headship of the Hospital:
Over time, the functional head of the tertiary hospital setting has been the office of the Chief Medical Director, CMD, and part of the Act establishing the hospitals specified that this position be held by a Medical Doctor. However, there has recently been a loud cry from other “Health Professionals” under the auspices of the Joint Health Workers Union (JOHESU) for the chance to also partake in the “enjoyment” of this office, as if to say it is a political office, a “National Cake” which should be shared equally to everyone in the scene, whereas, it is the most sensitive of all positions in the hospital setting, one with huge implications on the health of patients. The Medical Doctors on the other hand, insist that the office of the Chief Medical Director and the headship in general, of the Hospitals is their exclusive reserve.
How true is this claim by the Doctors? Again, it is very simple. Healthcare is all about patient care, and in rendering care to the patient who is the main focus of everyone, the Doctor is the arrow head. He brings together the activities of all in the health care delivery system to bear fruit on the health of the patient. He has a broad-based and yet in-depth medical knowledge that enables him to function as a leader in patient management and take responsibility for the outcome. It is then indeed a funny ideology to expect the Doctor to maintain leadership of Patient Management and then cede the leadership of the Hospital Management to a Non-Doctor. Right thinking people would agree that whoever takes the blame should take the lead. Leadership is about responsibility, and Doctors embrace such responsibility mainly as it involves lives which they have sworn an oath to protect.
Furthermore, JOHESU, a body comprising of other “health professionals”, support staffs and in fact all in the Hospital setting except Doctors, claim to be equal and allied to Medicine. But my question is, how is the clerical staff allied to Medicine? How can a support staff head the core members of the organization? Also, why should a “profession” that is “allied” to Medicine surmount Medicine? Can a Non-Lawyer become the Attorney General of the Federation? Why isn’t the office of the Vice-Chancellor made open to every staff in the University system since ASUU and NASUU both consist of “professionals”? How would ceding hospital leadership to JOHESU improve the health indices of our country? These are people that do not deal directly with patients, people that do not really understand the agony of patients which Doctors do. The saddest part is the extent they can go to press home their irrational demands. We have a documented occurrence of how they turned off power supply to the Intensive Care Unit during a JOHESU orchestrated strike action in a southeastern Teaching Hospital leading to death of patients on life support. This was an attempt to frustrate the Doctors’ effort to keep hospital services running while they were “striking”. How can people who have displayed this level of irresponsibility be allowed to head the Health sector? Again, God forbid!
It is a common saying that Doctors are “proud”, and I insist, they have very just reasons to be, and when it comes to arrogance, the patients can tell who amongst Doctors and Nurses are more approachable. Doctors are a select class of elite and comprise the best brains of the society. Yes, the entry requirements into the profession and the medical training ensure that only the best emerge as Doctors. As such, the government has to understand that any arrangement that sees a Non-Doctor in a sensitive position to head Doctors in any Health related issue would be met with fierce resistance and the never ending tussle it will ensue will have detrimental effects on our nation’s healthcare delivery. In the interest of peace and decorum, the Federal Government has to dig in and ensure that the status quo is been maintained. The ear that will hear needs not be the size of a raffia palm.
On conferment of Consultancy on other “Health Professionals”:
[b]A Consultant (Medical) is the title for a senior hospital-based physician or surgeon who has completed all of his/her specialist (Residency) training and has been placed on the specialist register (Fellow) in their chosen specialty. This level of Doctor joins the Civil service as a Consultant and automatically leads a team of Doctors comprising Residents, Medical Officers and House Officers who train under him.
Currently, there has been an outcry by JOHESU to also be awarded Honorary Consultancy based on the fact that Doctors are been appointed as Consultants, why not they too. The concession of the government to this particular demand has led to the entire hospital going berserk in some centers. This was done against the warning of the Nigerian Medical Association that the introduction of such “alien” practices would be detrimental to the lives of patients and the results are showing.
At the Nnamdi Azikiwe University Teaching Hospitals, it is been said that a “Consultant Pharmacist” invaded the wards with his team, cancelling patients prescriptions and also demanded that a Consultant Cardiologist remove a key drug in an inpatient prescription, on grounds that the drug has some known adverse effects. Another report has it that in Abuja University Teaching Hospital, the Ante-Natal Clinic was invaded by Nurses who decided to consult patients and make prescriptions, of which the Doctors left the clinic and the Patients were confused. Patients who sought to see their Doctors were told that there was a “Consultant Nurse” who does whatever a Consultant does. Also, in University College Hospital, Ibadan, stories had it that a Consultant Plastic Surgeon was barred from reviewing the surgical wound he created post-operatively because a “Consultant Nurse” had reviewed the wound earlier and was satisfied with her findings.
Let us address one of these occurrences. It is grave ignorance for a Pharmacist to tamper with a drug prescription simply because he has looked through his drug formulary and has identified a known adverse effect of the drug when he/she has no knowledge of the processes involved in the making of diagnosis and prescriptions. Patient management is highly individualized. To make a prescription, the Doctors put many things into consideration viz; patient’s history and examination, financial cost of the drug, benefits against the risk of using the drug, other drugs to be administered etc. Sometimes the side effect of a drug is the desired effect needed in one patient but would remain a serious adverse effect in another patient. But no, the Pharmacist didn’t think in that line before cancelling prescriptions. I am not saying every doctor’s prescription is infallible. No. But if a pharmacist wishes to express concern over a patient’s prescription, he should discuss with the Doctor to sort out their concerns.
This whole consultancy for non-doctors arose as a result of their quest to have better remuneration. I am not opposed to better remuneration for other health workers, but looking for cheap means to it at the expense of the lives of patients is grossly unacceptable. Why would you want to be a Specialist (Consultant) when you have no specialty, or you have a specialty in an area whose service is not needed? Even if a non-doctor must be a consultant that does not automatically make him/her a Doctor. We all know how to become a Doctor and age is no barrier.
If non-doctors must immutably be made consultants, their duties and jurisdictions must be clearly spelt out and understood by all involved. A Consultant Nurse should be confined to Nursing Practice and she will be expected to enhance it, not to invade Medical Practice. She must ensure that the management plan of a Doctor is properly carried out, even if he is a House Officer. Unfortunately, the idea of non-doctor consultant emanates from the desire of these other “health Professionals” for position and better pay than the desire to meet any specific needs. For instance, a ward Nurse that does her duties properly becomes a Consultant, what extra services and improvement does that bring to nursing care? The fact that there exist non-doctor consultants in a few foreign countries does not explain why the government should channel huge sums of money into the payment of honorarium to consultants that add nothing to the existing system but chaos. The NMA have identified these unhealthy health policies and should do all it can to prevent it from killing Nigerians.[/b]
On relativity of Wages:
Another very important object of discord is the demand by JOHESU for a unified salary scheme for everyone in the health sector and that will see a close approximation of the eventual earnings of all in the sector. What else can be sillier? Need I remind us that in every organization there is usually an established strata. Even in heaven, there are Angels and Arch angels, and the angels are content with their positions and would not want to usurp the duties of the Arch angels either. People cannot obtain different qualifications, different expertise, subserve different needs and end up earning similar pay. No. That cannot happen. Why would a non-specialist insist on being paid specialists allowance? Why would a Non-doctor terrorize the government because he wants to be paid like Doctors? Where in the world is that obtainable? Relativity is sacrosanct and must be reflected both on the basic salaries and all allowances.
Granted. Doctors are few. Very very few. The World Health Organisiation recommends that a Doctor should consult not more than seven patients in a clinic session and should pay maximum attention to their needs, but our environment see us in a situation where a Doctor consults over 40 patients in one clinic session, yet, he is underpaid compared to his colleagues even in nearby Ghana. There are less than 30,000 Doctors currently practicing in Nigeria subserving over 170 million Nigerians, and there is a dire need for more, but that will not push the Medical schools to take in everybody and churn out unqualified people as Doctors, neither will the Nigerian Doctor allow a Non-Doctor to tamper with the lives of patients. Doctors swore an oath to preserve lives and the NMA must see to it that the lives of Nigerians are safeguarded. If the Hippocratic Oath is to be taken serious, then the NMA must win this battle.
More often than not, we are clear on the knowledge that it is injustice to treat equal people unequally, but it fails to come to our minds that, it is graver injustice to treat unequal people equally. This is not pride, it is a statement of fact. Doctors and Non-doctors in the Health sector are not equal and they cannot be treated as equal. There is a reason why some students work harder than others to become Doctors. Some sat for JAMB several times to achieve that, although many fail to do so and even some do fail out of medical school and end up as “other Health Professionals”. To eventually anticipate to be rewarded equally with those who triumphed where you failed is simply madness. The government must see to it that relativity is maintained. For if a Nurse or Pharmacist consults patient, not regarding quality of the consult, earns equally with a Doctor and even get a chance to head the Doctor, why then would one need to work harder to become a Doctor when he can easily become a Pharmacist? Tampering with relativity is a conscious attempt at breeding mediocrity, again at the expense of lives. If the Nurses and Pharmacists accept to be paid equally with the Lab “Scientist” and Janitors, it’s their own cup of tea, but paying Doctors and Non-doctors equally? God forbid!
On the Physiotherapists’ demand to make first contact with Patients:
According to Prof. K. E. Obidike, there are three reasons why patients go to see Doctors. Firstly, is to ascertain the causes of their complaints and resolve them. Secondly, is to identify any other health problems unknown to the patient, and again, resolve them timely, and finally, to have a baseline documentation of the patient as a reference for subsequent health issues. The second reason especially, answers the question as to why a Physiotherapist cannot make first contact with patients. Medicine is holistic, and the initial assessment of a patient takes the entire body system into account not just the presenting complaints. Therefore, Physiotherapists should remain Physiotherapists and should come into action when consulted. Simple.

THE TROUBLE WITH THE NIGERIAN HEALTH SECTOR
For a longtime now I have come across so many articles and reports in the national dailies and in online social media on the rife in the health sector which centers mainly on the row between doctors and non-doctors working in the healthcare system. Most of these reports and articles, mostly lopsided, have one common denominator, presenting the Doctor as an enemy of the people and the manner of their submissions is such as to draw undue sympathy from the unsuspecting public. But for the neutral members of the society who have had cause to have sufficient contact with the hospital environment, I’m not talking of some quasi journalists, they need not be told, if there are, who the Angels and Demons are.
This article is not aimed at indicting or exonerating any of the two combatant parties as both have had a fair share of the blame, and honestly, the deplorable state of our healthcare system is not as a result of the performance of the health workers, but it is a component of an overall failed system called Nigeria which the current government is still trying to salvage amongst other difficult challenges. Considering the lines along which the divide has been made, I shall delve into an inquest of some of the key issues at stake, mostly those that affect the general public, and this I will do by placing the Nigerian Doctor on one side to be reviewed alongside a few of the numerous “health professionals” working in the healthcare system with due consideration to the most important person in the system, the Patient. I shall concentrate mostly on the tertiary healthcare institutions where the bulk of the rivalry is most felt.
The Patient and the Hospital:
Let us begin from the beginning. A healthy person falls sick and needs to regain his health and function properly. He says to himself, “I don’t feel well enough, I need to see a Doctor. May be I should go to the hospital tomorrow”. He sets out of his house with this principal aim. On getting to the hospital, he first gets to the reception, obtains a card at the Out Patient Department and then proceeds to see a Doctor (usually a Medical Officer) if his condition is one that necessitates a Specialists attention, he is then Referred to another Doctor, the Specialist (Consultant) for further treatment. On getting to the point of referral, the Record staff assist him in opening a folder containing case notes, and in the process of this, a Doctor (Consultant) is assigned to him. The entire process of obtaining a card and folder have no direct effect on the patient’s condition but help ensure proper documentation and recording within the hospital. He is then directed to the designated Specialist or Consultant Clinic where he is received by a Nurse who does further documentation and records his vital signs which may or may not be repeated by the Doctor. Then the patient enters the clinic to see the Doctor, his primary aim for coming to the hospital ab initio.
The Patient, the Doctor and Other Health Workers:
The Doctor begins by taking a complete history of the patient which includes his current complaints, previous health challenges, living condition, social habits, family history, drug history, financial capacity, religious and cultural beliefs, and then proceeds to do a complete physical examination of his entire body system, at the end of which the Doctor would have verified the patients complaints and identified any other problems unknown to the patient, before arriving at a Provisional Diagnosis. He then counsels the patient, draws up a treatment plan, which is to be strictly adhered to provided the patient is within the hospital environment, and automatically takes full responsibility for any problems encountered along the line. He finally schedules him for a follow-up visit to ascertain his response to treatment. This process of history taking creates a personal relationship between the Patient and the Doctor and this is where the confidence of a patient on the Healthcare system of a Nation is built; the Doctor-Patient Relationship.
The treatment plan of the Patient, drawn by the Doctor, may or may not include; the investigations (or tests) both laboratory or radiological to be carried out, the drugs to be dispensed and the appropriate prescription, the additional care to be rendered outside the basic nursing care and the treatment orders to be followed, some of which he does himself (or via his subordinate Doctors) and others by the Nurses. There is no stereotyped outline of what must be done for every patient; investigations to be carried out, treatment to be administered or drugs to be prescribed lies solely at the discretion of the Patient and his Doctor.
Apart from the Nurses, all other “Health Professionals” come into patient care when the Doctor’s plan involves them. Clearly, a patient has no business with the Radiographer if the Doctor’s plan does not involve radiography, neither does he have any business with the Pharmacist if the patient does not require any drugs, of course, not every patients require drugs. Therefore, it is safe to assert that if Patient Care is the sole interest of everybody in the Health sector, then the Doctor takes the Central stage in this service to Patients and must carry the Nurses along at every point in time, and together they look out for any other “Health Professional” that should be roped into patient care. Why then should the Doctor take the Central stage? Very simple. He has been trained thoroughly to do so. Invariably, the Doctor is naturally the undisputed leader of the Health team and only two classes of people can challenge this standing; the criminal minded ones pursing their selfish interests and the dim-wits incapable of any logical reasoning.
On the Headship of the Hospital:
Over time, the functional head of the tertiary hospital setting has been the office of the Chief Medical Director, CMD, and part of the Act establishing the hospitals specified that this position be held by a Medical Doctor. However, there has recently been a loud cry from other “Health Professionals” under the auspices of the Joint Health Workers Union (JOHESU) for the chance to also partake in the “enjoyment” of this office, as if to say it is a political office, a “National Cake” which should be shared equally to everyone in the scene, whereas, it is the most sensitive of all positions in the hospital setting, one with huge implications on the health of patients. The Medical Doctors on the other hand, insist that the office of the Chief Medical Director and the headship in general, of the Hospitals is their exclusive reserve.
How true is this claim by the Doctors? Again, it is very simple. Healthcare is all about patient care, and in rendering care to the patient who is the main focus of everyone, the Doctor is the arrow head. He brings together the activities of all in the health care delivery system to bear fruit on the health of the patient. He has a broad-based and yet in-depth medical knowledge that enables him to function as a leader in patient management and take responsibility for the outcome. It is then indeed a funny ideology to expect the Doctor to maintain leadership of Patient Management and then cede the leadership of the Hospital Management to a Non-Doctor. Right thinking people would agree that whoever takes the blame should take the lead. Leadership is about responsibility, and Doctors embrace such responsibility mainly as it involves lives which they have sworn an oath to protect.
Furthermore, JOHESU, a body comprising of other “health professionals”, support staffs and in fact all in the Hospital setting except Doctors, claim to be equal and allied to Medicine. But my question is, how is the clerical staff allied to Medicine? How can a support staff head the core members of the organization? Also, why should a “profession” that is “allied” to Medicine surmount Medicine? Can a Non-Lawyer become the Attorney General of the Federation? Why isn’t the office of the Vice-Chancellor made open to every staff in the University system since ASUU and NASUU both consist of “professionals”? How would ceding hospital leadership to JOHESU improve the health indices of our country? These are people that do not deal directly with patients, people that do not really understand the agony of patients which Doctors do. The saddest part is the extent they can go to press home their irrational demands. We have a documented occurrence of how they turned off power supply to the Intensive Care Unit during a JOHESU orchestrated strike action in a southeastern Teaching Hospital leading to death of patients on life support. This was an attempt to frustrate the Doctors’ effort to keep hospital services running while they were “striking”. How can people who have displayed this level of irresponsibility be allowed to head the Health sector? Again, God forbid!
It is a common saying that Doctors are “proud”, and I insist, they have very just reasons to be, and when it comes to arrogance, the patients can tell who amongst Doctors and Nurses are more approachable. Doctors are a select class of elite and comprise the best brains of the society. Yes, the entry requirements into the profession and the medical training ensure that only the best emerge as Doctors. As such, the government has to understand that any arrangement that sees a Non-Doctor in a sensitive position to head Doctors in any Health related issue would be met with fierce resistance and the never ending tussle it will ensue will have detrimental effects on our nation’s healthcare delivery. In the interest of peace and decorum, the Federal Government has to dig in and ensure that the status quo is been maintained. The ear that will hear needs not be the size of a raffia palm.
On conferment of Consultancy on other “Health Professionals”:
A Consultant (Medical) is the title for a senior hospital-based physician or surgeon who has completed all of his/her specialist (Residency) training and has been placed on the specialist register (Fellow) in their chosen specialty. This level of Doctor joins the Civil service as a Consultant and automatically leads a team of Doctors comprising Residents, Medical Officers and House Officers who train under him.
Currently, there has been an outcry by JOHESU to also be awarded Honorary Consultancy based on the fact that Doctors are been appointed as Consultants, why not they too. The concession of the government to this particular demand has led to the entire hospital going berserk in some centers. This was done against the warning of the Nigerian Medical Association that the introduction of such “alien” practices would be detrimental to the lives of patients and the results are showing.
At the Nnamdi Azikiwe University Teaching Hospitals, it is been said that a “Consultant Pharmacist” invaded the wards with his team, cancelling patients prescriptions and also demanded that a Consultant Cardiologist remove a key drug in an inpatient prescription, on grounds that the drug has some known adverse effects. Another report has it that in Abuja University Teaching Hospital, the Ante-Natal Clinic was invaded by Nurses who decided to consult patients and make prescriptions, of which the Doctors left the clinic and the Patients were confused. Patients who sought to see their Doctors were told that there was a “Consultant Nurse” who does whatever a Consultant does. Also, in University College Hospital, Ibadan, stories had it that a Consultant Plastic Surgeon was barred from reviewing the surgical wound he created post-operatively because a “Consultant Nurse” had reviewed the wound earlier and was satisfied with her findings.
Let us address one of these occurrences. It is grave ignorance for a Pharmacist to tamper with a drug prescription simply because he has looked through his drug formulary and has identified a known adverse effect of the drug when he/she has no knowledge of the processes involved in the making of diagnosis and prescriptions. Patient management is highly individualized. To make a prescription, the Doctors put many things into consideration viz; patient’s history and examination, financial cost of the drug, benefits against the risk of using the drug, other drugs to be administered etc. Sometimes the side effect of a drug is the desired effect needed in one patient but would remain a serious adverse effect in another patient. But no, the Pharmacist didn’t think in that line before cancelling prescriptions. I am not saying every doctor’s prescription is infallible. No. But if a pharmacist wishes to express concern over a patient’s prescription, he should discuss with the Doctor to sort out their concerns.
This whole consultancy for non-doctors arose as a result of their quest to have better remuneration. I am not opposed to better remuneration for other health workers, but looking for cheap means to it at the expense of the lives of patients is grossly unacceptable. Why would you want to be a Specialist (Consultant) when you have no specialty, or you have a specialty in an area whose service is not needed? Even if a non-doctor must be a consultant that does not automatically make him/her a Doctor. We all know how to become a Doctor and age is no barrier.
If non-doctors must immutably be made consultants, their duties and jurisdictions must be clearly spelt out and understood by all involved. A Consultant Nurse should be confined to Nursing Practice and she will be expected to enhance it, not to invade Medical Practice. She must ensure that the management plan of a Doctor is properly carried out, even if he is a House Officer. Unfortunately, the idea of non-doctor consultant emanates from the desire of these other “health Professionals” for position and better pay than the desire to meet any specific needs. For instance, a ward Nurse that does her duties properly becomes a Consultant, what extra services and improvement does that bring to nursing care? The fact that there exist non-doctor consultants in a few foreign countries does not explain why the government should channel huge sums of money into the payment of honorarium to consultants that add nothing to the existing system but chaos. The NMA have identified these unhealthy health policies and should do all it can to prevent it from killing Nigerians.
On relativity of Wages:
Another very important object of discord is the demand by JOHESU for a unified salary scheme for everyone in the health sector and that will see a close approximation of the eventual earnings of all in the sector. What else can be sillier? Need I remind us that in every organization there is usually an established strata. Even in heaven, there are Angels and Arch angels, and the angels are content with their positions and would not want to usurp the duties of the Arch angels either. People cannot obtain different qualifications, different expertise, subserve different needs and end up earning similar pay. No. That cannot happen. Why would a non-specialist insist on being paid specialists allowance? Why would a Non-doctor terrorize the government because he wants to be paid like Doctors? Where in the world is that obtainable? Relativity is sacrosanct and must be reflected both on the basic salaries and all allowances.
Granted. Doctors are few. Very very few. The World Health Organisiation recommends that a Doctor should consult not more than seven patients in a clinic session and should pay maximum attention to their needs, but our environment see us in a situation where a Doctor consults over 40 patients in one clinic session, yet, he is underpaid compared to his colleagues even in nearby Ghana. There are less than 30,000 Doctors currently practicing in Nigeria subserving over 170 million Nigerians, and there is a dire need for more, but that will not push the Medical schools to take in everybody and churn out unqualified people as Doctors, neither will the Nigerian Doctor allow a Non-Doctor to tamper with the lives of patients. Doctors swore an oath to preserve lives and the NMA must see to it that the lives of Nigerians are safeguarded. If the Hippocratic Oath is to be taken serious, then the NMA must win this battle.
More often than not, we are clear on the knowledge that it is injustice to treat equal people unequally, but it fails to come to our minds that, it is graver injustice to treat unequal people equally. This is not pride, it is a statement of fact. Doctors and Non-doctors in the Health sector are not equal and they cannot be treated as equal. There is a reason why some students work harder than others to become Doctors. Some sat for JAMB several times to achieve that, although many fail to do so and even some do fail out of medical school and end up as “other Health Professionals”. To eventually anticipate to be rewarded equally with those who triumphed where you failed is simply madness. The government must see to it that relativity is maintained. For if a Nurse or Pharmacist consults patient, not regarding quality of the consult, earns equally with a Doctor and even get a chance to head the Doctor, why then would one need to work harder to become a Doctor when he can easily become a Pharmacist? Tampering with relativity is a conscious attempt at breeding mediocrity, again at the expense of lives. If the Nurses and Pharmacists accept to be paid equally with the Lab “Scientist” and Janitors, it’s their own cup of tea, but paying Doctors and Non-doctors equally? God forbid!
On the Physiotherapists’ demand to make first contact with Patients:
According to Prof. K. E. Obidike, there are three reasons why patients go to see Doctors. Firstly, is to ascertain the causes of their complaints and resolve them. Secondly, is to identify any other health problems unknown to the patient, and again, resolve them timely, and finally, to have a baseline documentation of the patient as a reference for subsequent health issues. The second reason especially, answers the question as to why a Physiotherapist cannot make first contact with patients. Medicine is holistic, and the initial assessment of a patient takes the entire body system into account not just the presenting complaints. Therefore, Physiotherapists should remain Physiotherapists and should come into action when consulted. Simple.

candygosh: I wanted to write shut up before but then I just told myself not to. Do u have to be sarcastic, use ur brain when needed pls. You shouldn't ve quoted me to write tht rubbish. I understand u will be jobless as from tomorow but save us ur stupidity.
And. To think you r supposed to be a doctor, I shake my head for this country.

i am sorry. shouldnt have made that comment.please accept my apology.i wish you a good surgery and a quick recovery. best regards