IMAGE CREDIT IS MINE
The practice of medicine is described as hallowed and noble, and practitioners are regarded as professionals in their respective fields of specialty. The world of medicine is a group of professionals consisting of medical doctors, nurses, pharmacists, laboratory scientists, and other allied para-medicals such as community health extension workers, nutrition and health educators, medical record personnel, hospital assistants,etc.
My years of clinical and non-clinical practice of medicine are still below ten, and thus, I am yet to qualify as a medical elder; however, that should be achievable in less than five years from now.
Here in Nigeria, the supposed flow of medical attention by a patient visiting the hospital is summarized below:
Mrs. A visits the hospital and gets a folder from the medical record personnel, then proceeds to the Nurses’ station where body vitals such as temperature, pulse, and respiratory cycles are charted while the patient is queued to see the doctor. Once the patient enters the consultation room, a history and examination are taken by the doctor, who may refer them for investigations if necessary. Once an assessment and diagnosis are concluded, the patient can be worked up for surgical intervention or have a prescription for medications where indicated.
This is the pattern of getting treated in Nigeria and, I believe, in the medical field.
Without bias, it is saddening to know that quality healthcare is expensive in Nigeria, especially with the limited resources available. Many Nigerian medical professionals have opted for greener pastures in other countries, leaving behind a fragment of overworked medical professionals. The value of quality is thus questionable and may not be maximal.
The analogy of Mrs. A above, however, seems thwarted, and I happened to have a first-hand experience yesterday when I went to a pharmacy store. What I am about to mention has been ongoing for a while; however, I did not understand its full implications yet.
ANOMALY OF NORMS
A patient walked into the pharmacy store to have a Blood pressure (BP) and Blood Sugar test done. It is understandable when pharmacies market themselves through non-invasive procedures such as BP checks, heights, and weights, but where does a pharmacy begin to prick patients?
Now, the pharmacist usually asks what medications the patient is on for BP and sugar and, subsequently, modulates the usage to correct any anomalies. I was amazed to see that a booklet was obtained for each patient, and a track record of BP and Sugar test values was written on it. Thus, the pharmacy does follow-up management for the patient.
Another scenario witnessed is when patients present at the pharmacy claiming to have malaria and needing drugs for treatment. The pharmacists take an appreciable test to make some consultations as regards the symptoms before dispensing drugs, which is usually without a laboratory investigation. Drugs are subsequently dispensed; however, I have yet to see a pharmacy that administers intravenous medications.
Yet, some patients come to the pharmacy and request to see the pharmacists, where complaints are lodged. The pharmacist would want to make money and thus accommodate the patient's complaints before recommending drugs.
The doctor is not without blame, as few in the business of private practice, in an attempt to conserve expenses, end up running investigations such as packed cell volume (PCV), Rapid diagnostic test for malaria (MRDT), urine analysis, Blood Grouping, Bleeding of patients for transfusion (I happened to have been instructed to do this by my medical director about five years ago), dispensing of drugs, etc.
Other para-medicals are also implicated, where they begin to abuse antibiotics, antimalarials, and other drugs all in the name of being within the hospital environment. The medical doctor is sometimes made to prescribe drugs by proxy.
WHO IS TO BLAME?
Who should the blame be on: The patients, the medical professionals, or the system in Nigeria? As much as I would love to point fingers, I would say that all parties have a share of the blame. This cuts across the medical professional who condones unethical practice, the patient who instigates the abuse of proper flow, and ultimately the system.
Permit me to mention the status of the implications of the system.
Lack of or inadequate regulatory bodies
Lack of or inadequate medical professionals
Lack of or inadequate knowledge of the ethics of medical conduct
Lack of or inadequate medical equipment
Lack of or inadequate orientation by patients
Exorbitant cost of quality medical attention, etc.
All these factors contribute to the anomaly seen in the practice of medicine in Nigeria.
The huge cost of seeing a doctor may discourage patients from going through the proper channel. The slow pace of achieving universal health coverage (UHC) through health insurance is still inadequate. The patient would thus gladly walk into a pharmacy, get a free consultation, and be treated afterwards.
These anomalies create a huge gap in the practice of medicine and expose the patient to drug abuse and, ultimately, drug resistance.
In order not to bore you, permit me to put a stop here for now while I trust your comments and contributions.
Thank you for reading.