The news about a medical doctor who
abandoned medicine to become an oil pipeline thief may have cast a pall
on the prestige of what is supposed to be a noble profession. But a
seeming loss of the prestige of medicine did not start today. You may
have heard it before that many doctors regret reading medicine. For me,
it was during my secondary school days. I had told a neighbor who was a
doctor, who further endeared me to the profession, that I would want to
read medicine, and I thought he would have been pleased. But I was
taken aback when he said I should instead go into engineering or even
banking like my dad. He said medicine was not worth the trouble. I felt
his advice was suspicious. I also recall a visit to our family doctor
then. When I told him my ambition, he said, “Why medicine? Since I got
into medical school I have not rested, even till now.” In my young mind,
I just concluded that some people would say anything to make sure
others don’t become like them.
I got into medicine anyway. I remember
always waking up with a start. The only thought was how to scale
anatomy, physiology and biochemistry. I thought it strange when other
students from other departments made a face when I told them I studied
late in the cadaver room. We dissected with our bare hands, and from
there to the cafeteria. Reading was not by choice. It was a race against
time. Twenty four hours was not enough, so you found yourself borrowing
from the next day and accruing deficits.
Well, I passed somehow and got into the
clinical class. Just when I thought the hurdle had been reduced, without
congratulating us, the Dean, Clinical Sciences in introducing us to the
clinic said: “If you think you have made it, you are wrong. This is the
time to decide whether you should continue the journey―or to
voluntarily withdraw!” This is despite those who were withdrawn. And
despite those who became psychiatric.
Though a teacher of mine boasted about
the study of medicine: “It has never been easy, and it will never be
easy,” many doctors do not want their children to be doctors. A 2007
survey by Merritt, Hawkins indicated that 57 per cent of 1,175 doctors
questioned would not recommend the field to their children. Another
teacher of mine said his son was “crazy enough to become a doctor.”
With the coming of the Information Age,
doctors have been demystified. The awe is for software scientists, and
those who can give us breathtaking electronic gadgets. And that is where
smart kids now go into, and of course, sports and music. Perhaps, Bill
Gates or the late Steve Jobs would not have been popular if they were
doctors.
Never known before, there is now
unemployment in the profession. After medical school, you have to do the
compulsory one-year internship. There are fewer accredited places for
internship than the number of medical graduates. Even those with
accreditation lack the funds to absorb. So you find fresh doctors
staying more than a year, even up to two years to get placement. And by
the Medical and Dental Council law, if you do not do the internship
within two years of graduating, you have to write a council exam. Even
after the compulsory National Youth Service Corps scheme, doctors still
look for work. Many doctors who want to become specialists, have passed
their primaries, but cannot get anywhere to do their residency
programme. I know some who have given up on that dream after many years
of attending fruitless interviews. The majority of doctors, many with
primaries, are doing one locum or the other in a private hospital where
they are paid as low as N60, 000 per month.
There are other disincentives. In the
US, doctors face malpractice regularly. And many have stopped practicing. Yet, the majority of lawsuits brought are frivolous. In
more than 91 per cent of cases, the defendants won. And only six per
cent of all lawsuits go to trial. Those that are not thrown out are
settled amicably. In Nigeria, it is catching on. Of course, doctors who
make gross inexcusable mistakes are liable, as those who are
unqualified. When a patient dies here, and the hospital remains the best
place to, there must be something the doctor should have done he did
not do. As doctors, we took an oath, yes, but the oath did not say we
will save everybody. Even Jesus did not save everybody. There was still a
son of perdition.
The typical scenario in Nigeria is that
the patient has taken all sorts of self-medication including traditional
concoction, and when organs have damaged they are rushed into the
hospital for the doctor to perform a miracle. Children are brought in
chronically ill-looking, very anemic and needing blood transfusion
because the parents’ neighbors told them it is “teething”. When you
tell a woman she will have an elective caesarian section because she
risks a uterine rupture from a previous caesarian section, she will say
“I reject it”. Many laboratory investigations cannot be done because
there are no reagents. There are many diagnostic tools that Nigerian
doctors only read about in textbooks. Many patients are also poor and
cannot do investigations when it is available and cannot buy their
medications. So your medical knowledge hangs in the air.
There are still other frustrations of
daily clinical life. In most government hospitals, the crowd stretches
the capacity of the hospital. In seeing a patient, a doctor is making
the most of the 15 or so minutes he has to be with the patient, but the
patients outside grumble that you are taking a long time. But when they
themselves get inside the surgery, they don’t want to leave. Some
patients complain that their doctor does not listen. But it is not so.
As New York Times health columnist, Danielle Ofri, puts it,
“Sometimes, it feels as though my brain is juggling so many competing
details, that one stray request from a patient—even one that is quite
relevant—might send the delicately balanced three-ring circus tumbling
down.” She calculated the number of thoughts a primary care doctor
juggles to do a satisfactory job, and tabulated 550. She said doctors
keep pushing so many balls into the air and that there is no doubt a few
will fall. As it stands, it seems that doctors will simply have to
continue this impossible mental high-wire act, juggling dozens of
clinical issues in their brains, panicking about dropping a critical
one. The resultant neuronal overload will continue to present a
distracted air to their patients that may be interpreted as they not
listening, or perhaps not caring.
Ofri, adds that when her computer
becomes overloaded, it simply crashes. Usually, she reboots in a fury,
angry about all her lost work. However, she views her computer with a
tinge of envy. It has the luxury of being able to crash, and of a
reassuring, omniscient hand to press the reboot button. Physicians are
permitted no such extravagance.
There are still other things to ponder
on. The retirement age of professors is now 70. Yet, critically
speaking, doctors do more for the people. How about increasing their
retirement age to 70 also? It pains me when doctors go on strike. But
how about removing doctors from the civil service structure and creating
something different that covers all doctors in government and the
private settings? How about empowering many other hospitals, including
the private ones to do internship and residency training? How about
increasing the budget that goes to health? Wait a minute. Where is the
National Health Bill?
I can’t deny that sometimes, I feel if I
had not been a doctor life would have been much easier. I do not have
to do calls. My sleep will not have to be interrupted by distress
telephone calls. I do not have to leave my wife in a dash. I am
condemned to have more than my own fair share of grieving, for every
patient that dies in my unit is somehow connected to me. Gasp, and
needle pricks!
But, I also shudder at what it would
mean for patients if doctors walked away from medicine because of the
frustrations. I still marvel at discovering the wonder of the human
body. The honour of being trusted by my patient to give them advice, the
gratitude the elderly ones especially show when helping them through
their illness, their prayers and blessings. These things will remain
unchanging. When I look at all these – I still consider myself lucky and
privileged to be placed to look after God’s creation.
By
Dr. Cosmas Odoemena
Odoemba is a Medical practitioner based in Lagos, Nigeria.
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