For years, a healthy relationship existed
between the doctor and all other health care workers. The nurse
remained a nurse, the pharmacist remained a pharmacist, the laboratory
scientist remained just that. It was the same for all other health care
workers. There was no conflict in roles. No one crossed the other’s
path. No one envied the other’s pay package. Everyone was satisfied with
what they were.
In those days, there was no acrimony.
There was instead harmony that allowed the hospital to work for the
greater benefit of who it was really meant for: The patient. Everyone
understood that health care service was a team work and everyone knew
who the team leader was. Those days are gone. And gone, sadly.
All through the military regime, this
breakdown in relationship did not exist. But with the levity that comes
with democracy, it has come to be.
In the beginning, the doctor worked alone
in his practice. You see this often when you watch foreign movies
concerning doctors, who practise in a rural setting. He tends wounds,
dispenses drugs, has a microscope, a few laboratory equipment and
reagents. This is in fact how it was with medical practice from the
beginning. The doctor was an all-rounder in the real sense of it. But
with time, he began to have assistants. That was the birth of allied
health workers. But as it is, those who the doctor helped exist have
become Frankenstein monsters unto him.
But even in a hospital setting, while the
doctor can still do the job of a pharmacist, nurse, and that of a
laboratory scientist, they cannot do his job.
Perhaps, all those who used to agree that
health care work is team work, but the doctor is the head of the
medical team have now eaten from the “tree of life.” As we say it here,
“their eyes don open.”
Now, paramedics and even ward attendants
want to become Chief Medical Directors! The catechist can now become the
parish priest, or even the bishop. Indeed, the dog has eaten the bone
hung on its neck!
Can the court clerk or bailiff because of
his years of experience become a judge? Can the Clerk of the National
Assembly, who is the highest administrative officer in the National
Assembly now aspire to be the President of the Senate?
When we were in medical school, we had
those who could not cope with the rigours of medicine, who were
withdrawn. Some of those who were withdrawn went for other disciplines
not even near science. But some opted for allied courses, so that they
could work in a hospital. There were also others who wanted to read
medicine, but who could not meet up with the requirements, or the
cut-off marks, then they opted for related courses. There are many of
them. Brilliant chaps, but just that perhaps, as medicine is a calling,
they were not called. But they have now come with a vengeance. They want
to become doctors through the backdoor!
Care of patients is multidisciplinary,
does not mean a nurse will perform a doctor’s role, or that a pharmacist
should assume the role of a doctor. It does not also mean leadership
role can be rotated. It only means that all the disciplines play their
own unique roles to achieve a desired end.
There are many hospitals that have been
set up by businessmen who are not even educated. But those hospitals are
still headed by a medical director who is a medical doctor. Who heads
the hospital is not in dispute. Even if a pharmacist, or a nurse, or a
laboratory scientist decides to open a hospital, they will still put a
doctor as the medical director. They know anything short of that will
cast doubt on the integrity of the hospital. If these people will accord
the doctor this respect in a private setting, why do they begrudge him a
public setting? The grudge against doctors strikes at the concept
called public hospital. Only in a public hospital will there be argument
about who is in charge, only in a public hospital do you have conflicts
of roles or who should be paid more.
Every profession is unique, but certain
things make some professions premium. The Good Book called the doctor a
wise man. “Honour the physician for the need thou hast of him: for the
most High hath created him…he shall receive gifts of the king.
The skill of the physician shall lift up his head, and in the sight of great men he shall be praised.
Give a sweet savour, and a memorial of fine flour, and make a fat offering, and then give place to the physician.”
It cannot be controverted that the doctor
plays a special role in the health care system. In complex and risky
situations where there is uncertainty as the health of humans can often
be, the doctor is expected to manage the complexity. This is because of
his training which is rigorous and broad. We are told the syllabus for
medicine is the human being.
Doctors are expected to have good
judgment in every situation, even beyond the scope of guidelines and
protocols. They know when to use protocols and apply them to problems
and are quick to recognise changes.
In a multidisciplinary, team-based system
as medical care has increasingly become, the doctor has the ultimate
responsibility for a patient’s care. The team looks to the doctor for
direction concerning the patient’s overall health care plan.
When something goes wrong with a patient,
it is the doctor that is expected to provide answers. Leadership falls
automatically on the doctor.
The special training of doctors places
them in a position of authority on clinical standards and practice,
especially with the intricate nature of diagnosis and treatment.
The medical degree cannot be substituted
by on-the-job exposure by other health practitioners. There can never be
a substitute for the extensive knowledge of clinical science and the
full range of clinical skills that are the foundations of medical
practice.
Doctors are now the enemies that other
health care workers must join forces to defeat. But the same people who
are after the doctor’s job, when they have patients who are their dear
ones, they run straight to the doctor. They don’t assume to know
anything anymore.
The usual excuse those who begrudge the
doctor give is, “It is what happens in the US and the UK.” Just because
the white man does something does it make it right? Abortion and
homosexuality are the norm in many developed countries, why are we not
following them? If you are doing the right thing, you can stand alone.
We must stop copying the West, or making references to them. They are
not smarter, or greater than us. They can learn from us.
But you might be tempted to think that
those who begrudge the doctor are actually after his role, or position.
But it is far from it. The truth is that money is what they seek. They
think that by doing those work the doctor does, it will equate them with
the doctor and a justification for greater pay package. If a nurse or a
pharmacist, or a laboratory scientist or a physiotherapist earns more
than a doctor, that ends the grudge against doctors. The doctor can keep
his title with all his work!
Dr. Odoemena is a medical practitioner in Lagos
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