WHY FIGHT DOC­TORS OVER LEAD­ER­SHIP OF HEALTH?

THISDAY - - EDITORIAL -

A“group” has de­cided to go on strike in the gov­ern­men­towned hos­pi­tals over cer­tain issues of which one of them is the fight for the lead­er­ship of the health team. An­other is that its mem­bers want to earn what doc­tors earn. Strange things that have never hap­pened any­where in the world. They have pad­locked con­sult­ing rooms, oper­at­ing the­atres, lab­o­ra­to­ries and any­where any form of health ser­vice can be ren­dered to pa­tients, and even at­tack­ing doc­tors phys­i­cally who are ren­der­ing care to pa­tients. To this amor­phous group in an un­holy “mar­riage” char­ac­terised by orgy, delu­sion, in­fe­ri­or­ity com­plex, in­or­di­nate am­bi­tion, un­bri­dled in­dis­ci­pline and warped logic any­one who works in the hos­pi­tal can be the Chief Med­i­cal Di­rec­tor!

Like I said in my ar­ti­cle “Why be­grudge the doc­tor,” pub­lished al­most four years ago when this same is­sue reared its ugly head “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.”

Now, hos­pi­tal is a kind of busi­ness. Any­one who has the money can open a hos­pi­tal. In La­gos State the Health Fa­cil­ity Mon­i­tor­ing and Ac­cred­i­ta­tion Agency (HEFAMAA) will ac­credit such a hos­pi­tal which meets the min­i­mum re­quire­ments as long as the oper­at­ing of­fi­cer is a qual­i­fied med­i­cal doc­tor. The busi­nessper­son is then re­garded as the pro­pri­etor. Any­thing but this is not al­lowed. So, while in a pri­vate hos­pi­tal the busi­nessper­son is the pro­pri­etor, in a pub­lic hos­pi­tal the gov­ern­ment is the pro­pri­etor for it is the one that re­mu­ner­ates the oper­at­ing of­fi­cer (Chief Med­i­cal Di­rec­tor). Any place called a hos­pi­tal whether pri­vate or pub­lic not headed by a doc­tor won’t be al­lowed to op­er­ate. So, there is no room for non-doc­tors to be­come the chief ex­ec­u­tive in a hos­pi­tal set­ting.

Now, these reg­u­la­tory bod­ies not only li­cence hos­pi­tals, they li­cence nurs­ing homes, con­va­les­cent homes, lab­o­ra­to­ries, phys­io­ther­apy clin­ics, and for phar­ma­cies it is the Phar­ma­cists Coun­cil of Nige­ria (PCN). In all these places a doc­tor can’t come there and lead the place. To make it sim­ple, a doc­tor can’t be the oper­at­ing of­fi­cer in a nurs­ing home, or in a con­va­les­cent home, or in a lab­o­ra­tory, or in a phar­macy, or in a phys­io­ther­apy clinic. But a doc­tor can be the pro­pri­etor of any of them.

Those ag­i­tat­ing for non-doc­tor lead­er­ship in a pub­lic hos­pi­tal should in­stead fight for pub­licly-owned nurs­ing homes, pub­licly-owned con­va­les­cent homes, pub­licly- owned lab­o­ra­to­ries, pub­licly-owned phar­ma­cies and so on.

To be fair, many “good” nurses don’t agree with this “body”, they still hon­our the age-long “Hip­po­cratic-Nightin­galic” sym­bio­sis.

Health­care is mul­ti­dis­ci­plinary, and in­volves ev­ery­one who con­trib­utes to the health of the pa­tient. Yet, if there is no ar­row­head it leads to an­ar­chy. Imag­ine where the pi­lot (doc­tor) is in a tus­sle with the med­i­cal lab­o­ra­tory sci­en­tist or phar­ma­cist (flight en­gi­neer) and the nurses (flight stew­ardesses) on who is in con­trol of a plane in flight. Of course that plane will crash. And that has been the lot of our health sec­tor.

The same peo­ple who are fight­ing for lead­er­ship po­si­tion with the doc­tor want their chil­dren who are science in­clined to make medicine their first choice for univer­sity ed­u­ca­tion. Some even go as far as say­ing “medicine or noth­ing.” Now they want to ar­gue lead­er­ship with the doc­tor through the back­door. The best way for them is to get their Per­ma­nent Voter Cards, join a po­lit­i­cal party and be voted in as the pres­i­dent of the coun­try. Doc­tors an­swer to the pres­i­dent.

It must be stated here that a doc­tor-lead­er­ship is a sine qua non for qual­ity health­care ev­ery­where and Nige­ria is not an ex­cep­tion. Doc­tors have long years of train­ing in med­i­cal school, learn­ing sub­jects that peo­ple study as sin­gle de­grees. Six years is even too short. That is why they still go fur­ther to post­grad­u­ate school for al­most equal du­ra­tion of train­ing as in the un­der­grad­u­ate. Those al­lied dis­ci­plines which are mis­chievous think that by con­tin­u­ally length­en­ing their own un­der­grad­u­ate train­ing it will equate as doc­tors’. They might as well stare at a one-page tract for six years!

Again, it’s im­per­a­tive that doc­tors main­tain author­ity for the care of the pa­tient to en­sure safety and over­all care of the pa­tient. Doc­tors must take re­spon­si­bil­ity in all hos­pi­tal mat­ters and main­tain qual­ity con­trol for non-med­i­cal doc­tors in a hos­pi­tal set­ting.

Ac­cord­ing to a sur­vey by the Amer­i­can Med­i­cal As­so­ci­a­tion (AMA), pa­tients also sup­port physi­cian-led team-based care. In a 2012 sur­vey it found that pa­tients over­whelm­ingly want a co­or­di­nated ap­proach to health­care, with a physi­cian lead­ing the health­care team.

“Physi­cian lead­er­ship of the health­care team does not mean that physi­cians must have all the right an­swers for ev­ery task the team needs to ac­com­plish. Rather, it re­quires physi­cians to ask the right ques­tions, in­vite par­tic­i­pa­tion, com­mu­ni­cate clearly, pro­mote a cul­ture of re­spect, re­ward ex­cel­lence and en­sure ac­count­abil­ity, among other im­por­tant lead­er­ship skills.” Dr Cos­mas Odoe­mena, med­i­cal prac­ti­tioner, La­gos

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