Dear Doctor...

I have contemplated doing this post for a while but haven't really had the time or drive to bring myself to do so. That changed this morning after I read Mrs Chukwuma's, the late Chaz B's wife, account of her husband's tragic end at St Nicholas Hospital.

I recently gave up clinical medicine after six years of donning the white coat. I miss being a doctor sometimes. Other times, I do not. Not because of the crappy pay or uninspiring work conditions. To be responsible for peoples' lives is a big deal for me. It was one I took quite seriously during my time in the consulting room but being an outsider now affords me the luxury of a different perspective.

My learned colleagues who are still practising medicine in Nigeria will probably not agree with me. This is a natural reaction as I imagine I probably would not have agreed also two or three years ago. I will therefore understand and even appreciate such divergent views or submissions.

I found Mrs Chukwuma's experience at St Nicholas relatable. Largely because I also had such an unsavoury experience in the same hospital about three years ago. It is an experience millions of Nigerians can also relate with. Hospitals staffed with doctors who may have lost touch with their humanity and mortality. I have worn the shoes before so I think I know what I'm talking about. Now, I see hospitals differently from the time I used to work in them. Working in hospitals and attending to patients create an aura of immortality. Is it a conscious thing? I'm not quite sure. It becomes easy to just forget you are also human when people, old and young, look at you in awe like some deity and often beg you to take action because their lives or that of their loved one depend it. So you strut around the hospital with a stethoscope hanging on your neck and you bark at patients like they are nuisances. Again, this is probably not developed on a conscious level. It is often retrospective.

Doctors must think deeply about their profession and be reminded that indeed we are all just a breath away from the grave. The doctor as well as the patients he treats with such condescension will all end up six feet under, sooner or later. Often, we are only reminded the hard way when affliction befalls either the doctor or his relatives. Then he goes around howling that he's a doctor and demands to be treated properly. He forgets very quickly that he meted out worse treatment to someone's wife, child or relative. The attitude is quite foul and rephrensible. I have worked with such vile characters in the past who totally lack compassion and often leave me wondering if truly intelligence is enough to qualify as a doctor. 

Another angle of public medical practice that worries me is the misconception of entitlement and narcissism. Doctors in the public sector constantly hold the government to ransom by downing tools and then demand to be paid for work they did not do. It is a disgusting trend that we need to sit and ponder on if we are as noble as we proclaim based on our profession. The question to be asked of these no-work-but-pay professionals is if such indulgence can be tolerated in the private sector. Can their colleagues who work in private hospitals even go on strike not to speak of going on strike and demanding the wages for the barren hours? Of course not! Like I said, my sojourn outside the hospital into the business world has exposed me to a totally different perspective on these things. Especially when you eat what you hunt as an entrepreneur or in corporate organisations where there are proper structures in place. In my opinion, taking gap years for corporate attachments in such firms may help doctors inculcate proper work ethics and a corporate culture that abhors passiveness and lousiness. 

Finally, I believe it is time to reorganise how hospitals run in Nigeria. Recently, I've had to visit an upscale hospital in Victoria Island frequently at the behest of my wife. Each time we take our son there, we are seen by medical officers who probably have less clinical experience than I do thus rendering the entire trip futile. As much as the whole exercise irks me, I play along because of what they say about hell's fury and a woman's scorn. This is the scenario in  many hospitals. Accident & Emergency units are manned by largely inexperienced doctors who often encounter patients at their most critical states. While it is important to get hands-on experience, it is also reasonable to ensure that this learning is guided and not to the detriment of patients. As it is in the public sector so it is in the private sector. It is simply unacceptable to have your weak foot in front when you ought to bring your A-game. The first-on-call should be adequately supervised by specialists/ traumatologists who are physically present during the calls and not a phone call away! It will cost more to have a sit-in A & E specialist but it will help so much. It will not only speed up the training the young doctors receive, it will also ensure they learn the proper things.

I recall an experience I had, circa 2008, manning the A & E of the hospital I started my housemanship in. Then, consults used to be addressed as 'PTOC, GTOC, MTOC or STOC' to stand for Paediatric-/Gynae-/Medical- or Surgical-Team-On-Call. Interestingly, during the call hours this 'team' on call usually comprised of just one house officer present in the hospital. He or she ran the department till morning and usually sought guidance via the telephone from more senior doctors if a case went awry. So, that night it was I and a smart UNTH-trained doctor called Victor Onyena. We were casually seated in the consulting room in the A & E of a top Army Reference hospital (the status of a teaching hospital) as not just the firsts-on-call but the onlys-on-call. A man was rushed in, he had been shot in the chest at a barracks around Ojo and he was referred to us, two neophytes, in the middle of the night. I had started sweating profusely and turned to Victor for reassurance. Victor looked confident! He was up in a flash and I was about to breath easy when he whispered to me 'Oboy, wetin we go do?'. My goodness! So, we got to work and toiled all night exchanging ideas on management of circulatory shock till we were able to refer the patient to a cardiothoracic surgeon. We were lucky. Another day, another time, the man would have died on our hands. But, luck is simply not good enough! We must institute a system where specialists are available around the clock to guide young doctors in training. We gain more overall in patient outcome and human capital development.

Nigerian hospitals are miles away from utopia I agree. But a good first step is to address the most basic things. The doctors manning these hospitals should be assessed on not just intelligence but also on their humanity and compassion. You need a healthy dose of such especially in a land like Nigeria. They need to develop the right attitude to work for the greater good of the society. They have to exorcise the 'Nigerian' in them. Our systems must also change. If we place a premium on the sanctity of human life then we should staff our most critical entry points with our best and only the best. The fledgling certainly have to receive training but this should not leave a trail of blood, sorrow and tears. 

Dear doctor, remember things can change very quickly. Today's doctor can be tomorrow's patient. Expect to be managed the same way you managed others on your worst day. Because even the good book admonishes us to love our neighbours as ourselves and to do unto others as we would want to be done to. 

Oro abo la nso fun omoluabi....