Medicine Vs Practice, The System Vs The Doctor, And The Way Forward

 

Medicine Vs Practice 

Medicine is both a science and an art; it is not an exact science per se. There are inherent uncertainties and risks to the practice of medicine. For example, almost all drugs have side effects, so, despite good intension in prescribing even simple medications like Aspirin, Paracetamol or Antibiotic, things can go awry. To confuse this risk with an error is not helpful to the doctor. The doctor’s duty is to weight the risk of using the drugs against that of allowing the patient to suffer the discomfort of not using the drug. 

 

Another example is when doctors order a test, most patient are only aware of two possible outcome- positive and negative. In reality, there are four possible outcomes.  

 

True Positive (when the patient has the disease and the test shows it) and the converse, True Negative, are what the patients would like to know. However, there are instances when the test results are False Positive (test is positive but the patient does not have the disease), or the converse – False Negative. Most times doctors do not accurately know which category the test results belong to. They rely on probabilities from scientific studies, on intuition and experience. 

 

The doctor’s dilemma should remind us of the saying by the great Greek philosopher, Epictetus: 

 

Nigerian Medical Doctors: Hippocrates or Hypocrites? By Dr. Olawumi ADEKOLA Pt 1

 

“Appearances to the mind are of four kinds.  Things are either what they appear to be;  Or they neither are, nor appear to be;  Or they are, and do not appear to be;  Or they are not, yet appear to be.  Rightly to aim in all these cases is the wise man’s task.” These uncertainties are the underlying risk the patient will face whenever they receive medical care.  

 

The System Vs The Doctor 

Nigerian doctors are not isolated from the society, they often complain of poor working and training environment, poor remuneration, bad government policy and public health ‘illiteracy’. Medical practice is a very stressful endeavour, most doctors worry about everyday life issues and have to combine that with worry about the complexities inherent in their practice. Many doctors have stress related symptoms which often predispose to mental and physical illnesses. 

 

Doctors are expected to be good clinicians (ensuring high professional standard and quality of care), be administrators, researchers, teachers, and economist. They are also expected to protect public health, fight quackery and in essence dominate public life. Unfortunately, the Nigerian doctor is poorly trained to do all at the same time. In fact, today’s doctor as different from doctors of the past decades does not want that sort of control on public life and is not willing to play or act god. 

 

Are Nigerian doctor hypocrites pretending to be true to the Hippocrates oaths? The truth is that Hypocrite and Hippocrates can co-exist. Finding a one-fit-all answer will be futile. There will always be good and bad doctors just as there will always be good and bad nurses, pharmacists, journalists, lawyers, teachers and politicians. He that is without sin …, let him cast the first stone. If much is expected from whom much is given, then, little should be expected from a system to which little is given. 

 

Nigerian Medical Doctors: Hippocrates or Hypocrites? By Dr. Olawumi ADEKOLA Pt 2

 

Most probably, the distribution of doctors in Nigeria is like a dumb bell shaped curve with the two extremes being the ‘bad’ and ‘great’ doctors while in the middle are the good doctors.  

 

The Way Forward: 

Not exonerating the doctor completely, doctors have contributed to the current predicament of the Nigerian health system and have a lot to do for restoration of public confidence and trust. If the Nigerian society is to achieve qualitative and affordable healthcare for the majority of its people, the Nigerian doctor must be supported and his pride restored. The doctor must in turn, work hard to gain the confidence of other health workers, the public and policy makers. 

 

As Albert Einstein said, “Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning.", "You can’t solve a problem with the same thinking that created the problem.", “The difference between stupidity and genius is that genius has its limits.”  

 

Doctors need to learn from past mistakes, create a new thinking for the future and recognize limitations. Currently, there seem to be a lot of defensive medical practice with the philosophy being ‘First, do no harm’. The new thinking should be to ‘First, do good’. ‘Doing good’ involves thinking ‘out of the box’, getting involved in policy and being imaginative and passionate about continuous improvement. 

 

Being a doctor is a very privileged position and comes with enormous responsibilities and work for a better society. Doctors must learn to take the heat (as evident during NMA strike action and when errors are committed) just as they take the praise during the good times (as in the ‘defeat’ of Ebola in 2014 and when breakthroughs are achieved). 

 

Health should no longer be viewed as merely the absence of disease or infirmity but as defined by WHO- a state of complete physical, mental and social wellbeing. In other words, health is not strictly due to health care but dependent on several factors: Employment, Education, Security, Housing e.c.t. Any advances in these social elements will ultimately lead to improvement in the health status of the society. 

 

Emphasis should be placed on the proper training and retraining of doctors- which NMA and the Medical and Council of Nigeria (MDCN) seem to be doing effectively. The NMA must also use all its goodwill and strength to ensure and uphold equitable access of all Nigerians to qualitative health care services. 

 

The Nigerian doctor of the last century will be remembered for prompt adoption of advances in science and technology, for humility and sacrifice. The doctor of today should be remembered for leadership, humanity and health promotion- enabling people to increase control over and improve their health.    

  

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Further Reading: 

1. Medical World Nigeria: How many more damning newspaper editorials before strike ends?

2. Kara Rogers. Medicine and healers through history. Britannica Educational Publishers. 2011. 

3. Encyclopaedia Brittannica. 

4. Reason J. Human error: West J Med. Jun 2000; 172(6): 393–396. 

5. Rajan Madhok: Doctors in the new millennium: Hippocrates or Hypocrites? Royal College of Physician’s Milroy lecture, 2003. 

6. Belkin L. First, Do No Harm. Faucett Crest. 1993. 

7. Ebenstein and Ebenstein. Great political thinkers; Plato to present. Harcourt College Publishers, 2000. 

8. Olusegun Obasanjo and Akin Mabogunje: Elements of Development. Africa Leadership Forum (ALF) Publishers. 1991. 

9. Constitution of the WHO. Official Records of the World Health Organization, no. 2, p. 100. 1948.