After
writing a piece in this column entitled “new hospitals, new corruption, new
challenges”, the article elicited one of the highest responses, and many of the
readers shared their experiences with me via email. One of the key issues that
they drew my attention to was the issue of misdiagnosing the illnesses of
patients, but once they travel to either Egypt, India or UK, they are told
that, they have been wrongly diagnosed, and within a week or so after treatment
they become normal. To address the reasons behind this problem, I have invited
Dr Jaliya Braimah (jaliyaadda@hotmail.co.uk), a highly experienced medical
doctor in Manchester with a comparative understanding of Nigerian and UK
healthcare systems as a guest columnist. The original title of his article was
“Reasons behind
Misdiagnosis of Patients’ illnesses in the Healthcare systems of Nigeria”.
Enjoy. Jameel
It
is universally accepted that no healthcare (HC) sector in the world is spared
the unfortunate issue of making a wrong diagnosis of diseases afflicting
patients under its care. Although this article is on Nigeria Nigeria
The
main reason for writing this article is to highlight a few of the important
reasons behind our doctors’ inability to make the correct diagnosis of diseases
in Nigeria. For ease of discussion, I’ll like to separate this under three
sections i.e. the ‘Doctors factors’, the ‘facilities factors’ and the ‘Patients
factors’ although these three do overlap extensively.
Doctors’ factors
Nigerian
universities have historically produced and still continue to produce some of
the best medical graduates in the world. However, the recent economic/political
climate has meant that the standard of training has become progressively worse.
Overcrowding in our medical schools leading to very low teacher student ratio
has resulted in sub-optimal training in most places. This has a direct impact
on the quality of the graduates with increasing numbers becoming less able to attain
the minimum standard required to cope with life as doctors. This phenomenon is
true for both the undergraduate and post-graduate trainings. As a consequence
the patients suffer. For example every case of fever is then treated as
typhoid/malaria despite evidence to the contrary.
The
2nd most important reason for misdiagnosis is what I call the ‘I
know it all syndrome’ where doctors find it impossible to simply say to
a patient “I’m sorry I just do not know what is wrong with you”. Hence there is
a failure to suggest referral to a colleague who may be better able to help.
The old medical dictum of ‘First do no harm’ will remain
relevant till the end of times! In fact, patients are better left alone with
their illnesses than putting them through an intervention which may cause them
more harm. In this regard the behaviour of this group of doctors is not any
different from that of our traditional native ones (the Babalawos).
In
addition, the art of making a correct diagnosis in Nigerian Hospitals depends
largely only on physical examination of the patients at bed side because of
limited lab/imaging support. No matter how well trained a doctor may be, if
they find themselves in a hospital with little/no access to experienced
colleagues, they will struggle to make correct diagnosis. This is the
experience of many NYSC doctors who work (especially) in rural areas where
cases often come in late and are therefore more complex to manage.
‘Facilities factors’
There
is no doubting the fact that modern technological development has made a big
impact on the tools available for investigating diseases more accurately.
Except for a few centres, most of these tools are lacking in Nigerian
hospitals. This is the reason why experience of using them is lacking which
means doctors do not get trained to use them, hence the patient suffers as a
consequence. It is also true that even in the few hospitals with these
facilities, when patients undergo such investigations, the results are
sometimes not interpreted correctly, thus emphasising the need to ask for help
from more experienced colleagues.
‘Patients factors’
The
fundamental reason why issues of poor diagnosis will persist for a long time is
due to the largely uneducated nature of our population. This means that
patients are not able to challenge any decisions made on their behalf because
they perceive seeing a doctor as a privilege/favour rather than as a matter of
constitutional rights! Doctors are seen as demi-gods who are to be worshipped
as they can do no wrong.
Another
factor to consider is the fact that the Nigerian society is one of the most
unbalanced in the world in terms of the haves and the have-nots. This means
that while our leaders are suffering from diseases of gluttony (like in
Europe/US), the masses are still dying of essentially old fashioned largely
preventable diseases of poverty. This is an area that needs to be remembered
when treating patients from differing social classes.
Even
among the elites, there is another problem which we need to be aware of. For example,
how many of them will be happy (content) to be sent home only on paracetamol
and the advice to drink lots of fluids and take some rest following a trivial
(often viral) chest infection (such as flu) which by its very nature is self
limiting? ‘Haba man no antibiotics
and no injection(s) for oga? chineke god’. The expectation to ‘do
something’ sometimes adds to the pressure on doctors leading them to
make diagnosis which will not stake up to scrutiny. Sometimes doing nothing is
best medicine but a number of the “shakers and movers” of our society prefer to
be given a medical label. The fear of some doctors losing their customers can
be overwhelming. The overall effect of it all is that the Nigerian healthcare
system is defined by the over medicalisation of the rich and powerful, and a
lack of even the most basic care for the many more!
Finally
in this short article, I’ve tried to highlight areas that I think many who work
and use the health sector in Nigeria will recognise, but this is by no means an
exhaustive discussion. What is also clear is that I’ve done the easy bit i.e.
identifying some of the reasons for this phenomenon without delving into the
more difficult area of proffering possible solutions. Perhaps this is best left
for another day? Let me know what you think.
21:08
Newcastle upon Tyne
04/11/12
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