Let’s call a spade…a spade

One of the reasons that Nigerians fail to trust doctors is in the area of misdiagnosis and the reasons are legion. Diagnosing pneumonia for cancer and calling cancer, Tuberculosis is all too common. Stroke is often misdiagnosed. One of my recent patients with arthritis was misdiagnosed as stroke and so prevented from effective therapy for months. Typhoid is also a very common diagnosis in Nigeria, by doctors who do not know better. Malaria has been blamed in error, so much that if I was Malaria, I would have left town long ago.

Poor laboratory services
Why are Malaria and Typhoid diagnosed all the time? This is often because the commonest tests performed by our ubiquitous laboratories are Malaria and Typhoid. After all, they must eat and no one is supervising the training or regulating their activities. We are not even trusted by many international AIDS organizations to diagnose HIV properly. Because sometimes they get it spectacularly wrong and you know how devastating that could be.

Poor radiological services
The other source of poor acumen is radiological services. Many doctors are truly untrained in radio-diagnosis and I trust very few reports from our radiologists. Many just dabble and are so bad it hurts to read what they write as reports. In many situations, they actually mean well but are limited by poor exposure to common sense. Many radiologists fail to go the extra mile and confirm the diagnosis. At the end of the day, the patient becomes confused with multiple diagnoses. I blame the radiologists! They blame the referring doctor! The patient blames all the doctors! We all blame each other till the pathologists arrive.

Poor clinical services
About a year ago, I attended a conference of the Ophthalmological Society of Nigeria to talk about patients with visual loss due to brain tumors, who have been misdiagnosed. Many of the patients had been seen by several optometrists and ophthalmologists before the penny dropped. They had been offered several prescriptions for glasses and treatments for Glaucoma in error. The optometrists and ophthalmologists were only interested in selling spectacles to these patients and then sat back watching them go blind. The real diagnosis was huge brain tumours causing blindness. This could have been easily diagnosed through a careful history and examination.

Poor judgment
The key focus must be that we practice medicine to the very best of our abilities. There are too many doctors and of course other people like nurses, physiotherapists, and laboratory scientists who are practicing beyond their level of expertise. Recognition of the limits of those abilities and limits/ extent of training is very, very important. There are pharmacists who prescribe and administer drugs in chemists. I have heard of theatre nurses who open hospitals and start operating because they have seen it done many times before. There are elderly doctors who think they know best and continue to give outdated information and advice. There are young doctors who think they know it all and perform beyond their level of experience.

We all are contributing to the rot in the Nigerian health sector. We all should know what we can and cannot do. We should know what we have been trained and proficient in as compared to what we ‘want to try’… because we can. We must be conscious of our level of expertise. This has been best summarised as below, in the levels of skill and consciousness:

Level 1: ground level: Unconsciously Unskilled
Level 2: next level up: Consciously Unskilled
Level 3: next level up: Consciously Skilled
Level 4: Highest level: Unconsciously Skilled

The unconsciously unskilled are the total novice and charlatans who do not know that they do not know anything. The unconsciously skilled are the experts who can operate without even thinking about it. It is the highest skill level. This does not necessarily equate to the level of consultant! Though, it should be this cadre that are at the highest level. Going to India or America as an observer for a few weeks does not make you a specialist. You cannot come back from observing other people do the work and suddenly think you know it all.

Knowing the limits of one’s experience and expertise and asking for help does not have to be demeaning. It should actually be celebrated. The key problem is a mixture of greed and lack of communication. Poor communication and working in silos is killing us and killing Nigerians. Nigerians are of course voting with their feet by trailing off to other countries. Sadly, of course, they return to us and the rot continues. So, it is actually time to take stock and clean the system.

Perhaps Nigerians can do us all a favour by embracing medical negligence. It is time to sue people who maim or kill in our clinics, chemists, laboratories and hospitals. It is time to communicate by hitting health practitioners where it hurts.

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