I belong to several groups of doctors and other medical people. There are those I work with locally in Abuja and we share information and advice through local courses and seminars. There are those I correspond with on Facebook and Twitter who are a variety of doctors in different specialities and a different cadre. I also have another group on the World Wide Web, specialist neurosurgeons and others involved in just solving problems of the brain and nerves. All because one tree does not make a forest.
So, there is hardly a problem that I cannot solve. As they say, a problem shared is a problem halved. There will be someone somewhere in the world who may have seen the same problem and be able to proffer an appropriate solution, of benefit to me and my patient. And, if no one in the world can solve the problem, then, at least we would all have tried, going beyond the limits of medicine. As Arthur Clarke said, ‘the only way to find out what is possible, is to go beyond them into the impossible’. So, why are we still suffering in Nigeria through ignorance and small-mindedness?
A Nigerian Problem
There is a Nigerian problem we should all collaborate to solve. It is a little problem that has become a huge one in the minds of small people. This is about collaborations between public and private hospitals and referrals of patients from one to the other. It is about local sharing of expertise, equipment and knowledge. It is about saving lives.
There is an unwritten rule that public hospitals cannot formally refer patients who require care to a private hospital that can provide such care. General Hospitals and even our teaching and specialist hospitals would prefer to refer their patients, miles away to India or to another ‘crummy’ government hospital, rather than a nearby private hospital that can actually help solve the problem. It simply makes no sense to people who know better.
Take a real-life example
A patient could be referred for specialist care at the Teaching Hospital. But, if for whatever reason the hospital cannot provide that care, there seems to be a stumbling block against referring to a local private hospital where care can actually be given. The patient is often thereby not treated and care denied. Such patients find their way to India or Egypt feeling let down by their own kin. Sadly, many come back to later learn that there was indeed a local hospital that could have attended to their problems.
A friend related the case of a patient who had nearly died from blood loss. Incredibly, the patient had been to two other hospitals with a bleeding cut on the leg (from a broken glass). A simple problem that the doctors could not fix. Yet, they did not ‘phone a friend’; in this case, a surgeon, to come and help them out. The patient had to go to several hospitals before getting succour. He could have died as many indeed do. Too many people have incurred unnecessary morbidity and mortality from such poor care and the ones that survive just write us all off and jet off to India.
It seems that as always the stumbling block and the cause of death in many situations is this lack of communication and lack of trust. We have to change this situation. George Bernard Shaw also said, ‘progress is impossible without change; those who cannot change their minds, cannot achieve anything’.
Sharing information and seeking help when necessary does not have to be so painful and difficult. Knowing the limits of one’s experience and expertise and asking for help does not have to be demeaning. It should actually be celebrated. I once wrote that every doctor or nurse or even a lowly cleaner in the hospital should have a list of about 20 doctors or specialists on their phone. People you can call on when YOU need help, either personally (which can happen) or for your patient. You must know someone in your local area that you can trust to bail you out when you need help.
It makes sense to have a list of people around you who can help. It makes sense for each hospital, to know of another in the neighbourhood that can provide much-needed support. It makes sense to be able to communicate readily and easily without feeling threatened. And sharing information improves the local practice and saves lives.
Some will say that patients will be diverted to private hospitals owned by consultants for money. Some may even say that the patients are no better off. But, too many deaths and too many disabled people lays bare the need to review the system and facilitate a better working environment in each local area. Hospitals must know which other hospital has staff, equipment, drugs or whatever of real benefit to their own patients. Then, let us work together to maximise the quality of care and of course revenue. Collaborate in saving lives so the patients can continue to thrive and restore some dignity to the profession.
Basil Fadipe said this much in his article about the medical oath. In a nutshell, he said, ‘it is not a suicidal pact between the practitioner and his practice. It is also not a pact between the doctor and his employer but between the doctor and his patients’. Your first and only interest MUST be the best interest of your patient.
It is time we sit up and put the little people in straitjackets.
Dr. Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc