When medical diagnosis goes awry
No amount of excuses can justify misdiagnosis, increasingly a cause of several deaths in Nigerian hospitals. Instead of passing the buck, following strictly the ethics of the profession may be a surer way out.
During one of the sessions of her driving classes, Mandy Dikibo noticed tremors in her legs while pressing the clutch in the manual car used for the training. Prior to that time, she noticed she had difficulty stooping, climbing steep places, intolerance of heat coupled with heart palpitations and fast pulse rate.
With these symptoms, Dikibo went to one of the renowned hospitals under her Health Maintenance Organisation (HMO) located in the highbrow Ikoyi neighbourhood in Lagos.
After narrating all the symptoms to the doctor, she was told that everything she noticed was normal, especially since they were obvious after carrying out some activities.
Four months later, Dikibo was rushed from the office to the hospital, a different one this time because her office had changed its HMO. On getting to the hospital and narrating the symptoms, she was given a prognosis of hyperthyroidism pending further examinations she was asked to undergo.
When the results came out, they confirmed the prognosis for a disease in which treatment would have started four months earlier. The doctor was even kind enough to apologise for the misdiagnosis from his colleague in the first hospital. A year and four months later, Mandy is still undergoing treatment. Perhaps an early and accurate diagnosis would have arrested the disease.
Most times people do not think much about the problem of misdiagnosis and its far-reaching consequences unless when such leads to death. Sad to say, there have been several deaths and most times complications arising from misdiagnosis, the latest of which is the death of Kolawole Idowu, a 29-year-old who had just completed the mandatory one year National Youth Service.
According to reports, Idowu took ill just after his service and had gone to the Ikeja Medical Centre, a private hospital in his neighbourhood, where he was treated for malaria and after a negative reaction, he was admitted for mental illness.
After spending about two weeks at the hospital, Idowu was transferred to the Lagos State University Teaching Hospital, LASUTH, Ikeja, where he was placed on admission at the psychiatric ward. He later went into coma and was taken to the Intensive Care Unit of LASUTH. After about two months in the ICU, he passed on. The autopsy report said Idowu had an infection called meningoencephalitis and later, bronchopneumoni, which “continued till death”.
How Idowu’s case moved from “ordinary” malaria to mental illness to an infection called meningoencephalitis, and then to bronchopneumonia continues to baffle many.
A worrying trend
Idowu is just one out of many cases of misdiagnosis recorded in Nigeria, and as is often the case, deaths arising from situations like this are brushed aside as seeking redress seems farfetched.
“Clinical negligence and medical errors is rife in most developing countries such as Nigeria because of chain reactions of events viz: cultural notion regarding adverse medical events; poverty and financial ineptitude to pursue legal action against perceived negligence; ignorance of the rights of the individual to seek redress in court in the face of gross clinical negligence and serious harm; indifferent attitude of health-care providers toward their patients’ well-being; limited options of treatment; and poor health-care delivery system,” said Felix Nzube Chukwuneke, senior lecturer, Department of Maxillofacial Surgery, College of Medicine, University of Nigeria, Nsukka.
“It is also important to note that clinicians and health-care providers in Nigeria and elsewhere are not infallible and a lot have been doing their job diligently in keeping the good reputation of the health-care profession,” Chukwuneke said in a paper, ‘Medical incidents in developing countries: A few case studies from Nigeria’.
According to him, the moral worth of a clinician’s action in patients’ management depends exclusively on the moral acceptability of the rule of obligation to duty on which the clinician acts.
“Since every rational being thinks of him or herself as an end, all people must act in such a way that they treat humanity, whether in their own person or in the person of another, always as an end and never simply as a means. A duty of care is, therefore, paramount in the relationship between clinician and patient. While litigation in healthcare system is rapidly increasing globally, which affords individual explanation and compensation for perceived wrong diagnosis and treatment, it is still rudimentary in Nigeria. This default position has made most health-care providers indifferent in the presence of gross clinical negligence and medical errors,” he said.
“Though most Nigerians may be aware of their rights to institute legal action in situations such as negligence with serious harm or death, the socioeconomic factors, cultural and religious notions among other reasons within the society often make litigation impossible for an individual. Attributing every medical adverse event in the course of treatment as ‘God’s Will’ and the saying ‘It’s God’s Time’ for every death among most African people has also become a great impediment to curbing clinical negligence in our environment,” he added.
Chimaobi Udenze, a gynaecologist and general practitioner, is of the view the misdiagnosis issue is a sad one because it queries the competence of medical professionals and withdraws patients’ confidence on even the so-called consultants.
“Imagine giving a neighbour’s child wrong prescription and he dies days later. Many will refer to the doctor as quack, and how would he live peacefully in that same compound with such neighbours or even raise his shoulders high when they call doctors? As journalists are conscious of their byline, so also should a doctor because name is everything in medical profession,” he said.
Passing the buck
At its National Executive Council meeting held in Calabar, Cross River State, recently, the National Association of Resident Doctors (NARD) lamented that the Federal Government was frustrating resident doctors due to lack of training, alleging that the government’s insincerity has often forced resident doctors to seem indifferent to patients’ conditions.
John Onyebueze, national president of NARD, said the perceived ‘indifferent’ behaviour by the resident doctors has been a result of repeated cases of insincerity by the various government agencies.
“Over the years, there has been incessant disharmony in the health sector owing to the inability of various government agencies to abide by agreements reached or obey extant circulars. A case in mind is the July 14, 2016 stakeholders’ meeting chaired by Hon. Yakubu Dogara,” said Onyebueze, who spoke on the theme ‘Funding postgraduate medical education – a panacea to medical tourism’.
He maintained that funding postgraduate medical education in the country would ensure that the current brain drain in the profession is stemmed, while the number of those going for medical tourism abroad would reduce to the barest minimum.
Onyebueze lamented that resident doctors were made to work under very unfavourable conditions, thus adding to their frustration which, according to him, is transferred to the patient.
Excuses are not enough
But Onari Duke, wife of former Cross River State governor and chairperson at the event, challenged doctors to rise above the current challenge and work out solutions to their persistent problems with the authorities.
She urged the resident doctors to come up with a practical programme of action that would enhance their welfare and professionalism, saying the country had suffered enough through persistent strike actions.
Udenze, in a separate response to BDSUNDAY inquiries, said no excuse could justify misdiagnosis and negligence by doctors.
“My colleagues are quick at blaming government for not providing world-class medical facilities as well as an environment conducive for them to profitably ply their craft here, but if one follows the ethics of the profession, there will not be cases of misdiagnosis,” Udenze said.
“Of course, do not conclude until you are sure of the final result. If possible conduct the test again or consult your senior colleagues on intricate issues. You can check referrals on such cases and compare results and trends. At the end, you will end up doing everything that is medically possible to save life and if death comes, then it is the patient’s fate,” he said.
Any way out?
Chukwuneke proposes that health-care stakeholders and policymakers should put in place legal and legislative measures to curb this menace while clinicians, for the sake of obligation, should ensure that they maintain the highest standard of patients’ care in their practice.
“There is a need to emphasize early medical ethics training for health-care professional at the undergraduate level as well as promoting and organizing workshops to constantly keep them well-informed,” he said.
“The public from time to time should be encouraged to report any case of suspected negligence and medical errors in order to have documented evidence on the rate of occurrence. This in turn will help the health policymakers and medical regulatory body (NMDC) to understand the extent of the health problem and find out the best method to reduce the rate of occurrence in the health-care sector,” he said.
For Udenze, however, change should start from the entry level.
“You cannot gain admission to study medicine on compassionate ground or lower cut-off point. With the disparity in entry requirements occasioned by quota system, Nigeria has graduated different levels of medical doctors, many of whom saw graduation as a must. You must not be a doctor because your father or mother is a doctor and needs you to take over his/her hospital. That is why the issue is escalating,” said Udenze.
“I think medical students should have separate hostel arrangement. Update of medical facilities should be taken seriously and monitored to ensure funds are not diverted to personal use. EFCC has not beamed its searchlight on government hospitals, they should because the chief medical officers, procurement and finance managers need to tell Nigerians where all the allocations captured in the Federal budget for health go,” he said.
He also suggested that registration of private hospitals be stopped for now until existing ones improve on facilities and remuneration of doctors because younger doctors do not see the goldmine their colleagues saw in the 70s and 80s now.
“There should strict rules and compliance for registration and renewal of licence,” he said.
Brain drain in health sector
Meanwhile, citing poor working environment, Nigerian medical doctors are trooping out in their numbers in search of better work opportunities abroad.
Ben Murray-Bruce, senator representing Bayelsa East and founder, Silverbird Group, took to one of his twitter handles to lament the brain drain facing the health sector in the country.
According to him, “700 Nigerian doctors relocate abroad annually because we prefer spending $1bn on medical tourism than spending it on our health sector.”
As expected, there were many rejoinders to his comment. Some challenged the senator to reveal where he does his annual medical check-up, while others asked him to propose a bill criminalising medical tourism and banning public officers from seeking treatment abroad.
One respondent said, “As a doctor, I cannot argue with the statement, but the healthcare system needs a full overhaul and political will and you can help.”
“Sir, unless a law is passed that stops lawmakers from travelling abroad for medical check-up, all this won’t solve anything,” another retorted.
Another respondent registered his disappointment and displeasure saying, “Unfortunately Buhari has disappointed Nigerians. He promised an improved medicare, but he’s the first to travel abroad for treatment.”
Some others pointed out that the figure mentioned by the senator was an understatement, stating that the number was in the thousands. To all these comments and retorts, the senator made no remarks to take up the challenge of bill proposition.
While discussing survey findings during a panel session with stakeholders on its recent poll on ‘Emigration of Nigerian Medical Doctors’, NOIPolls said almost 9 in 10 doctors interviewed disclosed they are currently seeking work opportunities abroad.
According to the polls carried out in partnership with Nigeria Health Watch, of 88 percent doctors who said they were considering work opportunities abroad, 91 percent are at junior level, followed by 8 percent who are mid-level, and 73 percent are senior level medical practitioners. Top locations for Nigerian doctors seeking work opportunities abroad include United Kingdom 93 percent, United States 86 percent, Canada 60 percent, Saudi Arabia 59 percent, Australia 52 percent, and UAE 29 percent.
Several doctors complained of relatively poor working environment, which implies lack of adequate equipment, infrastructure, and medical supplies.
The poll also rated other reasons some Nigerian doctors are seeking overseas job to include low work satisfaction 92 percent, poor salaries & emoluments 91 percent, huge knowledge gap 47 percent, poor quality of practice 8 percent, and high taxes/deductions from salary 98 percent.
Measures recommended to stem the tide on the emigration of doctors from Nigeria include better salaries 25 percent, more funding in health sector 24 percent, better working environment 11 percent, and provide career development plan 9 percent.
The pll harped on the need for the government at federal and state level to focus on upgrading tertiary health facilities, adding, “There is need for the right people to head the health sector, so Nigerians can access proper medical care.”
“Between now and September 2,500 doctors will be leaving the country for better opportunities because it has been a trend. It is imperative to improve and invest in the health sector. What happens to the sector if all trained doctors emigrate?” said Bell Ihua, CEO, NOIPolls.
“Globally, there is a call for universal health coverage, providing the needed health finance for a conducive working environment for medical doctors translating to more remuneration, and increased training opportunities,” Ihua said.
Akeem Lawal, chemical pathologist at National Hospital Abuja, is of the opinion that government should ensure an enabling environment, particularly in terms of structures/facilities in the health sector.
Abimbola Olajide, general surgeon, Ladoke Akintola University Teaching Hospital, agrees, urging the Nigerian government to look inward and ensure a change in the health sector.
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