Tuesday, 6 November 2012
(31): Misdiagnosing patients in the Nigerian healthcare system
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 (firstname.lastname@example.org), 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
, it should not be seen as
purely an issue peculiar to the Nigerian HC system alone. However in developed
countries at least, such events are the exceptions and whenever they occur,
they are thoroughly investigated, lessons learnt from the mistakes and
recompense given to victims where appropriate. There is no evidence at the
moment that such investigations are a normal practice in 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.
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.
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.
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.
Newcastle upon Tyne