EDITORIAL: The incidence of doctors’ errors

Medical personnel, especially doctors, are very important in the chain of persons in the health care delivery system in society.

It is inevitable that the human body will break down at some point and the need to seek medical attention will arise.

Once there is an identified need for medical care, medical personnel, stand at the bridge between life and death.

The decision to bring a sick person to the hospital, usually reflects a high level of trust that the doctor and other medical personnel will display the highest level of professionalism.

This is in line with the Hippocratic oath in which doctors vow “to abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free”.

However, there have been concerns that too many medical personnel especially doctors and nurses in governmentowned hospitals in Nigeria do not exhibit the highest standard of professionalism in their work.

Newspaper reports and numerous personal stories abound with the tales of woe of Nigerians who have had their lives cut short or become gravely harmed because of preventable medical errors.

While these cases were infrequent in the past, there is growing concern that more medical personnel in Nigeria now care less about their patients. Various factors have been identified as accounting for medical errors.

Some of these are systemic, that is pertaining to the shortcomings of the health care system while others are personal to the practitioners themselves.

Admittedly, medical personnel in Nigeria work under severe infrastructural constraints. For example, doctors have been known to carry out surgeries with light from handheld rechargeable lamps.

A popular refrain in public hospitals is lack of bedspace to enable admission of patients. Where government has a policy of payment-for-treatment, the inability of a patient to make the required deposit for treatment often means that they are left unattended to.

Doctors also work under a heavy workload especially in public secondary and tertiary hospitals.

The ratio of medical doctors to patients in Nigeria is abysmally low at 1: 2753, while the World Health Organization (WHO) prescribed minimum is 1:600.

The Nigeria ratio translates to 36.6 medical doctors 100000! Doctors and nurses who must attend to many patients daily run the risk of making fatigue-induced errors.

Yet, those who try to avoid this situation run the risk of coming across as being insensitive when they decline to render service at a time they are at breaking point. Perceiving that the government that has the overall responsibility for health care is inadequately committed, many practitioners begin to steel themselves against their patients’ pain.

While one can sympathise with medical personnel working under extremely hard conditions, what cannot be ignored is the growing trend of nonchalance and a culture of abuse of patients.

Some have asked whether some of the medical personnel trained and certified for work in fact, have the temperament and skills for the work.

Others have asked whether the training process adequately screens trainee medical personnel for soft skill competencies required for the clinician’s job.

In other words, could it be that some of those who enrol for studies in the clinical fields choose these fields before they have enough experiential maturity to appreciate the kind of demands that the jobs will place on them?

Still others have alluded to the disillusionment that qualified practitioners experience when they find that the reward system offers grossly inadequate compensation.

All these are true to some extent, but they remain insufficient to excuse preventable mistakes and patient abuse.

The agony of illness and in some cases, the consequent death or injury is always a lot easier for the patient or the loved one to bear when there is the perception that the patient is getting the best care.

Conversely, the pain that flows from knowing that a loved one lost or nearly lost a chance of life simply because a medical care provider was either negligent or nonchalant can hardly be described.

If life is as important as it is and without replacement, and good health is wealth, medical errors must be kept at the barest minimum.

To ensure this, there must be zero-tolerance for medical errors or unprofessional conduct in the treatment of patients.

Unfortunately, there is systemic failure when it comes to dealing decisively with those who by their conduct have proven that they do not deserve a place as licensed medical practitioners.

This failure, in turn, fosters and entrenches a culture of impunity. All the relevant regulatory professional institutions provide mechanisms to discipline erring members, but these are ineffective largely because they must be activated by victims.

Victims can hardly be expected to activate mechanisms they have little knowledge of and the cost of pursuing redress is often high and unaffordable.

Widespread lack of public trust in the integrity of official grievance processes also make many Nigerians decline to pursue redress through official processes.

In addition, a religious-cultural tendency to predestination and fatalism informs a popular approach to life which contributes to a disinclination to tenaciously pursue the demand for accountability for professional negligence. T

he result is that very few cases of medical errors and professional misconduct are pursued against practitioners.

Priority interventions must aim at changing public attitude to medical errors and unprofessional conduct of medical personnel.

The Nigeria Medical and Dental Council (NMDC) through its Professional Discipline Department should create broader and more accessible grievance mechanisms.

Reported infractions should be punished and announced to the general public.

There is the need to increase public awareness of patient rights using both formal and informal education opportunities.

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Governments at all levels should renew the Service Compact with All Nigerians (SERVICOM) and ensure that appropriate units are activated in all government hospitals to vitalise the Compact.

Finally, government should adopt policies supportive of mandatory reporting and ensure through the supervisory Ministry of Health and NMDC that professional standards are maintained all the time.