Doctors' Strike: The Fear And The Tear!

by L.Chinedu Arizona-Ogwu

Unfortunately, too many of Nigerians suffered or lost their lives because they weren’t given the right clinical diagnosis, right medicine and or the proper medicine application. Nigerians are yet to give experience some legislation that should end the secrecy and foot-dragging when it comes to letting consumers know about unsafe medicines. This legislation shows how the law-makers can and should be working, and the impact real people can have on reforming consumer protection laws.

In a global marketplace, there is a need for assessments of migrating doctors whose credentials may be outdated, difficult to interpret, or not aligned with local standards. Currently, most tools used to assess doctors who are beginning to practice in a new location are derived from examinations for initial entry to practice and do little justice to the abilities that seasoned practitioners have gained through experience. Reentry to practice after a career interruption also justifies a fresh assessment of competence, as does any major change in the scope of a physician’s practice. Some regulatory authorities are instituting policies to ensure the competence of doctors in these circumstances.

It’s now up to the law-makers to enforce this law and make sure we get the straight story on the benefits and risks of drugs on the market. This law will make critical, life-saving improvements in drug safety in the years to come, though the public may not see many immediate changes. One of the biggest consumer victories in this legislation is that it will be harder for drug companies to fudge or hide the results of their clinical trials.

Taking medication that contains an active ingredient other than what was prescribed by a qualified health care professional is generally unsafe. Counterfeit and misbranded prescription drugs are pouring into this nation from China and other countries. We’re just beginning to learn how dangerous these drugs can be. Working these investigations takes unprecedented international cooperation, but we’re committed to going the distance.

Importing any counterfeit, misbranded or unapproved pharmaceutical drug is a significant danger to the Nigerian public in many respects. The authorities should partner with other law enforcement agencies to eliminate this threat, and to bring to justice the organized criminals who profit.

Those that deal in counterfeit pharmaceuticals are solely motivated by greed and they prey upon an unsuspecting public with no regard for potentially placing the public’s health at risk. We will continue to work with our law enforcement partners to pursue drug counterfeiters to the fullest extent of the law.

When administering medicines, the domiciliary care assistant will: wash their hands, where a clinical tasks protocol is in place, undertake such preparations and infection control procedures as are required , check the service user’s identity , check against the medication record that the medicine has not been changed , check the required dose, check that the dose has not been given by someone else , measure or count the dose and give it to the service user , record on the medication record sheet that the medicine has been given or that it has been offered and refused , return the medicines to a safe storage place , return the medication record sheet to the service user’s notes and wash their hands.

As a result, the assessment of competence must go beyond the identification of which practitioners are, on the basis of evidence of their personal attributes or dated credentials, to capture what they actually do in the context of contemporary practice.

Our main frames of assessment of physicians’ competence can be distinguished. The familiar assessments undertaken before actual practice: achievement tests and simulations, including practice under supervision, which permit evaluators to predict a trainee’s future competence, competence in practice from participation to continue medical education and training programs or related achievement tests, measures that examine physicians’ job processes — for example, peer reviews of medical records, surveys of coworkers and colleagues about a physician’s communication skills and collaborative practices, and assessments that use data from standardized patients, diaries, or portfolios to add contextual detail about work activities. In this nation, regulatory authorities have implemented systematic, peer-based assessments using many of these tools in order to improve practice quality.

Physicians who practice for many years should have their competence reassessed and reaffirmed periodically, although views differ on appropriate objectives and tools for such reexamination. The most contentious question is not whether such reassessments of practice are needed but rather how they should be linked to licensure, certification, or employment. In the United Kingdom, where the National Health Service looms large in the everyday life of doctors, employment-based assessment predominates. In Canada, a major role is being established for assessments by regulatory authorities and specialty societies. In the United States, combinations of assessments by specialty societies, state medical boards, and provider organizations or payers are evolving. Whereas some view reassessment primarily as a filter to protect the public from doctors who perform poorly, others argue that valid practice assessments serve predominantly educational needs and should be integrated into individualized programs of continuing professional development.

The death of Nike Abiode, the 24-year-old given a typhoid complicity last week from an incompetent doctor, has become the latest argument in this issue against this regimes plan to limit malpractice damage awards. With doctors in several states staging work stoppages to protest the soaring costs of premiums, the plan to put caps on pain-and-suffering payouts had been picking up steam.

Yet in all the discussion of tragic cases and dollar amounts, a major cause of the malpractice problem is ignored: the failure of state medical boards to discipline doctors.

The fact is, only a small percentage of doctors account for most of the money paid out in malpractice cases. From 1999 to 2007, just 5 percent of doctors were involved in 54 percent of the payouts — including jury awards and out-of-court settlements — according to the statistics report in the Federal Ministry of Health. Of the 35,000 doctors with two or more payouts during that period, only 8 percent were disciplined by state health ministry. Among the 2,774 doctors who had made payments in five or more cases, only 463 — one out of six — had been disciplined.

Is it any coincidence that the states least likely to discipline doctors are among those with insurance crises? Lagos — where the governor had to intervene to keep doctors from going out on strike over controversial salary structure — has disciplined only 5 percent of the 51 doctors who had made payments in malpractice suits five or more times, the lowest percentage of any state.

And while Lagos has 5.3 percent of the doctors in Nigeria, they make up 18.5 percent of Nigerian doctors with five or more malpractice payments. One doctor there paid 24 claims between 1999 and 2001 totaling more than N8 billion (one was for operating on the wrong part of the body; another was for leaving a “foreign body” in the patient) yet was never disciplined by Lagos Health ministry.

Incidentally, medical clinics and hospitals in Nigeria have already been invaded by brief-case-carrying salesmen of Asian origin who persuade our medics to buy drugs imported from India as opposed to those from elsewhere. One wonders whether these too are not ‘quack’ salesmen dealing in ‘quack’ drugs.

There is even Indian-made Viagra and other products that have lately infiltrated the Nigerian market. Someone offered that it is possible for some tablet from the same batch to be less effective than the others, depending on the manufacturer. But what he did not say is why that is so.

Are the responsible departments seriously looking into these problems? How, with the rampant corruption that permeates all levels of our society today, can we be sure that the drugs we are taking are safe, effective and short on side-effects? Someone in the government should have an answer to these questions and probably tell the country what is happening or what plan is in stock to protect the citizens from such quacks?

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1 comment

ADI A September 6, 2008 - 1:38 pm

If our government cannot subsidize the cost of “real” medications, most of our citizens will still want the “fake” medication becuase is cheaper and once the medication does not kill instantly. Most American has insurance that pays certain percent of their medications and the people who cannot afford the medication and are obviously poor, American Goverment pays. So the issue of banishing fake medication is good but the real question is ” can Nigerian citizens afford the cost of real medication?, how much is the Government willing to provide for drug manufacturing and research?, do we have what it takes to make our own drugs for critical illness? the questions continues……. we have to start by doing away with exam malpractice expecially in medical fields.


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