Nigeria: Are Doctors Still Bound By the Hippocratic Oath? (1)

Isah

19 September 2010

Despite the oath doctors swear to, to uphold in the discharge of their duties, tales still abound of the shoddy manner and attitude in which they treat their patients, irrespective of the patient's plight. Winifred Ogbebo reports on the issues.


I swear by Apollo the physician, Esculapius, and and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation.



To rechon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look up his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according the law of medicine, but to none others.


I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give a woman a pessary to produce abortion.


With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.


Whatever in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!"



The original text of the Hippocratic Oath is usually interpreted as one of the first statements of a moral of conduct to be used by doctors, assuming the respect for all human life, even unborn. It requires a new doctor to swear upon a number of healing gods that he will uphold a number of professional ethical standards.
In the words of the immediate past president, Nigerian Medical Association, FCT chapter, Sir, Dr Jerry Oguzie, it is very necessary to bring all these issues up with respect to medical training and the Hippocratic Oath because majority of the challenges which the medical doctors face in these contemporary times, is as a result of abuse of medical training and violation of the oath.


Referring to some nasty experiences he has had in the hands of some doctors , Sam Asowata, a journalist and public analyst said, " most doctors' attitude to their patients is appalling. They fail to take into consideration, the plight of the people who brought the patient to the hospital and also the well-being of the patient.
A national daily, This Day last weekend published an article on how twins were carelessly left to die in some public hospitals in the Federal Capital Territory.


Corroborating the view of most Nigerians who have had raw deals in the hands of the medical practitioners in the country, Prof Christian Onyebuchi Chukwu disclosed at the Medical and Dental Council's third plenary session, in Abuja that Nigerians now believe that the doctors are the ones disrupting the health sector.
In his first annual distinguished member's lecture of the Nigerian Medical Association, FCT chapter, on the topic, "The Medical Doctor In Contemporary Nigeria", Dr Oguzie took a cursory look at some of the issues that have been contravened by doctors under the oath.




1. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan. Though euthanasia is not yet legal in Nigeria, how many of us by misdiagnosis have actually given "lethal drugs" to a patient? How many of us have painstakingly examined the laboratory results of a patient brought to us to know if he has a malignancy or not? How many of us even bother to carry out some laboratory investigations ab initio before commencing treatment of supposedly minor ailment, which may turn out to be a major one?
2. Similarly, I will not give a woman a pessary to cause an abortion. "Again, abortion is not legalised in Nigeria, yet every day, we treat complications arising from abortion.


How many of us have actually built our practices on the proceeds of abortion? It is commonly stated that soon after his O & G posting, the first "surgery" a medical student performs is "Menstrual Regulation" which is an aphorism for abortion. How many of us have turned the other eye when those we have engaged in our practices have resorted to "menstrual regulation" Life is sacrosanct, it is said and one of the things that God hates with a passion is "the shedding of innocent blood." Though sometimes, circumstances beyond the control of the medical doctor may make him resort to committing abortion, but at the end of the day, the question that usually begs for an answer is "was it really worth it?"


Specifically, on the 7th issue of the oath which focused on keeping the good of the patient as the highest priority. He said there may be other conflicting good purposes such as community welfare, conserving economic resources, supporting the criminal justice system, or simply making money for the physician or his employer that provide recurring challenges to physicians.



His words: " When we bleed the patient unnecessarily, are we keeping the good of that patient? When we do not do what we ought to do and rather do what we ought not to do, are we keeping the good of the patient? When we mislead the patient just because we want to collect more money from him, are we keeping to the good of the patient? When we reject patients because of their financial status and pander rather to those that can pay our bills, are we keeping to the good of the patient? These are questions that really need a soul searching response"
The immediate past president of the NMA, FCT chapter, who came down hard on his colleagues in the profession, disclosed that the medical practice in Nigeria has become an all comers affair as absence of legislation and inappropriate legislation has given room for charlatans, usurpers, pretenders and imitators to take over the medical air space.


"A lot of quackery is going on right under the noses of the genuine practitioners and there seems to be nothing anybody can do about it. Pharmacists, nurses, medical laboratory scientists, community health officers, community health extension workers, even patent medicine dealers are all masquerading as various joints as medical doctors since the average Nigerian patient regards every man in a white ward coat as medical doctor. Either due to lack of political will or lack of necessary resources or a combination of two, medical practitioners through the Medical and Dental Council of Nigeria Monitoring Committees is unable to stem the tide of quackery going on in the nation"



But the President of the Nigerian Medical Association, Dr Omede Idris, said that one's attitude is a reflection of upbringing and training received in the field of medicine as in his words is enshrined in training under ethics and code of practice and codified in Hippocratic Oath.
According to him, " all these emphasize empathy, care, compassion, concern and firmness in taking decisions that would be beneficial to the patient. This orientation is built upon in the cause of rendering services and through workshops, courses training and conferences. I believe most doctors exhibit this quality and attributes. If there are deviations and variations from this, it may not be unconnected to individual differences. However, the bottom line of doctors' attitude to patient is optimal care and attention for the patient."
To ensure accountability and efficient quality health care, the former minister of Health, Prof Babatunde Osotimehin, last year directed health workers in all tertiary hospitals to wear name tags to enable patients report quality of service rendered them.



At the formal launch of the patient's feedback platform supported by MTN and Globacom last year, Osotimehin said the system was designed to enable patients who visit any of the 52 Federal Government Hospitals and Medical Centres across the country to provide feedback on the quality of services provided by the healthcare centres through text massages.
He said that healthcare workers has the responsibilities to render quality service and most be held responsible in an event of failure.


His words, "The way the Doctors, Nurses and pharmacist go about as if they are doing patients a favour. It is not because we have a responsibility which we swore to and if we are not discharging it, then it is a problem that must be addressed."



He said the platform is commencing in the 52 federal hospitals but will soon be extended to the states and local government levels to make the health workers accountable to their actions.
He said the messages will be delivered directly to the ministry, adding that it will be disaggregated according to hospitals through a dedicated code number.
"On a weekly, monthly and quarterly meetings all these will be collated and analysed so that we can sit down and talk to Chief Medical Directors in our hospitals to arrest issues that may come up," he said.


On what the Medical and Dental Council of Nigeria (MDCN), a regulatory body for all medical and dental workers in the country, is doing to enhance doctors' attitude towards their patients, the registrar, Br Abdulmunin Ibrahim said the council has been receiving a lot of complain against doctors as regards their behavior towards their patients.






He said, "If you look at it critically, it falls back to when they were trained. If you look at the training now and the training of those days in the 80s, the doctors that graduated in those years conform with the ethics of the profession. Am sure these complaints are against the younger doctors. And what is happening now, if you look back to their training institutions, you find that most of the training institutions are producing large number of doctors that I will say are without control. Without control in the sense that council being the regulator allows each institution to take a particular number so that they will get both teaching in the profession and also learning in character. But a lot of these are absent. The doctors will go through the curriculum of their training but the character and the ethics of the profession is not adequately brought to them so when they come out, how then do you expect them to behave? These are people that have not imbibed the culture and the ethics of the profession properly so they will behave in such manner."


Speaking further, he said, "Most of them that really do not confine themselves to the ethics are the ones found wanting so the council for now cannot do much unless we go back to their training institutions and sanitize those training institutions. You will see of recent that the council is getting commendation that it has woken up. We have closed down two medical health training institutions because the condition in those institutions, both infrastructure facility and also the manpower has fallen below the standard expected by the council so the council decided to close down particularly the medical school in the University of Benin and Igbinedion University. We gave them a period of one year to amend those deficiencies. The council will continue to also hammer other medical schools that have fallen below the standard. I believe that if the training institutions should do what is expected of them both in character and learning, the crop of doctors that will be graduating in the near future will be as comparable as the doctors that were produced in the early years."