Want To Be A Doctor? Check Again!

You need to read this if you are a youngster keen on reading medicine. It is also a must read for you if you are a parent who has that bright child besotted with medicine or if you had been striving to ensure that your kid or ward reads medicine. For you might be looking forward to reaping "returns" on "investment" on that smart son or that bright daughter of yours.

And the young lad should also be looking forward to a life of relative comfort....in which even if devoid of opulence, should at least provide him with the resources to take care of his family. But medicine offers no such guarantees....especially if your child would not cut corners....or blend with a bad system....in line with the fine rearing you have given him. Because in medicine, the patient takes the centre-stage....and his life takes precedence over that of the doctor.

Little if any consideration is given to the survival....financial or otherwise.....of the doctor. There are some issues which bear specific peculiarities to private medical practice in Nigeria. These issues must be ingrained in the doctor. They must also be discussed with that brilliant high school student keen on reading medicine....so that he would be well aware of what he is getting into. A copy of the Physicians' Oath must be presented to the medical school applicant prior to enrollment...not only after graduation! He must realise....at that tender age....that formative stage....that medicine is not all about white overalls....and stethoscopes....and prestige....and wealth....and popularity and influence. That it is not some utopia. Not a bed of roses! That beyond the inferred glamour of it all, he must settle down one day and raise a family...and provide for them! To do this, he needs money. He must earn this money. He must work for it.

As he works for it, he MUST GET PAID for such work! Otherwise he would be deemed irresponsible....as he fails to perform his fundamental duties as a father. This is the blunt truth. Of course there would be such individuals who would still opt to read medicine....in spite of such "scary" prospects....that I detail below. But they must know! Long before! Not after they commit....or condemn?.....their life to medicine....Nigerian style! It is only after this that we can truly and justly pronounce that theirs is an INFORMED CHOICE! For starters, he would be required to grapple with the following:

1. The fraudulent attitude of Nigerian patients. Their preference for traditionalists and auxiliaries. The sureness to encounter avoidable complications therefrom. Their pitiable and penniless state when they present usually late, to doctors. Their tendency to beat up doctors and damage hospitals out of frustration and anger if we do not treat for lack of money. Their tendency to elope if we treat and trust them to pay up. Their tendency to accuse us of illegal detention if we save their lives but insist on being paid before discharging them. The fact that it is unrealistic to sue all such debtors to court.

2. The sentimental and unrealistic nature of medicine that labels it humanitarian.....meaning Drs should certainly provide service especially in emergencies but may not certainly get paid. Yet, as the value of a service decreases exponentially with time after it has been enjoyed, the best time to get paid is when the customer is in desperate need of such service! That is, before the service is provided....before it is enjoyed!

3. The mass poverty in the nation that compels people to put medicare low on their priority list thus making them ignore or postpone medical problems till too late. Or resort to chemist shops, traditionalists and auxiliaries....who entice them with low bills. With the high unemployment rate, even in high density areas like Lagos, the high population is a potential market and not a real market. The dispensable income of citizens is low. After people have managed to pay rents, school fees of kids, buy foodstuffs, little if any money, remains for medicare.

4. The fact that people pray not to spend their monies on ill health, police "trouble" or law suits...but would not pray against eating, transporting themselves, educating their children or wearing fine clothes. Thus any money spent on ill health or law suits is considered as misfortune whereas people pray to buy cars, build houses, be able to train their kids, have clothes on their bodies and have food on their tables. So, they gladly pay the cement seller, the bricklayer, the labourer, the cloth seller, the canteen operator and the car dealer. But pay the Dr grudgingly, if they pay at all!

5. It is wiser to work as a government doctor in Nigeria as govt is now the highest payer of doctors' wages...whereas the Dr as a professional would prefer to be self-employed. In fact, government cannot possibly employ all medical personnel in the land! So if he is not among the few Drs lucky to secure govt jobs, hmmmm....

6. The societal poverty and the refusal of doctors to co-operate especially in unifying bills means we compete! Unhealthy competition and rivalry translates into undercutting and very low bills that aggregately, do not meet our running costs. So, as we struggle to balance up our books, we look for cheap staff, we defraud patients and engage in other unwholesome practices. Cheap staff would include male nurses including CHOs and male auxiliaries quacking as doctors, female auxiliaries quacking as qualified nurses. We also train auxiliaries to use as adhoc cleaners and to raise funds from training fees. It is so mentally tasking to entrust the care of patients to auxiliaries and relate with them directly in a professional setting on a daily basis. Drs defraud patients by resorting to spurious admissions, playing the mind game on patients by using the element of fear to extract money from their pockets. We twist diagnoses and render false diagnoses in collusion with labs and radiology centres. We compel labmen to do these things and blackmail those that do not!

7. Drs pay kickbacks to traditionalists and stand-alone auxiliaries for referrals. We expect commissions and kickbacks from labs and radiology centres. We readily switch alliances to the highest payer of kickbacks. The emphasis is on the amount of money paid as kickback and not the competence.

8. Private practice is especially bad for Drs with poor family backgrounds....as their frugal resources can only lead them to afford rents in slums whose inhabitants are mostly guilty of the infractions stated above. Those from wealthy backgrounds do not fare much better...as their practices sited in posh neighbourhoods can only attract few patients who mostly travel abroad for medicare.

9. As the doctor deludes himself that he had dedicated his life to the service of humanity, the average patient believed he is not doing him a favour....for he is paying for such service. But can human life be quantified in naira and kobo? The average Nigerian patient thinks so. He even believes that the doctor wishes him ill-health....as the doctor may not eat if he sees no patient to treat!

10. The average Nigerian patient also sees the doctor as his glorified househelp. It shows in the way they glow with vain pride when you address them as "Sir" or "Ma". They love the "Mr Biggs" treatment! And who complains? Only if they would pay up!

11. If the Nigerian Dr opts to work as a government medical officer, he would not have the appropriate tools to work with and thus may not have professional fulfillment. To get this, he would have to relocate abroad and practice there....prior to which he must pass foreign qualifying exams. As he reads for such exams, and as he must eat, and as he must work to eat, he may be required to do menial jobs....including washing corpses!

12. The only language the Nigerian govt understands is strike....so he may find himself being frequently called out on strikes against the dictates of his conscience.

13. Those MB,BS or MB,Ch.B degrees that he foresees as his utopia are seen as thrash by his colleagues who are fortunate enough to go into residency and qualify as consultants. So the donkey years of medical school are child's play. His longsuffering re-starts after graduation....if he must be considered as "somebody" in the committee of Drs.

14. Then the most important. The Dr would have to deal with the corruption endemic in the system. He either pays and receives kickbacks.....and stays financially afloat. Or "stay clear" and rot in penury....as nobody refers in Nigeria without expecting some gratification. He would have to take a stand! He cannot sit on the fence! He either "blends" with the system....or not!

It is not uncommon to see young doctors enroll for ICAN or NIB exams, go into music....or some other vocation....after such rigors of medical school...and such expenditure on time! Finally, I repeat that the future doctor must have an insight into what he is getting into....ab initio. We as seniors particularly medical teachers and mentors, have no right to harry unsuspecting youngsters into a life of dissolution and penury. This is not as hard as it sounds. A buyer must KNOW what he is buying!

ADDENDUM
I refused to include the general problem of inadequate infrastructure and lack of enabling environment. It may take away the flavour...

Private medical practice has been challenging for Nigerian doctors for many reasons. By our training, we are not given to giving up easily! Banks are very reluctant to lend money for medical practices as the default rate is high...even if we can meet all their daunting preconditions.

But in spite of our resourcefulness, native brilliance and wont to improvise as we bring our ingenuity to the fore, such hardship in sourcing for funds for start-ups, the lack of stable electricity, pipe-borne water, good roads and generally, an enabling environment....makes the very idea of contemplating to start a private practice in this nation quite depressing indeed. For as the doctor runs and maintains a generator, sinks a borehole and purifies his own water and grades his own access road, he is confronted with the dilemma of either passing the cost to his consumers and over-pricing himself out of the market....or charging minimally-unrealistic bills and and not recouping his investment. He also risks not meeting his running costs.

Dr Tosin Akindele is a Lagos-based medical practitioner and good health advocate