An Analysis Of Dr Okoro's Mail.
"Instead of expending energy in this kind of writeup T.A (Dr Akindele) should devote more time in building a practise".
"It is not enough to flaunt skills and knowledge in medicine, time has shown that wisdom and favour is vital".
Dr C.C. Okoro...
Above being the pertinent section of an e-mail I received from the sender. I should publish the full contents of the particular mail he refers to in due course.
KEYWORDS THEREIN....
1. Building a practice.
2. Wisdom.
3. Favour.
ECONOMIC REALITIES.
Clime....Nigeria.
Near Zero output by the production sector....most factories either folded up or relocated....perhaps to Ghana. Most factories and warehouses are now converted to churches.
Near zero electricity...affecting major industries as much as the artisanry....barbers, welders, tailors, hairdressers, cobblers... Private patients....
Latter group either stays idle or run their trades on generators...and factor the extra running cost on their pricing.
These are people....expected to form the bulk of hospital clientelle....patients....with whom you BUILD PRACTICES....hopefully not our kith and kin!
Most are unemployed.
Most of those employed are beset with contraints as above....so their disposable incomes are low....as they are less likely to expend it on medicare....which rates low on their priorities list.
Now if your clients are in financial ruin....as we have in Nigeria....and they cannot pay up....and it is with them "you" BUILD MEDICAL PRACTICES, how do you cover "your" running costs? Merely rev up on your prayers....as you naively ask God for divine FAVOUR?
Can there ever be an output without an input? Would such divine intervention magically thrust cash into people's pockets so that they could pay for your services?
Now a closer look at INSURED PATIENTS. Low capitation. Most enrollees make CLAIMS on their medical insurance packages....as they access medicare often, severally and frivolously....an antithesis to the principle of insurance....which presumes that only few of insured persons actually make claims.
Medical insurance packages have no ouster clauses in small prints.....via which you may preclude enrollees from their rights to claims.....so they all....or almost all access medicare!
Now as unrealistic as medical insurance is in this nation, it is not for all-comers....most definitely!
Only hospitals with multi-storey structures seem to stand any chance of wooing the ever-powerful ever-exploitng HMOs....in the mad scramble to gain their attention!
The fleecing of the nation continues relentlessly by our leaders....and the fevour is likely to be maintained....or worsened.
PROFESSIONAL REALITIES.
Medical practice is capital-intensive....levies, fees, dues , rates, taxes....direct, indirect.
It mandates you to provide prompt service...especially in emergencies....but is relatively unconcerned if you get paid or not! Refusing such service makes you liable to professional litigation...especially when patients die! And it is bad publicity anyway....and no business thrives on bad publicity....as even non-medical entities crave public goodwill. And we thought we could always detain debtor patients until they pay up....untll they started accusing us of illegal detention!
CHANGING GOVT POLICIES AND PATIENT PREFERENCES.
There seems to be a new-found obsession by government for trado-medicine....new legislation....gingles....posters. Skeptical and discerning citizens who were wary of the antics of the trado-practitioners ab initio lost their fears when the govt started advocating for alternative medicine....even in states where orthodox Drs are in surplus.
Cautionary calls by us that trado-medicine need only be promoted in climes where the orthodox is inaccessible, unaffordable and in short supply fell on deaf ears. ...as we lost millions of our pregnant women and neonates to TBAs! The recent call by the Lagos State Deputy Governor on women to refrain from their preference of TBAs to orthodox medicare may be coming rather late!
Many women see fetal wastages as an act of God....and factor such deaths into their calculations in birth numbers and birth orders!
Most women who register for antenatals in hospitals prefer to give birth at TBAs....resulting in revenue loss to doctors, high incidence of complications requiring interventional surgeries....albeit with bad outcomes for mothers and babies!
Many of the survivors fail to pay up....and accuse doctors of illegal detention if kept on the wards for want of payment.
We then shamelessly scramble to woo and please the referring TBAs by competitively upping the kickbacks we pay them, fearful of missing their child-christenings, weddings, or religious holidays as we hound them down to give huge presents....lest we lose favour with them!
The recent ban placed by the National Broadcasting Commision on payed programmes and adverts by trado-Drs may be a panacea too little too late.
We do antenatals for peanuts in the hope that we would recoup our losses if such patients deliver in our hospitals....but do they? Some even come only to confirm labour but abscond after we examine them on the pretext of going to fetch their "baby things"!
Our tendency to compete rather that cooperate in matters of pricing means this trend is likely to continue.....or get worse... Dwindling revenue....
WISDOM. This is a word that has been used mischeviously in Nigeria. Most users of the word really mean "blending" or being "crafty"....commissions and kickbacks, falsification of lab results in collusion with labmen, false diagnoses, mandatory "drips", spurrious surgeries, use of CHOs and male auxiliaries for medical and surgical duties....even unsupervised!. The word CRIMINAL has never been known to be a synonym for wisdom.
Of course persons with criminal tendencies should be "at home" in situations as this. Time has shown that criminals wish for anomalous climes, strive to create, nurture and sustain them, rationalize them and thrive better in them!
Private hospitals are folding up at an alarming rate....propelling AGPMPN....at state and zonal levels...to counsel members to diversify....as the prognosis of private medical practice in Nigeria is bad!
Let those that have ears hear!
Dr Tosin Akindele is a Lagos-based Medical Practitioner and public affairs analyst.
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