Doctor of Medicine, or Interpreter of Results?

There is now a recalcitrant trend among our people. It is not new, but
it sure is growing. Before now, everyone knew to seek the (medical)
doctor out whenever they ailed. It was the doctor who then decided
what investigations to order, and what treatment to give, after
thorough history taking and relevant physical examination. What we
find now is rather different, the well-documented physician-apathy
(illness behaviour) nonetheless. Now, our people wake up with symptoms and head straight to the medical laboratory or diagnostic centre.

Between them and the technicians, somebody decides what tests to be done, what scans to be carried out — because medic no suppose chop — and then the inevitable happens…

Again and again, I have had to explain to patients that yours truly is
a Doctor of Medicine and not an interpreter of results. I am licensed
to treat patients who are patient enough to subject themselves to my
care, not those who already know what to do and merely need my medical licence and indemnity insurance to safeguard their rashness. I find myself in this situation when the laboratory technician (or scientist) sends them to me with a laboratory result I did not request, or the sonographer (or sonologist) urges them away with the report of a scan I did not order, and that is invariably not useful to the patient at that material time! This is even if the patent medicine seller had not emptied the patient’s pockets before Mr. No-Free-Consultations is remembered.

There have been instances where patients underwent absolutely
unnecessary investigations for want of physician guidance — outright
fishing expeditions, in fact. This middle-aged bricklayer fell off the
scaffolding and noticed a chest pain not amenable to the numerous
massages of the traditional bonesetter. He was advised (don’t ask by
whom) to go for an abdominal scan! And then the inevitable happened: they needed a “me” to interpret the useless report and prescribe medication. Needless to say, I sent him for a chest x-ray which expectedly revealed two broken ribs and lung contusion. And after specialist treatment, he was back on his feet in a week! The medical curriculum is there for a reason and that is the reason medical students stay the longest in the university! Everybody is important o, but if you did not spend seven to ten years studying Medicine and Surgery, chances are that you cannot know all of what “I” am expected to know. If e no be panadol…

Our people go to the pharmacy to ask what eyedrop to use. They do not know, or do not care, that there are more than half a dozen causes of ‘red eye’. Someone took her friend’s glaucoma eyedrop container to the pharmacy to buy, without any tests or diagnosis. The ophthalmologist must be avoided at all cost, and when they go blind it must be their village people, demons or arrows at work! The first aid for ear ache is olive oil. But no, our people must put ear drop (do not mind that there are various types), and even hydrogen peroxide with its exothermicity is not spared. The otologist is their enemy, and they only go to him for hearing aids — or polypectomy. Someone was taking his friend’s heart failure medication, never minding that the cause of his own chronic cough was tuberculosis! How many shall one recount? And when they complain to me and I say why not go to the hospital, they are quick to remind me that they are not sick; “they that are whole have no need of the physician, but they that are sick”. — Mark
2: 17.

Our people now only remember the hospital when they see the grave
approaching, but when they die after spending precious time going from one druggist to another, the medic must be held responsible for not performing magic. As I am writing this, a patient has come to complain of easy defatiguability after treating malaria and ‘typhoid’
exhaustively and undergoing self-prescribed blood work that confirmed nothing else. Guess what? He has simple old hypertension! He could have had a stroke or a heart attack if commonsense had not finally dragged him to the hospital…

Those are the things we see. And oh, let me not remember the
Google-said people. If Google is good enough to diagnose (not
diagonise, please) you, let Google treat you abeg. Do not endanger my medical licence with your recklessness; do not turn and say it was Dr. Ayk who managed you; we both know you had damaged your kidneys from consuming “mix” (a concoction of varied analgesics and steroids with or without vitamins and calcium tablets) from chemists for years. Hmm, all the roadside gbogbonise and homemade decoction nko — with and without alcohol? Perhaps in future we will discuss how some alagbo fortify their ‘natural products’ with conventional drugs!

It will take a lot of reorientation to even begin to scratch the
surface. For starters, let the relevant government agencies enforce
extant laws on what patent medicine sellers cannot dispense, let
pharmacies seize prescriptions, let medics stop over-the-phone
consultation AND PRESCRIPTION BY TEXTS, and let unlicensed health workers be dissuaded perceptibly. The Nigeria Medical Association should hasten doctor prescription stamps so our pharmacist siblings can root out fake prescriptions and save our people from themselves.

Let all genuine healthcare providers remember that customers may
always be right, but patients seldom are…

Ayokunle ADELEYE writes from Odogbolu LGA, holds an MBChB from Olabisi Onabanjo University, and is licenced by the Medical and Dental Council of Nigeria. He may be reached at adelayok@gmail.com.