By Osmond Ekwueme
I believe that those in power are morally obliged to preference the needs of the poor. I hope the people pushing the changes should step back and not disregard the enormous weight of the evidence against the changes they are contemplating, such as non-medical trained Directors of hospitals and etc. Logic, reason and reflective thought should not be jettisoned in favor of wishful thinking. However, as Upton Sinclair said “It is difficult to get a man to understand something when his salary depends upon his not understanding it “.
Obviously, the Nigerian health sector is facing a myriad of challenges and shifting lately (disclosure, I was once among a state’s representatives for the National Association). These changes are being carried out subtly despite non-implementation of the agreements the Federal Govt reached with the NMA. I will not comment on the salaries or compensations but rather on the policy.
No other profession in our capitalist/welfare state and free market economy is subjected to anything like this imperious intrusion of the clinically untutored into medical decisions and physician compensation. Nigerians have no caps on spending for food, clothing or housing, nor are their limits on the remuneration for attorneys, entertainers, athletes or some executives of our natural resources.
As a matter of fact, this is actually a prescient of a position paper I sent to a colleague in
Poland when such ideas were evolving. The idea of appointments of Directors in the Hospitals should be opposed with deadly seriousness. Resolutions Nos. 2 and 23 of the National
Officers’ Committee (NOC) held on the 10th of June, 2014 pretty much sums up everything I was going to say and more…nails it. This is exactly one of the ways health care delivery in
USA started shifting to the present mess. It is an indefensible, visionless position. It is blindingly obvious. Non-doctors, non medical professionals trained in patient care has no business being in-charge of Hospitals, period!! I can guess exactly where this idea is coming from. Yes, it is still this fuzzy romanticism with everything USA. America remains the most visible reminder about the power of entrepreneurial thinking. It has an environment that supports bold and innovative ideas…..but health care delivery is not one of them. All one needs to do is check out the WHO (World Health Organization) country rankings with regards overall health system performance and the health expenditures per capita. According to the CIA World Fact Book, the US ranks in the 40th percentiles in both, that means below average.
As a medical professional here in USA, who had practiced in Europe and Nigeria, I know firsthand that the present US medical care is dysfunctional. Healthcare should never be a profit making business. I wholeheartedly support Resolution 4 “consultant” in a hospital setting describing only the relationship of a specialist doctor and his/her patient and not any health worker plus the passage of the National Health Bill (NHB) and the extension of Universal Health Coverage to 100% of Nigerians and not 30% as prescribed by National Health Insurance Scheme (NHIS). A scheme indeed (excuse the pun). One logical solution to health care is to decide that it is a right; paid for by some sort of taxes and there whenever and where it is needed. It has the potential of being the cheapest for Nigerians. Since our health sectors are built on a search for the middle ground between (it is a right and not a right), they do not and cannot make sense either morally or in terms of economics. Why create another kafkaesque bureaucracies within and between which we will willingly or unwillingly wonder.
In fact, these moves, if allowed and successful, would decrease the individual physician’s complete therapeutic freedom. The sine qua non of high-quality health care is the open-ended arrangement between physicians and their patients. All evidence indicate that preserving the individual physician’s freedom will naturally give the people the highest-quality health care. Nigerians will hate to be called “consumers” instead of patients, when seeing a physician!!
Health sector is not an industry and should never be modeled in that manner. Industries put the interests of their shareholders first not the patients. It’s a far cry from the Hippocratic Oath, which directs doctors to put the benefit of their patients first. Here in USA, managed care is obsessed with “cost containment” that puts profits over patients. Today in USA, as many of you probably know, patients are called “consumers”, physicians are “providers”, and health care is a “product”…all terms of commerce, not of a profession, and certainly not of a humanitarian profession. The new vocabulary, and it’s obvious intentions are grossly inappropriate.
Physicians do not provide inanimate commodities, as salespeople and service people do; they treat human beings. They deal with our most precious possession…our health and well-being, and to apply rules of commerce to such activities is unsound, indeed disastrous. The industry has been on a mindless quest to reduce the average length of hospital stays, without considering patients’ preferences or physician’s judgment. Even routine prescribing has turned into a bureaucratic nightmare. That approach to cost control is inefficient and disrespectful of the physician as a professional.
Instead of being allowed to focus primarily on the patients’ health problems, physicians must now expend much of their time complying with unreasonable paperwork and awaiting a decision regarding treatment from a faceless non physician “authority” at a remote point that has never seen the patient but consults a computer for “guidelines”. Thus, the overriding dictum is to save money for corporate officers, not to provide quality health care to patients.
Medicine still remains the most exhilarating and perhaps the most gratifying career one can have. Since this subtle metamorphosis is just taking place in Nigeria…all men of goodwill, physicians and non-physicians should fight against it and nip it in the bud sooner than later.
We shall all demand that the supervision of our health care be left to those qualified by education, special training and experience-physicians and other health-care professionals.
I hope I have said it all…that the insidious intrusion of unqualified, profiteering entities into decisions regarding patient care can have only a deleterious effect on the patients welfare. All we need is improvement of our present system and some first steps have been taken by the Nigerian Medical Association. Primum non nocere…first do no harm. I can with pleasure volunteer some salient policy ideas for improvement later, whenever I am consulted.
Osmond Ekwueme MD., PhD
Medical Doctor and policy analyst.
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