Why would anyone want to become a doctor?

The news about a medical doctor who abandoned medicine to become an oil pipeline thief may have cast a pall on the prestige of what is supposed to be a noble profession. But a seeming loss of the prestige of medicine did not start today. You may have heard it before that many doctors regret reading medicine. For me it was during my secondary school days. I had told a neighbour who was a doctor, who further endeared me to the profession that I would want to read medicine, and I thought he would have been pleased. But I was taken aback when he said I should instead go into engineering or even banking like my dad. He said medicine was not worth the trouble. I felt his advice was suspicious. I also recall a visit to our family doctor. When I told him my ambition, he said, “Why medicine? Since I got into medical school I have not rested, even till now.” In my young mind I just concluded that some people would say anything to make sure others don’t become like them.

I got into medicine anyway. I remember always waking up with a start. The only thought was how to scale anatomy, physiology and biochemistry. I thought it strange when other students from other departments made a face when I tell them I studied late in the cadaver room. We dissected with our bare hands, and from there to the cafeteria. Reading was not by choice. It was a race against time. 24 hours was not enough, so you find yourself borrowing from the next day and accruing deficits.

Well, I passed somehow and got into the clinical class. Just when I thought the hurdle had been reduced, without congratulating us, the dean clinical sciences in introducing us to the clinic said: “If you think you have made it, you are wrong. This is the time to decide whether you should continue the journey―or to voluntarily withdraw!” This is despite those who were withdrawn. And despite those who became psychiatric.

Though a teacher of mine boasted of the study of medicine: “It has never been easy, and it will never be easy,” many doctors do not want their children to be doctors. A 2007 survey by Merritt, Hawkins indicated that 57% of 1,175 doctors questioned would not recommend the field to their children. Another teacher of mine said his son was “crazy enough to become a doctor.”

With the coming of the Information Age, doctors have been demystified. The awe is for software scientists, and those who can give us breathtaking electronic gadgets. And that is where smart kids now go into, and of course sports and music. Perhaps Bill Gates or the late Steve Jobs would not have been popular if they were doctors.

Never known before, there is now unemployment in the profession. After medical school you have to do the compulsory one year internship. There are fewer accredited places for internship than the number of medical graduates. Even those with accreditation lack the funds to absorb. So you find fresh doctors staying more than a year, even up to two years to get placement. And by Medical and Dental Council (MDCN) law, if you do not do the internship within two years of graduating, you have to write a council exam. Even after the compulsory youth service doctors look for work. Many doctors who want to become specialists, have passed their primaries, but cannot get anywhere to do their residency programme. I know some who have given up on that dream after many years of attending fruitless interviews. The majority of doctors, many with primaries, are doing one locum or the other in a private hospital where they are paid as low as N60, 000 per month.

There are other disincentives. In the U.S doctors face malpractice regularly. And many have stopped practising.  Yet, the majority of lawsuits brought are frivolous. In more than 91% of cases the defendant won. And only 6% of all lawsuits go to trial. Those that are not thrown out are settled amicably. In Nigeria it is catching on. Of course doctors who make gross inexcusable mistakes are liable, as those who are unqualified. When a patient dies here, and the hospital remains the best place to, there must be something the doctor should have done he did not do. As doctors we took an oath, yes, but the oath did not say we will save everybody. Even Jesus did not save everybody. There was still a son of perdition.

The typical scenario in Nigeria is that the patient has taken all sorts of self medication including traditional concoction, and when organs have damaged they are rushed into the hospital for the doctor to perform a miracle. Children are brought in chronically ill-looking, very anaemic and needing blood transfusion because the parents’ neighbours told them it is “teething”. When you tell a woman she will have an elective caesarian section because she risks a uterine rupture from a previous caesarian section she will say “I reject it”. Many laboratory investigations cannot be done because there are no reagents. There are many diagnostics tools that Nigerian doctors only read about in textbooks. Many patients are also poor and cannot do investigations when it is available and cannot buy their medications. So your medical knowledge hangs in the air.

There are still other frustrations of daily clinical life. In most government hospitals the crowd stretches the capacity of the hospital. In seeing a patient a doctor is making the most of the 15 or so minutes he has to be with the patient, but the patients outside grumble that you are taking a long time. But when they themselves get inside the surgery they don’t want to leave. Some patients complain that their doctor does not listen. But it is not so. As New York Times health columnist Danielle Ofri puts it, “Sometimes it feels as though my brain is juggling so many competing details, that one stray request from a patient—even one that is quite relevant—might send the delicately balanced three-ring circus tumbling down.” She calculated the number of thoughts a primary care doctor juggles to do a satisfactory job, and tabulated 550. She said doctors keep pushing so many balls into the air and that there is no doubt a few will fall. As it stands, it seems that doctors will simply have to continue this impossible mental high-wire act, juggling dozens of clinical issues in their brains, panicking about dropping a critical one. The resultant neuronal overload will continue to present a distracted air to their patients that may be interpreted as they not listening, or perhaps not caring. 

Ofri, adds that when her computer becomes overloaded, it simply crashes. Usually, she reboots in a fury, angry about all her lost work. However, she views her computer with a tinge of envy. It has the luxury of being able to crash, and of a reassuring, omniscient hand to press the reboot button. Physicians are permitted no such extravagance.

There are still other things to ponder on. The retirement age of professors is now 70. Yet, critically speaking doctors do more for the people. How about increasing their retirement age to 70 also? It pains me when doctors go on strike. But how about removing doctors from the civil service structure and creating something different that covers all doctors in government and the private settings? How about empowering many other hospitals, including the private ones to do internship and residency training? How about increasing the budget that goes to health? Wait a minute. Where is the National Health Bill?

I can’t deny that sometimes I feel if I had not been a doctor life would have been much easier. I do not have to do calls. My sleep will not have to be interrupted by distress telephone calls. I do not have to leave my wife in a dash. I am condemned to have more than my own fair share of grieving, for every patient that dies in my unit is somehow connected to me. Gasp, and needle pricks!

But I also shudder at what it would mean for patients if doctors walked away from medicine because of the frustrations. I still marvel at discovering the wonder of the human body. The honour of being trusted by my patient to give them advice, the gratitude the elderly ones especially show when helping them through their illness, their prayers and blessings. These things will remain unchanging. When I look at all these – I still consider myself lucky and privileged to be placed to look after God’s creation.

Dr Cosmas Odoemena