Why fight the doctor over who leads the health team?

Cosmas Odoemena

A group in the health sector has decided to go on strike in the government-owned hospitals over certain issues of which one of them is the fight for the leadership of the health team. Another is that its members want to earn what doctors earn. Strange things that never happened anywhere in the world.

They have padlocked consulting rooms, operating theatres, laboratories and anywhere any form of health service can be rendered to patients, and even attacking doctors physically who are rendering care to patients.

To this amorphous group in an unholy “marriage” characterised by orgy, delusion, inferiority complex, inordinate ambition, unbridled indiscipline and warped logic, anyone who works in the hospital can be the Chief Medical Director!

Like I said in a recent article, “Why begrudge the doctor,” published in this newspaper almost four years ago when this same issue reared its ugly head, “The grudge against doctors strikes at the concept called public hospital. Only in a public hospital will there be argument about who is in charge; only in a public hospital do you have conflicts of roles or who should be paid more.”

Now, hospital is a kind of business. Anyone who has the money can open a hospital. In Lagos State, the Health Facility Monitoring and Accreditation Agency (otherwise known as HEFAMAA) will accredit such a hospital which meets the minimum requirements as long as the Operating Officer is a qualified medical doctor. The businessperson is then regarded as the proprietor. Anything but this is not allowed. Likewise the public hospitals of which a body like HEFAMAA monitors. So, while in a private hospital the businessperson is the proprietor, in a public hospital, the government is the proprietor for it is the one that remunerates the Operating Officer (Chief Medical Director). Any place called a hospital, whether private or public, not headed by a doctor won’t be allowed to operate. So, there is no room for non-doctors to become the chief executive in a hospital setting.

Now, these regulatory bodies not only license hospitals, they license nursing homes, convalescent homes, laboratories, physiotherapy clinics, and for pharmacies, it is the Pharmacists Council of Nigeria. In all these places, a doctor can’t come there and lead the place. To make it simple, a doctor can’t be the operating officer in a nursing home, or in a convalescent home, or in a laboratory, or in a pharmacy, or in a physiotherapy clinic. But a doctor can be the proprietor of any of them.

Those agitating for non-doctor leadership in a public hospital should instead fight for publicly owned nursing homes, publicly-owned convalescent homes, publicly-owned laboratories, publicly-owned pharmacies and so on.

To be fair, many “good” nurses don’t agree with this “body”, they still honour the age-long “Hippocratic-Nightingalic” symbiosis.

Healthcare is multidisciplinary, and involves everyone who contributes to the health of the patient. Yet, if there is no arrowhead, it leads to anarchy. Imagine where the pilot (doctor) is in a tussle with the medical laboratory scientist or pharmacist (flight engineer) and the nurses (flight stewardesses) on who is in control of a plane in flight. Of course, that plane will crash. And that has been the lot of our health sector.

The same people who are fighting for leadership position with the doctor want their children who are science inclined to make medicine their first choice for university education. Some even go as far as saying “medicine or nothing.” Now, they want to tussle leadership with the doctor through the backdoor. The best way for them is to get their Permanent Voter Card, join a political party and be voted in as the President of the country. Doctors answer to the President.

It must be stated here that a doctor-leadership is a sine qua non for quality healthcare everywhere and Nigeria is not an exception. Doctors have long years of training in medical school learning subjects that people study as single degrees. Six years is even too short. That is why they still go further in postgraduate school for almost equal duration of training as in the undergraduate, if not longer. Those allied disciplines who are mischievous think that by continually lengthening their own undergraduate training, it will equate as doctors’. They might as well stare at a one-page tract for six years!

Again, it’s imperative that doctors maintain authority for the care of the patient to ensure safety and overall care of the patient. Doctors must take responsibility in all hospital matters and maintain quality control for non-medical doctors in a hospital setting.

According to a survey by the American Medical Association, patients also support physician-led team-based care. In a 2012 survey, it found that patients overwhelmingly want a coordinated approach to healthcare, with a physician leading the healthcare team.

“Physician leadership of the healthcare team does not mean that physicians must have all the right answers for every task the team needs to accomplish. Rather, it requires physicians to ask the right questions, invite participation, communicate clearly, promote a culture of respect, reward excellence and ensure accountability, among other important leadership skills.”

A Harvard Business Review article entitled, “Why The Best Hospitals Are Managed by Doctors”, is instructive. In the article, James K. Stoller, Amanda Goodall and Agnes Baker noted that physician-run hospitals topped the US News and World Report rankings and earned 25 per cent higher quality scores than non-physician-run hospitals; this is according to a study published in Social Science & Medicine. (The non-physician talked about is the equivalent of proprietor and not the operating officer). They also cited a study that found that hospitals in Brazil, France, Canada, Germany, India, Italy, Sweden, the UK and the US that had more clinically trained managers also had significantly higher management scores.

This should not come as a surprise. As Bruce Y. Lee, writing in Forbes magazine, said, “Keep in mind that in the medical field, the word ‘training’ often means work. The word ‘practice’ also means work. The word ‘resident’ means work multiple jobs for little pay. The word ‘attending’ means work multiple jobs for more pay. In fact, the word ‘time off’ sometimes means work too. The medical field has lots of euphemisms for the word ‘work.’ Therefore, by the time a physician has become an attending, he or she has had many, many years of work experience in healthcare settings. That kind of experience just can’t be learned from a website, an app, a book, a television show or even from watching others do the work.”

The Mayo Clinic is America’s best hospital, according to the 2016 US News and World Report (USNWR) rankings. Cleveland Clinic is second. John Noseworthy and Delos “Toby” Cosgrove, their CEOs respectively are highly skilled physicians. Both institutions have been physician-led since their inception about a century ago. Is this speaking to someone?

But if this group continues to stand logic on its head, then government can let Nigerians decide who should lead their health team or healthcare. Put it to vote in a referendum and settle this once and for all. In the unlikely event that Nigerians decide to give the vote to a nurse, or a lab scientist, or a pharmacist, or a physiotherapist, or a radiographer, or a dietician or an optometrist, or a medical records staff, or even a ward attendant to take the ultimate decision on their health, then let the doctors continue to migrate to developed countries where they are valued. But, God forbid!

Dr Cosmas Odoemena