It is not acceptable for doctors to dictate, control other professions in hospitals-Okara

June 20th, 2018

As the controversy on whether or not the pathology laboratory departments should swallow the medical laboratory science departments in hospitals, HASSAN ZAGGI had an encounter with the President, Assembly of Healthcare Professionals, Dr GODSWIL OKARA, to get the true situation. Excerpts:

Recently, the NMA in a statement claimed that Chief Medical Directors/Medical Directors (CMDs/MDs) are not under any legal obligation to set up the Department of Medical Laboratory Science aside from the Pathology Laboratories departments headed by qualified Pathologists in hospitals in Nigeria. How did we get this level and what is the true situation?
Well, it is unfortunate that when people want to indulge in mischief, they stop at nothing in falsifying facts to have their way. The truth is that there are subsisting court judgments. As we speak, up to seven of them including the one of Jos University Teaching Hospital (JUTH) that was delivered by the National Industrial Court of Nigeria (NICN), none of these 7 judgments has been set aside, none of them has any stay-of-execution order.
What was tried at the Court of Appeal was the contempt order issued by the NICN against the CMD and the Director of Administration of JUTH. The actual judgment was not the subject of the trial or ruling. Therefore, for NMA to mix the two is nothing short of mischief and a calculated attempt to cause confusion.
The position of law and court judgement is clear, that is, there is supposed to be laboratory services as an organizational or coordinating department in the hospital, just as you have nursing services department in the hospital headed by a nurse for coordinating the professional career activities of the nursing profession and nurses in the hospital; pharmaceutical services under a pharmacist for coordinating efficient and effective service delivery by pharmacists; engineering services in the hospital under a seasoned and experienced engineer coordinating the activities of all other category of engineers in the hospital. Laboratory services comprise a number of laboratory departments just as nursing services which is headed by a nurse. You have nurses working in various departments in the hospital, pediatrics, medicine, surgery departments, labour ward and so on. They all belong to their professional service under the control and leadership of their head of nursing services. The same way, the scheme of service for medical laboratory scientists has clearly provided for a well coordinated service structure for efficient service delivery in the hospital. That you belong to laboratory service does not mean that you will not work in other laboratory departments of the hospital.
It does not remove anything from the doctors who are working in those departments, it rather complements and strengthens their own service delivery for holistic patient care.
The same way we say, as the law and scheme of service have provided for laboratory services, for purposes of career progression, efficient service delivery and job satisfaction, allow this group of professionals to have their service properly structured for purposes of giving out their best to the patients and to other professional partners they are supposed to work in conjunction with in the hospital. That is what the judgement is all about.
The court of law has critically examined and interpreted the Medical and Dental practitioners Act visa-vis the Medical Laboratory Science Council Act, the scheme of service of pathologists and the scheme of service of medical laboratory scientists, to clearly point out that there is no overlap or conflict between both laws, and that there should be a situation of live-and-let-live by both parties in the hospital in the interest of patients.
Medical doctors cannot have their own clinical services headed by a clinician or physician and you say nursing services, pharmaceutical services and laboratory services should not exist or headed by their respective professionals. Medicine and surgery is a distinct profession, separate and different from medical laboratory science, that is the position of law.
The laws of Nigeria are clear on that. For anybody to arrogate to themselves the power to dictate, control and perpetually head another professional service in a multi-professional sector is not acceptable and it will never be accepted.
If anybody feels that because he is a head of department and therefore other departments and head of services should not exist, that will be overstepping their bounds and promoting acrimony and instability in the system.
What is the difference between a medical laboratory and a pathology laboratory?
They are the same thing, it is a matter of choice of terminology. A pathologist is a physician who has specialized in the laboratory discipline called pathology. By their training, pathologists are supposed to run their specialty clinics to attend to and treat patients who have problems or abnormalities related to their specialty.
For example, a hematologist is a specialist physician who has specialised in a branch of pathology called hematology- the study of blood disorders. That physician is supposed to run a hematology clinic where he attends to, treat and manage patients who have blood-related disorders like sickle cell disease, leukaemias and many blood-related disorders.
On the other hand, medical laboratory science also has its various sub-specialties. A medical laboratory scientist is trained and licensed to carry out laboratory analysis and testing, produce biological reagents and vaccines for accurate diagnosis, treatment and effective management of health conditions. You have hematology, chemical pathology or clinical chemistry, histopathology and cytopathology, medical microbiology, immunology and many others as subspecialties of the profession.
Medical laboratory scientists concentrate on laboratory testing, operation of the medical laboratories, generation and interpretation of laboratory reports to ensure the effective diagnosis, treatment and management of patients by physicians and surgeons. They are two different professions, but they complement each other in a teamwork for the wellbeing of the patient.
During our days at the University College Hospital, Ibadan, histopathology physicians had their clinic called oncology clinic. All the consultant histopathologists took their turns according to the days of their clinics to attend to patients in the clinics and they also had bed space in the ward where they admitted cancer patients for adequate care.
It is rather unfortunate what you see these days, are young pathologists who don’t want to run clinics, they don’t want to attend to patients, rather they just want to come to the laboratory and struggle over laboratory testing with medical laboratory scientists who have been trained, certified and licensed to do the testing and analyses in the laboratory.
Instead of these highly skilled professionals doing their job as specialised physicians by running clinics, they abandon their duty as physicians and they want to come and struggle over laboratory testing and laboratory operation with medical laboratory scientists. The law courts have looked at the case and passed judgments accordingly, instead to obey the judgments of the court, the NMA will want people to believe that the Appeal Court has nullified the judgments, which is not true.
Instead of obeying these judgments, the NMA will go about insulting and vilifying the judiciary for passing judgments. They will go about insulting the legislature for enacting laws. They will go about insulting and vilifying the National Council on Establishment for releasing schemes of services for orderly conduct of professional services in our hospitals.
The time has come when the elderly people in the medicine and surgery should call to order the younger ones. We have high distinguished physicians, surgeons and pathologists who have played tremendous role in the development of the medical laboratory science as a profession in Nigeria. Indeed we have acknowledged and deeply appreciated them by conferring on them the Distinguished Service Award and Honorary Membership of our Association. This unhealthy rivalry and acrimony must stop in the larger interest of our country.
Modern day health care practice is multi-disciplinary and multi-professional. No one profession can do it alone. It is an illusion for any doctor to come out and say that they don’t need the contributions of other professions, or that they will do it alone. That is why people are losing confidence in the health sector in Nigeria.
What will be the negative impact if the medical laboratory scientists are forced to be under the pathologists?
It does not arise. No profession is put under another profession. We work in complementing each other. The pathologist has his role to play, the medical laboratory scientist also has his role to play, the nurse, pharmacist and all other professions have their role to play.
It is not the job of a doctor or pathologists to determine the standard of skill and knowledge to be attained by medical laboratory scientists for practice. You cannot control what you don’t you know. You cannot deliver what you don’t have. The law has not given the pathologists that mandate to determine the level of skill and knowledge that I have in order to give maximal service to the patients. That is the statutory mandate of the Medical Laboratory Council.
You have some Nigerian doctors saying that the patient belongs to the doctor, nothing could be farther from the truth. In modern day healthcare practice, the WHO model of health service delivery, the patient is at the centre of a circle.
Way forward
For us to make a headway in the Nigerian health sector, our friends and colleagues in medicine and surgery must reconcile themselves with the fact that change is the only constant factor in human existence.
The practice of healthcare delivery has left the medieval era, it has left the stone age. So, for doctors to feel that we must go back to the medieval era when healthcare practice was a one-man job- the doctor, that will amount to insulting the sensitivity and sensibility of the Nigerian public. They should accommodate the realities of present day healthcare practice. That way, the Nigerian healthcare industry will blossom like its counterparts in the advanced world. It is certainly doable and achievable.

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