Overworked doctors are bombs waiting to explode!
“It’s something I’d rather not talk about but yes, I’ve punctured a few patients’ uterus (womb) in my practice!” That was Dr. Bola’s sober confession after countless attempts and repeated fruitless visits to get her to speak on the impact of her long work schedule on her patients. Uterine rupture is regarded in medical circle as a disastrous and life-threatening occurrence for a pregnant woman and her baby. Managing it is often an emergency procedure which could sometimes result in a total removal of the womb to save the patient’s life,
Dr. Bola is an obstetrician and gynecologist in a government hospital in Lagos mainland. She’s very popular both among her patients and colleagues and is indeed a warm and likeable personality. Ordinarily, she is not one of those doctors you will regard as careless or incompetent. But she admits, she has committed quite a number of medical blunders that left patients barely lucky to leave the theatre alive. Her story about an unfortunate young lady whose uterus was ruptured was an eye opener. Dr. Bola recalled she was on call for the second day running when the patient came along:
“Just like today (the day of the interview), I had been on call for the second day running without resting”, she told revealed. “Then a senior colleague brought a young lady, obviously his relation, and asked that I perform a Dilation and Curettage (D&C) on her. I’d actually planned to end the day’s work but then I couldn’t turn down an assignment from my superior.”
In the theatre, Dr. Bola recounted that her legs and hands shook all through the operation; her vision was blurred as she was seeing double and she had an unusually pounding headache.
“I was really stressed out and longed for a rest,” she further confessed.
On that eventful day, Dr. Bola performed a suction curettage on the patient because the pregnancy was less than six weeks old. Suction curettage is a variation of vacuum aspiration in which a suction machine is used to get the unwanted baby out of the womb. The remaining parts are then scraped out of the uterus with a surgical instrument called a curette. Having done this, she made another pass through the patient’s uterus with the suction machine as she (the doctor) ought to have done. This is to help insure that none of the baby’s body parts had been left behind.
“That day, I’d dilated the woman’s cervix large enough to allow a cannula, (a hollow plastic tube that is connected to the hand pump by a flexible hose for insertion into the uterus). As I created the vacuum, I ran the tip of the cannula along the surface of the uterus to cause the baby to be dislodged and sucked into the tube in pieces
“Having done this successfully, I moved on to the next phase by using a curette, a metal rod used to scrape any ‘remaining part of the baby out of the uterus. And that was when I committed the fatal mistake which almost cost the patient her womb and probably would have led to some litigation which would have caused me my license.”
In her fatigued state, Dr. Bola over-scraped the patient’s uterus and in the process punctured her womb with the curette. The doctor immediately embarked on another tortuous procedure to patch the patient’s womb to avoid threatening complications and other issues that would have cropped up as a result of the fatal mistake
“Unlike the ‘real me’, this particular D&C which almost landed me in trouble took so long. Patching the womb on the other hand, took like forever all because I was overworked and too tired. I am not a quack but only human, she disclosed soberly.
Several other doctors across the country have admitted one fatal mistake or the other as a result of overwork. In government hospitals, the average daily working hours for a doctor is not expected to exceed 12 hours and he is expected to observe some break during this period. My investigation however discovered a contrary trend in most hospitals where a doctor could sometimes cover the whole day’s shift stretching beyond a full day. The situation is even worse in the private sector. My investigation reveals that a doctor may report for work on a Friday and never see the four walls of his house until Monday afternoon – when the number of patients to be attended to had reduced.
An Abuja-based doctor who pleaded anonymity admitted to how he almost sent a patient to her early grave because he was too tired to examine her.
According to the doctor who works in one of the General hospitals in the Federal Capital Territory, he had spent over 24 hours on duty because a colleague who was to relieve him did not turn up. He had attended to a long list of patients non-stop, without an opportunity to go for a short break but just chewing snacks whenever he was hungry.
“Although I was physically in the consulting room when the patient entered, I tell you, my soul was already on my bed at home!” he revealed.
The patient had complained of stomach pains but the doctor could not summon enough strength to examine her.
“I was too tired and could barely see. In fact, I was just forcing my eyes to stay open in order not to embarrass myself in front of my patients. Mind you, our offices had been partitioned to take more doctors yet the patients outnumber us. As the patient sat down, I remembered I just went through her file in my sleepy state. I discovered she was an ulcer patient and simply added two more drugs which I believe should help her condition. This happened within the few seconds of trying to stay awake in front of the patient and I did not even realised I’d prescribed an overdose.”
Three weeks later, another colleague and close friend who saw the patient when she was later rushed back to the hospital quietly called him aside and showed him the patient’s file to confirm if he really prescribed what his signature indicated. The colleague informed him that it was appendicitis and not ulcer that had brought the patient to the hospital. His prescription was not only an overdose but the patient was lucky to have been rushed back alive for an emergency appendectomy operation.
The doctor was shocked to see his own prescription and what could have been the fate of his patient – another victim of prolonged working hours.
It is however not only in the big cities alone that patients are receiving dreadful medical treatment as a result of doctors’ exhaustion considering the fact that only few of the nation’s trained doctors reside in the rural areas. Investigations indeed reveal that the situation could be more pathetic in the small towns and cities across the country.
For instance, I encountered a young medical doctor in Warri, Delta state, Dr. Ese (not real name) whose marriage is on the verge of collapse because she could hardly spare some time to enjoy her marriage. Married for over three years, Dr. Ese’s in-laws now call her a man because she is yet to be pregnant.
Fertility tests have so far revealed that she is fertile. Her husband has also been through numerous fertility tests at several hospitals and all results indicated him to be fertile as well. Dr. Ese’s work however seems to be the problem! While at work, her husband, a business man is usually home and the few times she is not at work, he would be away doing business.
Dr. Ese confided in this reporter how she had to fane illness during her ovulation in order to be able to copulate with her husband, unfortunately, something urgent cropped up taking her husband away from home.
As a result of the commotion in her home which is unconnected with her work schedule, her concentration on-the job is now being affected. She revealed to this reporter how she once absent mindedly prescribed pyrazinamide, ethambutol, isoniazid and rifampicin for an asthmatic patient. These drugs are standard short course treatment for tuberculosis!
Fortunately for the patient, the hospital’s pharmacist who knew the patient to be asthmatic queried the prescription and sent the patient back to the Dr. Ese. That was when she realized how much her state of mind was telling on her job and patients.
Like the Australian doctors who in a study in September 2010 admitted to many instances of patients being seriously injured or killed due to doctors’ exhaustion, some Nigerian doctors are also calling on the Nigerian government to intervene and get hospitals to reduce the number of hours a doctor should attend to a patient in a day.
In August, the European Union issued a directive limiting hospital doctors’ working hours to 48 hours a week. This directive has been largely followed except in Britain where the Labour government is fighting the implementation tooth and nail.
My investigations further reveal that a large number of Nigerian doctors are not only physically battered due to stress, they are also emotionally and financially drained. Contrary to what they preach to their patients, majority of them do not have time to relax, how much more spend quality time with members of their families. Virtually all the doctors who spoke to this reporter attributed this to their choked schedule as well as poor remuneration which is not commensurate with the years and rigours spent in medical school as well as the energy, skills and time put into the job.
“Of course the job does affect our personal lives but we get along with it. That’s all I can say. It is something you have to get used to and get along with.” A surgeon at the Lagos State University Teaching Hospital (LASUTH) Dr. Lucas Daniels revealed.
When asked when last he took time off to relax, especially with his family, he said:
“It has been a long time, a very long time. Beside the time, the resources are not there. You must have the resources to be able to do such. If you are not paid sufficiently, you will not be able to do that. You will discover that your salary is not enough to carry you through that. Sometimes, your salary may not be enough to carry you through the month because you will have school fees and other things to pay”.
Commenting on the recent rise in cases of wrong diagnosis, complications arising from improperly carried out surgical operations and wrong prescription of drugs by doctors, Dr. Felix Osia of the Federal Medical Centre, Namoda, Zamfara state disclosed that these may not be unconnected with their being overworked.
“Behind most wrong diagnosis and wrong prescriptions are fatigued doctors who are seriously overworked and who will surely underperform and deliver wrong medical judgments,” he stated.
But the Chief Medical Director of the Lagos University Teaching Hospital (LASUTH) Prof. David Oke is of a different view. According to him, doctors do not just rush into theatres to carry out operations; he disclosed that they plan every operation, both emergencies and electives. He explained that having considered all prevailing circumstances, his schedule and available facilities inclusive, a doctor plans his or her operations accordingly such that there will be no clashes. Even emergencies, he noted are planned in chronological order based on the seriousness and survival rates of the patient.
Prof. Oke
A Consultant Surgeon at Shammah Specialist Hospital Amukoko who identified himself simply as Dr. Abikoye agrees with Prof. Oke. According to Dr. Abikoye, doctors generally run the routine shift from 8am to 4pm while that of call is 4pm to 8am the following day. He however disclosed that in private hospitals such as his, there is what is called weekend coverage which involves working from 8am on Saturday till 8am on Monday.
“Of course, the doctors who work with me have time for themselves. If they are not on weekend call, that means they will have as from 4pm on Friday till Monday morning to themselves and they can use their free time as they please. Is that not enough”? He queried.
But Dr. Daniels disagrees with the duo entirely. According to him, while LASUTH, for instance, has adequate number of surgeons and the government has also made considerable efforts in building and developing infrastructures, the numbers of patients still remains very high compared to the available facilities.
“The operating space determines the operating time and number of patients to be operated. For instance, if there are four spaces and 20 patients on the waiting list, then it is already determined how many patients per theatre and time to be operated in a day. The doctors, particularly in teaching hospitals, work round the clock. Even when not on emergency call, we still have work to do. We look for ways to carry out certain treatments; we just have to do something even if it means putting more time in order for patients to get well”.
We don’t bother about being overworked because our training scheme builds us to endure a lot of physical strain but what we worry about is for the society to appreciate us doctors. Doctors are people who work long hours in a day so people should stop treating them like they do not matter”.
Said Dr. Efunbo Dosekun, chief medical director/pediatrician, Outreach Children’s hospital, Festac, Lagos: “A doctor’s routine in Nigeria is a lot of work. It’s a lot of dedication having to come up here early in the morning and being driven by the volume of work here (the hospital) because if there is much work, you can’t go home. As a doctor if you are careless, you will lose lives. You only stop where the work stops and it can be quite stressful to our physical bodies but you can’t do this type of job without maximum concentration. You have to be determined, dogged and physically strong” Dosekun dislcosed.
Dr. Dosekun
But when asked when last she spent quality time with her family such as going out on picnic or vacation her response was startling:
“I apologise all the time to my family because they have been much neglected. There has been no time for family life. It has been a very poor-work-relaxation balance.” the pediatrician with over 20 years of experience revealed.
All efforts made to reach the Registrar, Medical Dental Council of Nigeria (MDCN) for comments however proved abortive. A senior official who would not reveal his identity on the grounds that he is a civil servant however sharply disagreed that exhaustion was responsible for the doctors’ fatal errors as confessed to this reporter.
“I don’t know of any doctor working 16 hours at a stretch. The maximum I know is 12 hours and if there would be an over run, there is usually break in between”.
However, when confronted with some of the facts presented by the doctors, the official simply retorted that the doctors should sue their employers.
“Then they should take their employers up. In short, I have never heard of doctors working long hours in Nigeria but I am not saying it is not possible but will be really surprised. Even in most public hospitals, they don’t work as long as that even when they are on shift. It is not usually more than 12 hours even in the night”.
“But if that is the case, really strange things actually do happen in this country, I repeat, they should take their employers up legally because the MDCN will not take being stressed or operating under stressful conditions as an excuse for mismanaging a patient. If they are stressed, they should be able to know because they are medical doctors. They should be able to tell their employers and not toil with the lives of innocent patients” he declared.
Over the past few years, some medical practitioners in the country had on a number of occasions been tried and convicted for some malpractice or the other. But records at the MDCN- the body responsible for such trials, revealed that there has been no case whatsoever wherein a doctor’s negligence or malpractice was traceable to long hours on the job.
Unfortunately, the doctor to patient ratio in Nigeria still has a wide gap. Contrary to the World Health Organization’s standards, the doctor-patient ratio of a doctor to less than 3000 persons is exceeded. In Nigeria, a doctor unfortunately attends to much more than 4000 patients and in addition has no stipulated regulated work time.
At the Victoria Island office of the MDCN, the earlier mentioned source disclosed to National Mirror that there is no exact number of hours doctors are allowed to work in the country. Rather, the employer determines that, while the hours being put into the job for most of such hospitals determine the remuneration package of the doctors.
Investigations however revealed the MDCN has stipulations about work hours on the job which shouldn’t be more than 12 hours but this is only in theory. In reality, employers or owners of hospitals call the shots though professionally, the job actually entails running shifts.
But then, there are some exceptions to whatever contractual agreement is sealed. One of such are operations which take up to or more than 24hours, though these are exceptional cases. Medical reports indicate that anything can happen while performing operations; there could be complications and doctors will have to be on their feet though this is not a regular phenomenon.
Head of the council’s department of Medical Education, Dr. Nnaemeka Nwakanma in a chat also reiterated that the hours doctors put in the job are determined by their employers or management of the hospitals. Junior doctors, he disclosed, in addition to their regular work shifts are subjected to do extra hours which are often time quite long and rigorous.
“Personally, I feel it is very wrong for them to be subjected to such because outside Nigeria; the developed nations, that is not what obtains there. But that unfortunately happens here in Nigeria. In some private hospitals, some doctors are made in addition to their normal shifts and duties to undertake extra hours such as being on duty on Friday till Monday when they will go home ” he revealed.
As the way forward, Dr. Osia opines that “whosoever tells you that doctors in Nigeria are enjoying is telling you a lie from the deepest part of hell. The ratio of doctors to the Nigerian populace is quite frightening. Our higher institutions of learning are churning more entertainers, making science to lag behind. Imagine for more than two years now, no one in Nigeria has been able to win the LNG Prize for science. It speaks volumes about our nation. Which economy prospers with more comedians, dancers, singers who call themselves entertainers? But that is what our society is producing and celebrating”.
He concluded that “our tertiary institutions should please churn out more science graduates, medical doctors and medical practitioners. Parents should encourage their children and wards to go the science path, especially medicine otherwise, doctors will continue being overworked which will make them run away to other countries at the slightest opportunity while those who have the fortitude to remain here will continue giving wrong prescriptions and committing blunders in theatres as a result of the notoriously long hours they run”.
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