Abdullahi Yahaya Bello & Eunice Udida
20 September 2008
interview
Dr. Abdulmumini Ibrahim is the Acting Registrar, Medical and Dental Council of Nigeria (MDCN). He says most newly graduated medical doctors coming out of Nigerian universities are incompetent. According to him, "the situation is so serious that some of them can't interpret laboratory analyses". Excerpts:
Weekly Trust: You were recently quoted at a stakeholders' meeting as saying most fresh graduate doctors are incompetent and incapable of rendering medical services. How serious is the situation?
Dr.Abdulmumini Ibrahim: It is a very serious issue. In every profession, the aim is to conform to the ethics, rules and regulations of that profession. I said because a lot of them are incompetent and there are reports reaching us about their incompetency. Most of them are found wanting in the basic things which a newly graduated medical doctors should handle. Like basic procedures. Usually, housemanship or internship is the last stage in training where a newly graduating doctor will be tested on what he or she studied in theory and practical which he or she was exposed to in teaching hospitals. They are expected to put what they learnt into practise during housemanship under the tutelage and supervision of consultants and senior colleagues. These basic procedures include veno puncture that is drawing blood from body of the patient for laboratory analysis, interpreting common ordinary x-rays, interpreting laboratory results, taking of blood pressure. You find some of these doctors cannot do these basic things. You will be surprise that even to examine patient from head to toe, they can't do it. I raised these issues in my welcome address where I blamed it on over admission of students. You find out that a class that is supposed to have about a 100 students is having 200 to 300 hundred students. During training period, a lot of them do not have the opportunity to observe patient properly and carry out investigation and other things required from them. So, when they are exposed especially during housemanship, they display their ignorance. It is a very serious matter.
WT: One of the issues you raised at the meeting has to do with alternative to practical instead of real practical. Can you shed more light on this?
Ibrahim: When you have a normal number of students in a class, everybody is exposed to the same opportunity to carry-out the expected practical for those subjects that required practicals.What we call alternative to practical are those things being put on paper when actually they are supposed to be demonstrated or displayed, but instead, you put something imaginary on paper. Even in some cases because of the unwieldy number of students in the class, you find that even the alternative practicals don't even go round.
WT: You said over admission is the main reason for the incompetence of some of our newly graduating doctors. Are you then suggesting that those who meet the required entry qualification should not be admitted because of over population?
Ibrahim: This goes back to the admission process. Actually, the best are supposed to be selected for this type of professional courses. Unfortunately, that is not the case. The admission racketeering that is going on in some universities does not help matters. Those who are supposed to be given admission at the end of the day don't get it. Thank God that most universities are now doing post UME to test the competence of our students in order to select the ones who can pursue courses in the universities. If this is adhered to, you will find the right calibre of people attending universities. I also made mention of indexing .That is admitting based on the quota allocated to each medical school. If that is religiously followed, it will enable the students to have access to patients. They will be able to examine and carry out the various tests that are required on the patient up to the end.
WT: Is there any mechanism put in place for citizens to seek redress through the council anytime they feel short changed by doctors?
Ibrahim: We have such mechanism in place. The council functions through its standing committees. We have two committees responsible for discipline of doctors. They are the Investigative Panel and the Disciplinary Tribunal. Nigerians are advised to come closer to the council by reporting any misdeed or what they perceived as misdeeds or malpractise by any doctor either in government or private practice. Nigerians should report such misdeeds in writing to the council. The council through its investigative panel investigates and invites the doctor to appear before it to answer some questions. The other party will be around during the panel sitting. If a prima facie case is established against the doctor, his case will be forwarded to the disciplinary tribunal. So, this is the mechanism in place to check the excesses of all doctors in Nigeria.
WT: You threatened to sanction erring medical school. How will the sanction look like?
Ibrahim: The sanction has already been spelt out in some documents of the council. Even the act establishing the council says the council is responsible for approving courses which will lead to the award of degrees in medicine. The council also has the power to approve the establishment of medical institutions. The council has also been empowered by the act to close any institution which violates the rules and regulations set down to be part of the training procedures. The sanctions include closing, withdrawal, suspension and cancelling already awarded accreditation to such institution. Right now, the council is not in place. But that does not mean it cannot exercise its rights. Like I mentioned in my welcome address, most of the medical institutions we have are owned and funded by government. Even that council which is supposed to carry out the functions, is also a government funded agency. So, it will look like an embarrassment for the council to go and close down these institutions. Instead we have what we call minimum standard. When we go for accreditation, we look for these minimum standards. We know most of the institutions will not attain the maximum but there is a minimum below which they must not fall. If they fail to meet this basic minimum, then we will place the right sanction on them.
WT: Can you shed more light on your submission that you also received complaints about Nigerian doctors practising overseas?
Ibrahim: Nigerian professionals including doctors perform excellently well outside this country. However, most advanced countries don't joke with enforcement of rules and regulations because most patients in these countries know their rights. They have the right to challenge whoever is treating them. In advance countries, even a small complaint against a doctor would be fully investigated. And at the end of the day, if that doctor is found wanting, he will be sanctioned accordingly. They will refer to the institution the person trained. If the person is a foreigner, they will inform his country. For instance, we have been receiving reports from the General Medical Council of the United Kingdom and whenever they sanctioned a Nigerian-trained doctor who trained in Nigeria whether he is a Nigerian or a foreigner who was trained in Nigeria, they have the right and a duty to report back to Nigeria that a doctor who trained at so and so time was found doing one thing or the other and was tried and was found to be culpable. If the doctor did not agree with the charges, he has the right to appeal. The council will inform us that the doctor has appealed and if the appeal exonerated him, we will be duly informed. This is the extent these advanced countries go.
WT: As an experienced doctor, what do you think is the greatest challenge facing doctors today in Nigeria?
Ibrahim: This question will not be easy to answer because there are so many challenges facing doctors. Poor welfare package is the greatest challenge facing doctors today. The other challenge is that of specialisation. In the course of trying to specialise, you find some doctors over staying and along the line, they drop-out either due to poor welfare package or lack of sponsorship. There are also challenges from patients. These days you find highly engaging and well informed patients who while complaining to doctors give clinical symptoms and signs of their conditions. A patient can even tell the doctor that he has searched through the internet and got information on his condition. The doctor himself has to update himself through what we call continue professional development. We have enforced it that every doctor after graduation must update his knowledge on the current trend. Otherwise, you will find the patient challenging the doctor.
WT: Nigeria is still far short of the World Heath Organisation's standard doctor -patient ratio and the council is complaining of over admission. When are we going to bridge this gap?
Ibrahim: Going by the WHO standard which is one doctor to 500 patients, Nigeria is yet to come close to that. Going by what we have in the register, it is one doctor treating about 4,500 patients.
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