Jesus said to them, “Surely you will quote this proverb to me: ‘Physician, heal yourself!’ And you will tell me, ‘Do here in your hometown what we have heard that you did in Capernaum.’” Luke 4: 23
Luke 4:23–30 – The story summary and the context
Jesus Christ – The benevolent healer they were so familiar with
Capernaum – A nearby Galilean city
Nazareth – Jesus’ and the enquirers’ hometown
Jesus’ statement paraphrased was: What you want done CAN be done BUT there is a problem! The problem had to do with them. The problem started in verse 22 when the people of Nazareth saw and treated Jesus not for who He really was but as Joseph’s (a carpenter’s) son. A lot of the challenges that doctors encounter stem from the necessary direct contact with their clients most of the time – verse 24. There are many things that doctors can do during their service lives but the challenges that they have may reside in sources outside of doctors. Most importantly, physicians must ensure that they are not the stumbling blocks to themselves – by healing themselves of those challenges first. In this lies the crux of this article.
WHO IS THE PHYSICIAN IN NIGERIA – and in many countries?
THE FORMATIVE YEARS
Brilliant boy or girl, in top tier of the (high) secondary school class
Hard-working student with choked and long lectures with practical sessions in the medical school laboratories and hospital wards and emergency departments
Obtained twin-degree in the medical school but is paid salary for one degree
Introduction:
THE GRAND SHOCK /WELCOME
Did incredible work during first year as a doctor and beginning to wonder why they held the opinion that the medical school program was the most hectic thing
When ready for NYSC most of their “mates” are already in possession of their Master degrees!
Toast of other members of NYSC during year of service (for one reason or another)
*NYSC = National Youth Service Corps
If they choose to go into private-practice they:
face a hefty capital overlay
are forced into partnership whereby another produces funds and they do the work
discover that the banks are not interested in funding newor small medical outfits
discover that a hospital is medical facility, plus “restaurant, hotel, laundry, standard office, TV-viewing center, cab/taxi business” all in one!!
CONTRADICTION OF SORTS
Comes from and belongs to a community which believes they are richer than other graduates and have to contribute at least as much as the others to that small or large community
Neighbours hold them in high esteem – at least until they discover this doctor’s financial “worth”
Everybody believes they are ALWAYS strong and healthy and should not become ill or show vulnerabilities of “mere mortals” – sometimes the doctor even believes that myth too!
THE INADVERTENT SKEW
They quickly and smoothly get used to working twice the normal official 40hr in a week
When on vacation they usually do not rest but must do “PP” – especially the young doctor
If they own a practice, their ‘phone is open even when they are overseas on a course or vacation, to attend to hospital problems at home/base
Their telephones (min. 2 but usually 3 or 4 lines) are permanently on – in silence or vibration in church/mosque + in normal profile when asleep!
*PP = Private practice
FURTHER COMPLEXITIES
Until much later in life they do not believe in having a driver – which driver could cope with the impossible lifestyle/work schedule in the doctor’s earlier years?
Has had a couple of brushes with death from sleep-driving rather than from being “under the influence” – their DUI is completed with …of exhaustion from work
Usually have a house but not a home – have to struggle to maintain a home
Spouse and children hardly understand what family outings or vacation mean
THE RAW FACTS!
They constitute one of the few professionals who work like an elephant but eat (earn) like an ant
When/if they belong to the big league in terms of financial standing you can see/tell that they worked for every penny of it!
To their patients they play multiple roles – doctor, teacher, counselor, helper, burden-bearer, burden-sharer, etc.
They may soon start paying the litigation price for malpractice – ?product of exhaustion
SOBER REFLECTION
Physician,
As a boy/girl, why did you choose Medicine?
Do those reasons still hold true? If not, why not?
Does the doctor still have class? – in their mind, in their family, among friends, in the club, in church/mosque, in community/society?
Is the doctor engaged in/should they engage in the rat race?
Where is that DIFFERENCE between us and others?? Where and why was it lost – if lost?
A WAKE UP CALL
Who did it? Picture the following relationship scenarios that exist:
A doctor as Minister/Commissioner of Health
A doctor as CMD or Medical superintendent
A Part 3 Medical student vs. Final year student
The GP and fellow GP in private practice
The specialist vs. the GP in private practice
The resident during training vs. consultant
The doctor in politics – senator, governor, or president
The Nigerian Medical Association (NMA) vs. Church car stickers: Which draws doctors closer?
How well do we relate with one another?
THE OSTRICH SYNDROME – OBLIVIOUS OF OUR LOSS?
It looks so! Otherwise why do the Attorney General/Minister of Justice and Solicitor General remain lawyers each and every time?
Why is the Minister of Finance usually from Economics and related areas?
Why have other professionals almost cowed doctors to submission while doctors are busy consulting and carrying out operations?
Does excellent team work not apply with the services of the aforementioned professionals who have wisely refused to share their “bread” or give up their “turf”?
THE QUESTION
But,Physician,won’t youhealyourself?
If you ignore the question you should consider that your admirers are asking themselves even if they do not ask you face-to-face!
DEALING WITH THE CHALLENGE
Two approaches proposed:
Group approach
Individual approach
GROUP APPROACH
Medical school curriculum
Housemanship program
Physicians’ pledge
Residency curriculum
Doctors’ general groups and their duties
Government and regulatory bodies
MEDICAL SCHOOL CURRICULUM
What ideas did you have about the medical school and medicine before admission?
Major features: High volume of academic work; dizzying speed; deficiencies e.g. in Economics and Human Resources Management
Coping mechanisms – Recognition of areas of weakness; welcoming team work; timeliness; involvement in practical work; non-accumulation of theoretical work or assignments; importance of character vs. IQ
HOUSEMANSHIP PROGRAM
Seniors to remember that the house officer is new in the profession
Teach house officer; don’t harass them
Commitment of consultants, etc. to teaching and house officers to learning PRINCIPLES of practice of medicine
Admit and place the right number of house officers for the known work load of the housemanship center
Ensure adequate staffing with doctors, nurses, laboratory scientists, etc
Provide functional accommodation for house officers
Maintain good, functional library
Provide at least one meal daily for all house officers
Provide three meals daily for house officers on-call
WMA PHYSICIANS’ PLEDGE (2017) *WMA = World Medical Association
AS A MEMBER OF THE MEDICAL PROFESSION: I SOLEMNLY PLEDGE to dedicate my life to the service of humanity; THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient; I WILL MAINTAIN the utmost respect for human life; I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;
I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice; I WILL FOSTER the honour and noble traditions of the medical profession; I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
*(For the first time explicit attention is given to the welfare of the doctor – though in just one sentence)*
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely, and upon my honour.
DOCTORS’ GROUPS AND THEIR DUTIES
WMA = World Medical Association
CMA = Commonwealth Medical Association
WONCA =World Organization of National Colleges, Academies,……
NMA = Nigerian Medical Association,
MDCN, = Medical and Dental Council of Nigeria
ANPMP = Association of Nigerian Private Medical Practitioners
WACP = West African College of Physicians
WACS = West African College of Surgeons
NPMCN = National Postgraduate Medical College of Nigeria
SOGON = Society of Gynecologists and Obstetricians of Nigeria
SOFPON = Society of Family Physicians of Nigeria
MDCAN = Medical and Dental Consultants Association of Nigeria
NARD = Nigerian Association of Resident Doctors
MWAN = Medical Women’s Association of Nigeria
MEDICAL ELDERS, etc.
Multiplicity of groups of doctors should be a blessing, not a curse!
Generally, emphasis should not be to show pre-eminence of one over the other but to complement one another
Doctors must know that they can and should belong to more than one group and always remember what the core business /function of each group is.
Doctors’ groups should fashion gap-filling programs to meet doctors’ urgent day-to-day needs and not just to acquire more knowledge in medicine and its sub-specialties (which is endless). Suggested examples are:
Business proposal writing;
Human resources management and Interpersonal relations;
Law of contracts and Medico-legal issues;
Client/Customer services
Coaching;
Decision -making at the top;
Business/Personal financial management;
Community relations, etc.
Relate well with other healthcare professionals
Doctors’ groups should present strong +ve presence in society, use influence of our patients and friends to our group advantage
GOVERNMENT AND REGULATORY BODIES
It is my personal and humble opinion that our governments (at various levels) want a strong medical society on the one hand, but on the other hand do not seem to want/need it!
This apparent conflicting state is evident in the history of health services disruptions in Nigeria and is fuelled by both counter-forces and the fact that physicians are yet to heal themselves!!
INDIVIDUAL APPROACH
No doctor should wait for solutions to be made for them from outside or by outsiders as they can take control of their lives and welfare as individuals. They should take into consideration the following:
Prioritization in life
The allotted 24 hours
The patient – the good, the bad, the ugly!
The patient’s relations
PRIORITIZATION IN LIFE
We need survival and sanity to function as doctors: both as a group and individuals
Priorities are individualized but choose the order among: Family, Health, Peace of mind, Dignity and Integrity, Success as personally defined, Relationship with friends and colleagues, Making societal impact, Spirituality, Rest and relaxation, Lofty academic attainment, The “acquisitions”, etc.
THE ALLOTTED 24 HOURS
The only asset that is uniformly and fairly shared is the 24-hr day
Time has NEVER been on the side of the doctor or would-be doctor (and may never be!)
Time management is crucial in our success or failure as individuals and as doctors
Take a mental picture of your typical 24 hours and multiply by months and years and assess the impact on your priorities SO FAR! – is thereneed for a modification or drastic change??
PATIENTS – THE GOOD, THE BAD, AND THE UGLY!
Let’s start by asking: Who is “the boss”?
Patients and failure or success of the doctor – their word against yours!!
Where is a patient in the doctor’s scheme of things?
Among our patients we can honestly identify the good, the bad and the ugly!: The good bring pleasant reminiscences; The bad remind you of when you were forced to pray, had nightmares and were not sure of outcomes; The ugly want to own you!!
PATIENTS’ RELATIONS
Patients’ relations viz.: Spouses, Children, Parents, Siblings, More distant relations, Friends, etc. are very significant persons!
The perspicacious doctor will quickly identify the “negative” relation and wean themselves off such and the “positive” relation and benefit from them within acceptable limits
Simply put, we frequently make FOES and not FRIENDS out of these important non-patients!
CONCLUSION
We will heal ourselves individually and as a group if we pay attention to these and other important matters.
Let us agree that the problem is mostly within us and minimally outside doctors.
Physicians, heal yourselves – do not cast me , the messenger, OVER THE CLIFF!
Dr. Inyang Ukot, M.B.; B.S., FMCGP, FWACP, DOccMed.(London) is a
Chief Consultant, Family Medicine, and Medical Director at
RST Clinics Ltd., Uyo, Nigeria
Abideen Gbolahan says:
well put!