‘Let’s diagnose accurately and restore confidence of Nigerians in their doctors’

Published.

September 15, 2011 By nigerianhealthjournal 1 Comment

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Austin Obichere,MD

“I was diagnosed with pneumonia and being treated for pneumonia until I got to London where I was told I had cancer of the lungs”. That was the story of Late Chief Gani Fawehinmi and indeed the story of many patients in this part of the world; and Austin Obichere, a Consultant Colorectal Surgeon at the University College London Hospital (UCLH) is concerned. He shared this concern with NIGERIAN HEALTH JOURNAL which led him to set up D&TEC (Diagnostic &Therapeutic Endoscopy Centre, Ikoyi, Lagos) which is the first purpose designed endoscopy suite in Nigeria offering world class endoscopy services. In 2003, Austin was appointed Hon. Senior Lecturer, University College London (UCL) in having completed specialist training in coloproctology at St. Mark Hospital London and Mount Sinai Hospital in Toronto.  He is a Joint Advisory Board (JAG) accredited bowel cancer screening colonoscopist and currently the Director Bowel Cancer Screening Programme at UCLH. He had also held the post of Chairman Colorectal Cancer Tumour Board HCA Hospitals, U.K. His area of specialist interest include laparoscopic colorectal cancer surgery, screening and surgical management of colorectal cancer along with other benign disorders of the gastrointestinal tract and pelvic floor.
What’s the attraction for you in medical diagnostics?
Accurate medical diagnosis with an emphasis on the word ‘accurate’ is critical before any doctor can begin to formulate a plan to successfully treat their patient. A good doctor given the tools at our disposal in modern medical practice should strive to make an accurate diagnosis in more than 90 percent of all cases.
What is wrong with our approach to diagnosing diseases in Nigeria?
It’s basically inability to make accurate diagnosis more frequently than not! I believe competent doctors are in abundance in Nigeria but they carry an “Achilles Heel” in that the necessary infrastructure / support services required are either none existent or at best rudimentary.  By these services one is referring to a triad of; a) Laboratory Services (inclusive of pathology services; b). Imaging services (Ultrasound scan, ct-scan, mri-scan, mammograms etc; c) Endoscopic services (ability to visualise any luminal structure or organs using flexible fibre-optic cameras).With these triad of services provided that they are quality assured, the clinician is empowered to make an accurate diagnosis in more than 90% of cases.
Can there ever be an acceptable justification for the high cost of medical diagnosis especially CD4 Count, Viral load tests, ECG and the likes?
The answer is a categorical NO! Because, you end up denying the vast majority of our population access to basic health services that should not be a privilege but the right of every Nigerian. The simple problem is that the expertise is lacking therefore demand exceeds supply-meaning that the few providers have a monopoly and thereby escalate prices. The fact is that the cost of these equipments/agents used worldwide for medical diagnosis is relatively cheap so what we need is training enough personnel with the expertise to provide these tests effectively and thereby bring down costs. In the case of cancer; for instance, cancer of the bowel, it is known that this is on the increase or has always been there, but we did not have the equipments or expertise required to diagnose it.  Furthermore, endoscopy services are critical to allow the doctor to directly visualise any part of the body not only to see the problem but also to take tissue samples to confirm diagnosis. This is standard practise all over the world but sadly is lacking in Nigeria in terms of availability of these service and paucity of the necessary expertise to deliver this essential arm required for accurate diagnosis.
Chief Gani Fawehinmi was wrongly diagnosed with pneumonia until he got to the UK where he was diagnosed with Cancer. Where does this place our healthcare system?
It places us at the very bottom on the League of Nations providing quality health care for their population. This in my view is the single most degrading aspect of modern day Nigeria given that many of our citizens have no other choice but to join the band-wagon of health migrants with significant contribution to foreign economies like India.
Is there anything synonymous with what you are doing and the clamour for evidenced-based care?
What we are doing is merely trying to address one aspect of the triad (Endoscopy) of services alluded to above. There is no greater evidence than to directly visualise a diseased organ at endoscopy, obtain appropriate tissue samples for confirmatory histology of the disease. In other words we are providing the evidence in the area of diagnostic endoscopy that will arm clinicians to deliver the right treatment based on “accurate diagnosis”. This is one small contribution D&TEC is making towards a quality service and hopefully, the eventual eradication of the TMD (Typhoid, Malaria Doctors) syndrome from our society.
Iam sure some would be interested in what the TMD Syndrome is all about?
The TMD syndrome refers to the fact that these are the only two diagnoses (typhoiod and malaria) that many doctors in Nigeria make when patients come to see them with an illness without thinking of other causes.
So what then is the contribution of improper diagnosis to the growing cases of medical accidents especially in Nigeria?

Gani:a victim of wrong diagnoses;a diagnostics centre has been dedicated in his honour by the Ondo State govt to avert wrong diagnosis ta least in the state.

The contribution is immeasurable! I am too embarrassed to even consider mentioning numerous personal experiences in my practice here in Lagos and the U.K. I have seen many Nigerians in my private practise in Harley Street who presented with bowel symptoms that were investigated in Nigeria and found to be normal. However, on repeating a colonoscopy I was surprised to find the presence of bowel cancer- indicating that the previous examination in Nigeria was either not complete or that the doctor did not have the necessary skills to complete the examination. There are also cases where patients have been told they have cancer only to discover after a repeat colonoscopy that there was no evidence of cancer. Sadly, I am not alone in these experiences and quality of Diagnosis was the subject of ridicule amongst my English colleagues. This was the catalyst that led to my setting up D&TEC.

Is there any close correlation between the problem of fake drugs and the quality of diagnosis?
I think we are dealing with two separate issues here in that fake drugs relate to attempts to treat what is often a flawed diagnosis resulting in “double jeopardy”. Firstly, the diagnosis is wrong more often than not, and secondly, you are receiving fake drugs that can lead to the demise of the patient concerned as we have seen from various cases in Nigeria.
Have you been able to evaluate your organisation’s contribution towards improving the quality of healthcare in Nigeria?
Yes; and one has to be careful not to appear boastful. However, at this point in time we have performed over 250 endoscopic procedures and 11 colon cancers diagnosed from nearly 150 colonoscopies, equating to 7 per cent


incidence within this small group that were screened at D&TEC. Many did not have a diagnosis until they arrived at D&TEC and more than half had advanced cancers that were not surgically treatable because they had either ignored the symptoms for too long or were treated for the wrong condition. On the other hand, 5 patients in the group with cancer have been successfully treated by surgery with excellent prognosis. I believe we have succeeded in not only raising awareness in the need to embark on preventive screening strategies but also demonstrated that D&TEC can provide that very same world class endoscopic service seen abroad right here on our doorstep in Lagos.
Recently, Dr. Okonjo-Iweala was quoted as saying that Nigerians spent about N300 Billion seeking for healthcare overseas. Does this give an indication of a business prospects for anybody like you interested in diagnosis…since it is a search for the best quality of care?
It certainly does! And just imagine how much the Nigerian economy would benefit if the very same amount of money is left within these shores rather than diverted to build up the economy of others. This is where I believe our government has an essential role to play using whatever resources are at its disposal to reverse this trend. They can start by changing the attitude of some state and Federal governments who think it is cool to send employees abroad for medical treatment. Imagine the uproar in the USA if Barack Obama had to travel to India to be treated for an ailment. The message is clear; our government has to assist/partner those who have a genuine desire from their actions to raise the standard of healthcare in Nigeria so that we can reverse health tourism.
And can you articulate the role quality diagnosis can play in turning the tide of medical tourism in our favour?
Accurate high quality diagnosis should be our “holy grail” as it is the single most important step in transforming the health care service in Nigeria from dependency on health tourism to independence. It is the critical building block in ensuring that our country can provide a health service comparable to the best in the world because we are already blessed with Nigerians who have expertise in all aspects of any comprehensive health care system. D&TEC, I would hope, is one’s small contribution towards the Holy Grail that hopefully will trigger many other similar ventures and restore the confidence of Nigerians in their doctors.
Interview  by Kingsley Obom-Egbulem
©NIGERIAN HEALTH JOURNAL

Comments

 

 

Biodun Ogungbo says:

September 16, 2011 at 1:00 pm

This article raises very important issues and I could not help but comment on it.
One of the reasons that Nigerians fail to trust doctors is in the area of misdiagnosis and the reasons are legion. Diagnosing pneumonia for cancer and calling cancer, TB, is all too common. I blame the radiologists. They blame the referring physician! The patient blames the doctor. We all blame each other till the pathologists arrive.
The key focus must be that we practice medicine to the very best of our abilities. Recognition of the limits of those abilities and limits/ extent of training is sometimes the key problem. There are elderly doctors who think they know best and continue to give outdated information and advice. There are young doctors who think they know best and perform beyond their level of experience.
This has been best summarised as below, in the levels of skill and consciousness: Where do you fit in on a daily basis? In respect of particular care, procedures and skill when treating patients.

Level 1: ground level: Unconsciously Unskilled
Level 2: next level up: Consciously Unskilled
Level 3: next level up: Consciously Skilled
Level 4: Highest level: Unconsciously Skilled

The unconsciously unskilled are the total novice and charlatans who do not know that they do not know anything. The unconsciously skilled are the experts who can operate without even thinking about it. It is the highest skill level. This does not necessarily equate to the consultant!!!!!

Recently, I attended a radiology conference and presented patients with CT and MRI scans misdiagnosed by radiologists. Most of the radiologists agree and one hopes that many would refrain from reporting on areas where they have little or limited knowledge. But, they did say that many referral letters fail to provide adequate information. Return them, I say, but its not that simple.

Again, only last week, I also attended a conference of the Ophthalmology Society of Nigeria to talk about patients with visual loss due to brain tumors, who have been misdiagnosed. Many of the patients were treated for refractory errors and given glasses for progressive blindness. They finally had huge brain tumors such as pituitary macroadenoma diagnosed. They should have been offered early neurological evaluations and CT or MRI scans. The optometrists and ophthalmologists were only interested in selling spectacles to theses patients and watch them go blind. The cost, morbidity and mortality related to treating these huge tumors is very high.

Is it the training that is deficient or the level of communication? Lack of communication? Is it mistrust? Is it greed?

But, what about patients who default and go off to traditional healers and faith healers in churches and mosques? What about those who present daily at the chemists and pharmacies asking to be treated by untrained people simply because it is cheaper. The treatment may then complicate the diagnosis and affect recovery.

So many issues and so many reasons.