I read with amusement the claims that patients were stranded during theperiod some paramedics went on strike nationwde, as it particularlyaffected the University College Hospital (UCH) Ibadan. I am a doctor in this same hospital, and a part of the team that looked after over 80 in-patients in my own department, and so could tell that the in-patients were well attended to.On no account did we changed the course of management of some patients due to the sad strike. The fact that few out-patients had some difficulties in locating some research laboratories which were working in full capacity, was not enough to have concluded that the whole hospital was stranded. Given this, the pertinent question is, could a minister of the Federal Republic of Nigeria wake up one morning to assume the duties of the Commander-in-Chief just because he is helping to advance the course of the nation' The bvious answer is no. Medical laboratory sciences just like any other paramedical disciplines, originated from medicine.They are branches of Medical Science.Every medical graduate undergoes a training in all aspects of laboratory science, and passes it with good grades before advancing to the last phase of his training as a medical doctor.Most people don't know that some doctors, after the basic 6-year MBBS degree, opt for a 4-year-post graduate degree (specialisation) to become a histopathologist, microbiologist, chemical pathologist or haematologist, from either National Post-Graduate Medical College of Nigeria (NPMCN) or West African College of Physicians or both.The reason why doctors specialise in laboratory medicine is to improve on quality of output. This is because with a background in clinical knowledge, a doctor is likely to appreciate a bizarre laboratory test. For example a technologist might think he made a mistake if s/he sees a WBC (white blood cell) count of 50 * 109/L (50,000/uL) or 100 * 109/L (100,000/uL), but a doctor would know that it would probably be a leukaemoid reaction or leukaemia respectively. A technician will heroically report serum potassium of 9mmol/L, but a doctor knows it is fictitious as that level is incompatible with life.That is why anybody in Nigeria suffering from joint pains and body weakness will just go to a laboratory and have MP test done, naturally MP + will be 'reported.'The unsuspecting client will be told he has malaria and so should go and take drugs, but few honest technologists will advise him to see a doctor.Can a technician perform an autopsy' Will it make any sense to a technician who cultures Staphylococcus epidermidis from cerebrospinal fluid (CSF) of a child with ventriculo-abdominal shunt' He will certainly report it as a culture of normal skin commensal,but a physician knows how serious it is.These physicians who know the interpretation and meaning of every laboratory result, were the ones working hard in the laboratories while the so-called lab scientists/technologists' strike lasted. This goes a long way in affirming that these medical areas are medical and should not be separated for their tap root, otherwise patients will suffer.The leadership of the areas is therefore not in question and therefore any agitation to the contrary is like having the Roman Catholic Church without a Pope.There is nothing wrong in people agitating for self-advancement, but it must be done within the confines of their training and limit, and without usurping the authority and leadership of the physicians.In other climes, physicians in academic centres conduct their research in their own laboratories(laboratory physicians, surgeons, neurosurgeons, endocrinologists, neurologists, ophthalmologists and psychiatrists, every specialty and subspecialty) and employ technical and other staff (e.g. statisticians), including those who now agitate for control of clinical laboratories over doctors, while also seeking a "scheme of service" that excludes all supervisory role of physicians in their work!It is a common knowledge, to the average patient who goes to the hospital to see; of course the doctor! Now, to diagnose a disease, a doctor first takes clinical history (patient age, sex, tribe (race), address, marital status, religion, complaints, systemic review, past medical, drug, family, social, occupational, travel, obstetric and gynaecological histories etc), and do systemic (general, nervous, endocrine, respiratory, cardiovascular, gastrointestinal, genitourinary, musculoskeletal) clinical examinations. With a good history and examination, you can make correct diagnosis in up to 90 per cent of cases.Investigations (tests) are done for the following major reasons; to confirm diagnosis and or differentials, to determine the extent of the disease, to determine complications of the disease or treatment if any, for follow up and patient optimisation, among others. This is so since medicine now is evidence based. Every other thing done in the course of patients treatment is to HELP the doctor make appropriate decision.It is then surprising that some helpers want to become th Master of the house, and trying to create the impression that when a helper goes on strike, the Master of the house would become stranded and would no more receive his visitors or take care of his house. Judge for yourself.'Nwachukwu is the chairman, Association of Resident Doctors,University College Hospital, Ibadan.
Click here to read full news..
