The Daily Nation’s coverage of malpractice in Kenya health sector was no doubt widely read. The articles gave a negative impression of the medical fraternity in general and doctors in particular.
There are is an almost infinite number of confounding circumstances that influence the kind of treatment offered by a doctor and the outcome.
This, however, is not to say that there are no outright cases of professional negligence or malpractice. However, in some cases, what to a lay person may appear like negligence or malpractice is in fact a very comprehensible or unavoidable occurrence which professional colleagues can comprehend.
Take the diagnosis of cancer, for example, various specialists are involved. The patient presents to the surgeon or clinician with a lesion, which the doctor will examine and if found to be suspicious, appropriate investigations, often imaging (CT scan, MRI, X-ray, or ultrasound) will be recommended.
The radiologist will analyse the image of the lesion and give a report which may indicate that it is consistent with a particular type of cancer and recommend that a sample of tissue be taken for analysis in the laboratory. The sample will be taken by the surgeon in a procedure known as biopsy and sent to the pathologist, who will analyse the tissue and report that the features are suggestive or consistent with that of a particular cancer. Note that both the radiologist and pathologist will very rarely state with indisputable certainty that this is cancer.
The surgeon will then act on the basis of his clinical findings backed by the radiological and pathological results.
REMOVING ENTIRE ORGAN
If after removing the entire organ it turns out that the lesion is actually a different one, then it may be unfair to condemn the surgeon who actually followed the proper patient management protocol. Peers can only condemn an act of omission or commission in which their colleague could have performed better if matched against the performance of a similarly trained colleague.
In a country like ours, finding these specialists in one centre outside Nairobi is indeed a great privilege. The surgeon may be the radiologist and pathologist and whatever he does at this point is judged by what any other reasonably trained doctor would do under similar circumstances. In other words, what may constitute negligence in a well-equipped urban hospital may be a life-saving effort in an ill-equipped rural village health centre.
A reasonable number of patients give half-truths to avoid blame or responsibility or even seek compensation. Others may be in denial and deliberately mislead the doctor into making a wrong diagnosis.
The other problem is simply failure by the lay people to understand medical manoeuvres, for example a situation where a patient’s ribs fracture during resuscitation. This has often been taken as malpractice by people who do not understand that when the heart stops suddenly, every effort is made to keep it manually pumping even as attempts are made to restart it.
Under such circumstances, fractured ribs are the least of the doctor’s worries as one would rather have a living patient with fractured ribs than a dead one with the ribs intact. This is just one of the many examples where medics may be condemned as accomplices to murder, especially when handling a politically high profile patient.
Finally, not everyone who works in hospital or wears a white coat is a doctor. Doctors are even blamed for what has been done by cleaners. The media should inform patients of their rights while working with doctors and other health professionals to improve the quality of care.
Dr Odhiambo is a senior lecturer in the Department of Oral and Maxillofacial Surgery, University of Nairobi. [email protected]