Written in the 5th Century B.C., the Hippocratic Oath remains one of the oldest documents in human history. While its creators intended the document to serve as a binding covenant on physicians, modern doctors see the oath as a promise to uphold the art of medicine and also act in the interest of patients.
The original form of the oath reads inter alia: “I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.”
It added: “With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage. Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child. Further, I will comport myself and use my knowledge in a godly manner. I will not cut for the stone, but will commit that affair entirely to the surgeons.
“If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate,” it stated.
In 1973, the US Supreme Court rejected the oath as a guide to medical ethics and practice by stating that the oath was incapable of covering the latest developments and methods of medical practice and research.
Despite undergoing modifications in many parts of the world, the oath, which comes from Greek medical texts, and is attributed to Greek physician Hippocrates, has remained significant in the medical world because it requires, among other things, that physicians swear to the healing gods that they will do no harm, treat the sick to the best of their abilities, and preserve patients’ privacy.
In Nigeria, the excepts from the modified version that is in use go thus: “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.”
It continues: “I will respect the secrets that are confided in me, even after the patient has died; 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 attend to my own health, well-being, and abilities in order to provide care of the highest standard; 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.”
Even though medical doctors pledge to dedicate their lives to the service of humanity, make the health and well-being of their patients their first consideration, commit to not harm their patients, treat the infirm to the best of their abilities, and preserve their privacy, unforeseen circumstances sometimes cause them to err in the discharge of their assignments, thereby breaching their professional oath.
Whenever these situations crop up, defaulting personnel are made to pay a hefty price that sometimes includes stripping them of their licenses to practice.
Unfortunately, some patients or their relatives are usually overcome by emotions or suddenly run out of patience when things go south. This inability of patients and their relatives to contain their emotions, or to restrain themselves has led to the death of several medical personnel, especially medical doctors, and the country is still grossly in a deficit.
Former Prime Minister of India, Jawaharlal Nehru, it was who said: “Evil unchecked grows, evil tolerated poisons the whole system.” This timeless truism by the late Indian leader mirrors how the failure of concerned authorities to deal decisively with the cold-blooded killing of doctors has foisted a reign of terror on the medical profession, as well as taken to alarming heights, incidents of workplace violence against doctors.
For instance, no fewer than 345 incidents of violence against doctors were reported in the country last year (2022), as captured by a “Workplace Violence Against Doctors” report compiled by the Nigerian Association of Resident Doctors (NARD).
Workplace violence is described as any act or threat of harassment, intimidation, and physical violence, or other threatening disruptive behaviours that occur at the work site.
According to the World Health Organisation (WHO), in the course of their careers, between eight per cent and 38 per cent of health workers suffer physical violence at some point, adding that most violence is perpetrated by patients and visitors (mostly patients’ relatives).
The NARD Workplace Violence Against Doctors report indicated that 74 per cent of the attack on medical doctors required medical attention, while 15 per cent were life-threatening.
A breakdown of reasons that were given for the attacks saw that 65 per cent were due to death of patients; 56 per cent due to patients not being attended to promptly (workload), 41 per cent were due to poor communication (workload), 28 per cent due to inadequate security and surveillance, 26 per cent due to lack of facilities and drugs, while 24 per cent of attacks was due to over-bloated patient’s intake, and 23 per cent as a result of the personality of the perpetrator.
Catalogue Of Sustained Onslaught Against Medical Personnel
MILLIONS of Nigerians woke up to the chilling news of the gruesome murder of Dr. Uyi Iluobe, an Edo State-born medical doctor, in the hospital where he worked in Delta State.
Barely 24 hours after his death, reports had it that he was killed by aggrieved relatives of a patient. But the Delta State Police Command swiftly countered that position, claiming that the murder was carried out by suspected cultists.
Responding to an inquiry, the command’s spokesman, Mr. Bright Edafe, said: “A doctor was actually killed, but the story making the rounds is not correct. What happened is, suspected cultists went to the hospital disguised as patients who came for treatment. According to nurses, a lady came pretending to be sick and the doctor took her to his office. While the doctor was attending to the lady, she made a call to some people asking where they were, then two gentlemen came in a Toyota Camry and asked one of the nurses where the doctor was while bringing out a gun. The nurses took them to the doctor’s office, and it was at his office that he was shot and killed.”
Earlier in December last year, fracas broke out at the Federal Medical Centre, Idi-Aba, Ogun State when a man and his son beat up a medical doctor, and a nurse after their family member was pronounced dead.
The medical personnel were dealt several slaps and thoroughly beaten by the duo after their wife and mother was pronounced dead at about 2 am.
The chairman of the state chapter of the Nigeria Medical Association (NMA) Ogun State chapter, Dr. Kunle Ashimi, while lamenting over the incident, said that all efforts to calm the assailants down proved abortive, despite the presence of police officers from the Kemta Police Division.
According to him, the patient was brought into the facility 24 hours earlier with end-stage heart failure, adding that despite all efforts to save her life she died at about 2 am the following day.
Still, in December 2022, the management of the University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State seized the corpse of a patient and arrested one of the relatives of the deceased for physically assaulting a medical doctor.
Three family members of the deceased, one Alhaji Saliu, on Tuesday, December 27, allegedly beat up a medical doctor in the Accident and Emergency Wing of the UITH, following the alleged nonchalant attitude of medical staff.
Trouble started when the news of the death of their relative who was suffering from blood cancer filtered out. The deceased was rushed to the facility after he suffered complications upon returning from a business trip. When relatives got a wave of his demise, they pounced on one of the doctors on duty, accusing him of negligence.
In February last year, a relative of a patient who was on admission to the hospital beat up a medical doctor on duty at the University of Medical Sciences Teaching Hospital (UNIMED), Akure, Ondo State.
Relatives of the patient attacked a medical officer simply identified as Dr. Sayo, at the Accident and Emergency Department of the hospital while he was discharging his duty. It took the intervention of Amotekun Corps operatives before Dr. Sayo was rescued from his attackers.
President of the UNIMEDTH Chapter of NARD, John Matthew, flared the attack and urged the state government to establish proper security in the hospital, which has witnessed the departure of over 100 doctors, leaving behind only 48 to deliver babies.
Dozens of scenarios like these daily play out in different parts of the country, but are not captured by the media, especially where loss of lives by concerned medical personnel is not involved. Be that as it may, at least 19 medics were killed or abducted in the country in 15 Months.
One of those kidnaps prompted a protest by members of the Abuja Branch of the Nigerian Medical Association (NMA) who frowned at the harassment of their members by a patient’s relative.
The protesters took to the streets after a female doctor was assaulted at the Maitama District Hospital. The doctor was reportedly stripped naked by one of the relatives of a patient following the death of their mother from a chronic medical condition.
The protesters marched in numbers to the Federal Capital Development Authority to express their grievance over the incident.The FCT NMA Chairman Ekpe Phillips, condemned the incident saying: “There should be an undertaking by patients that their relatives will not show any act of violence to any doctor or healthcare worker, as doctors are scared to come to work due to the violent act of some patients.”
Professional Negligence, Nonchalance As Triggers For Violence
BETWEEN January 2019 and December 2021, the disciplinary tribunal of the Medical and Dental Practitioners (MDCN) sacked three medical doctors and suspended 12 others that were found wanting. The MDCN is the professional health regulatory agency for medicine, dentistry, and alternative medicine in Nigeria. Considering what many allege to be widespread professional blunders committed by doctors, is the number of doctors punished not abysmal?
The period of the suspension of the 12 doctors were from three to six months, just as five doctors were convicted and admonished accordingly.
Conversely, 10 doctors were discharged and acquitted 10 from all allegations of misconduct that were levelled against them. Also, charges against seven doctors could not be substantiated and were struck out.
Additionally, three charges based on the report were withdrawn by the prosecution, and two of the cases were handled administratively. Sadly, two of the subpoenaed doctors died before they were arraigned.
The verdicts, which were among the 37 cases decided by the tribunal, were contained in a report by the MDCN. Dr. Ebunoluwa Soyinka, a young medical doctor agrees that: “It’s a known fact that professional blunders are responsible for the death of some patients. These errors can generally occur due to different reasons. Some of these are doctors being overworked, negligence on their part at times, and also inadequate facilities available for patient management. It’s not a doctor’s fault if he knows what to do, but the facilities are not available.
On the other hand, she said: “Doctors should be trained on how to break the bad news to relatives; how to best handle and keep safe during such cases. They should also learn how to be courteous and empathetic while dealing with patients and their relatives. A doctor lashing out at relatives who just lost a loved one can trigger violence on the part of the relatives.”
Negligence, Blunder Does Not Justify Violence
EVEN though both Dr. Soyinka and Dr. Laz Ude Eze see negligence and professional blunders as contributors to the rising spate of violence, they also maintain that whatever the cases may be, there are no justifications for the soaring assault on doctors by patients’ relatives.
Said Soyinka: “If the doctor is wrong and responsible directly for the death of a patient, the patient’s relative can sue, instead of taking laws into their hands.
“As a young doctor, the rate of violence and killings of doctors is alarming. Cases of assault in our hospitals are becoming very common, with some cases leading to the death of doctors. I feel that the Nigeria Medical Association (NMA) should push for a bill that would ensure that offenders face the wrath of the law because the majority of these culprits still go scot-free hence they still believe that they can always have their way. If they start to face the wrath of the law, it would serve as a deterrent to others. If such laws eventually get passed, the penalties should be conspicuously displayed in medical facilities for all to see and understand what they would be up against if they try anything funny.”
For aggrieved patients or their relatives, Eze, a public health specialist and sustainable development consultant said rather than resort to violence or self-help, they should “lay complaints in writing against erring medical doctors and seek redress from the hospital management. Servicom units in federal hospitals also entertain complaints. If not handled satisfactorily, they may petition the Medical and Dental Council of Nigeria (MDCN) tribunal, which has the powers of a federal high court to discipline erring medical doctors.”
Reacting to claims that the MDCN tribunal’s recent sack of three medical doctors and suspension of 12 others for infractions appeared to be a slap of the wrist considering the alleged widespread cases of medical negligence, Eze said: “I do not know the number of cases that the tribunal entertained within this period. I know that many people simply complain verbally, or on social media without taking the bold step of sending petitions to MDCN. But I will like to see all hospitals take deliberate measures to eliminate or minimise medical negligence.
Wider Implications Of Rising Workplace Violence
WITHOUT word mincing, Eze stressed that the wider implications of rising workplace violence against medical personnel are simply dire. Simply put, the more violence, the less the number of medical doctors and other health workers that are willing to work in our hospitals. Our people may just prepare for babalawo full takeover. Violence against doctors is absolutely unacceptable and should never be tolerated.
“Put differently, violent attacks on medical doctors and health workers, which I condemn very strongly is a reflection of the frustration of citizens on the increasingly worsening state of the Nigerian health sector. When patients are not satisfied with the quality of healthcare services that they receive, there is a higher chance that their relatives may behave inappropriately. The japa syndrome (massive emigration) of health workers especially in the past three years has reduced the number of available ones, increased their workload, and led to a decline in the quality of care. There are also rising cases of violence of health workers against fellow health workers. Everyone is just frustrated and expressing it in different ways.
“Like the patients, medical doctors are also victims of the dysfunctional health system in Nigeria. They’re not happy and that’s why many are leaving the country. Patients’ relatives should channel their anger to leading advocacy for the government especially at the state level to make our hospitals work. I also believe more litigation against erring doctors and the hospitals will help to hold health professionals more accountable,” he said.
On how to effectively end the malaise, he said: “I believe the problem should be tackled from the roots. Deliberate efforts and investments should be made to make our hospitals work effectively and provide satisfactory services to the patients. In addition, perpetrators of violence should be prosecuted following the law. I do not think having armed guards in the hospitals for the sake of tackling this menace is the way to go, as it may create another problem.”
Asked whether the NMA is doing enough to curb this violence, Eze said: “Ordinarily, the NMA should self-regulate members, but the abysmal state of many hospitals especially those in the public sector has made delivery of quality healthcare almost impossible in many facilities. For many years, NMA has been pushing for a conducive environment for its members to provide the best possible quality of care, but this has not been attained. The NMA has been calling on the government to make primary healthcare facilities fully functional to decongest tertiary hospitals, but this hasn’t happened either.”
Doctors Point Accusing Fingers At Chief Medical Directors
THE NARD not long ago called on chief medical directors to live up to expectations since they must provide security for medical personnel. Its president, Dr. Emeka Innocent Orji, told The Guardian: “We know the flash points where most of this violence takes place – accident and emergency departments, general patients department, and of course, sometimes, the wards. These places should be appropriately secured. Sometimes, when the doctor is attending to a patient, you see relatives surrounding the doctor, and watching. This shouldn’t be. They do not even know what you are doing, and at every opportunity, they throw insults at the doctor. So, these places should be restricted. And the people who are supposed to do that are the security agents. There must be water-tight security arrangements in hospitals.
“Secondly, you are supposed to have armed security personnel stationed in a hospital possibly opposite, or in front of these flashpoints. We do not encourage armed security agents to be inside, but they should be stationed at a place close by. The fact that they are there would serve as a deterrent to people who may want to foment trouble.
“In addition to the visible presence of both armed and unarmed security personnel in our hospital environment, we have also advocated that chief medical directors, medical directors, and CEOs of hospitals should be held accountable because we believe it is their responsibility to protect their staff, and if that is not done, then the government has to query them to find out why they have not provided the necessary security arrangement.
“This is not a banana republic, so the government should protect medical staff. And indeed, if the relative of any patient feels that the services they are getting from a hospital or a particular doctor are not adequate, he should not resort to self-help. There are laid down rules of how to seek redress,” he stated.
Orji also added that “violence itself is also worsening the brain drain because insecure enough to do their work will simply go to places where there is better protection.
So, we believe that it is serious enough for the government to do something to prevent it, or even stop it completely from happening. Sadly, some of the measures that we have advocated remain largely unimplemented. And we want to appeal to the government to do this because we are not going to continue to tolerate this violence against the doctors.”
