THE CURE IS IN YOUR HANDS

When I was in clinical medical school, there was one thing I was sure of doing whenever I went home for the brief holidays. It was the simple task of checking my grandma's blood pressure, then of course, that of every person in the house, (whether they needed it or not). Grandma was hypertensive and some reason, my mum always told me to tell her that all was well with her no matter what recording I got. When I asked why? She'd simply reply; that's what the family's doctor does. His explanation for not telling her the truth picture of her ailment was that it would scare her, or cause her more anxiety and as such elevate the blood pressure to an even higher and more dangerous level. To me at that time, it was a perfect reason and a wonderful practice. I pocketed it as one of the lessons learned on my way to becoming a great doctor. Nobody wants to be mediocre!

As I progressed in the medical field and started to practice, I saw that this was a practice by many people. A man is sick, on admission with cancer or whatever terminal illness you can think of and the family says; "don't tell him, he'll die faster". Another person has diabetes or hypertension (high blood pressure) and the same story goes. I began to wonder how the relatives can manage them without them (the patient) realizing that he is sick. Is it possible to give a person drugs or change the diet without him asking why? Well, unless that person is unconscious.

Overtime, I discovered that there was a high percentage of patients who weren't adherent to their treatment plans. Whether it was medications or a change in diet or even exercise. They come back every clinic day with the same problems, the blood pressure or blood sugar is going higher no matter how many drugs these patients are on. For example, you see them today, give then 2 drugs and give a 1 month appointment. They show up with elevated BP, you add another drug and another and another until you can add no more. Lol. The simple thing that has happened is that you prescribe drugs, they leave your consulting room (sometimes dissatisfied with services rendered), hiss and dump your prescription till the next clinic day. In a place like the one I work, you can come 4 times and meet 4 different doctors. Sometimes, they hope to me a different doctor and hope for a different approach.

My choice to go for a residency training in family medicine is one that I won't regret anytime soon. In family medicine, we are thought to look at the patient's illness from the patient's point of view, then treat using medical knowledge. We realized that a patient is a human being just like anyone of us and would desire to be treated as such. If you are a medical doctor and your are reading this, ask yourself this simple questions;

• How would you like to me treated if you fall ill?
• If it was any of your friends or relatives on the sick bed, what would your reaction be?

We are thought to look at the patient and his illness in the context of his family and vice versa. We do not forget that the patient has religious beliefs especially in a place like Nigeria. We learn how to communicate with people, counsel them and break bad news. The act of managing a "difficult" patient is not something you can do without. With all these said, we have one problem. It is a problem that plagues every doctor and infact the health sector. It is TIME! Patients are maybe the only group of people who have been wrongly titled. Have you ever heard the phrase, "patients are not patient?" so true. They are in the waiting area, ranting that the doctor is taking up so much time with one patient, then they go in and refuse to come out and the cycle goes on. Lol. The doctor tries to compensate and then misses out on the need to adequately counsel the patient and just prescribes drugs, hoping to get a better chance by the next visit, and..... then we are back to the scenario painted earlier.

The moment I realized this defect, I decided it was time to refresh some of the things I'd learned over the years. In my mind, it was time to empower these people with the simple truth they deserved. Why hide information and continue to mismanage a patient? To tell you the truth, contrary to what had been in practice, these people want to know the truth. I adapted a few strategies to work around the time constraint and patient's demand.

First, I divide the patients into 2 major groups as the consultation begins;

• The ones with acute illnesses that will recover completely with medications and no sequelae e.g. people who present with strictly malaria or straight forward urinary tract infection. 
• Those who have chronic diseases, terminal illnesses, emotional or family problems. E.g. diabetes, hypertension, asthma, peptic ulcer e.t.c.

The first group I see in a bit of a hurry, minimal counselling and off they go. The second group, the reason this post, I have to counsel extensively, sometimes over several visits. They are always the reason a developed my rule to counselling a patient. It is my 80/20 rule.

Secondly, I apply my 80/20 rule. The 80/20 rule is simple. Just let the individual know from the onset that his recovery is totally up him. I tell my patients with chronic diseases this so they can step it up a notch. Many come to me feeling dejected and I let them know that the battle is up to them to decide if they fight and if they want to win. My favorite line simply corresponds to "when life throws you lemon, you make lemonades". Sometimes, I tell them that my job ends with making the right diagnosis and implementing the correct treatment plan, but it is entirely up to them to follow through or not.

Thirdly, I do not fail to employ something I learnt about counselling a patient with a chronic medical condition while in medical school. They need to know the cause of the illness from you the expert. You don't want them getting infomation from relatives or babalawo (native doctor), that will be the downfall of your management. They need to know the course of this illness. How will it progress? Any there any complications? What are the treatment modalities?

The patient leaves the consultation feeling satisfactied, empower and much better. They leave you with many thanks and a heart full of joy for a job well done. This post is to tell you! that you have every single right to know what you are been managed for, the right to know to names of the medication(s) you are given. People have died from not knowing the name of their medications. Families have been torn apart because the bread winner didn't get to know he was dying enough to make a will before the time.

Empower yourself today and take charge. The CURE is in your hands......
Cheers........

15 PROBLEMS WITH GMB's FAKE LAB TESTS

Over the weekend, some lab results surfaced on the internet, supposedly said to belong to one of the candidates running for the position of the president, (general Muhammadu Buhari). When I saw them, my heart sank. Not out of sympathy for him or anything, (because the results are fake). But out of pity for a country that I call home. It reminded me of the reason why many good people of Nigeria leave the game of politics for those who can get their hands dirty. The reason why politics in Nigeria is viewed as a "do or die" affair. The reason why we are still in this backward movement with corruption thriving like no man's business.

Any medical doctor with half a brain, any good lab scientist, infact, any properly trained medical personnel who sees this results should know that they have been fabricated. Whether the fabrication was done by a very jobless individual as a prank, or whether it was a well plotted plan by the opposition, it makes absolutely no sense. We should focus on a better tomorrow no matter who wins the elections come February, 2015.

For the benefit of millions of the non-medical Nigerian population who wouldn't know what the interpretation of this report could mean, I have decided to analyse it. The first report is that of a kidney function test and prostate test. Let's start from the form;

1. For starters, there is no such hospital in Nigeria as "Ahmadu Bello Teaching Hospital",  what we have is "Ahmadu Bello University Teaching Hospital".
2. When you are unsure but almost certain of a diagnosis, you query it. That 'query' is written in form of a question mark, before the diagnosis not after. So, it's supposed to be "?prostate cancer" not "prostate cancer??".
3. The department should have corrected a mistake like "chemical pathology report from" by now to "form". 
4. Results of kidney function tests (e/u/cr) is gotten within hours even in a very small private hospital (like the one I worked in). Unlike the 4 days indicated in this lab report. 
5. On the other hand, a psa (prostate specific antigen) result can take up to a week to get ready, but let's assume that they are extra fast in processing psa results.
6. In analysing the e/u/cr report, first the values and even SI unit of some of the parameters are wrong e.g. the SI unit for creatinine is in umol/l not mmol/l. The range of potassium is (3.5-5.0) not (30-5.6). Correct values.
7. Notice that there is no result for chloride.
8. At a potassium of 7, the patient would be dead not campaigning around the country 3 months later. 
9. A psa result is non-specific for a cancer of the prostate. Also, certain procedures elevate its values, e.g. passing a ureturethral catheter or performing a digital rectal exam before blood samples are collected. 
10. You don't suggest a diagnosis in a chemical pathology report. But, even if you want to, wouldn't you draw attention to the sinister e/u/cr, rather than a psa?

1. Again, the above report for a "histology" of a prostate biopsy belongs to an institution that is clearly not in Nigeria.  *wrong name of institution*. 
2. The is no request for this prostate biopsy, which is why I put histology in quotes in number 1. For all I know he might have requested a cytology.
3. The request is also staging the disease. You can't stage cancer of the prostate before biopsy ( before confirmation of a cancer), and definitely not by a DRE. Staging is done using bone scan, MRI, CT Scan e.t.c. 
4. The staging is also wrong. There is nothing like prostatic intra-epithelial neoplasm, it's not the cervix. The TNM method is used. Besides that "DRE" done, the person should be thinking more of stage 2 or 3, not a pre-malignant stage. Haba! 
5. Finally histology reports in Nigeria take weeks not 4 days to get reported. Unless, again, ABTH is so fast.

This is the correct ABUTH histology request form.

Please Nigerians, this is not a get in or die trying situation. The Niger-deltans are already threatening fire and brimstones should GEJ lose and the bokoharam, well, will continue their terror should it go the other way. What should other tribes who have never been given an opportunity to rule the country do then? Burn it to the ground? Please let us #votenotfight. If you kill yourself over election wahala, remember that the politicians would still be alive and well, chopping the money that you are hoping to get a pinch of. Be wise!

Cheers....

I GOT MY MIRACLE

Hello there everyone,

Right now, I'm in a jubilant mood and I want to shout a big ALLELUIA from the rooftops to my marvelous God. Sitting down on my bed, about to call it a day and turn it for the night, I began to contemplate on whether or not to write this post. While I was at it, I decided to browse through blackberry updates. A particular display picture caught my attention and made my mind up for me. This photo is shown below. The story of my miracle continues after the photo.

So, I woke up on Saturday the 3rd to see that finally, the harmattan decided to show up. (Harmattan is just like winter - the African type. It's cold and dry, the whole weather is hazy and bad enough to disturb flights but it snows dust. Lol). Anyway, so there is harmattan and I chose to lend a hand to do the dishes. The water was sooo cold, I was sneezing in minutes, literally! Well trust "the doctor" to have a handy explanation for that. The sneezing continued till the end of the day and I decided I may have developed catarrh afterall. I took a very hot bath, crossed my fingers and went to bed hoping for the best. (Doctors are the worst patients right?).

Woke up Sunday morning with more cold and a terrible shoulder pain. The shoulder pain, I attributed to poor positioning as I slept. My mother decided it was time to take some action, so she pulled out her medicine bag and gave me something for cold and a big jacket, since I was also traveling that day. The journey was mostly uneventful, but I remember waking up at some point and realizing I'd worn the jacket inside out. Got home. Still no Biggy. Did what needed to be done and went to bed. And I never go to bed early. 

Woke up sometime on Monday morning to my younger sister asking if I wouldn't be going to work. Thank God I was on afternoon shift that day. I slept most of the day, got up at 1pm and went to work. Work was terrible that day. First of all, one of my colleagues met me at the gate and told me about a mortality we just have in the emergency room. Secondly, there was an overload of patients from both the on-going johesu strike and the holidays. The emergency room was overflowing and I was alone. After taking over, I decided to review the patients, send some to the wards, some home, and stabilize the remaining. To cut the long story short, I lost 2 patients at the end of that shift, 30 minutes apart. I became very sad (thankfully I didn't get to the depression line). Again, the shoulder pain from the previous day became generalized body pains after doing CPR (cardiac massage). That day, when I got home, the first thing I did was sleep. I woke around midnight to eat, take some pain relievers  and headed straight to bed again.

By Tuesday morning, I felt broken. I ached from head to toe. I knew the harmattan was in town, but I also knew from experience that it wouldn't make me wear a leather jacket in the afternoon. I was beginning to think that something was wrong somewhere. I pulled out my own medicine basket, brought out my antimalarial drug, (in Nigeria, everyone thinks once you feel feverish, it's malaria until proven otherwise) called my senior colleague to give me the "go ahead" to take the drug, and he says "hold off on the drugs, why not get to the hospital so we can talk about it? ". I called my hubby, and he says "do a test first before throwing medicines in your mouth". (So now, I'm feeling like a drug addict, I tell you, we doctors are really terrible patients.  lol). So, I follow their advice and waited. After consulting with my colleague, he thinks I may be too stressed up. "Take some multivitamins and rest, he says". To tell you the truth, I was truly tired of taking medicines. I'd been taking antimalarials almost on a monthly basis. With joy, I headed home to start the multivitamins. That night was worse than the others. I normally bath with hot water, but that night, the temperature of the water was almost at boiling point, and I was still shivering. I called for my sister to give me a hand with applying some hot balm to my body. She obliged me, and as she applied, I began to complain bitterly. She also said it could be due to stress or lack of multivitamins. She however, said one very important single word - PRAY.

I did pray, and on Wednesday morning, I woke up to the sound of my alarm clock. Until that moment, I hadn't realised that I hadn't heard that sound in a couple of days. (Somehow, I slept through it). I said a short prayer, got off my bed and made breakfast. At the end of the day, I felt even stronger. Filled with so much joy, I decided that maybe I should share it with you.

I don't know what you might be going through right now, or whether you have totally given up on God, I am here to tell you that he lives and he is true to his words (the bible). He is the same God yesterday, today and forever, and he never changes.  Call on him while believing and you'll be glad you did. Remember, his grace is sufficient for us.

Have you had any miracle lately?  Even the tiniest one? Maybe a near miss? Then, feel free to share your experience with the rest of us.  Someone out there may be in need of some encouragement.

Cheers........

SEE WHAT NIGERIANS ALLOWED TO HAPPEN! #JOHESUSTRIKE

Hello everyone,

Sorry for being away this long. That wasn’t the original plan. I got too busy so suddenly with work. It is same work business that has brought me back to you, plus I couldn’t just let the year go by without celebrating the Christmas holidays with you. This post is not intended to castigate or lay blame on the health workers, but to remind Nigerians of how insensitive and one sided their judgment can be. I am a medical doctor, and I am not ashamed of that fact neither do I regret it.

For at least 5 weeks now, the joint health sector union (JOHESU) has been on a strike and now embarked on a nationwide strike action. The details I heard, has something to do with salary increment, precisely the hazard allowance (since that of doctors have been increased) despite being granted their consultancy wish. Let me refresh your memory once again to the reason that the Nigerian Medical Association went on strike about six months ago with this post. The doctors hadn’t been on strike for up to a week when I started hearing comments of how wicked doctors are for abandoning the healthcare system and allowing patients die. How greedy we are for going on strike because of such a thing as relativity and increment in hazard allowance and fighting over such a trivial matter as to who should be the chief medical director of the teaching hospitals.

I work in the private sector and even though everyone can’t be 100%, I am happy with a majority of the people I work with including the attendants (orderlies). I have also been in the system long enough to see certain things that the layman would never understand. So when the general public decides to argue or quarrel over health care issues, they must gather the correct facts first. Noe, fellow Nigerians, why are you not yelling for JOHESU to come back to work? By your silent action, are you indirectly calling them incompetent and easily dispensable? (Because I know that they aren’t). Are your relatives no longer dying from lack of healthcare? Because I know the federal hospitals are barely functioning. The emergency rooms are closed down for now. Does it mean you are totally ignorant of this situation, your relatives are not falling ill or you have decided to turn the other way.

Many times during the NMA strike, doctors were reminded of the hippocratic oath they'd sworn to and how they weren't living up to their words. Now I ask you, did the pharmacists or nurses not swear to an oath? Why haven't I heard songs about those yet?

Finally, consider the singular fact that JOHESU, (meaning everybody that works in the hospital except doctors) are on strike and the nation is carrying on like it’s a normal day at the park, but the doctors went on strike and became devils for fighting for what they deserved. What does that tell you about who should be at the top of the food chain in the health sector? (Not bragging, just saying).  Naija, before you start lending your voices to any argument that may lead you to choosing sides, please think deeply, if possible, write down your argument and do it objectively, not emotionally. Do not be easily influenced by someone else’s well thought out plan (most of the time, not to your benefit). It is the same reason most of us are undecided who to vote in the next elections.