6 June 2010

Address professional negligence in the medical profession

Management theory warns us about the “arrogance of expertise” whereupon experts in any field—medicine, law, education, agriculture, engineering, economics, etc—as a result of mastering the mental map that defines their field, grow more confident that their reputation is deserved, and that their interpretation of situations is correct.

Because of this “arrogance,” experts become fixated and fail to recognise the limits to their knowledge. Eventually, they loose their intellectuality and succumb to rigor mortis—a medical condition that refers to the stiffening of muscles after death.

The “arrogance of expertise” has manifested itself in many forms in Uganda, with detrimental consequences. The collapse of numerous buildings under construction in Kampala and other areas; shoddy road works whose construction had been overseen by expert government engineers; the procurement and supply of sub-standard seed and other farm inputs to farmers by agricultural officials; loss of high profile legal cases in the courts of law by government—are some of the overt examples.

Disappointedly, government response to this “arrogance” has been too little and too late for many Ugandans. The medical practioners for instance enjoy extensive latitude to commit professional crimes without fear of consequences. There have been reports of patients left to die on their hospital beds by government doctors whose preference is to hawk their expertise in private clinics. Doctors who never have time to attend to and diagnose sicknesses end up prescribing inappropriate treatments by phone call to a nurse.

Two weeks ago, my four year old son was taken to Mengo Hospital for medical attention after developing some high fever. The pediatric doctor in-charge told us we had come at a time for his Bible School, and without carrying out any tests, prescribed some medicines—which we were reluctant to buy until a proper examination had been carried out. Another doctor in another medical unit prescribed a completely different course of treatment after doing the necessary tests. It took a lot of courage to reject “expert” advice from the Mengo pediatrician.

Of late, it has become a norm rather than the exception for expecting mothers to deliver by caesarian. A friend, who is a medical doctor recently told me that doctors order caesarian operations because they make quick money from it, considering that the average cost of C-section in Kampala is shs1,200,000. The doctor in-charge of the operation often moves away smiling with the lion’s share.

A wife to a close friend suffered a miscarriage after a Senior Gynecological Consultant at Kabale Hospital administered a strong dose of quinine injections even though he was fully aware that the mother was in advanced term. The mother recovered from her sickness, but she lost her baby. Even the nursing aid who was on duty that day confessed in private that quinine was probably not the best treatment for a mother in advanced term.

And I will never forget the mockery of medical expertise, when in 1997, my boss, an expatriate from Holland was advised by a Buhinga Hospital doctor that an injury to a nerve was responsible for the groin pain he was suffering. A second opinion from another doctor after failure of the “conservative treatment” prescribed for “the injured nerve” revealed that the groin pain was in fact due to hernia. The expatriate was operated upon and he instantly recovered.

Cases could go on and on ad infinutum, and although we don’t have statistics, it’s probable that a sizable proportion of the deaths occurring in hospitals could have been averted, or at least delayed if the responsible doctors had treated the medical condition differently. Yet, transgressing doctors are never brought to account for professional negligence as has happened to for instance, KCC engineers who presided over the shoddy CHOGM road works.

Deaths due to professional negligence continue to be generalized as “untimely;” and while the marauding medical quacks wait upon their next victim, bereaved families helplessly reel in eternal loss that could have been avoided or at least delayed. Surely, the bereaved deserve justice! “Arrogant” medical experts must account for their omissions and commissions.

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