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Of Public Doctors and Private Practice

 Of Public Doctors and Private PracticeThe recent pronouncement by the federal government of its determination to stop doctors in public service from engaging in private practice has generated a lot of controversy across the country.

The Minister of Health, Prof. Isaac Adewole, who broke the ice at a press briefing shortly after the weekly Federal Executive Council Meeting in Abuja early October, said that the decision had become necessary because of the worrisome nature of the development in the health sector.

He went on to say that government was desirous to resolve the issue in accordance with what the law of the land stated and what the rule of professional ethics said. In giving what looks like a peep into what to expect on the matter, the minister had disclosed that the law of the land did not allow any public officer to do anything other than farming.

Chairman of the Medical Association of Nigeria (NMA), Lagos State Chapter, Dr. Omojuwolo Olubunmi had during an interview with an online news medium called on government to clarify what it meant by the pronouncement.

However, the Medical and Dental Council of Nigeria (MDCN), the body responsible for the practice of Medicine and Dentistry in Nigeria, came up with its stand on the issue as reported on its website as follows:  “The Council notes with concern the trend among practitioners whereby persons in full time employment of the public service engage in full-fledged private practice. This practice puts members of the public who have to access care in either public or private health institutions in which such practitioners are involved at grave risk, and is inimical to the image and reputation of the professions.

Registered medical and dental practitioners and members of the public are hereby called to note that the MDCN has made Rules on the conduct of medical and dental practitioners in full employment in the public service. These are contained in Rule 49 of the Code of Medical Ethics in Nigeria 2008 edition.”

There have been allegations making the rounds that many doctors working in public hospitals spend most of their working time in private practice, and are hardly available at their place of employment.

It is also alleged that some doctors do this indirectly by engaging their proxies – nurses and other junior staffers of the hospitals where they work. This they do in the pretext of providing better services to patients whom they lure to their private practice thereby pitching themselves in competition against the public institutions.

If these allegations are real, then those involved should be regarded as non-professional medical practitioners and appropriate sanctions meted out to them.

Medical practice at the public service level is regulated by certain codes of conduct which prohibits practitioners from engaging in private businesses as highlighted by MDCN in its response to the current development. Therefore, doctors working in public hospitals should concentrate on rendering their services to patients in government owned hospitals because doing otherwise amounts to disobedience to laid down rules governing the profession.

Professionalism is core element of being a good doctor. Good medical practice is based on a relationship of trust between the profession and society in which doctors are expected to meet the highest standards of practice and behaviour. But government must share in the blame for its inability to fulfill its responsibility to health sector workers, leading to a plethora of avoidable strikes.

The doctrine of no-work no-pay which the government intends to invoke as a means of “whipping striking workers into line” would have made a lot of sense if government regularly fulfilled its part of the bargain with its employees. This dual practice syndrome is often a means by which health workers try to meet their survival needs, reflecting the inability of government to ensure adequate salaries and good working conditions for its employees.

More so, government is constantly being accused of reneging on agreements reached with its workers soon after the agreements are entered into. Ordinarily, such a weakness on the part of government could arouse suspicion and erode general worker confidence. However, all of these cannot in any way justify the kind of shared attention doctors in public hospitals exhibit at the expense of public health.

As Hippocratic Oath demands, doctors in addition to maintaining their clinical competence should also show integrity, compassion and concern for their patients. In clinical practice, patient care is the primary concern of a medical doctor, yet the welfare of the healthcare provider remains vital.

 

•Sammy Adaba is a Staff Writer with PharmaTimes

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