RE: EXPERTS WORRY OVER SUPREMACY BATTLE BETWEEN PATHOLOGISTS, LAB. SCIENTISTS
I read with keen interest the article by one AZOMA CHIKWE. The article passes as one of those banalities that often appear on topical issues to muddy the waters the more and this one typically added nothing new positively to the narratives of the discourse between Medical Laboratory Scientists and Pathologists. Yes, it contains some historical facts about the humble origin and evolution of the profession of Medical Laboratory Science as we know today but so what? Every profession has evolved. There is nothing to be ashamed of in that. God did not create any profession in His 7 days of creation! No profession was created on day 1 or any day for that matter. Today’s medical doctor evolved from the fads of medieval times that ripped off sick people. Everyone has a past and we Medical Laboratory Scientists are not ashamed of our own. I wonder if some of our doctors ever gave a thought as to why Hippocrates had to institute the oath that all aspiring doctors these days have to take before practice? That doctors had a hand in the creation of Medical Laboratory Scientists is certainly nothing to be too excited about. That was only a necessity and we in humility acknowledge that debt of gratitude to the medical profession but the time to let loose the leash is overdue.
By the way how did Pathology evolve? The well-known Scientists of old, Virchow, Pasteur, Koch, Ehrlich e.t.c. were they Pathologists? Let us not be too carried away by our own self-interest. In the practice of medicine today, it is recognized and acknowledged that no one individual would have all the knowledge and skills to handle all the myriads of issues arising from today’s modern lifestyle. So, it would have been necessary to develop other health professions if they did not exist by now. It is indeed these other professional contributions that give essence to the art and science of medicine today. That Medical Laboratory Science has grown so much in its short history is indeed a CREDIT to the great efforts of its founding fathers and those who came after them in nurturing what has now become something of an envy of some members of the health fraternity. But we must realize that this development has been in parallel with advances in medicine, so much so that the roles and expectations of Medical Laboratory Scientists have grown out of all proportion to what would have been achievable in the past. Instead of applauding the growth and contribution of the profession of Medical Laboratory Science to the development of medicine as it is today, these few are in their myopic mind plotting its downfall. It is not a moot fact that 70% of today’s disease conditions can be defined by a laboratory result! These unwearied contributions of the laboratory to decision making by today’s doctors rather than depending on anecdotal and subjective opinion is a glory we all need to bathe in, not disparage.
We are not unaware of the “rivalry” that exists between family physicians and the Pathologists (are Haematologists, Microbiologists etc. Pathologists too?); even there is a strong argument among eminent doctors that doctors who work in the lab are not clinicians but, we will put all that in the “parking lot”. Perhaps the worry of the lab doctor is this unsubstantiated fear that Medical Laboratory Scientists want to push them out of the laboratory! The origin of this fear is hard to fathom, but this is paranoia of a specie that feels threatened by the fact that it is unable and unwilling to come to terms with development in the work place and face the reality of our times. One would expect the lab doctors, by their training to be more discerning even though we live in a nation agog with rumours and social media frenzy! That the Medical Laboratory Scientists like members of other health professions have grown by dint of hard work to a position whereby they can work shoulder to shoulder with the lab doctor in a non-hierarchical manner and rule their own world (drawing from Glo!) as members of the same team in a non-master/servant relationship may be the worry of some lab doctors.
The unfortunate case of Baby Eniola of LUTH in 2016 has been bandied around by lab doctors too often to justify their misplaced claim to headship of the laboratory. Whereas this was indeed the classical case of what happened when they were unable to provide leadership and management in the laboratory and at the same time preventing the right custodians of laboratory matters from taking ownership of their responsibilities (a case of a dog in a manger, you may say). In stating their alternative facts (apologies Kellyanne Conway) they have often failed to indicate that in this particular case that Medical Laboratory Scientists lost their jobs while the lab doctors only walked away with a slap in the wrist.
One fact that we have failed to realize or chose to deliberately overlook is that these days, the extreme complexity of laboratory procedures often makes it necessary for the physician to rely on the Pathologist for assistance. The Pathologist performs the role of interpreting and correlating for the physician the results obtained by the Med. Lab. Scientist in order that he may fully utilize them in the treatment of the patient .While it therefore follows that the lab doctors operate at the interphase of the laboratory and the clinic, thus they and the Medical Lab Scientists must work together with the physician as members of a team whose goal at all times is better patient care. There is no doubt that the most effective medical laboratories are where the Medical Laboratory Scientists/Pathologists work in a collaborative environment sharing knowledge, information and utilizing the skill sets of both groups. Frequently, laboratories end up with a combative culture if this opportunity is lost. Unfortunately, this appears to be the case with Nigeria at the moment.
In 2006, a highly respected surgeon had circulated a document in which he claimed other health professionals were clamoring for the doctors’ job. This clearly shows the mindset of many doctors in Nigeria which is an indication that they are completely unfamiliar with developments in the workplace around the world. Even though this doctor gentleman later withdrew his claims and apologised for conceiving such ideas, damage had been done and some of his minions still hold to those opinions these days. Tenaciously holding on to the past will not help matters. In England, Nurses with adequate expertise and skills act as Nurse- Practitioners – see patients and write prescriptions. That would almost tantamount to blue murder here in our country. Medical Laboratory Scientists of sufficient bent read and interpret histopathology/cytology slides as Consultants. Should this happen here, some people would become psychiatric. It is time to drop this EGO toga!
Medical Laboratory Scientists remain faithful and ready to engage in conversation with anyone working to build our system. We BELIEVE Pathologists are respected Medical Consultants who rather than ASPIRE to become Medical Laboratory Scientists should look for more rewarding tasks to give them job satisfaction and self actualisation instead of just expecting to supervise the Medical Laboratory Scientists at work and signing laboratory result forms of work carried out by these medical laboratory scientists. No profession can supervise the work of another. This is the reality of the day. The point is, if we cannot change the reality on ground, it becomes necessary that we change the eyes with which we see reality. The world is moving on and our health indices will remain what they are if we do not embrace developments in the health arena. Enough has been said for the wise.
Consultant Pathologist Umaru complained about blood touts. That we do not have a National Blood Service in Nigeria today is certainly not the fault of any Medical Laboratory Scientist. For over 5 decades the idea of building a blood service in Nigeria has been on the drawing board. Eminent Nigerians (Chief Emmanuel Iwuayanwu for example) many doctors and medical laboratory scientists have WORKED TIRELESSLY for its actualization over the years. The only evidence for their hard work is that during the period of Prof Eyitayo Lambo (a non-medic) as Hon.Minister of Health and with funding and the kind assistance of the people of USA under PEPFAR, he was able to develop many infrastructure and set up 17 operational centers in the 6 geo-political zones of the country that we have today.
There is a national blood policy that has been denied the necessary translation into law in form of a National Blood Service bill to set up an operational agency free from the red tape of the Civil Service. This is because new Ministers (all Medics and Professors for that matter) believe the NBS will take away the jobs of teaching hospital departments that run an uncoordinated, haphazard service whose safety cannot be guaranteed. Meanwhile Nigeria is signatory to World Health Assembly resolution No WHA2872 of 1975 which advocated a centrally coordinated national blood service. The NBS in England is one of the essential components of the NHS. Teaching Hospitals in Nigeria are nowhere comparable to those in England. Blood would have been available for President Mohammadu Buhari should he have needed it in England. He wouldn’t have had to mobilize tout donors as we often do here before he could access safe blood. It could happen here too if only “the powers that be” would allow it. In the meantime, Nigerian experts have worked with WHO in developing thriving blood services even in tiny countries like the Seychelles! This is the tragedy of our country and some people would like us to continue in this manner. The solution is for members of the medical profession to accept that it’s a different world we live in now. These are exponential times and lamentations no matter how genuine would not help matters.
There are clear differences in the roles and responsibilities of the MLS and Pathologists but both must work together for improved patient care. There must be mutual respect and recognition that will enable them build strong work ethics and develop a new order of a more efficient medical laboratory eco system. As baseball enthusiasts are wont to say it’s time to “call a big time out”.
Paraphrasing the words of Martin LUTHER KING Jnr. The time has come when the sons of former slaves and sons of former slave owners will sit down together at the table of brotherhood. Yesterday is not ours to recover, but tomorrow is ours to win.
Reading this rejoinder reminded me of the photo I took recently in Bodija, Ibadan – of a lovely flower blooming in a bed of green …
We are all different, but in our diversity lies our collective let us embrace it. Meanwhile, who here is an horticulture afficionado? What is the name of this beautiful pink bloom?