Syndrome of inappropriate care for mild-moderate diseases in government facilities

I am sure many critiques will pop up saying where did he read about the syndrome? Who coined it? Is he an authority in medical literature? However, it is a genuine way to ease boredom disorder. Meanwhile, I am quite certain you will agree with me at the end of this article.

Concept

Syndrome as it is well defined in the medical lexicon is the combination of signs and symptoms and on the other hand, “mild –moderate diseases’’ are diseases following their natural course of evolution without complications or severity such as uncomplicated malaria etc. This simple explanation brings me to the topic being discussed above. It is quite often noticed that patients suffering from chronic conditions in our society today are inappropriately managed due to so many factors some of which would be elucidated based on the knowledge of the author and limited space on the competitive magazine page.

Factors to be considered

One of the major factors responsible for this aforementioned syndrome is the inadequacy of medical doctors to attend to cases so that precise tentative diagnosis can be worked out for the benefit of the patients. Another factor to be mentioned is the lack of basic and adequate medical equipment to confirm diagnosis. Let’s talk about this a little. For a doctor to be on top of a case, clinical skills which includes history taking and physical examination is extremely paramount in making diagnosis of such a patient. However disease can present in so many ways such that a patient with a history of recurrent loin pain might suffer any severe disorder which is beyond clinical skills to make appropriate diagnosis. Such case thus needs sophisticated orthodox medical equipment for proper diagnosis and management, if not the topic being discussed manifests.

More so, the issue of empirical doctors in our nowadays patients google searching for diagnosis is alarming. In the sense that patients present to the consulting room with premeditated diagnosis from Google, Neighbours or relatives with previous similar symptoms. Most at times, they self-medicate before coming to the hospital thereby masking the symptoms and signs and occasionally end up confusing the healthcare provider. Work time overload, if am not misquoting the WHO normal work time for a doctor , an average of 8 hours per day, should be a proper working time frame  for a doctor to mentally function well while consulting. Okay let’s say give and take of an average of 10- 12 hours for African doctors because of the peculiarities of the environment, they just have to be super human beings.

The proliferation of unqualified staff consulting and dispensing drugs in the chemist/pharmacy is an unspeakable act which has caused more damage than benefit. This is a terrible situation which needs urgent attention from concerned authorities. A lot of cases have been mismanaged, to mention but a few, are the adverse drug reactions which the innocent souls of the patients are being subjected to. In fact there was a recorded case of Stevens-Johnson syndrome which caught the attention of the media.

Another factor which I have considered to be of interest in this article is the non-orthodox medical diagnostic equipment proliferating every nook and cranny of our beloved country. To my surprise, even the international and local airports accommodate them. I wonder if the concerned authorities that regulate medical practices in our country don’t pass through these places or they intentionally shy away. In fact it baffles me as a doctor that somebody will connect a gadget with electrode and make diagnoses of all the organs in the body to the extent of investigating the renal function without taking blood sample or quantifying the level of urea and creatinine in the blood.

To cap it all up, are the One-time fake miracles from religious leaders instigating and confusing the patients to stop taking medications and go for deliverances. I never dispute or doubt the divine power of healing but necessary measures should be taken while you pray.

Consultation via social media

Worthy of mentioning, is the “Consultation via social media syndrome” which has become a tradition. Patients are fond of consulting healthcare providers via social media instead of visiting the hospitals for proper diagnosis and management. The advent of Internet/social media has indeed made the world a global village. In fact it has influenced the way we think, the way we access and process information including health information. Most importantly, is the power of the Internet to ease and facilitate the process of learning and acquiring of knowledge. However, this hasn’t changed the basic rudimentary of practicing medicine till date. More so, I am yet to see a social media medical school where medical students are being trained to diagnose and manage cases via social media. Maybe in the future we might get there. But for now let’s stick to what we know and what is right.

Final thoughts

In conclusion, the aforementioned factors are responsible for inappropriate management of cases in our environment because most patients do not present so bad to the doctors initially. And since they keep moving around and receiving poor management until the case gets worse or presents with organ failure, then it is that they seek for appropriate management at the referral centers. Unfortunately, some cases end up as terminal cases with palliative management. Hitherto, such degeneration to severity due to syndrome of inappropriate care for mild – moderate diseases can be avoided if adequate medical facilities and equipment are put in place including proper control measures by concerned authorities.

Dr Basaru lives in Lagos