CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Many patients in Nigeria do not know their rights and many have limited knowledge on the subject matter of their rights. If those patients become better informed of their rights and the reality of their taking out successful law suits against negligent health care providers, the quality of health care in Nigeria is likely to improve. The provision of medical services brings together the doctor, patient and at least the relatives or the friends or both of the patients concerned with the relief of his illness. We believe life is God given as such a doctor figure in the scheme of God as he stands to carry out his command. A patient generally approaches a hospital/doctor based on its/his reputation. Therefore, it is expected that a doctor carries out necessary investigation or seeks a report from the patient. The health care system in Nigeria has recorded unimaginable and unsatisfactory performance in quality delivery for a very long time. Medical services are still not accessible to many people, especially the poor. When accessed, patients receive sub-standard care in many cases due to the negligence on the part of one health care provider or another. On the other hand, when services are unaffordable, the patients go to quacks that may provide cheaper services, while causing greater harm or damage to the injured patients and their families. Generally, negligence is a breach of a legal duty to take care, which results in damage to the claimant1 . Professional medical negligence or malpractice as it is often called has been on the increase and there is an urgent need to address the issue in terms of attitude of law towards medical practice so as to protect the patient, as well as make liable to punishment any medical personnel who negligently cause harm or injury to a patient. These health care providers need to be brought to order, especially since many helpless victims have been sent to their early graves as a result of medical negligence and to also revive the confidence of patients in the once highly revered medical profession. Today most people who go to the hospital for treatment or medical advice tend to do so with some level of pessimism in the face of rising cases of medical negligence in our dear country Nigeria. There exist laws to regulate human conduct which includes medical practice, the law is formulated to protect people’s rights and to make sure that certain basic rules of social conduct are complied with. For instance, the National Health Act was formulated to provide a framework for the regulation, development and management of a national health system and set standards for rendering health services in the federation. It is in the light of this that the medical profession, like any other profession has become more open to legal scrutiny.
The idea of duty of care is founded on the assumption that in a civilized environment each individual is responsible to others not to cause any injury to them and that there should be liabilities for occasioned injuries, whether such liabilities are designed to primarily punish or deter wrongdoers or to generally compensate victims. A duty of care is an obligation on a party to take care not to allow injury to be suffered by another individual. In torti, duty of care is a legal obligation levied on an individual requiring adherence to a standard of reasonable care while performing any act that will possibly or foreseeable occasion harm to another. Where an injury is suffered owing to a failure to observe the duty of care, there is said to be a breach. Injury could be physical, fiscal or emotional and they are remediable through various remedial alternatives as prescribed by law.
In the medical field, the job of health personnel is to offer professional care to sick persons. This is a sacrosanct job in view of the fact that such sick person submits himself to the medical person and place full reliance on the supposition that he would be provided all reasonable care and that the health officio will act in his best interest all along. However, this does not always turn out to be the case as experience has shown that patients sometimes do not receive such care as commensurate with the seriousness of their condition. As far back as 1937 there was already recognition of the fact that there was a loosening of the old-time relationship of mutual confidence between patient and doctor, upon which so much of the satisfactory practice of medicine in the past had depended.ii Some studies show cases ranging from medical staff‟s rudeness, negative attitude to patients, lack of care and compassion such as staff not doing enough to ensure patients are comfortable, inadequate response to requests,iii to wrong diagnoses, administering wrong treatment, surgical accidents like leaving surgical instruments in the body cavity, accidentally severing vital blood vessels or nerves, operating on the wrong part of the body or removal of healthy tissues or organs, and handling of patients by unqualified health personnel. There has been an increase in cases of unqualified medical personnel as noted by the Medical and Dental Council of Nigeria (MDCN)iv with quacks and unlicensed medical persons boldly operating in public and private hospitals unnoticed. Shocking illustration is the notorious case of one Martins Ugwu who confessed to having stolen a medical certificate, managed to get an employment with the Federal Civil Service and worked with the Federal Ministry of Health before he was finally caught. vThere are also several cases of pharmacists, nurses, medical laboratory scientists and technicians as well as other health personnel parading as doctors and rendering medical services only doctors are licensed to render to unsuspecting members of the public thereby leading to considerable harm to the patient. The patient only gets to see the qualified doctor after the harm has been done.
The consequence of insufficiency or outright lack of adequate medical care could be catastrophic and such catastrophe is suffered by no other than the ordinary man who innocently placed his life in the hands of the medical personnel with the belief that he will be a better and healthier man afterward.
The World Health Organization (WHO) ranked Nigeria‟s government healthcare system 197th out of 200 in 2014. In 2015, another report noted that the medical personnel-to-patient ratio in the country fell far below WHO‟s recommendations of 1:600 for doctor-to-patient and 1:700 for nurse-to-patient ratios. Chiejina, throwing some more light on the issue, said that going by official statistics there is one doctor to every 64000 patients in Nigeria as against the WHO‟s standard of one doctor to 600 patients.viThese readings will likely not be better in 2018 if not worse. Owing to this paucity of some health personnel especially doctors, quacks are having a field day and the patient is the worse for it. This problem accentuates the need to amplify discourse on the issue of protection of patients. In advanced countries legislative steps as well as reliance on court action have been effective in ensuring that medical negligence is placed under serious check. Unfortunately same cannot be said for Nigeria as many cases of medical negligence are left unreportedvii or unprosecuted owing to lack of fund, ignorance, illiteracy and lack of confidence in the institutions. Even the internal regulatory mechanisms within the medical field such as the Medical and Dental Council of Nigeria (MDCN) and Nigerian Medical Association (NMA) have been perceived as sleeping dogs. This is partly due to the fact that both MDCN and NMA only regulate doctors thereby allowing room for non doctors to commit all sorts of atrocities against patients without being punished. The patient only comes to the doctor for salvage after the harm has been done. Overtime the circumstances under which duties of care were recognized moved further and further from the specific factual context of its origins.viiiCase law has come to recognize many duty relationships like one highway user to another, employer to employee, manufacturer to those affected by his product, doctor to patient. This work seeks to focus on doctor-patient relationship and duty of care in Nigeria.
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1.2 Statement of the Problem
All patients hope they will have a good relationship with their physician. Unfortunately, problems can sometimes come up in a doctor-patient relationship.
Recently, a Consumer Reports article pointed out some of the more common doctor-patient relationship problems that can arise. Here are the problems the article highlighted:
- A doctor ignoring patient input in their decision making.
- Disorganization at a doctor’s office.
- A doctor withholding relevant information.
- A doctor giving off the impression of not respecting a patient.
- Poor communication between a doctor and patient.
- A doctor discouraging second opinions.
Problems with a doctor-patient relationship can be very damaging. They can seriously erode the relationship between a patient and their doctor, which can have major negative implications. It could lead to a patient not fully trusting a doctor and their recommendations. It could also result in a doctor not being as engaged in a patient’s care as they should be. A doctor not being properly engaged in a patient’s care could increase the chances of mistakes occurring in connection to the care. Thus, doctor-patient relationship problems could have serious patient safety ramifications.
All these and more makes up the statement of the problem that initiated the study of the above subject matter.
1.4 Objectives of the Study
The specific objectives of this study are;
i. To determine the extent of doctor-patient relationship in Nigerian hospitals.
ii. To examine how caring Nigerian doctors are.
iii. To determine how the health system of Nigeria contributes to doctor-patient relationship.
iv. To tackle the challenges of doctor-patient relationship with respect to Nigerian health system.
1.3 Research Questions
The research questions are as follows;
i. What is the extent of doctor-patient relationship in Nigerian hospitals?
ii. How caring are Nigerian doctors?
iii. How can the health system of Nigeria contribute to doctor-patient relationship?
iv. How can the challenges of doctor-patient relationship with respect to Nigerian health system be tackled?
1.5 Hypotheses
The study tests the following hypotheses stated in its null form;
i. H01: There is no significant relationship between Nigerian health system and doctor-patient relationship.
ii. H02: The doctor-patient relationship plays no important role in the wellbeing of a patient.
1.6 Significance of the Study
Health care system in Nigeria has recorded unimaginable failure due to a degenerate doctor-patient relationship among other reasons. This work looks at doctor-patient’s relationships in Nigeria as it relates to health care provision.
This study will be beneficial in a number of ways especially to the government as it will help them to understand the significance of good health system and how it is tied to doctor-patient relationship.
It will help the staff and management of health institutions in Nigeria to know why they need to have and maintain a good doctor-patient relationship in their profession.
It will also help researchers in the sense that it will serve as the foundation of knowledge upon which other research works in this direction can be founded.
1.7 Scope of the Study
This study centers on an appraisal of doctor-patient relationship and duty of care in Nigeria, with patients of LUTH as a case study.
1.8 Limitations to the Study
The time frame was not enough for the researcher to delve into the issue as comprehensively as would have been desired. This also informed the decision to focus on one hospital so the time would be invested in identifying and evaluating all possible aspects of the subject matter so as to make the study as comprehensive as possible. The use of a case study arguably has many limitations; however, it allows for a level of research that was commensurate with the nature of results expected.
1.9 Definition of Terms
Doctor-Patient Relationship: The doctor–patient relationship is a central part of health care and the practice of medicine. A doctor–patient relationship is formed when a doctor attends to a patient's medical needs and is usually through consent. This relationship is built on trust, respect, communication, and a common understanding of both the doctor and patients' sides. The trust aspect of this relationship goes is mutual: the doctor trusts the patient to reveal any information that may be relevant to the case, and in turn, the patient trusts the doctor to respect their privacy and not disclose this information to outside parties.
Duty Of Care: In tort law, a duty of care is a legal obligation that is imposed on an individual, requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others. It is the first element that must be established to proceed with an action in negligence. The claimant must be able to show a duty of care imposed by law that the defendant has breached. In turn, breaching a duty may subject an individual to liability. The duty of care may be imposed by operation of law between individuals who have no current direct relationship (familial or contractual or otherwise) but eventually become related in some manner, as defined by common law (meaning case law).
