Why we reject patients – Nigerian Doctors

Nigerian hospitals and doctors are known to reject patients; but the COVID-19 pandemic has worsened the situation, such that many patients have died as a result. In this series of reports, physicians discuss why they sometimes turn away patients, what patient ‘rejection’ means and legal steps that those rejected can take

An expert says any medical doctor who feels insecure or struggles to get a patient to comply with protocols has the right to tell the patient to seek medical attention elsewhere.

In an exclusive interview with a pulmonologist with the Federal Medical Centre, Abeokuta, Ogun State, Dr. Olusola Adeyelu, says the aphorism that ‘No patient should be rejected,’ as the Hippocratic Oath indicates, comes with its own caveat.

It may be recalled that public outrage had trailed the death of former Super Eagles and Shooting Stars defender, Ajibade Babalade, who was rejected at a private hospital after suffering cardiac arrest in Ibadan, Oyo State.

According to his former team mate who was also an ex-goalkeeper of the Super Eagles, Ike Shorunmu, the defender died shortly after they took him away from the private facility to the University College Hospital, Ibadan.

“He was rejected by doctors at the first hospital, from where he was referred to the University College Hospital. But on his arrival at the UCH premises, he died at the gate,” Shorunmu said.

Adeyelu, however, cautioned that it may be unfair for anybody to blame a private facility for rejecting a patient in a capitalist society where market forces determine a lot of things.

He explained that medical doctors or hospitals can take decisions based on their assessment of a situation.

Likely causes of patient rejection
“If a patient is violent, fights or intimidates people in the facility or fails to comply with hospital rules, he may be asked to leave.

“If, as a health worker, you are unsure of your safety, there is no need for heroic act. It is expected that a patient must assume a sick role by avoiding the aforementioned. A sick role is when a patient is genuinely looking for solutions for his illness,” he said.

He said the National Health Service in the United Kingdom thrives on capitalism and market forces, which he described as a contrast to Nigerian government’s claim of ‘health should be free.’

“A hospital is, as of today, a business enterprise, though people may not want to agree. That is why I used the example of the NHS.

“Access to quality healthcare should be the right of anybody, but a patient who comes to the hospital with no money to obtain card, in need of free blood transfusions and antibiotics is asking for the impossible.

“Even if the hospital decides to give the blood free, who will pay for the screening of the blood, supply of antibiotics and other things of necessity?

“If it’s a private hospital, the doctor may look inward and demand deposit. If it’s not forthcoming, he will creatively ask the patient to seek help elsewhere,” Adeyelu said.

According to him, it is easy for people to abuse medical doctors, especially those at the frontline of the COVID-19 pandemic because they [patients] are not the ones on the other side of the divide.

“For instance, look at the issue of COVID-19 and how the Federal Government has repeatedly broken its promises of raising hazard allowance from N5,000 on innumerable occasions. To date, my own hazard allowance is also N5,000,” he stated.

The pulmonologist further stressed that if only the public understood the pains doctors and hospital management undergo just to carry every patient along, they will learn to appreciate that the operation of a hospital (private or public) is not sustainable in Nigeria.

“Do you know how many government-owned hospitals now run ‘private hospitals’ within their facilities, where patients deposit between N50,000 and N100,000 just to get access into the Accident and Emergency rooms? You need to visit most tertiary hospitals in Lagos to understand what I am saying.

“Also, I think the Hippocratic Oath is an often misused term in Nigeria. It has had multiple reviews and no longer applicable, at best antiquities. Once money comes into a doctor-patient relationship, the oath will go up in flames,” he bemoaned.

In his perception, advocacy remains the key to resolving some of the major challenges in the health sector.

In another interview, President of the Nigerian Medical Association, Prof. Innocent Ujah, told our correspondent that the issue of rejection should be viewed from both sides of a doctor-patient relationship.

“A person might refuse to be attended to in a hospital. Do you also know that? When such patient doesn’t want some persons to attend to him, there is nothing you can do. I can only speak for doctors and not the hospital because of the ethics of the medical profession.

The word ‘rejection’ is overused

“We cannot reject any patient. But I think the word ‘rejection’ is overused. Because one doctor may be working from morning to night and seen hundreds of patients, it is expected as a human being that he may break down at some point.

“There is what we call diminishing return. If you cannot give maximum attention to a patient, you can exclude. But some patients don’t understand this. In English, it means they need to see some other doctors,” he said.

The NMA president, however, cautioned that the patient should be politely told, because a patient who comes to the hospital is obviously in distress and needs to be empathised with.

‘Medical ethics forbids rejection of patients’
“For any reason, a patient could be referred to another doctor who will take over the management. In that case, it is not a rejection. However, you know the way Nigerians react to things. It could also be possible that the doctors did not probably explain to them in detail and they see it as rejection,” he said.

Ujah said it was possible that patients might not also understand what it means when they are referred to another doctor.

“But ethics does not allow us to reject any patient, even if it’s your enemy. We must commit ourselves totally to the care of our patients. That should not be called to question at all,” he said.

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