Doctors in Nigeria

• For centuries, the medical doctor has been one of the most respected members of society. Traditional healers of indigenous tribes were revered for their knowledge of the healing arts. In Nigeria, the doctor is called upon not only treat patients, but is also called upon for advice and guidance as well. This is one of the reasons why year in, and year out, Medicine has been one of the most sought after courses in UTME examinations. But what does it mean to be a medical doctor?

  The Joys of Being a Medical Doctor

  I am a surgeon, an orthopeadic surgeon. Orthopaedic surgeons treat diseases and injuries to bones, ligaments and tendons. Yes, I love being a surgeon. Each day when I wake up and look in the mirror, I know that my goal is to help my patients get better. I do this either directly or by teaching students and resident doctors – hopefully making them better doctors.
  Medicine satisfies my yearning for knowledge. Patients are often like mysteries in a detective story. They come with problems which the doctor has to decipher. Doctors collect clues in form of what the patient tells them (this is called history), physical examinations and appropriate diagnostic investigations. Using those clues, doctors strive to develop a management strategy which takes into consideration the patient's desires and our best knowledge of the evidence.
  The doctor patient interaction is special, very special indeed. When I introduce myself to a patient, I almost always sense the patient trusting me. This gives me the encouragement that we are working together towards the common goal of getting them over their diseases. It is a very special feeling. You feel very fortunate that patients trust you with their information.
  I remembered the first time I watched a caesarian section as medical student at the university Teaching Hospital, Ibadan. The surgeon brought the baby boy out of the uterus. I went with the nurse to examine the baby and check his weight and height, count his heart rate, and check his breathing. That day, I couldn't help but marveled at the mystery of creation. I also couldn't help but think how wonderful it would be to be a doctor who can take care of women at the moments of their worst fears and their greatest joys.
  Some years ago, I managed an eleven year old boy with club foot. The parents were very poor. It took them almost three months to raise the less than thirty thousand Naira needed for the final phase of the treatment. The boy had been walking with a limp all his life. When I took off the POP on his foot, and he saw how close to normal his foot was, he moved to me and hugged me tightly, saying over and over again "Thank you, thank you….." When I looked at his mother, she had a huge smile on her face and tears were trickling down her face. Those were the kinds of memories that makes being a doctor worth the toils and the tears and the grit that goes into making you one. The challenges of patient care and the non-monetary rewards will continue to make medicine a wonderful field.
  Yes, many doctors are not making a lot of money, but they are making enough for themselves and their families to be comfortable. Most derive their greatest compensation from the personal satisfaction of caring for all those who came to see them.
  Sometimes, I wake up wondering why I'm a medical doctor, knowing I could be whatever I had wanted to be. However, with the same line of thought comes the realization that there's nothing else I'd rather be.

  Do You Have What It Takes to Become a Medical Doctor?

  Becoming a doctor takes time. After secondary education, you will spend six years in the medical school, one year as an intern and another year as a Youth Corper. That's eight years from starting university to practicing medicine. If you decide to become a specialist, then you are looking at another 4-7 years of residency training in a teaching hospital. This means that to become a specialist doctor, you need between 12 and 17 years of training, counting from your first year in the university.
  It takes a certain amount of intelligence to become a medical doctor. However, organization and good study habits can make the difference between an average student who succeeds in the medical school and, a brilliant student who fails to make it.
  There are three cornerstones of a successful (this success is not defined by money!) career in medicine:
  • A love for learning in general.
  • A true intellectual curiosity about medicine in particular.
  • A strong desire to help others.
  Being smart and doing well in the sciences are obviously important components of being a successful physician. But these are not the only requirement, you must also be able to relate well with people. As a physician you have an opportunity to help others. Wanting to help others and enjoying helping others are necessary attributes of a good physician. This is something that cannot be taught.
  In medicine, you have many choices. In what other career can you choose between delivering babies (Obstetricians), taking care of children (Paediatricians), treating women (Gynaecologists), handling emergencies (Traumatologists), removing a hernia or appendix (Surgeons), helping those with behavioural problems (Psychiatrists), or preventing diseases (Community Medicine)? Better yet, as a specialist, you can teach others your medical specialty, while still practicing your profession. Alternately, you can do research in whatever specialty you choose, with the potential to make a real breakthrough in preventing or treating illness. There is even a Nobel Prize for Medicine. You can become the Wole Soyinka of Medicine! In addition, being a physician is honourable and is held in high esteem. It allows you to live just about anywhere, and provides job security.
  However, all of this comes at a price. The many years of preparation, the discipline, the awesome responsibility and the long call duty hours can take their toll. Medicine is a unique field and it demands a unique person.
  Recently, I gave the induction lecture to the 12th graduating medical doctors of the College of Health Sciences, Ladoke Akintola University of Technology, Osogbo.

  What Subjects Should You Take in Your Senior Secondary School to Qualify for Admission to Read Medicine?

  According to the MSSN website (the Red Book), the following secondary school subjects are required for medical education in Nigeria:
  1. Biology
  2. Physics
  3. Chemistry
  4. Mathematics
  5. English.
  Prospective medical students must pass the West African School Certificate or the Senior Secondary School Certificate Examination or any equivalent examination, such as National Examination Council (NECO), with at least Credit level passes in the above five subjects.
  They must then either:
  1. Pass the JAME Joint Admission and Matriculation Examination) for admission into the University preliminary (premedical) year or
  2. Secure exemption from the JAME and the University Preliminary year by passing the Advanced Level General Certificate (GCE'A' Level). Higher School Certificate (HSC) or its equivalent examination in: Biology: Chemistry and Physics.
  Subject to the co-ordinating regulations of the JAME, it shall be the right of the Medical School to select candidates for final admission to their institutions from among eligible candidates who possess these minimum requirements. You need to score a high mark in your UTME examination.
  In theory, you are advised to score at least 200 in UTME examinations to be considered for admission into most universities, in practice, to be considered for medicine, you may need to score 250 and above. After that, you will need to pass the Post UTME Screening Examinations of the University of your choice very well too.
  Finally, some Universities have introduced pre-degree programmes through which candadates can qualify for reading medicine by doing a one-year University organised program similar to the HSC program.

  Life as a Medical Student

  You will spend at least six years in the University. These six years are likely going to be the toughest years in your life because of the sheer volume of work you will face.

  First Year

  Your first year in the University will not be in the Medical School per se, rather, they will be spent in the Faculty of Science where you will be studying mainly Physics, Chemistry and Zoology, with a sprinkling of some other (minor) subjects. Unlike in most other courses where 40% is the pass mark, you must score at least 50% in all the subjects before you can proceed to the second year.

  Preclinical Years (Second and First semester of the third year)

  The next three semesters are probably going to be the toughest years of your life. No kidding. You will be in the classroom or laboratory for at least 10-12 hours everyday including some Saturdays. Thereafter, you need to read another 6-8 hours in so that you will not fall behind in your study.
  The preclinical subjects include:
  1. Anatomy: Gross and microscopic structure of the human body. You will dissect cadavers in the practical sessions
  2. Physiology: This subject deals with the normal functions of human body and its parts.
  3. Biochemistry: This is concerned with the chemical and physicochemical processes that occur within the human body.
  4. Medical Genetics: The study of heredity and the variation of inherited characteristics in humans.
  5. Community Medicine (Also called Preventive and Social Medicine).
  At the end of this period, you will sit for your first Medical School Examination. You must pass all subjects before you can proceed to the next level. The pass mark is 50%.

  The Clinical Years

  This is the next three and a half years. In most medical schools, once you reach this stage, you will move to the Teaching hospital, where hostels will be available to you. You will no longer run the regular nine months of schooling and 2-3 month long holidays that regular undergraduates run. You will no longer have regular holidays again, as you will spend almost the whole calendar year in the school. The hospital becomes your laboratory, and the patients becomes your subjects. In the class, you will learn the science of medicine, and in the wards and clinics; the art of medicine.  Within this time, you will metamorphosed from a student to a doctor. You will learn to gather facts from patients, and weave such facts together to make your diagnoses. You will become a new person: compassionate, caring, empathetic, responsible and curious.
  The subjects you will be studying at this stage are divided into two. The Basic Clinical Sciences and the Clinical Sciences. The two are taken concurrently in most medical Schools, but the basic Clinical Sciences are completed in the fourth year in most medical schools. The subjects included in the Basic Medical Sciences are:
  1. Pharmacology: The branch of medicine concerned with the uses, effects, and modes of action of drugs.  
  2. Pathology: The branch of medical science that studies the causes and nature and effects of diseases. Pathology is made up of the following specialties:
     1. Haematology: The branch of medicine that deals with diseases of the blood and blood-forming organs
     2. Medical Microbiology: The branch of medicine that studies microorganisms and their effects on humans
     3. Chemical Pathology: area of pathology that is generally concerned with analysis of bodily fluids. It is what can be referred to as Biochemical Pathology, the pathological aspect of medical biochemistry. The study of Medical Biochemistry gone wrong.
     4. Anatomical Pathology: The medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies (autopsy). It is the pathological aspect of Anatomy. The study of Anatomy gone wrong. 
  This subjects are laboratory based. You will learn the subjects by didactic lectures and laboratory practicals. At the completion of these courses, you will sit for the Second Professional Medical School Examination.
  For many, the Clinical Sciences are the essence of the medical school. The years are spent learning hands-on patient care. You wear Ward Coats, attend Ward Rounds and Clinics with Consultants, Resident Doctors and House Officers (also called Interns). You partake in taking care of real patients with real problems. These are the clerkship years. These are the years you actually learn to ‘become a doctor”. This is where you learn to apply what you have learnt in the Basic Medical and Basic Clinical subjects to living human beings.
  The subjects in the Clinical Sciences include: 
  1. Paediatrics: The branch of medicine dealing with children and their diseases.
  2. Obstetrics and Gynaecology: These actually comprises two major subjects: Obstetrics which is concerned with childbirth and the care of women giving birth and Gynaecology which deals with the functions and diseases specific to women, especially those affecting the reproductive system.
  3. Community Medicine: This is the branch of medicine concerned with the prevention of diseases and injuries.
  4. Surgery: This is the branch of medical science that treats disease or injury by operative procedures
  5. Medicine: This is concerned with the prevention, diagnosis and treatment of diseases by non-surgical means.
  At the end of this session, you will seat for the final Professional Medical School Examination, which qualifies you to become a Medical Doctor, and change your status forever. You will no longer be referred to as a mere Mr. or a Miss., Ms. or Mrs, you would have become a Dr. You will be given a Provisional License to practice medicine as an Intern for a year in Nigeria by the MDCN. However, you still have a step to take before you can practice without supervision.

  Internship (Housemanship)

  You must undergo a twelve month period of internship in a hospital certified for internship training by the MDCN before you can be full registered. After this internship, you will obtain your certificate of full registration which allows you to fully practice medicine in Nigeria. You must complete this internship within twenty four month of the date of graduation, otherwise, you will be required to sit and pass MDCN's assessment examination before you can be fully registered.

  Final Thoughts

  Many people think of medicine as a "calling" much like priesthood. To some extent this may certainly be true. You must have a great desire to become a physician. A driving passion to help people, to be challenged, and to learn throughout your life. You will sacrifice your time and energy for the care of your patients, often forsaking your family and yourself. Most doctors will tell you they can't imagine doing anything else. Being a doctor is simply who they are, not just what they do. The desire to help others is a need within them, like breathing, or hunger.
  Once you have made the decision to become a doctor, you must pursue it whole-heartedly.
  I leave you with this quote from Aristotle: “It concerns us to know the purposes we seek in life, for then, like archers aiming at a definite mark, we shall be more likely to attain what we desire."
  I hope this has helped you in deciding to become or not to become a medical doctor.
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