I followed the recent case in court put up by some members of the Kenya Medical Association (KMA) who wanted the court to make a very strange ruling. The complaint was that there were far too many people using the title ‘doctor’for their comfort. The starting point for this campaign was one profession they have had an age-old rivalry with, the pharmacists.
This is not the first time such an offensive was launched by these members of the ‘noble profession ‘against the pharmacists. It happened a few years ago, when some members of this dignified profession close to the policy makers, decided to come up with a well-crafted ‘clinical allowance’ that was primarily meant to lock out the irritants that were pharmacists than it was meant to reward the hardworking doctors who were then grossly underpaid. The pharmacists successfully wrestled this challenge by convincing the policy makers that they talk to, touch and stay in close contact with the patients for sufficiently long enough time to risk their health just like other health workers. This only served to heighten the professional tension to those who chose to go that way, as opposed to better working relationship and even more productivity for those who chose to accept the indispensability of the other.
Over many years, because of their sheer numbers and lack of many options, medical officers have dominated the public service from entry level to the policy level. The policies that sometimes inadvertently affected other health professionals, mostly negatively, could be lobbied through their non-statutory medical association. Better still an overzealous and pragmatic director of medical services who sits in so many boards that I have lost count of them was all that was needed. He is mandated by the law to lord over many concerns, from those that are of little concern to his backbone profession to those that are of no concern at all to him or his foot soldiers.
Now lets assess the damage this chronic infiltration has had on our health system.
All the management structures are based on their professional hierarchy model and all other health professionals are made to play supportive roles. This system inspired the titles like the District Medical Officer of Health (DMoH), the Provincial Medical Officer (PMO) being medical officers. I would not mind these titles if they were only mandated to oversee their fellow medical officers like it is for all other cadres. These individuals are however charged with the management of health services at the district and provincial levels respectively. Unlike other managers in all other sectors, all that one needs to be a DMoH, and theoretically a PMO is to be a post-internship medical officer. The Ministry of Health would then attempt to take these ‘managers’ through countless shuttle trainings that are costly to the taxpayer in an attempt to make them competent.
For a long time I have been made to believe that government funds for Primary Health Care (PHC) activities is actually nothing more a remuneration package for the DMoH. Why don’t they just call it DMoH extraneous allowance or bossing allowance, because that is what it is?
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The new move by a section of KMA is just but the reinforcement that the debates that started at the medical school are not about to go, rather they are getting more dreadful. While at the medical school level these debates were healthy because it was a critical ‘baby steps’ towards professional identity of the different health professionals being trained there, it only serves to inflate personal egos at the working environment level. For instance, at the medical school level, pharmacists were branded ‘shopkeepers’ in unending rhetoric. That concept was suddenly dropped as soon as all stepped out of the gates of medical school and scrambled to be shopkeepers. This is a case of a subject loathed at the medical school being the best alternative for all and sundry.
They want the court to strip this title from the pharmacists for a number of reasons. Let us keep that for another day.
The most puzzling thing about this campaign though, is the amount of negative energy devoted to it. The medical profession is plagued by so many problems, right from mushrooming clinics and quackery, unregulated alternative medicine practitioners, poor remuneration and working environment for those in the public sector among many other factors. These matters in my opinion were more urgent and needed more lobbying among the policy makers. By trying to fight pharmacists, the members of the medical profession are fighting against an insurmountable change in the provision of healthcare worldwide. The new trend in pharmacy training is biased towards training a new breed of pharmacist with wide range of clinical skills. The professional undergraduate degree of Doctor of Pharmacy (PharmD) is being offered each year in more Pharmacy schools around the world.
More pharmacists are enrolling for advanced degrees in general and chemical pathology, anatomy and physiology, clinical pharmacy (a pharmacy equivalent of clinical medicine). Pharmacists are specializing in paediartics, chemotherapy, nuclear pharmacy, diabetology and cardiology. Pharmacists are even now specialising in health policy and public health. I cannot think of any field that was tighly closed to pharmacists a few years back that is not wide open now. Not even clinical trials has been spared!
More are even advancing in their traditional fields, like in pharmaceutical analysis and drug quality control. Everybody now needs them in a liberalized world of medicine where both genuine and counterfeit products and ‘professionals’ are in the market. Does it really matter how good you are in therapeutics if the product you are using is fake?
More pharmacists are becoming more things. It is a herculean task trying to keep up with them, especially if your only motivation is striving to contain them. Good luck though!
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Call me Versita. I am the lawyer representing the defense and this is my closing argument.
“Your honour, I would like to submit to this court that this petition is in jest! ‘I slowly count to 5 then back to zero as I take in the reactions in the room. The petitioner’s lawyer winks at me because he knows that is the defense I use when I have no defense; but not today as he is about to find out.’ It’s in jest for two reasons: the pervasive quality of contempt exhibited by the petitioners and the big-man syndrome that has finally come to fore. The petitioner failed to prove to this court, beyond all reasonable doubt, that the use of the title doctor by the pharmacy profession adversely affects the enjoyment of the title doctor by the profession of medicine or in any way feasible, by omission or commission, harms the quality of health care in the country. These should have been the petition’s backbone but instead the petitioners brought expert witness after expert witness with trivial rhetoric on quackery, misuse and merit; and this is where the contempt factor comes into play: that the petitioner would single out or rather include the profession of pharmacy with such derogatory and subordinate characteristics. The petitioner also failed to show reasonable cause as to why the title doctor should be in the possession of the profession of medicine; and this is where the big-man syndrome comes in: that the petitioner would attempt to claim custody of the title doctor and lord it over others.”
“It is with great disrespect that a profession would contemplate, and proceed to actualize, the idea of not only attempting to micro-manage but also censure another profession by means of the justice system in Kenya. This is why: good students of sociology would remember that a profession is defined by a code of ethics, a regulatory body and a body of knowledge; qualities that are present in both; better students of sociology would also infer that a profession is thus an autonomous body that is only subordinate to the state and its laws; and the very good students would know that it would be to its disadvantage if a profession were to take a position that non-veritably severs its public relations. The petitioners were neither students of sociology nor good. ‘I hear mmhh’s. The judge calls for order.’ As the petitioner continually insulted the little knowledge he assumes the court has ‘The judge menacingly retorts “The defence will desist from belittling the court.” I acknowledge and proceed.’ I’ll rephrase. The fact that structured professions are not native to us Africans was continually exemplified by the petitioner’s witnesses, whose disjointed arguments, only served to show that, even after seventy three years of accepting, modelling and institutionalizing the idea of professions, we still are miles away from realizing that for professions to work for the good of the people, they must, and make no mistake about that, MUST, work as one inexorable articulate unit of skills and ethics.“
”The court should appreciate that, it is no longer necessary to spend our youthful years in medical school to attain the title doctor. The petitioner feels this is not right and maybe he should, but that’s a suit for another day ‘As I look at the petitioner’s attorney’. But consider this; the Right Reverend Dr. Martin Luther King could not treat a wart even if his life depended on it: his titles were awarded to him by his profession as recognition of the quality of work he had done in its interest; Dr. Mukhisa Kituyi would run to the pharmacy and get advice on how to manage an irritating dry cough. This does not make him less of a doctor to political scientists but it clearly does to the petitioner. If Dr. Ken Ouko, a sociologist of repute, had spent some time with the petitioners during their formative academic years, maybe we would not be here today. And, by inference, to represent to this court, that a member of the public would go to Dr. Dre to manage psychological distress is not only an insult to the member of the public, but to Dr. Frank Njenga. Let’s give the public a little more credit. They are actually smarter than they look! ‘I hear giggles from the gallery and know that someone understood. I think I see a smile cracking the judge’s face. But maybe it’s just me. I decide to play the sarcasm card further.’”
“While we are reserving titles, why stop at ‘doctor’? Who owns the title ‘Sir’? I suspect it is the English. The English should with immediate effect ban the use of the title ‘Sir’ by all persons of non-English origin. By extension, the English who are not geographically located near London should desist from using the title on their office doors or with their names. I don’t know about ‘Mr’, ‘Miss’ or ‘Mrs’. Someone should come fore and claim them before I do. Why should we have Bishop Margaret Wanjiru call herself Bishop? We all know that the title belongs to the Lutherans, the original Protestants. Or is it the Presbyterians? It doesn’t matter, let them have it back. Let’s also give them back Deacon, Reverend and Pastor; they’re all theirs too. Now, if we can’t find the owners of ‘Honourable Member’, then I think it’s time for the fall-back title: no title at all. ‘Your Worship’? ‘Your Worship’? That should only be reserved for His Real Worship. Too bad he can’t be represented. I would have loved to. I hear he rewards well. Oh, I almost forgot ‘I turn to face the judge’; ‘Your Honour’. Let’s shred that too. Can I call you Erico? ‘‘Versita, you are one sarcastic innuendo short of contempt of court.’ The judge warns me. I’m surprised he let me come this far. The petitioner’s attorney now knows where I am headed and sulks on his seat. I am lucky it’s the closing. Were it cross-examination, I would have had a few sharp objections up where the sun don’t shine.’”
“I am not in the medical profession, but I have some tips for the future for the ladies and gentlemen of the medical profession. As I was researching for this case, I became more and more convinced that this suit was based on nostalgia. Now I am sure. In the olden days you used to go to a doctor, and after asking a few questions, touching your tummy and listening for your heartbeat, I think, with the cold gadget (from the back!), he would write a prescription for medicines that would magically work. These were the grand times. Everyone wanted to be a doctor, even little kids with IQ’s of paper clips. But I realized they have a name for it. It is called, empirical treatment; that is, treatment based on nothing more reliable than the person’s oblique experiences. In better endowed countries, this has been superseded by evidence based medicine. The doctor’s experience is no more important than diagnostic and confirmatory tests. In our country, as modernity is slowly percolating through, the public is realizing this: that, tests when performed impeccably, are incapable of being reckless with someone’s life. But, even with all the tests available, the subtle input of the recall-factor is still as important today as it was, especially in areas where sophisticated tests are lacking. Of all people, doctors should know this. Now, there is a tug to remain the ultimate profession in the face of such ego-diminishing realities and this suit is just one way to regain it. But I want to tell them that, the size of the world has been proven by scientists to be big enough, for your egos and the little egos you assume the rest of us have. You are not as special as you imagine. ‘I don’t know why but I am now agitated.’ Be nice to your colleagues, for God’s sakes you go to the same medical school, share classes and even rooms at the university. The real troubles with your profession stem from the quackery that has blind-sided you from the infiltration of the clinic-business by untrained or undertrained persons who claim to be medical doctors. Experience is not recyclable, even the kid with the IQ of a paper clip knows this.”
‘I am now facing the petitioners and my voice is raised a little for emphasis.’ “Today, I am asking this court, with purpose and poise, to send a clear message to the professional organizations in this country and the world at large; THAT ALL PROFESSIONS ARE THREADS THAT INTER-WIEVE INTO ONE PERFECT TAPESTRY THAT CIVILIZATION SO DEPENDS ON, AND NO PROFESSION IS MORE SIGNIFICANT OR LESS SPECIAL THAN THE NEXT. To, even assume that your profession is of more importance than another is not only contempt for other professions but for the society at large. Without plumbers, would gynaecologists be able to explore ‘plumbing’ with clean hands? ‘More giggles.’”
“Today, I am asking this court, with temerity and tact, to teach a lesson to the professional organizations in this country and the world at large; THAT INTER-PROFESSIONAL CONFLICTS OF LITTLE MERIT WILL NOT BE DIGNIFIED BY ANY JUSTICE SYSTEM OF SUBSTANCE AND ENJOYMENT OF THE ENTERTAINMENT THAT ACCRUES FROM SUCH SHOULD BE RESTRICTED TO PUBLIC PLACES OF INEBRIATION.”
“Today, I am asking the court, with clarity and candor, to show the professional organizations in this country and the world at large, THAT TITLES ARE NOT POSSESSIONS, THAT THEY ARE NOT EVEN OWNABLE. To claim ownership is not only an absurdity, the sum of all its unnaturalness is equal to the difference between a wet-kerosene-soaked-rag-doll and the dried ink at the tip of a sharp-end-ball-point pen. ‘Now I know I have lost everyone with the esoteric metaphors. I close.’”
“Let this court set a precedent. Let this suit be what it is: a petition in jest. That’s all Your Honour. ‘I bow and take leave.’”
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