NEGLIGENCE AND QUACKERY IN MEDICINE: THE DIVIDING LINE

Quackery is when someone pretends to have experience or knowledge, especially in the field of medicine. Medical quackery in Nigeria is construed accordingly. In Nigeria, Bachelor of Medicine, Bachelor of Surgery (MBBS) confers on anybody holding such degrees the legal right to practise medicine and surgery in any part of Nigeria. This practice starts with Housemanship under the supervision of Medical Consultant, and thereafter can proceed as a practice without medical consultant supervision. The hallmark of the definition of medical quackery is that no registered practitioner can ever be called a medical quack in Nigeria. This is even codified in our laws that recognise any posthousemanship medical practitioner as fully qualified to practice medicine and surgery across medical ramifications albeit with corresponding competences.

Medical negligence in Nigeria, on the other hand, is a legal cause of action that occurs when a medical practitioner deviates from standards in his or her profession, thereby causing injury to a patient.The four Ds of medical malpractice are duty, dereliction, direct cause and damages. Each of these four elements must be proved to have been present, based on a preponderance of the evidence, for negligence to be found. While medical malpractice is the breach of the duty of care by a medical practitioner or medical facility, medical negligence does not involve intent. Medical negligence applies when a medical provider makes a “mistake” in treating patient and that mistake results in harm to the patient. The hallmark of medical negligence is that any medical practitioner can be accused. Therefore, no medical practitioner is a medical quack but every medical practitioner could be negligent.

A medical practitioner who goes beyond his area of competence is not a medical quack in that unfamiliar area. He is only indulging in medical malpractice that could result in medical negligence. It must be noted that not all medical malpractice is medical negligence. While the Medical and Dental Council of Nigeria is established to fight medical malpractice, it is not responsible for the prosecution of medical negligence especially when an award of damages is demanded by the victim of medical negligence. Medical negligence involves harm to the patient. That means that where a malpractice does not result in harm to the patient there is no medical negligence.

The issue of medical competency is even another area with questionable clarifications. It is our law that medical competence involves requisite knowledge and skills. Proof of this knowledge and skills does not solely depend on the acquisition of Part Two Fellowship Certification. Infact, Fellowship Certification for any medical practitioner in Nigeria is only a prima facie evidence of knowledge and skills which is all the same rebbutable. Knowledge and skills do not also cure an allegation of dereliction. The stalk of this contention is that every registered medical practitioner in Nigeria, by the extant laws, can theoretically lay claim to competence in any area of medicine and surgery, after full registration, irrespective of fellowship certification. This is because every medical practitioner in Nigeria, on the authorities of extant laws, is certified to practice medicine and surgery in Nigeria with utmost concern for competence. The Code of Medical Ethics in Nigeria went ahead to encourage Nigerian medical practitioners to regularly engage in Continuing Medical Education to maintain and improve competences. The Nigerian Medical College Act goes ahead to provide for specialization certifications. If a medical officer who has stayed under a Urologist, and who has acquired the requisite knowledge and skills from the Urologist over time, starts to undertake urology procedure like prostatectomy without Fellowship Certification in Nigeria, there is no law in Nigeria that precludes him from so undertaking. In a case where he runs into a malpractice proceedings for urology incompetence, he will only have to expend more energy to prove that he has the requisite knowledge and skills from a Urologist's tutulage than the certified Urologist whose fellowship certificate would have done the proof less laboriously. But to say that the medical officer is incompetent to undertake prostatectomy merely because he does not have Fellowship Certification in urology, is a mere unexplored ballooning medical fallacy in Nigeria.

In summary, the basic and the only medical practice certification to practice any area of medicine in Nigeria is MBBS. With this certification, a medical practitioner could acquire medical or further medical competences through Continuing Medical Education, Fellowship Certification or Enrolled Tutulage under a Fellow. While Fellowship Certification is a prima facie evidence of specialty competence, it is not the only proof of competence in any area of medicine. Enrolled Tutulage under a medical consultant over time can also produce competent practitioners who are legally eligible to practice medicine in any area of medicine in Nigeria. These are the "Eliza Fellows" whose only limitation is that they are not certified to train other medical officers under an Enrolled Tutulage.

Awkadigwe Fredrick Ikenna
08039555380
awkadigweikenna@gmail.com