Nigeria's Google Physicians: Young doctors using smartphones to diagnose patients

2016-01-30
THE PUNCH Newspaper- Jesusegun Alagbe

Sometime in November 2015, Joseph Ayinde, a bank employee in his mid-30s, almost broke the phone of a young medical doctor he had gone to visit for medical checkup in Lagos.

As he was narrating what he was feeling in his throat to the doctor, “who is in my age bracket,” Ayinde said he could not comprehend why he would be sharing his pain and the doctor would be fondling with his phone.

“He did that for almost 15 minutes and I was very angry. I did not understand why I should be talking to someone, moreso a doctor, and the next thing he does is to start playing with his smartphone. Seriously, I almost collected the phone from him for smashing because it was as if he was not paying attention to all I was saying,” he told our correspondent.

It was afterwards that Ayinde realised what the young doctor was doing with his smartphone.

He was actually not fondling with it — the young man in a grey suit was, however, checking up on the Internet what throat disease fits the symptoms Ayinde had just described.

“Eventually, he told me I was suffering from tonsillitis, to which he prescribed some drugs, which I bought that day. Some days later, I felt better,” Ayinde said.

Tonsillitis, according to medical experts, occurs when the tonsils (the lymph tissue in the throat) become infected. Symptoms include sore throat, fever and swollen tonsils. The disease is normally easily diagnosed and treated.

However, Ayinde could not stop marvelling why a doctor had to resort to using a smartphone before he could correctly diagnose his disease.

“Seriously, I was surprised, but I didn’t feel good. I mean, I don’t understand why the doctor had to google before he could tell me what I was suffering from. I could have as well done that without his help. I only wanted not to resort to drug abuse, especially because I could be wrong. He is a professional and I expected him to know his job at heart,” he said.

Probably, Ayinde’s experience is a new phenomenon in the way medicine is practised nowadays by doctors, especially the young ones, who are just starting practising.

Ms Ayibadiwori Charles’ recent encounter with a doctor in Port Harcourt, Rivers State, also confirms this.

Due to the delay being experienced most times before seeing doctors at some government hospitals, Charles always prefers visiting a private hospital for any medical checkup. But on a recent visit to her frequently-patronised private clinic, the senior consultant she’s used to was not around.

“I was told he travelled out of the city, so another consultant had to attend to me. He’s a young man, perhaps in his late 20s. As long as he could provide answers to my medical problems, I had no issue,” the dark-complexioned lady told our correspondent on the phone.

Instead of the young doctor to diagnose what was wrong with Charles, she was the first to diagnose what was wrong with the doctor.

“He felt nervous, I could see it in his face. He took a long time before he settled down in the swivel chair in front of me,” she said, adding, “By the time I started sharing what was wrong with me, he pulled out an iPhone from his jacket and was typing what I was saying on it.”

Charles didn’t at first understand what was happening, but eventually she did.

She said, “When I finished what I was saying, he brought out a pen and paper and prescribed some drugs for me. I asked him what I was suffering from, but he snubbed me. He only said once I took the drugs he prescribed, I would be fine. ‘Don’t I deserve to know what’s wrong with me?’ I asked him.

“He had to check his smartphone again to tell me what it was. Because I was not sure of his prescription, I left his office in annoyance to ask an old nurse what I could be suffering from and to confirm whether the drugs were appropriate. It was the nurse who helped me out. Sometimes, older nurses are even more experienced than young doctors, in my opinion.”

For Gabe Bassey, who lives in Uyo, Akwa Ibom State, he would probably reckon with Charles’ opinion.

When he was diagnosed with typhoid fever two years ago by a young doctor who he was referred to by a friend in the city, he had an instinct that that was not what he was suffering from.

“I suspected my problem was not as serious as he painted it. He had an iPad and was checking up certain things as I spoke with him and he diagnosed typhoid. I was only feverish and vomiting, but it could not have been typhoid fever,” Bassey shared his experience via Facebook chat.

Bassey’s guess was right — the following day, he met with a senior doctor who confirmed to him it was malaria.

“I just hope the guy knows he’s dealing with human lives in the medical profession, not animals’, because if he knew, he wouldn’t be misdiagnosing. Was it because of inexperience or because he wasn’t properly trained?” the baffled Bassey asked.

Doctors and smart devices

Technology is surely changing the landscape of almost every aspect of life, including medicine.

Mobile phones are transforming how people in the developing world such as Nigeria access and use information, and adoption rate is soaring, with about 30 per cent smartphone penetration in Nigeria, according to researches from the co-authors of ‘The new digital age’ — Google’s Eric Schmidt and Jared Cohen — and Pew Research.

There are now tools for patients in developing countries to search for and receive expert, highly-specialised care from licensed doctors around the world by phone, video or text messages.

There are innovative platforms to search for doctors by speciality, qualification, language, patient ratings and location. Then, patients can communicate directly with those doctors for a nominal fee.

Likewise, there are platforms whereby medical doctors and other professionals could hook up with their colleagues around the globe for help in the diagnosis and treatment of diseases.

This is why a 34-year-old Lagos-based medical doctor, Bukola Adelaja, said he sometimes uses his smartphone and tablet in the presence of his patients.

He said, “I graduated from the prestigious Obafemi Awolowo University, Ile-Ife, Osun State, so I’m a qualified doctor. But things are fast changing in this dispensation. New researches are carried out every day and there are new discoveries.

“And medicine is unlike any other field where you can delay your client till the following day for them to know what’s wrong with them. Patients are impatient; they want to know what’s wrong with them as soon as possible. Since no man is an island of knowledge, there are some medical communities online where, for instance, I can interact real-time with other colleagues across the globe and they help out instantly. So I don’t think it’s bad.”

This practice whereby doctors and/or other professionals collaborate to find solutions to problems using technology may not be bad, after all, as suggested by the United States Chief Technology Officer, Megan Smith, in a recent CNN article.

Smith, who once worked at technology giant Google, said a platform which brings together different people with different skills could solve the world’s most difficult problems.

For instance, during the outbreak of the Ebola disease in 2014, doctors complained that their protective suits were hot, uncomfortable and scared kids. By putting together a team of doctors, as well as fashion designers, artists and engineers, solutions were provided to the problem.

That was a case of doctors and other professionals working together as a team to find solution to a major problem.

“That is how we’re supposed to operate in this century,” noted Adelaja.

A former Chairman of the Lagos Chapter of the Nigeria Medical Association, Dr. Francis Faduyile, also said the practice should not be totally condemned as it exposes users of such platforms to more knowledge.

He said there are medical sites where doctors seek help from other colleagues from around the world in order to make appropriate decisions concerning certain medical problems.

“No one is an island of knowledge; we learn from others. For instance, I’m a pathologist and if I’m stuck somehow on certain lab projects, I refer to my books or online medical platforms for help,” he said.

However, he advised doctors using Google not to trust every information it brings, as some are sometimes wrong.

He said, “I think this is a function of the age we’re in — an advanced one. Today, you can get virtually any information you want at your fingertips. This practice is also done in the developed climes. Doctors hook up with one another in order to jointly find solutions. But it is not on Google.

“There are medical sites that offer help to doctors to make appropriate decisions. It’s not bad. It’s a result of the technology age we’re in. As a matter of fact, these sites are not open to everyone; you have to be a medical professional before you can gain access in, so it’s not the ordinary Google.

“A doctor should be able to give his best to his patient, but he should not trust every information on Google. All the same, a doctor should be able to make decisions using his college and residual knowledge and not rely on these platforms all the time.”

In 2006, the British Medical Journal published a study showing that Google is a useful tool in doctors’ toolkits, especially when it comes to difficult-to-diagnose illnesses.

In that study, doctors plugged three to five search terms into Google of 26 diseases that are notoriously hard to diagnose, including Cushing’s syndrome and Creutzfeldt-Jakob disease.

Researchers found that Google was right 58 per cent of the time in diagnosing the diseases, though they acknowledged that the person doing the googling needs to also have a wide knowledge base in order to know what to search for.

All the same, new researches suggest that using Google to diagnose illnesses could be a very bad way of getting appropriate medical treatment.

A recent survey by Netherlands-based global information services company, Wolters Kluwer Health, showed that 46 per cent of doctors frequently use sites like Google and Yahoo for treating, diagnosing or caring for their patients.

By comparison, 68 per cent of doctors said they frequently look to professional journals and 60 per cent of doctors frequently go to their colleagues, according to the survey. Forty-two per cent of doctors said they frequently get their information from conferences and events, and 42 per cent said they frequently get their information from online health sites like the Mayo Clinic and WebMD.

Meanwhile, 90 per cent of doctors think that the ability to go online for resources has improved their ability to provide care, while just 12 per cent think the opposite — that online resources have hindered their quality of care.

“Skilled doctors don’t rely on Google”

Just like Faduyile said, a 73-year-old Ibadan-based retired medical doctor, Adekunle Olaosebikan, who spoke to Saturday PUNCH on the phone, said in his early years in the profession, there was no Internet, no smartphones, nothing!

He said, “We made use of our brains and we did our best. I feel fulfilled as a medical doctor. There were (and still are, I believe) great medical schools and lecturers. As much as there are technological tools that young doctors can make use of today to be better on the job, they should not be stupid. Skilled doctors don’t rely on Google.

“If a doctor can’t diagnose his patient without resorting to the Internet, I don’t think such a fellow is qualified to be called a doctor. He should go back to the classroom. What if when you’re googling the symptoms of the disease of your patient, Internet connectivity fails? Will you ask your patient to come back when you’re back online or just dismiss them?

“It’s good we’re in the technology age, but there are many things a professional should know offhand without going online. Collaboration is good, definitely, but we should know when to seek for it. I also advise the government at all levels, especially federal and state, to equip medical schools in the country for the next generation of medical doctors.”

Olaosebikan’s last statement could not be unconnected with the fact that there is a shortage of (medical) facilities in most universities for students to be equipped with adequate knowledge.

Sometime last year, Saturday PUNCH investigations revealed that in certain medical schools in Nigeria, as many as 50 medical students were attached to only one cadaver for practicals.

“That is an insult to us as a country. In the beginning, this was not so,” lamented Olaosebikan.

To corroborate his point of inadequate training of young doctors in some universities in the country, an unfortunate incident happened to the sister of a Lagos-based businesswoman, simply identified as Mrs. Halimat, about five years ago.

Halimat’s pregnant niece — whose parents died when she was just five — was admitted in a private hospital in Abuja when she was experiencing difficult labour. Unfortunately, the owner of the hospital, an old and experienced medical doctor, was not in the city, so his medical doctor son had to handle the case.

Since her elder sister was already with the pregnant lady, Halimat did not at first bother to travel to Abuja to check on her niece, who was in her late 20s. But as the lady’s condition grew worse, Halimat had no option than to take a flight to Abuja to see what was happening to her niece.

She narrated to our correspondent, “On getting there, I was furious, I was mad. My niece was on the bed, lying in pain, due for labour, yet the young doctor was telling us she was not and that we should be patient. He said her water bag had not yet broken.

“Meanwhile, my niece was carrying twins and the water bag that was up had already broken. What the young man needed to do was to break the one down for delivery. He was just too arrogant, so I had no option than to threaten him that if anything happened to the lady, I was going to sue the hospital and I’d ensure he regretted not listening to me all his life.”

Luckily, the young doctor’s father arrived and a caesarean section was quickly done to remove the babies.

“Thank God that the older doctor came, maybe my niece would have died due to the inexperience and arrogance of the young man,” she added.

Telemedicine in Nigeria

The American Telemedicine Association defines telemedicine as the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.

In Nigeria, there’s already a campaign for the adoption of the facility, with stakeholders calling on the government to embrace the platform as it will facilitate the mobility or transfer of health services to patients in their locations using mobile phones and the Internet.

“The medical world in Nigeria would be a global village if mobile health care is fully deployed,” a health expert, Dr. Sonny Kuku, said in a report on logbaby.com, citing the reason that Nigeria does not have enough doctors, especially in the area of diagnosis.

A recent research by The Economist, titled ‘Emerging Health: Path to growth,’ showed that the about 70,000 registered medical practitioners available to about 160 million Nigerians was deficient, hence the need for the adoption of telemedicine.

“Telemedicine is one of the easiest methods in quick diagnosis and care. (For instance), a doctor conducting surgery could relate his procedure to any expert in the world and he/she would be told what to do because they are both seeing the patient,” said the President of the Association of General and Private Medical Practitioners of Nigeria, Dr. Omolola Anthony.

However, the country’s telemedicine project, which cost about N500m and co-initiated by the federal ministries of health, and science and technology in 2009 has yet to be completed.

The project, which was tied with the Nigerian Communication Satellite 1, has failed to continue because of the woe that befell the satellite.

NIGCOMSAT 1 developed faults after being launched into space and got missing afterwards.

 

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