Misdiagnosis, common feature in health institutions


…Prompt, accurate lab tests relevant panacea

No doubt, the importance of timely and accurate testing cannot be over emphasised. However, while many patients have faced various complications due to late and inaccurate testing, many patients have either died out of medical error or injury sustained due poor quality diagnosis. The ordeal of misdiagnosis can be said of Stella Emmanuel, if not for timely and accurate testing that saved the situation; even as some Nigerians are not fortunate to tell their story.

Sharing her experience to BusinessDay, Emmanuel revealed that if she had been diagnosed earlier, she won’t have made to undergo any kidney transplant. According to Emmanuel “if you live within Nigeria, you will always have strain of malaria in your bloodstream. When I started showing signs of malaria, I was tested and treatment for malaria. After the usual cause of treatment, I did not get any better. I was asked to do more testing.”

“After the second level of testing, which showed that she had typhoid fever, I became worried. I found that very strange, because I thought the source of typhoid fever is from the food and water you are getting. I am very particular of where and how I eat. At this point, I started wondering: In all of this, I was like, what is exactly going on? To cut the long story short, the doctors came to me again, and said: ‘From the result of the test we have done now, it looks like your kidneys are failing.” 

“I was thinking what point could this have been discovered?  Probably that should have been stopped. Eventually, it was true that my kidneys were failing. So, I traveled abroad. And there it was confirmed that both kidneys had actually failed and I had to be on long time kidney dialysis just to stay alive. While one is on dialysis, testing is key and fundamental to the success of the dialysis; one need to know one is reacting, the toxins, etc. to underscore the fact that timing and accurate testing is pertinent.”

Stella was able to have her kidney transplant done last year which saved her the stress of going for dialysis thrice a week at the hospital. She however revealed that to ensure that I did not have rejection of the kidney, I was placed on regular testing, a timely and accurate testing for that matter.

“I had my transplant done in May 2010 and still under observation from the hospital. I received a call in August 2010 from doctors for medical check. After seeing the doctors, I left.   Few hours later, the doctors I saw earlier in the day called back and insisted I must come back immediately and was subsequently admitted.  It happened that my body was showing signs of rejection from the transplanted kidneys. They were able to do an accurate test and the result was received timely. I was called back to the hospital, quickly changed the drugs and treated the signs. Now, I am okay and stable,” she concluded.

In today’s Nigeria, it is now a common feature to find physicians telling patients feeling feverish to be diagnosed for malaria without laboratory test been conducted. This has often led to wrong, inaccurate or incomplete diagnosis and consequently treatment of a disease, infection or other ailment.

Addressing this medical situation, Pamela Ajayi, Managing Director PathCare, Nigeria revealed that prompt diagnosis with accurate laboratory test before treatment would eliminate misdiagnosis and improve life expectancy.

Speaking during a seminar on Medical Laboratory and its Significance in Modern Medical Practice” 
organised by PathCare, Nigeria, Ajayi cautioned that self medication should not in any way be encouraged.

“Laboratory tests are very essential because no drug is absolutely safe. Self diagnosis only treats symptoms and not the problem. There is need for patients to take ownership of their body and object when doctors do not carry out laboratory tests before treating them. The advantages of medical tests is to improve the efficacy of diagnostic medicine, compliments the technology deficiency in the tertiary hospitals, avail doctors the opportunity of practicing evidence based medicine (EBM) and bridge the gap between Nigeria and other countries as well as engender trust in doctors request for quality laboratory results. There is the need to invest in upgrading laboratories to meet world standard. In Nigeria, ISO accredited medical laboratories are hard to come by.  PathCare is currently the only ISO Accredited Medical Laboratory in Nigeria,” Ajayi disclosed.

While lamenting the consequences of wrong diagnosis which has led to the untimely death of patients, Ibironke Akinsete, Chairman, PathCare disclosed that quality control measures must be put in place to ensure that each test is conducted according to set standards. Akinsete, who is also former chairman, National Agency for the Control of AIDS (NACA), described quality assurance as overall programme that ensures that the final results reported by the laboratory are accurate.

“Unfortunately in Nigeria, 90 percent of laboratories in Nigeria cannot boast of internal quality control which has become the bane of accurate laboratory results in Nigeria. Most laboratories in Nigeria have inadequate trained personnel, poor reagent equipment among others and this has made laboratory results from Nigeria unacceptable abroad. To improve the laboratory results, there is need to put in place standards operating procedure that everybody must follow. There should be regular audits to ensure that standards are maintained. Pathology supervision is also necessary. To put an end to patient doubts and medical tourism, there is need for laboratories to be accredited by recognised bodies to ensure that they meet minimum quality management standards,” Akinsete stated. 


Nigerian situation

It is believed that there is an estimated 300 pathologists are serving over 140 million people a situation experts say could be a major risk as when overworked. No doubt, tired pathologists are likely to make wrong diagnoses even when there are very good quality systems in place to try to prevent these mistakes.
Speaking to BusinessDay, Oyetunji Soriyan, Consultant Clinical Pathologist, College of Medicine, Lagos University Teaching Hospital (LUTH), idi-araba, revealed that pathology as a critical part of the medical process as without high quality pathology services, healthcare would degenerate and services could eventually grind to a halt.

“Despite the critical role pathologists and pathology play in medicine, very few people understand what pathology is all about. They play an important role in diagnosing and monitoring diseases such as diabetes and rheumatoid arthritis. They play an integral role in blood transfusion services and they are at the cutting edge of using genetics in diagnosing disease. More than 70 percent of all diagnoses involve pathology tests. Add to this, the important role pathology plays in monitoring disease giving the reason why the profession is critical unfortunately, Nigeria is in crisis in that aspect,” Soriyan concluded.

Way forward      

Sade Ogunsola, Consultant Clinical Microbiologist, College of Medicine, University of Lagos, identified perceptions as one of the factors fueling poor laboratory results. According to her, most Nigerian patients see laboratory testing as last resort after self medication. 

In her words “There is need for Nigerians to change their perceptions and unfortunately, governments at all levels don’t see laboratory medicine as a priority. In the last two decades, the laboratories in Nigeria have been allowed to degenerate. There have been poor infrastructures both in private and public, no clear definition of job descriptions for the different professions within the facilities,” Ogunsola conluded.

Currently, there is no clear policy and guidelines on the management and leadership of facilities, lack of internationally adopted standards that encompass all professionals and no intentionally accreditation and monitoring system amongst others have continued to plague the system.

Comments

Popular posts from this blog

Unilever named most successful brand among FT500

Nigeria now emerging hub for pharma market expansion in Africa

WHO unveils list of essential diagnostic tests to improve health outcomes