Medical Education

Saturday Aug 3, 2013 -

Today let us talk about medical and nursing education; how we train these most important healthcare professionals.

Most of us are not medical educators and, very likely, have practically no direct input into the formulation of medical school or nursing school curricula or the training of doctors and nurses.

On the other hand, we all, I suspect, know the kind of doctor or nurse that we will want to take care of us when we are sick or when we send a sick child, a father, a mother, a wife or a husband to a hospital.

Again, we all can understand that, in addition to their own innate characters, what is taught to medical and nursing students in medical/nursing schools in the classroom and the hospital wards, what they are taught and evaluated for during their initial practical training (housemanships, nursing clinical rotations) and, lastly, what they see their mentors and seniors do, are the things that mold them to become the caliber of medical professionals that we, eventually, see in our hospitals and clinics.

I believe that the fact that we know what kind of medical professional that we want to see in our hospitals gives us some permission, as it were, to comment on and to suggest to our medical educators what to consider when they draw up medical school and nursing school curricula, training manuals and selection criteria.

Someone once said that students for medical and nursing schools should be selected first on the basis of their hearts before we train their minds. A very apt idea, indeed, for producing compassionate doctors and nurses.

Our medical school curricula must train the kind of professionals that will meet our peculiar needs as a society. Luckily our “peculiar needs”, when it comes to our doctors and nurses, are similar, if not the same, as those in all parts of the world. We want to be taken care of by doctors and nurses who know their stuff, intellectually and technically, but who are also compassionate, caring and ethical. That is the universal characteristic of a “good” doctor/nurse all over the world. The fact that we have some who are not, makes those ones the abnormality rather than the norm.

So how should we educate our would-be doctors and nurses?

I believe that the selection/interview process is important. The heart and the character of the applicant are important. Very important, I believe. Between two equally, academically, qualified candidates, we should choose the one who we can perceive as empathetic. We should develop application and interview questions that will bring out this in an applicant.

We should choose the one who, by exceptional performance on entrance examinations, can succeed in a very academically demanding professional training.

These two criteria, to my mind, must have equal weight in selecting candidates for medical education.

Other selection parameters may be important to different institutions, such as ability-to-pay, for the full fee-paying schools, but I am of the opinion that no matter the additional parameters, the emphasis should be on selecting excellent candidates and training “good” doctors and nurses. Eventually, it is the quality of the products which determine the reputations of medical and nursing schools. And what are the good products? Well educated, compassionate and ethical doctors and nurses! Same as we, the patients are looking for!

Personally, as I have noted and explained in a previous blog entry (May 27, 2013 under “What is wrong with healthcare in Ghana”), we should train our doctor under three themes or headings: the science and practice of medicine; the art of medicine; and the business of medicine.

We should develop training programs and evaluation methods that can confirm that the important things that have been taught in medical school are being practiced in real life. Let me give an example. Any student who does not demonstrate at least an average level of academic grasp of scientific medical knowledge or practice in real life most likely would fail his/her examinations and would be considered a sub-standard doctor in real practice. We teach ethics in our medical schools (as has been clearly established on this blog), and I suspect that students are examined and likely pass their ethics classes. The question is, how much of this ethics training manifests in real life practice? Why do students seem to lose the ethics training (which should include empathy, respect for patients and equity) in practice?

How much emphasis are we putting on the non-pure science component of medical education? Ethics classes and instruction should not be “fillers” to make curricula complete. They should be as important in student training and subsequent evaluation as the knowledge of anatomy, physiology, internal medicine, nursing practice and surgery.

The art of medicine should be as important as the science of medicine.

That is my take. What is yours?

99 comments on “Medical Education

  1. I personally do agree with the writer of this article. All the parameters described here are normal to be considered. One thing, I strongly believe is that an examination should not be the sole criterion to use in selecting medical/nursing students into the medical fields. One maybe brilliant and would be selected but at the end of the day he would not have the job satisfaction because he lacked the passion for the sick.

  2. Really some of the nurses/doctors are not doing the right thing they do not have human feeling and mercy. They do as if they do not fall sick.

  3. Well, first and foremost, humans are the most elusive organism on earth to study, and consideraring our corrupt country, no matter the amout of interview and or questionair that is developed will sort out the passionate ones.
    I studied biological sciences in Legon, whiles there, i noticed that the same laboratory practical questions that was used in the 1980′s is what is being given to the students and I believe probably that is what it is today too. fact is, those who had connections and the answers to those questions were getting 99% in all the lab practicvals, today they are all doctors. in the interview too, those who knew someone got ahead on the questions they ask. Yes many did it for the prestige and the money but that is not important, after all once they got in there they had to study to become Doctors.
    The truth is that it is after becoming a doctor that matters.
    The other fact is, in ghana onces one becomes a doctor or a nurse and etc, thats it. there is no ‘continual education” requirement that must be fulfilled yearly or bi-annually.
    Today I am a registered nurse in the USA and belive me, every two years lic. must be renewed and proof of related continual education is required. Also the company hiring you must periodiccally traing each staff member i topics such :patient/staff relationship, state requirement and any laws regarding practicing proffesion, etc,
    I did not ever though i would be a nurse, ever but I hve come to love it becouse of this little little things i have to keep on learning. rememeber, love grows over time’
    The more people read about a particular thing, thier love grows for it and that is how the passion comes in. sometimes people may be doing some thing they themselves do not relized its effect on others. its important to continually prompt them to be on the alart.

    • 1.Medical students at Legon in the 80s did not study biological sciences(botany and Zoology) They only did Zoology and genetics –Prof Coker.
      2.–The other fact is, in ghana onces one becomes a doctor or a nurse and etc, thats it. there is no ‘continual education” requirement that must be fulfilled yearly or bi-annually– PLEASE can you check your facts before making sweeping statements?
      3. Your piece abundantly,eloquently and loudly speaks a lot and I an resisting the urge to add anymore.

      • I never said they were getting anything from biological sciences, i said they got lab practical questions for chemistry and etc. tell me in the 80′s they were doing chemistry practicals.

      • If you have something to say, don’t hold back. That is what we are all here for. i don’t think anyone is intersted in fighting you.

        • The other fact is, in ghana onces one becomes a doctor or a nurse and etc, thats it. there is no ‘continual education” requirement that must be fulfilled yearly or bi-annually —-when you make such statementsn without checking your facts about doctors, you will have a fight with me

          • CMEs and CDMs ; To Patrick

            Yes , Ghana has the continue education requirements and you can verify from here(http://www.mdcghana.org/cpd.html). you are right though about many other issues raised, the interviews does not sort the non passionate ones out and THE PASSIONATE ONES CAN CHANGE OVERTIME due to frustrations at the job, demands of the profession and sometimes realizing that, this prof. is not for me.

            To. Y. berko,
            Patrick has some truth in what he is saying, I was in legon my self and I saw that. Though he maybe wrong on the CMEs and CDMs your approach of responds was totally uncalled for. it sounded very hash and makes decent discursions difficult.
            Tolerance is very important your field of practice as it is to Patrick’s
            please reach out to Patrick to make up. who knows, one day Ghana may rely on one of you for health service reforms.

            Thank you all for your contributions.

          • Dear Dr. Berko: I am a little concerned about the way some contributions, such as yours, provoke angst and discord rather than enlightened debate.

            Physician contributors to this blog come from different times in their medical training, different environments (those practicing in Ghana and those practicing abroad) and different experiences.

            Some contributors are not doctors. Some are nurses, some are nursing assistants (NA’s), and some are not in the healthcare profession at all.

            My happiness and encouragement is that all these varied contributors are making time and effort to comment, make suggestions, and provide information on this blog.

            On a blog like this, some contributors, including myself, will make statements that are not true now but were probably true in the past, or are even totally false.

            When this occurs, I believe that the best thing to do is to correct the erroneous information in a decent and respectful way without creating the impression that the contributor is maliciously stating a falsehood in order to malign or bash Ghanaian based doctors. That personalizes a, possibly, genuine mistake.

            A statement like “when you make statements without checking your facts about doctors, you will have a fight with me” personalizes issues to a point that, I believe, is unacceptable on this blog.

            There are ways to correct misinformation without taking a distruptive pugnaceous stance (contrast your response to Patrick’s submission with that of Doris below). I know we all have different temperaments and ways of dealing with situations but I will like to suggest that, on this blog, we should all try as much as possible to be civil and decorous with each other and engage in enlightened debate rather that defensive posturing and personal confrontations.

            This blog is a very serious effort to help improve the quality of healthcare delivery in our country. Any and every lover of Ghana, whether he or she lives and works outside Ghana or lives and works in Ghana, is welcome to contribute. There will be disagreements, there will be wrong information, there will be information that others have and others do not have. The bottom-line for me is: Are we able to glean some usable information that can be applied locally to improve healthcare delivery in Ghana? You will agree with me that there have been some truly brilliant ideas that some contributors have put forward on this blog.

            I have gone through the blog and re-read most of the contributions and I will say this, I do not see a deliberate effort by the doctors, nurses, non-healthcare workers abroad to castigate or malign doctors working in Ghana. The information in some contributions may, as I have said above, be wrong because the contributor does not know what pertains in Ghana now. It is in order for other contributors to correct the misinformation without turning the process into a literary “fight”.

            The interesting thing about talking about improving anything is that most people will talk about the bad experiences they have had. Very few people, if any, comment on the good things that occur. This blog is no exception. In a way it is not surprising and should not be interpreted as bias. Every system, including the healthcare system in Ghana, is expected to do good things. That should be the norm so it is when things do not go right that one should expect criticism and call for improvement. This should not be taken personally.

            Our healthcare system has flaws as EVERY healthcare system everywhere in the world has. The aim of critics and commentators is to bring out these flaws and help to make things better. This happens in the US, happens in the UK, happens in South Africa, happens in Japan etc.

            So if we seek, as we are doing on this blog, to identify the peculiar problems that we have with healthcare delivery in Ghana, with the genuine hope of making things better, I think we should all contribute, as imperfectly as we are doing, without creating defensive postures and divisions that are not real.

            Let us all tone down and think of how we can make healthcare delivery better; for the patient, the healthcare workers, and for the healthcare profession.

            Let us really make an effort to contribute constructively to a debate that is important to our country.That is how great institutions and nations are built.

      • Funny how some will attack others but will not share anything sensible of their own. The man wrote what he observed, if you have something else to share, go ahead and share. this place is for matured people, not for poeple needing anger management.

        • every Doctor in Ghana has to have continuous medical education during which cpd points are awarded and this is used to renew their license every year. Please pleas kindly get the right information before commenting because we are all educating each other on this forum.

          • it makes it difficult to read and agree with a comment if i find an untruth in it so please verify and be sure of whatever you put out. we are trying to find ways of bettering our health system, ut this does not mean we should vilify those who are already in it or deny the good practices that already going on. Continuous medical education is regulated by the medical and dental council, every doctor has a number of cpd points he/she is to attain within a year to enble him/her renew his/her medical license. these are advertised in circles only knolwn to the people it affects-i. Doctors, and so if a nurse does not know about this, it is acceptable because it is not information mean’t for nurses. in the same vein, i doubt doctors know much about how nurses renew their license. and so the best thing to do if in doubt, would be to ask a doctor if in doubt.

        • I have something to say , and it is that what Patrick said was wrong and he knows that. Unfortunately for him , he spoke about a time when I happened to be a medical student.
          This site has a potential to do good. It also has the potential to be seen as a lynch mob for doctors and nurses.
          Take your time and read all the threads.
          Give a dog a bad name and it will be very easy to hang it.

          • maybe you don’t know what you are talking about. You been a medical student isn’t anything to anybody, body, so you can angrily make all the noise you want. you can read other people’s comments and see. Ghana must have the most secretive continue education credits requirement. I was in Legon I saw it first hand how practical answers were passed on from generation to generations. it is this arrogance in certain Doctors that has brought us this far.
            I am a Doctor, so I know it all kind of mentality. Sir, I have just finished my masters in HealthCare administration and now looking to a PhD program, my friend and I both from legon. cut your pride because it serves not one, not even you! sorry it had to come this way but next time detach your emotions from the subject. Either you didn’t see it or you are just been defensive.
            have a GOOD Day and make sure, you heart does not explode out of chest due to anger!

    • I think this is a very reasonable contribution and I fully agree with the idea of continual retraining and evaluation. In Ghana we are largely shut off from the rapid results from new research in science and so professionals like doctors, nurses, etc are forced to rely on rehashed information and knowledge over years. In that situation practitioners become bored and frustrated because everything becomes routine.

      However, it is important not to lose sight of the fact that in most countries where retraining schemes are required, it is usually the trade unions and professional associations who have fought for them and not something instituted from above by central government. It is the professionals who understand the need and benefits from such schemes.

      In Ghana, no one should expect such things to be initiated by parliament unless the initiative comes from below. That is how social advancement comes about, people identifying their needs and engaging in collective struggle to achieve them

    • i second u on the past questions issue. we still use these past questions popularly known as grand paa. it really kill my spirit when i realized this in my first year. Ghana is pathetic, africa is pathetic

  4. I suggest people with passion and innate desire to care for´ the sick or injured should be selected for medical or nursing schools in addition to their good performance in the examination

  5. This is another interesting piece for discussion. I just want to share some undertones that have informed the results of products of medical education in Ghana. The products that we find undesirable that is largely informed by the quality of services received.

    I agree that interviews, exams, lectures on ethics, practicum etc, are the standard procedures to assure quality. We have done, and continue to apply these yet have the same outcome, poor quality of services. Upon reflection, I think we have evaluated and reformed these processes, but without paying attention to the real cancer! Are these not done for formality sake, a practice Ghanaians know to do best? Ask new graduates from a medical school, and you would be amazed that not less than 70% passed through the institution because they had connections. This is not to say that they were not brilliant, but questions how effective these processes have better served the larger society. Thus, did the process really yielded persons who were passionate to serve the sick? May be we can’t blame a Medical School Lecturer for pushing the child through this process to create a family of doctors? But I am sure society does not get the best of this arrangement.

    As much as being intelligent is important, it should not be equated to interest. If you ask some graduates from medical institutions, you would be shocked about expressions of frustration and disinterest in the field, and in fact, they wish to be in other professions rather than medicine/health. For them, they served the interest of their parents or immediate families just to honour them with a social honour “my child or family member is a doctor/nurse”. Obtaining the desired profession becomes rather late, hence they are left with no option but to keep on, use their intellect to be on top in their specialities, yet not serve the patient as expected.

    Yes, there is need for continuous education. I appreciate the establishment of the Ghana College of Physician (GCP)and I get excited about the enthusiasm of young professionals who make a lot of sacrifices to obtain the standards. Here again, this is the sad one. Let me get a GCP qualification, an appointment as a specialist and then you can make others slaves! This is the culture and interpretation graduates from medication education give to acquisition of knowledge. Who suffers? The patient. The sub-culture of status given to seniors in the medical field and its effects is saddening. They are bosses, kings/queens in their own empires. They careless about teaching young professionals, let alone rendering services to patients at the time of need. They choose to come on duty as and when they please and yet receive thousands of Ghana cedis from contributions made by poor Ghanaians. Was it wrong to give them opportunity for further training and even pay for it? They passed all the exams in ethics, but we could not fix the poor attitude queries.

    Solutions:
    We should look at expanding access to medical education incorporating it with more stringent evaluation tools that could involve community service components. I think reflective writing from community service should be key.

    We need career guidance centres that could assist us to monitor students and intervene as and when their interest change in the field.

    We can apply a Temporary Appointment (2years) mechanisms for Senior Officers in the field of health to ensure that they are committed to duty and that the patient gets value for money. This could also provide us with opportunity for proper coaching and mentoring of new graduates.

    Medical education and its outcomes has best not served us to our expectation. May be the child did not want to be there in the first place, or got there because of the money and prestige. He/she is intelligent and can remain so to pass all the exams and continue to cope with further educational demands; yet may be abysmal in the conduct of the art. The politics of selection, poor guidance, societal pressures and misconceptions needs re-examined; Sacrifices need to be made.

  6. In Ghana continuing education is lacking for healthcare employees including physicians, nurses, and pharmacists because they cannot afford. In a country where nurses and physicians are underpaid, it is very hard for them to put up any investment towards their continued education.
    In developed countries, especially in the United States, the government has regulations and requirements in place for continued education for healthcare professionals. Healthcare providing institutions, physicians and nurses associations, and other healthcare professional organizations sponsor their employees and members, or reimburse them for signing up to improve their skills. Individuals having their own money due to better remuneration are able to pay for their own continued education to keep themselves abreast with new technologies and techniques.
    There are also donors who support the healthcare profession by giving monies to medical institutions to setup labs and other technological structures for research and training. In Ghana, the money in the system that happens to go to corrupt politicians and their business accomplices does nothing to improve healthcare.
    The worst part is that those who benefit from the government by spending other people’s money add more problems by engaging more ‘spouses’ and producing more children without adding a penny to the healthcare economy. Meanwhile they have provided for themselves money making avenues, and also benefited from bribes and extortion from innocent people to live lavish lives while those people are deprived; ending up in diseases as a result of stresses of life.
    The situation in Ghana can never be resolved because we never have decided to make healthcare a priority. We have never agreed to make the government accountable. As most of us agree to continue to give praises to politicians who steal from us and wave them when they pass by, as well as happy to pay bribes, denying how troubling it is to live in a culture of corruption, our healthcare system will never improve because those who control the money in a dubious system will never give it to a good cause.
    What bothers me is that it looks like most Ghanaians have psychological symbiosis where they are unable to recognize the difference between their minds on one hand and the minds of dubious politicians on the other hand.
    At least, can we believe in the least form of moral concepts if we cannot believe in the whole? Values, virtues, and ethics are so eroded in religion, politics, and business, (the three important aspects of our daily lives), that FALSEHOOD has overtaken the minds of almost everybody. Now we are all left wondering why we cannot have effective and competent healthcare professionals.

    BECAUSE MONEY PUT INTO TRANING HEALTHCARE PROFESSIONALS EQUALS QUALTY HEALTHCARE

  7. ARE DOCTORS THE SAME ???
    a doctor can be
    1, christian
    2.pagan
    3.moslem
    4.poor.
    5.rich
    6,lazy
    7,male
    8,female
    9,married.
    10,not married.
    11,divorced.
    12,had scholarship.
    13,paid his full fees,
    14,paid partial fees,
    15, post graduate entry
    16, has children
    17, no children
    18,academic
    19,non-academic,
    20, you can then add all the numerous specialities and subspecialities in which all these permutations and combinations can enter.
    So they are all as varied as all human beings.
    These will then come forth after their various trainings as the doctor you meet in the clinic, office, or hospital.
    Then comes the employer/employee relationships as well as pay issues and their effects on patriotism and selfish behaviours.

    GOOD MORNING COUNTRYMEN and WOMEN

    • Y Berko, in spite of the variety and implied differences among the list of backgrounds that you have listed, there is always a universally accepted expectation of a good doctor. A good doctor is academically sound and knowledgeable (that is why we pick the best and the brightest to go to medical school and insist on continuous medical education for practicing doctors). If he or she is a surgeon, we expect him/her to be technically competent. In addition to these characteristics, a good doctor is expected to be humane, empathetic and ethical.

      Ones background, whether in an academic setting or non-academic setting; whether he/she has children or is childless,; whether rich or poor; whether working n Johns Hopkins Hospital in Baltimore, USA, Korle Bu Teaching Hospital in Accra, Ghana, Jirapa Hospital in the Upper West, Ghana or a hospital in Khandahar, Afghanistan, these are the characteristics that define a good doctor in the varied settings.

      So even though we are “all as varied as all human beings” the characteristics of a good doctor are universal and identifiable. We cannot, and should not, excuse irresponsibility, negligence, disrespect to patients of a doctor because he/she is in one setting or another. If the setting creates difficulties or limitations that makes the doctor less good then we should all assail the bad environment, identify the limiting factors and ask for and contribute to its improvement.

      Our call is, and should be, that we should find ways to train good doctors, and expect them to remain so no matter their backgrounds.

      • —-We cannot, and should not, excuse irresponsibility, negligence, disrespect to patients of a doctor because he/she is in one setting or another. If the setting creates difficulties or limitations that makes the doctor less good then we should all assail the bad environment, identify the limiting factors and ask for and contribute to its improvement.—–However we should also not ignore patients responsibilities and failures. If they cannot afford medications, investigations, even transport if referred to a secondary or tertiary, do we blame the doctor for holding on for too long???

        • –I will also want to humbly add that the fee paying and the non-fee-paying dichotomy that has been introduced in the mix of Ghanaian medical education will generate bitterness and suppress the little patriotism left in the new doctors — i do not have the means to address that

          • Dr. Berko, I disagree with you that the introduction of full fee paying medical school education will create bitterness and “supress the little patriotism left in the new doctors”.

            I am assuming that the bitterness you are referring to, will be created in those students who had to pay full fees as opposed to those who had government scholarships who would then, by corollary argument, be more patriotic and less bitter.

            First, what is your basis for making such a, rather serious, supposition?

            I will like to suggest to you that it is such artificial adverserial assumptions(and positions) that create some of the unreal divisions and the unnecessary and unproductive friction in the profession.

            My second point is that I have just participated in the teaching, clinical training and final examination of the first batch of doctors coming out of the first medical school in Ghana that is fully fee-paying. I can assure you that those students are as patriotic and committed as any medical students coming out of medical school.

            Indeed because they were fully fee-paying I got a sense that they were very committed and rather serious with their studies. The whole faculty was surprised at how these students will draw up topics that they wanted more instruction in and demand that we give them extra tutorials or set questions for them in unscheduled examinations. They are one of the most examined medical students I know of.

            They called me several times to come to Cape Coast from Accra to cover one topic or other that they felt they were not strong in! I was too happy to do just that.

            As a teacher, I found their enthusiasm and effort to become good doctors very admirable, indeed. It is no wonder then that all of them passed the final examinations and are waiting for their graduation at the end of this month.

            They have planned with me that they are going to develop their own evidence-based clinical pathways and clinical protocols (based on protocols of Cleveland Clinic, Johns Hopkins Hospital and Mayo Clinic!) during their house jobs in order to improve and standardize the care of patients in the Cape Coast Regional Hospital. Pipedream? No. I see innovation and striving for a higher standard!

            I do not detect any bitterness in them and I am unable to accept that they will be bitter doctors or less patriotic in the future because they had to pay fees. Indeed I get the impression that they want to be good doctors in order to justify the heavy sums of money that their parents or parent surrogates paid for their education.

            Dr. Berko, I will like to suggest this: some of us seem, sometimes, to be so intent on creating artificial and acrimonious divisions and positions that distract from the central core issues of our profession: how to be good doctors who do good things to and for our patients as our profession and the oaths we swear demand.

            Have we become so distracted and disillusioned that these non-issues are the things that capture and drive our emotions, as doctors?

            If so then we need to get back to the base! That is what some of us are trying to say.

        • Dr. Berko, I do not understand this issue of a doctor “holding on for too long” and how it relates to patient non compliance or pernury.

          If a doctor, encounters a patient who requires a level of care that the doctor is unable to provide because of lack of expertise or institutional resources, the right thing to do is to refer the patient to a level of care or institution that can treat the patient adequately. It does not matter if the patient has not been taking his/her medications or has been unable to do investigations.

          The equation should be straightforward: patient doing poorly + no available services or expertise = refer immediately.

          (Dr. Berko, I am inferring from this your contribution that you are in private practice. ??)

          • I disagree, Dr Boateng,-
            —–The equation should be straightforward: patient doing poorly + no available services or expertise = refer immediately.—-
            That is too simplistic and this is where the education of our Doctors need to be modified to include
            —WHAT TO DO WHEN THE PATIENT YOU ARE SEEING (or relatives)CANNOT AFFORD YOUR REFERRAL.—–but (THEY)can afford his expensive funeral.
            It is an economic and socio-cultural issue which cannot be disentagled from health care.

  8. I have been thinking about this topic of medical education in Ghana for while and I can’t seem to see any headway to improve it . In my opinion, it’s a question of attitudes and traditions as acquired from home and the Ghanaian culture and society that have been shaping our lifes and consequentlly affect the kind/mode of training not only in medical/nursing schools but all levels of education. In as much as we try to instill In children to respect and obey elders and grown ups , we inadvertently or conscious do not recognize the contribution of the young, the less formally educated individual among us. It’s easy to see how hard it is for the grown ups or those who consider themselves more educated to accept opposing/different views. A teacher cannot be “challenged” by a student with new/additional info, neither can an elder or profs be told otherwise.
    When a prof is walking into a classroom, he does so with air of importance. So does the “rich guy” living in the community. Everyone feels so important to him or herself its hard to “come down” to teach how to respect or change attitude towards patients when the teacher or student is learning from home/ society how to carry oneself “big”.

    I may be wrong but I think most of us who are seeing and appreciating the these problems in Ghana have either lived, worked or attended school in the western countries especially USA. Most of us came to this part of the world and realized how different things are, how a person regardless of status or achievement is treated.

    I will give u a personal eg. I lived and spent time with friends at legion and korle bu while pursuing my undergraduate degree at UST. I shadowed doctors at korle bu hospital for years while preparing my myself to ener medical school. I saw first had how my own friends and acquaintances who are doctors were treating & talking to pt. My own sibling was working there as a nurse so i paid her occasional visits and saw how some nurses world shout on pts . I recall these with sadness because I witnessed a lot of unfortunate attitudes from all kinds of health personnels not only the doctors and nurses.

    I left ghana and was fortunate to attend medical school in the USA after obtaing a Bsc in ghana. As medical student I met and followed newly accepted interns and residents from ghana and other African countries who had difficulty knowing how to talk or instruct medical students like their American colleagues. They did so with strong instructive voice and harshness jst like i witnessed in ghana from my profs. It takes a while to learn that residents/nurses/profs in America talk to their students like their equals and respect b4 they adjusti.

    During my residency it was really odd to meet and hear a freshly accepted Ghanaian trained physician trying to exhibit “I know it all ” attitude initially and later learning to deal with people as equals as the local americans do. I have never blamed anyone of them. I always chose to become a friend , listen and share ideas as to how to improve. It’s been worthwhile. I hv been fortune to lived in both worlds, attended university/ college at all levels obtained all kinds of degrees from both countries, seen my children born,brought up and grown to be adults in this system..

    Sadly sometime I meet some of them later and they talk as if they know everything about America after they have stayed here for residency just 3 or 4 years after passing teir usmle and jumping into the 3% doctor enumeration level. The same attitude pops up in some of them. Hard to let go.as most of u know, in America, a clerk or factory worker can acquire similar if not better things lie a doctor or congressman or prof, extreme sense of pride of achievement or attitude as in ghana is hard to witness.

    Americans have in general great respectful attitudes that’s transcends money, academic achievement etc.u see at factories, grocery stors, play grounds. And everywhere. With that attitude they attend medical/nursing schools and i was fortunate to be their mate at undergraduate, grauate, med school, working in factories, wal art, nursing homes, grocery stores prior.They may not be as smart as we in ghana may expect but their attitudes and treatment of patients, each other or customers on the average with admirable respect. It’s their culture and what the society expects. U are expected to do the right thing all the time to a situation or to person. That’s the tradition.

    They try to see the good in everyone before resorting to criticism unlike Ghanaians in general. Don’t forget I am one- a Ghanaian too in an adopted country. Somebody help me here, I am finding it hard to see how Ghanaian attitudes will change vis a vis medical/nursing education and perhaps practice. Help me to see what you see to be hopeful

    As I said from the beginning I find it hard to see how Ghanaian attitudes and traditions can/ change to give way to proper respect and care for one another. A typical eg is what I have just read between berko and Patrick or so. How come we cannot Overlook our personal knowledge/ achievement and say nice things to each other. At least see the good intent of te first writer and say something nice instead of ” you have a fight with me” Especially when u are a doctor. In the society where I live doctors are expected to be the most humble ,respectful, accepting least critical people.

    Obviously it’s not the same everywhere.the exhibition of “i was there and I know better than u ” is what prevailed in that discussion. Something I see and hear among the Ghanaian trained doctors who come here.

    Dr. Boateng are right about everything you stated . I worry more about the profs and elders and pecialist as you said than the in coming students who need help to forgo relearn acceptable attitudes from tem. One med student told me while I was with him at korle bu that a prof told a class a medical certificate is awarded and NOt EARNED And it takes him and the rest to award to whom they want to and not because tey studied and fulfilled all the requirements. he told hr can should to fail anyone and no one can question him. wow! Meaning, you should FEAR him as long as you are medical student under him. ” big man” attitude. The students obviously are behaving the same way. BTW this was in the 80s. They are the ones heading the institutions now. Can they change and adopt some of te suggestion put forward on this forum to mprove medical education & practice? Lets keep trying and pray. Thanks every one

    • Definitely right. The attitude of “I know it all ” after the achievement is what is killing the profession but of Couse, many do not see it that way.

    • It is very interesting to note.
      1.The originator of this blog was trained in Ghana, had his further training in USA. Perfect physician, knowledgeable, patient, kind hearted.
      2.Very few contributors were trained in Ghana as doctors/nurses, however these are the people we tend to write about. They tend to say little. Mostly corrective statements. People find them arrogant. Can you think of any of your school mates who ended up in medical school in Ghana. They were everything but arrogant.Most of their statements are about themselves and they know themselves as correct.
      3.Then there the people who did other courses in Ghana and somehow managed to end up at doctors, nurses, managers. PHD holders mostly in USA. Somehow these people seem to know more about the medical schools in Ghana. They have nothing good to say about the students ,lecturers,professors, and they are very quick to refer to the US system and how the Ghanaian trained doctors are ? STRUGGLING with ARROGANCE.
      CORRECT ME IF YOU THINK I AM WRONG, but please read all the threads first.

    • Teddy, I can assure you, very much so, that this is not bogus at all.

    • Teddy, this is decent forum where decent people are sharing wisdom. To be dismissive of all that is going on without sharing your opinion isn’t a very polite way to engage in discourse. So everyone’s contribution bogous except your own. But where is your’s so others can judge as well.

  9. Dr. Boateng,

    I have a question and I hope you or any Dr who attended medical school in Ghana can help me with the answer. I have already stated in my previous post that I attended and completed medical school in USA so I do not know it all as to how medical education/ethics are taught and perhaps tailored to suit the Ghanaian society and culture.
    I am of the view that attitudes and tradition have influences and may make it hard to effect changes. However I do hope that in general every medical student in the world is taught the same principles of how to care and manage a patient hence my question below:

    My question is: Are medical students taught that the patient can ask the physician what the diagnosis and treatment plan are and the Dr has the OBLIGATION to patiently answer in simple easy to understand terms without being/feeling “challenged”? This is what I was taught and do daily in US. Is this part of the medical education that is taught or it is ASSUMED once a person graduates it will be part of the practice?

    Or is this part of the attitude syndrome of “big man-ism” ie ” I am the doctor, I tell you what you should know and you have no right to ask me why I am doing/giving that to/for your body”

    Please tell me students are taught as I was here because I keep telling my friends and relatives in Ghana that every dr is taught the same thing in the world so they should trust their drs.

    I ask this question because every now and them relatives and friends will call and tell me some medical problems they are having. I tell them to see their local primary care physician as I cannot diagnose and manage on the phone as taught in school here.

    When I later ask them if the dr told them what the diagnoses is/was, some of them say ” the dr seem angry when I asked questions, he told me to take this or that and see him /her in ……” without answering the question.

    Please Dr Boateng, is this still generally true or its an exaggeration about some drs in Ghana? what exactly does the medical education entails in Ghana besides the scientific and clinical knowledge impartation? Is the art of practice really not taught as you alluded to in the 3 main issues you listed? I know not all the drs in Ghana were trained there but please tell me a gist of what is taught/happens at UGMS or KNUST or UCC if anybody/alumini knows or will not mind volunteering the info.

      • Dr Arthur, I would not say that the art of medicine is not taught to Ghanian doctors. There are didactic instruction in ethics and even patient rights in medical school curricula.

        However most of the instruction in what constitutes the Art of Medicine occurs during the “apprenticeship” (housemanship and junior doctor) stage through mentorship and by observing senior colleagues.

        What I am saying is that we need to pay attention to how much of the Art of Medicine (which is a more imprecise concept than the Science of Medicine) is imparted to student doctors, how we impart this knowledge and how we ensure that the art is as enduring as the science in the subsequent real life practice of the young doctor.

    • Dr. Arthur, there are similarities and differences in the way doctors and patients relate to each other in Ghana when compared to what pertains in the US.

      The similarities are that doctors in both Ghana and the US are confronted with the same diagnostic challenges and the need for doctors to be knowledgeable enough to make correct diagnoses and treat appropriately.

      Each system has its own peculiar set of challenges when it comes to patient access to care, the availability of services and the responsiveness of the system to the needs of the patient. Obviously the US has more resources and services than Ghana with its attendant diagnostic and therapeutic advantages.

      The major difference in answer to your specific question, is in the strength of patient assertiveness and the way the system protects and institutionalizes the rights of patients to demand and expect communication from their doctors and protect their private medical information.

      There are two, rather disturbing, complaints that one hears, quite frequently, from some patients: that some doctors do not discuss diagnoses and/or treatment plans with patients or family members. When patients ask for diagnoses or treatment plans their queries have been met with refusal to answer the patient’s questions, rude remarks, or in rare cases, insults.

      The second complaint is that some patients perceive doctors (and nurses) as unempathetic and uncaring especially in the case of emergencies.

      I have met quite a few patients who do not know what they have been diagnosed with in the past or the treatments they have received. Their answer is “the doctor did not tell me”.

      I personally am of the opinion that even though it is not every doctor who does not communicate with his/her patients, (indeed I suspect that this poor communication may well be with the minority of doctors), its implications for patient compliance, continuity of care, and the protection of patients’ rights, makes it a serious issue that must be brought out into the open and discussed. The solution lies in patient empowerment and regulatory oversight and sanctions of abusive doctors and nurses.

      It is wrong and unprofessional for a doctor or nurse to be rude to a patient or to refuse to communicate with a patient about his/her diagnosis and how he/she, the doctor, intends to treat the patient.

      That behaviour should be punished in Ghana as it is done in the US, UK, Japan etc. I do not see it as an economic development issue. I see it as a human issue.

    • Arthur,

      I do share some of your concerns about the way patients are treated. And the issue of professionalism has been raised and discussed extensively in other posts (See my prior posts on the “Private Hospitals in Ghana” section)

      Clinical practice is highly variable in different parts of the world. In the United States (where you went to medical school), medicine is less paternalistic and patient autonomy is very strong. The physician is seen as an adviser, and the patient directs their care. While this is also true in the United States today, this has not always been the case. Historically, the family physician was known to carry his black bag and tell patients what to do, and they (patients) oblige without question because “doc says so”. That is no longer the case today.
      On the contrary in Ghana, and most parts of Africa, and less so in the UK, the practice of medicine has not evolved to that extent as you have experienced. Paternalism still features prominently in these parts of the world compared to your current practice setting.

      You have to understand the sociocultural context of where you practice; a point that Yberko alluded to in his comments. I agree that we (Physicians) ought to do a better job at communicating with our patients, and there should be no excuses for poor communication(see my prior posts). The ability to recognize a patients background and their preferences/expectations and being responsive to it is called “cultural competence”. Its an art that ought to be incorporated into our medical education curriculum. While Ghanaian medical schools may not have a formal curriculum for cultural competence, it is being taught there, informally. I think, formally introducing it and evaluating this art ought to be an integral part of our medical training (as was introduced in the United States by the ACGME not too long ago). This is what Dr. Boateng’s blog is trying to do by stirring up the conversation among the general public and among us physicians.

      Some of your comments and questions about the nature of training of physicians in Ghana highlights your lack of experience about healthcare in Ghana and perhaps the developing world. I suggest that you do a visiting-observer-ship to one of the Medical schools so you can get a “first hand experience”. It will be an excellent opportunity for you learn, and potentially inspire younger doctors and medical students, just like Dr. Boateng is doing, to be more culturally competent, and professional.

      I will also like to let you know that Ghanaian-trained doctors are among one of the finest to come out of Africa and that is exemplified by their excellence when they leave the country (a sad fact). The same way you give anecdotes of doctor trying to do the “Know-it-all” I have seen doctors from Ghanaian medical schools excel in residencies in the United states- with recognitions/awards for best residents and even chief residency appointments. The current WHO deputy director, Dr Anarfi Asamoa-Baah, went to school in Ghana. If you check out the Ghana physicians and Surgeons network on linkedin, you will find Physicians “Par-excellence” all over the United States in all specialties.

      The most important thing Arthur, is how to harness all that knowledge and expertise to improve health care in Ghana; and I think This forum is uniquely situated to stirrup the discussion. It is important that we check our egos and confront the issues without resorting to name-calling and making statements based on false preconceptions.

  10. THE WAY THE QUESTION HAS BEEN ASKED— assumes a foregone conclusion.
    It could have been asked in a far better way than this that actively seeks to antagonize every doctor trained in Ghana.
    Dr Boateng has the patience of a SAINT so he will find way of answering it.

    • Dr. Berko,
      Thanks for your comment and contribution. I sincerely appologise if my question carried that impression. I do not in anyway wish to “antagonize any dr trained in ghana”. That would be unprofessional and unacceptable on my part. Training in USA or anywhere in the world does not make me or anyone better than any dr. We are all colleagues carrying the same knowledge ,title and responsibilty caring for the poor helpless patients. Again I apologize. I only wanted to debunk what my friends and relatives have been telling me on the phone. I wanted some authentic info from colleagues like you and dr boateng,then call and tell them they are exaggerating. This was my intent. I am sorry idid not do a good job. Thanks for bringing it to my notice. You are a marvel.

      The strange thing is that I do have relative who trained in ghana is is currently practicing but not in the clinical setting. This person also keeps criticizing those of us who are “clinicians” saying we don’t do good a job answering patients concerns in ghana – adding me to folks in ghana though i am far away in a foreign country simply because i am ” a clinician” by the person’s view like coleagues there.

      The person is in the public health/preventive med sector. My own uncle too taught for many yrs at your school – ugms as a surgeon from the early 70s thru late 80s. I could not get the opportunity to ask him this question as I was not paying attention to medical issues then. he is no more there. he moved on. I believe he might have taught you and and perhaps dr boateng.

      So you can see I have no intention or desire to “antagonize” anyone trained in ghana. My extended family have been and are still part of it. I shadowed a few drs at korle bu and had some surprises but not to the extend friends call & tell me. Once again if my question came across like that, I am sorry. I will have to do better next time. We are colleagues and I cherish and respect that dearly. This forum is meant for us to seek to improve our system there. I just had a little question to clarify an issue and I did not do a good job.

      Thanks for alerting me. Dr. Boateng is really a saint.
      God bless you.

      • Dr. Arthur’s letter (and a previous apology by Nurse Assistant, Rossie Mensah) is clearly an illustration of why these personalized positions and confrontatons on this blog are misplaced and disruptive.

        The contributors on this blog who think that every criticism or negative comment about healthcare delivery in Ghana is part of a deliberate grand scheme of doctors and non doctors living outside the country to malign and insult doctors who ‘stayed back’ or trained in Ghana, are wrong. I do not perceive any grand scheme so the personalization and the thin skin syndrome should stop!

        We should concentrate on the core issues of this debate; correct each other’s misinformation without making it a ‘war’.

        I have tolerantly watched the trends on the blog and clearly understand what is happening. My mandate, as the initiator and moderator of this blog, is to protect the blog from degenerating into what it is not. I intend to do exactly that!

        Let us have a robust, respectful and ideas driven debate about healthcare delivery in Ghana.

        • —-Let us have a robust, respectful and ideas driven debate about healthcare delivery in Ghana—
          ——Dr. Arthur’s letter (and a previous apology by Nurse Assistant, Rossie Mensah) is clearly an illustration of why these personalized positions and confrontatons on this blog are misplaced and disruptive—
          These responses are good but they were not voluntarily expressed. They came after my comments. these have not been my only comment. I have drawn sword and done a few rounds of verbal/digital/literal jabs with a lot of people in this blog, including your good self. That has not reduced my respect for you, if anything it has increased it.
          Disagreement is not an affront on anyones credibility or intergrity (sorry I do not intend to be verbose).

          —-About CapVars Docs–They have planned with me that they are going to develop their own evidence-based clinical pathways and clinical protocols (based on protocols of Cleveland Clinic, Johns Hopkins Hospital and Mayo Clinic!) during their house jobs in order to improve and standardize the care of patients in the Cape Coast Regional Hospital. Pipedream? No. I see innovation and striving for a higher standard—-
          Good luck to them, and congrats to their teachers.
          Universities train students to learn how to learn.
          I am not a ggod fan of clinical pathways and protocols,
          They stiffle innovation and impede free thinking , adventure and advancement.
          –In medical defence, protocols are not worth the papers they are written on.
          I think we should aim at doctors who can think for themselves, by themselves on their own feet.

          happy Weekend

          • Dr Berko, WOW! You mean to tell me that hospitals like Cleveland Clinic, a world renown center for cardiovascular surgery where cardiac catheterization and coronary artery bypass grafting were first developed and performed is wrong to use clinical pathways and checklists?

            All Electronic Medical Record software and the great ones such as EPIC use evidence based clinical pathways and protocols to develop their treatment algorhythms. (Incidentally, EMRs have become required in all hospitals in the US. A hospital that does not use EMR will not get paid by CMS for services after a set date).

            The problem about the so called “innovation” and “free thinking”, as you call it, is that it leads to unstandardized care, poor quality and high costs. There are voluminous research findings on this topic.

            I have had the opportunity to actually develop (with a brilliant team of doctors, pharmacists, nurses, laboratory scientists, case managers etc) protocols and clinical pathways for two hospitals (one 118 bed and another 100 bed) and an ICU and to evaluate their efficacy. They improve the quality of care, the efficiency of care, clinical outcomes and reduce costs. This is from experience and not from some emotional non-experience-based ‘belief’ or gut feeling or being a “fan”!

            And….I will NEVER (NEVER) recommend “adventure” in the treatment of any patient. Medicine is a science with a veritably robust research and evidence base and should NEVER (NEVER) lend itself to the adventurous inclination of a doctor no matter how ‘self-assured’ he is!

            Medical advancement, in this day and age, is achieved through well designed, well performed clinical trials with strict institutional (IRB) regulatory oversight and patient protections.

  11. it is self evident from this blog alone that Ghana, our beloved country has a big problem. The bad nuts among the numerious Doctors, nurses, pharmasist etc. have given bad names even to the good ones. The arrogant,selfish,God-like personality,the angry healer,and the untouchables.
    When one compares Ghana to USA it is not to say Ghanian doctors died and went to Hell but a good standard is the point to which all standard are compared to. We would wish it were the other way round but for that reason is what prompts all of us to write in an attempt to communicate,identify,delibrate,ague, agree, disagree,point out, assimilate, , accept, discard and improve.
    i see no reason to be agree to accept my mistake,to learn, and most importantly to teach those seek,explain to though in doubt(patients),and to humbly listern to those that seek to share.
    One of this days, maybe in my time or yours, patients will demand better service from thier healthcare professionals by siuing them.
    it is irrelevant to to defend incessantly the indefencible. If you are not praised for what you do, dot not be angry, for our chosen profession demands humility not saint-like as i read from one of these threads. the mistaken should not be attacked.
    Dr, Boateng, Doris, Patrick, Dr. K Arthur, i have enjoyed reading your piece. continue to be bold and share.Hopefully, someday it will help. Thank.

    • Dr Agyei, what this blog is saying is simple: doctors should care about the welfare of their patients. Most doctors do care and are doing their best for their patients sometimes under very difficult situations. A few doctors, however, are arrogant, full of conciet, disrespectful, and treat patients poorly. Some are even unethical and negligent. Our advocacy is that we should find a way to protect patients and smoke out the bad nuts whose activity give the profession a bad name.

      We can do this if the profession, through its associations such as the Ghana Medical Association and the Society of Private Medical Practitioners, will be bold and sanction any unprofessional members. A public exposure of very eggregious examples of patient abuse or disrespect will serve as a deterrent and engender public confidence.

      The second, more effective, solution is to have the Medical and Dental Council, which is the statutory body which has the mandate and legal backing to discipline bad doctors in the country, to be strengthened and resourced to investigate patient abuse and negligence in an effective way.

      These solutions will work, however, if there is a clear public and well advertised system in place for patients who are abused or harmed or their familiy members to get in touch with these institutions with their complaints. Currently most patients do not know that they have a right to complain or do not know who to complain to. The complaint system is not public enough.

      This process will be good for patient care, will be good for the medical profession, and will be good for the country.

      There is really, absolutely, no reason to be defensive about poor medical practice and disrespect to patients or patient abuse.

      My appeal to every doctor, nurse or healthcare worker is that we should respect our patients, we should do our best to cure them of their ailments, we should be empathetic to their suferring, we should be comforting in their times of need. That is what the medical profession is all about. This is not a call to weakness, it is a call to strength.

      • ANOTHER WOW —And….I will NEVER (NEVER) recommend “adventure” in the treatment of any patient. Medicine is a science with a veritably robust research and evidence base and should NEVER (NEVER) lend itself to the adventurous inclination of a doctor no matter how ‘self-assured’ he is! etc etc
        From what you are saying, DR BOATENG, there will
        never have been the FIRST HEART TRANSPLANT, or B-LYNCH BRACE SUTURE for massive PPH, ETC ETC ETC because 1.They were not standard treatments,2,They were not evidence based, 3,They were mindless ADVENTURISM.
        IN THIS PROFESSION,We stand on the shoulders of giants, if we cannot see beyond what they see, and improve on them,then we have failed.
        Then we can just stick to protocols and so called evidence-based or standard care.

        • Dr Berko, have you read about the history of heart transplantation? Have you read the autobiography of Dr. Christiaan Barnard? Have you read about the history of transplantation and all the preceding animal (primate and non-primate) research that eventually culminated in the transplantation of the young woman, Denise Darvall’s heart into Louis Washkansky in South Africa?

          Also read about the work of Dr. Norman Shumway and Dr. Richard Lower whose work at Stanford and and Virginia, respectively, preceded Prof Barnard’s epic surgery.

          You will discover that heart transplantation was not the result of “mindless adventurism” at all but based on several years of solid research and science and meticulous protocols developed by several preceding transplant researchers from all over the world with an underlying dose of fierce competition and driven egos.

          It is an interesting subject to read about; as is all stories of the history of medicine. It is very enlightening.

          • NEED I SAY ANYMORE???–
            You deliberately avoided the other parts of my argument and chose heart transplant
            HOWEVER
            —-You will discover that heart transplantation was not the result of “mindless adventurism” at all but based on several years of solid research and science and meticulous protocols developed by several preceding transplant researchers from all over the world with an underlying dose of fierce competition and driven egos.—-
            -And have you thought of why the first heart transplant was in South Africa???despite the relatively limited technology???
            The US system was delayed,limited, stifled,impeded, hampered, restricted and obstructed by so called guidelines, pathways,protocol and most of all legalities and litigation.
            I say it again, this will take away any flashes of imagination and originality, and we shall keep re-inventing the wheel.

          • To Drs Boateng and Y Berko,
            It looks like this is gradually turning into a one on one arguement match which we should try to avoid.Slowly we are loosing focus of the main discussion points.
            From the look of things and the kinds of responses and contributions I am reading ,there are lots of Ghananian Health care professionals who are genuinely interested in what goes on in the medical institutions in Ghana.
            Lets keep the discussion going.

  12. May be it is important to consider how the quality of medical education is regulated; and how the organs responsible have fared.

    If we can review the objectives, functions, responsibilities and performance reports of the Ghana Medical Council, the Nurses and Midwife Council, the Pharmacy Council and other regulatory agencies, we could address the regulatory gaps that account for keeping non-performing professionals.

    Do we assume that just an opportunity for further education could guarantee quality health professionals, without cognisance of how the regulatory agencies monitor and evaluate their performance. If they do monitor and supervise, is this sub-optimal thereby accounting for the current state of affairs?

    Yes, lets look at issues we can control to account for weeding out those not called into the professions. I shudder, that individual traits may be difficult to change, but we can manage it if there is a rigorous framework for compliance and conformity.

    • Kofi, I had a very encouraging meeting with the Registrar of the Medical and Dental Council. I believe that this issue of healthcare quality is not only topical but is a shared concern of many institutions in Ghana. We can do a lot working together on this topic.

  13. This topic is long overdue but it has been brought to light. Thank you all for your contributions! As a Human Services professional, I deal with various aspects of human needs; this is one of them.
    The heart of this concern is not only about education and it’s subsidiaries but basic common sense. Human attitudes are not learned over night or acquired as a result of elevation in status. It is learned from infancy and developed over a long period of time through numerous exposures to life’s experiences, hence attitudes are built and ingrained in our conscience(s).
    The training we receive from home is what we take into society and that says a lot about who we are. If we speak out of turn to our families then it becomes easier to do the same to others and then we forget or think that is the way it should be. But remember that what goes round comes around eventually. If you learn arrogance without being chided, you will most certainly face the wrath of someone some time if not more.
    The medical training curricula should include the study of a chapter or two of human service and cultural competence (particularly Ghanaian cultures)to understand how people behave, understand, respond, react the way they do to help them properly utilize all their training in providing the best possible care for each individual (patient). This particular area of service has not been tapped to deliver the services required. So, this is your [medical/health care] chance to learn more. Thank you for this lively chat.

  14. Dr Boateng
    While we are still discussing medical education, I will like to make a few more suggestions. My initial comments were mostly about profs, trainers and elders and attitudes etc. I remember Patrick commented on medical students and you also did the same.
    First let me start by asking: Is it possible to include in the admission process or evaluation of medical students the need to have at least a bachelors degree before applying?

    I think Students can applying when about to graduate or after graduation with Bsc. I may be wrong but I learnt that currently all students obtained Bsc. Human Biology during their first 3 yrs. before proceeding to the rest of the medical program in all the schools. Everyone has the same Bsc discipline – Human Biology – what every medical student in the world learn during the basic sciences period. I am talking about obtaining the degree in other disciplines at any level, Bs or MA, MS or Phd ie in any thing and then asking them to do a prerequisites( chemistry -physics, biology, English, math some social sciences like the psychology, economics, philosophy etc)either during their Bsc program of after graduation and standardized exams like the USA (MCAT) before admission.

    - My thought is if you really want to be a medical doctor you will not give up. I did not and so were/are many and you learn a lot in from human interaction in the process of preparation.

    My reason for suggesting this is that I am thinking it may help in students maturity and give them time to think it through whether they really want to be medical doctors. Human life is so delicate and we all die but once. It should not matter how long it takes a person to learn for eg. when and how to prescribe APC or aspirin to someone with respect- a slight mistake and the person is maimed for life or dead.

    Worse of all an immature doctor with insulting attitude, intolerant disposition shrouded in ” I am academically smart with a medical doctor degree” mind set and character consulting and treating a poor sick patient can kill rather than heal/cure. We are not cars to give to any wayside immature arrogant mechanic to repair and move to other if that does not work.

    My thought again is that it will be one option to DECREASE the number of people who enter the profession for prestige and money right from the secondary school simply because they score 3 A’s in GCE A level or did well in biology and sciences in the current system. Some however had such performance, chose the right profession to be doctors and are doing great. However as being academically smart INITIALLY in the sciences does not equate good physician as we all know.

    I think that most students from secondary school at time of applying for admission are teenagers or rather too young and most really do not know what they want to do except follow their parents/peers dreams and desires in spite of so called academic counseling . Though others do, but a large proportion perhaps think of Medicine, pharmacy and engineering as the only careers if you are science student in the secondary school.

    It easier to be cloth in a sense of pride and arrogance if you got admission straight into medical school over your classmates so many As to assume you are smarter than everyone else who had admission into a let say a social science program as a teenager. This is may be what is carried on into adulthood and into practice. I know many do not or did not have such attitudes or problems but I think it can be curtailed if students are admitted long after secondary school education inot the field of medicine. It is a unique filed in which which lifes ate stake ALL THE TIME. Some level of maturity should be required. One means of ensuring that it letting the student grauduate from university first with any degree.

    A 3yrs or 4 yrs undergraduate education with a high good enough GPA will further prove that the secondary school grades were not gimmick and also not depended on which secondary school graduates/alumni deserve to be admitted.

    I think this will also will help to admit students with various backgrounds and experiences. For instance students who engaged in research, Psychology, PhD graduates who are matured and really want to be doctors. I believe for example there are students pursuing degrees in Microbiology or Pharmacy who engage in serious research work in HIV or infectious diseases during their final years at the BSc level or masters program who would have been great doctors with both background knowledge and maturity who cannot have such opportunity in Ghana.

    It is also possible that by the time most of these matured students apply to medical schools, they would have married, had children and the thought of traveling ( brain drain) would be reduced dramatically.

    Also if part of the criteria for admission consideration will be volunteering, paid or unpaid work among the needy, poor, the elderly, hospital or clinics that will also help. It will not only expose them to what is out there, but will learn to interact and respect individuals,the poor and the sick before entering medical school.

    This is basically the US system. I am not advocating the adoption of everything as imperfect as it may be but I think somethings have been tried and proven to be help in admitting and training students in whose hands a who life will be committed to for care and survival.

    I will add my personal example: I obtained a degree from here as I have said before. In USA, I started what iis called Pre-medicine courses and obtained another degree a the end of it though I didn’t need to as I had one already. It gave me time to continue to evaluate myself just like my colleagues whether I really want to spend the rest of my life pursuing another intense and demanding medical education profession – i.e. do I really want to be a doctor? I after graduation, I started my masters/PhD degree program while attending interviews for medical school. This is not unique to me. most of my classmates did the same. They were either holding Doctor of Pharmacy degrees, Bachelor of nursing, Masters of science in Biology, chemistry or Engineering degree or MBA before they applied. At least everyone had a bachelors degree in something not necessary biology.US medical school like some other countries is 4 years after the first degree ( Bsc or Masters or PhD).

    What I think it does it, most entrants are somewhat matured to know what they want and have various experiences be from working or by reason of age.

    I had also had to engage in volunteering work, shadowing doctors to know what they do. This is the norm. Almost everyone applying to medical school in US or Canada have to do that. I started mine in Ghana and while in US I volunteered at a rural hospital wheeling the disabled form admission to other parts of the hospital from emergency dept to ward, xray etc. I also worked for pay at Nursing home, assisted living facilities among others where I had to care for the elderly.

    Again this is a common thing for applicants ( I am not sure there are nursing homes in Ghana yet) but there are certainly rural and village clinics for to-be medical students to go and volunteer. BTW, a applicants are also required to submit one or two recommendation letters from supeversors of their volunteering or shadowing program ( of course these not really reflec the reality but it can be verified or if it sound too good to be true ignored)

    In essence, if admissions to medical schools can also be modified to follow what the developed countries have incorporated into theirs to reduce prestige seeking applicants ( though not the sole reason, also its impossible to weed out such) it will go a long way to help improve the system. Most doctors will come out more matured. The childhood/teenage arrogance/had human interaction and disrespect for others opinion Ms Quartey talked about above perhaps will reduce.

    Also it will give chance for more qualified and matured people to apply to the medical schools from various universities. As it is right now, I may be wrong, but it appears to me if you do not get the initial admission into UGMS or KNUST or UCC sciences or medical school whether you later d have take a qualifying exams or not, your dream of becoming a doctor is out the door.

    I know people who completed degrees in Accounting, others in computer science who worked for years and later applied to medical schools and got accepted. They tell they really wan to be medical doctors like also. I also know some who started with me in my undergraduate years as pre-medical students. they performed really well and yet decided after the Bachelors degree that they have lost interest in the medicine as profession after going through all the shadowing. Some even had Bachelor degrees in Respiratory care, Physiology, certificate in phlebotomy occupational therapy etc.

    In summary, These background:
    -degree
    -volunteer in rural setting
    -shadowing doctors
    -working experience
    -research work
    -national standardized entrance exams like the MCAT (medical college admission test)

    These I think will help to increase maturity, improve character and attitudes besides sharpening knowledge before entrance into the medical field to deal with the sick.

    Lets copy well and fully the people who started the formal medical education for doctors and nurses instead of the whom-you-know and straight form secondary school admission process and in spite of the limited resources
    This is my six pence to improve medical education before a person is even admitted to participate.
    Thanks.

    PS
    Dr. Boateng, from your piece,BTW it is still disgusting to learn and know that some doctors show up for work ( in government establishment I think) when they wish and leave the same and get paid for work not done or poorly done. Its a shame!

    • I will add my personal example: I obtained a degree from here as I have said before. In USA, I started what iis called Pre-medicine courses and obtained another degree a the end of it though I didn’t need to as I had one already. It gave me time to continue to evaluate myself just like my colleagues whether I really want to spend the rest of my life pursuing another intense and demanding medical education profession – i.e. do I really want to be a doctor? I after graduation, I started my masters/PhD degree program while attending interviews for medical school. This is not unique to me. most of my classmates did the same. They were either holding Doctor of Pharmacy degrees, Bachelor of nursing, Masters of science in Biology, chemistry or Engineering degree or MBA before they applied. At least everyone had a bachelors degree in something not necessary biology.US medical school like some other countries is 4 years after the first degree ( Bsc or Masters or PhD).

      –I think the abilities of the products of our medical schools are not in question here.
      can Ghana afford the internal brain drain when pharmacists, engineers,nurses,psychologist all want to become doctors, Why don`t we keep them in their various professions to enhance their lots.

      • Oh shut up, you retarded brat. everyone here is sick of you and your rants. i will be plain and straight unlike those whom you attacked and were still cordial to you. If you ask me, I say you are more of a retard than a doctor. I bet you have killed a lot of your patients here in ghana. Am sory it had to come this far but this idiot must live this blog so those with good ideas can contribute.

        • Samuel, this is a rather harsh and indecorous piece.

          As I have said in several previous contributions, we should desist from personal attacks and insults no matter the provocation.

          This should go for all of us. We should not be guilty of the same “crime” that we are complaining about.

          I will entreat everyone who wants to stay on this blog to avoid insults, rudeness and disrespect.

          Please let the blog itself deal with contributors who are disruptive.

          I can assure you that we are on top of the issue.

  15. PLS, I WILL LIKE O STUDY MEDICINE IN ANY OF THE PRESTIGIOUS UNIVERSITIES IN GHANA BUT I NEED GUIDANCE, I DON’T KNOW IF I CAN GET ANY HELP HERE

    • Marygreat, I will recommend that you get in touch with the four medical schools in Ghana, say through their websites, for admission information. The schools are:
      1. University of Ghana Medical School (UGMS)
      2. Kwame Nkrumah University os Science and Technology School of Medical Sciences (KNUST-SMS)
      3. University of Developmental Studies School of Medical Sciences (UDS-SMS)
      4. University of Cape Coast School of Medical Sciences (UCC-SMS)
      Best of luck.

  16. To those who wanna defend Ghanaian Doctors and nurses of their bad atitude, we own you no aplogy. this is an article from joy FM news page.
    (Expecially : medical student Y. Berko)not a Doctor yet, and rude already.

    Extortion and Bribery at Korle-Bu Polyclinic

    From: Seidu Kpebu /seidu@gfmradio.com Published On: August 19, 2012, 00:45 GMT

    It is regrettable how our health personnel in our hospitals, polyclinics, clinics and health posts across the country have held Ghanaians hostage for all these years.

    Their constant demands for higher salaries and better conditions of service, which put much strain on the national budget, adds to the siege of Ghanaians in the health delivery system.

    First of all, the National Health Insurance Scheme (NHIS) was introduced to ease the burden of cash and carry that it replaced. However, a visit to any of our health institutions tells a different story. It is a tragedy that people using the NHIS scheme are given less attention.

    The situation is even worst when you visit Korle-Bu Polyclinic. The bribery at the Polyclinic makes nonsense of the NHIS scheme. When you arrive there, you are confronted with the choice of paying bribe to see a doctor early or go through a nightmare waiting for nearly eight (8) hours.

    Some support staff are used to front this bribery scheme by some unscrupulous and extremely rude nurses at the front desk. They will ask you to put an amount in your folder to speed up your chances of seeing a doctor early.

    Then when you get to the desk of the very nurses that you have already bribed, they charge you GHc3 (three Ghana cedis) for taking your temperature and blood pressure and no receipt given. One may ask: is this extortion or an approved charge as no receipt is issued?

    The situation is so bad that patients who cannot afford to pay to circumvent the process are frustrated. These patients are made to believe that it is the fault of the Government that they are going through this undue stress at the Polyclinic.

    Tragically, some of these nurses and staff are extremely rude, arrogant and less professional. After five (5) hours of observation at the Korle-Bu Polyclinic, I was horrified with the level of impunity, exactly what the Asantehene was speaking against – nurses shouting on elderly patients who are old enough to be their grandparents.

    The situation was not different at the Korle-Bu Teaching Hospital itself. Indeed, the situation was so despicable that I lost my ‘cool’. A cashier at the Haematology Department (blood centre) by name put up an insulting attitude when she called yours truly by a lady’s name and when she was corrected she nonchalantly said “whatever”.

    I sincerely believe that the hardworking Ghanaian taxpayer is less respected at our hospitals and other health institutions especially at Korle-Bu Polyclinic, Korle-Bu Hospital and the Children’s Hospital in central Accra.

    At the children’s hospital two weeks ago, the nurses were seen chatting and speaking on phones ignoring the concerns of patients. It took the intervention of a lady pharmacist to get the nurses to attend to the patients who were all children. The doctor on duty who was supposed to be at post by 7pm finally got to work at about 8.46pm.

    In all of this, our health personnel have forgotten that the very people they have taken hostage paid for their training and are paying their salaries.

    The administrators at the Korle-Bu Polyclinic must come out and tell the public whether they are aware of the GHc3 charged by the nurses at the desks in front of the OPD office and why no receipts are given. The public will like to know how these monies are accounted for since no receipts are issued to patients.

    The nurses at the Polyclinic deliberately waste patients’ time in order to create frustration and extort money from them. I was a witness to an elderly lady who sat there for more than five hours and the nurses did not even attend to her let alone a doctor seeing her. I literally wept for her.

    Last Tuesday the 10th of April, I personally saw five (5) patients walked away with their folders out of frustration. A lady said she paid GHc10 (ten cedis) so she could see the doctor early. But after 4 hours she had not been able to see the doctor.

    Unfortunately, some expatriate doctors shamefully support the rude behaviour of the nurses.

    • I qualified as a doctor in 1991. That means I have been a doctor for 22 years.
      Now you will say I am being rude when you just make such a statements above and I try to correct you.

      • ALSO—–Then when you get to the desk of the very nurses that you have already bribed, they charge you GHc3 (three Ghana cedis) for taking your temperature and blood pressure and no receipt given. One may ask: is this extortion or an approved charge as no receipt is issued?

        Do you know you are guilty to GIVE bribe??? To GIVE and accept bribe are both agaist the law but you seem to think it is only those who accept bribe who are guilty.
        Your story is so one sided it has no credibility apart from the fact that you just confessed to a criminal behaviour.

        • thats not my story. read it well. its from joy FM news page, Mr credible!

          • Brother-Kwame NOT your story but very pleased to pass it on to prove your point.(come again and do not re-publish falsehood) Any comments about giving bribes.
            Read back and you will see that I have made several contributions about education of Doctors although you still think I am a medical student –am flattered,

        • Dr. Berko,
          I think the whole idea of this platform is not to fight. I believe Dr. Boateng has created this opportunity for ghanaians to pull our heads together for the better.

          I understand that, sometimes people may not have the full story and so may be a bit one sided in their augement but that should be okay. whether giving bribe is a crime or not, do you think many people have any choice if they or their loved ones are sick and they’re asked to? We are professionals. we’ve code of ethics, i hope, which probably strongly oppose such behavior and should not be encouraged. I believe nurses and doctors take an oath to abide by the code of ethics and conduct of their professions. The layman who gave the bride is not under such. So these nurses, and behavior should be investigated and something done about it to stop it. You appear to be in position of power and I’m urging you, Dr. Berko to do something. Thank you.

      • Dr Berko
        I assume this is your real name and not a pen name. I am not a doctor but I have been reading all the blogs for many months . I have noticed the Host Dr Boateng has been literary urging you not to personalize your contribution if any as its obvious most have been distasteful in recent times to readers. You seem to relish in it or its your character. Its disheartening to read your blogs if indeed you are doctor. Its full of disrespect and arrogance. It appears you don’t care and you think its your way of proving yourself to readers that you know what you are saying as a doctor. If this is how you really are as a doctor for the 22 years you claim to have been then its a shame to the medical profession and yourself..

        I was at Legon the same yr you did. I know some of the 1991 graduates and I don’t remember anyone being as arrogant as you sound now. I know Drs Rudolph Kumapleh- the most smartest guy in the class of 1991- (I was invited to your graduation ceremony and I saw and heard what he achieved), Kumah, Ampofo, Sodzi, Debrah, Osei ( affectionately called Koo) A. Owusu, Ghartey, Engmann, Derick Amakye- the President of your association etc most of whom are in United States and UK. Once in a while I travel out to Europe and USA for business. Any time I have traveled to USA I see or talk to some of them in Illinois and New Jersey. None is as arrogant and rude like you sound. I even know some of those who graduated 1990 like Paintsil – a nice doctor at the same hospital with Dr Kumapleh and Osei and many more. They are all very nice and talk with a high sense of respect to even someone like me who is not a doctor making me respect that profession. Please have some respect for your profession and your colleagues and stop being bity and constantly rude looking for only bad stuff in peoples contribution to comment on lately. Or stop contributing so that only respectful doctors will send in their ideas. So far you are a shame to the class of 1991 with such rudeness. I believe one of your classmates is either the head or the most senior at the the Obgyn dept of Korle bu,( unless you are the same person with pen name Berko) so is Hammish Oddoye who I think is a pastor at Lighthouse chapel with Dr David Asomani who graduated a yr later. Please behave and don’t hide behind the computer and disgrace yourself, your colleagues and the profession. After 22yrs as a dr if you still “talk” like this then the medical profession has not benefited you at all nor the country. You can react to this and say any terrible thing about me for this it will not matter anymore because I am not a doctor, you are and it will be a shame one once again. Have some respect for Dr. Boateng and the rest or stop contributing so that we the non medical/nursing people who read this blog can keep and maintain our respect for those of you who take care of us when we are sick.

        • M Kissi, thanks for your input. We can all understand your frustration and where you are coming from.

          I suspect that the personalized “attacks” that might have instigated this your strong response will hopefully abate.

          Secondly, as I have mentioned previously, I am on the lookout for comments that are meant only to cause distress and distract this movement and will respond appropriately to keep this blog focussed.

          So I will urge that we all go back to the rationale for the blog and put this distructive personalized distracton behind us.

          Again, thank you for your input.

    • Brother-kwame, this article really says a lot. It is painful to read but needs to be taken seriously. Thanks for sharing.

      • Dr. Boateng, what is your position in the ghanaian health care system, apart from being a doctor? and how can you help if at all, to address some of these behaviors, apart from talking about it on this blog. I think this is disgusting and something needs to be done about it soon. Thank you.

        • Lydia, I will describe myself as a doctor with a passion. A passion for the profession and what it stands for. I am not in any policy making or high profile position in Ghana, if that is your question.

          I believe that we, the members of the medical profession, have a sacred mandate to do good for our patients and our professon. We must be clear, unambigous and committed to our beliefs and do whatever we can, from whatever position we find ourselves, for the public good. Our dear nation and our patients deserve no less.

  17. its ok to correct people but don’t be rude about it. i see you have single handedly drag this dicursions on here into personal jabbing and attack and at the same time requesting appology from others. please next time disagree with people with respect. you have been behaving like the Ghanaian politicians.

    • Oh I do not think you want my answer to that suggestion. Let us respect our leaders.

        • Dear Contributors, it is becoming clear that the disruptive personalized engagements on this Blog that I alluded to in an above contribution, will not self regulate in spite of fervent efforts to make the perpetrators aware of how their acivities is hurting the focus of this Blog.

          As much I hate to do this, I believe it is time to protect the Blog from these individuals.

          I am officially stating that I will be closely watching the entries of individuals who seem hell bent on personalized attacks and literary wars which derail the focus of this Blog.

          Any disruptive or rude or abusive statements will be removed from the Blog as soon as I become aware of them.

          If the perpetrators continue their activities inspite of these initial sanctions they will be barred from contributing to the discussion on the Blog completely.

          I honestly wish that we did not have to come to these rather drastic sanctions but the activities of one or two contributors leave me no choice.

          Luckily the perpetrators are just one or two individuals.

          My hope is that this warning will encourage (him) them to self regulate so that these sanctions will not have to be applied at all (my prefference) and we can continue to have a lively and informative debate about healthcare delivery in Ghana.

    • Brother-kwame, I agree with you that we can disagree with each other without being rude or disrespectful.

  18. “TODAY LET US TALK ABOUT MEDICAL AND NURSING EDUCATION; HOW WE TRAIN THESE MOST IMPORTANT HEALTHCARE PROFESSIONALS”.
    The above comment on August 3, 2013 is how I was caught up in this blog. Dr Boateng has been trying to nip this in the bud by trying to refocus our attention to the topic, but some of these professionals are trying to derail his intensions. Can you please get back to the basics so people can follow how it can be resolved. I have read all the thread and have a question for Dr Boateng. Can you find a way to be the “Dr Oz” of Ghana TV and bring all like-minded professionals to educate Ghanaians about simple protocols and expectations when we visit our Doctors? The record must be set straight between doctors and patients in another open forum. I think it will be very interesting. I love your attitude.

    • Gad, I have sent a proposal to a TV station for a regular program that talks about healthcare quality and patient experience. No response yet but I am hopeful.
      There are other activities being organized which will be announced soon for all contributors to become part of.

      • We hope you and Ghanaian patients are given the chance. In the end, its Ghana that wins. A few weeks ago, many under-estimated the powers of the suprime court of the nation. it took a few ‘contempt citations’ for poeple to come to thier senses. The media in the hands of the good can help alot. keep on pressing opong it. Ghana will thank ou for that. if you would, begin making videos from various hospitals and clinics accross the country with the help of the Ghana medical assoiation to capture the behavior at work, though without implicating anyone for now. it could be used as trasining videos in medical and nursing training institutions across the country.
        Also perhaps mandating all hospitals and clinics to use cameras will make healthcare professionals aware that , thier behaviou may be captured and used against them may also help.

        • We have had a lot of discussion about patient`s confidentiality.
          Having cameras around has the risk of breaching that.
          So not a very good idea,

          • It definitely is a good idea, it is being done in so many places and it works like a charm.
            like a medical record, the footage is keep only by the hospital administration unless otherwise summoned for investigation or for training purposes.
            take for instance places where people have been conniving to steal or swap babies, staff who abuse patience .
            it will help hospital administration and law enforcement agencies to have evidence for good decision making.
            here in The USA, every hospital u can think of has cameras everywhere except of cause patients room, exam room and bathrooms and others may expose their privacy.
            take also another example in the psychiatric hospitals, how pts. are beaten.
            if humans know they are being watched, they put up their best behaviors.
            we must also train people that the hospital must be forced to give them an office in their building or allow them to work for patient advocacy group. they will not work for the hospital but in the hospital to observe and to report unprofessional conduct to their administrations and the hospital administration for correctional actions, be it a retraining or termination.

  19. It is unfortunate that the core issue about medical education being lost in all the heated exchanges. Here are a few ideas about what is can be done to improve medical education in Ghana. To start off, I think we need to conceive the quintessential 21st Century Ghanaian doctor and work backwards to see how we can improve the status quo to achieve such a physician.

    The history of medical education around the world makes interesting reading, and there is no single system (British, American, Canadian, German, Persian, Cuban or African) that is the best. Each has its strengths and weakness and training is usually tailored to the requirements pertinent to each location. It is easy for us to assume that a particular system is “better” because that is what we know. One can say that generally, the current education system in Ghana is largely influenced by Britain for colonial reasons. In this age of globalization, we need to tap into the various systems and build an African Education System that is responsive to our needs and at the same time globally competitive.

    Key attributes to achieve this include the following:

    1. Strong Scientific foundations- here we can learn from Flexner’s reformation of the US education system in advocating a strong biomedical foundation in the pre-clinical years. I think this should be relatively easy because all 3 Medical schools do have a pre-med BSc. Human Biol/Med Sci curriculum that can be improved. I think stronger emphasis on research methodology are areas where there is more room for improvement. Bridging the gap in technology by improving the infrastructure of basic science labs and promoting basic science research will help strengthen this. Most labs in Medical schools can easily pass as Science Museums because equipments there were made at the turn of the industrial revolution. Most of the newer equipments are in the Research Labs such as Noguchi and KCCR. These institutions should be the work stations/labs of the premedical students. Doing so will not only generate good physician-scientists but it will also help them work with other scientists without clinical backgrounds and in doing so, foster the team work that will help better lab tech/doctor communication when they graduate.

    2. Strong Clinical foundations: Medical students need to spend a good deal of time in hospitals observing and actively participating in the care of patients. As a medical student I had the privilege of doing rotations in some of the top universities in the UK and the US, and I was allowed to order tests, write notes in the patient’s charts and talk to patients as the primary contact under direct supervision. In Ghana, medical students do not “actively manage patients”, they take histories, and present orally only to get “washed” by consultants and senior residents. Being more actively involved in the care of patients makes for better learning and gives students a feeling that they are actually part of the medical team.

    3. Inter-disciplinary skills: Medicine has become more and more complex these days. The doctor-patient relationship is changing. Good care requires input from nursing, physical therapy, dieticians and social work inter alia. Being able to lead and co-ordinate this care requires mutual respect for all professions involved in the care of the patients. Having nutritionists, physical therapists, nursing and pharmacists rotate together as a “team” will enable all to appreciate the input of the other in the care of the patient. Certainly this can be achieved by having the NTCs, Pharmacy schools and Physical therapy department schedule rotations together with medical students as a team. That way, medical students can learn to work with other professsions as students (before their egos get too big). With this, I feel working in the future will be a lot better.

    Indeed these are but the tip of the iceberg but based in my experiences as a medical student in Ghana, I feel these can be achieved at a reasonable cost and within a reasonable time-frame.

    • Fambondi, agree with your ideas especially the clinical training. We should try and make it as much a process of student participation in patient care as trying to teach and find out how much students know.
      I think we have concentrated on the latter two to the exclusion of the first, as you have correctly pointed out.

    • Fmbondi, I agree with your suggestions and ideas. These are practical solutions that work in the Western world, where their systems supports that. Unfortunately, our Ghanaian culture and system does not support such practice – collaborative work among all the allied health workers. Do you think a Ghanaian doctor will “stoop too low” to accept a suggestion from a nurse or a dietitien if that suggestion is contral to what he/she wants? think about it.

      Yes our educational system needs to be fixed but we’ve produced very good doctors for the western countries. I’m here in USA with many Ghanaian Doctors and nurses who were trained and some practiced in ghana and are highly regarded here. Some of these professionals acknowledge that their practice is quite different from how they practiced in Ghana. Why? because you can’t bring those nonsense from home to here. I hope you get my point.

  20. Dr Boateng, please how do i contact you? There is something i’d like to discuss with you. Could you kindly drop your email or phone number?

    Thanks.

  21. Dear Dr. Boateng,
    Thanks for this discussion. I ramdomly got to this discussion but I’m glad I did. I don’t disagree with you at all about the need for appropriate calibre of people and the right education to meet the needs of our health care system. You mentioned three theams under which we should trained our healthcare professionals: the science and practice of medicine; the art of medicine; and the business of medicine.

    What is wrong with our professionals to me is the lack of the third criteria – the business of medicine/nursing. I agree with everybody that the heart of man is very deceptive and so being able to choose the “compassionate” person for our schools in Ghana might be daunting task. But if there is accountability in the system, people ( doctors and nurses) would be forced to do the right thing. I’m a nurse in USA. I consider myself to be compassionate and caring but there are times that I don’t want to do the right thing. However, I’ve no choice. I had to because if not and something goes wrong,I lose my job and probably land in jail.

    So you see. The whole Ghanaian culture must change re: professionals. A ghanaian doctor thinks he/she can’t be questioned because he/she is a professional. If only Ghanaians can start making these healthcare workers, and all workers, for that matter, accountable, probably, they would start practicing what they’re taught in school – the ethics of nursing/medicine. If doctors and nurses can be sued, you think they would not think twice about what they do and how they do it? you bet!!

    • Lydia, I agree with you that strengthening our oversight and regulatory function to sanction or punish bad behavior will be the most effective weapon in the “fight” against unprofessional activity of both nurses and doctors. It will engender accountability for sure. Suing doctors and nurses for malpractice in Ghana will be a challenge but I agree that it should remain a credible option for egregious activity.

      • Dr Boateng,
        I also could not agree with you and Lydiia more. I believe it will be hard and complicated to sue and so on in Ghana but we have to start from somewhere. I hope your quest to have a TV program to highlight these issues will be accepted by the station you contacted. Thank you for pushing so hard to help our healthcare system.

        It’s scary for some of us out here in the western world to continue to hear and read articles and news like the one posted by brother-Kwame 2 weeks ago. Very scary to note how in some instances patient have to bribe some to have simple vital signs checked. i wonder how much they have to pay to the imaging personel (x-ray, ct etc) or the lab techs for blood work. Sometime I want to come home as soon as possible to help but I am constraint lie many others by a few concerns among which is a huge medical student loan to pay back to the US Education Dept..

        But as a single person what can I do other than showing on time, do my work with respect and yet someone out there will be destroying and tainting the effort. I still love my country and I can’t wait to ome and help just like you Dr Boateng. No matter how long you stay here, you still miss home and wish to help save life there more than here.

        Talking student loans and tuition/fees for medical education in Ghana. I think it’s a great idea. However, I wonder how the system can ensure repayment programs as is done here in the USA with both private health care companies and government programs like HRSA for the under served areas. Perhaps if more private hospitals are established, as you suggested, drs can sign contracts to have it paid tied to how long a person stays. Here in US the average medical doctor graduates with a debt of over $250000. I hope it does not get that far in our system for the burden to be pushed unto the patient. Here the patient really bears the blunt financially unlike Canada, uk and other places. I hope we can figure out some realitic means to our economic situation with the current insurance and other possible options. In any case I still like the idea. Kudos you all.

        • Dr Arthur, I agree that those of us who have spent some time working abroad should see how best we can contribute to improving things in our nation in whatever profession we find ourselves.

          Those of us in the medical profession must recognize that, however we decide to help, we must respect the people on the ground, some of whom are tryng hard in the face of daunting challenges. We should all team up for a common purpose to improve those challenges.

          However, respect for the people and the pertaining system in Ghana should not absolve us of clearly pointing out bad things and substandard care.

          We should all, both returnees and locals, be focused on one thing, improving the qualiy of healthcare to the patient and keeping our profession true to its creed.

      • Thank you, Dr. Boateng for your reply. I wanted to clarify that making our healthcare professionals accountable, whether by suing or any other means should not be a way of punishing them but rather to discipline and to correct them. Disciplinary actions can be plenty including suspending their licenses for sometime, providing oversight of their practice for some time until we believe they now get it,making them take refresher courses may be in ethics or any area that they fall short, etc. Once people know that they can’t get away with bad or inappropriate behavior can be a deterance in itself. okay, enough of this.

        Seriously, our health care system needs a revamp and starting with education is in the right direction. One of the things we can do about nursing education for instance is to start promoting nursing as credible and desirable profession. I remember when I finished six form, a pastor suggested to me to go to a nursing school instead of university, although I qualified for university but my dad died shortly after that. My reply to this pastor was – if I were your daughter, would you have told me that? I was made to believe that if you don’t make it to university,then you go to either teacher training college or nursing school. So I went to Legon to do socio, p-science and russian lang. I could never imagine myself being a nurse if I had remained in ghana. But here I’m after earning two master’s degrees in social work and MBA, I ended up in nursing and very proud of myself. So what is the catch? Let’s start nursing education by rebranding it to become more appealing to everybody – poor, rich, intelligent,etc. Thank you, Doc, for all you’ve been doing to ensure we too match up to the other worlds in our healthcare. Kudoos!!!

        • Lydia, that is a really fantastic observation and advise you give about rebranding the nursing profession!

          It is a profession that is pivotal in the delivery of quality healthcare. It must attract the same respect and professional independence as the other healthcare professions especialy from doctors.

          My hope is that the introduction of degree nursing in Legon, UDS, Cape Coast University, and some private universities in Ghana will improve the “image” of nursing as a professional choice.

          • Hopefully, Dr. Boateng, hopefully. But you know, degree nursing in Legon has been there for at least the past 20yrs. I was in Legon in 1992 and the program was there, although many people were not aware of it. We need to do more. I think empowering Nurses can be one of the things to do. Nursing should be their own profession but not an “Aide” to the doctors. They must be educated to think critically independent of the doctor and encouraged to do so in their practice. Another area that we can use to achieve this rebranding may be through the movie industry. Ghanaians are now into movies so why not. Thanks

  22. Dr. Boateng big up yourself for starting this forum. It is great to see that after reading this long thread,despite the difference(which should be appreciated, since no one person holds all the solution to the problems) we all have one aim: improve care delivery for our OWN people.

    First, I want to thank all of you on the ground doing the real work, with limited resources, and systems that are designed to make your work more difficult than its need to be. I believe there are no “bad doctors” in Ghana, but rather bad systems that governs the education, training, health care delivery. Most physicians in Ghana, I believe wants the best possible care for his patients. The barriers to providing the best possible care for patients have to objectively documented.

    Citing these barriers are not enough, if we really want to change things. We should go beyound these and create a “culture change” among health care providers( nurses, doctors, pharmacy, hospital executives). Culture change, as it turns out is a very challenging barrier to overcome for all humans( I trained at Johns Hopkins, and we have these problems. I just use these illustration to make the point of how we are similar as people irrespective of environment, not to assert any superiority of a Hopkins trained physician).

    Even in a system with the infrastructure to provide the best care for patients(eg Hopkins), the right thing is not always done, and it took leadership and culture change to make care safe and efficient at Hopkins.

    As bliblicated stated ” People perish for lack of knowladge”. Even though physicians and nurse are best trained to improve care for patients, we lack the training and tools necessary to improve upon systems and make change.

    This science of improvement is not a new concept in industry, but currently bieng adopted to improve care in the US, and other parts of the world. As it turns out, spending more money and having the best state of art medical infrastructure does not provide efficient and quality care. A lot of times, we cite lack of resource in Ghana as a barrier, but many at times we can do better by removing waste in the system-there is a science to doing this, and perhaps we lack this knowledge. I will end here

    We need leadership, with the knowledge of improvement, commitment, and love to make this change. Lets keep talking about this issue and come out with constructive ideas to turn all these talks into improving care for Ghana.(pardon my typos)
    God bless Ghana.

  23. You’re right, Mr. Asare, about removing waste in the system as probally the starting point to ensure a better healthcare system. Yes, having up-to-date infrastructure in place, and the needed resources are important aspect of ensuring quality of care. However, without any oversight, people might not always do the right thing with these resources even if we do have them. That is not to say these people are bad. It’s just the nature of man. There should be checks and balances in the system to ensure that waste is avoided and that professionals do the right thing. Leadership is very crucial in this case but I personally doubt that any change in our system can come from the top because, there are some people in the top who are benefiting from the status-quo and may do everything to preserve it. I believe, the bottom, ie, the people can force and forge change, if there can be any change at all in Ghana.
    In US, whenever there has been a major system change in practice and patient care, it has almost always resulted from the patients and their families complaints, and their dissatisfaction (and of course, legal action taken against the system). The patients and their families, and for that matter, the people, have to be the advocates for change.

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