It was a hectic Monday morning, recalls Dr Ibrahim Urio when early this year, a long queue of patients was lined outside his office at Mwananyamala Hospital in Dar es Salaam.
“On that day, there were just a few doctors attending to patients,” says Dr Urio as he narrates how he almost misdiagnosed a patient.
“I felt a little under pressure when some patients began lamenting outside. Their noise was too loud to bear. Then, I opened the door and saw a long queue.
“I felt the dilemma of balancing between satisfying the patients outside and spending enough time on those who were already in my office,” says Dr Urio, whose story is almost similarly told among other medics who were interviewed by Your Health.
How it happened
Dr Urio explains that one of his patients, a middle aged woman from the city, had reported to the hospital with a four-day history of abdominal pains. “In the course of trying to save time and attend to many patients waiting outside, I rushed to the final diagnosis. But I slightly overlooked one aspect. I didn’t examine her abdomen.”
“I proceeded to request for basic laboratory tests for typhoid, blood, stool and urine. The lady returned the results to my office after about four hours. However, before I went ahead to give her a prescription, my instincts pushed me to do something that was very necessary,’’ he said.
He had to examine her abdomen.
And to his surprise, the patient had a swelling. Dr Urio says that he felt regretful that he had wasted that woman’s time and also that he was just about to misdiagnose her condition.
Dr Urio says he immediately requested for an ultrasound imaging and the results showed that the lady had a huge fibroid. “If I did not examine her abdomen, I would definitely provide wrong diagnosis,’’ he admits.
Doctor-patient relationship deteriorating
Researchers say cases of patients complaining about being rushed out of offices, with mis diagnoses from hurried doctors, are a sign of the deteriorating the doctor-patient relationship. This, they say, has often compromised the quality of health services.
Dr Anzibert Rugakingila, a researcher from The National Institute for Medical Research (NIMR), who recently did a survey on how people in Dar es Salaam perceive the quality of healthcare services, says that the communication gap between doctors and patients has always frustrated the patients and hurt the quality of healthcare.
“When it comes to doctors failing to spend adequate time listening to their patients’ problems, the heavy workload factors on the doctors and the human resource gaps must be considered. When medics work under pressure, quality is compromised. But that does not rule out the possibility of negligence by the medics,’’ says Dr Rugakingila, a research scientist from the National Institute for Medical Research (NIMR).
Studies done in other countries show that when doctors don’t listen to patients, they miss important health cues and misdiagnose illness. And, for the patients who don’t understand what their doctors say, they fail to follow their regimens, leading to preventable hospitalizations, complications and poor outcomes of treatment.
And a breakdown in physician-patient communication is cited in 40 percent or more of malpractice suits in US, according to an article published in the Wall Street Journal, titled: The Talking Cure for Health Care.
In another article: The Battle Against Misdiagnosis, published in the same journal, experts warn that as new forms of diagnostic and information technologies are implemented, managing large amounts of data will become increasingly complex, and physicians could become more vulnerable to misdiagnosis.
Realities in Tanzania
Ms Halima Mumba, 30, a resident of Tabata in Dar es Salaam, tells Your Health that she recently had to take her 4-year old son to five different health facilities in the city becasue none of them gave him a right diagnosis. And then she found a keen doctor. This doctor simply examined the boy’s ear and discovered that he was suffering from an ear infection.
“We went to five health facilities where all the health workers simply carried out routine tests for malaria, urine, stool and blood. None of them examined my child. They all concluded that the test results proved negative for all the common diseases,’’ says Ms Mumba to Your Health last week.
“My son had persistent fever for about four consecutive days. In all the five health facilities that we went to, I did not see doctors examine him. It was only the final doctor who took a small pen torch and examined all his body openings. That’s when he discovered some pus in his right ear,’’ she says.
“I felt cheated when the doctor said my son was suffering from an ear infection,’’ says Ms Mumba and continues, “I just wondered why it took us three days and five health facilities for something that required a doctor to simply go an extra mile in doing their job.’’
In Tanzania, where the doctor-patient ratio is 1:30,000, the medics are very overworked. This means that they spend few minutes with each patient. Experts say the situation increases the risk of misdiagnosis or under-diagnosis.
“In hospital settings where doctors attend to few patients, the risk of misdiagnosis is reduced. This is because the doctors have adequate time to fully evaluate the patient’s condition, medical history and other related factors,’’ says Dr Rugakingila.
While doctors attribute certain cases of misdiagnosis to the dilemmas they face as they strive to remain professional in a challenging work environment, some studies show that there is need for the health workers to improve their customer care skills as they go about their job.
A study carried out at Mwananyamala Hospital in Dar es Salaam two years ago, revealed that healthcare providers—including doctors and nurses, lacked the required customer care skills to deal with patients’ expectations.
During the study, published in the Pub Med Journal, the researchers noted that patients expected compassion, empathy and availability of treatment facilities but not necessarily the complete cure for their ailments. It suggested important aspects for improvement.
“Key areas of concern include: improvement on communication skills in showing compassion, politeness and active listening, availability of essential drugs, and improvement on clinicians’ prescription skills,” says the study.
Patients and doctors, clash of ideas
Various studies, Dr Rugakingila says, have shown that the low quality health services offered by certain hospitals may not matter to the patients if healthcare workers treat the patients with politeness and good customer care skills.
According to Dr Rugakingila, majority of the patients go to hospitals with high expectations of good conduct by health workers but their anticipation does not usually match with the reality and the quality of services offered at the facilities.
“For the patients to enjoy the good treatment from their healthcare providers, policy makers must strive to improve the welfare and working environment of the caregivers but also patients must be told the realities in hospitals,’’
“I carried out a study on that aspect this year and used Amana Hospital in Dar es Salaam as case study. I am yet to publish the findings. I found out that about 50 per cent of healthcare workers were not satisfied with their working environment,’’ he says.
“Talking to 141 patients and 79 health workers, I realized that there is a clash of ideas between patients and health workers, regarding the quality of healthcare at Amana Hospital. This also determines how healthcare services are delivered,’’ he explains.