Disturbing revelations are emerging that senior doctors at Kenyatta National Hospital, popularly known as consultants, have left management of patients to their students as they spend much of the time in their well-paying personal clinics or private hospitals.
The students, popularly known as registrars, are junior doctors pursuing specialization degrees in various fields, and usually require very close supervision from senior doctors (consultants) to help them horn their skills.
But the senior doctors seem to be spending much of their time away from the hospital and their students, instead engaging in other activities.
A Taskforce Report submitted to the Hospital a couple March this year, and which has not been made public, notes that there is “inadequate supervision and mentorship (of registrars) by consultants and lecturers.”
Titled Report of the Taskforce formed by Kenyatta National Hospital and the College of Health Sciences University of Nairobi to Propose Solutions and Recommendations to the Challenges Facing the two Institutions and Perceived Factors that Precipitated the December 2011 Doctors strike, is a confirmation of the fear that doctors abscond duty at KNH.
One registrar, who requested anonymity for fear of victimization, said: “sometimes the supervisor will allow you to go ahead to do an operation on a patient without supervision, yet such procedure requires him or her to be there to guide and teach you.”
“Most of the time you find that we learn by ourselves since the senior doctors who are supposed to show us how to manage the patients are most of the time away from the hospital,” he adds.
What makes matters worse is the requirement by the University that a student must have done a given number of tasks for them to graduate, for instance, a set number of surgical operations.
Desperate registrars are therefore going ahead with procedures without the presence of the supervisors to ensure they meet the required target to enable them graduate.
Some of the senior doctors at the hospital confirmed that this is a serious issue since some of their colleagues are rarely at the hospital.
“It is a pity. I have witnessed consultant doctors allowing the registrars to even teach students in the school of medicine on areas that require senior doctors to do so,” says one of the doctors, who supported the findings and recommendations of the task force.
“Its about failure to respect ethics and values that guide this profession,” another doctor added.
Its about failure to respect ethics and values that guide this profession,” another doctor added.
“The rate at which patients are seen could be higher if all the senior doctors are present,” said one of the nurses in the unit.
Another doctor summed the absence of the consultant from the hospital as “Lack of discipline and bad manners.” “If we senior doctors are always present at this hospital, the long queues you see in some of our clinics would a thing of the past.”
The Task Force report is categorical that the consultants in the School of Medicine and the teaching hospital at KNH are ultimately responsible for the patients.
Says the report: “In order to maximise patient safety and educational opportunities, the clinical faculty will be available during clinics, major ward rounds and admission rounds to provide guidance and meaning to the student’s experience.”
“Newly admitted patients will be reviewed within 24 hours of admission by the consultant.”
Sources within the hospital say much has not changed since the release of the report, with consultants still spending much of the time away from the hospital.
According to the task force report, the consultant doctors are supposed to strictly follow a four-staged approach when it comes to management of patients by registrars.
At Level 1, the consultant is physically present and directly involved in the care/procedure; Level 2-the consultant is present in the operative/procedural suite or on the unit and immediately available for consultation. Level 3-The consultant is immediately available in the facility or on the campus. Level-The consultant is off-site, available on phone and is expected to be present in the hospital within a reasonable amount of time, when needed.
“For the resident, the essential learning activity is interaction with patients under the guidance and supervision of faculty members who give value, context, and meaning to those interactions,” says the task force report.
This staging seems not to be working at the hospital with registrars in Levels 1 and 2 attending to patients without regular supervision. Demands by registrars for better pay and good working conditions partly stems from being overloaded with patient care, which in some instances, is supposed to be done by the consultants.
It is understood the consultants continue to resist any attempts to rein them in, with senior managers taking a softer approach for fear of angering them.
One of the doctors said the money they earn at KNH is too little to sustain their families, hence the need to spend time in their private clinics or private hospitals.
“What I earn at Kenyatta hospital can only meet a third of my family budget which includes paying school fees for my children and maintaining my family at a certain standard of living,” the doctor says.
“That is why I cannot spend much of the time at this hospital, unless our pay is raised to what can comfortably meet our needs.”
Indeed, the Task Force report acknowledges the poor pay of doctors employed by Ministry of Health, arguing that this is contributing to the brain drain. It recommends the establishment of a Health Service Commission to look into the issue. The report further recommends the need for the treasury and the Salaries and Remuneration Commission “to take the issue of health workers for special consideration.”
The construction of the private doctors clinics at the hospital’s Doctors Plaza was to ensure the doctors were within reach whenever needed by the hospital. But the concept seems not to have achieved much with doctors shuttling between their private clinics and private hospitals.
Interestingly, when the senior doctors are told to resign from KNH to concentrate on running their private clinics or work in private hospitals, they are adamant.
The other issue raised by the report is how the large numbers of students admitted by the University of Nairobi has overstretched facilities at KNH. While the university’s module two programme for self-sponsored students has left the institution smiling all the way to the bank; it has presented serious problems and misery for the hospital.
The number of postgraduate students admitted has increased from 80 in 1995 to 196 in 2010, while that of the undergraduates increased from 115 in 1995 to 415 in 2010. Yet, the task force report laments that the “infrastructure at KNH and CHS has not increased to cope with the four-fold increase of the students numbers.” These high numbers have strained the training facilities at the hospital.
The junior doctors complained that the inadequate facilities, overcrowded and underequipped consultations rooms at the hospital is making it very difficult for them to receive quality training as well as give the patient high standards of care.
There is a feeling that the University of Nairobi should involve KNH in determining the numbers to be admitted as students to ensure those enrolled are matched with the facilities available.
According to the Task Force report, the government needs to decongest KNH by establishing satellite training centres where the senior doctors can offer training to junior doctors.