When Saving Lives Depends on Diligence, Not Sophistication

Twenty-two year old Ada (not her real name) had been admitted for two weeks and was being managed for stroke in the young. Contrary to her family's expectations, her condition only grew worse. When she became deeply unconscious, the managing consultant had to invite the hospital's ''young'' neurologist to take over Ada's management. Fortunately for me, I was training under the neurologist as a house officer.

I count myself fortunate to have been trained by him because under him, I learnt an important principle which I'm about to share in this piece.

To a fresh doctor, as I was then, it was like a miracle when five days after we took over Ada's management, she was almost fully conscious and could speak to her relatives, albeit in a slightly slurred manner. Interestingly, Ada's case wasn't isolated.

I spent three months of my housemanship under this neurologist and within this period, we received a myriad of referrals for patients who seemed to have been referred just because the teams previously managing them didn't want them to die under their care. They were almost certain these patients would die from their illnesses. The good news is- none of them died! Within the three months of my posting in this unit, we didn't lose a single patient!

Having 0% mortality for three months in a field like Internal Medicine, which is known for high mortality rates globally, is no mean feat. Surprisingly, this was in a hospital that had no sophisticated investigative or therapeutic gadgets. I'm talking about the Neurology Unit in a hospital that didn't have a functional CT scan, talk less of an MRI scan. What then is the secret of my team's success? It is called DILIGENCE!

Contrary to what was obtainable, my consultant never depended on histories taken by his senior registrars, not to mention house officers. He took every patient's history himself, regardless of what his residents report. He also goes ahead to thoroughly examine every patient of his during his ward rounds. This made our ward rounds very long, but it also eliminated possible errors in patient management that would have resulted from depending on histories and examination findings gotten by rookies like me then. Needless to say, our patients were better placed for it. In Ada's case, a fresh history and physical examination by my consultant revealed she didn't have stroke, but cerebral abscess, and was treated appropriately for it.

My diligent consultant goes ahead to inspect patients' treatment charts to check if patients received their medications as prescribed and if he discovers drugs aren't administered as prescribed, we must furnish him with the reason for that and the steps we had taken to correct it. Financial constraint wasn't a valid excuse for non-procurement of drugs as he expects us to have taken steps to ensure that relatives of every patient make funds available for their care. When they're genuinely unable to do so, we are to make sure such patients do all requested investigations as well as get all their prescribed medications by utilizing the hospital's welfare package for indigent patients.

In view of the aforementioned, it becomes less-surprising why a unit in Internal Medicine, in a relatively poorly equipped hospital, would record zero mortality for a whole three months. Again I say it boils down to diligence!

Another example we can learn from is the recent Ebola outbreak in West Africa and its spread in the United States. Suffice it to say that after Ebola was confirmed in Nigeria, no single healthcare worker contracted the illness in this country. The only cases of infection of health personnel were in the private clinic where the index patient was treated, when it wasn't known that he had Ebola. Now let's take our minds to happenings following the spread of Ebola to the US and Spain.

In the US, an infected patient was even sent home after reporting with symptoms and volunteering a travel history to Liberia, a country with a high Ebola burden. This happened partly because of poor communication among the healthcare team but also majorly because the role of diligent history taking has almost been relegated to the backgrounds in the developed world. Consequently, the attending physician ended up not getting the patient's travel history to Liberia.

Another testimony to dangers that arise where diligence is lacking is the spread of the disease among health personnel and their associates even after it's been confirmed that they're dealing with Ebola. The picture in Spain isn't different. Despite the far more advanced healthcare system these countries boast of, when compared to Nigeria, they still had spread of Ebola among attending health personnel due to lack of diligence in observing laid down protocol of management of Ebola cases.

In the final analysis, though having a top-notch, sophisticated health system is good and desirable, the efficacy of such a system would be greatly jeopardized if it's run without due diligence. So, the next time you see your patients or plan a healthcare system, remember to pay attention to the minute details for a patient's life may depend on your diligence!