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Things You Don’t Really Learn In Medical School. By: Peju Adeniran

Reading the sad story of the University of Lagos female undergraduate, who was alleged to have died in unfortunate circumstances that had to do with sex, consent and an alleged concoction of sex pills my mind went back to a lesson l learnt many years ago in my 4th year of Medical school.

One of the lessons taught in Clerkship involved creating physician room scenarios where pretend patients, with pretend illnesses would be admitted, examined, diagnosed and treated by medical students under the guidance of the lecturers.

On this day, I was pretending to be treating a patient who was a middle-aged hypertensive man and had come into the emergency room in a hypertensive crisis, despite being long-term diagnosed of the condition and placed on properly designed medication.

I was presenting to a Professor, who we had nicknamed “Go forth and do like I say” because of his habit of admonishing his students to do just that.

I had my clinical case notes and had presented, to my mind, a near perfect scenario and how I, as a future doctor, would handle it. Everything had gone well until I got stuck at the final question that the Professor asked me:

“What is the first reason why this patient, who has been hypertensive for five years, would present in an emergency room?” asked the Professor.

All my answers were wrong, as varied as they were:  from the expected and logical “hypertensive stroke” or “cardiac arrest” to the illogical; “food poisoning?”

“All wrong”!” boomed the Professor. “In a middle-aged hypertensive man from these parts, from clinical experience, the most likely reason why he would present in your emergency room is sex!”

A pin could have dropped on the floor that day and it would have been heard on the other side of the ward.

Not quite getting what my teacher was trying to say, I asked him if he meant that a hypertensive patient could present in the emergency room from a heart attack or stroke that occurred during sex but he said a loud “no” and continued the lecture.

“This is what you must know,” began the Professor, leaning close towards us like he was about to tell the world’s most important secret. “You must always be careful when you are prescribing drugs, for instance like one for hypertension, even to a patient that might be currently at the risk of death. If the drugs will affect his ability to have sex, your patient will eventually stop taking your drugs and be non-compliant. So, the treatment will fail, the patient’s health will fail and you the doctor, would have failed them both!”

“But Sir…” I stammered in protest “Are you saying that a patient will fail to take his drug even though he knows that he  might die just because he doesn’t want to give up sex?…. That does not make sense.” I was incredulous.

Choosing to ignore my impudence, the Professor instead looked at me and asked.

“Baby doc, have you treated any real patients before?”
“No, Sir” I said sheepishly, now sufficiently humbled.
“Have you treated Nigerian male patients before?”
Silence
“Or perhaps you have been married to a Nigerian male before?”

Indeed, at year four, I hadn’t. So, silence reigned.

“Then you have no insights into the politics of sexual virility and the bedroom antics of the Nigerian male. You need to gain some insight because it is going to affect how you treat your male patients….”

This time I could only nod my bowed and chastened head in agreement.

“So, do not argue with me, just keep this in mind when designing treatments for your patients and go forth and do like I say.”

I never forgot that lesson, and it is fortunate that I did not.

Today, years later, and in clinical practice and experience of my own, I have seen that my esteemed Professor could not have been any more right. And that was the lesson that came to mind as I read about the girl who died after her boyfriend plied her and himself with sexual stimulants.

As the facts of the case are still currently under investigation, I will not state my opinion, professional or otherwise on the case per se. What I will, however, add is that our society is to blame because it keeps promoting the myth of sexual virility and performance, especially in the male thus leading to pressure and unrealistic expectations.

*Postscript/ introduction to blog
It is on a sad note, and while mourning Ella, that we introduce this blog, where you get to sit in with me in my physician’s room, and we discuss not diseases, but people and how we all cope with disease. Welcome to my doctor’s room, sit in that chair, and let me tell you what I know.

(Brief Bio: Dr Adeniran is the C.E.O and Editor in Chief of Docsays Integrated Services (www.docsays.com) a health content production and consulting company based in Lagos., which also produces “The Docsays” radio show, a popular call-in medical talk show programme that airs three times a week on City FM 105.1 with immediate plans to syndicate. Her first degree is in Medicine, from the University of Lagos.)

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