Dear Editor,
I am passionate on patients having the best care in Guyana. This issue is very close to my heart from personal experiences. It is because of these experiences that I had an informative debate with a close mate of mine, who is also a doctor in Guyana.
I do believe that patients in Guyana deserve better. For too long, they have been receiving poor care. This has been occurring for many reasons. The main reason is that many doctors, despite trying their best, are not adequately trained. Also, many doctors are returning from overseas and without presenting any credentials, refer to themselves as specialists.
In our debate, my former colleague and good friend queried how doctors are accredited in the UK before being entered onto the specialist register.
In the UK, on completion of rigorous – at least ten years medical specialist training – the doctor’s electronic portfolio is forwarded to the Joint Royal Colleges of Physicians Training Board (JRCPTB). Each medical specialty would have groups of independent specialists who would assess the doctor’s training. This assessment can take up to six months. If successful, the doctor’s electronic portfolio is forwarded to the General Medical Council (GMC) with recommendations to be placed in the specialist register. They also do their own assessment which can take up to two months. Clearly, this is not a casual look over but in-depth review. Lives are involved. After that extensive review, the successful doctor is then issued a Certificate of Completion of Specialist Training (CCST) and entered on the specialist register. Surgical specialties and paediatrics go through the same rigorous process through their boards.
My former colleague rightfully said that Guyana does not and cannot afford such rigorous assessment since they lack the required expertise. I concurred but I made the point that they need not. Any doctor returning from overseas training should have a certificate to confirm that they have completed specialist training. The word-of-mouth accreditation that is happening in Guyana is not good enough.
I would argue that the assessment of a doctor’s overseas training credentials should be provided by an independent regulatory board, not the medical council, before they are placed on the specialist register. The rules have to be as rigid as the rules in the West. Patients’ lives are at risk. All lives matters. Guyanese are not guinea pigs for inadequately trained doctors to experiment and hone their skills on.
The question is how many of those doctors returning from overseas are actually specialist. I’ve reviewed doctors’ qualifications on the Guyana Medical Register and my estimation would be less than 25% who claim to be specialist are actually specialist. I’ve seen one doctor, who took the Specialty Certificate Examination in Acute Internal Medicine in 2016, referring to himself as a specialist. I’ve seen a doctor who did the MRCP (Edin) examination referring to himself as a specialist. I’ve seen a doctor who did a couple of fellowships and got a couple of honorary fellowships that nurses can apply for, referring to himself as an interventional cardiologist.
The fact is that the universities where these fellowships were undertaken explicitly state that doing these fellowships would not make one a specialist. I’ve seen two doctors who both did fellowships, one in emergency medicine and the other in transplant surgery, referring to themselves as emergency specialist and transplant surgeons. I’ve seen a doctor who did a one-year theoretical master’s degree in India then refer to himself as a surgeon. And there are many more. Don’t take my word. Do your own research. Check the website www. medicalcouncil.org.gy then check under registers with names listed in alphabetical order.
I would argue that it is this lack of standards and accreditation that is placing poor patients at risk. Rich folks and politicians rightfully get their medical care overseas. I will repeat. All it takes is to request the doctor, before he/she be registered as a specialist, to provide a certificate that they have completed same. This is a serious matter. The seriousness of which I stressed to my former colleague and good friend.
We then discussed fellowships and postgraduate theory-based degrees. I advised him that none of those makes a doctor a specialist. A fellowship is for doctors who have already completed specialist’s training in their field. They can then undertake a fellowship to consolidate knowledge and skills. It is a kind of a top up to one’s already completed specialist training and to make oneself more marketable. A postgraduate theory-based master’s degree is just that, theory. Medicine is learnt on the wards and not in a classroom.
I write this letter today because I think it is time that Guyanese patients get better. They should be informed. They deserve the best. With the advent of oil, foreigners will not accept substandard care by inadequately trained doctors. It is in the Govern-ment’s interest to address this issue before 2020.
Yours faithfully,
Dr Mark Devonish
MBBS MSc MRCP
(UK) FRCP (Edin)
Consultant Acute
Medicine
Nottingham
University Hospital
UK
