Who is your doctor?

A visit to a health institution sometimes leaves women unsure of who’s who among the vast number and grades of doctors often available. This is especially so in teaching hospitals, which are becoming more common in Kenya. Every doctor should wear an identity badge, and always introduce themselves.

Medical students are found in almost all big hospitals, observing patients and procedures. They have limited responsibility for direct patient care. Your permission for their presence should always be sought.

After qualifying from medical school, doctors in Kenya spend one year working under close supervision. They are often called interns, and rarely take independent care of women. If an intern sees you, they usually discuss your care with a senior colleague.

After internship, doctors become eligible for postgraduate training in Obstetrics and Gynecology. Postgraduate trainees are referred to as registrars or residents. They progressively acquire specialized skills and experience in Obstetrics and Gynecology, and undergo competency assessments and examinations. Gradually, they become the ‘front line’ doctors dealing with emergencies and common problems in Obstetrics and Gynecology, often in close liaison with consultants. On completion of training residents become senior registrars or instructors, and work semi-independently prior to being registered as consultants by the Kenyan Medical Board.

A consultant leads the care of patients under his/her team, and also takes responsibility for the training of junior doctors. Consultants usually have additional managerial and organisational roles. Even though consultants may delegate some chores to junior colleagues, they have ultimate responsibility for your care. You may not always be aware that key decisions seemingly made by junior doctors have often been discussed with, and authenticated by consultants.

Some consultants spend more time training in specialized areas of Gynecology, for example infertility of cancer surgery. They are referred to as sub-specialists, meaning that they have additional expertise. They may still practice general Obstetrics and Gynecology, but some will only see patients with complex problems in their field of specialization. Your Gynecologist may sometimes refer you to a sub-specialist, or you may choose to see one from the outset.

The training and supervision of Gynecologists means you can have confidence that your doctor is capable of taking good care of you. You reserve the liberty to ask what level of training your doctor has gone through. Even though it’s desirable to allow medical students and postgraduate doctors to be involved in your care, your consent for their involvement must always be sought. If you expected to see a certain doctor and a different one shows up, you should always demand an explanation. Your choice of who to consult must always be respected and facilitated.