HEART BEAT Maurice NeliganI think I must be developing delusions of grandeur. Last week I found myself sharing indignation with Dean Swift, and now I identify with St Luke (3: 4-5): "the voice of one crying in the wilderness". I feel like a John the Baptist, in that for many years I have tiresomely and repeatedly pointed out flaws and mismanagement in our health service.
While I cannot claim to have straightened the path, at least I have been joined by many disciples. In fact, you can scarcely get into the wilderness now by dint of the crowds, and the crying would deafen you. I wonder would the Powers wear a wilderness deafness tribunal. I suppose not, although it would have as much relevance as some of the others. Perhaps I should seek a legal opinion? On second thoughts, I'll just forget it.
Whether the crying will make any difference, is moot. The present situation is indefensible and grows more so by the day. A recent TV programme highlighting patients on trolleys in the A&E department in University College Hospital Galway also elicited the fact that there were 60 empty uncommissioned beds in the same hospital. To staff these would exceed the hospital staff quota. Similar situations exist in other hospitals throughout the State. Another report tells us that job numbers in the service are to be cut by 2,000 during the year. Liam Doran of the INO tells us no nurses are due to graduate from the nursing schools this year. This was well flagged, as was the European Working Time Directive, which we now breach on a daily basis. We await the planned response, with the sinking feeling that, as usual, there is none. A fellow consultant described his recent experiences with the Department of Health as akin to being a guest at the Mad Hatter's tea party.
An headline in the Irish Medical Times (February 18th): "Huge shortage of renal beds, staff hit patients". I hope this is merely an error of punctuation, as in present times it is the patients and their relatives who are more likely to hit the staff. The same issue carries another headline juxtaposed to the above: "€1,500 a day to train staff in business". A communications firm has been retained to provide a full range of skills training in personal effectiveness; thinking style/problem solving; group and interpersonal effectiveness; managing for results and HR skills. I am left wondering if the people who dreamed up this nonsense in the present climate of chaos actually live on the same planet as the rest of us.
Every night the citizens of this country lie on trolleys in inhuman conditions. This is the number one priority. Open and staff the beds to allow the doctors treat the patients, and forgo nonsense like the above until our people are properly cared for. Many have high hopes for the present Minister. I hope she realises that the inspiration for change will not come from the Old Guard. I hope she will cast her net widely and listen to those who face the problems daily.
Returning to the start of my medical career, knowledge gained as interns and throughout diverging professional pathways was hard learned and nothing came easily. I make the point because of a perception that doctors can be brusque and unfeeling and, above all, arrogant. I think this can arise from impatience in trying to make the case for medicine today to people who do not understand what you are trying to do. We are moulded by our training expertise and by our experience, so it is difficult to argue with people who have no idea of our lives and problems. To fix something, you must first understand it; that understanding we find lacking.
Dr Raymond Tallis in his book, Hippocratic Oaths, describes this modern doctor's dilemma very well. I can recommend this book to anybody who wishes to learn what weird creatures we are. For instance, "The notion of the God-like Consultant awakens a complex image. He is a white, male, late middle aged, upper middle class character. He browbeats and humiliates the staff with whom he works: the deferential, terrified and hand maidenly nurses, therapists, social workers, managers and, above all, the cowed junior doctors who do the work for which he himself is paid out of taxes. He talks past or over, silent, compulsorily grateful patients whose views are neither sought nor welcomed and who are denied the respect due to equals. He organises the world around his advancement, convenience and comfort, and blocks any reforms in healthcare lest they impinge on his privileged status or slow his passage through the public hospital on his way from the golf course to his private rooms."
This sounded like the life I had signed up for. Can you imagine my terrible disappointment when I found that the Dinosaurs had vanished from the earth? Maybe I was just too slow.
Maurice Neligan is a cardiac surgeon.