Prof Niall O'Higgins speaks to Padraig O'Morain about his new role as president of the Royal College of Surgeons in Ireland.
'The human side is the only side that counts,' declares Prof Niall O'Higgins.
The new president of the Royal College of Surgeons in Ireland (RCSI) is convinced that in the age of high technology, doctors must never forget that "medicine is an art, not a science. Despite the technology, there is still a sacrosanct relationship between the doctor and the patient."
He is also concerned that the hype about medical advances may give people an over-inflated view of what can be achieved.
"We are not getting across to people, I think, that in spite of the great things going on, we remain in very limited control of biology," he says. "We are not getting across the message sufficiently that we can do a lot of things in medicine now, but there are limits to what medicine can do. That is why listening to and informing people is part of the total package of care.
"We need to help them to be realistic in their expectations."
The professor of surgery at UCD and consultant at St Vincent's University Hospital says of his patients that "the more my own clinical life goes on, the more I am listening to them rather than telling them.
"There is an old adage in medical education: if you listen long enough to people, they will tell you what's wrong with them."
As one of the authors of the expert group on breast cancer services, he has also had to do a great deal of listening, some of it to people who are disappointed his group did not recommend their areas as locations for centres of excellence in treatment.
The expert group, which reported in 2000, recommended that 13 specialist centres be developed to bring the very best treatment to women with breast cancer.
"Everyone would like to have cancer services on their doorstep but technically and humanly we can't have the multidisciplinary expertise available on the doorstep," he says.
The key to getting the public to back the plan, he says, is to convince people that the new centres offer them an improved chance of survival, even if they have to travel to get to them.
"It is argued that it's not fair to send people to another place for cancer services," he says. "But we have evidence that people are willing to travel from A to B provided there's a survival advantage and they get a better service from hospital B. What the public do not want, in my opinion, is to be deceived by saying we are going to send you from A to B, where the likelihood of surviving is no better than it was in A."
He has publicly criticised the slowness of the Government in developing these centres.
"To be fair, the Minister will state he has put a lot of money into symptomatic breast cancer services," he says. "But it is equally true to say the development of these centres has been far too slow."
He supports the Hanly report reforms, which would see many smaller hospitals lose their 24-hour A&E departments in favour of bigger, regional hospitals.
He refers to a survey done in California about 20 years ago, which compared the outcomes for people injured in traffic accidents and who were brought to local acute hospitals to the outcomes for those brought to hospitals with specialised, well-resourced A&E services.
"The analysis indicated fairly clearly that about 30 per cent of patients [brought to local hospitals] who died, needn't have died," he says. Long-term disability was also reduced in those brought to the specialised hospitals.
"The message is that you shouldn't bring people with multiple injuries to the nearest hospital," he says. "You should bring them to the most appropriate hospital."
None of this, he says, need involve downgrading of hospitals. If the smaller hospitals were not dealing with serious emergencies (under the plan they would have nurse-led minor injuries units), their beds and theatres could be used to treat people on the waiting lists.
"You could get rid of waiting lists," he says. "The hospital could be hugely enhanced by having a lot of activities there in the surgical area that are currently being put on long waiting lists but which could easily be dealt with in the smaller hospitals."
To win the argument, the Government needs to begin by developing the highly-resourced regional hospitals which are part of the plan, he says. "If you have a super place, people will come to it."
But the regional centres will have to be really good, he warns, if people are to accept a change in the roles of their local hospitals.
He is proud of the breadth and scope of the activities of the RCSI, which he will serve as president for the next two years. Its most recent international venture, the new Medical University of Bahrain, will take its first students this October. RCSI and UCD also have a medical school in Penang, Malaysia.
He is also proud of the RCSI's new special skills laboratory, which will teach the basics to trainee surgeons and new skills to experienced surgeons outside the hospital setting. "It's not appropriate now to learn your skills on the patients," he says.
But the key interest of doctors, he adds, is the relationship with patients and that includes being advocates for patients. "Consultants must continue to have the right, which their present contract allows them, to speak out on behalf of patients," he says.
"There is no way anyone can condone bad practice. Some of the scandals in medicine have been highly damaging to society. They have put the profession on the back foot. But most of the doctors I know are absolutely committed to improving services to patients. They are not seeking self-aggrandisement. I am not saying there are not some people who are avaricious and greedy - but it's very distressing to have the whole profession accused of feathering its own nest."