HEART BEAT:A YOUNG COLLEAGUE wrote to me from medical exile recently. He was anxious to know about employment prospects back home. In theory they should be very good as he is working in a specialty that is seriously underprovided here and yet is very necessary, writes MAURICE NELIGAN
The manpower deficit in this branch of medicine was to be tackled as a matter of urgency some years ago. The situation was described as a national emergency. Needless to say, little was done. Does any of this sound familiar?
I should have been able to reassure him that his prospects would be excellent. However, these are not normal times and logic plays little part in the running of this “most distressful country’’.
All I could do in honesty was to advise him to acquire as much experience as possible and to hone his clinical skills in the excellent hospital where he now works, in order that when an opportunity arises, he would be well qualified for consideration.
That message is not much consolation to a young man who has changed environment and is lonely and misses family and home. It is even less consolation to know that he and others with differing skills are exiled while the placemen, parasites and freeloaders prosper as before.
As a nation we are retracing our steps down a road we hoped we would never walk again, the way of exile and emigration.
Some other country will benefit from the education and skills of our sons and daughters as they shoulder the burdens of separation. The ties that bind us are strong and enduring. That has been shown over the generations of our diaspora.
But why, oh why was it allowed happen all over again? I am writing about medical emigration but am conscious that this plague on our land seeks all sectors and disrupts the lives of our children and ourselves.
There has always been a medical exodus. Some left because then as now, employment prospects were very scarce at home. Some left consciously seeking fresh fields, believing that medical practice and opportunity was better elsewhere.
More left to get training and experience abroad, always intending if possible to practise at home. In consultant ranks a minority never left at all.
It was considered a strength of Irish hospital medicine that so many of the hospital staff had part of their training abroad. Many worked in some of the most prestigious hospitals in the world. Britain, the US, Australia, Canada and continental Europe taught our graduates in all medical disciplines.
Many Irish rose to consultant ranks in these institutions before they returned. A big Irish hospital therefore might have a mixture of doctors in various fields who had acquired skills and experience overseas.
This was greatly to the benefit of patients and also to medical students and non consultant hospital doctors (NCHDs) as it lifted training from the realms of inbred parochialism and placed it on the world stage.
Working abroad in medicine enabled you to establish enduring friendships both with those who taught you and those who were in training with you and who in turn worked in major hospitals throughout the world.
This doctors’ network ensured that you, in your turn, could recommend young Irish graduates to your peers abroad and thereby augment the skill mix in your own hospital. It was networking that usually worked for the benefit of all.
That sounds simple and logical. It assumes, however, that the end product was appropriately trained and experienced and ready to go. That was usually the case.
However, doctors are not all the same and no amount of training can make it otherwise. Some are better than others.
This has always been the case. Accordingly, sometimes the overseas trainers that you have sent the trainee to, may not hold the same opinion as to their capabilities as you do.
The trainee, however, seldom doubts their own capabilities, and there is always a reason as to why they did not get on in the unit in which they were working. To put it mildly, this causes a problem and requires tough decisions – and decisions like that are seldom made in committee or by interview boards. Hard choices like these cannot be made easily in a politically correct world.
You are left pondering your own judgment. As William Osler told us, the best doctors must be skilled, clever and humane. They must be approachable and considerate. Above all, they must possess the quality of Aequanimitas or imperturbability and be confident in their own ability and be able to project their sense of capability to patients and those around them.
- Maurice Neligan is a cardiac surgeon