From appointments at her clinic to house calls, Dr Mary Rogan faces a typical weekend on call for a general practitioner
IT’S HARVEST season, and there’s a reassuring rumble as a tractor works a field out on lands close to the lower reaches of lough Corrib in north Co Galway. Wildflowers are in full bloom, as is the verdant garden at Annaghdown Medical Clinic.
Dr Mary Rogan, the clinic’s proprietor, admits that she doesn’t get much time to enjoy it – such is the life of a rural GP.
“I think we’ll soon be importing GPs from abroad, just like we are with junior doctors, if the workload continues. It’s not appealing to the younger generation,” she says.
Originally from Castlebar, Co Mayo, Rogan was reared in the grounds of the local hospital, as her father was a psychiatrist there.
She studied medicine at NUI Galway, set up her own practice and her catchment extends from Annaghdown to Corrandulla. Some 700 of more than 1,000 of her patients are on the GMS scheme.
She is a member of the Westdoc Co-op, is on call one night a fortnight and on four weekends of the year, for which she receives no extra payment.
She is a mother of five children. She practises psycho-sexual counselling outside her normal working hours.
This was her schedule during a recent weekend on call. Patients’ names and certain details have been omitted to protect confidentiality.
Saturday
8am:On call.
9.10am:Call from triage nurse with Westdoc to ask her if she can treat a patient with "some kind of eye injury". Details of the cause are somewhat vague. Given the location of the patient, she refers him to hospital in Galway.
9.30am:A child has a bead in the nose. "This would take several pairs of hands to immobilise the child, and I could have to apply forceps," says Rogan. She has no nurse available in the clinic at weekends, so she directs the triage nurse to refer the case to the hospital's emergency department.
10am-1pm:Six visits by patients. Cases include ear infections, a sick child, several chest infections, a couple visiting the area who have a complicated medical history and need to be seen, several cases of sore throats, and an elderly patient who had an episode which the family describes as anxiety, but the patient is demanding to be seen. It is confirmed that the patient has shown symptoms of shortness of breath.
“I take that seriously in anyone over 50 years of age,” Rogan says. She checks the patient, who now appears to be fine. She advises that the family bring the patient to his own GP on Monday for blood tests and a chest X-ray if necessary.
2pm:Woman with vulval pain, referred through triage. Rogan sees her, but advises on further specialised medical help.
2.45pm-5pm:Several children brought in with different complaints, ranging from sore throats to ear infections.
6pm:House call to a patient the other side of Headford, 24km away. An elderly patient of another GP has a chronic condition and requires help.
8pm:Back home at Annaghdown. No further calls. "I'm very lucky, as you can get four to six calls between now and into the early hours of the morning," she says. It's late August though, and it should be "quiet".
Sunday
9.30am:First call from a triage nurse about a case.
10.30am-1pm:Cases involving two children with temperatures, and a young man with abdominal pain which wasn't urgent.
1.35pm:Rogan is just starting lunch when she receives a call about a child with a severe asthma attack. It is a patient of hers, and she knows the family – and knows they don't tend to get stressed, so it must be urgent. The child is brought in, clearly suffering and hunched over, trying to draw a breath. Rogan administers oxygen and calms the child.
She knows the child needs to go to hospital, and discreetly calls an ambulance. “If the child hears me on the phone, it will cause further alarm,” she says.
She asks one of her sons to go out onto the road to direct the ambulance. “They have GPS, but they still need directions sometimes.”
6.30pm:Child with a kidney infection brought in by parents. "In fairness, most people do come in, and you are really only going out to elderly people who are immobile or bedridden," she says. A Westdoc four-wheel drive with a driver is available over the weekend for transport.
“We get calls to pubs, and sometimes to situations involving domestic disputes,” she says. “I won’t go to pubs, and I won’t go to domestic situations without a Garda being there. The co-op driver is not trained in security, and basic first aid training emphasises that one’s personal security is paramount.”
8pm:She makes a house call four miles away to an elderly patient of her own who has recently been diagnosed with an illness, and has chest complications.
Midnight:She receives a call from a triage nurse asking her to see a patient whose GP is in Tuam, where there is a separate weekend on-call arrangement for cover. The Tuam doctor on call has "had to go" to Roscommon for the night. She agrees on the basis that the patient is living close to her area.
“This is not the first of these calls,” she says. “There has been an effort to get us to cover Tuam if their ‘red-eye’ locum is overstretched . . .
“I’m in Headford, Ballinrobe, Tourmakeady, Cong and Clonbur, and my area, of Corrandulla. I’d be hung out to dry if I’m out on a call in Tuam, and then there is an emergency here.”
She travels to the patient’s house. It turns out to be a minor complaint.
Monday
9am-6pm:Regular clinic at Annaghdown starts.
6.35pm:Call about a child with a minor complaint.
8.20pm:She sees a very sick child, who is referred to hospital.
8.50pm:A patient is brought to the clinic for treatment after an accident at home.
9.30pm:Triage nurse rings about a patient visiting the area, who is reporting a history of back pain and requires medication. Rogan asks a family member to be close by.
“The patient was genuine, but you have to be careful when it’s an unfamiliar case, and there is a request for pain- relieving medication.”
11pm:House call to elderly patient of her own.
Midnight-7am:A series of calls from triage nurses throughout the night, seeking advice.
COUNTING THE COST: HOW THE DOWNTURN TAKEN ITS TOLL ON DOCTORS
"There is a tide of despair out there," says Dr Mary Rogan, and many of her cases relate to the economic climate.
There has been a rise in GMS patients, due to the downturn, and she has cut her private fees by 10 per cent in the past year.
She charges €45 for a new consultation, €30 if it is a second consultation for the same problem and €10 for a third. She charges €20 for a driving licence medical, and for a private flu vaccine.
However, her overdraft is extended to its limit and she is faced with cutting staff hours.
"All costs relating to setting up and running your clinic are borne by the GP. You provide your own premises and pay for your own utilities," she says.
"I never sleep well when I am on call, and I carry the phone with me all the time – everywhere.
"A locum costs €500 a day to hire, for which you get €325, less 20 per cent for DIRT tax deducted from the HSE.
"Most people looking at the published annual list of GP earnings don't realise they are looking at the gross figure, and not the actual figure after deductions."
Rogan says there is a multiplicity of paperwork, and the "whole monolithic bureaucracy" has seeped into out-of-hours work, which encourages a dependency in patients.
"And apparently there are a lot of patients who complain about us when we are working out of hours – much of it petty, trivial stuff," she says.
Rogan has had requests for letters from people who are overdue car tax, or who are facing a parking fine, or haven't used up their gym membership.
"The idea behind co-ops like Westdoc was to share the load among us, but it seems to have invited in the dead hand of the State," she says.
"As a primary-care team, we have to attend many meetings, which I don't go to. In my view, the less efficient that people are, the more meetings they have to call.
"As US writer and economist Thomas Sowell said, 'You will never understand bureaucracies, until you understand that for bureaucracies procedure is everything and outcomes are nothing.'
"Outcome is vital to us medics . . . that's why we do what we do."
