Madam, - In her book Unhealthy State - Anatomy of a Sick Society, Maev-Ann Wren traces the compromises and self-interests that led to the current hospital consultant contract. In his column of June 11th, Vincent Browne accuses "the most highly paid and most powerful lobby within the health system, the hospital consultants", of contributing to the current unfairness in hospitals.
Despite such comments and analysis the current debate is notable for the absence of hospital consultants' voices. The Irish Hospital Consultants' Association has frequently reiterated that it wants to safeguard private practice. However, we do not know the attitude of most of our hospital consultants to accountability, fairness, equity, or indeed the current healthcare system.
In private, the majority of decent, hard-working consultants despair of our current system and its values. In practice, most go the extra mile for patients, but they feel beleaguered by the system and know that their conflicts of interest are unsustainable. The system has "dumbed down" many of our finest medical minds and has led to an increasing number effectively giving up on the public service as they find it too difficult to change it from within.
There is an inevitable temptation for the current debate to centre on consultants' salaries, while failing to persuade consultants to use their influence and power in Irish healthcare and Irish society. It is now necessary for the fair-minded and committed majority of our consultants to articulate the independent professional values that underpin their practice of medicine and which drew them into the profession in the first place.
Perhaps the process of consultant formation gives us rugged individualists who do not find it easy to respond to issues as a group. But they are doing healthcare no favours by relying on the IHCA to articulate a vision of medicine that is seen to be about salaries, private practice and self-interest. The next year will be important in reshaping Irish healthcare and it is important that our consultants engage in the process if we are to have a fair, safe and competent system. - Yours, etc.,
Dr TOM O'DOWD,
Professor of General Practice,
Trinity College,
Dublin 2.