Madam, - As the widow of a consultant who was neither rich or arrogant, just too hard working for his own good, I greatly resent the remarks of Dr Eric O'Brien (June 6th).
Consultants earn their spurs, as Dr O'Brien should well know, through long years of exile during which they undergo intensive training and long hours of study in their chosen speciality at centres of excellence in the UK, North America and Australia. They are probably the most highly qualified professional group in this country. They have to be so as few posts become vacant or can be funded in the Irish health service. Add to this the fact the competition for such posts is quite fierce. The standard of each candidate is so high that the appointment boards are spoiled for choice and visiting consultants from the UK sitting on such boards are often envious of the wealth of talent on offer to Irish hospitals.
When the lucky consultants do make it back to Ireland they are joining a health service in chaos, taking a drop in earnings, facing criticism from all sides, and, the unkindest cut of all, forced to endure disloyalty from within their own profession.
Shame on you, Dr Eric O'Brien. - Yours, etc.,
EILEEN MALONE,
Butterfield Avenue,
Dublin 14.
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Madam, - I refer to the recent series of articles in The Irish Times regarding the relative costs and benefits of private medicine to the health of the Irish population. Throughout the debate, there appears to be a consensus that patients who purchase private medicine obtain better care. Among patients, there seems to be a general belief that the purchase of private medical insurance will guarantee an improved level of service, regardless of the type of illness.
The decision to seek medical attention through the private sector may be beneficial to those requiring a specific intervention, such as a surgical procedure, or to obtain an initial consultation with specialist. However, it is not necessarily true that the purchase of private health insurance is beneficial to those with ongoing or chronic disability. This is an important and often neglected point.
A large proportion of medical, (as opposed to surgical) illness is chronic and although treatable, rarely curable. Common examples include diabetes, high blood pressure, high cholesterol, heart disease, etc.. In the case of patients with neurological disabilities such as multiple sclerosis, motor neurone disease, Parkinson's disease, epilepsy, etc., the best forms of treatment require the services of broadly-based teams of specialists that includes doctors, specialists nurses, psychologists, social workers, physiotherapists, occupational therapists, dieticians, speech and language therapists, and others. These teams are hospital- based, and for some disciplines such as occupational therapy, a public community-based network also exists, albeit in a very under-funded capacity.
Multidisciplinary teams have the capability to treat the entire person, and not just the disease. They are "low-tech", out-patient based, expensive because of the personnel involved, and are grossly under-resourced by the current public health system, despite the fact that large number of patients benefit from their interventions. Their outcomes are measure by "health status" rather than by "cures". Team based management of chronic disease is the model of care to which the 2001 Health Strategy aspires.
Such a model simply does not exist in private hospitals. The rudimentary preventative, health promoting, and rehabilitation services that are available through the private sector within the community are not well-organised, and are not re-imbursed by the private insurance companies.
It may well be the case that the two-tier system of health care available in this country is beneficial to some patients with specific ailments, in the ways outline by Mr Sheehan in his article of June 10th. However, there is a large section of the population, both public and private, for whom the services currently provided by the private sector are essentially irrelevant.
The Irish population has a right to proper medical care. The public system, if functioning properly, should first serve to prevent complications that require acute admissions to hospital. The system should cater for acute admissions in a timely and cost effectve manner, and perhaps most importantly, should serve to maintain the health status, well-being and quality of life of those patients with disabling and non-curable conditions.
These do not appear to be the principal objectives enunciated by the current model of private medicine in Ireland. In this context, private medicine is of limited benefit to many citizens, regardless of their ability to pay. - Yours, etc.,
ORLA HARDIMAN,
BSc,MD,FRCPI,
Consultant Neurologist,
Beaumont Hospital,
Dublin 9.