Do you need a doctor now?

The annual general meeting of the National Association of General Practitioners (NAGP) took place this weekend in Limerick. It didn’t tell us anything we didn’t know already – that is, if you have been following the health debate in Ireland for any time. The problem is, like most things in health, most people don’t really follow health issues until they have a ‘health issue’ of their own. It’s a perfectly logical position, but one that allows for a lot of obfuscation by the ‘powers that be’.

Those ‘powers that be’ are the Health Service Executive, the Minister and the Department of Health and ultimately, the government. For them, it’s all about the statistics and how they can be managed. It has very little to do with, and is only coincidentally related to the care of patients.

Take, for example, the crisis in Emergency Departments. Again, if you have no need (or you are unlikely to need) an Emergency Department in the near future, it’s not something you think about a lot. It’s out of sight and out of mind. It’s not like the Irish Water crisis which affects everyone and affects them now. But the crisis in Emergency Departments is affecting a huge number of people out there – particularly elderly people and people with serious injuries.

These are groups who will be unlikely to raise a stink, and therefore are easy targets. Even when they recover (if they recover) they are less likely to protest or create a great nuisance of themselves because their own particular crisis has passed. So the general public is left with little information on just how bad things are, except for the doctors themselves.

Emergency Department consultants (and to a lesser extent other medical staff) have come out on a regular basis to point out that the crisis is bad and getting worse. They deserve kudos for doing so, but it is much easier to be publicly critical of ‘powers that be’ when you are a consultant and have the security that such a position brings. Even so, people who work in Emergency Departments tend to limit their criticisms of their own Departments and the people who work in them. They, after all, have to go back to work with these people on Friday nights.

But the NAGP consists of the General Practitioners who have to deal with effects of A&E’s in crisis. They are the ones who have to deal with the patients who don’t get the treatment that they deserve and need. Note that I didn’t say ‘the treatment they deserve on time’, and I didn’t say that because while a few years ago people had to wait long periods of time for treatment, now, in some cases, they are not getting any treatment at all.

Take the case of Dr David Janes, a GP practicing in Waterford just by the Tipperary border. He told me today that he had experience of working in West Africa, but that even there, Emergency Departments were more efficient. Gambia, which is the country he was talking about, is in the official Third World, but they can do better than us in Emergency Care.

Dr Janes proposed a motion to the AGM of the National Association of General Practitioners yesterday calling on the Government to urgently address the Emergency Department crisis and ‘cease the current practice where patients are being returned to general practice without appropriate investigation and treatment’.

He cited the case of one of his patients who presented with symptoms of a blood clot. He did tests which confirmed this and sent her urgently to A&E. She was sent back saying the tests were inconclusive. She was sent back again and ended up going back and forth for over a month before she was ultimately diagnosed with a lung clot – which is a major life-threatening condition with a high death rate.

He also cited another case of a man elderly man who was very confused to the point where he thought someone had tried to assassinate him. The GP wasn’t sure if he had had a stroke or a tumour and sent him in to A&E at 11 am. He was still untreated in A&E at 5 pm and was told then it would be at least 1 am the following morning before he would be seen. He ultimately left A&E without any diagnosis or treatment.

Dr Janes said that this level of treatment was ‘dangerous’ and while he said he had every sympathy for the clinicians involved, there were 100 less nurses in the hospital (Clonmel) to which he was referring than there had been a few years ago. He said that Emergency Departments were simply overwhelmed.

“On one occasion I spoke to the junior doctor in the hospital about my patient. He simply didn’t have enough English to understand the basic question I was asking as to whether my patient was in the hospital as an in-patient or an out-patient – in other words, if he had been admitted. That level of English is simply not good enough to be working in medicine in Ireland. You have to have great communication to practice medicine – he hadn’t even a basic level.”

His stories are outrageous and we should all be outraged. Partly because of the pain and suffering we inflict on fellow citizens due to ‘austerity’ but also by the way this can be hidden from our consciousness because it is relatively unreported in the media. The cases that Dr Janes talks about are not likely to appear in any health statistics. They is simply neglect that can be ignored because it doesn’t stand out in black and white, in the way that any individual’s pain and suffering often fails to register in the world of stats and government statements.

He told me, for example, that there are 100 less nurses working in Clonmel Hospital than there were a few years ago. Think of that, for a moment. How do you replace the care of 100 dedicated nurses? How do you fill those gaps? The answer is that you can’t.

It’s a shocking indictment of this government that it allows such things to continue and such a government should also not be allowed to continue.


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