People in pain are bending the rules in desperation over diagnosis delay
Public patients, who have worrying symptoms and face gruelling delays before seeing a specialist, are making up their own rules in their desperate search for a diagnosis.
Increasingly, these patients, who do not have insurance, are paying the €200 or so out of their own pockets to see the specialist to have their condition assessed.
It means they bypass the backlogs that have formed as 466,631 wait for an outpatient appointment.
They may have skipped one queue, but for many who need surgery, they face another public waiting list.
A hip operation can cost €16,000 to do privately and a heart bypass €30,000, so they can be left with no choice but to revert to being a public patient.
But is it right that they have been able to speed up their journey through the public hospital system? What of the others left behind, who have remained on the outpatient queue?
The Dáil Committee on the Future of Healthcare said that it was not fair.
However, a patient whose condition may be at risk of deteriorating will argue that the action is entirely defensible.
They can also claim that they are freeing up a slot at the public clinic for somebody else.
The reality is that outpatient waiting lists are now so long they are leaving thousands of patients facing a delayed diagnosis.
This is just one way patients who are trapped in the public system are trying to get around the delays.
Others are presenting at hospital emergency departments in the hope of getting access to a specialist, or having a scan.
The system has become so dysfunctional that it is no longer possible to make hard and fast moral judgments about the behaviour of people who are in pain, distress and in dire medical need.
A plan to tackle outpatient waiting lists is currently being drawn up, but it is difficult to see what kind of meaningful headway can be made, as many clinics remain swamped. Thousands more patients are joining the waiting lists weekly.
Since 2012, the waiting lists for outpatient appointments have grown by 200,000.