Saturday 3 December 2016

Rude health... Good companions

Dr. Leo's maternity group has more guests than a wedding party, says Maurice Gueret, as bedside manners wane

Published 15/06/2015 | 02:30

Concerns: Health Minister Leo Varadkar at the Midlands Regional Hospital in Portlaoise where he met with hospital management
Concerns: Health Minister Leo Varadkar at the Midlands Regional Hospital in Portlaoise where he met with hospital management
Dr Maurice Gueret

With Portlaoise Hospital maternity services under the spotlight, you have to wonder about the ability of the Department of Health to learn from mistakes. It's not that long ago since the hysterectomy scandal in Drogheda.

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 It was well recognised that poor training, under-staffing and poor oversight was responsible for much of the disastrous management of women patients at the town's hospital. The team at that hospital was beefed up. But in true blinkered fashion, the delivery and resourcing of maternity and gynaecological care at other similarly sized hospitals around the State remained haphazard. A simple study of where Irish lady doctors and the wives of male doctors choose to have their own babies might tell us a lot. I suspect they warm water, towels and quite a  lot of diesel.

Steering group

It's good that Doctor Leo has convened a Maternity Services Steering Group to report back to him by the end of the year. But you really have to wonder what a room full of 29 people can achieve in a few meetings. These departmental think-tanks have gotten a bit like large family weddings. Ministers are petrified of leaving somebody important off the list. So instead of a table that is small, focused and decisive, they fill it up with grandstanding aunties and difficult uncles who always want the last word. Extra chairs are dragged in for long-lost cousins and people who are friends of a friend on Facebook. Having toiled on a health authority with 55 members, I have wide experience of large-group messiness. When you add executive and secretarial staff, not to mention a few hundred glass bottles of Ballygowan, meetings have all the decorum of a cinema premiere. A 29-person group is not conducive to planning any kind of strategy. In my experience, five or six works best. Only go to seven if you want somebody to make tea.

C-section rates

Speaking of maternity matters, the most recent statistics about Caesarean section rates across Europe are worrying. Twenty years ago, when I was doing a spot of baby-handling in Dublin, hospitals worried that deliveries by scalpel might be heading towards 20pc. Now it appears that 30pc is where we're at, and some hospitals may be nudging towards 40pc. Northern countries like Finland, Sweden and the Netherlands have managed to keep their rates at less than 20pc. The best performer in Europe is Iceland, which delivers less than 15pc of babies in operating theatres. Not a single obstetrician from any of these countries, not a single Dr Johnny Foreigner at all, was invited to join the 29-man steering group. Might have stopped us steering around in circles.

Companion selling

The art of companion selling is well recognised in most retail sectors. When a gentleman treats himself to a new jacket or suit, he will rarely leave the tailor without being offered a shirt. And if he accepts the collar, he may well be guided over towards the rack of ties. It's fine. It's the way of the world and we live in a free country where "No thanks" can trip off the tongue without repercussion. Healthcare is a little different. We don't expect surgeons to offer a whipping out of your appendix for an extra fee while he excises your gall bladder. But in pharmacies, particularly the chain ones without owner-managers, fine lines are getting a little blurred. A person who handed in a chest inhaler prescription for a family member was taken aback recently when a counter assistant suggested the patient should also take a combination of plant oils for nasal congestion. "Your pharmacist recommends" was the line used, and, to reinforce the message, the name of the oil was printed in capitals on the prescription bag's sticker. Now the pharmacist hadn't set eyes on the patient, who wasn't even in the shop, so presumably all they had to go on was the single item the doctor had prescribed, to make a secondary diagnosis of their own. I have also come across cases where patients who require antibiotics are told that they should also make a companion purchase of probiotics. I'd like to know if there are any guidelines in this arena, for it would seem that a minimum requirement for such 'pharmacist recommendations' would be some interaction or consultation with the actual pharmacist. If you have any stories of companion selling in healthcare, please do get in touch with me at mgueret@imd.ie or by post to PO Box 5049, Dublin 6w.

Pneumonia

A reader was in her local general hospital with a spot of pneumonia. She was well looked after, and is now in a reflective mood while recuperating at home. She confirms that nurses do an incredible job, working long shifts and performing tasks very few would wish to do. She observed the odd difficult patient, but was more surprised by some ungrateful, difficult members of the medical profession. She rightly points out that nurses at the very least deserve respect, courtesy and a simple 'thank you' from patients and colleagues. Her other observation is that junior doctors rarely introduce themselves to patients. One day, three complete strangers arrived at her bed. They asked questions and started discussing her case among themselves. When the lady asked who they were, she was told, "We're your new team", without them giving any names or clues to the fact that they were the registrar, senior house officer, and intern. My correspondent signs off by saying that a smile, a handshake and an introduction makes all the difference to patients, and costs absolutely nothing. Safe to say we are seeing the early results of choosing our doctors by how they tick boxes on aptitude tests.

Maurice Gueret is editor of the 'Irish Medical Directory'

drmauricegueret.com

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