Tuesday 27 September 2016

Rude health: Tasty tonsils

Money doesn't follow patients in Ireland, it follows scandals says Maurice Gueret, as he sniffs some tasty dog dinners

Published 14/03/2016 | 02:30

Minister Brendan Howlin.
Minister Brendan Howlin.
Dr Maurice Gueret.

The Irish Medical Directory is a door-stopper of a book that sits on or near the desk of every GP in the country. Known colloquially as the 'Doctor's Bible', it guides medics through the mysterious web of services that are available, in hospitals and beyond, to sick folk.

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Everything from late-night pharmacies to unusual medicines and suppliers of tongue depressors that cause you to say 'Aaah'. Ireland's first medical directory was published in 1852. Though it sometimes feels like I have been compiling it since then, I am reliably informed that my duties only began in 1994. It was re-launched that year by a very youthful-looking Minister for Health called Brendan Howlin. My 23rd annual edition will be published in April, and I feel a bit nostalgic. Having noted the various comings and goings of the last quarter century, there are some observations worth making that may be relevant to our current health service.

In 1994 we listed 2,400 GPs. This year, we detail just over 2,700. The population has gone up by about one-third, but the number of GPs has barely gone up over 10pc. There is a much better gender balance, but the flip side of this coin is that job sharing and limitations to on-call work are to the fore. Coupled with ever more elaborate political promises for free care, it is little wonder that the service is creaking, and queues are worsening by the day. In recent times, I have noticed that a handful of relatively young GPs are dying each year. It may not be just coincidence.

Now, back in 1994, there were about 1,200 hospital consultants. This year, there are well in excess of 3,200. It's some contrast, and tells us precisely where much of the investment in Health has gone. For every one new GP that stepped into our health service in that period, there were seven hospital consultants appointed. I am not complaining about this. We probably needed every one of them, and we need a lot more. But Ireland, courtesy of politicians with limited vision, has marched headlong into a 'hospital treatment for everyone' mentality when properly resourced care in the community was a cheaper and much more sustainable alternative. Money doesn't follow the patient in Ireland. It follows the scandals. And it's hard to beat hospitals for scandal. The GP scandal is that patients are simply not getting enough time with their family doctors. Many know it, but are afraid to say it. If you do the maths above as I have, it might help explain why.

Besides vaccinations, pet owners tend not to spend a lot of money on medication. They might need the odd antibiotic, wormer or flea treatment, but by and large they don't trouble pharmacies too much with pet ailments. Vets have the care side of things pretty well sewn up, and domestic animals cock a leg at alternative veterinary medicine. One way to tackle a limited market like this is to look at where pet owners are spending money. The biggest expense for today's animal owners is processed food, so this is where health-conscious or health-neurotic consumers are targeted. The market in medicalised pet comestibles is a veritable Lourdes, where miraculous claims abound. I spent a full hour walking into town the other day. Three-quarters of the way along, a big sign in a shop window caught my eye. 'Does your dog have sensitive joints?' Now, my own were a tad sensitive at that stage, so I stopped to read the spiel. They were flogging some sort of oven-dried doggy food in a bag that was going to anaesthetise thin-skinned joints. The pet-food industry is full of this stuff. There are foods for arthritis, foods for obesity, foods for dicky hearts and foods for leaking kidneys. Vets are big into this sort of thing. And why not? Sure, it's a neat little market with handy margins. I'd like to conduct an experiment to see how patients might react when their doctors send them home with giant bags of dried pellets. Any takers?

Speaking of dog food, how would Fido fancy tucking into your own tonsils? A very distinguished country GP in his 80s hung up his stethoscope last summer, and has been busy putting his lifetime of experiences into print. He sent me a booklet last month which I'm greatly enjoying, and I'll dip in and out of it for you in the coming weeks. He once worked as a junior doc for two Ear, Nose and Throat surgeons. Not unusually in Dublin medical circles, the ENT men were not on speaking terms. Their operating techniques differed, too. My retired colleague includes a wonderful description of how one of them performed a tonsillectomy. "He would leave a lighted cigarette to one side, guillotine the tonsils and toss them into a bag to bring home for his dog."

When you meet a girl or lady with the lovely name of Melaena, one assumption you can make is that her parents are not doctors. In the medical world, melaena refers to black, sticky poo, the sort of symptom that alerts doctors to secret bleeding higher up in the digestive tract. Other less common names for the kids of doctors are Claude and Claudia. Both being derived from the Latin for 'lame', claudication is a well-known cramping symptom of the lower leg. And I have yet to come across a nurse who named her child Kylie, as in clinical and care circles, a Kylie is an incontinence sheet that acts as an absorbent bed pad. I have it on authority that in sunnier climes than ours, there are more than a few Candidas, Placentas and Varicellas living quite happily in homes without medical dictionaries.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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