Rude Health: The killing season
July and August can be bruising months for unsuspecting patients, says Maurice Gueret who thinks he is in Greece
Black humour decrees the graveyard months of hospital calendars happen in summer. Wards get closed, experienced staff take holidays and the most junior medics are unleashed on wards to play doctors with red-faced nurses.
August is affectionately known as 'the killing season' in the UK, with a changing of the hospital guard on what is called Black Wednesday, the first one of the month. On this side of the Irish sea, the month to stay clear of serious illness has already passed. It was July. The phrase 'thrown in at the deep end' doesn't do justice to the difficulties faced by interns in their first few weeks. Thrown in at the deep end of a pool with no water is more apt.
On the surface, all may appear well to patients, but one of the things they may notice is that their arms start to turn black. The most difficult part of being a new doctor is learning how to take bloods and insert drips into patients. An eminent phlebotomist (clinical vampire) has been in touch with a few cross things to tell me about the lack of venepuncture skills among new doctors. Many years ago, she approached a medical-school dean suggesting that student doctors be taught the basics of blood-letting. A very long time after this approach, she received a rather sniffy reply saying it was not necessary. I would say patients beg to differ. Horrific bruising and needless needle anxiety can result from encounters with untrained interns in the summer of their careers. If it takes a full six years to train a doctor, perhaps one week, or even a day, should be spent watching the steady hands and careful manner of a good phlebotomist. Avoiding stress for patients and doctors, and saving plenty of money on inadequate samples and clinical waste.
I should really write to Leo about this. Last month, he proudly unveiled his new postcode - you can now receive Doc V's full medical attentions at Leo, c/o D02 VW90. Sounds like the registration of my first car, the 90WX metallic blue Polo. I'm sure Leo would welcome any suggestions on minor tinkering with the health service, seeing as he gave up on the idea of major reforms within days of receiving his ministerial seal. His internship at the Department of Health began with a flurry of expectations being hosed down. Universal health insurance was interred in an unmarked grave and the idea of turning a poisoned chalice into a sweet wine was pooh-poohed. Leo is a full year in office now and looks as popular as ever. With less than eight months to go before Dublin West cheers him back to Leinster House, Leomania looks set to continue. Doctors could soon have their own on-call Taoiseach.
I was telling you last week about my recent trip to the family homestead of Newry and the impressive array of medicines now stocked in its Sainsbury's supermarket. It doesn't have a pharmacy, but it certainly looks like one, with a whole aisle full of remedies of every brand. I was amazed at the price of their own-brand anti-inflammatory drug ibuprofen which, like paracetamol, is available for just 30 pence for a box of sixteen tablets. You are allowed purchase a maximum of two packets in a single check-out which means you can get 32 tablets of 200mg at just over two cent a pill. I gather that German retailers north of the Border also stock these lower-price medicines, but for some reason our European free market doesn't seem to extend to supermarkets south of Crossmaglen. Can anyone enlighten me? We are always being told that this is not Greece.
And speaking of Greece, I have been following some exchanges on social media between medical colleagues who have some experience of working there. It has long been rumoured that the average Greek doctor has a swimming pool in the back garden, but only pays an annual €10,000 to the taxman. The truth reclines somewhere in the middle. It seems doctors in their public service work long hours for little pay in chronically underfunded hospitals. Training is sub-standard, unstructured and haphazard and state doctors pay from their own resources to do courses abroad. The private sector is a law unto itself where the idea of providing receipts for services is an alien concept. Enda must be right when he says Ireland is nothing like Greece.
Just how confidential is your consultation with your doctor? A reader has been in touch with a query about how confidentiality works in a surgery where there is more than one doctor. He would readily give intimate information to his own doctor. But he worries that if notes are recorded in writing or on computer, that other staff in the practice may also see what he has divulged. It's a fair point. Confidentiality is a very ancient buttress of medicine. But teamwork is a modern and important cornerstone of medicine today. Most doctors would, I think, believe that sharing of clinical information is quite normal within a healthcare team. We assume consent without asking first and perhaps we have a duty to make patients more aware of this. Every patient has the right to object. If there is a matter of extreme sensitivity, you should really discuss your own preferences before disclosing this information to your doctor. There are rare cases in law and where public health is at risk when doctors have a duty to share information. But by and large confidentiality concerns are best dealt with at source. In most cases, good doctors should and would respect the expressed wish of their patients.
Dr Maurice Gueret is editor of the Irish Medical Directory
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