Thursday 18 December 2014

Department of Health passing the buck on Portlaoise

Passing the buck From understaffed obstetricians to overstaffed dentists, the medical profession is in a spin, says Maurice Gueret

Professor John Crown

Cries of "Is there a doctor in the house?" will draw plenty of medical attention on Kildare Street these days. There are so many doctors in Leinster House, I'd say that, after teachers, publicans and fellows who have never worked a day in their lives, we must be the best represented trade in parliament.

 I was particularly pleased this month that one of them stood up and called a spade a spade. Professor John Crown was spot on with his comments on Portlaoise maternity services. The Government spin on this internal report from the Department of Health's Chief Medical Officer sought to dump on poor communications and absolve staffing levels from any blame. Professor Crown pointed out that the number of births in Portlaoise Hospital doubled between 2000 and 2009, yet the number of obstetricians who had to provide a round-the-clock service stayed at a pathetic three. In medicine, as in life, when things go wrong, there are usually a number of reasons. Clumsy attempts to divert attention away from failures within the Department of Health itself, need to be seen for what they are. Well done, Professor Crown.

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A reader in my favourite village, Skerries, has been in touch about lead lotion and opium – an old remedy that I wrote about here last year. Back in the 1950s, in the days before arthroscopy cameras, he developed a knee problem after a football match. His mother advised him to go to a chemist shop at Number 3, Francis Street in Dublin, named Mushatt's, which dealt in strange lotions and potions of their own construction. Louis and Harry Mushatt were sons of a Jewish draper, Jacob, who came to Ireland to escape Russian persecution in 1886. Their chemist opened in 1922. On arrival, my correspondent was surprised to find a queue at their door. People from all over Dublin were there to avail of their expertise in strange medicines. He recalls that, when he explained his problem, he was advised to treat it with a concoction of lead lotion and opium. He had to wrap a two-inch gauze bandage around his knee and was given a bottle of liquid to pour over the bandage, and repeat it after three days. When he applied the liquid, it was icy cold. Glad to say that his problem cleared, with no recurrence. Some years later, he recommended this treatment to a friend with a similar problem, but, in his own words, the "health and safety police had decreed that Mushatt's was a health hazard and were prevented from dispensing their own concoctions." He says that pharmacies could dispense lead lotion for some after this, but the opium was barred!

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Another regular correspondent from the Kingdom of Kerry tells me that she, too, experienced the lead and opium treatment, known as the 'Robert Jones bandage'. When she was 15, she hurt her left knee when jumping off a small wall, and was sent to casualty "the following day" – the usual course of events in those days. Everyone was most attentive to the "idiotic schoolgirl", as she puts it, and, eventually, it was decided to treat her with a Robert Jones. A great deal of brown lint was soaked in lead and opium, applied to the knee while still wet, and she was then skilfully bandaged from mid-calf to mid-thigh. The Tale of the Knee came to its final chapter 20 years later, when she had a patella tendon transfer, followed by intensive physiotherapy. Fifty years after the initial injury, she can walk in the woods every day, and tells me that the lead and opium might not have been efficacious, but it sure sounded glamorous to a teenager in the early Sixties.

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These are painful times for Irish dentists. A lot of cosmetic work on the fangs of the Celtic Tiger has dried up, and there are a lot of overstaffed clinics having trouble just managing the weekly payroll. I often feel that those houses with "No junk mail" signs on their front door are missing out, not so much on special offers, but on the background to these offers, and why they are taking place. You can tell a lot about a country from its junk mail. The number of dental flyers popping through my door suggests that qualified fingers in the nations' oral cavities are not nearly as busy as they could be. One eminent clinic is offering an ESP (examination, scale and polish) for €70, while another is doing the scaling and polishing bit for just €50, and giving the examination completely free. Indeed, if you bring your flyer along, you get an examination free, without any scraping or sandpaper at all. One flyer mentions that the clinic is "Irish owned and run", which I think is quite superfluous. I'd rather we all treated dentists, doctors, barbers and taxi drivers on their human merits, and not on their origins. I have history here. My great grandfather once ran in a by-election for the Sandymount ward of Dublin, and his opponent branded him an "alien" because he had the cheek to have been born in Paris.

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Anyhow, back to the woes of work-hungry dentists. It takes a much larger capital investment to set up a General Dental Practice than a Medical one, with a lot of eye-wateringly expensive equipment and extra staff a necessity from day one. You can't have the dentist answering the phone with one paw while the other one probes your exposed root canal. And a recent rise in litigation against dentists means that insurance companies are extracting far more in malpractice premiums from the profession than they ever did before. I have two of the best dental surgeons in Dublin looking after me. They did such a good job on me two years ago, that I have hardly been back since. Got to go now. I think their flyer has just landed on the carpet!

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