Doctor's view: Stop doctors doubling up and spend more wisely on facilities
Tuesday May 16 2006
I have worked in the A&E department of hospitals in Britain, Australia, New Zealand, Gibraltar and South Africa. I have also worked at senior medical level in the A&E departments of four Dublin hospitals. My experience has led me to believe that a lot of the problems are not political but medical. They include:
* Inefficient work practices often ruled by medical expediency.
* Vested medical interests in maintaining the present economic system.
* Unnecessary duplication of medical work.
* Continually fooling ourselves that Primary Care is wonderful whereas, in reality, everyone except our leaders, can see it is lacking specific skills and is too often a matter of shepherding patients into consultants' clinics or A&E.
* An unwillingness to put Diagnostic Related Services into primary care where they are in other countries .
We also must stop blaming the wrong people for the crisis. It is easy for media personnel to blame A&E departments for all our woes. The problem lies elsewhere. Remember, patients lying in pain on hospital trolleys for days have already been seen and treated by the A&E staff but they have nowhere to go. The centralising of diagnostic related services (eg bloods and X-rays) totally to within a hospital environment means a patient has to go to this facility to see if they are sick enough to be admitted. Tests take time and patients lie around. GPs largely work within office hours, denying the fact that patients get sick 24-hours a day, 7-days a week. There is a lack of specific skills at GP level. Many GPs have become conduits for consultant referral rather than providing minor surgery facilities, cardiac monitoring etc. We must eliminate unnecessary duplication of medical work. We have a farcical situation at present that allows up to seven doctors to see the one patient before the relevant diagnostic equipment is reached. The irony is that a GP is probably more experienced than any of the five doctors involved but he cannot order the relevant test. We must employ a GP protocol for direct referral into the Diagnostic Related Services. There is little doubt that most of the inefficiencies that exist in our A&Es have developed as a consequence of improper Government funding.
The lack of direct admission by GPs onto hospital wards means that every patient has to see secondary doctors for re-examination. If we really want to clear the logjams in A&E, we must change the total system of delivery and dispatch: and stop throwing good money away down the hospital sluices.
Dr Patrick Treacy is Medical Director of the Ailesbury Clinics.
