Sunday 15 December 2019

Rude Health: Finding the quays

Our new ambulance HQ may need a bit more local knowledge, writes Maurice Gueret, as he ponders his own future care

The Square Shopping Centre Tallaght
The Square Shopping Centre Tallaght
Maurice Gueret

Maurice Gueret

All your 999 or 112 emergency ambulance calls are now diverted to Dublin. Into a vast new building beside The Square Shopping Centre in Tallaght. I wasn't invited to the opening, but I'm assured that the operation room is pretty impressive. I passed it recently on the way to the cinema, and there seems to be enough space in its cavernous entrance hall to swing a few lions.

But country folk are harder to impress. Word has reached me from a large coastal town, where locals put through a request for an ambulance. A person had been found collapsed on 'the quay'. They were promptly told by the Dublin operator, who was on a computer, that there's no place called 'the quay' in the town. This surprised them, as the place has a beautiful harbour and has been one of the busiest ports in Ireland dating back to the 18th Century. It also hosts a nice collection of trawlers tied alongside the quay. Every single person in the town and county would know where the quay was. But alas, locals don't field ambulance calls anymore. In some parts of Ireland, Tallaght might almost seem like a different country. I only hope that the bystanders weren't asked for the Eircode of the collapsed patient.

It's hard to know where we are going with our family-doctor business. Patients do grumble about the cost of surgery visits, especially when frequent calls are necessary. Most politicians decree that GP services should be free of charge to everyone. The under-sixes and the over 70s now enjoy free GP care. But entirely free services have knock-on effects on waiting times. Patients grumble about the number of sneezers and wheezers ahead of them in the waiting room.This leads to more of them choosing to fork out €125 at the local swifty clinic.

An acquaintance in the UK needed to have a prescription reviewed by her GP last month. The best she could get was a telephone consultation two weeks away, or an actual five-minute visit in three weeks' time. There is no Utopia, you see. No country in the world has solved the theorem. What is clear is that a service that performs 90pc of all consultations needs slightly more than 2pc of the budget. My personal preference is for a fair, transparent salary for Irish GPs instead of the current system that pays per head of cabbage and relies on nixers and the cash of 'privates'.

A wise patient pointed out to me that there will be even fewer GPs to go around if we elect more of them to the Dail as Independents. True. But the 'No Doctor No Village' campaign is really taking off in rural constituencies such as Clare and Mayo. These are counties where single-handed doctors are closing down for good each year. Dr Harty in Kilmihil and Dr Cowley in Mulranny have local reputations that seasoned politicians would die for. Their election could be interesting if the Government needs the support of reputable Independents when all the votes are counted.

I was disturbed by the recent case where a young Sudanese orthopaedic doctor didn't know his ankle from his elbow on X-ray. The fact that he was employed in three hospitals before obvious weaknesses were acted upon was bad enough. But the larger elephant in the room is that the Medical Council, which found him guilty of professional misconduct, also licensed him to work here in the first place. Ireland relies heavily on doctors from countries much poorer than our own. This means that we are dependent on the conveyor belts of overseas medical schools that we have no control over. It's an irony, considering that we have more medical schools on the island per head of population than anywhere else I know.

We seem to train our own lads and lassies for the export market and then import graduates from countries where doctors are already in short supply. I worked with many foreign doctors in my hospital career. There was the odd plonker, just as in every Irish group, but, on the whole, I found them really excellent. Working and conversing in a foreign country is particularly stressful in a healthcare setting. Hard cases may make bad law, but this is not the only recent episode of poor performance unearthed at the Council. I think we need to look seriously at keeping as many of our own doctors here as we can. And patients should expect some sort of filtering mechanism to remove poorly trained graduates before they are employed on wards to treat them.

You know you're the wrong side of 50 when you start to survey nursing homes and consider how you might fit in. I have decided, when the day comes for my continuous care, that I want mine to be centrally located, with a built-in Costa Coffee or Caffe Nero out front. This will allow me to mingle on sofas with my double espresso in the guise of an ordinary visitor or shopper. Good quality Wi-Fi is a must, and though I have never seen it, Netflix might be a good thing for an ageing man with time on his hands. Especially on these more frequent days when there's nothing on the telly. I'd like resident pets - cats and dogs - and the place should be warm enough to keep windows open all day long. A garden out back with secret nooks and crannies would be nice. And perhaps a potting shed, a personal bathroom, a manicured putting-green and an outdoor swimming pool. A recent Swedish study found that exercise for people with vascular dementia improves their balance and reduces dependence. It needs to be high intensity, and done three times a week for 45 minutes. Oh, go on then, put the gym in too.

Dr Maurice Gueret is editor of the Irish Medical Directory

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