Wednesday 22 November 2017

Rude health... Bleak midwinter

Failed health promises are an Achilles heel for Enda Kenny especially with elections looming

Enda Kenny
Enda Kenny

Maurice Gueret

With elections around the corner, don't be surprised if health services spew up a serious winter of discontent. With opposition health spokespersons the worst in my living memory, it probably won't be led by politicians.

Sinn Fein, Fianna Fail and Independents command little credibility on health. It may be patients, nurses and doctors who have to lead the assault. One battle line is already drawn. Long-standing difficulties for GPs in referring patients for hospital tests are bubbling to the surface. Social media allows them to share their immediate experiences, and this is galvanising their frustration. Recently, a patient with rectal bleeding was told that there was a 25-week wait for a colonoscopy.

They rightly told the hospital that a half-year wait to exclude cancer simply isn't good enough, and were advised to ask the GP to write a 'stronger' letter. This is X Factor medicine, with family doctors as judges. It isn't going down well. They are now expected to audition patients with potentially serious symptoms, and second guess who to send home until next year and who to give endorsements to. The mere mention of rectal bleeding makes a strong letter in any language. We now have a crazy situation where this country conducts tens of thousands of screening bowel tests on healthy people, yet cannot provide timely investigation for patients who have real symptoms. As a trained GP himself, Dr Leo needs to get to grips with appalling gaps in diagnostic services.

Patients on trolleys

Seeing as the opposition has no policies on health, they might decide to use Fine Gael election posters from 2011 instead. How about the one of Enda Kenny in an emergency room saying, "I'll end the scandal of patients on trolleys"? Five years on, and we have just had the worst summer trolley crisis in history. What about his other promises? Where is the 24/7 helpline and website to give worried parents easy access to basic medical advice? What about the 600 step-down beds for Dublin, promised within 30 months? Where are the drunks he promised to get out of being treated in A&E? Or the network of 18 nationwide Urgent Care Centres led by GPs equipped with X-ray, blood tests and ultrasound? What about his biannual health check-up for everybody? The only health promise he managed to get over the line was the free care for infants and toddlers. Voters who have to breathe in germs for longer in GP waiting rooms this winter might not repay the generosity.

Suppository of wisdom

Enda can thank his lucky stars that he is not premier of Australia. They're now on their fifth prime minister in five years. The hunting of sitting ducks and booting them out of high office is a popular political pastime in the land of Oz. Party rules make them easier to shift than they are in Fine Gael. Few tears will be shed for Tony Abbott, the latest casualty. But for those of us who like politicians to make public shows of themselves every now and then, he will be a great loss. A malaprop of considerable talent, Abbott once told his party conference that no one, however smart, however well educated, however experienced . . . is the suppository of all wisdom!

50 Ways to Kill Your Mammy

It's not often that retired nurses from Co Wicklow get to play at international TV stardom, but superstar septuagenarian Nancy Ashmawy has made up for this absence in spades. Nurse Nancy is the star of reality show 50 Ways to Kill Your Mammy, which is now on its second series on Sky 1. She plays the role of a down-to-earth Irish mother who is taken to some of the most scary places on Earth by her thrill-seeking son. The resulting series is television gold and quite the funniest thing I have seen in years. Nancy reminds me of so many old-school nurses I had the pleasure to learn medicine from, particularly the wiser ones who worked on the geriatric wards. She is proof that if you survive nursing in Ireland, you can survive anything, and laugh at it just the same.

The late Dr Oliver Sacks

I have been meaning to write about Dr Oliver Sacks, a personal hero of mine, who passed away in August. But I was afraid that if I started, I might never stop. His books on Awakenings and The Man Who Mistook his Wife for a Hat are well known, but to get to the centre of this magnificent specimen of medical humanity, two books are essential. His childhood memoir, Uncle Tungsten, and his recent adult autobiography On The Move will make this winter pass most pleasantly. At the tender age of 14, Oliver's surgeon mother took him along to the dissection of a female corpse. He later described the experience as one that evoked a lifetime of repressed memories. Sacks suffered from lifelong insomnia, migraines and fear of the dark. Fifty ways to kill your son!

Clinical examination

We continue this week our roving clinical examination of the body with a short dissertation on the nose. Badly taught in medical school, the nose is not an organ where non-ENT doctors dally too long. Patients rarely mention it, unless it's sneezing, snotty, bleeding, blocked or has a tap-like post-nasal drip. The nose has a number of functions. It's our primary organ of smell, but it also assists breathing, and its hairs acts like filters in a vacuum cleaner, preventing unwelcome particles from descending to where they are unwelcome. Examination makes sure the dividing wall, the septum, isn't leaning to one side like the Tower of Pisa. It also determines the health of the turbinates, spongy shelves of bone that swell and block the nasal passage in allergic conditions. The eyes have it next week.

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

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