Friday 15 December 2017

Rude health: concierge medicine

As the Health Service Executive gears up to launch its first robot, Maurice Gueret examines those streets of London

Picture posed.
Picture posed.
Maurice Gueret.

The Divine Comedy has a song about the London Irish and how the streets of Britain's capital can appear to be paved with gold for them. "You gain the world and you lose your soul", run the lyrics. The tune finishes with a rather stark line about your picture being seen on every magazine and every TV screen and wonders if afterwards there will be anything left? The song came to mind this month when that story broke all over the world's media about a young Irish doctor, an anti-ageing clinic and alleged involvement in prescribing for sports stars. They don't warn you about this sort of thing in medical school, for they assume you have the wisdom to protect your own reputation as well as the confidentiality of your patients.

The tabloids examined the doctor's Facebook page to find that "he constantly checked in at some of London's poshest venues and dines at A-list restaurants". His recent Twitter feed suggested that he was interested in the price of gold. They said he charged £150 for 15 minutes, supported the politics of Ukip and owned a £100,000 Mercedes. One of the tragedies of modern medicine is that the more you travel out on to its fringes, the more lucrative and slippery it can become.

The doctor at the centre of the furore in London had been calling himself an entrepreneur and concierge doctor. The former likes to dabble in new things, but the latter is one of the oldest medical types there is. While most of us practice bellhop or lift-boy medicine and run on the sight of any old trouble, the concierge doctor is more discerning. He or she takes on far fewer patients than the norm and charges more handsomely for his or her time. You find concierge doctors in the wealthiest neighbourhoods. Like good travel agents, they will make all your hospital arrangements for you. They act as tour guides through the mazes of medicine.

If you are laid up in hospital, they might even visit you, or liaise directly between you and your specialists. Much of concierge medicine is practiced in the patient's own home and the doctor will never give the impression of rushing, as he simply hasn't enough patients to allow any pretence of rush. It is not unknown for some concierge doctors to be asked to go on holidays with more demanding patients! In the United States, it has also been termed 'retainer medicine' because the patient pays a hefty annual sum to have the doctor at their beck-and-call 365 days a year.

We are all allowed a bit of tomfoolery in April. I greatly enjoyed the bit on the RTE News recently about Lucy the robot. She is the one who doesn't get breathless running along the miles of corridors in Tallaght Hospital to deliver telemedicine to surgical patients.

I'm not sure if the pilot project is more gimmick than cost-effective, but it's good to see hospital stories on the media that put smiles on everyone's faces. I heard on the first of this month that the HSE has its own version of Lucy in development. Its robot is called Breege. She is hard of hearing and programmed only to visit patients who complain about long waits on trolleys. She tells them firmly in no-nonsense Irish, English and Polish that the time they claim to be waiting is simply not correct. Breege's official waiting time begins the moment it is decided to admit you. The 48 hours having trolley tests before it was decided to admit you simply don't register with Breege. Expect a nationwide roll-out of Breeges very soon.

I have had one or two spats with the Road Safety Authority and its former esteemed chairman over the years, but I do have great admiration for some of the work it has done in bringing Irish road safety into a new century. My main criticisms would tend to be that its focus is too much on the state of drivers and their vehicles, and not enough on the roads. This month it issued a warning about tyres. Last month it was on driving the morning after the St Patrick's Day festival. In February, it warned about election posters. But the biggest current issue in Irish safety is that road markings have not been painted since we last won the Eurovision.

Things have become so bad in Dublin that entire stop lines, yellow boxes and bicycle-lane markings have completely disappeared. I have lost count of the number of cars I have seen drive straight through red lights. Part of this is driver behaviour, but equally big parts are an absence of basic white road markings and the mysterious disappearance of our Garda traffic force. It's not good enough for the Road Safety Authority to say these things are the responsibility of councils or others, and not in its remit. There is a lot more to road safety than nagging drivers, issuing licences and testing cars. Somebody in road safety needs to speak up about the dire state of actual roads.

Your letters continue to amuse and inform me. I cannot reply to each, but they are avidly read, one and all. 'Mercs & Perks' writes to tell me that the manager of one university hospital group secures free parking at his hospital by arriving before the barriers go up each morning and sticking his vehicle in with those of the consultants. Other staff must pay an hourly rate in the car park, or lodge vehicles at a nearby hotel with a minimum spend in the restaurant!

This tells me that things haven't changed since my hospital days. I tried recently to park at the door of a hospital in a spot marked 'doctor'. The security man came running out to tell me it was reserved for doctors. I put him in the picture.

Dr Maurice Gueret is editor of the Irish Medical Directory

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