Tuesday 24 April 2018

Rude health... Hospital freebies

Holding his hands up as a supplier to Irish hospitals, there is no free lunch from Maurice Gueret or exotic caravan trips.

Health minister Leo Varadkar
Health minister Leo Varadkar
Dr Maurice Gueret

Like most ordinary folk, my jaw dropped while watching the recent RTE Prime Time programme on disreputable practices in the hospital supply business. Only after the programme finished did it dawn on me that I am actually a hospital supplier myself. For two decades now I have been supplying hospitals with copies of a large book that I edit. We may be veritable minnows of the corporate world, but hospital suppliers we are, and we take orders from every hospital in the State. Once a year we receive a PO number and a delivery address, and they receive a nicely packaged order and an invoice. Nobody has ever asked for as much as the loan of a caravan in Clogherhead or a voucher for Clerys department store.

But I am rather puzzled by Leo Varadkar's response to this issue. His department was quick out of the blocks to state that the hospitals in question had nothing to do with the HSE. As if that made any difference. He then went on to state that unethical behaviour was "disappointing". Frankly, it's this sort of soft-soapy disowning response that I find disappointing. We need a minister who will go after malpractice with Talmudic zeal. Whistleblowers need absolute protection. Consideration might also be given to an amnesty, or even an anonymous reporting system so that the practices of times past can be unearthed and learned from. Apparently, goings-on not dissimilar to those aired on Prime Time were known to his department and the HSE for almost a year before the programme was aired. Makes you wonder what else might be known to them over the years? Humongous amounts of public money are spent by our hospitals, and not just on everyday sundries and equipment. There are contracts for ambulances, taxis, couriers and car parks, colossal fees paid to recruitment agencies and IT companies, not to mention pharmacy supply, hospital maintenance and project management. It's not enough for these business arrangements to be clean. They need to be squeaky clean and buffed like the floor of an operating theatre. Or there may be a great deal more "disappointment" for the minister.

Check online

If you are having trouble tracking down your doctor these days, then do check online. It seems that a growing posse of medics are going on the internet to dispense robotic advice and automatic digital prescriptions. Now, I'm a great fan of technology, and was one of the first Irish doctors on the world wide web two-and-a-half decades ago. In 1995, my first website won some class of award and I was interviewed on the six o'clock news about it. But I never tried to treat patients online. If you are stranded a mile above Mount Everest's base camp and need a doctor to diagnose why the tip on the end of your nose is turning black, then consultation by iPhone or Skype is all very well. But I see all the dangers and fail to see the point of booking an email, phone or video slot with a doctor who might live next door to you. Even if your doctor already spends most of his consultation staring at a monitor, a face-to-face meeting offers the opportunity for the physical examination that should be at the heart of all good medical consultations.


While we are on the subject of medical examination, I thought it might be an opportunity to launch a little slot in this column that explains what doctors can find while examining various parts of your body. We'll start this week with the hands. You would be amazed at the number of clues a quick glance at palms and knuckles can reveal to a medical Sherlock Holmes. First off, a simple handshake can assess the grip strength and the presence of sweating. Just a further glance is enough to spot a smoker, assess a tremor, look for muscle wasting and gauge personal hygiene. Swollen joints are easily recognised when one hand is compared with its partner in crime. These could be caused by old injuries or bony nodules (called Heberden's Nodes) that form at the very last finger joint in osteoarthritis. Anaemia can be assessed from the lifelines on your palms, and your fingernails can show splinter haemorrhages in certain heart conditions, or the brittle spoon shape of iron deficiency. The sign that most medical students are trained to spot, but most doctors forget in practice, is clubbing of the fingers. In this condition the soft tissue at the base of your nails thickens and the nail shape changes to round so that fingers begin to resemble the ends of drumsticks. It's an unusual but important sign in some diseases of the heart, lungs and abdomen. Next week, we'll open your sleeve and take your pulse.

Virgin boy eggs

A doctor returned from a holiday that he paid for himself this month and sent me a cutting from a newspaper he came across on his trip. It was the Easter recipe column from the Shanghai Daily and it invited readers to enjoy eggs the Chinese way. Nutritious dishes included eggette, red eggs and fertilised chicken egg, but the one that caught his eye was virgin boy eggs. This unique springtime snack is an old tradition from the eastern Chinese city of Dongyang. Local chefs soak and cook their eggs for a full day in the urine of boys under the age of 10. The initial boiling is with shells on, but all the simmering is with shells off. Street snack purveyors in the Zhejiang province claim remarkable health properties for virgin boy eggs including but not limited to general reinvigoration, better circulation and even a cooling of body heat. The only effect they have on this doc is a further cooling towards Chinese medicine.

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


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