Old-style medical reps are a great unsung source of wisdom and amusing stories from Irish healthcare. They are easily spotted in the waiting rooms of Irish doctors - they wear suits and never sneeze. Years of chronic exposure to every bug imaginable galvanises their immune systems.
ne retired specimen, who enjoys Rude Health, has been in touch with some thoughts of Christmases past. He remembers visiting a doctor at an old health-board premises in one of the poorer suburbs of west Dublin. During a December morning surgery, a patient presented with a cough. Appropriate medication and advice was given. Before the patient left the room, she asked for a roll of cotton wool. On the lookout for another possible ailment, the doctor asked the reason for her request. "Ah, ye know it's Christmas, and sure a tree wouldn't look right without a bit of snow on it!" Aside from a prescription, she left empty-handed and her tree went unadorned. They call that zero tolerance for freebies.
You would think that surgeons are pretty good at amputating legs. Goodness knows, they have been taking selfies during these operations for centuries. But a study conducted at hospitals in England, Wales and Northern Ireland shows that just four out of 10 patients who lose a leg are receiving ideal care. Although the death rate was slightly higher than it is in the United States, the problem is not so much with the operation itself. The experts found that over 7pc of amputations should not have been performed in the first place. They were critical of the fact that other illnesses of amputees, such as diabetes, can be neglected during care on surgical wards. Their advice is that larger teams of specialists need to get involved in the overall care of amputees in hospital, and not just surgeons. Just as there are now specialist nurses to co-ordinate all the care aspects of something like breast disease, we may soon see the rise of the bedside amputation nurse.
Another textbook of Irish in medicine has come my way. Compiled in 2006 and published by the HSE in Galway, Leaganacha Leighis is an English-Irish phrasebook for medical personnel. It was written by Dr Nicola de Faoite to improve the ability of doctors to communicate with native Irish speakers, and it remains true to the Irish as spoken in Connemara. Dr de Faoite's text, coupled with the older book of Professor MacConaill of Cork - which I now have in its entirety - cover everything I will probably ever need to know. Being January, more men visit a surgery than at other times of year. Ceapaim go bhfuil an fliu fhear orm means, "I think I have the man flu on me". Another common manly ailment is the athlete's foot. Now my pidgin Gaelige would have raided the vocabulary of the Gaelic Athletic Association for the word luthcleas and then would have to decide whether the word cos goes before it or afterwards. But I'd be wrong - very wrong. Barrpheist choise is the official term for the damp, itchy mess between the toes of athletes who don't dry themselves after the team bath (folcadan na foirne). From what I can discern, pheist is a worm and barr makes it a ringworm. We might have a look at some ailments for mna na hEireann next week, liacht bhan (gynaecology) to be precise.
One of my favourite jobs in general practice was the removal of ear wax. The job was traditionally performed with thick towels, a huge silver syringe and a kidney-shaped dish to catch grubby water on its way out. But a GP up the road who used to give me locum work showed me how to use an electric ear syringer, and I invested a week's takings in it during the early days of practice. It was a life-saver and patients would come from far and wide to see it and sample its delights. Tempora mutantur, nos et mutamur in illis was proudly written on the wall - "Times change, and we change with them!" The Irish Medical Journal has just published an interesting paper on ear syringing. In short, they pose the question - could we trust non-doctors like audiologists to deal with 'cerumen management'? Seventy-five per cent of ear, nose and throat surgeons believed wax removal by audiologists would be more risky to patients, whilst the number of audiologists who felt like this was much lower at 27pc. There could be a bit of a turf-war scenario developing here. Audiologists have argued that busy doctors can assign tasks like ear syringing to practice nurses, and wonder why they cannot receive the same level of training. I'd be interested if any readers have any experience or stories of ear syringing in other jurisdictions. We could be hearing more about this issue once the plugs of wax are removed.
Across the water in her majesty's kingdom, there is a royal row blowing over payments being made to GPs to diagnose more cases of dementia. Family doctors are being offered a €55 payment for every diagnosis they make, and many of them are up in arms at the whole concept of payment per diagnosis. Patients who forget their appointments could be first on the list! In seriousness, the profession is quite split on the diagnosis of very early dementia. There are doctors who want to diagnose everything, regardless of the consequences. But there are others, the silent majority perhaps, who hesitate. They are the wiser ones who recognise the dangers of overdiagnosis, misdiagnosis and the inescapable march of medical terminology into every human frailty of life. Targets are all very well in things like archery and darts. But innocent bystanders are often in danger when introduced into medicine.
Dr Maurice Gueret is author of 'The Doctor's Case'