Tuesday 24 October 2017

Who was the worst health minister ever?

The results are in, says Maurice Gueret, who reveals the head health honchos who made the grade and those who flunked it

Best health minister? Mary Harney. Photo: Steve Humphreys
Best health minister? Mary Harney. Photo: Steve Humphreys
Dr Maurice Gueret

I have more weather- related healthcare today, with a look at how best we might behave on ice. The car lobby shouts loud at councils to grit roads, bridges and motorways at the first sign of snow or ice.

Alas, pedestrians don't have an industry to do their lobbying for them. I would contend that they are the sector at greatest risk of serious injury whenever Ireland submits to a cold spell. In mainland Europe, it is increasingly common for councils to grit popular walking areas during icy spells. Casualty officers in our hospitals get to treat broken hips on the hour during snowfalls. The patients are invariably of vintage age, and the clue to their mishap is an externally rotated foot pointing sideways. It has been a very cold winter this year in mainland Europe, and the German Society of Orthopaedics and Trauma Surgery has been busy extolling the virtues of walking like penguins on icy surfaces. The key is to make sure your torso leans forward and your centre of gravity lies directly over your leading leg. Other good penguin habits are short steps, arms extended, flat feet (no high heels) and a slight bend at the knees. And they keep mobile phones well hidden in the front pouch.

To be fair to the HSE, it has been doing its bit to keep the population 'winter ready', as they put it. During a recent overnight frost, the Transport Minister issued a press release advising passengers to consult the winterready.ie website. So I did, and it confused me. It told me to get my vision checked, wear non-slip soles and to visit a doctor for a check-up, even after the most minor of falls. It even suggested that I might need my medicine dosage changed. It advised that I eat regular hot meals and drink plenty of fluids to give me energy to keep active, only then to suggest that I limit my walking in cold weather. Not a word about penguins or gritting of pavements. It made me think. There is a world of a difference between advice that is good and advice that is cheap.

* I have been having an interesting reaction to my recent piece on the best and worst health ministers of all time. Mary Harney's name has cropped up quite often in the best category, with the Fair Deal nursing-home scheme and the reorganisation of cancer services being among the achievements cited. I would have given Michael Noonan credit for many of the improvements in cancer services, but all the good he did was, perhaps, undone by the clumsy handling of the hepatitis C brief. Surprisingly, Leo Varadkar received a worst nomination for his introduction of premium loading for new members of private health-insurance schemes. Most health ministers of the last 25 years have now been nominated as the worst, with the exception of Brendan Howlin and young Simon Harris. Noel Browne and Mary Harney seem to be head-and-shoulders above the rest as best minister, although it has been suggested that this category deserves a more apt title - the 'least worst' health minister.

* Thomas brightened things up here by bringing some medical jokes to my attention that I had never heard before. That's a real rarity. He tells me of a girl from the hospital's X-ray department who married the consultant radiologist in the unit. Her friends were all wondering what she saw in him. And he tells me that one nurse of his acquaintance was nicknamed 'Appendix' because so many doctors wanted to take her out.

* There was a very sad case reported from the Dublin Coroner's Court recently of a young patient who died from complications of a trichobezoar. Bezoar is a Persian word that surgeons have long applied to an undigested lump which can block the intestines. A trichobezoar is one that is made of human hair. A hairball is probably the best lay description of what it is. The human gut can't digest hair and if a habit develops of continually eating it, it coalesces in the stomach and duodenum and can hinder food passage. The condition has also been given the fairytale title of Rapunzel Syndrome, hinting, I suppose, that the usual patient is female and has long hair. But patients don't tend to use their locks as stepladders. Hair eating is by no means widespread, but it can develop in anxious children and teenagers. Cases are slightly more common if there is a learning disability, too. It can take many years before a hairball comes to the attention of doctors. Many of the larger ones can be felt by palpating the abdomen, and most will also show up on X-rays or CT scans. Many medical museums around the world display trichobezoars, usually taken from patients that survive them. They are those rare peculiarities that doctors rarely forget and patients never get to hear about.

* First we had the apothecary's shop. Then it became a medical hall. Chemist was the trendy title when I was growing up, and this was replaced by pharmacy in more recent years. Now they are the all-singing and all-dancing 'your care plus total local-health, neighbourhood all-drugs lifestyle-haven express late-night 365 drugstores'. I don't care much for these new-fangled titles. Nor, I suspect, do patients. I'm not really interested in how many focus groups they have been tested on or how much has been spent on branding. Give me the name of a good man or good lady over the door any day, and perhaps the year the business was established. Coupled with good advice, a bit of continuity guarantees reputations in my book.

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


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