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Doctors not joining scheme leave families stranded


Kevin Denny

Kevin Denny

A doctor examines a child.

A doctor examines a child.


Kevin Denny

My mother reared us to believe that wasting a doctor's time was evidence of poor character. Even though this policy resulted in my giving birth at home unexpectedly because I didn't want to raise the alarm unnecessarily, it's hard to shake off the policies one is taught as a child. After all, this is a woman who apologised for making a fuss when she phoned the Doctor-On-Call when my father was on the floor clutching his chest in the throes of a heart attack.

Anyway, one day last year I found my two-year-old lying on the floor, unable to stand up. He wasn't crying. He had no visible injury. He didn't have a fever. Apart from the fact that he couldn't walk, there didn't seem to be anything wrong with him. "How weird", I thought, half suspecting him of malingering. When there was no improvement the next day I considered bringing him to the doctor, but janey, it's €50, and I don't have €50 to be throwing away on children who aren't actually sick. In the absence of any distress, I decided to bide my time.

When it came to the weekend, I was really starting to worry, but the out-of-hours charge is €80, and there was no way I was paying that. Finally, on the Monday, I brought him to the doctor; and before long, we found ourselves in Crumlin Hospital.

It was the second time I was in a children's hospital, and yet again, it reminded me that we should lock up anyone who claims we have a Third World health system. An incredibly professional team was not letting my child out of there until they had ruled out a gruesome illness called Infectious Arthritis that, left untreated, could leave him with a life-long disability. Every time I had to tell a different specialist that he hadn't been walking for a week, the guilt overcame me. What was wrong with me? He couldn't walk! In the end, and to huge relief all round, my initial instincts proved correct. He was diagnosed with something else called Transient Synovitis, a temporary mystery diagnosis of exclusion. He actually walked out of the hospital.

But that's not the point. The point is: if you don't have a medical card, a doctor's fee is prohibitively expensive. Fine, I might be a particularly casual mother, but it was the money that deterred me from taking him earlier. The outcome could have been a lot different.

So I was hugely cheesed off last week when I tried to register the poor neglected cratur for the Under-Six Medical Card and discovered that our doctor isn't signing up to the scheme.

That is not fair. I have three children, and, excluding vaccinations, I think each of them has seen a doctor once. I am not a time-waster. I live on a tight budget. And I never want to be in a position again where I'm weighing up the health of my child against the cost of seeking medical attention. Already, 40pc of the country sees a doctor for free, and with the new scheme I'll end up in a small minority who has to pay for everything and so does without. I'm sick of it.

Now, I understand where the protesting GPs are coming from. Ireland has this weird hybrid system whereby a GP is a self-employed business-person, but most of his income derives from public contracts. Only 2pc of the entire health budget is spent on general practice, and severe cutbacks have reduced their public income greatly. On top of that, their private practice has suffered with the likes of me holding out at home with leeches and herbs rather than spending the money on a private consultation. They know from experience that many patients who have medical cards could do with a dose of my mother's common sense and stop wasting doctors' time on minor ailments. There is no doubt that when something is free, it gets abused.

So I can understand why doctors are afraid that their already pressurised surgeries will break under the weight of hysterical mothers bringing their healthy children in to waste everybody's time.

They say that the number of visits will increase from an average of 2.5 visits a year to six. But what is the evidence for that?

Kevin Denny is a behavioural economist at UCD. He's used data from the 'Growing Up in Ireland' survey - a population-based study by the ESRI - that tracks, among other things, how often people see a doctor. He's calculated that actually, the number of extra visits will be one per child per year - significantly less than the worst fears of GPs. The doctors are basing their public statements on anecdote and should pay more attention to the data. In the meantime, they are putting a gun to the heads of parents who, certainly in rural areas, have no choice about the matter.

I'm sorry if doctors have discovered that their business model is failing. I'm sure there is a way to do things better. Either by charging everyone something or turning GPs into public sector employees. But medical cards for the under-sixes is Government policy, and it's wrong to deprive those children of that care. If there's a better way to fund general practice, then doctors need to thrash that out with the Government, and not on the steps of their surgeries leaving families with small children stranded.

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