After 17 years of working in Accident and Emergency, Ms Mary Rose, the Senior Sister in Beaumont's A&E department, is still surprised at the trivial nature of some complaints from people arriving at casualty.
"I've had a person who arrived to the Accident and Emergency Department wanting us to check out a pain in their toe they'd had for a year-and-a-half.
"A few times I've had people who were scratched by their cats and wanted a tetanus shot."
However, at 3.30 p.m yesterday, not a single person with a "minor ailment" had darkened the door of Beaumont's A&E, despite the fact that Monday is the A&E facility's busiest day.
Every patient who turned up had either been referred there by a general practitioner or had been asked to call back after a previous visit.
The ailments they attended casualty with were sufficiently disquieting to warrant being in a hospital: chest pains, seizures and serious asthma attacks featured prominently on the list of problems dealt with by staff yesterday.
While staff at the hospital welcome the Eastern Health Board's campaign to get people with minor ailments to attend a GP before they go to casualty, they regard the phenomenon of "inappropriate attendances" as the least of their problems.
An Accident and Emergency consultant, Mr Leo Vella, acknowledges patients now came to hospital more readily than they did in the past, but he is unconvinced that raising the A&E charge is an effective way of persuading them to go to their GP first.
"The fee that the Government has made us charge patients has not really made any substantial difference, especially when so many of our patients have medical cards."
Mr Vella sees the public's increasing preference for A&E over GP care as part of a "convenience shopping" culture.
"Ten years ago, a doctor would examine a patient with a pain in the back, and the patient would be happy to be told to go home and take a bath and a few pills. Now many patients would expect an X-ray on their back and maybe even an MRI.
"People equate good medical care with hospital a lot more than they did. The GP has suffered a loss of stature in people's thinking - a belief which is quite unfounded."
While Mr Vella welcomes the Eastern Health Board's A&E campaign, he has doubts about its success, even on its own limited terms.
"I'm not cynical about this initiative. We welcome it and fully support it. Indeed if the campaign did not take place then everyone would criticise the Eastern Health Board for not having one. However, I am a little sceptical about whether it will have any effect."
Privately, some of the staff in Beaumont's A&E department see little hope of cutting down on "inappropriate attendance".
There are complicating factors, especially in deprived areas, where many GPs fear to visit after dark. There is also little financial incentive for GPs to visit medical card patients at home after surgery hours.
Patients on low incomes who don't have a medical card are attracted to A&E by the fact that they do not have to pay the charge immediately, as they would if they attended a GP.
Beaumont's A&E facility deals with 50,000 patients a year. Of the 16,000 who have passed through since September 11th, this year, only 1,700, or 10.6 per cent, paid their A&E charges upfront.
Some 8,500 patients, or 53 per cent of the total, were entitled to free treatment. The remaining patients were billed after they attended casualty.
Even if those patients eventually pay their dues, the hospital incurs substantial administration costs reminding them of their debt. But staff are powerless to remedy the situation as they will not turn away a patient who needs treatment solely because they do not have the money to pay up on the spot.
The major concern of Mr Vella and the rest of Beaumont's A&E staff is the shortage of acute and step-down beds in Dublin.
"The girl who comes into casualty with a rash on her hand is irritating, if you'll pardon the pun, because she takes up our time. And you can't complain because the customer is always right. "But the vast majority of people who attend inappropriately don't end up in a hospital bed and the turnover of hospital beds is our major problem.
"Even if today's Eastern Health Board initiative were 100 per cent successful, it would not improve that situation one bit."
