HEART BEAT Maurice NeliganIt was with no little astonishment that I recently heard a colleague state on steam radio that we Irish had a great record of compliance with the law. It just goes to show how wrong I can be as I would have supposed the opposite to be true. Mind you he was talking about the smoking ban which has made us all healthier and emptied the hospitals.
Dare I ask why the patients still lie in undiminished, even increasing numbers on trolleys? We were told that the effects on respiratory conditions and on heart attacks would be immediate. The decline in the various cancers attributed to smoking would understandably take more time. I reiterate my simple query. Why are the patients still on trolleys in considerable numbers?
Have they not read that they are supposed to be healthier, with less chest conditions and heart attacks? Couldn't they be like all the newly healthy barmen who no longer clog the A&E departments? Have they no shame?
Incidentally the trolleys numbers game poses an interesting conundrum. There appears to be a divergence of opinion as to how many patients enjoy this privilege on a daily basis. The Irish Nurses Organisation gives one figure (the higher). The administrators proffer another (the lower). Whom should one believe? All the nurses I knew could count. Maybe this ability is no longer required as part of their new training courses. In any case, what possible benefit accrues to the nurse in exaggerating the true and awful situation? I can clearly see a benefit on the other side of the equation as concealment of the true state of the health services has become an art form over the years.
The answer to this question is obvious. Let these unfortunate patients be counted at an agreed time by representatives of the doctors, nurses and administrators. The agreed figures throughout the country and their regional variations could then be made available, not only to the powers that be, but also made known publicly. We can then see improvement happening as we have been promised. Doctors and nurses must retain their obligations as patient advocates. Concealment of the true state of affairs is in the interest of nobody.
In this context, a young consultant doctor, recently appointed, found that no facilities existed for the position in question, no space, no staff, and no beds. Local approaches having proved fruitless, he spoke publicly about this farcical situation. The doctor was summoned to meet the administration, not, it was stressed, for a disciplinary hearing, just a general warning about the creation of waves.
I and many of my colleagues throughout the country who have spoken out about the conditions of the service are familiar with this marine phenomenon. If you little doctor fish make waves, we administrator fish can make bigger ones, even tsunami if you annoy us sufficiently.
Co-operation between all branches of the caring professions and administration remains the only way forward. The latter should strive to make the doctors and nurses' tasks easier, and should themselves, without fear, highlight deficiencies. There are many excellent and dedicated administrators, and one can understand some reluctance to put jobs and promotional prospects in jeopardy by speaking contrary to the official line. We need an open atmosphere where problems of whatever nature can be aired and not hidden.
In the meantime, having abolished smoking and drinking in our fantasy land, we must establish another fear. Apparently this time it is going to be obesity. We can expect the usual outpourings and calls for repentance and salvation before this cataclysm of fat envelops us all and costs the State millions in extra health costs.
Considering that the State cannot provide a service right now, this should prove interesting. I have already made this simple observation before and I will make it again.
We will not save any money for the State by preventing people dying from excesses of tobacco, alcohol, obesity or anything else. The world is still ordered such that everyone dies and the ultimate cause of death is not necessarily less expensive than that prevented by adhering to the good life as deemed by some. We doctors should be stressing the benefits of moderation, the wellbeing that ensues and the chances of extending useful and pleasurable life. We should not preach that whatever our particular crusade may be, it will somehow save the State money. It will not.
I do not wish to write about such subjects for the rest of my days. Would it be possible to instil some common sense into these endless debates? We all know the problems of excess. We can provide education in these matters but we must accept also that individuals have free will. Some individuals become addicted to things that are bad for them. As doctors we must treat with compassion, and as best we can. Moderation in all things including moderation itself should be the goal. We must live alongside each other and tolerate our respective frailties.
Do we really need smoke police, drink police, fat police? I think not and they certainly won't save us any money. I am afraid the obesity scare is upon us now and won't depart anytime soon. More about this anon, in the constant fight to stop the lunatics possessing the asylum. In the meantime, enjoy what may be your last Mars bar.
Maurice Neligan is a cardiac surgeon.