Heart Beat: The Drogheda debacle has provoked much concern and debate. Some commentaries were informed and thoughtful, others merely hysterical. Inevitably, there was the leap from the particular to the general. Doctors were to be circumscribed, evaluated, and monitored as never before. They were to be regulated in a way that applied to no other profession. It was even proposed that there should be a lay majority on the Medical Council.
The fact that this would be unworkable did not occur to anybody. I would have thought that professional knowledge and experience would be desirable to participate in its governance.
There were strident calls from some quarters for what was termed "a whistleblowers charter", for whistleblower, read informer. This is a most dangerous road to travel. Those informed against have rights also, and cannot be expected to abrogate these in the face of what may prove to be totally unfounded allegations. If someone has serious allegations to make they should be prepared to stand over them. They should also understand the subject matter about which they are implying malfeasance.
Informers have a poor track record in Irish life and I do not think special protection is warranted. If somebody has concerns, let them voice them and in substantiating them lies their protection.
The Society of Cardio-Thoracic Surgeons of Great Britain and Ireland met in Dublin last week. At the business end the working surgeons were given a glimpse of the future by Dr David Cunningham of the NHS. He presented figures from the British register of cardiac surgery: ie. audit on a national basis. He also told the group that from next year such information would be available on the internet from 19 of the 31 units in Britain and that there would be a breakdown of surgical results on a surgeon-to-surgeon basis. It is anticipated that the other units would comply soon. He expressed disappointment that the Irish figures were not available. This surprised me as previously this was not the case. Doubtless, there is a simple explanation.
Some years ago it was agreed here that there would be established a national cardiac register, that would record all cardiac interventions, medical or surgical, and provide a statistical basis for efficacy and follow-up. This would be a major step, not only in maintaining standards, but providing a long-term assessment of the effectiveness of the various kinds of treatments over time. Given our population of four million and the limited international mobility of such patients, such a register could well be unique.
It would provide transparency and patient-centred information and would provide early warning of any incipient problems. It should be mandatory and no vested interest should be allowed stand in the way. It would be relatively inexpensive and would signal a commitment to actually do something about audit and review, rather than merely talking.
Meanwhile, those awful greedy consultants, so beloved of our Minister of Trolleys are actually doing things that might benefit patients. They must have gone mad.
A new cardiac specific CT scanner has been installed in the Blackrock Clinic. This provides information on cardiac and coronary anatomy on a non-invasive basis and may well make cardiac catheterisation unnecessary in about 30 per cent of cases. It is also relatively inexpensive. It is truly ground breaking technology and together with cardiac MRI imaging gives a vivid picture of the anatomical and physiological profile of the working heart. The cardiac stress test may well become a thing of the past, and the workload of cardiac investigation laboratories lessened. The load of the poor overburdened cardiologists may well be lightened.
It may be further diminished by the revelation during the week that one of the statin family of drugs, currently used for the modification of blood cholesterol, has been shown to cause regression in the fatty plaques that build up in, and may block vessels in the heart, and elsewhere in the body.
In my surgical days when so much work involved bypassing such arteries in the heart, you had an uneasy feeling that someone would develop a sort of biological Harpic which would clean around the bend and scour the arteries, thus leaving one almost redundant. This report, however, needs to be treated with great caution. It is an initial and isolated report, although from a very reputable centre. The drug involved has been around for some time and the regression of blocks noted is of a very modest amount.
Furthermore, the doses employed were at the upper limits of toleration and this is a drug that is known to have serious side effects on occasion. It is not suitable for everyone and is positively contra indicated for some.
Rather this report points the way to something that may be achieved in the not too distant future and thus make many cardiac doctors redundant. I suppose they could retrain, as something useful, like epidemiologists, thus knowing all the answers and possessing the wonderful gift of transmuting bullshit into airline tickets. Then they would be able to travel the world to the meetings where they tell each other about the myth of everlasting human life available to us, if only we would do as we are told.
Don't hold your breath; in the meantime we will get sick and die as usual. We're still going to need the doctors for a while and maybe it would not be a good idea to piss them off unnecessarily.
Maurice Neligan is a cardiac surgeon