Sitting together for meals is important, especially at this time of year love my Aga. It heats the house, dries my clothes, and makes the best toast in the world. I love the food it cooks, but you must cook the Aga way. Oven temperatures are fixed, so you move the food from hot to…Read More
The UK is growing ever more divided in what is essentially a civil war without the guns My Scottish brother-in-law, Neil, is standing in the Westminster election on 12 December. He’s the Liberal Democrat candidate for the Western Isles. I’ve had a vague interest in British politics since I lived there, but now I’m taking…Read More
The worst solution for the trolley crisis came from an engineer. “Remove all trolleys,” he said. That will force the system to respond with efficiencies. It was around the time former Minister for Health Mary Harney declared a national emergency, because almost 500 people were waiting for a ward bed. Since then, beds have closed.…Read More
The dotMD conference led me to some personal reflection I missed the first day of dotMD. Instead, I drove two hours in the opposite direction to a funeral. Just 24 hours after a death, hundreds of us were summoned by phone, text and RIP.ie to sympathise with the family by an open coffin. I was…Read More
Relief rather than surprise was my dominant feeling after reading the new Scally report “Nothing would surprise me,” Dr Gabriel Scally said, “I’m absolutely amazed at some of the things that I’ve found.” In forthright language, Dr Scally explained that both Quest Diagnostics and CPL/MedLab had outsourced slides from Irish women, without informing the HSE.…Read More
Dr Christine O’Malley gives a personal account of the IMO AGM 2019 in Killarney Once again, CEO Susan [Clyne] and the IMO team gave us a wonderful AGM. Usually, they organise glorious sunshine too; this year Storm Hannah swept in. But the Europe Hotel, spiritual home of the IMO AGM, kept us safe as we…Read More
Dr Christine O’Malley recounts the difficult experience of deciding upon a medical specialty and when she knew geriatrics was for her It’s odd that people are so prescriptive about the “right” personality for doctors. Medicine is a broad church;there’s room for everyone. I left school in the Dark Ages, before the CAO. I was offered…Read More
Dr Christine O’Malley says the most important factor in choosing a consultant is how good they are at their job, even if their personality might rub patients up the wrong way “Please choose a consultant for me.” My ophthalmologist said I needed to see a retinal surgeon about my complex eye problems. She named specialists…Read More
Dr Christine O’Malley Dr Christine O’Malley challenges the view that the Irishhealth sector employs too many nurses Ireland has more nurses than France.” It was 10 or more years ago, and I was asked for a comment on whether Ireland has an excess of nurses. I don’t remember what I said, but I didn’t think…Read More
A teacher was giving out over a cup of coffee. She asked her class to do their maths homework in a copy book. Next day, a mum said her child was tired so she told him to do it in the workbook instead. “What’s wrong with that?”
My friend sighed. Parents don’t realise the task isn’t just about arithmetic. She wanted the children to organise themselves, assemble pencils and ruler, draw lines.
Aha! I get it. It’s the magic of good teaching.
When I told this story to some teachers, one said: “We call it ‘the Hidden Curriculum’.” It was just after the Dromineer Literary Festival and the Committee was celebrating a very successful event.
It was also the weekend of the Rural Doctors Conference; in between poetry and prose, I had given a talk. Now I was pondering the unexplainable qualities of general practice. People understand surgery, but they haven’t a clue what physicians and medical wards do. As for general practice, I know there’s some magic between patient and GP that allows most people to be treated without a hospital.
It’s the Hidden Curriculum.
In preparation for the GP conference, I dug out my box of old health service reports. It’s important to realise, no-one reads reports; media stories may be based only on a press release. So it was interesting to have a look back and delightful to have the distraction of literature.
At the Festival, there were debates between writers – Julian Gough, John Connell, Ruth Padel, and John Banville. Later in the bar, there were debates about health. A poet (from a medical family) said: “Didn’t it all go wrong with Mary Harney?”
That’s when the health strategy – more beds, more staff – was abandoned. Instead we got the health reform programme: The Brennan, Prospectus and Hanly reports.
Prospectus gave us the HSE.
The Brennan Report says that clinical independence of consultants is a budgetary problem. No mention of patients or quality; controlling consultants is a cost issue. So the new consultant contract obliges consultants to obey corporate policy.
I didn’t sign it. Doctors need clinical freedom to act for their patients.
The Hanly Report, supposedly about doctors working hours, is actually about centralisation into large hospitals. In the Mid-West we were told that Limerick inpatients would become day cases, so the wards in Ennis and Nenagh wouldn’t be needed.
That didn’t work. Our patients are treated on trolleys instead.
It was the end of the magic of small hospitals. Our Hidden Curriculum was that, while treating the primary illness, we fixed as many problems as possible. Tests were done, consults with other teams and all in a short time. My job was to assemble information and make decisions, get the patient sorted.
No more; only the primary illness is treated now.
On discharge, the patient goes on multiple waiting lists for tests and clinics. Often it’s not clear whose job it is to put it all together afterwards. So the GP chases results and clinic appointments, trying to make sense of the jigsaw of information. It’s the GP who makes the hospital system work for patients.
Looking at the reports, there’s been a decade of flip-flop policy on private patients. Co-located private hospitals meant apartheid between public and private patients. Under universal health insurance, everyone’s private; now with Sláintecare, they’re all public.
The Sláintecare Report is also very keen on something called “integrated care”. I puzzled over it for a while. Then I got it! Integrated care actually means fragmented care, even more than it is now.
Instead of admission to hospital with pneumonia, the patient will get antibiotics and physiotherapy, x-rays and scans all done from home. Apparently, it’ll be just like hospital care, because somehow it will be “integrated”. It’s the latest cure for the trolley problem.
It doesn’t say who’ll do the “integrating”, so presumably it’ll be the GPs. That means patients will need free GP care and a new contract will have to control and direct the work of GPs.
But it seems to me that clinical independence is what makes general practice work and I reckon having paying customers is an important part of that freedom.
Anyway, if GPs are doing hospital work, they can’t do the work we can’t see, the Hidden Curriculum. The magic will be lost. And that’s not good for patients.
Back at the festival, it’s a beautiful autumn day out on Lough Derg. We’re on a boat, listening to readings about hammering through ice to go lake swimming.
I let the tangle of thoughts in my head float away across the water.Read More