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Entering the conflict zone of medical politics

A lawyer once said to me: “You lefties think if everyone gets around a table, it can all be sorted.”

I was silenced. I didn’t realise that I thought that, or that it was ‘leftie’ thinking. Now I cringe a little whenever I hear it said. Then again, maybe it’s why I enjoy the IMO AGM.

Lately, I’ve been wondering what the equivalent ‘rightie’ thinking is. It’s probably the one about “just bring in Michael O’Leary/Gerry Robinson to fix it”. Well, that doesn’t work either.

In between lie the confusion and conflicts of daily life. It’s funny — when there’s no money, there’s little conflict. Everything is difficult but we’re in it together. Now, with Ireland supposedly recovering, there’s the possibility of investment again and the question is where it may go.

The big conflicts, even among doctors, are that health costs too much and if there’s any new money, it should go to primary care and not be wasted on hospitals.

So there I was, at the IMO AGM in Galway, in a room full of doctors mesmerised by health economist Brian Turner.

It was such a relief to hear a rational outsider explain that health is indeed under-funded due to the historic deficits over decades. He also said we must invest in primary care, but it can’t be instead of hospitals. He told us Ireland is so short of hospital beds for our population, we’d have to add 8,000 beds to catch up with Germany. Wow!

I quoted this number to Minister for Health Simon Harris. He went a little pale, but cheered up again when I said 2,000 beds might be enough. I think he’s the first Health Minister in a long time to acknowledge the need for extra beds, publicly, in his speech.

During the AGM motions sessions, there was an interesting dispute about Medical Assessment Units: GPs demanding, consultants objecting. The consultant view seemed to be that acute illness should go through a single door, into the emergency department. GPs don’t agree.

In a later, private discussion, I took the middle-ground between GP and consultant and blithely concluded “we agree”. My colleague said briskly “we don’t agree” and I winced at myself for assuming we were all around that table.

The funny thing is the smaller hospitals are obliged to run Assessment Units. It seems to be the larger hospitals that are less happy with the idea, maybe to keep a barrier against throngs of patients they have no place for.

I find consultants think ‘care in the community’ is a great idea. It allows them to discharge patients early and presume the GP will pick up the pieces. It’s great for getting bloods done on clinic patients but I don’t see much enthusiasm for giving support to GP colleagues in return. I don’t necessarily expect consultants to campaign for money or staff in primary care to do the extra work. But it’s odd that consultants don’t feel any obligation to provide back-up to GPs when the early-discharge patient has complex problems or the blood results are worryingly abnormal.

In the end, the AGM motion was “referred to Council” with a proposal for a more detailed discussion next year. Maybe the topic should really be the GP/consultant interface. Or that the health service for acute patients simply isn’t big enough.

Conflicts with the HSE employer continue, and the net effect is trouble keeping doctors in Ireland. Fellow Mindo columnist Dr Anthony O’Connor took us through a session on the topic and there were sad stories over coffee of doctors in mid-career leaving the country, doctors leaving medicine entirely and difficulty recruiting to the GP training scheme.

It was great to catch up with not one, but three, Mindo Editors in Galway. There was the usual late-night bar talk with journalists from medical papers and the national media, including an interesting analysis of what a new editor means for The Irish Times.

Annie came to the AGM as usual. She has zero interest in health or politics but always enjoys the IMO. While I did early-morning educational sessions and late-night bar talk, she worked away on her dissertation on stage management.

Dr John Duddy passed on the chain of office to our new President, Dr Ann Hogan. After the Presidential address, there were approving murmurs that she’ll be a good President. Then an exciting rumour swept through the AGM: Next year we’ll be back to Killarney, to the Hotel Europe — ‘our’ hotel. Hurray!

Now, if we can just get around that table next year, we’ll sort it all out.

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