Walking from the surgeon's embrace

Unfounded rumour and scurrilous allegation were all there was to it, I'm sure

Unfounded rumour and scurrilous allegation were all there was to it, I'm sure. But it hung around for a long time, the idea that female learner drivers fall in love with their driving instructors. Something about learning in a confined space was supposed to increase the statistical likelihood of falling for the teacher.

Some surgeons have the same effect on patients. It depends not so much on the surgeon as on the type of surgery performed. Patients rarely develop an impassioned loyalty to the person who removes their appendix or adenoids. And, when an orthopaedic surgeon replaces your real hip with an alloy ball-and-socket, your gratitude (at least if Maeve Binchy's account is anything to go by) is somewhat lessened by the amount of walking you have to do. But if a brain or heart surgeon has a surgical go at you, it's different.

Perhaps because both tend to operate when patients feel themselves to be in life-threatening pain, these medics have a most extraordinary effect on their patients. If anybody looks crooked at Maurice Neligan, for instance, patients leap to protect him from attack, offering as evidence of his value their personal survival.

Not that I would ever look crooked at Maurice Neligan or any of his colleagues. You never know the day nor the hour you might need to be on good terms with a household-name heart surgeon.

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I just find it odd that, before I ever met him, I knew him, whereas I don't know the man who invented one of the most attractive preventive measures in the area of heart and general health: those walking routes called Sli na Slainte which are springing up in one local authority area after another. Moral: we may say that prevention is better than cure, but we don't really believe it. The gurus of preventive health don't have quite the same hold on our hearts and minds as the surgical rescue force do. Those of us who had family experience of heart disease before the development of bypasses and transplants find that easy to understand.

My father suffered several heart attacks before the one that killed him and, growing up, I remember the heavy dread associated with the very words "heart attack". Back then, if you survived a heart attack, you tended to have little more than half a life and relatively few treatment options; whereas today, almost everyone knows someone who has gone through major heart surgery and bounced back to a life arguably better than the pre-problem years. But neither the success of surgery nor the glamour of the surgeons should distract us from the value of prevention. I have always found the Garda Siochana attractive as a group and as individuals, but not attractive enough to make me want my house burgled in order to justify a visit.

Similarly, there's a certain drama about the fire brigade, but most of us still put fire-guards up and unplug the TV at night rather than create a situation where we get to meet them.

I would not suggest for a moment that the Maurice Neligans of this world are so fascinating that potential patients of theirs are going to lash into cream cakes, chips and couch-potatoism in order to make their hearts dicky enough to justify meeting the cardiac surgeons.

What I am saying is that we're not that amenable, these days, to advice on dietary restraint and physical exercise. That stuff has a penal ring. Hence the demand for liposuction and plastic surgery.

In that context, the cleverness of Sli na Slainte shouldn't be underestimated. As a sporadic walker, I love to know how much ground I've covered. It's like getting a statement from the bank that shows I'm in credit.

Sli na Slainte is a clever way of reinforcing the habit of walking, and of showing that you're making lodgements into your health account by taking regular exercise. According to the Irish Heart Foundation, whose CEO, Paddy Murphy, is the unsung hero behind the idea, exercise is one of the four key factors affecting heart disease.

If you can build it into your life, you can make a major improvement to your heart health, reducing your chances of premature coronary heart disease or stroke. This is much more than a health promotion issue. it is an economic issue. Right now, Ireland not only has a rapidly ageing population, which is going to play hell with our health insurance provision and place huge demands on our health services into the next century, but has the highest death rate from coronary heart disease in people under 65 in the European Union.

Some of this is unpreventable. Nor should patients suffering any disease be made to feel guilty as well as sick. But there can be no doubt that substantial inroads could be made in the figures for illness and death from heart disease if individuals could be motivated to take control of their lives in such a way as to improve their chances of avoiding the disease.

That control requires knowledge and action on diet and exercise. It also requires young people to refuse the "two for everybody in the audience" gifts they're currently lining up for when they buy cigarettes. Many young smokers know that they get the freebie of lung cancer along with the cigarette habit. Not enough of them know they get the freebie of heart disease, too.

The economic benefit to the nation of attacking habits of citizens which kill, maim and cost money is immense. Except that it requires political courage. It requires political courage to say to the drivers of Dublin: "If you don't want gridlock and air pollution, leave your car at home."

Changing the behaviour of the general public is easy, if the change is fun. Using a mobile phone or surfing the Internet is a major change of behaviour, but not much hassle. Giving up cigarettes, cutting down on fats and getting out for a walk requires a bit more effort, and I cannot recall a single minister for health who decided that they would be the one who would be known for ever as the great disease-preventer.

That's unfortunate for our economy, and for patients who end up meeting household name heart surgeons in the operating theatre, rather than socially.