Head physician interview: Should the end of Arthur’s Day be just the beginning?

The new president of the Royal College of Physicians wants to reform the way Ireland sells alcohol

Prof Frank Murray, incoming president of the Royal College of Physicians of Ireland. Photograph:  Fergal Phillips

Prof Frank Murray, incoming president of the Royal College of Physicians of Ireland. Photograph: Fergal Phillips

 

If you’re ever wondering what happened to Arthur’s Day this year, look no farther than Kildare Street in Dublin to discover who killed off Guinness’s promotion.

The campaign against the excessive drinking that was a feature of the event had its headquarters not among the politicians working out of Kildare Street, but down the road at No 6, the headquarters of the Royal College of Physicians of Ireland.

No one was more centrally involved in the argument against Arthur’s Day than gastroenterologist Prof Frank Murray, who is starting a three-year term as president of the college.

A tall, softly spoken man with a touch of a grown-up Harry Potter about him, as chairman of the college’s policy committee, Murray’s clinical, evidence-based and repeated criticisms of the excesses of the event helped to put it out of its misery this year.

With that scalp under his belt and starting a new post as advocate for the country’s hospital doctors, Murray has his sights set on reform of the way we sell and market alcohol in the State. First on his Christmas present list from the Government is a minimum per-unit price on alcohol to discourage the sale and consumption of cheap drink.

The proposal has been kicked about for some years now without making it to the statute book, a hesitancy that is in contrast with the leadership Ireland has shown on tobacco control, but Murray isn’t showing signs of impatience.

“We’re not against the Government,” he says. “They have difficult decisions to make and a range of interests to take account of. We see our job as acting as a counterweight to the drinks and advertising industry in this debate. The Government is moving in the right direction, albeit slowly.”

As one of the country’s top liver specialists, Murray gets his motivation from his patients. “Liver disease is mushrooming, “ he says. “When we were children, most of the liver deaths you’d see were of men who milled into pints in the pubs all day, starting with the early houses. That’s all changed now. We’re seeing far more women, and people much younger, in line with the shift from drinking in pubs to drinking at home.”

Some readers probably think these cases are outliers, involving heavy consumption, but Murray doesn’t: “We’re seeing a lot of people who are drinking half a bottle of wine at night during the week and then a bottle a day at the weekend, coming in with liver disease.”

Figures on alcohol abuse

Thanks to health scientists such as Murray, we have a strong read on the extent of our alcohol abuse: one in four of us drink in a harmful way; 200,000 people are dependent on alcohol; consumption rates are among the highest in the world, and twice as high as 50 years ago. “I don’t understand any reason not to act urgently,” Murray says. “Problem drinkers drift down to drink the cheapest drinks. So why don’t we say, ‘If you are going to drink, drink better alcohol in smaller quantities?’ ”

The notion of hardened drinkers abandoning their “tinnies” of cheap lager for a tincture of fine claret might seem a little unlikely, but Murray says France has succeeded in reducing consumption through “a push to quality”.

Improving public health isn’t all about alcohol, of course. The college would like to see a ban on the advertising of high-sugar products to children. As with alcohol pricing, progress is slow and, Murray says, “it’s hard to identify where the resistance is”.

The manpower crisis in medicine is likely to absorb a lot of his time as president of the Royal College. Emigration is rising among both junior doctors and consultants, and huge numbers of posts remain unfilled. Murray says the college has tried to do what it can to encourage staff to return, by holding exams in Australia, for example, and doing interviews by Skype.

“It’s part of a much bigger issue,” he says. “With a medical degree you can work anywhere in the world and, in most parts, there is a shortage of qualified doctors. And the terms and conditions are often more attractive.”

The solution lies in more flexible working arrangements. For Murray, this includes allowing doctors to work “off-site”; a code for private practice. “In other countries, consultants can work part-time, or work part-time in public medicine and part-time in private. It’s not about the money; it also has to do with people’s autonomy and ability to work outside where they are primarily working.”

Murray works at Beaumont Hospital, in Dublin, where the emergency department regularly has the highest number of patients on trolleys of any hospital in the State. He says it is “deeply frustrating” that up to 20 per cent of beds in the hospital are occupied by patients who no longer need to be there but can’t move because there is no long-term care available.

Sorting out the problem isn’t that difficult, he argues. “There is a critical need to sort out the long-term care issue. We need immediate and urgent investment in moving those patients to nursing homes.”

Freeing up delayed-discharge beds in the five Dublin hospitals would liberate the equivalent of a new hospital in terms of extra space, he says. By international standards, we have too many hospitals, he adds, but any change has to take account of the economic and social impact even smaller hospitals have on their location.

“We’d be better off having a smaller number of bigger hospitals, from a safety perspective. If I was ill, I’d rather be in a bigger hospital with more resources.”

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