Events have been dominated by the needs of the system and not those of women patients , writes Medical Correspondent Dr Muiris Houston
"A health system that is there when you need it, that is fair, and that you can trust... A health system that encourages you to have your say, listens to you and ensures that your views are taken into account... A health system that supports and empowers you, your family and community..."
These statements are prominently branded as "The Vision" at the core of the 2001 Health Strategy: Quality and Fairness, A Health System for You. For many, both healthcare providers and patients, this vision reads like a Utopian dream this morning. Certainly, it bears no relationship to a health service that has clearly lost its way and no longer appears to put patients at its centre.
Further cases of breast cancer are unlikely to be identified by the review of women who had breast ultrasounds performed at the Midlands General Hospital between August 2005 and August 2007. This is because the women concerned are all under the age of 35; most also had a medical examination, placing them at very low risk of a misdiagnosis.
Nevertheless, the manner in which the 568 women concerned have been treated by our health system has caused widespread shock and indignation. And the fact that, up to yesterday afternoon, the 97 women identified as needing follow-up had not yet been contacted by the Health Service Executive is completely unacceptable.
No matter that most will be given the all-clear; that their individual needs and rights have been deemed to be secondary to the needs of the "system" is a sign of a health service in deep trouble. At the core of healthcare is the interaction between a patient and a healthcare professional. The person is there because he or she is concerned about a health problem; the doctor or nurse is there because they want to use their knowledge and skill to help the person get better.
Healthcare professionals are governed by a code of ethics: one of the most important principle is that of beneficence - putting the patients at the forefront of clinical practice. Primum non nocere (above all, do no harm) is the traditional axiom behind the ethical imperative that one should not harm one's patients.
Regrettably, the investigation of events at Portlaoise has been dominated by the needs of the system and not those of the women. Their need to be seen on a one-to-one basis was not recognised; instead the focus has been on identifying a cohort of women who could be treated as a group rather than as individuals.
If, as claimed, the charts of 568 women have been reviewed over the last number of months, why, as soon as they were identified, were the women requiring follow-up not contacted immediately and offered a medical appointment?
Both the HSE and individual doctors have a duty of care to these patients based on previous consultations and investigations. It should have triggered immediate contact with the women and their GPs. A phone call from an experienced breast-care nurse offering an early review appointment would be considered normal practice.
Instead, the need to identify and package the women in an administratively tidy way became the imperative. This mindset was illustrated by the HSE decision to prioritise contacting the women who do not require further follow-up and who have nothing to worry about. The fact that the person who made this statement yesterday has the job title "head of consumer affairs" tells its own story.
It is ironic that after many years in which the medical profession has been justifiably seen as excessively paternalistic, the head of the HSE's National Hospital Office should decide to inform women in the midlands they have a potential problem via the media and the Oireachtas.