Heart Beat: I had not quite realised what a dangerous society we live in until two recent editions of Prime Time on RTÉ 1 television. As far as I could ascertain, the thrust of these was that if the Gardaí don't beat the bejasus out of you, the doctors will get you anyway, either terminally or in what is euphemistically called an adverse incident, writes Maurice Neligan.
I shall return to that matter. Meanwhile, I must come clean and admit bad things happen. They happen for all sorts of different reasons but seldom wilfully. The incidence of such in this country would be very small indeed and, of course, is criminal. Likewise, culpable as opposed to wilful negligence has redress in law, and, despite the number of allegations made, is seldom proved.
Medicine is not an exact science. Things are seldom black and white, rather a spectrum of various different shades of grey. There is no such thing as a seamless service, delivering an endless stream of good outcomes. Disappointed people who have not attained the desired result and whose hopes and expectations may have been too high may sometimes seek to lay blame on others by alleging lack of due care. Sadly, occasionally this may happen for more venial reasons.
We are all repeatedly told such misunderstandings may never have arisen if communications had been better, and the risks or benefits of a procedure had not been properly explained. It is often unfortunately said that doctors, nurses, paramedics, etc were uncivil and uncaring.
Undoubtedly, from time to time such complaints are justified but in my humble experience very rarely. Little attention or understanding is given to the hours worked by the staff, the physical conditions under which they work, and the constant stresses of dealing with the seriously ill, not to mention their relatives. An impression can be easily given of surly uncaring medical staff looking after scared and vulnerable patients. How about the other side of the coin? Tired, overworked doctors and nurses taking dogs' abuse from aggressive patients and relatives, occasionally intoxicated, who are venting their spleen at the inadequacies of the service on the luckless individuals who are trying to keep the leaking boat afloat? First of all, doctors are like any other group. There are fat ones and thin ones, tall and small, men and women. There are talkative ones and quiet ones, good communicators and indifferent ones. There are doctors who deal face to face with patients day in day out and there are doctors who seldom, if ever, even see a patient but whose contribution to patient care is crucial.
There are those doctors who are amazingly skilled and perceptive and those who are less gifted. It is not a profession of uniform talent, nor could it be so. The profession, and the various specialist bodies that comprise it, tries always to provide the optimum levels of skill and knowledge among the practitioners. To maintain very high standards over such wide horizons is extraordinarily difficult and occasionally, very occasionally, things slip. No matter what checks and safeguards are put in place, this will always happen. Doctors are fallible, and error and weakness are inherent in the human state.
What are often very hard to take from the doctors' viewpoint are the almost hysterical and often ludicrous allegations about professional competence and self-regulation that are bandied about freely, sadly with little understanding of the issues. Medical audit, peer review, continuing medical education are nothing new to the profession and pose no real challenge to a committed and caring body.
Ireland has a huge and deserved medical reputation and many of the founders of modern medicine, surgery and obstetrics were Irish. Irish doctors have taken their skills all over the world and most Irish consultants working today have spent time working in centres of excellence overseas. Continuing medical education is an integral part of every doctor's life. I can attest to many educational meetings on Saturdays, Sundays and late evenings in order not to disrupt patient schedules. There were no marks or bonus points for giving such lectures or attending such meetings but it was unquestionably felt to be part of our professional life.
Audit is a more recent concept and is clearly more easily applied to some disciplines than to others. It is possible to crudely audit a surgeon and surgical procedures, much more difficult to do the same in psychiatry. I say crudely audit in surgery deliberately. Some patients are high risk, some are low risk and comparing like with like becomes very difficult. The overall results for a given surgeon will depend upon the relative complexity of the cases undertaken. There is a very real risk that in the advent of league tables of surgical performance, many high-risk patients might go untreated as happens elsewhere.
By and large, the profession does its best in often very difficult conditions. Very few of our major hospitals now do not have almost overwhelming problems of beds, finances and staffing, and those struggling to provide a service in such conditions can well do without the added burden of ill-advised comment and criticism.
Now we stand accused of killing half the country, 2,000; 6,000; 14,000 deaths by extrapolation from somebody else's study. Considering that about 30,000 people die every year in the Republic, we are obviously a dangerous lot. Not alone that, but 25,000 adverse events! Can I ask the Minister for Health, what is an adverse event? Is it something the doctor, the nurse or the paramedic did or did not do? Who reports them and what are the criteria? Throwing out figures like 25,000 is meaningless unless we know what we are talking about.
Is spending three days on a trolley in the accident and emergency ward an adverse event? Is having your treatment delayed because no hospital bed is available an adverse event? Is waiting two years to see a neurologist or dermatologist an adverse event? Is suffering pain, anxiety and even death on a waiting list an adverse event?
As I write this, patients are lying on trolleys in Dublin, Naas, Cork, Limerick and Cavan, according to this evening's news. Let us deal urgently with this real problem now and everything else later. In the meantime, the doctors and guards have the worthy investigations of Prime Time keeping an eye on them. To borrow a phrase from my children. I would merely say to them "get a life".
• Maurice Neligan recently retired as a leading cardiac surgeon.