READER RESPONSE:People with severe ME would benefit from a return to doctors' house calls
Re: House calls stage a comeback, Healthplus, March 31st
Dear Sir,
Following the success in incentivising US doctors to make house calls under the Medicare system, it would be good if similar incentives were introduced in Ireland.
Only a small fraction of those affected by ME need house calls, but many of those who do have told us they have great difficulty availing of such a facility. This problem is compounded by the fact that community health nurses won’t take blood samples.
Patients with severe ME, such as those who are bedbound, can easily relapse from “exertion”, such as trying to attend a GP’s surgery.
The mechanism for this is still not clear but a research study by White (2005) found, in ambulant ME patients, that there was an increase in some immune compounds not just in the period following an exercise test but also following the journey to the test centre itself.
Orthostatic intolerance may be one of the factors at play.
We realise that people with severe ME would make up only a very small percentage of those who might benefit from a return to this practice, so are unsure what the overall cost incurred would be.
But as your article pointed out, a home-visit scheme, for some elderly and chronically-ill patients, could make financial sense in the long run.
Yours, etc
Tom Kindlon
Information Officer
Irish ME/CFS Association
PO Box 3075, Dublin 2
Re: No-shows draining resources, Healthplus, March 31st
Dear Sir,
I read with interest and surprise the article yesterday, No-shows draining resources.
I am amazed that not one of the no-shows surveyed by Dr Murphy gave as a reason the length of waiting time after the time given on their appointment card.
This might suggest that it is not perceived as a reason (and is just accepted as a norm) or that patients are not giving the real reason (perhaps out of deference to the doctor).
My own personal experience and most recent experience with my elderly father at St James’s Hospital also suggests that the medical profession do not count the cost to the patient and their families.
It seems to be a common practice to give everybody the same appointment time and to attend to them on a first-come basis.
Last Wednesday, with my father I had to wait for two hours after arriving for a 2pm appointment. The lady before us (who was also accompanied) also had a two-hour wait.
The secretary said the clinic was late starting because the room was being used by an earlier clinic that overran. No apology was given by the doctor for the delay.
Perhaps Dr Murphy would like to calculate the cost of the time “resources” lost from work and other pursuits by elderly people who need to be accompanied to attend an appointment.
Might I also suggest that another possible reason for non-attends might be the perception or belief by patients that no real progress is being made in their treatment, for what are often chronic conditions?
Yours, etc
Vincent Bourke
Internal auditor
City of Dublin VEC
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