Heart Beat:Come here to me now. Do you think I should ask The Irish Timesfor a bonus? They'd probably spin me some nonsense about how the paper is nearly broke and I'd wind up giving them money. However, this time I have the answer for them. I'd ask them had they ever heard of the HSE.
The same HSE that wasted all that money on PPARS and God knows what else, and apparently are now so broke that they can't employ any new staff until the millennium dawns - no locum staff, no agency nurses, nobody at all. The poor folk have even to forgo foreign travel and gatherings in hotels. How do they stand it?
Well, they'll just have to grit their teeth and get on with it. Maybe they can sweeten the bitter pill a little by giving bonuses to 100 or so top-line management, say about €20,000 each to augment their pitiable salaries of €180,000-200,000 each. Surely that's the least they deserve? Never mind the doctors and nurses, let alone the patients, they don't count.
I don't want to believe this, as I think such arrogance and stupidity would be beyond any sentient being. I think it would be crass in every sense of the word and should give pause to the nurses and consultant doctors both involved in negotiations involving a pay element as I write.
They might be bright enough to say "Hold on a minute folks, this crowd haven't got any money, so what are we all talking about?" They are going to employ 1,600 new consultants when they can't even employ an agency nurse or a locum for a sick doctor?
Welcome to the fantasy world of Prof Drumm and the Minister for Trolleys, the Harry Potter world of medicine, painfully short of wizards.
The feel-good factor of even a quasi summer thus quickly dispersed, I find that nothing has improved over the period and indeed much is getting worse. The above and the implications for service delivery is truly shocking even for us hardened folk and I will return to this and its implications for patient care over the coming weeks. Meanwhile, other things require notice, just to prove that we're not all asleep.
Brian Cowen (Chief Elf presumptive) had some hard things to say about the media in a recent summer school address. Paranoia allied to selective vision came to mind as I read his contribution, I also wondered if an educational summer school was the proper forum for such a diatribe. However, Mr Cowen would not stand alone in blaming the press for highlighting Government affairs. Sir Robert Walpole, the first Englishman to bear the title of prime minister, wrote in 1711 "the great licentiousness of the press in censuring and reflecting upon all parts of the government, has of late given too just cause of offence".
Incidentally, when the Earl of Oxford was replaced as Lord Treasurer by the aforesaid Walpole, stocks rose immediately. South Sea Company stock rose 12 per cent in one week! It only goes to show that prosperity can be founded on different bubbles. The trouble seems to be that there is no such thing as an everlasting bubble.
I read with interest Minister Hanafin's proposals for changing entry to medical school. I say at the outset that there is no universal system for such entry and ours seems to work as well as most. The basic thrust of the new proposals seems to be lowering the points requirement and including an aptitude test at an early pre-entry phase. Such aptitude tests are used in various parts of the world, Australia, parts of the UK and in the US. In the latter country, the MCAT (Medical College Admission Test) is widely employed. It is essentially a five-hour MCQ involving subjects such as physics, chemistry and biology and a section on deductive reasoning. Predictably enough, grind schools have sprung up, tutoring pupils in the intricacies of the exam and thus rather defeating the purpose of allowing the candidate to display both knowledge and spontaneous reasoning.
Neither does such a test measure qualities of empathy and social concern - desirable qualities in any future doctor. Does such a test tell us anything that the qualifying end-of-cycle examination results does not?
Very little would appear to be the answer. The best predicator of safe passage through medical school and in post-graduate exams seems to be the grades achieved before medical school entry. There is a psychological principle that "the best predictor of future behaviour is past behaviour".
Clearly, it is not a satisfactory situation that some should choose what to most is a vocation, merely because they obtained the points necessary. Aptitude testing and exam results attest intellectual skills but tell us nothing of the human attributes necessary. Is there any way such can be measured?
Two things come to mind; firstly that before entry to medical school, all aspiring doctors should spend some time in a realistic medical environment, eg working as a nurse's aid or similar position. For some it may show that their conceptions and the reality of medical life are not the same; others may be further enthused.
Secondly, some form of interview is desirable. No employers hire for any critical position without the benefit of interview. Interview allows you, superficially it is true, to glimpse the person and perhaps the motivation behind the career choice. I do not accept that such interviews cannot be as fairly done in medicine as elsewhere.
I shall return to this subject.
Maurice Neligan is a cardiac surgeon.