Heart Beat: It is beautiful here today with, as Matthew Arnold wrote in The Scholar Gypsy, "all the live murmur of a summer's day". It is also Gathering Day, the first day of Puck Fair. I am removed from that environment and am sitting while typing this, overlooking the inlet where the Caragh River flows into Dingle Bay.
Gloomy news from London about some major terrorist threat intrudes on this idyllic scene and propels attention back to the world. Travel will become necessarily more burdensome and more expensive and we in Ireland will suffer from years of under-investment in airport facilities. We will put up with it as we always do, so long as the good times roll, but there is a spreading feeling that change for the worse is on the way.
This is something that will profoundly affect each of us and I wonder if I am alone in my impression that few efforts have been made to shield us from what many think is an inevitable downturn.
Gloomy thoughts on such a glorious day but I definitely feel the cares of the world, banished temporarily, close in on our island community with our heads resolutely buried in the sand.
In matters medical at home we are getting leaks as to the competence assurance proposals of the Medical Council. These proposals, we are told, are to protect you all against us. I prophesy that they will do no such thing and will merely add another layer of bureaucracy and expense to a non-functioning system.
These proposals are supposed to have been put forward after wide consultations within the profession. Neither my colleagues throughout the State nor I are conscious of any such wide-ranging consultations.
In the absence of such, one must question the right of the council to foist such egregious nonsense on the rest of us. We are told they represent best practice. In the past couple of weeks I have discussed them with American, Canadian and Dutch doctors, all of whom queried the establishment of such bureaucratic interference. Of particular concern, they pointed out, would be the anonymous status accorded to complainants.
In general terms everyone has the right to know of what they stand accused and by whom. I appreciate that there are derogations to this principle; for instance, in the fight against terrorism. With respect, however, doctors are not terrorists to be deprived of their livelihoods by anonymous whisperers.
There exists in the profession no significant support for this colander of half-baked proposals. The profession is not averse to change but would like genuine discussion rather than dictation by those elected by us with no such mandate.
Turning to something sensible and timely: I welcome the provision of more places in medical schools as the first step to alleviate our shortage of doctors. Seventy places is not a great amount, but Minister for Education Mary Hanafin assures us that this is only the first step in doubling the current numbers. Hopefully this will lessen the points needed to enter our medical schools, but this is far from certain as, for some crazy reason, people still want to be doctors.
This brings us to consideration of the problem of graduate entry to medical school. I have been told, I hope wrongly, that any primary degree would be eligible. This is not a good idea.
Medicine is becoming a very scientific subject. It is hard to see how lessening the importance of chemistry, biochemistry, physics, nuclear physics and chemistry can help students in these days of molecular biology and genetic mapping. Let us have more doctors but let us not dumb down our profession by lowering the basic standards of scientific background required. Charles H Mayo of the Mayo Clinic and Foundation wrote: "There are two objects of medical education: 'to heal the sick and to advance the science'."
I do not always agree, the perceptive reader may have noticed, with everything the Minister for Health propounds. Today, however, as features of the Dunne report become public, I must support her stand. In this, as in the contaminated blood products disaster, she has made firm and sensible decisions.
There is, as she points out, no gain in travelling a road that will lead nowhere other than to further colossal expense. In the world of medicine such things happen and always will. We learn from them and move on. It is ironic that amid all the confused talk about competence assurance, one of the foremost guarantors of medical performance should have come under threat. I refer, of course, to the postmortem examination. This examination and the analysis of the results were a major patient guarantor and always recognised as such.
This major pillar of assessing medical competence has been damaged by the organ retention controversy. So also was organ donation. These storms of protest can be conflicting and are seldom of help to the patients they are meant to protect.
In another context altogether and one for us doctors to ponder and absorb: Disraeli wrote - "All power is a trust, from the people and for the people all springs, and all must exist." In medicine we forget that sometimes.
Maurice Neligan is a cardiac surgeon.