MEDICAL MATTERS Dr Mick MolloyMany cars get a routine service, probably even more so nowadays as the NCT looms for cars of certain ages. Oil gets changed, water levels checked, tyre tread and pressures tested etc.
We generally pay for this service and in some quarters we will pay well for the reassurance that our vehicles are as safe as they can possibly be. We know getting into the vehicle leaving the garage that it is in shape.
But what about the person behind the steering wheel? What of their fitness to drive or to live? Their fitness to drive may never have been assessed, they may have had a competency exam and an eye test or they may be one of a large group of drivers who were awarded licences when there was a backlog in testing much like that which exists today.
Do people get serviced or schedule themselves for a regular overhaul? Few enough I'll wager and many who do so are at an age where it may be more difficult to modify the lifestyle choices which can make a difference as to how healthy we are.
The younger a person is when they find out they have marginally elevated cholesterol or blood pressure, the better the long-term outcome for the individual - if they make adjustments to their life which will lower both cholesterol and blood pressure.
There is no outward sign of having either level raised, nor is it painful, thus making it difficult for the average person to know when to present to their general practitioner.
Significant numbers of Irish people in their 30s have not seen a general practitioner/family doctor since they were in secondary school and probably still use that GP's contact details despite the fact that they are living away from home.
When these levels (blood pressure and cholesterol) have been elevated for 10 or 15 years, changes will begin to occur in the arteries putting the individual at a much higher risk of having a heart attack or stroke.
In our society we do not go to doctors, in particular our GPs, unless we are very ill. Ultimately this means we are in the worst shape we can be when we are trying to fight an infection or recover from an illness. In other societies, the culture is very different and patients attend while in good health to prevent themselves from becoming ill.
There are more than 2,500 GPs in the health service who have about 15 million domiciliary and practice attendances. With a population of around 4 million, this means some people attend a lot but there is a large cohort who, for various reasons, cost included, rarely see their family practitioner. To reduce costs many use A&E or emergency departments as their first point of medical contact which can lead to the long delays we often read about. Most patients do not know that there is no charge for a patient who has already seen their GP so they will not get double billed for the same complaint if they are referred by their GP to hospital.
There are around 40 emergency departments in the State with about 50 A&E consultants, meaning some of the departments have no A&E consultant at all while others have up to three whole time equivalents in the larger departments.
Around 400 non-consultant hospital doctors or junior doctors work in these departments treating patients also. Together they see up to 1.5 million patients a year throughout the State. This is not a large number of doctors for dealing with the numbers of patients who attend each department. The number of consultants is also very small by international standards.
Recent statements regarding waiting times and attendance patterns at A&E by politicians, and even by the Taoiseach, are put into perspective when one considers that to have a round-the-clock presence in our emergency departments by emergency consultants is not feasible with the numbers currently employed. It would take an unprecedented increase in manpower levels for this even to be considered - just to provide a single consultant throughout the 24-hour period, 365 days a year.
Even then that would only be one consultant present when attendance patterns dictate that there are periods where multiple consultant presence is required, in particular in paediatric facilities.
Health reforms have gotten a bad name but if we are to progress to 21st century healthcare this is required. None of the facilities in any hospital is of 21st century standard yet and it will require new ways of working on behalf of staff and new ways of thinking about services on behalf of patients if they are to develop.
It will not be possible to have every service in every hospital running 24 hours a day, we simply do not have the health budget to do so nor is it required. There are, however, areas which do run on a 24-hour basis and these need to be enhanced to provide the best possible care.
Whether we will see these changes during this current Government I cannot say for certain. What I can say is that a new approach is required which stretches beyond a government's term of office and which is consistent in its long-term outlook if we are to develop the health service that we all want, to hopefully deliver quality and fairness for all.
Dr Mick Molloy is a specialist registrar in accident and emergency medicine at Cork University Hospital.