Rural doctors case studies: Vital to their communities

Thurles GP tried to retire but could not while Dr Marguerite Madigan provides support a girl in need

Niamh Costello, who suffers from chronic juvenile arthritis, with her mother, Wendy. Dr Marguerite Madigan has been a central figure in her life.

Niamh Costello, who suffers from chronic juvenile arthritis, with her mother, Wendy. Dr Marguerite Madigan has been a central figure in her life.

 

The doctor who tried to retire but could not

Dr Edmond Fitzpatrick has served the communities of Ballysloe and Gortnahoe, near Thurles, Co Tipperary, for more than 40 years. It is time for the 71-year-old to hand on the baton to a younger generation but so far he has been unable to.

“I’m very close with my patients, I know them all very well. They’re concerned obviously about me retiring but I can’t stay until I’m 80. I don’t think I’ll be able to carry on much after next October,” he says.

He tried to step down last year. However, after several failed attempts to find a new GP to continue the practice in north Tipperary, Dr Fitzpatrick put his retirement plans on hold, continuing to serve up to 1,000 patients at his one-man practice in Gortnahoe.

“The HSE advertised several times but there were no applications. I agreed to stay on two years but I don’t think it’ll be any different when they advertise again.

“There’s no interest at present. It’s expensive to set up. I’ve two sons that are doctors and neither is interested. Rural practice is on the way out. I enjoyed it here but I don’t think it’s everybody’s cup of tea.”

The mandatory General Medical Services retirement age was recently extended from 70 to 72.

‘She’s built up a great relationship with Niamh. Our GP had become part of the community’

Dr Marguerite Madigan has been a central figure in the life of 16-year-old Niamh Costello throughout her teenage years as she struggles to live a life as normal as possible despite dealing with chronic juvenile arthritis.

“She’s built up a great relationship with Niamh. Our GP had become part of the community,” says Niamh’s mother, Wendy, particularly “when we need to change Niamh’s meds or if she’s having a very bad day and can’t get out of bed in the morning.”

Having Dr Madigan nearby has been essential to cope with flare-ups of the disease and minimise interruptions to school for Niamh, who showed symptoms soon after she was born, says her mother.

“Niamh didn’t have a normal childhood unfortunately. She can’t play sports, she can’t run, even simple things like skipping she can’t do that because she has it in her knees and her ankles, and her toes,” says Ms Costello.

Fortnightly blood tests are done early in the morning by a nurse at Dr Madigan’s practice “so Niamh doesn’t end up missing any school”, she says.

“I used to get them done in the hospital and that took up a whole morning, and she misses enough school as it is.”

Ms Costello says her daughter’s autoimmune disease has been difficult to manage: “Even now it’s not fully under control, she has very bad flares when she ends up in her wheelchair. It’s been tough on us. Having a local GP gives us some peace of mind.

“I don’t know what’s going to happen in the middle of the night. Her immune system attacks her joints and it causes inflammation and swelling. It can come on really rapidly and Niamh will be in an awful lot of pain.”

Having a local GP means her daughter can avoid the emergency department in hospitals: “Niamh is on a lot of drugs so her immune system is suppressed. She can’t go sit in an A&E [because of the danger of picking up infections].”