Sir, - Dr Muiris Houston's accurate and graphic description (May 5th) of the hazards and intense difficulties experienced by "junior" hospital doctors (many of whom are married, and in their late thirties) is a disturbing and timely account of a dangerous situation. While agreeing wholeheartedly with his account in general, I would take issue with two aspects of it.
Dr Houston maintains that junior hospital doctors have the full support of their consultants in taking industrial action. If so, this is a new development in their otherwise systematic exploitation by their managers. During the past 15 years, consultants may well have paid lip-service to the difficulties encountered by their juniors, but they have also, week in and week out, signed off duty rotas which would make a Victorian factory-owner blush. Serious criticism from the consultant ranks has been exceptional, muted and ineffective during the disgrace of the last two decades.
Secondly, Dr Houston notes that, "due to a complex system", hours worked in excess of the basic week are paid at an overtime hourly rate which is actually less than the basic hourly rate. There is nothing complex about this at all. It is a simple, crude and bloody-minded system. It places a huge economic imperative on cash-strapped management systems, at hospital and health board level, to ruthlessly and incessantly exploit a vulnerable group of young men and women to the greatest extent possible. This is precisely how and why you will be treated by a semi-comatose senior house officer at 6.45 on a Monday morning, who will have been on duty for Accident and Emergency and covering the intensive care unit for the previous 36 hours, living on take-away food and snatches of sleep in between emergencies and routine care.
This ruthless exploitation has been signed off (with whatever degree of reluctance) by consultants.
The costs of this odious system of exploitation include an enormous and selective drain of highly trained Irish medical graduates - about 200 a year or more during the past two decades - including young men and women who simply will not accept the gombeen approach to manpower management taken by successive administrations. Without exception, all of these graduates scored highest points in their Leaving Cert years and they are now lost to us. By far the most important cost, however, is that incurred by public patients, who are exposed, in their most acute medical crises, to care delivered by the most inexperienced doctors in the medical hierarchy, who are also exhausted well beyond a level that is safe.
I sincerely wish the Minister well in addressing the accumulated injustice and grievance among hospital doctors, and among members of the public who have been subjected to a disgraceful system of manpower management.
The HSEA and the consultant body have, I believe, forfeited any significant consideration in this matter. The former should bear responsibility for their action, and the latter for their inaction in tacitly propagating such a highly dangerous system of employment and healthcare. The number of junior positions should be halved, and the number of consultant positions doubled. The clear-cut, rule-based approach to doctors' working time described by Dr Houston in his excellent article should be implemented. The wrong should be acknowledged - to the doctors concerned, and to their patients. We are, after all, saving lives, as opposed to saving faces. It is as simple at that. - Yours, etc.,
Dr Brendan O'Shea, MICGP, MRCGP, Public Relations Officer, Kildare Faculty of ICGP, Newbridge, Co Kildare.