"The Bitter Pill" by "Dr. X" - any opinions

ergo

as the title goes

have just been reading the above titled book, subtitled "An insider's shocking exposé of the Irish health system"



Now I haven't completely finished it yet but was just wondering what people's thoughts were..

My initial reaction is that, although some points are well made, there are some sweeping generalisations which are unfair eg. " out of the hundreds of doctors I have worked with I have yet to see more than one or two performing one or more of these activities (wearing gloves or using an alcohol swab to clean the canula) when administering i.v. antibiotics"

I'm thinking you would have to work for quite a few years (more than Dr. X has worked) to have the chance to witness "hundreds" of doctors giving i.v. antibiotics and the above unhygienic practices (which I would personally dispute). Just a small point I know but there you go

It was, in fact, on the first page of the prologue I felt Dr X missed a point. A taxi driver asked Dr X "What is the problem with the Irish health system, us being one of the richest countries in Europe etc etc?" and this is in part what led him/her to write the book

one answer to this I didn't see mentioned is years and years and years of underfunding (compared with other EU countries) throughout the 1970's and 1980's when we were the poorest country in the EU and unemployment rates were through the roof. This has been well documented and I feel is a large part of the reason our medical infrastructure and consultant levels etc are still struggling to catch up with our fellow EU countries despite money being thrown at it left right and centre (well, up until a few months ago)

any thoughts?

any completely non-medical people out there completely "shocked" by this book?

N8

By far a much better read and one offering solutions. It would certainly shock any non medical people and should be required reading for all politicians. The book is a serious indictment of the Canadian health system and demonstrates how poor management wastes fortunes and mistreats millions of patients (sound familiar?). It is sharply critical of health politics but not “anti-doctor.” The best of medical science is applauded in the context of multidisciplinary respect, proposing renewed efforts to place all patients into the most effective hands as quickly as possible.

tallaght01

"The bitter pill" writes a blog that I've been reading for a while.

It's not bad. Having said that though, being a doctor or a nurse or a physio of whatever doesn't make you an expert in health systems.

We all recognise things that are substandard that affect our own practise. So, this book is bound to be very one-sided.

Healthcare isn't just about hospitals (or "disease palaces" as the public health fraternity call them).

It's also about how wealthy a country is over a long period of time, economic and social policy. It's about how well the population takes care of themselves. It's about alcohol, drugs, healthy eating.
It's about equality of access to primary and secondary healthcare. It's about finncial equality. It's even about access to education. It's about listening to healthcare professionals.

It's the ultimate example of a multifactorial problem.

Doctors or nurses administering IV antibiotics is not a big issue. I don't know how wearing a pair of gloves that have been hanging up in a box above a filthy sink for days is going to prevent infection when giving IV antibiotics. As far as I'm concerned, those gloves are there to protect the person giving the drug, not the patient.

Do docs in Ireland really still have to give all the IV antibiotics? When I tell people about this abroad they laugh their asses off. I assumed that it had been sorted by now. Total waste of time for a busy intern who's covering several wards. Maybe the efficient use of doctors time would be something we could look at, with a view to giving optimal care.

Chunky Monkey

tallaght01 wrote: »

Do docs in Ireland really still have to give all the IV antibiotics? When I tell people about this abroad they laugh their asses off. I assumed that it had been sorted by now. Total waste of time for a busy intern who's covering several wards. Maybe the efficient use of doctors time would be something we could look at, with a view to giving optimal care.

It's funny, not saying this is your opinion, but I've heard people voice these same sentiments and then give out about how the boundary between a nurse's and a doctor's role is becoming blurred.

I was reading the HSE's Health Matters newsletter today. Apparently the first nurse prescribing course started in RCSI in spring. Would be interesting to hear your opinions, as a doctor, on this.

DrIndy

I've read the book - its really just a summary of what is happening. His viewpoint is slightly variant from mine, but is much the same.

We're in big trouble and steps need to be taken soon.....

tallaght01

Chunky Monkey wrote: »

It's funny, not saying this is your opinion, but I've heard people voice these same sentiments and then give out about how the boundary between a nurse's and a doctor's role is becoming blurred.

I was reading the HSE's Health Matters newsletter today. Apparently the first nurse prescribing course started in RCSI in spring. Would be interesting to hear your opinions, as a doctor, on this.

I only complain about the boundary between nurses and doctors being blurred when the line between nursing and medicine becomes blurred.

Docs have no more (in fact we have much less) training than nurses in the actual administration and preparation of IV meds.

The issue of nurse prescribing started the mother of all debates on this forum about a year ago i think....

Here's the link http://www.boards.ie/vbulletin/showthread.php?t=2055049187&highlight=nurse+practitioners

Chunky Monkey

Oh dear, I haven't read the whole thing but it seems to be turning into a nurses v doctors debate, which is stupid because in my opinion, each should have their own role in the multi-disciplinary health care team and not be bitter about the other's role. If they really wanted to do medicine instead they should have been determined to jump all the obstacles as I'm doing now. Anyway from what I've seen student nurses are the only ones with this attitude. Experienced nurses seem to have a more mature attitude regarding this. All of the nurses I've talked to about prescribing don't want the extra responsibility. I've never seen a doctor administer an I.V antibiotic. I've only seen them put the cannulas in. Then again, for most of my short (four years) time as a HCA, I've worked in a private hospital. Maybe it's different in the publics where there are interns.

Dr Galen

its generally been first dose antibiotics that the Doc's had to administer, not every dose. As far as I know though, thats very much on the way out. Where I am anyways I haven't seen it in ever in four years.

I don't think this is turning into a Doctor Vs Nurses debare at all, tallaght is more making the point about proper and efficient use of the right people for the right job. For example, I have an interest in wound care and medicated dressings etc, I'd probably have quite a bit more knowledge on the topic than a lot of my doc friends, so then it makes sense that it'd be me making choices about the best dressing to heal such and such a wound. On the flip side, when it comes to reading an ECG say, I'd have only a rudimentary knowledge, whereas the same Doc mates would know what the patient had for breakfast from the same ECG. Thats what their trained in, so lets use them properly.

The OP though wanted opinons on the book, which I haven't read yet. I do keep meaning to pick it up just to see, but haven't yet. I do read the blog tho, which I think is the same person, and although I don't agree with every view, I think its fairly good.

tallaght01

Spot on Baz.

I worked in a hospital as an SHO where I had to give the 1st and 2nd dose of all IV meds. I had to make them up as well. In paeds, you mostly only get one or 2 doses of IVs (our antibiotics are often just given once daily for 2 days until the blood culture hopefully comes back negative). I had no idea what I was doing to be honest, whereas the nurses were so much better at it, but weren't allowed do it. They basically had to hold my hand through it all, and it took much more time than if they'd been alowed do it themselves.

I had surgery a few months back. A legendary district nurse dealt with the wound. Her knowledge of which dressing was best suited at different stages of healing was far better than mine. She was amazing, and I healed up in no time. I wouldn't have been able to sort a wound like she did.

So, yea, exactly what I'm saying is let's use people for their skills. It isn't docs Vs nurses, chunkymonkey. It's all about using everyone's different skills to achive the common end goal.

Also, paediatric/neonatal ECG reading = my least favourite job on earth

Dr Galen

just on a side note.........please lets not open up the nurse prescribing debate again.....it hurted my brain

Chunky Monkey

Sorry guys I was referring to the prescribing thread. Don't worry I won't open it up again. I can't offer an informed opinion on it anyway (ie I don't have a feckin' clue)

Splicer

Heya, I just read this book as well. I am not quite the wide-eyed idealistic medical student Dr X describes, but I am kind of scared to realise what I'm actually diving into! Is it actually as bad as he describes? Although, of course, the whole Michael Neary case on its own is a horror story...

Chunky Monkey

I'm scared to read the book now. Bedside Stories has already scared me away from my UK application somewhat.

nesf

tallaght01 wrote: »

Having said that though, being a doctor or a nurse or a physio of whatever doesn't make you an expert in health systems.

Similar to how being a council worker filling potholes for a living doesn't make you an expert in transportation systems.

wheresthebeef

i know in tallaght doctors give first dose of IV antibiotics only. nurses give all other fluids and further doses of IV antibiotics. which is a bit silly. the supposed rationale is in case of an anaphylactic response. for anaphylaxis to occur, the patient has to be sensitised to the antibiotic first so the first dose won't trigger a response. the doctor literally starts the IV, and then leaves, so chances are he'd miss the response anyway cos he or she doesnt have the time to wait around for 10 minutes. the second dose is where problems could occur most.

also the issue of gloves with IV Cannula insertion is because IV's are an aseptic procedure where the area must be kept as sterile as possible to prevent infection of the veins or surrounding tissue. gloves should always be worn when dealing with IV's. Furthermore it is irresponsible for these doctors to be not wearing gloves due to risks of Hepatitis, HIV etc... as the public exchequer will have to foot the bill if they contract something infectious.

Anywho, havent heard of that book until now. But will definitely go out and buy it over the Xmas period.

tallaght01

wheresthebeef wrote: »

also the issue of gloves with IV Cannula insertion is because IV's are an aseptic procedure where the area must be kept as sterile as possible to prevent infection of the veins or surrounding tissue. gloves should always be worn when dealing with IV's.

But where I used to work we just used gloves from a manky box over the sink when we were giving IVs. They weren't sterile gloves. Are they sterile gloves in tallaght?

The fact that I'm asking this question shows how eminently unqualified I was to be giving those Ivs when I was an SHO

Agree about the whole anaphylaxis thing. I was always gone to another ward by the time an anaphylactic reaction would have kicked off!

metrovelvet

tallaght01 wrote:

Do docs in Ireland really still have to give all the IV antibiotics? When I tell people about this abroad they laugh their asses off. I assumed that it had been sorted by now. Total waste of time for a busy intern who's covering several wards. Maybe the efficient use of doctors time would be something we could look at, with a view to giving optimal care.

There seems to be a gross ineficcient use of time all around, and time is crucial in illness.

Why for example, in Ireland, cant a GP refer someone straight to a scan? Why do they have to refer the patient to a specialist who then refers patient to specified radiologist?

Why for example, cant you just see a cardiologist on your own bat? Why do you need to go to a GP to then refer you to a cardiologist?

Its like theres this bizarre caste system at work.

PS. Gloves are great as long as you dont touch something inbetween putting them on and touching the patient. I had a dentist [Ireland] once who I saw put on gloves and then rubbed his nose. I quickly excused myself with a lie about not feeling well. Ugh. Paranoid ever since that.

Chunky Monkey

I can't stand it when at a deli people make a sandwich and then touch money with the same gloves, I never buy deli food now. With regards the GP referring to a cardiologists, cardiologists are crazy busy. They don't sit around in clinics all day, they have cath lab work too. If the world and his dog went to the cardiologist, the people who really need to be seen might not be. It isn't a 'caste system' as you put it. It's necessary filtering. Someone correct me if I'm wrong. That's my understanding of it.

Dr Galen

at the risk of this going off topic......

where i work we do give first dose antibx, realistically having the doctor giving first dose was a stupid rule, as others have pointed out docs rarely had the time to hang around waiting for a reaction. Considering that nurses administer blood products without a doc present, which are in my mind a lot scarier, there seems no point.

as for the gloves debate, i'd agree with both sides here, though recently i saw a patient in a 6 bed pick up a handful of gloves that had fallen on the floor and stuff em back in the box......obviously i came along and pulled them back out but thats hardly hygienic. in my opinon the gloves on the walls and over sinks are more for the medical peoples protection, i.e prevent spills and suc onto us. If your looking to carry out a task in a sterile or at least "clean" way, then really its the sterile clothes you'd need. unfortunately, many people see gloves as a substitute for proper hand hygiene and given the choice i'd rather have someone with properly cleansed hands at my cannula than those manky gloves that had been on the floor and stuffed back in the box