Brain drain, Lack of junior doctors (NCHD), Role of Irish immigration

drkpower

docbroc wrote: »

Which would be totally offset by not having to pay a fortune in locum fees as there would actually be enough staff to cover.

Are they actually employing locums for NCHDs now?:eek: Things have changed since my day - getting a NCHD locum to cover a sick/dead NCHD was a rare event.

docbroc wrote: »

It would also be offset in massive reducion in clinical indemnity payouts as half dead doctors arn't sticking canulas through radial nerves and giving gentamycin stat.

You would be surprised how rare claims of that nature are. While I have no doubt whatsoever that tiredness etc is linked to many adverse clinical incidents, I have never experienced a (legal) case where tiredness was cited as a primary factor by an NCHD. Of course, admitting such is still (sadly) seen as a 'weakness' so that might explain why tiredness is so rarely cited.

docbroc

They dont get locums for sick / dead shos. They get them to cover posts
where no sho will tread. Subscribe to a locum alert service. Your phone will be overloaded with texts. One way or another mistakes happen. They will happen less if the doctor has 1: Been Trained 2:Slept 3: Paid 4:Gives a $hit about their job. This is the anthesis of current policy

drkpower

My medical days are over, thankfully!

Jane5

drkpower,

The cost isn't just the few patients who do make a claim against the hospital, although these frequently result in massive payouts, and happen more commonly than you think:

If the exhausted NCHD gives the wrong medicine, or gives the medicine incorrectly, misdiagnoses, or damages a patient, the taxpayer bears the cost, as all our hospitals are publicly funded.

The patient who gets the gentamicin as a stat dose develops renal failure, and possibly goes deaf. This is incredibly expensive to treat. More bed days, blood tests, audiology, possible dialysis, medications, etc etc. runs the cost of this one little error well into the thousands.

And that's one of the simpler things that can happen if exhausted or understaffed. Quite often it's things like missing a subtle myocardial infarction. The expense associated with something like that is massive.

Put simply, if there were more docs around, working less hours, they would be paid less, they would be healthier and more productive and hence more efficient, and less costly mistakes would occur in hospitals. All of these measures save money.

drkpower

Jane, I appreciate all of that. I was simply making the point that the tiredness of a NCHD is very very rarely the central factor in a medical negligence legal case (or if it is, it is not admitted).

I have never defended the hours worked by NCHDs and spent my relatively short-lived medical career fighting them (with a certain degree of success).

SomeDose

Jane5 wrote: »

The patient who gets the gentamicin as a stat dose develops renal failure, and possibly goes deaf. This is incredibly expensive to treat. More bed days, blood tests, audiology, possible dialysis, medications, etc etc. runs the cost of this one little error well into the thousands.

What's the problem with giving a stat dose of gent, assuming their kidneys are in reasonable shape beforehand? Do you mean giving a large dose by fast bolus rather than the recommended 30min infusion?

In my experience, gent toxicity due to prescribing large doses 3 times daily instead of once-daily is a common overworked junior doc pitfall.

Jane5

Yes, that is what I meant, SD. Not in medicine anymore so starting to forget how to phrase things.
Really just using that as an analogy to illustrate how medical mistakes due to fatigue can be costly, wasn't really trying to give 100% medically accurate details.

resus

GOD I'm tired, but can't sleep. Just worked out I've done 84 hours this week and although it's 01h00, I must still be back in the hospital at 08h00 and could still be called in overnight. High Court ruling my @rse.

Things are really starting to get challenging here now that all and sundry have or are flying South West, if you think things WERE bad, just wait until the paediatric bombshell hits the Cork newspapers.

We're apparently 8 (or is it 9?) Registrars down accross the City. I trust in God my children don't get sick this year, because the good guys (and I really and truely mean the latter, no sarcasim here) have all bloody left to go home to a better life in Pakistan and India.

Jane5

Just read this article in the Examiner:

http://www.examiner.ie/home/junior-doctor-shortage-puts-lives-at-risk-124301.html

I like what Chris Luke has to say in this much better. Perhaps he was misquoted in the article we were discussing previously. Hopefully! A quote from the article below:

"He described the root causes for the decline as "indifference, incompetence and ideology" and suggested an urgent "triple therapy" to cure the health service’s ills. This would include employing more medical graduates in emergency departments, the use of highly trained and experienced super-nurses and a system of indenture to encourage young doctors to work in unpopular locations for a fixed term."

1) Employing more medical graduates. Good idea. Note this does not mean "more medical students graduating", which is different, and utterly useless. It means employing more qualified non-consultant hospital doctors, of which there would be more around if the working conditions improved, as they would not all abscond.

2) Advanced nurse practitioners. Absolutely. In Australia, and New Zealand, the doctor diagnoses the fracture, and prescribes some painkillers. End of. The advanced nurse practitioners do all the casts and immobilisation of fractures etc. The doctor only intervenes in cases where a manual fracture reduction under anaesthesia is needed, or similar complicated cases.
I'd say we'll be waiting though, as we live in a country where nurses won't give first dose IV medications!

3) Indenture. Ok. It may work in Australia, like he says. I have no experience of it so can't comment on whether or not it works. However, even if it does work, it absolutely should be illegal for the next 400 years in Ireland. The Irish system has abused trainee doctors in many callous ways, too much, for too long. It should absolutely not be trusted with a system such as indenture that is particularly prone to abuse. It has not shown itself to be of sufficient moral integrity to be allowed to have the serious responsibility that would come with implementing a system of indenture. I have to fundamentally disagree with anything like this.

One alternative idea would be, not to force people to do something horrible against their will, which always appears to be the only thing anyone can come up with in Irish healthcare. Why not offer rewards and incentives to doctors who will go to these places where no-one currently wants to work? This system is in fact employed in Australia, and does work.

Also an extremely sensible enlightening comment by Dr. Sadlier here:

"Dr Matthew Sadlier, chairman of the non-consultant hospital doctor committee of the Irish Medical Organisation (IMO), echoed Dr Luke’s concerns and said the reason some medics are being paid "ridiculous amounts of overtime" was because they "are being asked to work ridiculous amounts of overtime".

Bang on the money, and about time people realised this simple fact.

resus

Not bad coverage in the papers today, especially explaining that to earn €€€ you have to work dangerously long hours.

But I suspect nothing will happen, and in January, their will be an even bigger exodus of "junior doctors."

And Whilst I'm on the latter. I really dislike coverage that describes us as "young" doctors... ffs most of us are in our late 30s and have been qualified >10years

It is great to go to conference and compare yourself, the years you've "trained" the numbers of patients you see per annum, the skills you have etc. with American "Attendings" who are in effect "consultants!!"

lonestargirl

resus wrote: »

Things are really starting to get challenging here now that all and sundry have or are flying South West, if you think things WERE bad, just wait until the paediatric bombshell hits the Cork newspapers.

We're apparently 8 (or is it 9?) Registrars down accross the City. I trust in God my children don't get sick this year, because the good guys (and I really and truely mean the latter, no sarcasim here) have all bloody left to go home to a better life in Pakistan and India.

As you predicted, from today's Irish Times.

Cork hospital's A&E 'struggling to stay open' due to shortage of doctors

ORLY?

Honestly, I felt I could pay no heed to that article since Dr. Chirs Luke's name was attached to it even though I don't doubt there is a great element of truth in it. Going from what he wrote several days ago I would find it unwise to take anything the man says too seriously.