Part of where the money goes...

tails_naf

Mods - I don't know if this is the right forum, the main point here is related to the effect on the economy - but please move as you see fit.

I have been lucky enough to have good health (so far!) in my life - so have had little reason to experience first hand and observe our health system. When I did recently I came away with mixed feelings for sure.

Firstly, I went to my local clinic, which is new, for a standard checkup. I was more than impressed here - the doctors I met were really excellent, and seemed on top of things, and had a slick looking computer records system, could IM each other even! The checkup turned up that I should have a kidney scan, just to be sure. So I was issued an appointment for said scan at mallow hospital.

This is where things take a turn for the worst. I turned up for my scan, taking a half-day off work, and a 40 minute drive - and was directed towards the consultant's office. I had to wait a hour and a half - which in itself is not so bad - except when I finally went in I saw an office with floor to ceiling paper folders, with no apparent filing system - and on his desk another mountain of folders. The next few minutes was him asking me the most basic of details (name!, age - why are you here?) - he had NO information on me. He then gave me a 2 minute cough-cough exam, and said yes, we'll have to do a scan - but not here. You'll be issued an appointment, and I'll call you back in January to read the results. Sure, we'll fix up then for it. 5 minutes in total.

So there's the problem - consultant is involved - he had less info about why I was there than I had, no records at all (and if they did exist they would never be found in the mountain of papers) - I didn't get my scan, which was already requested by my doctor, and I have to now take 2 more half days off work - and pay consultant's fees 2x to boot.

So in my opinion, that's where some of the money is going - the middle man here is the consultant - he is more of a hindrance than a help in this case, as without him I would have had just 1 appointment which would be the scan, and the results sent to my doctor. It's loose-loose from what I can see.
I'm not blaming him directly, he seemed like a nice enough man personally, but the system that makes him part of the chain for a routine scan is very wrong.

I'm seriously considering refusing to pay the consultant's bill in protest. I've never not paid for something before, so unsure/nervous about taking such a stand.

In the hour and a half waiting, I saw many more things that showed blatant inefficiency at that hospital. It's not a surprise (but still very sad) that it's likely to be closed. I am surprised that these places and practices cannot be streamlined. I fully believe with a full review of processes that money could be saved AND services improved.

ilovelamp2000

So basically you think the health system would be better if it had less specialist doctors involved ?

Dannyboy83

ilovelamp2000 wrote: »

So basically you think the health system would be better if it had less specialist doctors involved ?

What role is the specialist doctor performing I wonder?
I'm open to correction but I would have assumed the specialist doctor would be the one reviewing the actual test results - not the guy basically doing the same job the GP did.

I can just give you can example from what I know - IT Support.

Level 1 Support collect the info and enter it all into the ticket, if it's not a common problem, they pass it up the chain

Level 2 Support have the ticket passed to them by level 1, all the info is already on the ticket and they can add their own info to the ticket, if it's a particularly nasty problem, they pass it up the chain

Level 3 have all the info on the ticket which was entered by Level 1 and Level 2. They deal with the nasty problems.


If you have Level 3 support - specialists - peforming the role of Level 1 support, you are wasting an awful lot of time and money.

bbam

So here's the thing...
You were brought to see a specialist... A person hugely experienced in the area of you'r particular problem... His job was to decide how immediate your problem was and even if there was one...
If you didn't need a scan why should you take up time on expensive equipment.
IF you have a problem that the GP missed you would need bumping up and maybe a scan there and then to possibly save your life through immediate intervention...

Take another scenario that has happened...

Doctor, a "general health specialist" decides maybe you need a scan, referrs you on for a scan... 1000's of appointments in the queue as all GP's are doing likewise.. You wait 6-9 months and have your scan...
Then it's...

Sorry DannyBoy you only have 3 months at best to live because your scan took so long...

Some wise guy at the top decided that Specialists were taking up too much time and money to be bothered with...

Running a health system is expensive, I don't work in the HSE but I know there are problems with money not being spent where it should.. Your IT example being one.. (I'd still rather be seen by a specialist writing on paper than a general practitioner with a fancy IT system)..

The problem I've experienced is that those who can pay aren't always...
Two examples..
I had an MRI a year ago.. Declared I had VHI when I arrived, no bother I was told... Job was done and no details taken. I said it again and was told don't worry we'll follow up on it... No payment was made from me or VHI..

I know of a couple with VHI who decided to go to a public clinic, the woman is having eye treatment on a public system even though they have a good VHI scheme.. They should be told to go to a private clinic or they should be charged for the treatment..


I'd be reviewing middle management type positions... I know of a hospital where two successive hospital general managers were moved into sideways manufactured positions because they were useless at their job.. On full pay and benifets, and no pressure to retire in the recent round..

tails_naf

ilovelamp2000 wrote: »

So basically you think the health system would be better if it had less specialist doctors involved ?

No, the health system would be better if the specialist was not involved in routine scans that were already decided as warranted.

tails_naf

bbam wrote: »

So here's the thing...
You were brought to see a specialist... A person hugely experienced in the area of you'r particular problem... His job was to decide how immediate your problem was and even if there was one...
If you didn't need a scan why should you take up time on expensive equipment.

This sounds sensible at first glance - except given the examination I had there is NO way the specialist determined anything more than the 'general practitioner' - the reason I can say this? The issue originally came up via a urine chemical reaction test, and not a physical exam. The specialist did a 'cough cough' physical (30 seconds max), but no urine test. So there was no way he had 'more information' that the GP in this case.

By they way, ultrasounds are not that expensive, so the economic argument falls down there. Many doctors (GPs) have ultrasounds these days. I actually expected the specialist to have one and do the scan there and then - but nope.

I have to agree with dannyboy - what he proposes would make efficient use of the specialists. As is it, the bottle neck is the consultants, not necessarily the equipment. So the equipment is under-utilized as it stands.

amen

As is it, the bottle neck is the consultants

I can;t find the study but a similar issue was identified in NHS hospitals in the mid '00s. Solution was to do standard tests before visiting consultant and having all records available at the time of the consultation. They also made consultants take 1 extra consultation a day and nearly all waiting lists down to less than 16 weeks within 18 months.

bbam

By no means am I defending the current system... It has flaws from top to bottom...
However...
I would always insist on seeing a consultant if my GP thinks there might be something wrong... My general opinion of consultants has been good although they do over charge...

But then sometimes the money is secondary to getting a proper specialist on board if things need seeing to...

markpb

bbam wrote: »

I would always insist on seeing a consultant if my GP thinks there might be something wrong... My general opinion of consultants has been good although they do over charge...

The problem is that what you think is best for your health is not necessarily what is actually best. Allaying your fears by wasting a valuable assets time is not a good thing.

bbam

markpb wrote: »

The problem is that what you think is best for your health is not necessarily what is actually best. Allaying your fears by wasting a valuable assets time is not a good thing.

My point is that no matter what if there is a possibility that I my family need medical intervention I want it reviewed by a specialist. I'd consider it making sure rather than allaying my fears.. And I pay for accessing the system.
This thread isn't about me...

The system is there to try and ensure the best outcome for those needing it and my feeling is that good consultants are key to this.. Can the system be improved, yes... But not by dumbing it down through removing specialists.

Godge

amen wrote: »

I can;t find the study but a similar issue was identified in NHS hospitals in the mid '00s. Solution was to do standard tests before visiting consultant and having all records available at the time of the consultation. They also made consultants take 1 extra consultation a day and nearly all waiting lists down to less than 16 weeks within 18 months.

Bingo! And in those cases the machines for the standard tests can be used from 6a.m. until midnight.

Godge

bbam wrote: »

My point is that no matter what if there is a possibility that I my family need medical intervention I want it reviewed by a specialist. I'd consider it making sure rather than allaying my fears.. And I pay for accessing the system.
This thread isn't about me...

The system is there to try and ensure the best outcome for those needing it and my feeling is that good consultants are key to this.. Can the system be improved, yes... But not by dumbing it down through removing specialists.

The point is it will be reviewed by a specialist....after you have had the tests. At the moment, people go along to a specialist. He listens to what you have to say and orders tests. If you had an efficient system where on the day before or the morning of your consultant appointment (depending on how fast the results can be done) you had standard tests, you might be moving to direct intervention by way of treatment after your first visit to the consultant rather than waiting for a second appointment for the tests and then a third appointment to see the consultant about the test results.

dissed doc

tails_naf wrote: »

Mods - I don't know if this is the right forum, the main point here is related to the effect on the economy - but please move as you see fit.

I have been lucky enough to have good health (so far!) in my life - so have had little reason to experience first hand and observe our health system. When I did recently I came away with mixed feelings for sure.

Firstly, I went to my local clinic, which is new, for a standard checkup. I was more than impressed here - the doctors I met were really excellent, and seemed on top of things, and had a slick looking computer records system, could IM each other even! The checkup turned up that I should have a kidney scan, just to be sure. So I was issued an appointment for said scan at mallow hospital.

This is where things take a turn for the worst. I turned up for my scan, taking a half-day off work, and a 40 minute drive - and was directed towards the consultant's office. I had to wait a hour and a half - which in itself is not so bad - except when I finally went in I saw an office with floor to ceiling paper folders, with no apparent filing system - and on his desk another mountain of folders. The next few minutes was him asking me the most basic of details (name!, age - why are you here?) - he had NO information on me. He then gave me a 2 minute cough-cough exam, and said yes, we'll have to do a scan - but not here. You'll be issued an appointment, and I'll call you back in January to read the results. Sure, we'll fix up then for it. 5 minutes in total.

So there's the problem - consultant is involved - he had less info about why I was there than I had, no records at all (and if they did exist they would never be found in the mountain of papers) - I didn't get my scan, which was already requested by my doctor, and I have to now take 2 more half days off work - and pay consultant's fees 2x to boot.

So in my opinion, that's where some of the money is going - the middle man here is the consultant - he is more of a hindrance than a help in this case, as without him I would have had just 1 appointment which would be the scan, and the results sent to my doctor. It's loose-loose from what I can see.
I'm not blaming him directly, he seemed like a nice enough man personally, but the system that makes him part of the chain for a routine scan is very wrong.

I'm seriously considering refusing to pay the consultant's bill in protest. I've never not paid for something before, so unsure/nervous about taking such a stand.

In the hour and a half waiting, I saw many more things that showed blatant inefficiency at that hospital. It's not a surprise (but still very sad) that it's likely to be closed. I am surprised that these places and practices cannot be streamlined. I fully believe with a full review of processes that money could be saved AND services improved.

Without specialists everyone would be sent for a scan, costing a massive amount of money, as non specialists would refer for everything (like non specialists like GPs prescribing so many antidepressant drugs, etc., ). That two minute exam was two minutes because the specialist has 15-20 yrs+ experience and training behind him just for what you see as a simple exercise.

The problem is a huge lack of specialists per population because salaries and working quality of life are simply not attractive.

skafish

dissed doc wrote: »

Without specialists everyone would be sent for a scan, costing a massive amount of money, as non specialists would refer for everything (like non specialists like GPs prescribing so many antidepressant drugs, etc., ). That two minute exam was two minutes because the specialist has 15-20 yrs+ experience and training behind him just for what you see as a simple exercise.

The problem is a huge lack of specialists per population because salaries and working quality of life are simply not attractive.

Sorry doc, how can you say salaries awarded to consultants (€240K +) following Mary harneys three year negotiation is not attractive?
And that dosent include their private practice