Ireland on the brink...how can health professionals help???

maninasia · 11-10-2010 01:02PM

Everybody knows with longer hours means you can't give as much time to each individual case ( I suppose there is preparation involved as for any job) and the last one to be operated on would have a higher risk of mistakes being made (due to lethargy and decreasing concentration span).
It's common sense. You mention cancer and it is well known cancer is a complex disease to treat.
Finally, as the other poster said, why should somebody be so well renumerated in public service if they are not putting all their efforts into that job. To be honest I couldn't hold down two jobs properly in the business I am , things wouldn't go well for my customers, that's a fact (and my job is not so stressful like a surgeon's and not so critical either). I could do it, would contemplate it if it came up, but I am aware of the consequences. I also know my employer would give me the boot quick smart if they found out!

I will explain the conflict of interest, I have heard that some surgeons are seeing the same patients in private practice that they would have seen earlier on in public practice due to waiting times. There is also the issue that a private job could pay more per patient, thus the surgeon may rearrange his schedule/focus onto the more lucrative pay/patient. That is just an example of two possible conflicts of interest. The final conflict of interest is simply overstretching oneself by working two jobs and consequently both jobs performance suffers.

I'm interested to see the surgeons views on this too.

Fado Fado · 11-10-2010 01:58PM

As a surgical trainee, a number of issues spring to mind.

maninasia wrote: »

Everybody knows with longer hours means you can't give as much time to each individual case

Wouldn't the fact that you work more hours in the day mean that you can devote more time to each individual case, rather than less?

maninasia wrote: »

To be honest I couldn't hold down two jobs properly in the business I am , things wouldn't go well for my customers, that's a fact (and my job is not so stressful like a surgeon's and not so critical either).

Just because you can't imagine yourself working extra hours in the job you're doing doesn't mean that nobody would be able to do so. And we're not talking about working a 40 or 50-hour week as well in another hospital - in the majority of cases we're talking about a consultant doing either one day a week in another hospital, or a few hours in the morning or evening.

maninasia wrote: »

I will explain the conflict of interest, I have heard that some surgeons are seeing the same patients in private practice that they would have seen earlier on in public practice due to waiting times. There is also the issue that a private job could pay more per patient, thus the surgeon may rearrange his schedule/focus onto the more lucrative pay/patient. That is just an example of two possible conflicts of interest. The final conflict of interest is simply overstretching oneself by working two jobs and consequently both jobs performance suffers.

In almost all cases patients are seen quicker privately because of the long waiting lists in the public service. This isn't just because there aren't enough consultants, but there aren't enough clinics and logistical facilities available to support their service. A consultant can't simply rock up to a hospital and say "I'm here, let's go.". They need support from admin, secretarial staff, clinical nurse specialists and so on. To think otherwise is to take a simplistic view of the situation. And if a patient wants to get seen tomorrow rather than wait a month, and has private insurance, and the consultant has worked their quota in their public job this week, what's the problem?

And as for job performance, you'll be happy to hear that (especially for surgeons), job performance in public hospitals is rigorously audited and monitered, at the very least via HIQA and the monthly M&M meetings. So the argument that job performance suffers because a consultant is running off to the private rooms is simply not true - if it was to suffer (i.e. via a pattern of bad outcomes) this would be recognised and rectified almost immediately.

tallaght01 · 11-10-2010 02:27PM

I'm always amazed at arguments like this. Outraged that people can't be doing their job properly if they're working lots of hours, but probably has never said a word to a politician about the hours juniors have to work.

theg81der · 11-10-2010 06:54PM

tallaght01 wrote: »

You're aware that there are docs all over the country working 12, 24, 36, 48+ hours routinely? Why should long shifts only occur when they are of no net benefit to the doctor?

Sorry, eh...where exactly in my post did I infer that I had no problem with docs working 12, 24, 36, 48 + hours routinely? And where did I mention public/private renumberation?

I believe there should be enough doctors to go round to give time adeqately to all patients. There should be a cap on hours worked, particularly in surgery, adeqate renumberation - yes, greed - no! Was in A and E while ago for 13 hours - 2 junior docs never saw them eat or sit down, because they didn`t. That is not just ridiculous, it`s dangerous!

ergo · 11-10-2010 10:41PM

for many consultants working in both the public and private sector, well, that is a massive conflict of interest in itself

theer is no incentive for a consultant working in the public sector to make the public system better and to make it as good as (in terms of access etc) the private system...if they did nobody would go private

hence long waiting times and poor access in public system mean people go privately *ching ching*

and the existence and "need" for the NPTF is a disgrace

Traumadoc · 11-10-2010 10:48PM

maninasia wrote: »

I will explain the conflict of interest, I have heard that some surgeons are seeing the same patients in private practice that they would have seen earlier on in public practice due to waiting times. There is also the issue that a private job could pay more per patient, thus the surgeon may rearrange his schedule/focus onto the more lucrative pay/patient. That is just an example of two possible conflicts of interest. The final conflict of interest is simply overstretching oneself by working two jobs and consequently both jobs performance suffers.

I'm interested to see the surgeons views on this too.

Why do you think in a country with supposidly free health care, 50% of the population needs private insurance?

What do you think private insurance is for?

Its so you can jump the queue.

You need to accept this as the basis for the two tier health system we have.

lonestargirl · 12-10-2010 12:49AM

I am friends with a good number of consultants, they are all utterly frustrated at their inability to treat adequate patients within the public system. If you are a surgeon you need theatres, theatre staff, ICU beds etc. Most surgeons I know would operate twice as much if they were let. As such many of them have the attitude that seeing patients privately removes them from the public list and results in quicker treatment time for everyone. I have a good friend who went to a urologist last year with testicular cancer. His public queue was shorter than his privae queue and he shifted my friend on to that, the result was he was from finding lump -> cancer diagnosis -> surgery in less than 10 days.

The incentivisation process in the HSE is completely screwed up, if you 2% over budget you are punished even if you treated 15% more patients for that money. It doesn't in any way promote efficiency within the system. There is no overall organisation and their is underuse of some services while others are at bursting point. It just takes far too long to change anything.

The hospital that I'm in now is such a sea-change from the HSE that I wonder if I'll ever be able to face going back. Here they value skilled staff highly, treat them well, pay them well, provide all the infrastructure they need and in reurn expect them to deliver a top class service. Which is what happens.

maninasia · 12-10-2010 04:59AM

Ah yes, but the current situation is actually incentivising surgeons to not push to change the system by giving them a large amount of additional income. This is a happy situation for 'some' (I believe you when you say some consultants lament the current system).

I also think fair enough, if surgeons want to work two jobs if they are not overworked and have free mornings etc (this is crazy to me, not many jobs would allow you take off and work somewhere else the odd morning or afternoon!)..but then why such high pay?

I agree the consultants are not the only people at this in the public service..it's the general public service culture in Ireland (everybody wants high pay down to the porters, everybody wants maximum benefits at detriment to the whole system). Where I live both private and public hospitals operate under a universal health system, much better and no significant difference in waiting times, treatment and costs between the two.

tallaght01 · 12-10-2010 07:08AM

I'm still a bit unclear as to why people often complain about the consultants working extra hours, when they care so little about the fact that juniors work so many hours.

opinion guy · 12-10-2010 07:50AM

maninasia wrote: »

Ah yes, but the current situation is actually incentivising surgeons to not push to change the system by giving them a large amount of additional income. This is a happy situation for 'some' (I believe you when you say some consultants lament the current system).

I never thought I'd say this - but I agree with maninasia on this point. The constulatans are in many cases the only ones with power to change the system and they don't Instead they maintain the status quo. This goes for junior doc working hours too - the consutlants are in many cases the reason why people are still workign whole weekends etc.

senordingdong · 12-10-2010 07:54AM

RobFowl wrote: »

It's 50c now but already nutterings that it'll increase in the next budget.

Exactly.
What will it be in five years time?

p_holmz · 12-10-2010 02:27PM

http://www.rte.ie/news/2010/0614/hse.html

You guys know any attempts to save HSE money is an absolute waste of time!.... The money you save will still go "missing" one way or the other :rolleyes:

Do you guys not see the picture? There is no point really... The educated ones suffer in this country while the "ppl who know the right ppl" sit back and enjoy till they get caught. Then they argue and argue until the case quietens and then we are back to square one!

Traumadoc · 13-10-2010 12:37AM

opinion guy wrote: »

I never thought I'd say this - but I agree with maninasia on this point. The constulatans are in many cases the only ones with power to change the system and they don't Instead they maintain the status quo. This goes for junior doc working hours too - the consutlants are in many cases the reason why people are still workign whole weekends etc.

Consultants do not want junior staff to work long hours - there is no need for it - have a look at the system in Australia - they can train in the same number of years without having to do crazy hours.

All consultants want to change the system - more consultants less junior staff with a consultant provided service.

maninasia · 13-10-2010 02:48AM

opinion guy wrote: »

I never thought I'd say this - but I agree with maninasia on this point. The constulatans are in many cases the only ones with power to change the system and they don't Instead they maintain the status quo. This goes for junior doc working hours too - the consutlants are in many cases the reason why people are still workign whole weekends etc.

I saw you mention junior docs need to stand up for their rights in another thread so maybe you agree with me more than you know

. I don't have a particular interest in the medical system, I just see it as an offshoot of 'bad management practices' in the public service and parts of the private business community in Ireland. I think these practices are deeply ingrained in the small island, what we need is a good deal of federalism .... that will set us free from the local entrenched interests (a bit like the South in the U.S.). If people lack integrity it needs to be forced in from outside, everything should be benchmarked to best practices in countries like Germany, Denmark etc.

p_holmz · 13-10-2010 08:14AM

maninasia wrote: »

I just see it as an offshoot of 'bad management practices' in the public service and parts of the private business community in Ireland. I think these practices are deeply ingrained in the small island, what we need is a good deal of federalism .... that will set us free from the local entrenched interests (a bit like the South in the U.S.). If people lack integrity it needs to be forced in from outside, everything should be benchmarked to best practices in countries like Germany, Denmark etc.

Nice poetry/thoeretical speech there... But in practice, ain't ever ever ever gona happen anytime soon. Not on this Island

maninasia · 14-10-2010 10:37AM

Actually I think it is happening..EU rules regulate many things in our lives, now the government is entirely dependent on the ECB and will probably need to be bailed out by early next year. Did you notice Lenihan cannot announce anything now without going to Brussels first? We also depend on the Euro as our currency. It is just a question of time and pressure. The government ignored certain rules (like deficit budget) but they will be brought to book by some of the big countries soon.

Nchd2010 · 14-10-2010 08:38PM

Right. So the general consensus seems to be "pay the greedy consultants, who are really just parasites, an awful lot less".

Realistically, this is not going to happen. Most regional hospitals are already finding it difficult to attract suitably qualified doctors to take on full time posts and are relying on substandard locums, really only a sticking plaster tbf.

Surely somebody somewhere must think there is actually something we can do? somebody? I mean can anyone even try to think of anything similar to what I suggested in the OP???

lonestargirl · 15-10-2010 12:56AM

The problem is that most of the inefficiencies are at a systematic level. If you order 10% less fbcs that is unlikely to result in any savings as the capital costs of running the lab and employing the staff will remain the same.

tallaght01 · 15-10-2010 02:01AM

Nchd2010 wrote: »

Right. So the general consensus seems to be "pay the greedy consultants, who are really just parasites, an awful lot less".

Realistically, this is not going to happen. Most regional hospitals are already finding it difficult to attract suitably qualified doctors to take on full time posts and are relying on substandard locums, really only a sticking plaster tbf.

Surely somebody somewhere must think there is actually something we can do? somebody? I mean can anyone even try to think of anything similar to what I suggested in the OP???

One word.."conferences".

An absolute waste of money. Fair enough if you're giving a talk. But nobody should be going out of town for conferences. They're mostly available on CD. They're basically tax payer (or drug company) funded junkets. Fair enough give the NCHDs/consultants time off to teleconference in, or watch the DVDs. But flying to America and staying in fancy hotels, to hear people talking about stuff that's going to be published anyway is a huge waste of money, to my mind.

Conference money could be put to better use in postgrad training for our docs.

maninasia · 15-10-2010 02:16AM

Nchd2010 wrote: »

Right. So the general consensus seems to be "pay the greedy consultants, who are really just parasites, an awful lot less".

Realistically, this is not going to happen. Most regional hospitals are already finding it difficult to attract suitably qualified doctors to take on full time posts and are relying on substandard locums, really only a sticking plaster tbf.

Surely somebody somewhere must think there is actually something we can do? somebody? I mean can anyone even try to think of anything similar to what I suggested in the OP???

I don't work in medicine but I sincerely doubt the situation is the same for consultant posts, in fact I have heard the opposite, that getting a consultant post is extremely competitive. Nobody said parasites either...don't change the debate to something that it is not.
Issues of cost are not sticking plaster, they are fundamental and every cost should be looked at, where costs are significantly out of line with other EU countries they should be cut down (they WILL be cut down anyway due to budget deficit).

opinion guy · 15-10-2010 07:35AM

tallaght01 wrote: »

One word.."conferences".

An absolute waste of money. Fair enough if you're giving a talk. But nobody should be going out of town for conferences. They're mostly available on CD. They're basically tax payer (or drug company) funded junkets. Fair enough give the NCHDs/consultants time off to teleconference in, or watch the DVDs. But flying to America and staying in fancy hotels, to hear people talking about stuff that's going to be published anyway is a huge waste of money, to my mind.

Conference money could be put to better use in postgrad training for our docs.

I strongly disagree with this. Conferences are very important. You often get to meet the researchers themselves and can make valuable connections (and I don't mean just for your own benefit - you can meet people who later you can contact for help with unusual cases etc). Its VERY important for us to keep sending our docs to conferences. You also often learn things that aren't in the published papers - almost always there is extra info left out that you only learn about by meeting the researchers themselves.
They are also not that expensive int he big picture and often come out of training grants

HSE management on the other hand don't need to be going to conferences on cleaning and waste management in far flung exotic destinations using staff training budgets as has allegedly happenened

tallaght01 · 15-10-2010 09:25AM

opinion guy wrote: »

I strongly disagree with this. Conferences are very important. You often get to meet the researchers themselves and can make valuable connections (and I don't mean just for your own benefit - you can meet people who later you can contact for help with unusual cases etc). Its VERY important for us to keep sending our docs to conferences. You also often learn things that aren't in the published papers - almost always there is extra info left out that you only learn about by meeting the researchers themselves.
They are also not that expensive int he big picture and often come out of training grants

HSE management on the other hand don't need to be going to conferences on cleaning and waste management in far flung exotic destinations using staff training budgets as has allegedly happenened

I know you don't go to conferences, but I've only been to two meself. Having said that, a lot of friends and colleagues have been, and their experience (and mine) is nothing like that above.

Sometimes a person will make a valuable contact at a conference. But mostly they won't.
Good quality research should be published. It's not always, but it mostly is. Some of the posters aren't published. But it's usually not earth shattering if it stays as a poster.

Very few of us meet all the researchers, either.

Is all this worth a plane ticket to the USA, a nice hotel for the week, and time away from the wards for docs and specialist nurses?

I don't think it is.

drkpower · 15-10-2010 09:57AM

opinion guy wrote: »

HSE management on the other hand don't need to be going to conferences on cleaning and waste management in far flung exotic destinations using staff training budgets as has allegedly happenened

Whats the reason for the divergence here?

Dont the HSE management-types get to make valuable connections?
Dont they often learn things from meeting people themselves, things they cant learn from reading papers?

It works both ways.

Jane5 · 15-10-2010 05:16PM

Tallaght01, for some specialities, most notably histopathology, conferences are a mandatory part of the training programme and attendance is taken. Trainees are expected to present and/or submit posters at least once a year. This year many that I know were badly out of pocket due to this in Ireland, with the axing of the training grant.
Not all specialities have the same training requirements, however not many appreciate this. For example, histopath until recently had to do a prescribing course! they have finally axed that but still, what a waste!

opinion guy · 15-10-2010 06:12PM

tallaght01 wrote: »

I know you don't go to conferences, but I've only been to two meself. Having said that, a lot of friends and colleagues have been, and their experience (and mine) is nothing like that above.

Sometimes a person will make a valuable contact at a conference. But mostly they won't.
Good quality research should be published. It's not always, but it mostly is. Some of the posters aren't published. But it's usually not earth shattering if it stays as a poster.

Very few of us meet all the researchers, either.

Is all this worth a plane ticket to the USA, a nice hotel for the week, and time away from the wards for docs and specialist nurses?

I don't think it is.

How do you know I don't go to conferences ? Seriously who are to be so arrogant? Actually I've been to one. In Dublin. I paid my own entrance fee. I made a bunch of contacts that are proving very fruitful. I learned extremely useful things that haven't been published. I also go to see the politics of the field at work at first hand which was a real eye-opener. I will go to others if they are of interest to me and I can afford them/get funding. Just because you treat conferences as a junket don't presume we all do.
So I won't tell you and the horse you rode in on what to do but I'm sure you can guess.

drkpower wrote: »

Whats the reason for the divergence here?

Dont the HSE management-types get to make valuable connections?
Dont they often learn things from meeting people themselves, things they cant learn from reading papers?

It works both ways.

Sorry dkpower I'm thinking of a particular news story on this that I can't find the link to where there was some junketism going on with hse types in the name of "cleaning practice". You don't need conferences on cleaning practices. Its not that complicated.

Nchd2010 · 15-10-2010 08:48PM

I don't work in medicine but I sincerely doubt the situation is the same for consultant posts, in fact I have heard the opposite, that getting a consultant post is extremely competitive. Nobody said parasites either...don't change the debate to something that it is not.Issues of cost are not sticking plaster, they are fundamental and every cost should be looked at, where costs are significantly out of line with other EU countries they should be cut down (they WILL be cut down anyway due to budget deficit).

Interestingly enough, you've managed to get nearly everything completely wrong here, which must be a first for you.

I was indeed talking about consultant posts. Whilst there is (some) competition for posts in large teaching hospitals, many regional hospitals don't even get reasonable applications when they advertise for consultants. Some of the reasons for this are that there is simply no way of knowing what exactly will happen to hospitals in the future as the powers that be just want to close things on a haphazard basis; there is little opportunity for decent research without the backup of a decent lab or university teaching dept; specialised and technically skilled procedures and management of complex cases is simply not feasible without a decent throughput and the jobs just aren't attractive to people coming from a fellowship in the states or somewhere, where there is an opportunity to actually use one's skills.

Furthermore, even in teaching hospitals, a hotshot on his/her way back from the states just doesn't want the hassle of dealing with HSE and management bureaucracy and bull****. For example, I've never worked in a hospital where a skilled and talented consultant, trying to perform complex surgical procedures isn't thwarted by a theatre nurse at least once a week, because the nurses "need their breaks". A hell of a lot of surgery is cancelled or postponed due to horribly self serving practices. If I was well published and finishing a fellowship or something, I'd be straight into private practice. A friend who finished orthopaedics training with a leading hip surgeon and brought a new procedure back to Ireland left public practice because of this kind of **** and is now offering invites to students and trainees to observe or assist in his clinics and theatres, because he is dedicated to teaching. Quite simply the HSE, and many others just do not understand doctors.

Issues of cost are not sticking plaster

No ****. I meant hiring short term, substandard locums to cover for the lack of experienced and quality professionals. Jesus.

I mean come on, I started this thread to see if there was any innovation out there (and to see how many photoradiographers would bite-disappointingly few).

Vorsprung · 15-10-2010 10:46PM

Nchd2010 wrote: »

Furthermore, even in teaching hospitals, a hotshot on his/her way back from the states just doesn't want the hassle of dealing with HSE and management bureaucracy and bull****. For example, I've never worked in a hospital where a skilled and talented consultant, trying to perform complex surgical procedures isn't thwarted by a theatre nurse at least once a week, because the nurses "need their breaks". A hell of a lot of surgery is cancelled or postponed due to horribly self serving practices. If I was well published and finishing a fellowship or something, I'd be straight into private practice. A friend who finished orthopaedics training with a leading hip surgeon and brought a new procedure back to Ireland left public practice because of this kind of **** and is now offering invites to students and trainees to observe or assist in his clinics and theatres, because he is dedicated to teaching. Quite simply the HSE, and many others just do not understand doctors.

I think your frustration is misdirected. Nurses are entitled to, and rightly take their breaks when they are scheduled. It is far from self serving to expect to be allowed to sit down for 15 minutes every few hours. In my experience (working in both regional and urban hospitals at home) nursing practice was to rotate people to allow breaks to happen, and I can't say that Ive heard if procedures being cancelled.

I'm well aware that plenty of hospital employees take the absolute piss. Just because our profession gets dicked around it doesn't mean we can expect other professions to get dicked around too.

Nchd2010 · 15-10-2010 11:45PM

Fundamentally disagree there tbh. The most important thing is the patient. Not the break.

Edit to say, within the last month, I've seen a whipple's and a gastro-jej be delayed by a week cos there "wasn't enough" theatre staff. I was post call. As was my reg. We were prepared to work. The "theatre staff" were not.The patient MUST come first.

Doubling time for some tumours is less than a week. I'm afraid sitting down must take second place.

To be quite honest, I think the whole nursing profession has been brought into disrepute because of the actions of the INMO and Liam Doran. Most conscientious nurses would agree.

opinion guy · 16-10-2010 12:28AM

Yes the patient should come first.
As a direct consequence of that, you and your reg should not be doing whipples or gastro-jej post call. Evidence overwhelmingly shows that mistakes go up the longer you work. Simple as.
The theatre staff may not exactly be right here - but they are less wrong than you are. Breaks are part of providing the best care for the patient, as breaks decrease the risk of errors. Simple as.

Nchd2010 · 16-10-2010 12:38AM

You're absolutely right. In an ideal world, all procedures would be carried out by fresh faced enthusiastic doctors, with the highest standards of education and training.

However if you really believe that we should delay procedures because we're tired then...

The country is ****ing broke. Bankrupt. Doctors have a moral and ethical and human obligation to do their absolute best. Not wait for some tulips to realise that we need serious investment in the health service. Waiting for the next theatre day or time simply puts the patient with a devastatingly horrific tumour at risk of death. Think about it.

I know its not a realistic example, but if you had the choice of having an operation now on an aggressive tumour, but the highly trained surgeons are a bit tired (but have built up a tolerance to this) or waiting till your tumour had doubled in size and possibly metastasised, what would you choose?

FFS

Ireland on the brink...how can health professionals help???

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