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

opinion guy · 16-10-2010 01:14AM

Nchd2010 wrote: »

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.

Oh I'm really glad you've said this. A) Doctors also have a moral and ethical duty to challenge the system they work in is dangerous. Simply getting on with it without kicking up a fuss is failing that duty.

there was a boom for ten years plus - nobody did anything about this. This is NOT about money. C) Take a pay cut in exchange for them hiring more doctors and you having less hours. Yes another one.

There is NO EXCUSE for the continuing status quo.

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

a) I don't believe you build up a tolerance to excessive working hours. Studies back this up. Longer shifts - in any line of work - errors go up. Full stop. Do not pass go. The scary thing is - many, including you apparently, believe they can work safely for 60, 70 hours in one go. They can't. you can't.

b) Of course anyone if faced with death or a tired surgeon would chose the tired surgeon. No one should face that choice. If one is that tired surgeon, one needs to do whatever is necessary to challenge that system

tallaght01 · 16-10-2010 02:02AM

opinion guy wrote: »

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.

It's not arrogant to assume a non-medic doesn't go to medical conferences. Especially when they're generally as misinformed as you are.

Arguing by counter-example proves nothing....."I found a conference useful therefore they are useful" is akin to the old "well my grandad smoked and loved til 90, so don't tell me to stop smoking".

Though I seriously doubt the published research you came across is particularly useful.

Conferences can be useful. But thousands of euros useful? More useful than proper training in the basics? No way.

Histopathology may require conference presentations. I thought we in public health (in Oz) were the only ones. But the way we do it is we throw on a huge "research meeting" once per year. A small conference by any other name. Anyone can come and present, and we get good speakers, but the public health SpRs all present their research too, and the public health assessors come along and assess them. To provide incentives for a good presentation, the best public health talk of the night gets a trip to present at an Australian conference (paid for by the royal college, not the taxpayer). It works well.

Every year our royal college flies us all to sydney, and puts us up in a basic hotel (most of the trainees are in Sydney, so cost is therefore less of an issue, as only out of towners need flights and accom). We get 3 days of solid lectures and tutorials from experts. They cover the latest research,and we get lots of small group teaching and scenario training (emerging disease, setting up health systems in resource poor settings etc, all very applied stuff).

The tutors just come in for 2 hours each, and don't ask for anything in return. It's way cheaper than a conference. There's no poxy drug reps trying to flog stuff that doesn't work, and it's way more educational. It's very hard to believ that Irish NCHDs wouldn't be better served by a model like that, then flying off to conferences.

lonestargirl · 16-10-2010 02:48AM

I agree with you Tallaght01, conferences can be a huge waste of money. A situation like you described already exists for the RadOnc Spr scheme. They have an annual radiation oncology update meeting, usually held in Dublin (where most people are based ) on a Saturday. The consultants divide up the treatment sites and each of them makes a presentation on the important publications for that site in the past year - invariably these are the results of the large US multi-centre trials, very interesting but not worth the trip across the Atlantic to find out about. I also think a good policy is if you send a member of staff on a training course then they have to give a presentation upon their return to disseminate what they learned to the wider staff population. This would also discourage 'junket-type' trips.

tallaght01 · 16-10-2010 03:04AM

lonestargirl wrote: »

I agree with you Tallaght01, conferences can be a huge waste of money. A situation like you described already exists for the RadOnc Spr scheme. They have an annual radiation oncology update meeting, usually held in Dublin (where most people are based ) on a Saturday. The consultants divide up the treatment sites and each of them makes a presentation on the important publications for that site in the past year - invariably these are the results of the large US multi-centre trials, very interesting but not worth the trip across the Atlantic to find out about. I also think a good policy is if you send a member of staff on a training course then they have to give a presentation upon their return to disseminate what they learned to the wider staff population. This would also discourage 'junket-type' trips.

Interesting. I didn't know they were doing that in radiology. It's a really good idea, and I think it's the way forward.
I had to give a presentation when I got back from the last conference I was at. It was a HIV/sexual health conference held locally, and no-one was interested in what I had to report, as I was working in immunisation/vaccine preventable diseases at the time (well they were interested in HPV, but that's about it), but I think it's a good idea in priniciple.

There's also other simpler ways to keep up. I run a journal club, with teleconferencing facilities, for public health SpRs and any other staff who are interested every month. To be honest, there's not a lot of interest in it, as it's only a core of us who turn up. But when there's a conference on offer, the amount of people interested in the latest research suddenly rockets.

I also go to a paeds journal club in the local hospital where I do my kiddy A+E shifts, and it's such a great way to keep up with the literature, and it's pretty much free.

Vorsprung · 16-10-2010 03:54AM

Nchd2010 wrote: »

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

Despite the addition of FFS at the end of your post, I don't disagree with most of what you're saying.

That said, one of the greatest principles of medicine is "first, do no harm". I've seen enough people go back to theatre because their anastomosis has popped, and their interest is not best served by overworked Regs/SHO who despite their best efforts to get the initial procedure done, come back to the ward a second time with a few Beclovacs hanging out of them.

Our moral/ethical duty must be balanced with a realisation of our own limitations.

opinion guy · 16-10-2010 08:01AM

tallaght01 wrote: »

It's not arrogant to assume a non-medic doesn't go to medical conferences. Especially when they're generally as misinformed as you are.

Who said I was a non-medic ?
How am I misinformed. You may not agree with my opinions, but I can assure you, I am very well informed.

Arguing by counter-example proves nothing....."I found a conference useful therefore they are useful" is akin to the old "well my grandad smoked and loved til 90, so don't tell me to stop smoking".

And your original arguing by example proves nothing - I simply returned in kind.

Though I seriously doubt the published research you came across is particularly useful.

Why because you've assumed I'm a non-medic, you automatically assume the research wasn't useful. I'm sorry you maintain you are not arrogant ??? Either that or you are taking a personal shot. If you can't argue the points then conceed them - don't get personal about it.

Conferences can be useful. But thousands of euros useful? More useful than proper training in the basics? No way.

Histopathology may require conference presentations. I thought we in public health (in Oz) were the only ones. But the way we do it is we throw on a huge "research meeting" once per year. A small conference by any other name. Anyone can come and present, and we get good speakers, but the public health SpRs all present their research too, and the public health assessors come along and assess them. To provide incentives for a good presentation, the best public health talk of the night gets a trip to present at an Australian conference (paid for by the royal college, not the taxpayer). It works well.

Every year our royal college flies us all to sydney, and puts us up in a basic hotel (most of the trainees are in Sydney, so cost is therefore less of an issue, as only out of towners need flights and accom). We get 3 days of solid lectures and tutorials from experts. They cover the latest research,and we get lots of small group teaching and scenario training (emerging disease, setting up health systems in resource poor settings etc, all very applied stuff).

The tutors just come in for 2 hours each, and don't ask for anything in return. It's way cheaper than a conference. There's no poxy drug reps trying to flog stuff that doesn't work, and it's way more educational. It's very hard to believ that Irish NCHDs wouldn't be better served by a model like that, then flying off to conferences.

This is all well and good. And for sure have research meetings. But to argue people shouldn't also go to conferences is dangerous and would isolate Ireland in the research community and to leave us behind. The trick is - not to send people on junkets. Restrict people to the conferences very relevant to their career.

tallaght01 · 16-10-2010 08:42AM

opinion guy wrote: »

Who said I was a non-medic ?
How am I misinformed. You may not agree with my opinions, but I can assure you, I am very well informed.

And your original arguing by example proves nothing - I simply returned in kind.

Why because you've assumed I'm a non-medic, you automatically assume the research wasn't useful. I'm sorry you maintain you are not arrogant ??? Either that or you are taking a personal shot. If you can't argue the points then conceed them - don't get personal about it.

This is all well and good. And for sure have research meetings. But to argue people shouldn't also go to conferences is dangerous and would isolate Ireland in the research community and to leave us behind. The trick is - not to send people on junkets. Restrict people to the conferences very relevant to their career.

Why don't you tell us what you do for a living then, because I would be really interested in knowing where you get your views from. Sure, the fact that I disagree with everything you say doesn't make you wrong. But, aside from the alternative medicine salesmen, I've never seen someone post here that I so regularly wonder how on earth they feel their views are worthy of broader dissemination. Despite what you say, you are very very very poorly informed.

It's not "dangerous" to reduce conferences. It's dangerous to have docs working crazy hours, and to not have done any APLS training, or to not have proper library facilities.

It is not dangerous to stop people flying to the states for a week at the expense of the taxpayer to hear about some new research directly from the horses mouth, and to look at some posters.

Nchd2010 · 16-10-2010 02:06PM

opinion guy wrote: »

Oh I'm really glad you've said this. A) Doctors also have a moral and ethical duty to challenge the system they work in is dangerous. Simply getting on with it without kicking up a fuss is failing that duty. there was a boom for ten years plus - nobody did anything about this. This is NOT about money. C) Take a pay cut in exchange for them hiring more doctors and you having less hours. Yes another one.

There is NO EXCUSE for the continuing status quo.

This is just brilliant. What kind of fool are you? Do you really think that the IMO and doctors around the country aren't working to improve conditions?

Personally, I have chosen medicine as a career cos I want to be able to spend as much time as possible tired and worn out. And when I have kids, I definitely don't want to spend every night in the same home. I'd much rather spend at least one night in four working. And maybe half of the weekends too. I think most doctors would agree tbh. That's why we do absolutely nothing to change the system.

No. The IMO and doctors are consistently fighting to change the system. It won't change overnight. And it's no surprise that we are in such a state if your level of insight is anything like the national average. In the meantime, we do our utmost with stretched resources to do justice to ourselves and our profession and ease suffering.

Your idea of paying doctors less is a good one in fairness. We're already paid less than radiographers for a more demanding and responsible job, so if you pay us less, then the cream of the crop at school leaving age won't go on to become doctors, and the qualified doctors will leave for greener fields. And the smart people will become radiographers, working a "39" hour week, from around 9.30 to 4.15 daily with a few coffee breaks, for more money than the even more overworked doctors, who are working their swiss off to cover for the deficiencies left by those who've gone to the Antipodes or north America. I think this is a flawless plan. Is there any chance you'd run for election? Though given your clear talent, you're probably earning an absolute mint in the private sector.

opinion guy wrote: »

a) I don't believe you build up a tolerance to excessive working hours. Studies back this up. Longer shifts - in any line of work - errors go up. Full stop. Do not pass go. The scary thing is - many, including you apparently, believe they can work safely for 60, 70 hours in one go. They can't. you can't.

b) Of course anyone if faced with death or a tired surgeon would chose the tired surgeon. No one should face that choice. If one is that tired surgeon, one needs to do whatever is necessary to challenge that system

Perhaps you'd like to quote a study or two? You might also like to quote where I said it was safe to work for 60 or 70 hours. Thanks.

Finally in response to Opinion guy, what exactly should we do to change the system? Strike and leave patients uncared for? Or maybe be part of a union which is licensed to negotiate and is making progress, slowly, to creating a better health service.

Not being personal or anything, but some of the sentiments expressed here really do show why Ireland is in such a state. No thought, no insight and raving certainties.

Oh and btw I think conferences are essential. You really do learn more hearing things from experts and leaders. If that wasn't the case, then in order to save money for the country we could just give every potential university student a copy of the syllabus and maybe a few lecture notes and tell them there's an exam at the end of the year. Thus saving money on lecturers, lecture halls and maintenance.

I actually knew most Irish people were stupid, but **** me, this forum is scary.

Edit to add: For those who think doctors aren't doing enough to change the status quo, cop on. Whoever shouts loudest gets heard. Reasonable arguments are just not listened to in Ireland. There were surely not many docs opposing the introduction of the cervical cancer vaccine, yet all of the advice from highly educated, conscientious professionals was just ignored. For the sake of €8m.

The majority of the population voted for FF, thousands of mortgage holders are in default due to amazing stupidity, and yet the leaders who led us into this mess are still in power. Most Irish people just can't see sense and do not want to listen to anyone who holds a differing opinion.

tallaght01 · 16-10-2010 05:07PM

Nchd2010 wrote: »

#

Not being personal or anything, but some of the sentiments expressed here really do show why Ireland is in such a state. No thought, no insight and raving certainties.

Oh and btw I think conferences are essential. You really do learn more hearing things from experts and leaders. If that wasn't the case, then in order to save money for the country we could just give every potential university student a copy of the syllabus and maybe a few lecture notes and tell them there's an exam at the end of the year. Thus saving money on lecturers, lecture halls and maintenance.

I actually knew most Irish people were stupid, but **** me, this forum is scary.

Edit to add: For those who think doctors aren't doing enough to change the status quo, cop on. Whoever shouts loudest gets heard. Reasonable arguments are just not listened to in Ireland. There were surely not many docs opposing the introduction of the cervical cancer vaccine, yet all of the advice from highly educated, conscientious professionals was just ignored. For the sake of €8m.

The majority of the population voted for FF, thousands of mortgage holders are in default due to amazing stupidity, and yet the leaders who led us into this mess are still in power. Most Irish people just can't see sense and do not want to listen to anyone who holds a differing opinion.

I don't know you, and wouldn't want to judge you, but a lot of what you've written above doesn't come across particularly well, and doesn't do your credibility a lot of good. It's maybe time to just take a step back and take a deep breath, though I'm sure your statements are borne out of frustration.

I would also disagree with your university lecturer = conference presenter analogy. There's a difference between a skilled lecturer explaining complex concepts to students, and someone presenting data. Fair enough, you can ask questions at a conference about why a certain analysis was used, or why a certain study design was chosen, but the data is the data.

SleepDoc · 16-10-2010 05:32PM

tallaght01 wrote: »

I don't know you, and wouldn't want to judge you, but a lot of what you've written above doesn't come across particularly well, and doesn't do your credibility a lot of good. It's maybe time to just take a step back and take a deep breath, though I'm sure your statements are borne out of frustration.

The Woodrow Wilson prize for diplomacy is on it's way!

Kurtosis · 16-10-2010 05:41PM

opinion guy wrote: »

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.

Not getting into the issues of conferences but I think you underestimate the importance of cleaning/hygiene policies in hospitals. No point giving patients the most up to date treatments and practicing evidence based medicine if every in-patient ends up picking up an infection. This area is more complicated than you'd think and definitely very important.

Nchd2010 · 16-10-2010 08:54PM

Interestingly enough, I'm not really frustrated or angry tbh. I'm more disappointed in the demise of our country. I actually thought a lot before writing my previous post. The language might be a touch (and only a touch) strident, but it may provoke a reaction. I'd love to know if anyone could reasonably disagree with any of the points I made? I'm open to opinion, but I always mean what I say and I genuinely don't think my previous post was all that radical.

I wonder how my credibility is damaged? The whole country seems to have gone bananas. Despite being on the brink of becoming another Argentina or Greece, we come out with nonsense like the frankly risible "Croke Park Agreement". Honestly, there's a lot of people out there who could really do with a good root in the swiss.

maninasia · 17-10-2010 04:43AM

Nchd2010 wrote: »

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.

I noticed your opinon that doctors are 'the cream of the crop', by what measure, studying ability in a secondary school with grinds thrown in? That's a fallacy right there, by your own words you know integrity and hardwoking is just or more important and I'm sure the current system excludes as many good candidates for doctors as it produces. I am FAR from convinced that a lessening of grade based competition would produce less competent doctors, it may do the opposite in fact.

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).

Fair enough forgot you were the person who started this...mea culpa.
Also I'll take your word on the lack of interest for the posts, it seems times have changed because I had heard it was very competitive and there were tonnes of Irish docs in the states who would love to get back here, it was so competitive that was the reason they actually went to the US to do the research i.e. to be able to get a consultant position here in Ireland. What with regional hospital closures I can see the hesitancy...probably more about job security than lack of research facilities though (doubt they had much to begin with!).

maninasia · 17-10-2010 04:51AM

Nchd2010 wrote: »

Interestingly enough, I'm not really frustrated or angry tbh. I'm more disappointed in the demise of our country. I actually thought a lot before writing my previous post. The language might be a touch (and only a touch) strident, but it may provoke a reaction. I'd love to know if anyone could reasonably disagree with any of the points I made? I'm open to opinion, but I always mean what I say and I genuinely don't think my previous post was all that radical.

I wonder how my credibility is damaged? The whole country seems to have gone bananas. Despite being on the brink of becoming another Argentina or Greece, we come out with nonsense like the frankly risible "Croke Park Agreement". Honestly, there's a lot of people out there who could really do with a good root in the swiss.

You are right to debate these issues, nobody ever got anything done by sweeping things under the carpet. There are too many selfish people only looking out for themselves or afraid of their 'reputation' and from the outside looking in it seems medicine in Ireland is run in an inefficient and hierarchial manner..too many chiefs, not enough Indians. Frankly it seems people don't have balls and it goes right through large swathes of Irish life..all talk but no action, like a fish flopping on the beach.

You get attacked just by pointing out the obvious, that there are too many selfish people, that a lot of doctors (and people) see the wood for trees etc, that the country is in a right **** state (and one of the reasons I'm not living there). How could anyone not agree with this?

opinion guy · 17-10-2010 06:02PM

penguin88 wrote: »

Not getting into the issues of conferences but I think you underestimate the importance of cleaning/hygiene policies in hospitals. No point giving patients the most up to date treatments and practicing evidence based medicine if every in-patient ends up picking up an infection. This area is more complicated than you'd think and definitely very important.

No you are right. Hygiene is very important and does merit keeping up international best practice. Forgive me my memory was failing me.
The story I was thinking of is this one. The training fund I referred to was supposed to be for catering and portering. Do people REALLY need foreign trips for training in catering and portering ?? Seriously ??? Am I reading this wrong or is there a 60million euro fund for training in these things ?!!?!?!?!?
http://www.irishtimes.com/newspaper/ireland/2010/0621/1224272953686.html

opinion guy · 17-10-2010 06:22PM

tallaght01 wrote: »

Why don't you tell us what you do for a living then, because I would be really interested in knowing where you get your views from.

No. I value my privacy.

Sure, the fact that I disagree with everything you say doesn't make you wrong. But, aside from the alternative medicine salesmen, I've never seen someone post here that I so regularly wonder how on earth they feel their views are worthy of broader dissemination. Despite what you say, you are very very very poorly informed.

I feel sorry for you if you can't comprehend that others might view the same problems with different perspectives than yourself.

It's not "dangerous" to reduce conferences. It's dangerous to have docs working crazy hours, and to not have done any APLS training, or to not have proper library facilities.

Agree. But those things are short term dangerous. Cutting us off from internationl progress is long term dangerous.

It is not dangerous to stop people flying to the states for a week at the expense of the taxpayer to hear about some new research directly from the horses mouth, and to look at some posters.

This is not what conferences are about. Maybe you've been to the wrong conferences.

Nchd2010 wrote: »

This is just brilliant. What kind of fool are you? Do you really think that the IMO and doctors around the country aren't working to improve conditions?

I really shoudl report you for that personal attack but I'll let it slide. As to the rest of that sentence I can't really answer it on this forum in this guise. Sorry.

Personally, I have chosen medicine as a career cos I want to be able to spend as much time as possible tired and worn out. And when I have kids, I definitely don't want to spend every night in the same home. I'd much rather spend at least one night in four working. And maybe half of the weekends too. I think most doctors would agree tbh. That's why we do absolutely nothing to change the system.

Your sarcasm is futile and irrelevant to both this discussion and you're working conditions. Maybe it makes you feel better however.

No. The IMO and doctors are consistently fighting to change the system. It won't change overnight.

Any yet nothing changes ? Weird that isn't it. Nothing changed from the agreement in 1999 until last year. Ten years of boom and national oppulence and nothing was done. Evidence speaks for itself frankly.

And it's no surprise that we are in such a state if your level of insight is anything like the national average. In the meantime, we do our utmost with stretched resources to do justice to ourselves and our profession and ease suffering.

My level of insight is very different from the national average I assure you. The remainder of this statement is true - but irrelevant to achieving change.

Your idea of paying doctors less is a good one in fairness. We're already paid less than radiographers for a more demanding and responsible job, so if you pay us less, then the cream of the crop at school leaving age won't go on to become doctors, and the qualified doctors will leave for greener fields. And the smart people will become radiographers, working a "39" hour week, from around 9.30 to 4.15 daily with a few coffee breaks, for more money than the even more overworked doctors, who are working their swiss off to cover for the deficiencies left by those who've gone to the Antipodes or north America. I think this is a flawless plan. Is there any chance you'd run for election? Though given your clear talent, you're probably earning an absolute mint in the private sector.

More irrelevant points and personal attacks. But it does betray your true feelings. You want change but you are unwilling to take a paycut. So you want to work less hours in better conditions and not lose any income. In the recession. This CAN'T and WON'T happen. Your only choice is to accept the status quo, or agitate for reform in exchange for giving up income. Throw all the tantrums you want - this simple equation will not change.

Perhaps you'd like to quote a study or two? You might also like to quote where I said it was safe to work for 60 or 70 hours. Thanks.

Leave it with me. Its in my to-do list. I have a rather long to-do list however. You may not have said those hours are safe - but you are claiming you can build up a tolerance to it - which implies you think its gets safer the more you do it. Stop deluding yourself.

Finally in response to Opinion guy, what exactly should we do to change the system? Strike and leave patients uncared for? Or maybe be part of a union which is licensed to negotiate and is making progress, slowly, to creating a better health service.

There are other options. Resign giving working conditions as your reason and locum working only the hours you consider safe for example. Write letters to your department head and HSE people laying out your concerns about your working hours. Create a paper trail (both tho achieve change and to protect yourself and colleauges should a tragic mistake occur as a result of the working hours)

Not being personal or anything, but some of the sentiments expressed here really do show why Ireland is in such a state. No thought, no insight and raving certainties.

You've made a bunch of ad hominem attacks - of course you are being personal.

Oh and btw I think conferences are essential. You really do learn more hearing things from experts and leaders. If that wasn't the case, then in order to save money for the country we could just give every potential university student a copy of the syllabus and maybe a few lecture notes and tell them there's an exam at the end of the year. Thus saving money on lecturers, lecture halls and maintenance.

Wow we agree on something!

Edit to add: For those who think doctors aren't doing enough to change the status quo, cop on. Whoever shouts loudest gets heard. Reasonable arguments are just not listened to in Ireland. There were surely not many docs opposing the introduction of the cervical cancer vaccine, yet all of the advice from highly educated, conscientious professionals was just ignored. For the sake of €8m.

Talk i cheap. Nobody, but nobody listens to anyone who shouts if they think that talk is cheap. You need to back up words with action of some sort or another. And for the record I don't think unions or strikes are effective actions.

The majority of the population voted for FF, thousands of mortgage holders are in default due to amazing stupidity, and yet the leaders who led us into this mess are still in power. Most Irish people just can't see sense and do not want to listen to anyone who holds a differing opinion.

Rabble rabble rabble. What does this have to do with your working conditions ?

Nchd2010 · 17-10-2010 08:20PM

Any yet nothing changes ? Weird that isn't it

Not really, as I said Ireland just seems to have gone baloobas. The status quo suits some people, who for some reason are held in high esteem by others.

My level of insight is very different from the national average I assure you.

In which way? If people are really less insightful than you...

You want change but you are unwilling to take a paycut.

I really don't think working less hours is the same as taking a paycut. I'm more than willing to work less hours and thus earn less money. However, to most right-thinking people, this is worlds away from taking a paycut.

Would you mind giving a ballpark figure as to what you think doctors should earn. Say for an average 48 hr week? Just curious here.

Resign giving working conditions as your reason and locum working only the hours you consider safe for example. Write letters to your department head and HSE people laying out your concerns about your working hours. Create a paper trail (both tho achieve change and to protect yourself and colleauges should a tragic mistake occur as a result of the working hours)

Another great idea tbf. I'm always writing letters tbh. But really, you honestly think that people should abandon training schemes and teaching and audit etc to work for more money, in a constant state of flux, with no continuity of care. The cost in itself would actually harm patients (if we think on a macro level for a moment) and the lack of knowledge of where basic things are in a different hospital, and adjustment to new working practices would harm patients on a micro level. You've alluded to protecting myself and colleagues. I wonder where exactly the patients stand in all of this???

Talk i cheap. Nobody, but nobody listens to anyone who shouts if they think that talk is cheap. You need to back up words with action of some sort or another. And for the record I don't think unions or strikes are effective actions.

Would you care to give an example of what would be an effective action. In fairness, reasonable trade unionism is really at the heart of much of the western economy, but if you have a better plan that doesn't involve resigning and endangering patients, I'd love to hear it.

Rabble rabble rabble. What does this have to do with your working conditions ?

I really should report you for that unnecessary attack on my reasoned post. But I won't cos I'm trying to give a leg-up here really, trying to break things down and explain them to you. The point I was making in the sentence or two you quoted and then abused was that, unfortunately sense and reason is lost in Ireland. As you have wonderfully illustrated.

opinion guy · 18-10-2010 01:06AM

Nchd2010 wrote: »

Not really, as I said Ireland just seems to have gone baloobas. The status quo suits some people, who for some reason are held in high esteem by others.

Oh I agree with you there.

In which way? If people are really less insightful than you...

More ad hominems. Attack the post not the poster.

I really don't think working less hours is the same as taking a paycut. I'm more than willing to work less hours and thus earn less money. However, to most right-thinking people, this is worlds away from taking a paycut.

Agreed. Problem is many docs WANT to work lots of hours for money.

Would you mind giving a ballpark figure as to what you think doctors should earn. Say for an average 48 hr week? Just curious here.

I think the base salaries are fair enough. If people work less hours then pay if fair I think. Thou I agree with dkpower - overtime rates shoudl be punitive to discourage the HSE from making people work ridiculous hours. Overtime about a certain limit shoudl become the exception, not the rule.

Another great idea tbf. I'm always writing letters tbh. But really, you honestly think that people should abandon training schemes and teaching and audit etc to work for more money, in a constant state of flux, with no continuity of care.

Absolutely I think so. What is a point of a training scheme, where you don't get trained and have no employee rights, and no career progression at the end of it. Anyone I know locuming has oodles of work to hand - long term and short term and can basically state they don't want to work over 24 hours in one go if they wish.

The cost in itself would actually harm patients (if we think on a macro level for a moment) and the lack of knowledge of where basic things are in a different hospital, and adjustment to new working practices would harm patients on a micro level. You've alluded to protecting myself and colleagues. I wonder where exactly the patients stand in all of this???

I consider the most dangerous practice currently to be the excessively long working hours. If you resign on the basis of working hours and only take safe working hours jobs I believe you are doing the best thing for patients. It will also incentivise the HSE to put into practice sae workign hours. The cost is the concern of health officials who have community wide responsiblity and not the individual doctor who has responsiblity only to the people he/she treats.

This WILL make the HSE listen by the way. Here is the evidence that lots of locums will make them change:
http://www.imt.ie/news/features/2010/10/harney-two-year-nchd-contracts-are-planned.html

Would you care to give an example of what would be an effective action. In fairness, reasonable trade unionism is really at the heart of much of the western economy, but if you have a better plan that doesn't involve resigning and endangering patients, I'd love to hear it.

I already have. Resigning does not endanger patients if you give them sufficient notice. IT is your employers duty to find a replacement - not yours. It its going to cost them money to hire locums then it is in their interests as well as their patients interests to reform the workign conditions.

I really should report you for that unnecessary attack on my reasoned post. But I won't cos I'm trying to give a leg-up here really, trying to break things down and explain them to you. The point I was making in the sentence or two you quoted and then abused was that, unfortunately sense and reason is lost in Ireland. As you have wonderfully illustrated.

Report away. Attacking the post is the idea around here. Your point was mute and irrelevant to the discussion. Attacking the poster - s you keep doing - is not allowed.

tallaght01 · 18-10-2010 01:17AM

opinion guy wrote: »

Who said I was a non-medic ?
How am I misinformed. You may not agree with my opinions, but I can assure you, I am very well informed.

.

tallaght01 wrote: »

Why don't you tell us what you do for a living then, because I would be really interested in knowing where you get your views from.

opinion guy wrote: »

No. I value my privacy.

Well, I think we all know what that really means. Thank you for clarifying.

opinion guy · 18-10-2010 01:20AM

tallaght01 wrote: »

Well, I think we all know what that really means. Thank you for clarifying.

Mind your assumptions.

knipex · 18-10-2010 08:34AM

opinion guy wrote: »

No you are right. Hygiene is very important and does merit keeping up international best practice. Forgive me my memory was failing me.
The story I was thinking of is this one. The training fund I referred to was supposed to be for catering and portering. Do people REALLY need foreign trips for training in catering and portering ?? Seriously ??? Am I reading this wrong or is there a 60million euro fund for training in these things ?!!?!?!?!?
http://www.irishtimes.com/newspaper/ireland/2010/0621/1224272953686.html

Its not quite as simple as you think.

Lets just concentrate on hospital hygiene (as it was the initial point raised)

Ten years ago the belief was that the environment played no role in the spread of HCAI's. (with one to two noted exceptions) If hospitals were cosmetically clean then it was good enough.

Based on that knowledge and that belief cleaners were trained, nursing staff were trained, supervisors and auditors were trained. Budgets were set based on that theory, bed management operated based on that theory.

Then people like Stephanie Dancer, John Boyce, Hillary Humphreys, Garry French and many others started re looking at the subject. The beliefs were turned on their head. it was discovered that not only was the cleaning regimen wrong, but the approach to cleaning was wring, the design of equipment needed work, the chemicals used were ineffective. The entire rule book was rewritten in a couple of years.

Companies got involved, the likes of Bioquel, 3M, Steris etc developed technologies, conducted or sponsored research, published data etc.

Yet 3 years ago I head a Microbiologist tell hospital management that the environment played no role in the spread of HCAI's. Last year I heard an infection control nurse tell a porter that it was Ok to take the patient bed out while the room was being sanitised and then bring it back in after. Last week I heard a nurse tell alcohol hand gel was effective at eradicating C.diff from their hands. Every day I see cleaners using wrong products and wrong techniques. How many believe that steam cleaning will kill c.diff ?

I have seen hospital refuse to even evaluate new technologies because they are convinced they will not integrate into a busy hospital environment. Despite the fact that they have already been integrated to multiple hospitals are over the world.

If you sit down with people and start discussing a topic its very easy to see who is keeping up with the latest research and innovations. Who is attending conferences, who is going to see the latest technologies. Its easy to see which hospitals are keeping up and constantly reviewing everything and then sharing that information.

Nchd2010 · 18-10-2010 08:52AM

Just to clarify, opinion guy you think:

Expensive short term substandard locums with poor quality control and no continuity of care as is the case at present is the answer to a long term problem

You think newly qualified doctors should be paid less than radiographers

You think doctors want to work long hours and be away from their family and have minimal free time

And you think individual doctors have no responsibility to society

Super!

tallaght01 · 18-10-2010 11:05AM

knipex wrote: »

Its not quite as simple as you think.

Lets just concentrate on hospital hygiene (as it was the initial point raised)

Ten years ago the belief was that the environment played no role in the spread of HCAI's. (with one to two noted exceptions) If hospitals were cosmetically clean then it was good enough.

Based on that knowledge and that belief cleaners were trained, nursing staff were trained, supervisors and auditors were trained. Budgets were set based on that theory, bed management operated based on that theory.

Then people like Stephanie Dancer, John Boyce, Hillary Humphreys, Garry French and many others started re looking at the subject. The beliefs were turned on their head. it was discovered that not only was the cleaning regimen wrong, but the approach to cleaning was wring, the design of equipment needed work, the chemicals used were ineffective. The entire rule book was rewritten in a couple of years.

Companies got involved, the likes of Bioquel, 3M, Steris etc developed technologies, conducted or sponsored research, published data etc.

Yet 3 years ago I head a Microbiologist tell hospital management that the environment played no role in the spread of HCAI's. Last year I heard an infection control nurse tell a porter that it was Ok to take the patient bed out while the room was being sanitised and then bring it back in after. Last week I heard a nurse tell alcohol hand gel was effective at eradicating C.diff from their hands. Every day I see cleaners using wrong products and wrong techniques. How many believe that steam cleaning will kill c.diff ?

I have seen hospital refuse to even evaluate new technologies because they are convinced they will not integrate into a busy hospital environment. Despite the fact that they have already been integrated to multiple hospitals are over the world.

If you sit down with people and start discussing a topic its very easy to see who is keeping up with the latest research and innovations. Who is attending conferences, who is going to see the latest technologies. Its easy to see which hospitals are keeping up and constantly reviewing everything and then sharing that information.

I think most of us appreciate that it's pretty complex. But the issue really is whether we need to go to conferences to get the info. There's some nice data on iatrogenic spread of disease (though not nearly enough high quality interventional data), but it would be a waste of money, IMHO, to send people on a conference to listen to the data being presented.

opinion guy · 18-10-2010 06:17PM

knipex wrote: »

Its not quite as simple as you think.

Lets just concentrate on hospital hygiene (as it was the initial point raised)

Ten years ago the belief was that the environment played no role in the spread of HCAI's. (with one to two noted exceptions) If hospitals were cosmetically clean then it was good enough.

Based on that knowledge and that belief cleaners were trained, nursing staff were trained, supervisors and auditors were trained. Budgets were set based on that theory, bed management operated based on that theory.

Then people like Stephanie Dancer, John Boyce, Hillary Humphreys, Garry French and many others started re looking at the subject. The beliefs were turned on their head. it was discovered that not only was the cleaning regimen wrong, but the approach to cleaning was wring, the design of equipment needed work, the chemicals used were ineffective. The entire rule book was rewritten in a couple of years.

Companies got involved, the likes of Bioquel, 3M, Steris etc developed technologies, conducted or sponsored research, published data etc.

Yet 3 years ago I head a Microbiologist tell hospital management that the environment played no role in the spread of HCAI's. Last year I heard an infection control nurse tell a porter that it was Ok to take the patient bed out while the room was being sanitised and then bring it back in after. Last week I heard a nurse tell alcohol hand gel was effective at eradicating C.diff from their hands. Every day I see cleaners using wrong products and wrong techniques. How many believe that steam cleaning will kill c.diff ?

I have seen hospital refuse to even evaluate new technologies because they are convinced they will not integrate into a busy hospital environment. Despite the fact that they have already been integrated to multiple hospitals are over the world.

If you sit down with people and start discussing a topic its very easy to see who is keeping up with the latest research and innovations. Who is attending conferences, who is going to see the latest technologies. Its easy to see which hospitals are keeping up and constantly reviewing everything and then sharing that information.

Knipex I completely agree with you. Hygiene is important. I already retracted what I said - my memory of a story was off - I was in fact referring to a 60million training budget for catering and portering. Clearly 60million to train porters and caterers is ridiculous.

Nchd2010 wrote: »

Just to clarify, opinion guy you think:

Expensive short term substandard locums with poor quality control and no continuity of care as is the case at present is the answer to a long term problem

You think newly qualified doctors should be paid less than radiographers

You think doctors want to work long hours and be away from their family and have minimal free time

And you think individual doctors have no responsibility to society

Super!

I have said none of these things. You are trying to put words into my mouth. This is a strawman argument. I don't respond to strawman arguments. You may want to look up logical errors.

Nchd2010 · 18-10-2010 07:28PM

the individual doctor who has responsiblity only to the people he/she treats.

(My italics) I don't have time to find your other quotes at present. But at least in one instance, qed.

Problem is many docs WANT to work lots of hours for money

Edited to add second example. Bizarrely, given your attempt to dissociate yourself from your statements, your capitals.

opinion guy · 18-10-2010 07:31PM

Nchd2010 wrote: »

I don't have time to find your other quotes at present. But at least in one instance, qed.

You are twisting the context. Of course the individual doctor has a duty to society when it comes to certain things - for example reportable disease etc.
However in the situation where the hospital is forcing the doctor to work dangerous hours - the doctors duty is to the patients he treat when dangerously tired nad his duty is to challenge the system or remove himself from it. Clearly.

Traumadoc · 18-10-2010 10:00PM

i.e. emigrate?

tallaght01 · 18-10-2010 10:02PM

Traumadoc wrote: »

i.e. emigrate?

Not worth it. I had to get up at 5am this morning to watch the football :mad:

opinion guy · 18-10-2010 10:07PM

Emigrating is one option.
Only taking jobs that ensure EWTD compliance is another.
Locuming and enforcing your own dictate of not working more than X hours in one go is another.

There are many ways to take action.

Vorsprung · 19-10-2010 01:03PM

tallaght01 wrote: »

Not worth it. I had to get up at 5am this morning to watch the football :mad:

Invest in Foxtel!

opinion guy wrote:

This WILL make the HSE listen by the way. Here is the evidence that lots of locums will make them change:
http://www.imt.ie/news/features/2010...e-planned.html

I had a read of that article, and I have to say I'm less than convinced. Are these 2 year schemes aimed at non-EU medics? There's a mention of 80 odd new ED SpR training posts. There's currently about 8 SpR jobs up for grabs per year (I'm sure Traumadoc will correct me on that if I' wrong) and there are less than 40 ED consultants in the country. So it's about an extra 16 odd SpR jobs per year (assuming a 5 year scheme).

That's great. 15 people applied for the SpR last year. Where are these applicants going to come from? Have plans been put in place to hire extra consultants in the large hospitals (no is the answer I think unless things have changed since I was last home). If the jobs aren't there at the end, where is the carrot? It seems to me that people without the necessary time will get on the scheme, and you'll get less and less qualified 1st year SpRs floating around.

Am I understand that correctly as has my long day taken its toll?

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

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