Second Opinion Anthony CarrollThe right to advocacy on behalf of their patients has emerged as a major focus of contention between the doctors and the HSE representatives in the current contract negotiations.
That the absolutist position of the employers seems to be easing became evident at the 23rd agm of the Irish Medical Organisation (IMO) in Killarney last month. In her address, Health Minister Mary Harney said that while she did not want to enter into detailed contractual issues, she believed that advocacy could be carried out "consistent with normal obligations of a senior employee to team colleagues, to a clinical director and to an employer".
As the following account indicates, the occupancy of these trenchant positions on both sides was not always the case:
In 1976, the jitters of the secretariat of the Irish division of the Royal College of Psychiatrists coming up to the annual dinner were understandable.
After all at the dinner in 1974 the president, Erskine Childers, had collapsed and died and, the following year, because of a national crisis over the IRA kidnapping of Dutch industrialist Tiede Herrima, the new president, Cearbhaill O' Dalaigh, had cancelled all social engagements including the college invitation.
In 1976, however, all seemed on course on the day, that was until 5pm. Then the bombshell: it was announced from Áras an Uachtaráin that because of the government's failure to take appropriate action in the face of an insult by the minister of defence to the Presidential Office, the president had resigned.
Was the college jinxed? It was a brand new royal college, founded only in 1972, and now sister colleges, never enthusiastic about this new sibling, were grumbling out loud.
Clearly, the psychiatrists didn't know how to comport themselves. Giving them a charter had been a mistake. Psychiatrists after all were not proper doctors.
The following year, 1977, the Irish division changed course and instead of inviting the new president (would he have had the nerve to accept?) the minister for health was to be the honoured guest.
It was to be different and so it turned out. After a somewhat subdued but pleasant evening enjoyed by a smaller number of members, the chairman of the Irish division made a short speech and then invited the honoured guest to give his address.
The tension was palpable. In his gravelly drawl, for it was he, Charles Haughey thanked the college for its hospitality, praised the profession for its excellent work and acknowledged that psychiatrists laboured in unsuitable, indeed in disgraceful, conditions.
The old decaying mental hospitals, relics of Victorian times, were no place for distressed patients.
The inadequate staffing, the poor furnishings, the insufficient funding, such low standards were quite unacceptable these days and, in fact, had been tolerated for far too long.
The diners were riveted and hung on his every word. Such candour, such straight-speaking was unexpected from a politician. At last here was a problem-solver, a pragmatist who understood their difficulties. It was refreshing, indeed comforting to have the problems honestly addressed.
But what was the minister saying now?
"Politicians respond to pressure, they have to. There are so many demands on the public purse that they can only meet some of them, those pushed by the most insistent. We lived in a world of real politick."
He continued by declaring that politicians could achieve nothing if they didn't stay in office. So, if the resources were inadequate, if the premises were below standard, the profession needed to look at its lobbying, at the representations it made, at its strategies to get political attention.
He wished to improve the psychiatric service and so did the officials in his department, but their medical and surgical colleagues were competing for limited public funds. This was the real world. Psychiatrists should become advocates for their patients. Not only was this their right, it was their duty. They needed to become much more active if these improvements were to be funded and implemented.
The psychiatrists were stunned. What a performer!
They had been deftly wrong-footed, it was all their fault. With one bound he was free, the man who had just enjoyed a marvellous evening at their expense. What chutzpah! And now they were clapping, applauding him and for what? Was it traditional politeness and good manners or was it for his neat foot work?
When they had recovered from their awe, and having given the minister's comments mature reflection, the psychiatrists concluded that he was right. Indeed not only was his guidance correct as strategy, it was clear that it was their duty to their patients to advocate on their behalf. It was an ethical imperative.
That was then. Now this advocacy is out of order, and has been replaced by the department with the ethic of "loyalty to the institution".
There you have it, the scene shifts and the doctors remain in the wrong.
Dr Anthony G Carroll FRCPsych is a consultant child psychiatrist, based in Galway.