My Working Day:Dr Kevin D Quinn, GP on Arranmore Island, Donegal, says island living means he has to manage most medical problems himself.
As an island GP, my role is very much that of a rural GP magnified by the fact that I live and work in an isolated area which increases the responsibility of serving a defined population.
There are increased expectations on me to manage most problems myself without recourse to hospital - an outpatient appointment involves at least a day-long trip and might involve an overnight stay, especially in the winter.
My skill base in the management of acute situations needs to be well maintained and also of chronic complex illnesses and psychiatry.
My typical working day begins at 9.30am with the routine of post and e-mails, Morning surgery begins at 10.30am as Arranmore time is a little later than elsewhere and morning really starts for most around 11ish.
Mid-morning, I discuss matters with the public health nurse such as changes needed for ongoing care or terminal care patients and I follow up any calls from the previous day. I work through to lunchtime before going out on planned and unplanned house calls.
A typical day involves consulting with 15 patients in surgery and two or three house calls. The island population is very elderly with 30 per cent over 70 years old, so there are more house calls than the average practice. There are more elderly people maintained in the community with the support of informal carers such as relatives, home helps and home carers. Currently none of our elderly are in nursing care, which can be provided only on the mainland.
There is a strong tradition of caring for older people within their own homes as isolating them in a nursing facility on the mainland, away from family and friends, would be considered very harsh. At present, there are no respite or residential facilities on the island.
After afternoon surgery, I finish the day's paperwork and head home to walk the dog and, hopefully, have an uninterrupted dinner.
The most difficult part of the day job is paperwork and coping with bureaucracy and the inability of those in management to manage and make decisions based on local need.
One of the great benefits of the modern world to rural dwellers is access to the internet and electronic communication which, in my opinion, is still totally under-utilised. Access to authoritative online education enables people living in rural extremes to participate in processes that would be otherwise impossible.
We need to support the heroes in Irish society - the informal carers. Carers need social supports, but they also need financial supports to underline their value to society.
Respite care facilities on the island would be a big addition to the care of the elderly and also to maintaining the health and welfare of carers. There is also a need for increased nursing in the community to maintain the elderly in their homes for as long as feasible.