Heart Beat:With a few notable exceptions, mostly in Cabinet and mostly PD, the rest of us are not born knowing everything.
The acquisition of knowledge is a slow business. Most of us are taught; some with experience, research and further learning may go on to teach others. Perceived truths and hence knowledge can change, requiring adaptability and the blessing of an open mind for both student and teacher.
In medicine this is acknowledged in the Hippocratic Oath with its strictures to respect our teachers and to pass on the torch to those aspiring to practice the art. This brings me to my problem. Recently I heard a colleague on radio declaring that his unit, when fully operational, would deliver a consultant-provided rather than a consultant-led service and that, in consequence, it would be more efficient.
This may be the case and it certainly fits comfortably with the claptrap emanating from the Minister for Trolleys and her cohorts in the Department of Health and the HSE. It leads me to ask a pertinent question: Where did this individual acquire his experience and training, or was he propelled on to the Olympian heights of consultancy without undergoing the pilgrim's progress that was the lot of the rest of us?
You don't just burst ready formed from the egg. Someone teaches you, a system trains you, and you acquire experience and competency in a gradual supervised fashion. In time we also must pass on our knowledge. We forget this at our peril or, worse still, to our shame.
Such sentiments expressed in the plush surroundings of a new private hospital may have seemed the right thing to say at the time. It, however, blithely ignores the reality that all medical, nursing and paramedical staff have to be trained, almost invariably in the public system, and at great expense.
It would have been expected that those so privileged would in their turn pass on their knowledge. Sadly, in this mercenary world, this appears to be no longer the case.
Think about it folks. All your doctors had to learn. It was structured learning but like all human activities far from infallible. In surgery, you started by stitching, closing operative wounds, minor operations for lumps and bumps, ingrowing toenails, etc. You moved on to appendicectomies, hernias, haemorrhoids (piles) and thence to gall bladders and bowel surgery. Over all of this activity there was a leavening of trauma, fractures and emergency surgery.
Initially you were an observer or second assistant, then first assistant, finally the operating surgeon. You were not alone and you were not let loose on your fellow citizens until it was felt you were ready. This was a judgment call of the consultant, maybe sometimes difficult. It was not, as a recent report adjudged, undue delegation of work to junior doctors. It was part of the consultants' duties and of our training. This principle holds good in every country and medical system I know. You could learn only so much from lectures, books and models. Sooner or later you had to step up to the plate.
The surgeons who taught me were not lazy or careless men. They carried the burdens of their responsibilities with care. They worried about their patients and they kept a close eye on us and our progress. We, in turn, worried about our patients and, above all, about our abilities. You out there, blissfully unaware of all this, didn't worry. It did not occur to anybody that they might be Mr X's first solo operation. Realistically, however, you had to start somewhere, it might have been with you!
All of this is pretty obvious really if you think about it, but as always in health matters there seem to be problems with perception and joined- up thinking. Such wooliness pervades the system. We have smokeless pubs and workplaces, we have safe working environments, and we are told we have no poverty. We have laws against drink-driving and drugs and possession of guns. We are terrific really.
How come then, that none of it seems to work properly? Approximately 30,000 of us have the temerity to die each year and I guess they always will, although they may last a little longer and cost us all more money. Despite all the good folk out there worrying about what we eat, smoke, drink or how we otherwise injure ourselves, we continue to behave irresponsibly. We always will, we're human beings.
The problem is that for those sick, whether self-induced, accidental or consequential upon just being alive, the facilities to look after you in the bad times are woefully inadequate. Prevention of disease, worthy though it may be, and aspirational as it is, will not obviate the necessity of providing proper care and facilities for those sick now.
The delivery of healthcare in this State has not worked and this was never more obvious than now. It is time for change, serious change. It is time to admit failure, to eschew lies, prevarications and half truths, and to urgently look for answers.
It is time for new ideas and new faces. The doctors and nurses know this, the patients know it too. We've all had enough contradictory nonsense, unfulfilled promises and spinning designed to avoid facing the stark realities.
Call it what you will, laissez faire, paralysis, incompetence, indecision, that's what we've got. The cure for this particular illness is in our own hands.
Maurice Neligan is a cardiac surgeon.