HEART BEAT:It's becoming a struggle to cope as the work piles up
THE DOCTOR looked at the list. It was as long as Santa’s.
“Let’s recap Seán,” he said. “Your brother-in-law definitely needs a colonoscopy. Your mother should see the physiotherapist about her back. Your daughter, well, the acne should clear up with the cream I prescribed, but it will take a while. You yourself may have indigestion. I recommend that you get your heart checked, but you say you will chance it, which means that I have to chance it, too.”
He was interrupted by the sound of Mission Impossibleblaring from Seán's pocket. Seán whipped out the mobile and became immediately engaged in a technical and expletive strewn conversation.
The doctor sat back. It was the third time that the phone had interrupted them. He stared gloomily at his computer. There was no denying it was on its last legs. The bright young man who was trying to flog him the latest practice software for several thousand euro had contemptuously referred to it as “that heap of crap”.
Heap of crap it might be, but he remembered when he had proudly bought it with money he had saved by careful prescribing. Happy days.
He thought about the courses he had gone on, at his own expense, to learn how to use it. He remembered all the bright concepts of just a few years ago.
Chronic disease management, totality of care, the holistic view of the patient.
It seemed that they were making a difference. Now, thought the doctor sourly, I’m firefighting with fewer and fewer resources.
The doctor walked over to the window and muttered softly to himself. How am I supposed to manage a chronic condition on one visit? If I drag a patient back for regular review, I’m accused of profiteering. Anyone who had a medical card has lost it. Anyone who had money has lost that too, but can’t seem to get the medical card. If they do come in, they want about 19 things thrown onto the consultation. “Would you have a look at the child? It’ll only take a minute.” And all for less money than a fill of the car.
Would you ask your kid's teacher to give you a run over the modh coinníollach, outside the school? Would you ask the waiter to feed an extra person at no extra cost? Sure it won't take a minute.
He remembered what his mentor used to tell him. Every time you examine a baby you are taking the risk of anything going wrong unto yourself. If you take a quick look you’re sloppy. If you’re painstaking, they call you slow, and the next one in complains about being kept waiting.
Seán had finished his phone call, but he immediately pumped in some numbers and started swearing at someone else.
The doctor put his head in his hands. No respect these days. He would love to take on a partner or assistant but he was worried that his job would be put out to tender so he couldn’t even take anyone on. Retire at 68? He had read that doctors in the NHS who retired at 60 lived another 15 years, doctors who retired at 65 lived two. So I’ll be dead for a year by the time I get a penny, he thought. Great.
The health centre he had built with his own money was now a white elephant. He’d never be able to sell it on. He had suffered two savage pay cuts. He knew things were going downhill when the patients started stealing the good magazines from the waiting room.
The two receptionists were now the sole bread winners in their houses, and even though he could barely afford to keep one on he couldn’t just fire them.
Speaking of money, Seán was off the phone.
“How much?” asked the doctor.
“€75 call-out fee and €25 to unblock the toilet and €20 for the hour I’ve been here. No cheques please, strictly cash.
“Can you look at the outside pipe?”
“No can do, doc. Too busy. You know we’re flat out. It’s the same all over. A couple of years ago it was all buy new stuff, now we’re fixing everything. Cars, houses – you name it. Thanks, doc. Sure you’ve plenty of money, the prices you charge.”
The doctor sat for a long time after Seán had left. “I could do that,” he thought. “Fix things, keep them going. If only I was let.”
Pat Harrold is a GP in Co Galway. Maurice Neligan is on leave