Time for a new broom

HEAR5T BEAT Maurice Nelligan I have been much heartened by responses to what I have written thus far

HEAR5T BEAT Maurice NelliganI have been much heartened by responses to what I have written thus far. These comprise ideas and suggestions from friends and colleagues and the general public, including articles and books for my attention. Many recalled the Dublin of my student days and reminded me of many incidents, not all of them printable, about our lives as medical students.

Inevitably, there are some folk who are not so happy about criticism of the system or indeed the Minister for Health. They are as entitled to their views as I am to mine. In this respect, however, I must point out that I have never encountered such dissatisfaction at all levels in the medical profession and in nursing and allied paramedical groupings.

The general feeling is that the health service is a rudderless ship, beset by a dense fog of over-

administration and shifting political winds. It lacks consistency and a clear sight of a safe anchorage ahead. There are plenty of gusts of hot air but little discernible forward movement.

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It is always difficult for working doctors and nurses to criticise the system. They perceive rightly or wrongly - and I believe rightly - that such criticism may bring consequences (bad) for themselves or their institutions. This does not apply to me now and I don't think it ever did. I have always felt it to be not just a right but an obligation to point out deficiencies and advocate reform beyond the usual channels if there is no other way. I do not say this for political reasons but change must come and come soon. Those responsible for creating this situation must accept the responsibility and the consequences. There is no point in saying "we got it wrong but now we'll try a different way".

You have had plenty of time in the Department of Health over the years, with successive Ministers and yet we have no coherent strategy, just grandiose and improbable plans with no realistic future. It is time indeed for a new system and a new broom. To quote one of Ireland's best loved Englishmen - Oliver Cromwell in his dismissal of parliament - "You have sat too long. Depart I say and let us have done with you."

This is a time for action, for humanity and caring, not for passivity and seemingly endless crisis management. To quote the Argentinian poet J. Hernandez in the poem The gaucho Martin Fierro:

"Yet don't let anyone take offence I don't plan any folks to gall;

If I've chosen this fashion to have my say,

It's because I thought it the fittest way

And it's not to make trouble for any man,

But just for the good of all."

It seems to be a part of the human condition that as things become ordered, coded and stratified, less and less work gets done. We have endless committees, reports, task forces, and the ultimate objective fades from view.

We need to return to simple, achievable goals. We need to employ the talents of the most able and appropriate and these are often the most critical people. We need to get to the essence and this will not be through sycophants and "yes men", be they political, administrative or medical.

Is there any field of human endeavour that has more experts than medicine? Some are real, some are self-appointed and this is an important distinction. The genuine articles by and large tend to be limited in their field while the ersatz variety claim a wide experience over broad pastures. My late father used to say, "if I knew half as much about anything as that ****** knows about everything, I'd consider myself a genius".

Medicine is a science albeit, as yet, an imprecise one and the problems inherent therein need scientists and genuine experts in other fields. We can do without the multiplicity of pseudo-experts who know little or nothing about how hospitals and general practices work, and what doctors actually do.

Far too long our profession has remained passive in the face of ill-informed criticism and has had the blame for the failures of the system attributed to them. To take the words of one of the founding fathers of the profession, Hippocrates(460 B.C.): "science and opinion are two different things; science is the father of knowledge but opinion breeds ignorance. Holy things are revealed only to holy men. Such things must not be made known to the profane until they are initiated into the mysteries of science."

Yes we are a holy lot, and the moral is clear. Shut up the rest of you and accept that doctor knows best.

Dr Maurice Neligan recently retired as a leading cardiac surgeon.