Sir, - We, the undersigned consultant obstetricians/gynaecologists, reject the unsubstantiated claims made by Ms MaevAnn Wren regarding consultants' work commitment in her series of articles on our health services. In particular we reject her claims that we do not fulfil our contractual and ethical obligations to our patients. Ms Wren should know that the Medical Council obliges doctors to "practice without consideration of religion, nationality, gender, race, politics or social standing." And, dare we say it, whether the patient is public or private.
There are 88 obstetricians attached to our public hospitals. We carry ultimate medical responsibility for the delivery of about 51,000 infants each year. While we would never claim that the service provided is perfect, readers - and in particular expectant mothers - might like to note that, according to figures published by the World Health Organisation, the maternal mortality rate in Ireland is the lowest in the world.
The three Dublin maternity hospitals are responsible for 21,000 deliveries annually. The ultimate responsibility for these deliveries rests with the equivalent of just over 26 full-time obstetricians. The 18 obstetric units attached to hospitals outside of Dublin are responsible for 30,000 deliveries annually. There are five obstetricians in each of the units in Cork, Limerick and Galway. The remaining 15 units are each staffed by three consultants or fewer, with two units staffed by single handed obstetricians. How can two or three obstetricians provide an on-site service for 168 hours a week?
The morbidity rate among obstetricians is far higher than that of their patients. More than any other group in the health services, we have campaigned for the appointment of extra consultants. Indeed the very reason for the meeting on October 7th, at which this letter was written, was to highlight the shortcomings in the State's obstetric services.
We reject the unproven claims that we delegate all or virtually all of our public work to junior doctors. We equally reject claims that our work, either in terms of quantity or quality, is not or cannot be monitored. Some of us have had outpatient and theatre sessions fixed for the same time and the same day for between 10 and 20 years. Unsubstantiated claims by nameless health officials that we cannot be monitored places a question mark over their competence and dedication rather than ours.
Health policy is decided by the government of the day. If we have a shortage of nurses and an over-dependence on non-EU NCHDs, or if we have the lowest acute bed ratio to population in the EU, or if the 850 admitting consultants cannot personally manage the 2 million outpatient attendances per annum, or if the national quota of 16 A & E consultants cannot provide a personal service to the 1.25 million attendees at A & E units, that is the fault of successive governments and not consultants.
It is not the profession that decides to keep some small, under-funded hospitals open; or to close beds without regard for the medical consequences; or to cancel theatre sessions at a moment's notice. Had the number of consultants in the public system grown at the same rate as the number of administrators over the past 20 years, and had our spending on health been more in line with our European neighbours, then patients would certainly have a better service delivered within a medically acceptable time-frame.
The standard of hospital medicine in Ireland is on a par with anywhere in the developed world. The problem of access to hospitals can and must be resolved by the Government. We do not decide government policy, but we do have to work with the consequences of government in action. Rather than resisting change, as Ms Wren claims, we are to the forefront in seeking such change both for our own sakes and that of our patients. - Yours, etc.,
Dr Paul Bowman, Coombe Hospital, Dr George Henry, Rotunda Hospital Dr Christopher Fitzpatrick, Dr Diarmuid Mooney, Dr Carol Barrykinsella, Rotunda Hospital, Wexford General Hospital, Dr Brendan Gill, Sligo General Hospital, Dr Peter Boylan, National Maternity Hospital, Dr Ray Howard, Dr Brendan Powell, St Joseph's Hospital, Clonmel, Dr Malachy Coughlan, Rotunda Hospital, Dr Mary McCaffrey, Tralee General Hospital, Mr Al Kennedy, Monaghan General Hospital, Dr David Mortell, Mullingar General Hospital, Dr J.J. Fallon, Louth County Hospital, Dr John Monaghan, Portiuncula Hospital.