Sir, - Brian Hurson, a consultant in St Vincent's Hospital, is to be commended for his diligence in personally treating non-private patients at his outpatients' clinics (October 10th). However, I fear he misses the point of Maev-Ann Wren's excellent series of articles last week, particularly with regard to the hold consultants have on the medical system, and the crazy way they are remunerated.
I think that nobody would begrudge consultants earning high salaries, as they perform a very responsible, skilled and vital service. But the understandable desire to increase their personal earnings (by treating private patients) means that the best-intentioned hospital consultant will always favour private patients over public. The minimum hours required of consultants to treat public patients are not properly monitored by hospitals; and the State salary is fixed regardless of the number of public patients personally treated. These facts mean that frequently the consultant is inaccessible to non-private patients.
My recent personal experience of vainly trying to get even a telephone conversation with the consultant of a public patient brought home to me that the only way of ensuring you get the benefit of a consultant's skill is to pay for it privately.
Unfortunately, like many closed-shop pressure groups which limit the number of new entrants and deliver an inadequate service because of their scarcity, consultants protest too loudly about their overwork, much of which is self-inflicted.
What is needed is a fundamental reform of the way consultants are paid. This should include some serious financial disincentives for favouring private patients over public and a system of accountability for time spent. After all, the public patients are paying for 90 per cent of the cost of the whole health system. - Yours, etc.,
David Cooke, Holmpatrick, Skerries, Co Dublin.