A chara, – As a doctor working in the area of mental health in Ireland, I was appalled and angered by Ann Marie Hourihane’s article (Opinion, April 23rd).
Doctors and nurses working at the frontline of Ireland’s health system are the first to recognise the glaringly obvious inadequacies in our country’s hospitals. We have to face those inadequacies day in, day out, and make the best of things. Instead of commending staff for their dedication in caring for patients in a difficult “fractured” hospital system, she launched an attack on both the nursing and medical professions.
To imply that nursing staff would punish a patient for complaining, that medical staff routinely withhold information from patients, that consultants spend their time hiding away from relatives is incorrect. Yes, sometimes nurses may not have as much time as they would like to speak with patients and relatives, but this is because they are generally under-staffed and under pressure. Yes, I agree it can be difficult to meet consultants at times, but this is because they have a huge number of patients to look after and are likely to be dealing with long ward rounds, over-booked clinics and full theatre lists.
In particular, her attack on psychiatric services “medieval fiefdoms . . . run by doctors” was outrageous.
I love my work as a psychiatric doctor and every day I, and all my colleagues, strive to engage with our vulnerable patients and their families with the compassion, care and respect that we would hope for if it were ourselves or our own relatives that were unwell.
It is extremely demoralising and frustrating as a hard-working doctor to read such an unfair and inaccurate piece of journalism. People in this country wonder why doctors are leaving Ireland; vilifying media coverage, as evidenced in this sensationalist article printed by your respected broadsheet newspaper is one reason. – Is mise,
MARY BUTLER,
Dromcollogher,
Co Limerick.
Sir, – Ann Marie Hourihane (Opinion, April 22nd) writes of the difficulty getting information about a patient relative in an Irish hospital. As doctors, our main concern and duty is to our patients, and privacy and confidentiality are paramount. We are required ethically, and under Medical Council guidelines to get express permission from patients to speak to their relatives.
Many patients request that we do not divulge certain information, and we respect that. Some patients are not in a position to give consent and it is the doctor’s duty to determine if breaking confidentiality by talking to relatives is in the best interest of the patient. Ms Hourihane’s approach of hanging around a ward to meet a consultant is quite foolish and I would strongly advise her, or any other relative, to make an appointment to meet with their relative and their doctors to discuss any concerns they may have. Appointments such as these are made on a daily basis in wards across this country.
Due to the many aspects of care we deliver as hospital doctors, from out-patients to procedures, to unforeseen emergencies, we are not available instantly and like to schedule meetings with patients and their families to minimise these clashes.
Contrary to Ms Hourihane’s view, the vast majority of doctors in Ireland believe that better informed patients do better, and strive to make sure our patients understand as much as possible about their disease. – Yours, etc,
Dr AUDREY DILLON,
The Richmond,
North Brunswick Street,
Dublin 7.
Sir, – Ann Marie Hourihane’s article (Opinion, April 22nd) has captured the reality of many patients receiving health services in Ireland. I can say this with the degree of evidence that comes from surveying over 25,000 patients since 2004 as part of my work with the Irish Society for Quality and Safety in Healthcare (ISQSH).
As a charity and independent organisation we have actively sought to promote patients’ rights and encourage patients to speak up about the care they receive, something that is not of interest to corporate HSE, but is of interest to individual hospitals.
The article rightly highlights many of the issues facing patients. There is no point lodging a complaint with the nursing staff, in the main they are overworked and under-resourced. If you are going to lodge a complaint do so with the CEO/hospital manager and do it in writing, alternatively you can contact the ISQSH, which is happy to assist.
Nearly a decade working in this environment has taught me that nothing else works. The HSE offers a complaints service but the results from our survey show that six in 10 patients do not know how to make a complaint and four in 10 do not believe they are actively encouraged to voice their opinion. To my mind this is adequate evidence that the system of the HSE looking after its own complaints is not working – yet despite this the HSE has taken the decision to terminate funding for a number of patient organisations including the ISQSH.
If patients can’t get heard now, while there are patient organisations battling for them, it will become next to impossible if the HSE is allowed to eradicate the independent watchdogs – patient organisations. – Yours, etc,
Dr HILARY DUNNE,
Chief Executive,
Irish Society for Quality &
Safety in Healthcare,
Bracetown Business Park,
Clonee, Co Meath.
Sir, – I was dismayed to read Ann Marie Hourihane’s article (Opinion, April 22nd) and regret she has had such a negative experience of our hospital system. My experience has been the opposite. My husband was re-diagnosed with cancer earlier this year and his treatment in Kerry General and Cork University hospitals has been wonderful, even though he is on a medical card. The care and compassion I received while he has been undergoing life-saving procedures has been second to none. We are indebted to the nurses and consultants here. – Yours, etc,
AVRIL ALFRED,
Tiernaboul,
Killarney,Co Kerry.
Sir, – Dr Shane Considine (April 24th) has understandably locked horns with Ann Marie Hourihane (Opinion, April 22nd).
As a UK medical student, then a medical educator in Ireland and UK from 1976 to 2006, I witnessed patient-centred concerns, such as communication skills and acknowledging the patient’s point of view, increasingly emphasised on undergraduate medical courses. As time went on, a balance was struck between knowledge of science essential for diagnosis and treatment, and the other “softer” concerns of feelings and attitudes that help us to imagine what it’s like to stand in someone else’s shoes. I don’t know what has changed in the seven years since I left that career, though it may be that this balance has been upset by process-driven educationalists.
From where I now stand, I hear that some patients and their relatives claim they are not told things that matter to them. This could be because they don’t remember what is said to them, that professionals are so busy that they can’t imagine how forlorn it feels to be a patient, that the prospect of litigation means that professionals won’t say anything until technology has provided evidence. It could be that some doctors have been educated in medical schools where, for whatever reason, patient-centred concerns are not valued as they are here. It could be that there is something that encourages doctors to think of themselves as set-apart, different from ordinary mortals. Many patients seem to want their doctors to be god-like and omnipotent, and yet complain when they act accordingly. The parallels with my present occupation are obvious. “White coat ceremonies” and graduations in medical schools, and the speeches made at them, are mystical ordinations and sermons by other names.
Medical professionals are human like the rest of us. We do ourselves no service by expecting otherwise. We do ourselves no service by refusing to accept that death is inevitable. I had a parishioner who was delighted – and yes, that is the right word – when the doctors told her there was nothing more that could be done. "At last", she said, "someone has been honest with me". – Yours, etc,
Revd Dr STANLEY
MONKHOUSE,
Rector of Portlaoise,
Dysart Enos & Ballyfin,
The Rectory, Coote Street,
Portlaoise, Co Laois.