Madam, - After spending morning, noon and night over the past few days wading through thronged emergency departments, trying to alleviate distress and expedite the care of patients of all ages and sorts, I was taken aback to find the likes of me portrayed by Marie O'Connor as an "arcane sub-specialist", installed at the insistence of the wicked Royal College of Surgeons so as to create an "empire" of emergency care (Head 2 Head, November 5th).
And I was positively flummoxed to read that "until recently, A&Es [ in Ireland] were run satisfactorily by general surgeons and physicians" (sic).
Neither of these assessments is remotely true, of course. As a consultant in emergency medicine, I am self-evidently a generalist filling the void (understandably) created by the many doctors who wish to stay as far as possible from the human landfill sitesthat are Ireland's emergency departments.
As for halcyon days, in the 1970s I attended casualty departments throughout Leinster and regularly received woeful treatment by ill-supervised doctors, often after agonising waits in Victorian squalor. I do not recall ever seeing - as a small patient or a junior doctor - a consultant treating patients in an emergency department until I went to Edinburgh to train in the mid-1980s.
Terrifying tales of mismanagement throughout Ireland's healthcare frontline were legion then and impelled me - and many others - to pursue a career in the emergency department, striving for better care of the 1.26 million patients a year who hurry to Irish hospitals after a mishap. There are still far too few senior doctors employed to deliver the optimal care of this industrial number of patients (mainly by getting away from the kind of medical "absentee landlordism" that led historically to avoidable deaths, disability and devastating legal costs).
We have a long way to go, especially in those departments where there is little or no dedicated medical expertise, but progress has been made. Ms O'Connor's imputation of mercenary motives is barely worth refuting, given ministerial prohibition of private practice by consultants in emergency medicine.
Finally, modesty precludes even an abbreviated list of achievements by the doctors (reportedly mad, with-short-attention-spans) who "specialise" in emergency medicine, but anyone with a real interest in good patient care - and its vital advocacy - can visit www.iaem.ie (website of the Irish Association for Emergency Medicine).
Like the Health Services Action Group, I am devoted to "organically sized" hospitals but, with friends like Ms O'Connor (and her strikingly bureaucratic aversion to speaking to the people she derides), the HSAG will need few enemies. - Yours, etc,
Dr CHRIS LUKE, Consultant in Emergency Medicine, Mercy University Hospital/ Cork University Hospital, Cork.