The debate sparked by Tommie Gorman's cancer documentary has put the spotlight on consultants, says Dr Muiris Houston
The letters pages of The Irish Times have been busy dealing with the aftermath of Tommie Gorman's reporting of his own encounter with cancer, following Kathy Sheridan's piece ( December 31st, 2001) and the RTÉ True Lives programme on the issue of cancer care.
Some of the contributions from hospital consultants have been labelled as arrogant and insensitive. Indeed the reference to knowing their monetary value and "to hell with the begrudgers" would seem to confirm many people's jaundiced view of the consultant body corporate.
The Irish Times has been criticised in the past for questioning the influence of private medicine on the way consultants run their practices. Correspondence of the nature we have seen in the last couple of weeks will certainly not help to change that view.
Yet, there is a need to look beyond this Harley Street image of monied medicine. The majority of hospital consultants of my professional acquaintance do not fit this particular mould.
There is a new breed of consultant in the Republic. He or she has returned from training abroad with a different set of priorities to those traditionally attributed to medical consultants. In the course of recent interviews with some of these doctors I have observed a singular lack of interest in pursuing private practice as a holy grail. The new breed has two principal professional aspirations: to work hard providing an improved service to their patients, regardless of their public or private status; and to continue to work at the cutting edge of medical research within the Irish health system.
Fourteen hour days are the norm for these doctors; not in the pursuit of private practice but to achieve their service goals.
Many have chosen not to set up a separate business in a private clinic but are to be found on the campus of our public hospitals all day, every day, dividing their time between wards, outpatient clinics and their research laboratories.
Such doctors are particularly a feature of our oncology or cancer-care services. The latter-day oncologist offers a consultant-provided service, best summed up by the experience of a patient who was deeply appreciative to be given the consultant's home telephone number and told: "you can phone me anytime for help". It is time to move the debate highlighted by Tommie Gorman's experiences on to considering how best we can improve cancer services in the State.
The National Cancer Strategy is already six years old and the need to update it has been acknowledged in the Health Strategy document launched by the Minister for Health in November.
The number of cases of cancer is set to increase by 50 per cent over the next 15 years. At present, one in three of the population face a cancer diagnosis in their lifetime; a quarter of these people will actually die from the disease.
There is still an unacceptable variation in the kind of treatment you will receive for cancer depending on where you live. Our survival rates for different types of tumour reflect this and in some instances fall seriously behind the rest of Europe and the US.
Bringing about change is not easy, as evidenced by the experience of a National Cancer Forum committee on breast cancer, led by Prof Niall O'Higgins, Professor of Surgery at UCD. Despite demonstrating a 20 per cent increase in survival from the disease if treatment was transferred to regional specialist units, the suggested improvement in the organisation of care became embroiled in electoral considerations of the worst "parish pump" type of politics.
The changes suggested by the O'Higgins group are, at best, moving forward very slowly, even though they would immediately solve the regional inequalities which have resulted in some women with breast cancer receiving only surgical treatment and being denied access to a modern, multi-specialist approach to the disease.
The availability of radiation treatment is a glaring deficiency in our national cancer service, reflected in figures which suggest that on the new changes, as few as 20 per cent of cancer patients receive radiation oncology, when international experience suggests it should be at least 50 per cent.
By developing dedicated cancer centres in the Republic - as advocated by Dr Crown's article (January 9th) - all necessary expertise and treatments will be available on a single site. With satellite units feeding patients into such centres, there should no longer be any excuse for inequitable treatment, either on geographical or "ability to pay" grounds.
CHANGE is never easy, but when it is implemented, it can have a powerful effect beyond the immediate area which has been improved.
Take breast cancer screening as an example. Because the screening centres in both the Mater and St Vincent's were properly funded and organised, it quickly became apparent that patients diagnosed with breast cancer as part of screening were receiving a much better service that women presenting to the same hospitals with symptomatic breast lumps. Both the speed and quality of treatment in the symptomatic surgical services were improved to the level of that offered by Breast Check, as hospital authorities realised that to do nothing would leave them open to the indefensible charge of introducing yet another example of "two-tier" health care.
Not that Breast Check is perfect. We have still to be given a confirmation date for its expansion nationally. With a limited number of mobile units, the service covers the east, midlands and north east.
But a shortage of radiographers notwithstanding, it is surely unacceptable that the women of the west and south have still not been afforded the same opportunities as their sisters in the east to effectively avoid a cancer death sentence. The success of Breast Check, albeit geographically limited, should already be replicated in other areas. Yet with the exception of a localised cervical cancer screening programme in the mid-west, we are still awaiting concrete plans to set up screening services for other cancers such as cancer of the colon. We need action on these now.
The big three cancer killers in the State are tumours of the colon, lung and breast. We have no screening process in place for two of them.
In the case of lung cancer it has been suggested that it is "the forgotten disease". Because of its strong association with smoking and the choice of some to contribute to their own demise, a recent conference heard that lung cancer, which particularly affects lower socio-economic groups, was not receiving the priority it deserves.
Cancer kills but it can be prevented and it can be treated successfully if caught early enough and managed according to best international practice.
The question must be asked: are we serious about giving the new breed of hospital consultant and their multi-disciplinary team the means by which to achieve their goals?
Dr Muiris Houston is Medical Correspondent of The Irish Times