Doctor X takes on flawed system

He might be shy about giving his name, but in all other respects this young doctor is not backward about coming forward.

Identified only as ‘Doctor X’, this male Irish doctor – who might have spent some time in the US – has laid into the Irish health establishment and listed its many flaws in his book, The Bitter Pill: An Insider’s Shocking Expose of the Irish Health System.

In the book Dr X says he did his medical training in Ireland and has first-hand experience of at least 10 hospitals, and interaction with many others. Apart from that he won’t say who he is, and his publishers, Hodder Headline, say he is determined to remain anonymous, mostly because of fears that he will be punished by the system and lose job opportunities.

However, in The Bitter Pill, he relates that preferment is already the prerogative of consultants, who choose young colleagues they like, and most importantly, who do not make trouble or question their decisions. Non-Irish doctors are also behind the eight ball when it comes to promotion, he says, in a chapter on racism within the health system.

Dr Altaf Naqvi, a consultant surgeon in Ennis, Co Clare, is currently compiling a study on racism within the health service, due to be published before the end of the year, he reports.

Doctor X took the bold step of going on RTE radio on September 28, where he sounded male, robust, and possibly with an American influence in his voice. He told ‘Morning Ireland’ that the two biggest problems in Ireland were lack of accountability in the Health Service Executive, and the two-tiered system of private and public health.

“Consultants hold all the power in the Irish system, and that is one of the main problems,” he said.

The Bitter Pill devotes a chapter to his criticisms of the two-tier system. “In order that a private health service can justify its existence, it is necessary that it offers a better service than the public health service. It follows, then, that the public service is below-par and therefore unable to deliver best practice,” he writes.

Among the many flaws he describes is the fact that consultants are often not in a hospital when one of their patients is ready for discharge, because they are at their private clinics. This can mean that a patient who is ready to leave must stay in hospital, sometimes over a weekend, with all the attendant costs on the system and the ‘blocking of the bed’ for the next sick person.

Dr X points out a number of financial illogicalities, such as the €350,000 per person it costs to send patients to England for certain procedures when they cannot be treated here within a reasonable time frame. He goes into some detail about the lack of magnetic resonance imaging (MRI) scanners, and the trouble, paperwork and expense in getting patients to hospitals which have MRI equipment. Were more MRI units purchased, the cost would be recovered within tow years, he claims.

Unlike, for example, Marie O’Connor’s excellent book Emergency, Doctor X does not give facts and figures to back his anecdotes. Many of his examples are stories of what happened to him or medical staff he knows. As a personal account, however, it does have impact. And the stories all ring true from what we know of the health service and its difficulties.

A strong theme in the book is the excessive hours worked by junior doctors, and the potential dangers to patients. Irish health service doctors officially work a 58-hour week, with 2009 as the deadline for a EU-imposed 48-hour week. However in reality many junior doctors work much longer hours. In the book Doctor X recounts how one of his colleagues was killed in a road crash when she was driving home after working 32 hours straight.

A very worrying observation Doctor X makes is that, because of little practical training, many doctors qualify without being competent to take blood or insert cannulae (tubes, as used in intravenous equipment). He cites his own experience, of having to take blood his first unaccompanied day on a ward, and the numerous attempts, causing discomfort and then anger to the patient, before he succeeded.

Doctor X also identified radiology as an area which needs radical overhaul, mostly because of lack of personnel and a huge demand for scans. “Radiology is the apparatus that keeps the whole machine moving,” he writes in a chapter devoted to the subject. However he describes it as a ‘massively in consistent service, with the only consistency being the universal lack of resources’. The consequences are felt at every level of patient care.

The system was very formal and junior doctors were not allowed to disturb radiologists by speaking to them directly, he said in his radio interview.

Doctor X also runs a blog, “As a junior doctor who is sick of seeing nothing being done, I hope to spark honest, open debate of the issues,” he writes.

The Bitter Pill: An Insider’s Shocking Expose of the Irish Health System is published by Hodder Headline and costs €12.99.

Emergency: Irish Hospitals in Chaos, by Marie O’Connor, is published by Gill&Macmillan, approx €12.99

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