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Two Weeks on a Trolley



Dr. Thunder, an Irish Paediatric Registrar currently working in Australia.



Updated: 2016-09-08T05:35:20.197+01:00

 



Vote Mick!!!

2011-03-28T06:19:20.932+01:00

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Don't vote Pedro, Vote Mick.

This post is a shameless plug for my friend Mick Molly, who's running for the Seanate in Ireland. Mick is the kind of guy we need in politics.

He's a doctor, who's worked in A+E for a long time, so he's knows all about Ireland and the problems facing our crumbling health system. He's been the president of the Irish Medical Organisation, and has been on the board of a regional health authority, so he also knows how health WORKS. he's been working in Harvard over the last 2 years or so, and has served on a pan-European body, representing the interests of junior doctors, so he knows how to navigate the global health environment.

As a person, he is incredibly helpful, incredible bright, and incredibly dedicated.

The Senate will hopefully start up Mick's career in politics, specifically in area of health politics.

For years, clueless politicians have run healthcare in Ireland.
This can change. Make sure that you check out Mick's site www.mickmolloy.ie and make sure you give him your number one.

This is my 100th post, and I'm glad to use it to endorse Mick for the position of Senator, representing my family and I. Voting is now open, so go and vote :D

Dr. Thunder





The downside of being down under.

2011-02-13T11:19:07.829+00:00

This blog, and many others are full of the joys involved in a move to Australia and New Zealand. A region where work/life balance is (usually) possible, and where we don't have to routinely watch patients die while they wait for outpatient appointments, or operating theatre slots.The weather is decent, there's lots to do, and our political masters don't seem to exist purely to screw up our education. Most doctors who come here never regret it.But there must be a downside, right? Of course, and many of them. So, here is the Dr Thunder MD official "Downside of being down under" list:1) Trying to get here: NIGHTMARE to get registered as a doctor. Very slow process, and they've outsourced the verification of medical qualifications to the USA!! This, of course, only prolongs the process.2) Patient expectation is higher: In my opinion (and I've been disagreed with on this topic on the blog before) Australian patients are more aggressively demanding than those in Ireland or the UK, often to the point of being unrealistic. Having said that, I think it's because they're used to a health service of a high standard. Whereas in Ireland, especially, we accept that we'll wait in A+E for 16 hours before seeing a doctor.3) Residents often rotate every 4 months: As opposed to 6 months in the European model. I don't think they get a good grasp of some of the specialties in 4 months. In fact, 6 months often isn't long enough for these junior doctors to get enough experience.4) Cost of living: In my experience, it's higher than in most places in Ireland and the UK. Though I found New Zealand much more reasonable. There will obviously be some regional variation here.5) It's a long way from home: Don't underestimate that side of it, especially if you're not used to living away, or if you're coming out for a long time. One of my grandparents passed away not so long ago, and I didn't get to say goodbye or go to the funeral.6) There's a craziness about cross-recognition of exams: We have a lot of very highly qualified paediatric doctors who come to Oz, and they have to re-sit all their specialist exams, because Australia won't recognise the UK/Irish ones (and vice versa), which is madness. We're all developed countries, and someone who has their postgraduate paediatric exams in the UK should be given exemption from those exams in Australia (and, again, vice versa).7) The place is full of GAMSAT course students: We won't go into this, as it's been covered to death on this blog, but we probably need to make the medicine course longer, not shorter, and I personally think that's reflected in the quality of many of the medical students. Though this is almost as much of an issue in Ireland too, as of recent years.8) Primary care: In contrast to the UK, primary care here is basically a business model. GPs can (and usually do) charge more for a consultation than the government pays. They also usually insist on patients paying cash up front and then reclaiming the money themselves. I'm not having a go at GPs. Anyone who reads this blog will know I have much love for GPs. But they are forced into becoming business people, and the financial realities of that inevitably mean that our poorer patients often can't afford to see their doctor, and get poorer follow up. It also means paediatric A+E is like a GP surgery, with a huge amount of "primary care types" of problems showing up. This will come as a bit of a shock to UK doctors in particular, who are used to a free-at-the-point-of-care NHS.9) Patients?: Not over here. Seems every second person is now referring to them as "clients". I heard some psych person call a patient a "consumer" the other day. I don't know why, but it boils my piss.10) The bloody chocolate: it's DISGUSTING!So, leave your comments below for the benefit of the hordes of UK and Irish docs fleeing their jobs. Remember, no positives. We've done them to death. This is all about the misery :DDr T[...]



the family doctor Vs the FAMILY doctor

2011-01-06T16:14:36.008+00:00

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I hate being the only doctor in the family. Aunts, grannies, nieces and friends of theirs all seem too keen to show me their bumps and bruises at any opportunity, in the hope of getting a quick diagnosis. I even had a relative show me his penis recently!

I hate this. Not because I don't understand their frustration at being stuck on a waiting list, or having to pay to see a GP. I hate it because I'm worried I'll get something wrong.

There's a meddling lady who lives near our family home, who brought her child around to my house when I was a 1st year medical student, and asked me to look at her injured shoulder. She'd fallen off a trampoline and landed on it. I'd never seen a broken shoulder before, and told her that.

"But what do you THINK might be wrong?"

I buckled and told her it didn't LOOK broken to me. But I told her I didn't know for sur, and that she should get it checked out in the emergency department.

IN her head that became "this shoulder is most definitely NOT broken, and there is no need to seek medical care for this child". Obviously, the pain persisted for a few days, and she got an x-ray....diagnosis = "broken" shoulder.

To this day she tells everyone who'll listen that it's a crime for me to be doing paediatric emergency medicine, as I can't even diagnose a broken shoulder.

So, today when my gran rang me to say she's getting "funny turns" I told her to see a doctor and she seemed disappointed that I wasn't offering a diagnosis. I don't want want to be that guy who can't even diagnose granny with x, y or z.

So, to the families of doctors out there, I ask you, on their behalf, to treat them like the clueless mucker you grew up with, and not as the professor of brain surgery that they actually are.

Happy new year to you all.

Dr. T





Kudos to you, Mr GP.

2010-11-05T10:25:39.382+00:00

Overheard in the supermarket today:

Mildly coryzal staff member: I've had this cold for 4 days now, and it's pissing me off. I went to my GP, and the idiot refused to prescribe antibiotics.

Other staff member: Seriously?? That's awful. You should change doctors.

Mildly coryzal staff member: Oh you better believe I will. I gave him a piece of my mind and told I won't be back to his crappy surgery ever again. He didn't care, though, and pretty much told me it was my perogative.

So, there you go. Props to that unnamed, unsung hero of general practice.

The future MRSA patients of the plant thank you :D

Dr. T



Why?

2010-10-29T11:13:15.224+01:00

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Dear baby Jesus. Why.......

1) do the sickest kids have the most difficult veins?

2) do the the kids with nothing wrong with them have the most anxious parents?

3) do doctors forget all non-bone related medicine as soon as they become orthopaedic surgeons?

4) do the kids with cancer always come from the nicest families?

5) are people not bothered when the doctor looking after their unwell kid has worked more hours than a pilot or lorry driver are legally allowed?

6) do we employ doctors from developing countries, when we know children in their home nations die in their droves for want of medical attention?

7) do the politicians always know better than us when it comes to health policy?

8) do we laugh when a baby pees all over us, but rush to change our clothes when Albert on the geriatric ward does the same thing?

9) do some parents oppose vaccination so strongly, while parents in poorer countries routinely watch their children die of tetanus and pertussis and other preventable diseases?

10) are physiotherapists and occupational therapists so much hotter than the general population?

If you can answer these questions (and any others posted in the comments section), Lord, then I shall return to church :D

Many thanks for your time,

Dr Thunder.





Long hours? Or a long time training?

2010-09-26T13:51:48.542+01:00

I’m not a fan of too much work. Over the years, I’ve done my fair share of long shifts, nights, weekends, public holidays, and combinations of all the above. I don’t function well when I’m tired and hungry and thirsty. And most patients don’t want to be seen by an overworked, sluggish, grumpy doc whose priority is a bed and some food. Certainly, I wouldn’t have wanted any member of my family to have depended on care from me after working 27 hours straight. I always thought my colleagues agreed with me. Enough miserable faces on the corridors of the various hospitals I’ve worked in made me feel a collective yearning for better conditions. I thought, therefore, that there would be widespread endorsement of the European Working Time Directive (EWTD) when it came into force in Ireland and the UK. The EWTD is designed to limit the working hours of doctors within the European Union. Depending on the stage of implementation, it can mean working a maximum of 48-56 hours per week. Of course, here in Australia, they’ve managed to do that without relying on international law. Down under, the rules for doctors’ hours seem to be enforced on a regional basis. In fact, from what I can gather, the rules seem to be MADE locally too. But, by and large, it works. Sure, I’ve been miserable and tired and hungry working in Oz, but I’ve never had to work 72 hours on the trot, let alone do it on a regular basis, as happens in Ireland. Forgetting for a moment that the Irish government has decided to simply ignore the EWTD, and continue to make their juniors work ridiculously long hours, I was amazed to learn that there are significant groups of doctors in the UK and Ireland who oppose the implementation of the EWTD. These doctors argue that registrars, like me, and other junior staff, need to be exposed to lots of cases in order to become proficient consultants. They argue that patients come to harm at the hands of tired doctors, but also from inexperienced seniors. I can see their point. However, I don’t buy it. I can’t accept that dangerously long hours are the only way, especially when urban Australia manages fine without total burnout of their medical staff. There has to be a middle ground. My take on the long hours culture is as follows: 1) If we juniors want to reduce our hours then we have to expect it to take longer to become consultants. Everything in medicine is being streamlined these days, and that needs to stop. We need to return to 5/6 year medical degrees, and long apprenticeships as house officers and registrars. 2) A lot of doctors' time is taken up doing admin work that anybody could do (chasing xrays, filling out blood forms, chasing blood results on the computer etc). These tasks should become the work of someone else, so that doctors actually spend their time doctoring. I remember as an intern working out that about 60% of my tasks could be done by a competent member of admin staff. 3) Our training is important. But so are our lives outside medicine. I sympathise with the wannabe surgeon who wants to work all hours, learning how to do craniozygomatic surgery. But, there are those of us who have wives, girlfriends, kids, and a family life. I want to be a good consultant. But I doubt I’ll look back from my deathbed and say “I’m glad I worked so much”. 4) Patients need to do more. Relatives, friends, patients and strangers are almost always sympathetic towards me, regarding the plight of junior doctors. But how many have ever raised the issue with a canvassing politician? I don't expect the public to have our interests forefront in their mind at election time. But this is about patient safety, as much as it is about modern day slavery. As things stand, the politicos and the media often betray us as greedy and as a vested interest group, and very little of that gets refuted.5) We have to be wiling to take industrial action. End of.[...]



Hi, I'm Dr. Thunder. What's your f*cking name, you little ****?

2010-09-08T06:05:17.721+01:00

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Maybe I'm getting old. Maybe the kids are getting a bit more ballsy. Maybe it's a bit of both!

This week I've been sworn at more in a single shift than ever before. This was a 10 hour paediatric emergency department stint, and there were 3 "incidents".

Normally a single episode of paediatric-potty-mouth is something you remember for a considerable amount of time, as it's reasonably uncommon. But maybe things are changing.


Episode one: I was putting a drip into an 11 year old. It went in nicely. Job done. Poor guy was a bit traumatised by the experienced, and when he regained his composure he screamed "Jesus fucking Christ, doc, that was fucking painful".

Episode 2: Another drip, this tie in a 9 year old girl. As it was going in, she screamed "SHITTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT" continuously. When it was all done, she turned around, with a big happy smile on her face and said "Thank you doctor", and started behaving exactly like a 9 year old girl should.

Episode 3: A teenager who just didn't want to be in the hospital. I came to speak to him, and he just ignored me. I asked his name. Nothing. Not a word. This wasn't unusual teenage behaviour, and it's relatively common. His mother got involved, and napped at him.."TALK TO THE DOCTOR NOW!". In frustration, He shouted "For F*CK sake, my name is Joe*. Happy now????".

You have to laugh, in all honesty. These are scared kids, who are all sick. It's a tough life being an unwell child. But I know I'd have felt an awful lot unwell if I'd sworn at an adult in front of my parents when I was their age!

But, as much as I'm supposed to be disgusted, they were the 3 most amusing interaction of the day :D



*Not his real name, obviously.



Another GAMSAT snoozefest from the desk of Dr. Thunder.

2010-08-28T05:17:08.828+01:00

zzzzzzzzzzzzzzzzzzzzzzzz. Yeah I know. I have an unhealthy obsession with GAMSAT. But I'm not just trying to be a bollix. It concerns me that the GAMSAT graduates I've worked with, and the senior GAMSAT course students I've taught, have been, in my opinion, less capable than their tradition course counterparts.I've expressed that view on here numerous times. Each time the comments section has been filled with people telling me that I'm a dinosaur, and my email fills up with people saying much worse.So, I decided to have another look through the published evidence to see if I've missed something. Though this entry won't be anything close to a literature review.For those who have never heard of GAMSAT, it is an admissions test for admissions to medical school. It's used in Australia, Ireland and the UK. Only graduates of other degrees can sit this exam. It tests rational thinking, scientific knowledge and written skills. Looking at sample papers, it's a straight forward enough exam if you put in some work, and have some scientific knowledge. Looking at the message boards on the net, it's pretty obvious that a lot of people are doing very well in this exam after a minimum amount of study. It's also obvious that a lot of entrants to medical school are scoring less in the science section than in the other sections.Having said that, I'm a great believer in evidence. In fact, it's become an obsession of mine in the last 2 years since I set up a journal club where I work, got involved in published research and did a masters degree with a significant stats component.But I just can't find the evidence for GAMSAT. It doesn't seem to correlate with med school results, whereas school leaving exams correlate very well (in the UK where this type of study has been conducted).I also read another study showing that GPA in a previous degree is a better indicator of med school performance than GAMSAT.Yet another study shows applicant selected by their GAMSAT results are less empathetic than those who enter via the traditional route.Then there's the study showing that GAMSAT grads are much more confident in their knowledge of cancer medicine than their tradition counterparts, but they actually know less.I didn't leave anything out in my search. I assumed there was a sentinel GAMSAT paper, on which the widespread adoption of this exam was based. But I couldn't find it. That doesn't mean it doesn't exists, as I used Pubmed, which is a relatively new plaything for me.I have to say that all the above rings through with me and a lot of my colleagues. I find GAMSAT grads and students to be extremely confident, regardless of how little they know. I have also long said that they have less empathy than I would have hoped. They themselves tell me the opposite is true, but I have yet to see this in practice. That is, of course, not to say they're all bad. I've worked with some fantastic GAMSAT grads and students, who will go on to be much better doctors than me. But I'd like to see a more evidence-based approach to med school applications. Does a degree really give people more "life experience"? I did a degree before med school. But I got more life experience outside of that....playing in bands, being involved in martial arts/boxing clubs, being involved in charities, being ill, being in relationships, summer jobs and my life in general. I don't think a few extra years studying and going on the piss has given me any more life experience.We're also often told that their extra knowledge of other fields is an asset to medicine. Sure, a recent resident of mine was a previous IT grad, so he could fix the computer when it went down, and we were able to access blood results again. But his 3 years at uni studying computers will mean he spends 3 years less as a paediatric consultant, which would have been more useful to the world in general.Some of the unis are telling us[...]



Who remembers their first emergency call?

2010-08-06T13:00:13.748+01:00

I think experience hardens us all. Nowadays, when I hear the emergency pager go off I stay pretty calm, and I know what has to be done. I know I have the skills to offer a high standard of care, and I know that I have a world class ICU in the same building to help out.But this sure as hell wasn't the case when I was an intern. On the nightshift, having only been a doctor for 5 days, the emergency beeper went off. This doesn't necessarily mean a cardiac arrest. It can just mean that a patient is heading for one if something isn't done quickly. Much of a muchness for a scared junior doctor, though.I heard the odd noise, and realised it was the red bleeper attached to my belt. The one I'd hoped might never go off. "222 ward 12" the screen read. When you get the location of an emergency as an intern, your first thought is "I hope I'm far enough away from this so that someone else gets there before me".I was on ward 11 at the time. Next door. Dammit.Anyway, no time to dilly dally. I strode into ward 11, trying my best to look confident as I walked over to the group of nurses surrounding a very very pale looking man in his 70s, who was desperately struggling for breath.medical school just hadn't prepared me for this. What the hell was wrong with this guy?? I knew a whole load of causes of breathlessness. But he was going downhill quickly, and I didn't have time to do a "medical school" history and examination. You know the ones I'm talking about...the examinations where you listen for renal artery bruits and ask about hobbies in the social history.First thing I decided to do was speak to him, and try to reassure him. But I couldn't. At least I couldn't get his name right. I kept mispronouncing his relatively simple name. I just got tongue tied. Needless to say, this inspired a world of confidence in me.Why aren't the rest of the arrest team here yet? I started some nebulisers, and asked the nurse to give him some intravenous steroids. Of course, his cannula wasn't working any more, so I had to put one in. My hands were shaking. My success with inserting drips was patchy at best. But I'd never been under this kind of pressure. I couldn't see a vein anywhere. So, I just rammed the needle into the part of his antecubital fossa where I knew there should be one! Thank god it worked.But he was still struggling. And I wasn't really sure what to do next.SURELY the team must be on the way. This guy needs aminophylline and ICU and central lines!!!! And we should probably intubate too!!!!With that, my Registrar and Senior House Officer (SHO) burst in. Looking at their sweaty, shaking, stammering intern they must have thought something awful was going on. But as I recounted the story, and the SHO examined the patient the registrar said "Ah, he'll be fine. Just keep going with the nebulisers, we'll get a portable chest x-ray, do a blood gas and ring me with the results. That was a nice easy one for your first emergency. Well done, kiddo".A nice easy one!?! Surely it doesn't get worse than this??Then the ICU registrar turned up, to see if we needed him. My Registrar said "Nah, it's nothing major. No need for you to be involved".So, there I was, living an event that will always stay with me. Yet it was "Nothing major" and "a nice easy one" all at once.To be fair, the registrar was right. In terms of what I deal with in neonatal ICU or in paeds ED, it's not much. But it was one of the scariest experiences of my career.So, was it just me? Or did anyone else loose half their circulating volume in sweat at their first emergency, and feign a stroke with their inability to speak?Dr Thunder[...]



Dr Under (the weather)

2010-07-03T06:51:46.037+01:00

Wow, April 2nd was the last post on this blog!

I've been out of action for a long time, and time has flown.

I was actually sick. I was on the other side of the fence, which is why I haven't been up to posting. I won't go into details of my medical condition, as it potentially makes me identifiable, but suffice to say I had pretty big surgery.

I'm well on my way back to greatness now, though!

It's taken several months to get back to some reasonable level of activity. But I'm almost there. I'm back running and cycling (though not much further than 2.5km in any given day). I'm also back to martial arts training, and I'm slowly getting back into boxing. Mind you, with my current fitness levels, 12 year olds are knocking me black and blue in the ring.

But it's all part of the process, and hopefully I'll be back to normal in a month or 2.

But I have to admit it's odd being on the other side of the doctor-patient relationship. Even allowing for the fact that the doctors I deal with usually give me some special attention (calls on my mobile after their clinic t have a chat about a result that's just come in, the surgeon phoning my parents back in Ireland to let them know everything was going well while he was taking a quick break during the operation), it's still not nice being a patient.

Waiting rooms are inhumane! I once waited 3 hours in the waiting room, while a clinic was running behind. The chairs are tiny, and the receptionists are cranky.

I once popped in on my way to work to leave a urine sample into the clinic for a dipstick. The nurse asked me to wait "a few minutes" while she did the test. So, I waited. And I waited. For an hour and a half! I went looking for her, and she was gone. So I just left. Never did get the result!

But, in fairness, however much we grumble about the health infrastructure, we really are very lucky to be able to get the care that we do. Most of the world's population don't have access to the type of surgery I had, or the support afterwards.

I'd like for this to be a learning experience, which could help me empathise with, and improve conditions for, patients. But, as always, I feel powerless to change anything.

So, the post-script to all this is that I think I have a better understanding of what patients go through. I think I have much more of an appreciation of how lucky we are to have the things we have.

But I don't know what to do with this lesson. All ideas gratefully received.

If there are any readers left, feel free to share your patient experiences in the comments section below.

Dr Thunder.





It's been a busy month in healthcare!

2010-04-06T14:56:40.282+01:00

I don't know what to blog about today. So many things have happened since my last post that I don't know where to start. So, why don't we have a little round-up of what's been happening:1) A large teaching hospital in Dublin (Tallaght Hospital) has been found to have 57000 x-rays lying around, that were never reviewed by consultant radiologists. Pretty shocking stuff. Luckily only 2 patients ran into trouble because of it (I believe), though that will be no consolation to those patients and their families. This is a direct result of the lack of staff in the Irish healthcare system. In many countries it would have brought down the government. But in good old Ireland, our trusty health minister, Mary Harney, continued her holiday to New Zealand when the scandal broke!!!I wonder did she catch up with any of the thousands of disgruntled Irish doctors and nurses working there, while she was visiting.2) In the same hospital where X-rays don't get read, it seems that GP referral letters don't get read, or even opened, either. 3500 letters were found to be unopened in the admin offices at this large hospital. These would be letters sent by GPs to consultants, asking them to see patients. The request could be for something minor, or it could be on suspicion of a life-threatening illness. Did this, on top of the x-ray scandal, bring Mary Harney back from her tax-payer funded holiday? No way! Why come back and provide leadership, when there are junior members of government to take the heat for you.3) Irish doctors and nurses unions have been in negotiations with the government over terms and conditions: GREAT!!! Does this mean they're discussing 24, 36, 48 and 72-hour shifts? Does it mean that they were going to try and make medicine safer for staff and patients by dealing with the dangerous working conditions that are the norm in Irish hospitals??Nope. They're negotiating so that frontline healthcare professionals don't have to pay extra to keep the health sector running over the next few years. Basically, the Irish economy is screwed. It's on it's last legs. So the government didn't have enough money to keep the public sector running over the coming year. They needed extra money, and fast. Most able-minded people assumed there would be a levy of sorts, where the population is charged extra, based on their ability to pay. This would make sense, as we all use the public sector, and we should all pay to keep it running.But no. The government decided that those who work in the public sector should pay the shortfall to keep the pubic sector running. So, doctors, nurses, unskilled labourers, office workers, police officers,teachers etc all had to take a paycut to keep their sectors running. Despite the fact that we don't use the public sector any more than anyone else, we had to pay for it. Despite the fact that junior doctors around the country are working ridiculous hours for free in order to prop up the failing health service, they were hit with a paycut to pay for the same health service that routinely screws them over.Of course, the public love it, as most of them work in the private sector, and can't see why the public sector workers are upset about all of this. Sure, the economic conditions have dictated that private sector pay has been reduced in many cases, and profits are down. But the only people taking paycuts for the benefit of the country are those who serve the public. The private sector have taken cuts to keep their businesses afloat, or to maintain their bosses' profit margins.Truly bizarre. But it's a about upsetting as few people as possible, and that strategy has been successful.Meanwhile in Australia, things are going pretty well for me. My training budget remains, and I can go to conferences and meetings. If I stayed in Ireland, I would be unli[...]



The 6 hour wait. This total con is coming soon to an Irish emergency department near you.

2010-03-06T04:57:33.706+00:00

Irish emergency departments are stretched to the limit. The above statement is no surprise to anyone who lives there. Sick people languish on trolleys for days at a time in crowded hospitals all over the country. The health ministry is the poisoned chalice of Irish politics. We've had the same health minister in place for many years, who has succeeded only in pissing off the staff, and improving some select health indices, while ignoring anything that doesn't fit into a succinct soundbite.Recently, our esteemed minister has realised how spectacularly unsuccessful her tenure has been.....so she tried her hand at deliberately misleading the public. Mary Harney told us that things are grannnnnd, as overcrowding in A+E departments has vastly improved, and that it's confined to a few repeat offender hospitals.BOLLOCKS!!!!!!I'm currently working in Australia, where we're fed less nonsense. BUT......we have less need to spin the issues over here. We have well staffed emergency departments, where the staff aren't exhausted, and there's senior support easily available. Australian politicians are as disingenuous as their Irish counterparts, if not more. However, they have no need to explain to the population why their elderly relatives are left to fester on uncomfortable corridor trolleys in overcrowded departments. That's because it doesn't happen. Back in Ireland, however, there are 3 options available to our political elite:1) Try a quick fix, in the hope of picking up votes in time for the next election.2) Do something about it. It might take time, it might take money, and it might not win immediate votes. But by looking at health as a problem that will need a consistent approach over time, it will reap benefits for the population.3) Lie about it. "Problem? What problem?" Ooohhh look.......a penguin!".Option 1 has been tried. As anyone with a rudimetary grasp of health would have guessed, it didn't work.Option 2 is, well, we all know that's never been a viable political strategy for politicians who have to get re-elected every few years.So, option 3 has been tried. Minister Harney seems to have been chilling in her office one random wintry day, just after we'd reached a national record of having 500 patients in A+E departments around the country who needed a bed, but were instead accommodated on trolleys. "How can I put a spin on this disaster?". "Is there any way I can get a few votes out of this?".So, she calls in her PR people: "OK guys. I want you to get in touch with all the broadsheets, and tell them that overcrowding is improving. Tell them it's only a problem in a few hospitals. And tell them it doesn't really matter if the elderly lie on hard trolleys for days, as long as they're being treated. And tell the tabloids that a monkey has been seen on the grounds of Beaumont Hospital. That'll distract them from the issue"."Em, excuse me, minister...." a young upstart in her media division may have said, as his more experienced peers shook their heads in despair...."...But last week we saw more people than ever waiting on trolleys in emergency departments, and hospitals that didn't have overcrowding problems in the past are now struggling to find beds. Oh, and there are studies showing that people are more likely to die or deteriorate if they are left on trolleys i overcrowded departments"."Well, duhhhhhhhhhhhhh. But do you think that would win me any votes?????".Obviously, that conversation is a figment of my imagination. But it beggars belief how one politician can spout so much nonsense, unchecked by her department.It's a given that politicians in Ireland are not the people we look to for guidance during tough times. We simply hope that we can survive, despite their interference. I had hoped that we could turn to our professi[...]



"The internet has improved the public's access to quality health information." Discuss.

2010-02-10T12:03:48.627+00:00

I heard a mother talking abut the MMR vaccine the other day. She said her first baby had it "because we didn't have the internet back then". But her subsequent children didn't, due to the "autism risk". Now that the Lancet have officially retracted the infamous Wakefield MMR paper, she says her children will be vaccinated in the near future.She regards this decision-making process as empowerment. And she's not alone. All over the world, patients come to see their doctor with reams of internet print outs. They say things like "I know what the diagnosis is, so can you write me a prescription for drug X".Undoubtedly, the internet has helped some people improve their healthcare. There are fora all over the web, where people with troublesome symptoms share stories of their eventual diagnosis, so others may prompt their GP or specialist to think about a similar diagnosis for them. The internet helps people compare GPs, hospitals and health tips. It's a source of support for those having children, or helping a loved one through serious illness. The internet definitely has its uses.But then there's the flipside. The sheer volume of information out there means the quality information gets lost in a sea of nonsense. Recently I was searching for some good info on thimerosal for a friend, who was worried about its inclusion in the swine flu vaccine. Googling "thimerosal" threw up pages and pages of conspiracy theories. Big pharma was supposedly trying to engineer a pandemic in order to profit off vaccine sales. The Americans were using the vaccine as a vector for microchips, which would be used to monitor the more troublesome members of society. And if you got the swine flu vaccine you'd join the ranks of those who went before you, in an early grave. This is, of course, the more extreme end of the spectrum. More worrying to anyone with a medical degree, are the amount of people who regard themselves as being well informed because they have delved further than the conspiracy websites. These people have......READ JOURNAL ARTICLES!!!!The mother I mentioned in the first paragraph told me she has "read many journal articles about MMR and autism" and went on to tell me about some of them. Now, anyone who has ever been on the receiving end of this type of scientific discussion will know that, on the internet, any concept of study quality, p-values, confidence intervals or basic study design go out the window, head first. There's no mention of the hierarchy of evidence and not a hope of comparing it to the existing literature.I'm not having a go at these people. I don't blame them for wanting to be informed. But my worry is that so many folk think they are highly informed about whatever drug they want, or whatever disease they may have. When the reality is they have just blindly accepted what's been written on the net by a stranger, rather than blindingly accepting what their doctor says. Is this really progress?I've been a doc for about 7 years, and I don't regard myself as fully informed on a lot of the stuff that's waved in front of me. But I do have the ability to judge evidence, and to ask the right questions, as opposed to just accept something as fact because of the eloquent prose.If I could get one message across to the public it is that just because something is a paper in a scientific journal does not mean we should take it as fact. Many (probably most) published papers don't give us "the answer". They give us a step in the right direction. Or the wrong direction in the case of the Wakefield paper.I think the best thing any member of the public could do in order to become more informed about their healthcare is to pick up an old style paper book on stats.As my old prof used to say.."If you haven't asked your[...]



I feel pretty useless right now. Mary Harney should feel the same.

2010-01-29T21:58:09.238+00:00

As the title says, I feel pretty useless at the moment.

I've been contacted by a friend of a friend in Ireland. Her baby has an agonising condition, and needs to see an Ear, Nose and Throat surgeon to have it treated. It's an easily fixable condition. Science has seen to that.

But science hasn't found a way to shorten hospital waiting lists for children in my home country. Sadly, we depend on our politicians for that, and they've been found wanting.
This family have been told their 10 month old baby will have to wait roughly 2 years just for an initial appointment.

Then they'll have to get scheduled for any procedure that the child needs, which will take another few moths.

This baby will be a 3 year old child by the time he gets sorted out.

They've contacted me in the hope I can do something. I'm a paediatrician, and I'm from Ireland. Surely I can do something to help...can't I?
They can't go private, as they're on social welfare. It costs almost 200 euros for each private visit, and that's before any surgery has to be paid for. Private care is not an option for these people. They rely on the state.
But there's nothing I can do. I don't know anyone at their local hospital. I've told them I'll have a think about it. But I know I'm just delaying the conversation where i tell them I can't help.

As well as feeling pretty low about the plight of this baby, I feel somewhat embarrassed to be associated (albeit pretty distantly) to a service where babies are given worse healthcare than many animals would receive. I'm reasonably sure that a pet owner or a farmer would find themselves in trouble with the law if they left an animal in pain for 2 years.

Mary Harney is the Minister for health in ireland. Rather ironically, when we consider how many cutbacks have been foisted upon the sick children of Ireland, she is actually the Minister for Health and Children.

I wonder if she feels embarrassed like me. I wonder if she's had trouble sleeping, thinking about these kids in pain, like I have.

Or will she continue to claim that Irish hospitals are failing because of the inefficiency of the staff?

I suspect we all know the answer.

Working in Australia, I'd forgotten about these problems. I'm amazed at the third world healthcare available to those without health insurance in ireland. I'm doubly amazed that the current minister has kept her job for the last 6 years.

I guess this blog entry is just a rant because I feel useless. I don't have answers right now. I don't know how to help this kid. I don't know how to help the hordes of other children in the same situation

I'm not paid to have the answers, though. But I guess I wouldn't be as worried if I thought our political masters genuinely cared. Because anyone who gives a damn about people would do everything in their power to make sure nothing like this happens on their watch.

I'm sorry this isn't well written. I'm sorry it's all over the place. I'm sorry it doesn't flow well.

But mostly I'm sorry I can't do anything to help this kid.

Dr. Thunder.



Before considering medicine as a career......

2010-01-22T22:19:08.077+00:00

......have a look at this anonymous post from an Irish junior doctor:http://www.boards.ie/vbulletin/showthread.php?t=2055799819The link is to a post in the health sciences section of a popular Irish discussion forum.While I think the doc in question has it worse than most, it's an interesting read for those thinking of going down the medical career path. Note the number of responses from other doctors, sharing stories of bullying. I think this is one of medicine's most shameful secrets.One piece of advice I would give prospective medical students is that you need very very thick skin to be a doctor. I've never had the problems with consultants that the poster in the link had. I've had my share of bollockings, and I worked with a surgeon for 6 months who did, by all industry standards :P, bully me for the duration of the job.I think I've been lucky, insofar as paeds attracts a type of doctor who's usually patient and caring. But bullying and abuse are most definitely part of the junior doctor package. Senior docs can give quite a lot of abuse (Ireland seems to be worse than anywhere for this...I didn't notice much bullying in Oz or New Zealand), nurses can be very harsh on junior docs (I found Australia and the UK pretty bad for this). Even admin have screamed at me in my time. It might be controversial to say this, but if you are female and from an ethnic minority, you are likely to get it in the neck more often than most (In my experience). But very few juniors get spared.The standard response from prospective students when you tell them about this issue is:A) But I know I'll love medicine, so I don't care about the other stuff.B) I'm going to find it hard to hold my tongue.Well, I've never met a doc who doesn't care about their working conditions. You spend most of your life in the hospital, and it's important to have a nice atmosphere. All the idealistic stuff doesn't play such a big part in your thinking once you're used to it. But how you spend up tp 14 hours of your day will always be important.As for holding your tongue...it's not that hard actually, wen you're embarrassed in front of a crowd of people, and your competence (which most junior docs have doubts about at the best of times) is called into question.I found that, until I was a registrar, it was open season on me. Anyone in the hospital would speak to me in any manner they choose. I remember what it was like. So, when the nurses on my ward ganged up on a young resident recently, I took them aside and told them to leave her alone or I'd report them all. Just like when my consultant heard about a consultant radiologist who tore up my request form in a rage, and threw it at me..he rang the guy there and then, and told him never to treat me like that again.I think we all need to stick together. I think senior docs have to watch the backs of the juniors more than they do. If I was advising the guy in the post above, I'd tell him to come to Oz or New Zealand until he's senior enough to defend himself.Though the fact that I'm even writing this post is a sad reflection on how we treat our juniors.Feel free to share your thoughts/experiences in the comments section.Dr. Thunder[...]



Dr. Ima Toilet

2010-01-07T17:47:25.470+00:00

So, what's the worst thing that's happened to you on the wards?A few of my non-medical friends were remarking recently how nothing can turn my stomach. No matter what we're wathing on TV, or what dead animal we see on the roads, I can just carry on eating, and acting like nothing has happened. I'd never given it much thought, but I was very squeamish as a youngster. Anything gross would have had me dry retching, regardless of where I was or who I was with.But I guess medicine and medical school gives you an iron stomach.I guess we are exposed to experiences that a lot of people would regard as abhorrent very early in our careers.Within days of starting medical school, we were cutting cadavers open. Not many 19 year olds operating within the boundaries of the law have had that experience.A particularly disturbing moment has stayed with me since the second year of medical school.We were dissecting an abdomen, which was filled with fatty tissue. To get through fat, you basically have to just pull it out with a massive tweezer and a scalpel. I was busily dissecting through the huge adipose layer, with the enthusiasm of a first year medical student. One of my colleagues was hanging over my left shoulder to try and get a glance. He was quite a keen student, but he hadn't mustered up the courage to get stuck in yet.So, I worked fervently, and was getting through to the prize that was the adominal peritoneum. As I got closer, I worked quicker. A small piece of fat flew from my tweezers. I watched in horror as it shot towards the guy who was standing behind me, with his mouth open.I can remember the huge hunk of human fat entering his mouth like it happened in slow motion. I still remember him swallowing reflexly as it landed in his mouth.GULP.And down it went. Jesus H Chist. I had just witnessed a colleague swallowing human fat. He turned white. Then yellow. Then green. Then he ran to the toilets to vomit violently for the next hour.Poor guy. It didn't help his anatomy phobia. But, bizarrely, he is now a surgeon. So, he must have learned to use a scalpel at some stage.There have been other moments that would make you grimmace. I remember being an intern on-call in a general medical ward in the UK. I was standing at the nurses' desk writing in a set of notes. Suddenly the back of my leg started to feel warm. I jolted and turned around to see a very elderly man standing behind me, urinating on my leg!!!!I jumped out of the way and he finished off on the floor, undeterred. But that's life, and I have to say it didn't phase me too much. I just pottered off, and got some scrubs. I was back on-call 5 minutes later.Paediatrics is full of things that would be gross if adults did them, but are considered cute when kids do them.I was resuscitating a baby at a delivery a while back, and he came around very quickly. So, as I was leaning in palpating the arteries in his upper thighs, he decided to have a pee. Straight into my eyeball. I was so stunned, it took me a second or 2 to jump out of the way. Like I said, disgusting if an adult did it, but because this was a baby, everyone just went "Awwwwwwwww".But I had to draw the line, when working in New Zealand, and classify a paediatric toilet incident as "gross". I was in A+E and saw a litte person who was constipated. I asked the nurses to put half a little dissolvable tablet into his bottom to shift the impacted poo. They weren't sure how to do this, as it wasn't a paeds emergency department. So, I said I'd show them.I leaned in and put the tablet into his bottom. Within a millisecond his bowels decided that A) They were going to work and B) They were going to make up for lost time.I was [...]



Time to outlaw the smacking of children. Seriously.

2009-12-30T19:21:43.576+00:00

Posted by: Dr. Thunder.Today I was in "The Square", a large shopping centre in Dublin. A young mother wheeled her trolley past me, and a small child was sitting in it. He was about 18 months old, and mum had let him play with a plastic bottle of milk that she was going to buy. As tiny curious people do, he threw it out of the trolley to see what would happen.Unsurprisingly, milk exploded all over the floor. Mum was very embarrassed. So, what was the first thing she did? Put the trolley over the spill to stop people slipping in it? Go and get a staff member to tell them?No.She slapped this tiny child across the face. I saw red. I was so angry. If she did that tme, a large male, she wold be arrested and charged. But it's OK to do it to a small toddler.I wanted to ring the police and tell the security guard. But there was no point. This behaviour is COMPLETELY LEGAL in Ireland.The baby looked stunned, and cried for a minute. But this obviously wasn't the first time it has happened to him. Will it stop him doing it again? No. He isn't old enough to know why he was hit. He isn't even old enough to know that it's wrong to throw a bottle of milk out of a trolley.I've been a staunch opponent of corporal punishment for as long as I can remember. I've heard all the arguments. I'm sick of "A smack never did me any harm". Well, smoking didn't do my 90 year old neighbour any harm, but anecdote shouldn't form the basis of policy. Plus some of the people who say it hasn't done them any harm are the most maladjusted individuals I know.I'm sick of the "I just tap him if he's bold" argument. Firstly a "tap" from a 20 stone man is probably quite painful to a child. And surely a "tap" that doesn't hurt won't have the desired effect.Aside from the fact that it's wrong for be to be allowed to hit a lid, when it's illegal for me to hit an adult, it's also not effective.Virtually all of the scientific studies and all of the paediatric bodies come to the conclusion that corporal punishent is the least effective form of punishment, and it can lead to problems in itself. I used to work in a paediatric behavioural clinic, and more problems are caused by smacking children than are solved by them. In fact, getting parents to stop hitting children is one of the first steps in improving behaviour.Smacking a child tells them A) Violence is an acceptable way t0 solve a problem and B) That their parents are not in control of the situation. A child who believes either of the above has the potential to be a disciplinary nightmare.I respect no-one who hits children. I know it's harsh. But I lose all respect for someone when they tell me they hit their kids. It's always followed by a nonsense excuse. But it's still assault in my eyes.The UK have gone some ways towards protecting their children. And special praise must go to New Zealand where they have banned the smacking of children in all settings. Sadly, Australia and Ireland (as always) are lagging behind. The Irish in particular have most to be embarrassed about, considering it's still legal to slap kids in reidential settings (though virtually all of these institutions have guidlines for staff advising against it).Both Ireland and Australia have a pretty shameful history of failing to protect the most vulnerable people in their societies. Outlawing corporal punishent would be a step in showing that we're beginning to take the welfare of our children seriously after all these years.Dr. Thunder.[...]



Irish healthcare workers feeling the recession blues.

2010-01-29T21:55:37.655+00:00

There's a recession in Ireland.A really BAD recession.We've had to stop buying new BMWs and 500,000 euro houses while earning 30k per year. That's no bad thing, it has to be said. But it's meant a pretty lean Christmas for a lot of Irish folk.So, a budget was called recently, to sort out this mess. This PR (and I mean that in the non medical way) exercise had, and will continue to have, signifcant repercussions for healthcare staff working in our beleagured public service. It was aimed at punishing those with a weak voice (with social welfare cuts) and placating those who tend to vote in greatest numbers (The private sector workers and pensioners).The public wanted public sector heads to roll, because they were angry at giving up their BMWs and 500,000 euro houses that they bought on credit. There was a bizarre thought process that permeated the private sector regarding the payment of all public sector workers. The logic was that "we've all taken pay cuts, so now it's your turn".The public sector is too expensive, went the argument, so the public sector workers have to pay to keep it running.We have hospitals that cost millions to run every month. We can't afford it, so we need money. Fair enough. The whole country uses these hospitals. So, how do we get the money? We take it from those people WORKING in the hospitals. A friend argued that he had already taken a 6% paycut while working for a large accounting firm, so he shouldn't have to pay for the hospitals and the police service and the fire service to keep operating. Only in Ireland.I'm just back from Australia for a holiday, so I thought I'd missed something. "But you've taken a pay cut so your boss's company can survive. That's exclusively for your company's benefit. But the public sector is used by everyone, so why do only the 1/6th of the workforce who work in it have to pay to save it?"I've asked this question several times, and have been told the following:A) The public sector are useless and "bloated". As this is a medical blog, I guess we should be focussing on whether that's true in healthcare. And healthcare workers took the same large cuts that everyone else did. In my experience in Ireland, EVERY SINGLE hospital department I've ever been in has been grossly understaffed. Pregnant doctors have been working 48 hour shifts. It's common to work 24 hours every 4th day. Now THAT is value for money!My sister used to work in medical records, and came home a shell of herself each evening. Another sister worked at a reception desk in a large hospital, until she got a much more sedate, and much better paid job in the private sector.B) The public sector are overpaid: This is more difficult to fathom. There are various reports that support this claim. But they compare averages. In the private sector, some people are on pheomenal money, but some people get left to the dogs with appalingly low wages. Averages work best when there's a normal distribution. The private sector has been quick to throw the crumbs to it's lower skilled workers for donkey's years. I don't think that should be applauded. My private sector friends have been almost boasting about how there are people in their offices doing long hours for a pittance while angrily frothing at the mouth thinking about public sector workers earning a fair wage.Then the comparisons with the UK start getting made (particularly in relation to doctors and nurses) and my eyes start to roll.People in Ireland look at the NHS as a utopia where fatcat doctors and nurses get paid a smaller wage than they do in ireland. It's probably true. But the morale of the doctors in [...]



Quote of 2009

2009-12-20T16:35:06.189+00:00

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Posted by Dr. Thunder.

I'm just on hoilidays at the minute, in the North of England. Last week I was walking down the street, and noticed a small frail nun standing outside a parish hall, just before their weekly saturday night service began.

Another little old lady, who looked like she's in her 80s, was hurrying home, when the nun waved to her. "Hello Carmel" said the nun.

"Oh hello, sister" she replied in a thick northern accent. "Sorry I haven't been to church recently. But the X-factor finishes tonight, so I'll be able to make it from next week".

And they say it's just kids who've got the X-factor bug!!!

PS...lots of "leaks" on the net tonight suggesting Rage Against the Machine have secured the Christmas number one. If this is true, it will make my Christmas :D

Dr. Thunder.



The antibiotic war.

2009-12-09T12:07:29.477+00:00

Posted by: Dr. Thunder.What are we doing wrong?Why have we not got the message out there about antibiotics?How come we struggle to get parents to give their kids life-saving vaccines, but we've convinced them to to demand an antibiotic for their little ones, at the first sign of a sniffle.I saw a 5 year old boy, Thomas, a few days ago in the emergency department. Thomas had a mildly elevated temperature, a runny nose, a sore throat, and a pain in the side of his head."We're here because we can't trust our GP any more"."Really? And why is that?"."He told us Thomas IS sick, but he won't give us an antibiotic", mum answered.As Thomas sat there on the trolley-bed watching his portable DVD player, and laughing loudly at the cartoon on his screen, I began to suspect that A) He did not have a bacterial infection and B) This consultation was not going to end well.I gave him a good look over, and concluded that he had an improving, self-limiting viral infection. Red ear, red throat, runny nose and a bit of a temperature. He was eating and drinking normally again, and seemed to be on the road to recovery.I sat down with Thomas' parents, and explained the difference between viral and bacterial infections. I told them that this infection seemed viral to me, and reassured them that their GP had made the right decision."Look, can we stop all the side stepping here? Are you telling us he's not going to get an antibiotic?"."I'm sorry. I'm not going to prescribe an antibiotic because.....""OK, can we get a second opinion. He gets these infections several times a year, and ALWAYS needs an antibiotic".I told them I'd happily get the consultant involved, but that this would take some time.They agreed to wait, and Thomas loaded another DVD to watch.After about 20 minutes they started to complain loudly to each other, as people do when they're trying to get your attention."I told you we should have brought him to the other hospital", dad said to mum, VERY loudly. "At least THEY know what they're doing".This went on and on, and I ignored them.20 minutes later, they got up to leave. On the way out, they told random nurses and patients int he corridoor that they were going to find a private doctor "Who bloody knows what he's doing".The thing is, I suspect they may have.These parents are very likely to have found a doctor who agreed to give Thomas some Amoxicillin. Then Thomas will have continued to get better, except for his antibiotic-induced upset tummy. In two more days he'll be right as rain, and they'll tell all their friends that the antibiotics cured them, and that the pillock paediatricians at the local hospital haven't a CLUE what they're doing.It has bewildered me for so long that we give out so many antibiotics without any justification. It's hard not to, and when I was a bit more junior I did so, when I couldn't stomach the fight. I don#'t resent the doctors who prescribe them easily. But I really wish they wouldn't.Anyone got any thoughts on what percentage of antibiotics given for acute respiratory illness actually result in improvement? I've no idea, but I'm sure it's very low.Dr. Thunder.[...]



To work in Ireland, the UK, Australia or New Zealand?..the choice facing thousands of junior doctors

2009-12-05T03:15:30.325+00:00

Posted by Dr. Thunder:As a registrar, who has worked in Ireland, the UK, Australia and New Zealand, I thought it might be useful to share my experiences here, in the hope of helping other doctors decide whether they want to trek halfway across the world in order to ply their trade.I've included my thoughts on each of the countries below, and what they're like to practice medicine in:Ireland: Oh Jesus. Juniors are still working shifts up to 48 hours. The European Working Time Directive will be implemented shortly, which will reduce the working week of doctors to 48 hours. In order to maintain a service, while halving the hours of medical staff, the Health Service Executive have decided they will simply ask the overworked juniors to work twice as hard while they're on the job. Simple.They will also be docking 30 mins per day from the wages of junior doctors for their lunch break. Just ask any junior doc if they get a lunchbreak. Even if they do, they're not allowed leave the hospital, and they still have to carry their pager. It's a total joke.Another disadvantage of being a junior doctor in Ireland is that the media, and consequently the public, think you're overpaid and lazy.The standard of medical care in Ireland is also likely to fall, as the universities adopt GAMSAT and PBL with gusto. It used to be very difficult to get a place at medical school in Ireland. Now, about 1 in 3 of those sitting GAMSAT get offered a place. Call it elitist if you like, but when I'm old and have a complex medical condition, I want someone who works hard and is brainy as hell treating me. To stop these GAMSAT graduates doing too much damage, nurse prescribing is also being introduced, which required the nurse to do about 6 weeks training to convert themselves into a doctor. Good times.Patients also routinely wait several days in the emergency department corridors on trolleys for treatment, as there are not enough beds.In the "pro" column, my family and oldest friends are in Ireland. So, I'll probably end up returning someday. But I'm doing postgrad qualifications so I can hopefully get a post in a university, or be based in Ireland whilw working for an aid agency.The UK: Also not a great life for a junior. Here you will find an imaginary 48 hour working week. In fact, they monitor you to make sure you're not working extra hours, by getting you to fill out an "hours diary". Essentially, you are expected to lie on this form, so your employer can ignore the fact that you work an extra 10-20 hours per week for free.My biggest peeve about working in the UK, was the famous "4 hour waiting time". This is possibly the greatest con in the history of medical politics. Essentially, what happened was the labour party government got tired of people complaining that they had to wait 12 hours in an emergency department to get treated. So, they announced"From this day fortwith, no man, women, child nor beast shall wait more than 4 hours in an emergency department".WOW, we all thought. That's going to require a hell of a lot of investment into acute services. Right?....Eh, yea,...sure.Obviously there was minimal extra invgestment. So, what happens is....the patient turns up to a crowded A+E department, and is seen about 3 hours later. So, they have some blood tests taken, which won't be back until 4 hours are long gone. You'd like to get a specialist down to see the patient in A+E, but they won't be able to make it before their 4 hours is up.The head nurse hassles the junior A+E doc to get this person home or onto a war[...]



2 Comments

2009-12-03T08:43:49.635+00:00

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Posted by Dr. Thunder.


Well, they said it couldn't be done......


A conference without drug company sponsorship.


It was a small gathering, but I was there. Last week I went to my first ever "pharma-free" conference. It wasn't big. It wasn't fancy. There was no breakfast provided. Lunch was a few sandwiches and a slice of cake. There was a dinner afterwards, which you could attend at your own cost.


The experts were mostly local. Nobody was flown halfway round the world on a first-class flight and put up in a penthouse suite.


But the information presented was pretty much as good as that presented at any other conference I've ever been to. The meeting was based in a large capital, so there's plenty of research going on locally to present. A couple of times, research was discussed that hadn't been conducted by the presenter, in a "new developments in....." format.


It was great. Nobody was trying to sell anything. Nobody was trying to con us into presecribing their new decidedly average wonder drug. The cost of attending hardly ate into our budget at all.


It was just doctors talking about the best science. I loved it.


I have real problems with the pharmaceutical industry. I have no problems with them developing lifesaving drugs. Let's be honest, we'd have much worse outcomes without the pharmaceutical advances of the last 10 or 20 years.


But the way they try and peddle their drugs, regardless of how effective they are, gets very tiring, and ultimately erodes any trust in them.


This was a small conference, though, and only a small step in the right direction. As things stand, there's a world of work to do in order to limit the interface opportunities between drug reps and healthcare professionals.


BUt this was one step that was supposed to be impossible. BUt it' wasn't.


Dr. Thunder.



A health-y appetite for the finer things in life.

2010-01-04T03:26:43.757+00:00

Posted by: Dr Thunder.Two of the most important people in Irish health circles are Mary Harney, the Minister for Health, and Professor Brendan Drumm, the CEO of the Health Service Executive (HSE).The HSE is, essentially, responsible for the day to day running of the health service. These are the head honchos. The buck stops with them.For years, doctors and nurses in Ireland have felt anger at both these public figures. They have lectured us on cost cutting, and the need for increased efficiency. In fact, professor Drumm is one of the main reasons why I chose to continue working in Australia, rather than going home to Ireland. I was visiting my family around christmas two years ago, and he came on the radio at my parents' house. He was giving a rousing oration, where he told the public how the front line staff in the Irish Health Service need to look at themselves, and to work harder, and to work more efficiently. This, to me, was a disgusting thing for a fellow doctor to say, while Irish doctors (including pregnant women) were still working shifts up to 48 hours long. I decided then that I would never work for a service with a man at the helm who was more concerned with populism and passing the buck than he was with the overworked demoralised staff doing their best in crappy conditions.Here is a man who has lost touch with the grass roots.This is a man who gave up his job in the understaffed specialty of children's oncology to earn big money running the HSE. Also, and this is VERY important.....professor Drumm spoke out criticising excessive bonus payments for senior HSE staff back in 2007/8. This fact will become important later.Then there's Harney, our erstwhile Minister. She has achieved a degree of popularity recently by "taking on" the "professional elites" such as doctors, pharmacists and nurses. In fairness, I do owe her a degree of gratitude, as her treatment of junior doctors mean I no longer feel homesick in Australia, as there are as many Irish doctors working here than I've ever worked with at home.One of Harney's favourite pastimes involves telling the public how healthcare workers are costing us too much. So, here we have Professor Drumm telling us we're not doing enough for our money. And Harney tells us we get too much money.Now, you would expect this pair of reformists to lead by example, if they're going to tell the workforce in a third world health system to tighten their belts and work harder. However, in a shocking development, which will rock the very foundation of the state, it has emerged that both Harney and Drumm are.......Talking out of their asses.We all know that expenses and bonuses are part of both political and business life. I expect a servant of our country to be able to fly first class, so they can do their work on the plane. I expect them to stay in a hotel with a business centre when they're away. I even expect people running the health service to get a bonus when things are going well.So, what do we know about Harney and Drumm's financial package?Well, we know that Harney and her husband (!?!) ran up a bill of almost 70,000euro over 3 years in JUST hotel and limousine costs. That's about 23,000 euro per year. On hotels and limousines!!!!!! How often was she going away???Then it emerges that she refuses to travel on commercial jets when going overseas. Instead, she insists on using the government jet. So, over the same period she ran up a ill of 750,000 euro on flights. That's a quarter of a mil[...]



So, will that swine flu vaccine give my kid mumps or what?

2009-10-17T13:00:54.321+01:00

Posted by: Dr. Thunder.I've just had my umpteenth conversation with a concerned parent about the swine flu vaccine. I'm starting to sound like a broken record now.Parents have every right to ask questions, when we consider what's been in the media, regarding this jab. It's a minefield of information, and it's difficult enough for those of us who work in healthcare to get our heads around it.I get asked a lot of questions about this vaccine. Some sensible. Some truly bizarre. I've had the crackpot conversations already, with the truly paranoid. We discussed mandatory vaccinations, and the big pharma conspiracies."This vaccine has been made to give us all swine flu""This vaccine has been made to stimulate the world economy""I've heard this virus was released accidentally from an American army lab, and they're trying to wipe it out, so unfriendly countries dn't get their hands on it".These people must live truly terrifying lives, if they're so convinced that government is out to get them.At the normal-ish end of the paranoid spectrum, I've had some unusual questions. But nothing prepared me yesterday for a previously sensible parent asking me, in hushed tones, whether I thought there was a risk of Anthrax from this vaccine!!!!!!!!Jesus H Christ!"It's just that I read it on a website".I tried to keep it calm. But I'm sure my face cracked a little, as the laughter tried to escape. I reassured Harvey's dad, and he was accepting of my explanation.Having said that, the concerns expressed to me have been, by and large, fairly reasonable. And those that are a bit crazy, have generally come from respectable looking websites, which are essentially conspiracy theory sites, or are peddling alternative meds. There is something ironic about these people claiming a big pharma conspiracy on hand, and trying to sell you expensive vitamin D "anti-flu" tablets at extortionate prices on the otherI feel I should put up a list of the common concerns here, and make an attempt to address them. Cleverer people than me might want to add some extra info too.1) This vaccine was rushed through the safety checking process: There's no doubt that the swine flu vaccine was made quickly. If there was a new vaccine on the market. it would take years to reach the market. But the swine flu jab isn't really new.Every year, we have different strains of flu circulating. We usually detect these many months in advance, and make a vaccine against them. The way we do this is by taking a vaccine mixture that is shown to be safe, and adding in the virus particle that is circulating this year. The virus particle is the bit that immunises you against a specific strain of flu. It is a part of the surface of the virus that your body will recognise. It is not live virus. This year one of the strains of flu is swine flu. We didn't know about it early enough to include it in the yearly flu vaccine, so we've had to make a new one. But it's almost identical to the seasonal flu vaccine that people get every year. It is very likely to be included in the normal flu vaccine next year.2) I don't need it as I don't have an underlying medical illness: Depending on the country we look at, we're seeing 30-50% of swine flu deaths and admissions to ICU in groups with no risk factors. Plus, vaccines are not designed to protect individuals. They're designed to protect communities. If you don't catch it, you can't pass it onto a baby, or someone else who will be less able [...]



Who are the trade unions kidding?

2009-10-10T10:10:41.898+01:00

Posted by: Dr Thunder.I think most public servants are underpaid. We all have the chance to work in the private sector, for more money and better conditions. We stayed with the public sector during the boom times, when all kinds of people were earning crazy money in the private sector.We have had to listen to the private sector telling us we were fools for staying put, for the sake of our patients, when there was big money to be made elsewhere. Now we have to listen to them telling us that we're overpaid and that our perks are too lucrative.I think, to an extent, the public sector have to suck it up. You take your risks in the private sector. When times are good, you earn big. But when things go bad, they go VERY bad.I have to say, though, the Irish trade union, SIPTU, have left me speechless recently. This trade union represents various public sector healthcare workers. Mostly nurses and paramedics. Oviously, these two groups do a vital job. A job that most private sector workers wouldn't have touched during the boom years in Ireland. But they stick with it, loking after the most vulnerable memers of society, under very trying conditions.They don't get a Christmas bonus. There was no free staff night out at Christmas for them. there is no health insurance.So, now their trade union has asked for a 3.5% pay rise for these workers.For those of you reading this from overseas, Ireland is in trouble. I mean BIG trouble. Think Iceland-Lite. I know there's a global recession. But Ireland is suffering a global recession, plus a national recession. There's just no money left. I wrote recently about how children's surgical services are being closed down because the piggy bank is empty. Unemployment is skyrocketing, and hundreds of thousands of familes are trying to survive on their weekly 204Euro social welfare payment, in one of the most expensive countries in the world.The people are fed up. They've seen politicians spend crazy money on lavish expenses, and they've seen the bankers bailed out with huge financial packages, while the self-employed don't even qualify for the dole when their businesses fold.The dole office is so busy, it's taking 3 months for applications to be processed.This is not the time to be asking for a pay rise.Healthcare workers continuously come out top of public opinion trustworthiness polls. There's a good reason for this. Healthcare workers are supposed to care more about the people than about money. I think that still holds true. But I think the trade union are trying to play hardball with the government.But how can we expect the public to have any respect for us if we're demanding pay rises in the current climate? The cost of everything is going down, so it's difficult to justify on the basis of inflation.For a nurse on 35k per annum, a 3.5 pay rise works out at about 20 euro per week extra, before tax. That is not worth alienating the public for.I hope common sense prevails. I hope our nurses and paramedics are rewarded when the economy turns a corner. I, and they, know that won't happen, though.But, in the run up to a very lean Christmas for most of the country, it's time to put the begging bowl away for now.Dr. Thunder.[...]