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Junior doctor’s strike shows Irish health service needs a cure

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Junior doctors counting ballots prior to approving industrial action in Irish hospitals next week.
Junior doctors counting ballots prior to approving industrial action in Irish hospitals next week.

Next week many of the thousands of junior doctors who actually do most of the work in Irish hospitals are due to go on strike.  And the interesting thing is that, unlike most strikes, this potentially disastrous threatened strike is not about money. It's about grossly excessive working hours.

For years the junior hospital doctors here have been pleading that their working hours should be reduced.  Many of them routinely work 70 or 80 hours a week and 100 hours is not all that unusual.  

Within the very long working week they occasionally have to work very long individual shifts and sometimes -- with cutbacks causing staff shortages -- these non-stop shifts can extend up to as much as 36 hours.  
Junior doctors have talked about how they don't have time to eat, rest, or even to go to the bathroom at some stages.  They have talked about being so sleep deprived that they are out on their feet some of the time, a situation that is dangerous not just for the patients but for the young doctors as well.  

Efforts are now underway to try to avert the strike, due to start on Wednesday of next week.   But given that this disastrous situation has been continuing for many years  and nothing has been done about it, sorting it out at the last minute is not going to be easy.  

The fact that hospitals are under ever greater pressure these days and that winter -- the worst time for hospital admissions -- is almost here doubles the difficulty.

What the junior doctors are demanding is an immediate end to shifts of more than 24 hours.  They also want a detailed plan on how the Irish national health authority, the Health Service Executive (HSE), by the end of 2014 is going to comply with the European Working Time Directive, an EU rule which says workers should not have to work more than 48 hours a week on average.

Incredibly, when this EU law came into force around 10 years ago junior hospital doctors in Ireland were excluded because there was a recognition that it would take time to solve the Irish situation without putting sick people here at risk.   Since then little or nothing has been done.  

Now it's crunch time, and the junior doctors are in no mood to back down or moderate what they are demanding.  They know that if they do the issue will be put on the long finger once again.

So why do the 4,500 junior hospital doctors in Ireland have to work such long hours?  There are a number of reasons, some of them very complicated.  

First of all, there are not nearly enough senior hospital doctors and consultants, who maintain their position and their very high earnings by preserving their elite aura and status.

A new deal has now been hammered out to increase the number of consultants, limit their huge earnings and make them more available in hospitals, but the changes are not extensive or immediate enough to correct the structure of our health system which is still badly skewed.  The fact is that most of the load in our hospitals for all the routine care still falls on the junior doctors and nurses.

The situation is exacerbated by the cutbacks in recent years.  In smaller Irish hospitals in particular with fewer junior doctors available, staff cutbacks and absenteeism mean that overtime has to be worked at pressure times to avoid a crisis.  

Junior doctors would do this anyway, but they are expected or even required to do it by hospital management under their terms of employment.

The obvious answer to the problem might seem to be to train a lot of extra young doctors so that we have a bigger supply for our hospitals.  But it's not as simple as that.

It costs the state a small fortune to put each new doctor through university here because medical students pay only a fraction of the total cost of their medical education.  If you get a top score in your high school leaving exams here you get enough points to do medicine in college, and the state then pays over 90 percent of the cost.  

Even if the state had the money to produce more junior doctors, the fact is that around 75 percent of them emigrate once they have completed their compulsory one year hospital internship after finishing college. They have to do this year to be fully qualified but once it's over, most of them are out of here.  

And it's not that they leave just to get more money in other countries, because  junior hospital doctors here are well paid (their pay is higher than in Britain, for example, starting at around €30,000).   Working overtime they can easily double that,  or even triple it.

So it's not primarily about money.   They leave, they say, because they need to get experience in other countries where medical technology and systems are  more advanced.  

Some do come back eventually to be senior hospital doctors and consultants, but a lot of them never return.   Which means that the Irish state is funding the very expensive education of a lot of Irish doctors now working in the U.S., Canada, Australia and elsewhere.

This causes justifiable anger among taxpayers here, yet no one seems to know how to stop it.  The medical profession opposes any restriction of their ability to work abroad after graduation.  

One way might be to require medical students to sign contracts to work in Ireland for five or 10 years after graduation, the only exception being students who have paid the full cost of their own education.  But this is also opposed.

The main reason they leave is that they cannot cope with the horrendous working hours.  They can earn as much abroad without having to work a 70 or 80 hour week.

And they can then come back after 10 years or so when they have enough experience to be consultants and join the very highly paid elite of the Irish medical profession.

The real answer to all this involves reducing the God-like status of the consultants, and having far more of them on the hospital floors doing the day to day work at a reasonable cost.  But that's a long way off.

In the meantime, the HSE continues to import doctors from India, Pakistan and African countries to fill junior hospital doctor staff lists here.  Our system is so screwed up that we are doing this at the same time as all the Irish junior doctors educated here at the expense of the Irish taxpayer are leaving!

These doctors are coming here rather than staying in their home countries where they are desperately needed and that's not good.

And it causes problems here as well, with lack of communication due to poor English or even doubts about the medical competence of some of these imported junior doctors.

Most of them seem to be okay, and they have to be approved by the Irish Medical Council before they can work here.  But some recent cases would make you wonder about how thorough this assessment is.  

Dozens of Indian and Pakistani junior doctors hired by the HSE have been refused a license to practice here because of language problems.  Earlier this year there were problems with a doctor from Sudan, and now another very worrying case involving a doctor from Nigeria has come to light.
 
This Nigerian doctor is accused of attempting to read an X-ray while holding it upside down and trying to cut open a patient’s hand with a scalpel in order to insert a tube.  He faces 13 counts of professional misconduct or poor professional practice, including telling a colleague that scans performed on a patient’s kidneys were “fine” when they in fact showed multiple growths.

He also is accused of asking a nurse whether a patient's pulse reading of 165 beats per minute was high; that he was unable to identify the nasal bone in an X-ray when asked to do so; and that he decided that a patient had a benign prostate condition when this was not the case.

The Medical Council inquiry which was in the papers here last week heard that he had been a qualified doctor for 10 years and had previously worked in Crumlin Children's Hospital in Dublin before working as a senior hospital doctor in the Midlands Regional Hospital in the town of Portlaoise in 2009.  

There were complaints about him less than three weeks after he started in Portlaoise.   God only knows what he got up to in the children's hospital.

The hearing into this case has been adjourned because the doctor is now back in Nigeria and is claiming he can't get a visa to return here.  He is a graduate of the University of Nigeria which produces hundreds of medical graduates every year.   Nigeria is a country where corruption is rife at all levels, and there is no reason to assume the universities there are immune.

It's no wonder that some people going into hospital here feel like asking the doctors treating them where they qualified but are afraid to do so because of fears of being called racist.  And it's part of the reason why so many Irish people do whatever they can to avoid hospital altogether.

As they say, if the disease doesn't kill you, the treatment probably will!

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