protected professions


#61

What I can tell you with absolute certainty is that the ordinary sole pracititioner of law is most certainly an endangered species. Where a practice is continued by a son or daughter and where the premises is owned and there are no huge liabilities they may survive.

But young people of modest means trying to start up do not have a chance. Those who went mad in the conveyancing and property game or were simply crooked have brought about at least a quadrupling of Professional Indemnity Insurance for those who have never had a paper clip out of place.

The Arhtur Coxs and their ilk enjoy a mistletoe-parasitic relationship with the State and with their roles as tax and employment specialists to multi-nationals will continue to grow fat.

Be careful what you wish for. The average ‘legal services shop’ in the near future may have Tesco over the door. The guy in the crumpled jacket up a back stair who will carry the cost of your no hope case for 5-7 years, blockaded at every step if it involves your fundamental rights -may not be around much longer. I am acutely aware that the best of them are dying out or being forced out.

But of course everyone knows property prices always only go up - all lawyers grow richer by the day and the 20k-30k spent years in advance to get the just case of a penniless client at least to the steps, comes from the tooth fairy -cos these days it aint provided by way of bank overdraft.

Law has always been an expensive commodity. Justice has always been more elusive and generally only achieved by hard slog by those who actually believe in it. Change is certainly merited but anyone effecting it should first understand what is wrong and
want to change it.

If change is based on the highly paid for advice of any of the big firms and wisdom of a few crowd pleaser politcians who will benefit? The lowly practitioner and Joe Soap ?


#62

Has anyone ever tried to haggle with an irish consultant? Id be interested to know how it went. I would assume that they wouldnt budge on price because they are so out of touch with the real economy.

On two occasions I refused to purchase a GP referral letter for the asking price of €60 and on both occasions I was turned away from the consultants surgery.

These people are all assholes. I will never cooperate with their cartel. Once we get done lynching all the bankers, we need to start into the hospital consultants and other public sector kleptomaniacs. If I needed a hip replacement or some other major procedure I think I would go overseas.


#63

In one of my previous incarnations, I had in-depth dealings with hospital medical consultants. As people, I didn’t like them much. I can state with authority that most of them are pampered pompous arrogant assholes who are so far removed from reality that they literally live on a different planet. They have no concept of the lives of ordinary plebs and care even less. All they care about is their minimum earning of €250,000 per annum – as far as they are concerned that is completely non-negotiable (it is of course negotiable upwards). If they are paid any less then they threaten to ‘leave the country’ – feck off and good riddance to them I say.


#64

Having been sick a few times myself I can honestly say you are freaking me out with this ‘let’s have dunces for doctors’ campaign, and let them all leave the country. I’m rather good on medical things, as am qualified in something quite similar. A woman called in to me in work and asked did I agree with her GP who had just told her a lump on her neck was nothing to worry about, just a swollen gland. I said no! Go to A&E! I got flowers from her (ironically, as she was ill, not me) a week later when she was told the lump was a Lymphoma, more treatable if caught early. Her doctor did not do a good job in spite of our competitive selection process here in fairness… But I still think letting people in to make such crucial decisions who are not clever is reckless.

Hospital consultants can be so arrogant and bereft of any compassion etc. But I still say one who has a good aptitude for understanding the stuff is preferable! So many gargantuan mistakes have been made here - healthy kidneys removed, etc. Surely we need better doctors, not a lowering of standards within an overloaded and failing system, as is already in place. Give me a good doctor who diagnoses and prescribes/treats correctly any day over some blubbering fool with a kindly bedside manner who will work for the minimum wage. Unemployable elsewhere?!

I feel better now


#65

The analogy with McDs reminded me of the book Fast Food Nation about thast industry in the US. It essentially documents the ruthless de-skilling of the food industry there at all levels. This can be regarded as as good/bad depending on how right wing/on you are but either way it’s remarkable in how all leverage has been removed from people.

The reason I mention this is that the core of the problem is not supply/demand of individuals, its more complicated than that. At a simple level, if we train shedload more doctors, they would simply emigrate for better rewards rather than offering cheaper services. Doctors are tricky as the state is involved in their renumeration but we cant reasonably expect in a global market to be able to pay doctors less than elsewhere.

In relaiton to barristers, the comment in relaiton to protections is+X completely misplaced. Half the law library would probably struggle to buy sandwiches every day with a smaller minority enjoying pharoic lifestyles. A barrister (particularly the first kind) would note that the difference in skills does not justify the difference in remuneration but c’est la vie. If you are purchasing services (particularly in a corporate role) you need to get good advice and since you cant differenciate, you tend to overpay to get the “best”. Increasing supply would not change this. Why would you pay half the price for a Cusco router from Hong Kong website even though there is a good chance it comes form the same line and will work perfectly?

All of this is not to say that I dont think there is a problem that needs to be solved. In accountancy there is a huge disparity between what the large and smaller firms charge. When there are only a few firms that the state will buy from, they charge too much. The comptroler and auditor general outsources audits to small firms, the competition is fairly savage. Maybe like Gama coming in and breaking the road building cartel, we need to outsource as much as possible to India to bring prices down.


#66

You make a good point and normally would have done quite a good job of convincing me (I like and value expertise), but I am in the middle of reading Bad Science by Ben Goldacre and it is not really as simple as a doctor knowing what they are doing. Doing it in a nice manner (the old-fashioned good bedside manner) accounts for a goodly proportion of healing (not everyone, but most people to varying degrees). It enhances the placebo effect.

Mind you, paying a lot for a service and having a highly paid consultant does too…


#67

I don’t understand your reasoning, I think it is a bit off, in fact I think it is a mile off and representative of how people in Ireland don’t understand how many other countries with successful systems work. You are presenting a false either or situation. Of course it is better to have a smart person dealing with things, but that is only one component of the whole package and there are plenty of smart people in the world.

What we need are doctors and consultants who are available to see without worrying if you can afford the 60 euro to check something. If the fee was only 10-20 euro your friend could have easily got a second opinion from another doctor without worrying about the money. If the system allowed direct bookings with hospital consultrants (as I do in the country I live in), you can skip the GP part if you so wish! It is a disgrace people have to go to an A&R to check something like that, an absolute disgrace if you know how it works in progressive systems. Where I live I can choose any hospital public/private, pay a one time 10 euro registration fee and then a fee to see the relevant consultant for 10 euro, I can check his availability online and then book it directly with the hospital. I can see the consultant within a few days anytime, their quality is equal or superior to Ireland (don’t believe it if they say Irish doctors/surgeons are somehow better and worth more money, they are not!).

Then there is the attitude of said doctor. In every profession the contribution from a positive attidude and hard-working is extremely important. You’ve got to make an effort, if you are lacksidasical you will make mistakes. The mistakes you mention before were made by smart people, they simply did not follow a check-list or were tired or had other problems. Many smart people are also overconfident in their own abilities, more doctors should say you are welcome to get a second opinion, that is the proper way to do things.
I am not a GP but I imagine that GPs have a checklist of things they run through to identify possible cancer tumours, that GP may simply have been lazy or forgotten his training, I doubt it was because he lacked a few IQ here or there.

I have met with one or two public consultants in my time in Ireland, they seemed a bit out of touch to me and the time allocated to the patient and the waiting list time was ridciulous, plus they are simply too expensive and too few in number.


#68

If you don’t mind me asking, where do you live? The health system sounds great?


#69

You can guess from my username.


#70

Over the Xmas period a friends young son had conjunctivitus, she went to her local chemist and asked for a certain cream, it was the cream she had been prescribed a couple of months previous from her doctor for the same condition for the same child. The chemist informed her that they could not give the cream without a prescription. My friend explained that there was a huge charge for an emergency Doc and a long wait - chemist still refused to give the cream. The cream cost 6.49.

That’s seriously fkd up imo.


#71

We have to get over this idea that you must pay extortionate prices, as dictated by the professionals themselves, to a small number of people in order to ensure expertise. That is a protectionist racket.
Is it better to have a hospital with 40 consultants paid €250,000 per annum or 50 consultants paid €200,000 per annum? Will all the consultants leave the country if they are only paid the latter? Are all the people currently undertaking medical qualifications or already qualified, where they are purely on merit? Do you ensure excellence by only allowing a small number of people entry to a professional clique?


#72

For GPs, being super smart really isn’t a job requirement at all - there really is no need that GPs are paid huge money.
For consultants and how the medical system works, the system in Ireland seems quite messed up - there seem to be lifestyle problems with the amount of study and work people have to do in the system such that it is effectively impossible for women to become consultants without completely giving up on the idea of having kids for example.


#73

I know someone who is on a medical card and needs blood-pressure medication (“ISTIN”). They will be on this medication probably for the rest of their life, and AFAIK they are supposed to get a check every 6 months to see if any changes to the medication is required. But - they only get ONE month’s supply at a time and have to go to the doctor’s surgery EVERY month to ask for a repeat - the prescription form is filled in (well a button is pressed and one is printed off), the doctor signs it without seeing the patient, and the pharmacist fills it - presumably both the doctor and the pharmacist get a fee each time? Why not 6 months i.e. the period between checkups?

I also don’t understand this nonsense of providing prescriptions that have 30 days rather than 28 - ALL the blister-pack pills are in 14 or 28 day packs, and the pharmacist has to add in 2 extra - does this happen in other countries?


#74

The drugs payment scheme sets an upper limit on what you have to pay for prescriptions in a calendar month. If 28 days supply was dispensed, you’d get to buy two lots of drugs in one month a year, possibly leading to an extra cost for the exchequer (if your drugs cost comes up to the monthly max)…

I’ve been on a course of drugs for the past 18 months. Supposedly with check-ups. I’ve never once been called back for checkup, never once been recalled by the consultant to check progress or side-effects. Anything that has happened since the initial consultation has been at my instigation. The drugs I take were initially just below the limit for cutoff on the drugs payment scheme of 100 euro. When the limit was raised to 120 euro, the drugs magically cost just below the new limit…

Every six months I get to pay 40 euro for a new prescription to be printed off…


#75

Same happened to me at Christmas - got a bad dose of conjunctivitis. Was going to go to a doctor once they opened again for a prescription of some sort - last time I had it they put me on antibiotics which are not really necessary for conjunctivitis. I was loathe to pay approx 60 quid for the doctor and then more money for the prescription but I knew I would have to get it sorted. Then a friend of mine told me to put some salt in warm water and to wipe the eyes with separate pieces of cotton wool three times a day. Am all cleared up now. The pharmacists who are in cahoots with the whole system wouldn’t have been able to give your friend the cream without the necessary prescription. A cabal the lot of them.

A few years ago in Hong Kong, I got a bad chest infection. I went into one of the many chemists and was able to buy enough Augmentin 2 tabs a day for 5 days to clear up the chest infection. I knew what I needed and just went in and bought them over the counter. Also acquired some sleeping tablets as a side purchase (I knew the brand I was looking for). I know I am not a medical professional but I knew what I needed to fix myself.


#76

Has anyone here ever bought prescription drugs online? I know we are fed a constant diet of fear about how there’s no way of knowing what you’re buying, but there must be reputable distributors out there. And all our partying seniors, I’m not just talking about Viagra here.


#77

Why hasn’t there been some online doctor system set up in Ireland? (or is there one?). e.g. skypedoctor.ie or something like that. Surley there is a market for basic low cost advise? (With the obvious caveats). I wonder could prescriptions be issued online or do you have to physically visit a doctor?


#78

Unfortunately, it is not legal here and customs will confiscate when the drugs come in.


#79

An informative Wiki-link about online medical consultations and prescriptions.


#80

Thanks Yog. More reading needed. I can’t imagine customs seizing a few dozen pills of antibiotics.