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 Post subject: Re: protected professions
PostPosted: Tue Jan 22, 2013 1:49 am 
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Real Estate Developer

Joined: Jan 4, 2010
Posts: 791
Location: Talamh an Éisc
drochfhiach wrote:
If anybody wants an insight into the morale and conditions of Irish hospital doctors have a read through this and the comments that follow. As someone who has been through the system it makes for very sad reading.

http://www.medicalindependent.ie/blog-p ... k#comments



That piece was an unwelcome trip down Memory Lane. Little progress seems to have been made on working conditions for Irish junior doctors since my time in the trenches twenty five plus years ago. Call is a bit like combat; the stress alone can destroy people. I know the financial situation is grim but a reasonable limit to hours should surely be enforced for all workers. Interns and SHOs are more conscripts than volunteers - they are obliged to take the jobs they do if they want to put their degrees to any medical use. The emphasis at that stage should be more on education rather than service work. More consultant posts will cost a lot of money but they are needed.


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 Post subject: Re: protected professions
PostPosted: Tue Jan 22, 2013 12:56 pm 
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Neo Landlord

Joined: Nov 12, 2007
Posts: 214
Location: Dublin
drochfhiach wrote:
Back in the real world...

If anybody wants an insight into the morale and conditions of Irish hospital doctors have a read through this and the comments that follow. As someone who has been through the system it makes for very sad reading.

http://www.medicalindependent.ie/blog-p ... k#comments

I predict an exodus over the coming years. Chatting with a few consultants they will not be far behind their juniors.


The suggestion (on here) that Doctors should go on strike is all well and good but the fact is patients would die if they did that, it's not that they might die, it's that patients would definitely die. The Doctors I know won't go on strike for that reason, and ultimately it's why they are worked so hard, because they know themselves patients will die if they don't. In a similar vein, when a Doctor is in the hospital working and gets a call and told they have to work an extra shift tonight because there is no other Doctor available, what do do expect them to say? If they say no, patients die -- you can rationalise it all you want that it's the fault of the hospital, admin, etc..., but if you were on the other end of that phone and your decision costs lives, how do you say no and live with that decision?

Pay isn't the issue, as has been pointed out here already also, pay in Ireland is not too bad (though many Doctors don't get paid their overtime), but quality of life is atrocious. A lot of Doctors who qualified here in recent years have left, and I for one do not blame them.

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 Post subject: Re: protected professions
PostPosted: Tue Jan 22, 2013 1:06 pm 
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Too Big to Fail

Joined: Jun 26, 2012
Posts: 3025
Location: The Second Æther! Hull Breach Imminent, Eschaton Immanent...
baeooddu wrote:
drochfhiach wrote:
Back in the real world...

If anybody wants an insight into the morale and conditions of Irish hospital doctors have a read through this and the comments that follow. As someone who has been through the system it makes for very sad reading.

http://www.medicalindependent.ie/blog-p ... k#comments

I predict an exodus over the coming years. Chatting with a few consultants they will not be far behind their juniors.


The suggestion (on here) that Doctors should go on strike is all well and good but the fact is patients would die if they did that, it's not that they might die, it's that patients would definitely die. The Doctors I know won't go on strike for that reason, and ultimately it's why they are worked so hard, because they know themselves patients will die if they don't. In a similar vein, when a Doctor is in the hospital working and gets a call and told they have to work an extra shift tonight because there is no other Doctor available, what do do expect them to say? If they say no, patients die -- you can rationalise it all you want that it's the fault of the hospital, admin, etc..., but if you were on the other end of that phone and your decision costs lives, how do you say no and live with that decision?

Pay isn't the issue, as has been pointed out here already also, pay in Ireland is not too bad (though many Doctors don't get paid their overtime), but quality of life is atrocious. A lot of Doctors who qualified here in recent years have left, and I for one do not blame them.


It's hard to see from the trenches, but patients die and suffer loss of quality of life because of the way the system is right now. Sure if the doctors didn't turn up for work tomorrow patients would die, but if the right fixes were achieved then the nett effect could be lives saved.

Ultimately, of course, it shouldn't be down to the medics to strike to get the system made healthy... and there's no guarantee that the resulting system would be better. Even when you get good management, it's not always recognised

Anecdote: a friend of mine works in HSE (not a doctor, but in a clinical role). She says her clinic manager is excellent, and highlights 2 aspects: (1) clinic manager personally triages all cases on the phone to determine whether case should actually come in for appointment, or can wait for normal 6 monthly check-up; (2) she treats the team members with respect, so turnover is much lower than in most clinics. (1) also helps reduce turnover because the service is not so oversubscribed (if a patient presents and is judged in the clinic as not needing intervention, then the overhead and paperwork are much greater) and more time can be focussed on patients who need interventions.

However, my friend says that colleagues in other clinics who know that this clinic has low turnover and a managed waiting list ascribe that to luck or to the neighbourhood. My friend has worked in many clinics, and she says it's management. She says she's never seen (1) done anywhere else and (2) is pretty rare too in the profession.


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 Post subject: Re: protected professions
PostPosted: Tue Jan 22, 2013 9:51 pm 
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Posts: 318
baeooddu wrote:
The suggestion (on here) that Doctors should go on strike is all well and good but the fact is patients would die if they did that, it's not that they might die, it's that patients would definitely die. The Doctors I know won't go on strike for that reason, and ultimately it's why they are worked so hard, because they know themselves patients will die if they don't. In a similar vein, when a Doctor is in the hospital working and gets a call and told they have to work an extra shift tonight because there is no other Doctor available, what do do expect them to say? If they say no, patients die -- you can rationalise it all you want that it's the fault of the hospital, admin, etc..., but if you were on the other end of that phone and your decision costs lives, how do you say no and live with that decision?

Pay isn't the issue, as has been pointed out here already also, pay in Ireland is not too bad (though many Doctors don't get paid their overtime), but quality of life is atrocious. A lot of Doctors who qualified here in recent years have left, and I for one do not blame them.


Do doctors' strikes save lives?

Have you heard that, when doctors strike, the death rate goes down?

More or Less investigated a doctors' strike in Israel, where it was reported that the death rate dropped by 39% over a three-month period.

We spoke to Judy Siegel-Itzkovich of the Jerusalem Post, who covered the strike, and tried to explain why the number of deaths dropped.

Baroness Julia Neuberger suggested that non-essential surgery is postponed during any strike causing a short-term drop in death rates.


http://news.bbc.co.uk/2/hi/programmes/m ... 408337.stm

Apparently there are other incidences of similar results in California and in the UK...


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 Post subject: Re: protected professions
PostPosted: Wed Jan 23, 2013 10:19 am 
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Too Big to Fail

Joined: Jun 26, 2012
Posts: 3025
Location: The Second Æther! Hull Breach Imminent, Eschaton Immanent...
blanchguy wrote:
baeooddu wrote:
The suggestion (on here) that Doctors should go on strike is all well and good but the fact is patients would die if they did that, it's not that they might die, it's that patients would definitely die. The Doctors I know won't go on strike for that reason, and ultimately it's why they are worked so hard, because they know themselves patients will die if they don't. In a similar vein, when a Doctor is in the hospital working and gets a call and told they have to work an extra shift tonight because there is no other Doctor available, what do do expect them to say? If they say no, patients die -- you can rationalise it all you want that it's the fault of the hospital, admin, etc..., but if you were on the other end of that phone and your decision costs lives, how do you say no and live with that decision?

Pay isn't the issue, as has been pointed out here already also, pay in Ireland is not too bad (though many Doctors don't get paid their overtime), but quality of life is atrocious. A lot of Doctors who qualified here in recent years have left, and I for one do not blame them.


Do doctors' strikes save lives?

Have you heard that, when doctors strike, the death rate goes down?

More or Less investigated a doctors' strike in Israel, where it was reported that the death rate dropped by 39% over a three-month period.

We spoke to Judy Siegel-Itzkovich of the Jerusalem Post, who covered the strike, and tried to explain why the number of deaths dropped.

Baroness Julia Neuberger suggested that non-essential surgery is postponed during any strike causing a short-term drop in death rates.


http://news.bbc.co.uk/2/hi/programmes/m ... 408337.stm

Apparently there are other incidences of similar results in California and in the UK...

Very interesting. Albeit they seem to look only at the period of the strike as opposed to looking at a longer time-period and total effect.

e.g. Say I have 100 coronary-bypass candidates in January, and my team of surgeons processes the cases during January, 20% die on table, 10% die afterwards, and at end of year 70% are alive with good prognosis. Let's say there was a doctors' strike in January and no operations that month. A few of the patients die anyway, but probably not 20%, so it looks like lives were saved. Say 5% die in that month. But when I start operating in February because the patients are not as fit as they were originally now 30% die on the table and 15% die of complications afterwards and I have maybe 50% alive with good prognosis at end of year (much worse than 70%). Plus the deteriorated treatment scenario will carry on for longer than a month in the real world as the backlog gets worked out of the system (so patients who would have been operated on in February ideally get moved to mid March, etc.,).

That said, I think there is a tendency in medicine to be rather selective in data interpretation (much more than one would hope for given the scientific trappings) and I could well imagine that for certain procedures specialties a doctors' strike might actually turn out to be beneficial if you really got access to all the data.

At least for drugs trials, people are campaigning for better data publication:
http://www.badscience.net/2012/10/quest ... ng-trials/

In surgery/medical-devices domains however it is even worse, and a lot of it is rather voodoo/anecdotal.


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