Mandate graduate doctors do 5 years in Ireland post qualification?

steddyeddy

ScumLord wrote: »

So they don't charge insurers for medications used? They wouldn't do things like use up leftover budget before year end?

I talking specifically about foreign student doctors. Do they pay student doctors? Any time I've been in the public hospital doctors always had one or two in toe, so they're all paid for medical staff?

I don't see how their more selective. They treat people who can pay but I don't think they cherry pick who they're going to treat. The private hospital I went to had an A&E, it just wasn't open 24/7.

How can I be misinformed by what I experienced?

Bingo. They do claim back money on the insurance if the patient has it. They also claim back money for scans. You would have to wonder if half the scans ordered for patients would be ordered if they weren't on the VHI i.e they might not be needed.

Dilly.

seamus wrote: »

This is the emotive argument, but unfortunately it all comes down to bare numbers at the end of the day.

As a nation we want to be able to live in any ****hole backwater and still have hospital services on our doorstep. But we don't want to pay for it. These things are not compatible, one of them has to go. So we can either increase the average household's tax bill by €4,000 a year so that the HSE's budget is bumped by 50%.
Or we can make our hospital system more effective at the current cost by reducing the immediate availability of services to remote rural areas.

Sh*thole? The places you are referring to are peoples homes, their lives, their family.

What do you propose realistically? That everyone moves to an urban location or they don't deserve the same level of care? What about a 6 month old baby who is ill? An 80 year old man who has just being diagnosed with cancer? Should they up an leave by themselves and move closer to a hospital or is it tough luck suffer and die, they made a choice?

This is an emotive argument because it's real people I'm talking about, not statistics. Management in hospitals is where the issues lies.

Lucas Castroman

steddyeddy wrote: »

Bingo. They do claim back money on the insurance if the patient has it. They also claim back money for scans. You would have to wonder if half the scans ordered for patients would be ordered if they weren't on the VHI i.e they might not be needed.

So let me get this clear, you're suggesting doctors in public hospitals are prescribing lots of unnecessary medications and and ordering scans that are not required just because you have medical insurance. This is simply not the case.

steddyeddy

Dilly. wrote: »

Sh*thole? The places you are referring to are peoples homes, their lives, their family.

What do you propose realistically? That everyone moves to an urban location or they don't deserve the same level of care? What about a 6 month old baby who is ill? An 80 year old man who has just being diagnosed with cancer? Should they up an leave by themselves and move closer to a hospital or is it tough luck suffer and die, they made a choice?

This is an emotive argument because it's real people I'm talking about, not statistics. Management in hospitals is where the issues lies.

Also people who are sick won't be able to work and afford to move. The right wing "If his daddy was as rich as my daddy he could have my life" only gets you so far in logical thinking.

shruikan2553

Dilly. wrote: »

Sh*thole? The places you are referring to are peoples homes, their lives, their family.

What do you propose realistically? That everyone moves to an urban location or they don't deserve the same level of care? What about a 6 month old baby who is ill? An 80 year old man who has just being diagnosed with cancer? Should they up an leave by themselves and move closer to a hospital or is it tough luck suffer and die, they made a choice?

This is an emotive argument because it's real people I'm talking about, not statistics. Management in hospitals is where the issues lies.

It's not that they dont deserve it, it's that it is near impossible to provide it. If someone decides to live over an hour away from a hospital what do you expect to happen? By living in a rural area you are going to have less services.

steddyeddy

shruikan2553 wrote: »

It's not that they dont deserve it, it's that it is near impossible to provide it. If someone decides to live over an hour away from a hospital what do you expect to happen? By living in a rural area you are going to have less services.

There's that word that comes up in right wing rhetoric with regards life circumstances "decides".

ProfessorPlum

shruikan2553 wrote: »

It's not that they dont deserve it, it's that it is near impossible to provide it. If someone decides to live over an hour away from a hospital what do you expect to happen? By living in a rural area you are going to have less services.

Add to this that smaller hospital have less case mix, less expertise and poorer results. It makes sense to concentrate our resources in larger 'centres of excellence'. However, for this to work properly, we need to provide basic care in rural areas and a proper ambulance service, including air ambulance so that those who live in rural areas have access to the same level of care as urban dwellers. Unfortunately, that's not the case at present in many rural areas in Ireland.

shruikan2553

steddyeddy wrote: »

There's that word that comes up in right wing rhetoric with regards life circumstances "decides".

Im sure there are people who cant leave but there are also people who can but decide to build there house in a random location far from anyone else. You can hardly claim that everyone building and living far from everyone else is because of bad luck or they just had to buy that house an hour drive from town.

ProfessorPlum wrote: »

Add to this that smaller hospital have less case mix, less expertise and poorer results. It makes sense to concentrate our resources in larger 'centres of excellence'. However, for this to work properly, we need to provide basic care in rural areas and a proper ambulance service, including air ambulance so that those who live in rural areas have access to the same level of care as urban dwellers. Unfortunately, that's not the case at present in many rural areas in Ireland.

I would agree with that. Something like equipping doctors to better handle the basic stuff. You'll still have to travel for more serious conditions though as it's just not possible to provide everything within close distance to everyone, there will always be someone just outside the range.

ScumLord

Lucas Castroman wrote: »

So let me get this clear, you're suggesting doctors in public hospitals are prescribing lots of unnecessary medications and and ordering scans that are not required just because you have medical insurance. This is simply not the case.

I have a friend who was in a car crash and he was left sitting until they heard he was covered by the other drivers insurance and they sent him in for a load of tests because of the insurance, they even told him as much. Or at least gave him the impression he was getting the fast track because it turned out he was covered by insurance.

The fact remains the bill I got from the public hospital (you get a bill if your on insurance) was substantially more than exactly the same care in a private hospital. When you take into consideration they ran out of sheets in the public hospital because they had to hand them out instead of towels that they'd ran out of, it shows that the public hospitals are not able to manage their resources.

steddyeddy

ProfessorPlum wrote: »

Add to this that smaller hospital have less case mix, less expertise and poorer results. It makes sense to concentrate our resources in larger 'centres of excellence'. However, for this to work properly, we need to provide basic care in rural areas and a proper ambulance service, including air ambulance so that those who live in rural areas have access to the same level of care as urban dwellers. Unfortunately, that's not the case at present in many rural areas in Ireland.

This exactly. It's logical that we can't treat every disease equally in all locations (E.G cystic fibrosis) however we need a basic level of care in all hospitals for the prevalent diseases and terminal cases.

ProfessorPlum

ScumLord wrote: »

I have a friend who was in a car crash and he was left sitting until they heard he was covered by the other drivers insurance and they sent him in for a load of tests because of the insurance,

I'm sorry, but that is pure bullcrap. No one working on the front line in A&E derives direct benefit from a patient's health insurance. Your 'friend's' story just doesn't add up.

Lucas Castroman

ScumLord wrote: »

So they don't charge insurers for medications used? They wouldn't do things like use up leftover budget before year end?

I talking specifically about foreign student doctors. Do they pay student doctors? Any time I've been in the public hospital doctors always had one or two in toe, so they're all paid for medical staff?

I don't see how their more selective. They treat people who can pay but I don't think they cherry pick who they're going to treat. The private hospital I went to had an A&E, it just wasn't open 24/7.

How can I be misinformed by what I experienced?

So they don't charge insurers for medications used? They wouldn't do things like use up leftover budget before year end?

Well the nature of private health insurance is that they cover the cost of treatment. The suggestion that doctors go wild in public hospitals prescribing treatments which are not required for the sake of profit is simply incorrect.

You're telling me the tired A+E doctor rubbed his hands with glee when he saw you and prescribed 3 antibiotics so the insurance company could charge more for your treatment? If yes, you'r more delusional than I feared.

I talking specifically about foreign student doctors. Do they pay student doctors?

Medical students don't receive a salary. Your initial accusation was public hospitals were making a fortune off employing qualified foreign doctors which you have conveniently forgotten and cannot substantiate.
Hence misinformed.

I don't see how their more selective. They treat people who can pay but I don't think they cherry pick who they're going to treat. The private hospital I went to had an A&E, it just wasn't open 24/7.

If you're unstable/critically ill you will get transferred to a public hospital as private hospitals generally don't have the resources and also these type of cases are not cost beneficial for them. Try going to the Blackrock clinic A+E after being in a car accident.

zl1whqvjs75cdy

If we went down this road we'd also want to look at keeping PhD students here for a time after graduation. I'd estimate that once I finish my PhD I'll have cost the state the guts of 150k, but there are relatively few jobs here in my field so I will probably end up leaving which is a real shame. Least doctors will always have jobs here, even if they are worked half to death.

jon1981

donkeyoaty0099 wrote: »

If we went down this road we'd also want to look at keeping PhD students here for a time after graduation. I'd estimate that once I finish my PhD I'll have cost the state the guts of 150k, but there are relatively few jobs here in my field so I will probably end up leaving which is a real shame. Least doctors will always have jobs here, even if they are worked half to death.

I guess the difference between medical doctors and PHDs is that the HSE is a critical service and is the main employer of graduate doctors here , it is understaffed (apparently debated here) and we losing good percentage of graduate doctors upon qualification.

I don't see any other public service crying out for a supply of such a niche skill set.

I've no real sympathy for anyone that does a PHD in Arts or philosophy who can't get a job.

jon1981

seamus wrote: »

Most don't leave because they want to specialise in some obscure medicine or do the latest high-tech research. Most leave because they can go somewhere that they work 50 hour weeks for good pay and get treated like a human being.

This reason has been mentioned so many times on this thread. So without putting in practices to keep doctors here, such as making it part of the course that they do a number of years here in Ireland post qualification, what is the answer?

This seems like a vicious cycle to me, not enough junior doctors -> students see the chaos in the health service and are thinking no this is not for me i'm outta here -> junior doctors continue to be under pressure...and on and on

conorhal

seamus wrote: »

On the face of it, yes, perhaps. But then you run the risk of a lot of other problems - hospitals full of junior doctors who have their head somewhere else and are going through the motions. Junior doctors who are incompetent and want to leave the profession completely but have this 5 years hanging over their heads.

Rather than having the desired effect of keeping good doctors in Ireland, you just make the quality of staff worse and effectively prevent good doctors from immigrating to Ireland.

Perhaps the aim should be to address the reasons why so many doctors leave or want to leave. Primarily criminally long working hours with no overtime and chronic understaffing of junior doctors in hospitals.

Most don't leave because they want to specialise in some obscure medicine or do the latest high-tech research. Most leave because they can go somewhere that they work 50 hour weeks for good pay and get treated like a human being.

There's a couple of problems with you critique, you won't be keeping imcompetent doctors in a post, or are our medical schools passing and qualifying people that are not competent?

Secondly, good doctors aren't immigrating to Ireland, some pretty shockingly bad ones are. Like Irish doctors, the cream of the crop in Pakistan, India and Africa are looking for jobs in America, Australia and the UK. At best we get the third rate of the third world.

Where you are absolutely correct is the fact that working conditions have to improve. We also need more doctors, it's baffling as to why we are not funding more places.
I would also sweeten the pot to soothe the sting of a mandatory 5 years of service, if you are a medical student I would ensure that you were provided free accomodation, that you were subject to no fees whatsoever and you got a 5 grand annual grant if your grades met a certian standard. This would cost millions, but whats a few million compared to the cost of the millions the government spends in stuff we don't critically need? I'd also give students the option to emigrate on graduatiion, but they would be subject to the cost of their own training and accomodation if they wished to do so.

Taco Chips

jon1981 wrote: »

This reason has been mentioned so many times on this thread. So without putting in practices to keep doctors here, such as making it part of the course that they do a number of years here in Ireland post qualification, what is the answer?

This seems like a vicious cycle to me, not enough junior doctors -> students see the chaos in the health service and are thinking no this is not for me i'm outta here -> junior doctors continue to be under pressure...and on and on

I think making proper, structured and high quality training schemes would go a long way. Theres too much arsing around with job changing and too much of a junior doctors time is wasted on inappropriate, non educational tasks. You can go to places like US/Oz/UK and get specialty training completed in 5-7 years versus at least 10+ here. This is 5-7 years of high quality, rigorous education and accreditation instead of shuffling trainees out to service posts in low quality peripheral hospitals because theres no one else that wants to work there. Training needs to be more hands on, starting in medical school. The US has the right idea here where students are given more autonomy and responsibility over patients, with a very clear and defined hierarchy in place that ensures people aren't left stranded in their training.

Junior Dr contracts last for 6 months at a time in one hospital site as it is. This means every few months they're moving hospitals, towns, cities to the next post. How are people supposed to rent? To settle? Theres no stability. If you're a young doctor applying to schemes in Dublin/Cork/Limerick, thats where you want to spend your time training, set up a family and live. You don't want to be punted off to a rural centre at different stages where the conditions and education are often worse or non existant.

There have been steps to implement this in some specialties with 'run through' schemes such as Anaesthesia, Surgery and EM but there are still problems. There are proposed culls of trainees in these schemes at certain time points along the scheme. So if you're 3-4 years deep into one area of training and you're part of the cull, then what? Start again in a new specialty? Resign yourself to never completing your training? Ridiculous idea.

Then at the end of all this there is constant fiddling and cheating by management of timesheet in an effort to underpay juniors of overtime hours. Allowances for training, exam expenses and relocation have been cut. It used to be the case that people could at least tolerate all of the poor conditions because the wage made up for it, but now not even that remains. So you have poor training, low quality hospitals that you have little choice to work in and shortchanging of pay. The number one reason medical students and doctors are emigrating are because of the training and conditions available in other places.

ScumLord

ProfessorPlum wrote: »

I'm sorry, but that is pure bullcrap. No one working on the front line in A&E derives direct benefit from a patient's health insurance. Your 'friend's' story just doesn't add up.

It can be an unwritten policy to charge as much as possible to people with insurance. While individual doctors won't benefit, they would know it benefits the hospital to get as much out of insurers as possible.

Lucas Castroman wrote: »

Well the nature of private health insurance is that they cover the cost of treatment. The suggestion that doctors go wild in public hospitals prescribing treatments which are not required for the sake of profit is simply incorrect.

How do you know it's incorrect? I'm working off my experience and the experience of friends. It's anecdotal but what proof have you it that it doesn't happen? How do you explain the private hospital being cheaper for the same care? It was much better care by every account but the end result was the same.

Medical students don't receive a salary. Your initial accusation was public hospitals were making a fortune off employing qualified foreign doctors which you have conveniently forgotten and cannot substantiate.
Hence misinformed.

I meant foreign student doctors, a simple mistake on my part.

If you're unstable/critically ill you will get transferred to a public hospital as private hospitals generally don't have the resources and also these type of cases are not cost beneficial for them. Try going to the Blackrock clinic A+E after being in a car accident.

What's that got to do with anything.

conorhal wrote: »

There's a couple of problems with you critique, you won't be keeping imcompetent doctors in a post, or are our medical schools passing and qualifying people that are not competent?


Secondly, good doctors aren't immigrating to Ireland, some pretty shockingly bad ones are. Like Irish doctors, the cream of the crop in Pakistan, India and Africa are looking for jobs in America, Australia and the UK. At best we get the third rate of the third world.

If Ireland can't produce incompetent doctors why do you think foreign colleges would produce incompetent doctors?

Icemancometh

steddyeddy wrote: »

On a separate issue three antibiotics is far too much. No wonder antibiotic resistance is on the rise.

Pretty much every hospital admission for cellulitis is treated with dual antibiotics, and I've seen resistant cases where a third antibiotic is added in for anaerobic cover. Although more generally, cases with three antibiotics should usually only be handled with microbiology involvement.

More generally for this thread, I've worked in a few different public hospitals. Much to patients' disappointment, the only difference I've seen private insurance make, is accessing private or semi-private rooms. The consultants need to know because of the 25% of work on private patients rule, but its never made a bit of difference to me or anyone else on the team.

conorhal

ScumLord wrote: »

It can be an unwritten policy to charge as much as possible to people with insurance. While individual doctors won't benefit, they would know it benefits the hospital to get as much out of insurers as possible.

How do you know it's incorrect? I'm working off my experience and the experience of friends. It's anecdotal but what proof have you it that it doesn't happen? How do you explain the private hospital being cheaper for the same care? It was much better care by every account but the end result was the same.


I meant foreign student doctors, a simple mistake on my part.


What's that got to do with anything.

If Ireland can't produce incompetent doctors why do you think foreign colleges would produce incompetent doctors?

I suspect the massively disproportionate representation of foreign doctors in fitness to practice hearings might give you a clue.

ProfessorPlum

ScumLord wrote: »

It can be an unwritten policy to charge as much as possible to people with insurance. While individual doctors won't benefit, they would know it benefits the hospital to get as much out of insurers as possible.

You really have no notion about our health service, do you?

zl1whqvjs75cdy

conorhal wrote: »

I suspect the massively disproportionate representation of foreign doctors in fitness to practice hearings might give you a clue.

Got a link to those stats? Not having a go just be interested to see them

take everything

Taco Chips wrote: »

I think making proper, structured and high quality training schemes would go a long way. Theres too much arsing around with job changing and too much of a junior doctors time is wasted on inappropriate, non educational tasks. You can go to places like US/Oz/UK and get specialty training completed in 5-7 years versus at least 10+ here. This is 5-7 years of high quality, rigorous education and accreditation instead of shuffling trainees out to service posts in low quality peripheral hospitals because theres no one else that wants to work there. Training needs to be more hands on, starting in medical school. The US has the right idea here where students are given more autonomy and responsibility over patients, with a very clear and defined hierarchy in place that ensures people aren't left stranded in their training.

Junior Dr contracts last for 6 months at a time in one hospital site as it is. This means every few months they're moving hospitals, towns, cities to the next post. How are people supposed to rent? To settle? Theres no stability. If you're a young doctor applying to schemes in Dublin/Cork/Limerick, thats where you want to spend your time training, set up a family and live. You don't want to be punted off to a rural centre at different stages where the conditions and education are often worse or non existant.

There have been steps to implement this in some specialties with 'run through' schemes such as Anaesthesia, Surgery and EM but there are still problems. There are proposed culls of trainees in these schemes at certain time points along the scheme. So if you're 3-4 years deep into one area of training and you're part of the cull, then what? Start again in a new specialty? Resign yourself to never completing your training? Ridiculous idea.

Then at the end of all this there is constant fiddling and cheating by management of timesheet in an effort to underpay juniors of overtime hours. Allowances for training, exam expenses and relocation have been cut. It used to be the case that people could at least tolerate all of the poor conditions because the wage made up for it, but now not even that remains. So you have poor training, low quality hospitals that you have little choice to work in and shortchanging of pay. The number one reason medical students and doctors are emigrating are because of the training and conditions available in other places.

Good post.
Too many people don't know the ridiculous stuff that goes on for NCHDs. You get it in no other profession. People should really inform themselves before spouting populist crap.

ScumLord

ProfessorPlum wrote: »

You really have no notion about our health service, do you?

What makes you such an authority?

tony007

steddyeddy wrote: »

On a separate issue three antibiotics is far too much. No wonder antibiotic resistance is on the rise.

steddyeddy, MD.

jmayo

Guy:Incognito wrote: »

How long does it take to be qualified, 7 years?You're basically making medicine a 12 year course then.

Ehh if you think that someone is a fully functioning doctor after the basic 7 years in college you are mistaken.
They have to do number of years residence, or whatever it is called here, in hospital as experience.
For other major discplines such as surgery or anaesthesia they would be training up to 12 years anyway.

FalconGirl wrote: »

When my uncle was dying, one of my cousins friends was a doctor in the ICU. She came into the rest room area and was chatting away to us and told us she was moving onto her 26th hr of duty and said its quite regular. Insane:eek:

This is somthign that always bugs me.
A truck driver can only work so many hours straight and has to have mandatory breaks, same with a pilot.
Yet a doctor can be working for days.
Some kind of lunacy there.

ProfessorPlum

ScumLord wrote: »

What makes you such an authority?

Do you have anything of substance to add? At all?

diograis

Kinda off point but the most expensive course in my college is dentistry, not medicine. Pretty sure its the same for Trinity. So technically it's the second most expensive course :P

ProfessorPlum

diograis wrote: »

Kinda off point but the most expensive course in my college is dentistry, not medicine. Pretty sure its the same for Trinity. So technically it's the second most expensive course :P

According to NUIG, the government payment for an undergrad medical student is less than €33,000 over the 6 years. So it's not really a huge issue for tax payers to be calling for indentured servitude. Now Dentists - aren't they all loaded?........

jon1981

diograis wrote: »

Kinda off point but the most expensive course in my college is dentistry, not medicine. Pretty sure its the same for Trinity. So technically it's the second most expensive course :P

I caveated that with "probably" Although you're probably splitting hairs with the cost difference

Taco Chips

ProfessorPlum wrote: »

According to NUIG, the government payment for an undergrad medical student is less than €33,000 over the 6 years. So it's not really a huge issue for tax payers to be calling for indentured servitude. Now Dentists - aren't they all loaded?........

Added to that most medical schools are stuffed with non EU students paying full whack fees around €33,000+ per year. Over 5-6 years! As well as all of the graduate entry medical students also paying full amounts. Medical schools in universities are probably one of the most profitable wings of the whole system. Makes the whole "make them stay and pay back what they owe" even more laughable an idea than it is already.

ScumLord

ProfessorPlum wrote: »

Do you have anything of substance to add? At all?

All you've done is make statements that don't seem to be based on anything other than your own assumptions. Unless you're an A&E doctor, or a hospital auditor you can't say anything with certainty. I've always found that people that talk in certainties about things they have no actual experience in tend not to be worth talking too.

I gave my experience and my friends experience. You've done nothing but throw insults around. You've given nothing to back up your argument other than you assume you must be right and resort to insults when you've run out of argument.

You've added nothing of substance and try to hide the fact by pointing fingers and accusing others of your own failings.

tony007

ScumLord wrote: »

All you've done is make statements that don't seem to be based on anything other than your own assumptions. Unless you're an A&E doctor, or a hospital auditor you can't say anything with certainty. I've always found that people that talk in certainties about things they have no actual experience in tend not to be worth talking too.

I gave my experience and my friends experience. You've done nothing but throw insults around. You've given nothing to back up your argument other than you assume you must be right and resort to insults when you've run out of argument.

You've added nothing of substance and try to hide the fact by pointing fingers and accusing others of your own failings.

Do you not think that you were on 3 antibiotics for a reason?

ProfessorPlum

ScumLord wrote: »

All you've done is make statements that don't seem to be based on anything other than your own assumptions. Unless you're an A&E doctor, or a hospital auditor you can't say anything with certainty. I've always found that people that talk in certainties about things they have no actual experience in tend not to be worth talking too.

I gave my experience and my friends experience. You've done nothing but throw insults around. You've given nothing to back up your argument other than you assume you must be right and resort to insults when you've run out of argument.

You've added nothing of substance and try to hide the fact by pointing fingers and accusing others of your own failings.

I didn't think it was necessary to add my CV to a boards debate. Everything I've said is true and factual, and based on my own experience of working in the health service (yes, in A&E - now called ED by the way) and the experience of literally hundreds of my friends, colleagues and family members. You on the other hand base your assertions on anecdotal evidence and third party - blatantly false - 'experiences'. I haven't insulted anyone. The truth hurts sometimes.

ScumLord

ProfessorPlum wrote: »

You on the other hand base your assertions on anecdotal evidence and third party - blatantly false - 'experiences'. I haven't insulted anyone. The truth hurts sometimes.

I'm basing my opinion on the fact the public hospital charged me more for roughly the same amount of care. I say roughly because the private hospital visit included an MRI, I had clean sheets and proper food amongst other things.

How is the supposedly more expensive private hospital able to come in cheaper than the public hospital? Did they just make a mistake with the antibiotics? Is it right to give a person more antibiotics than they need?

There's nothing anecdotal about the bill.

Duggy747

Do a weekend course and become a faith healer instead :pac:

jon1981

Guy:Incognito wrote: »

Nothing, as long as you do it for all courses. Why single out medicine?

I've no problem with people paying for their college education, I was questioning the practicalities of the 5 year idea. As in, how do you physically stop them just leaving and not doing the 5 years.

Sure many professions do this. I know of a person doing a 3 year post grad in Psychology in the UK and one of the conditions of the course is that that person must work in a hospital there for 3 years, likewise people I know doing a post grad in teaching funded by the UK government, likewise that person has to work in a school there for a number of years. You leave, you pay back the fees.

There is nothing illegal about this proposal if implemented correctly. I'm not proposing imprisonment!!

Jezek

ScumLord wrote: »

I'm basing my opinion on the fact the public hospital charged me more for roughly the same amount of care. I say roughly because the private hospital visit included an MRI, I had clean sheets and proper food amongst other things.

How is the supposedly more expensive private hospital able to come in cheaper than the public hospital? Did they just make a mistake with the antibiotics? Is it right to give a person more antibiotics than they need?

There's nothing anecdotal about the bill.

the fact is, antibiotic therapy can't be boiled to down to the number of antibiotcs you received. One vs three means nothing at all. You need experience and a lot of knowledge to interpret antimicrobial treatment. Even if the single antibiotic worked, you don't know if it was the correct one to use. Of course this is is a complicated issue. It really doesnt boil down to if you got one or three antibiotics.

And then you talk of overstaffing in the ED, but you expain that a lot of these people were students. That's not staffing. The students dont work there, they don't change your management at all. They are only learning.

Taco Chips

jon1981 wrote: »

Sure many professions do this. I know of a person doing a 3 year post grad in Psychology in the UK and one of the conditions of the course is that that person must work in a hospital there for 3 years, likewise people I know doing a post grad in teaching funded by the UK government, likewise that person has to work in a school there for a number of years. You leave, you pay back the fees.

There is nothing illegal about this proposal if implemented correctly. I'm not proposing imprisonment!!

The proposal is unworkable for a variety of reasons that have already been mentioned. Doctors are highly skilled, highly educated professional graduates not sheep to be heralded into a pen. If proper restructuring of the training and working conditions was implemented to say, follow the Oz/UK/US models then there would be less reasons for them to leave in the first place. Doctors get better training, better qualifications at home and can practice better medicine. Win win for everyone.

At the same time however there is a strong tradition for Irish doctors to spend some portion of their training abroad, to gain important highly specialised skills and knowledge that is only available in places like the US, Canada etc... This is actually extremely important because Ireland just isn't big enough to see some of the rarer diseases in clinical settings.

steddyeddy

Icemancometh wrote: »

Pretty much every hospital admission for cellulitis is treated with dual antibiotics, and I've seen resistant cases where a third antibiotic is added in for anaerobic cover. Although more generally, cases with three antibiotics should usually only be handled with microbiology involvement.

More generally for this thread, I've worked in a few different public hospitals. Much to patients' disappointment, the only difference I've seen private insurance make, is accessing private or semi-private rooms. The consultants need to know because of the 25% of work on private patients rule, but its never made a bit of difference to me or anyone else on the team.

Which is a treatment scientists have been disagreeing with for years. Stating the common practice doesn't make it acceptable. Could you give the scientific reasoning for three antibiotics. Clinical microbiologists are needed with every antibiotic prescribed IMHO.

medicine12345

steddyeddy wrote: »

Which is a treatment scientists have been disagreeing with for years. Stating the common practice doesn't make it acceptable. Could you give the scientific reasoning for three antibiotics. Clinical microbiologists are needed with every antibiotic prescribed IMHO.

Eg gram neg, gram pos and anaerobic cover

Icemancometh

steddyeddy wrote: »

Which is a treatment scientists have been disagreeing with for years. Stating the common practice doesn't make it acceptable. Could you give the scientific reasoning for three antibiotics. Clinical microbiologists are needed with every antibiotic prescribed IMHO.

Well I'm not a clinical microbiologist tbf, so I'm not going to able to give any thorough description of the need for triple antibiotic therapy. Dual are used frequently; in the example I gave it covers staphyloccocal and streptococcal organisms; amoxicillin and clarithromycin covers both typical and atypical (ie HACEK organisms) for acute exacerbations of COPD); amoxicillin and metronidazole are part of triple therapy for eradication of helicobacter but I'm not sure what the basis for this is, but it's established practice worldwide.

I agree there should be less antibiotics prescribed on the whole, and more involvement for clinical microbiology, but to suggest they should be involved with every prescription is pushing it. Are you going to call one when you want to give a prophylactic cephalosporin dose to your hip-hemiarthroplasty patient for example?

ProfessorPlum

ScumLord wrote: »

I'm basing my opinion on the fact the public hospital charged me more for roughly the same amount of care. I say roughly because the private hospital visit included an MRI, I had clean sheets and proper food amongst other things.

How is the supposedly more expensive private hospital able to come in cheaper than the public hospital? Did they just make a mistake with the antibiotics? Is it right to give a person more antibiotics than they need?

There's nothing anecdotal about the bill.

Nobody is disputing the fact that you got a bill. One that you thought was excessive, and one that you thought covered roughy the same amount of care as you received in the private hospital.

Neither is anyone disputing the fact that there are inefficiencies in the health service (not that these are necessarily a central factor in your particular quibble).

None of that has anything whatsoever to do with the issue under discussion though, does it.


On the issue of your antibiotics, nobody can say either way unless they at least have your medical notes (and only then if they also have some expertise in the area, which you don't). But it's worth noting that healthcare is not static - what may have been an entirely appropriate course of action today may be superseded by a different tact tomorrow. It doesn't make today's decisions wrong.

seamus

conorhal wrote: »

There's a couple of problems with you critique, you won't be keeping imcompetent doctors in a post, or are our medical schools passing and qualifying people that are not competent?

Just on this point, incompetent doesn't mean stupid.
Everyone knows at least one person who went to college, did really well, got a first class degree, and then discovered that when it came to working in the real world they were actually really crap at it.

Doctors go through training and assessment in college, but all that really does is cull the intellectually feeble and the complete weirdos. Until someone has actually been placed out into the hospital system and all that entails, you don't really know if they're going to be able to make it as a competent NCHD.

My wife does the exams for RCSI, she's an actress and so is given a scenario where she plays a patient and the student has to attempt to diagnose. It's a pretty robust test - it examines their manner, their ability to troubleshoot/diagnose with a live patient and their overall level of general medical knowledge.
Many people that in her words she wouldn't allow near her, still pass this test because it's only one facet of the whole thing. But if someone freezes up when attempting to diagnose a live patient or completely panics when that patient is screaming in pain and/or anger, they're likely to completely crumble when the hit the A&E in Tallaght.

And then we tell them that they're stuck there for five years unless they cough up €100k to buy their way out.

Eh, no thanks, I'd rather we let him go than let him near any patients.

keyboard_cat

Surely saying to graduates you have to work for us for x number of years is just going to push them further away? Hospitals in other countries won't care if they have the 5 years that the hse insist
Same situation is essential in place with nurses my gf and her friends were told repeatedly before graduation that if they ever wanted to work in ireland they had to do a graduate program (which was work for minimum wage for 9 months until the year after them start placement) and most of them went to London or signed u with agency nursing
I can imagine a similar situation if doctors are told to stay and do 5 years

ScumLord

ProfessorPlum wrote: »

None of that has anything whatsoever to do with the issue under discussion though, does it.

These threads never stay on topic, especially when I'm around.

My point was/is, there's something seriously wrong with the health service. I got the impression with my stays that they can't even begin to deal with the inefficiencies. They ran out of just about everything while I was there, I would have thought all this was normal until I experienced the private side. It's a night and day difference.

The only reason I ended up in the private hospital was because the public hospital sent me home with the all clear. They obviously didn't check my blood work because my immune system would have been in overdrive at that stage. That's the first thing they noticed in the private hospital, I was in there two days after my public visit because all the public hospital did was mask the symptoms for two days allowing it to get worse. After the private hospital got my blood work back they then sent me for an MRI and I was in surgery an hour later.

ProfessorPlum

ScumLord wrote: »

These threads never stay on topic, especially when I'm around.

My point was/is, there's something seriously wrong with the health service. I got the impression with my stays that they can't even begin to deal with the inefficiencies. They ran out of just about everything while I was there, I would have thought all this was normal until I experienced the private side. It's a night and day difference.

The only reason I ended up in the private hospital was because the public hospital sent me home with the all clear. They obviously didn't check my blood work because my immune system would have been in overdrive at that stage. That's the first thing they noticed in the private hospital, I was in there two days after my public visit because all the public hospital did was mask the symptoms for two days allowing it to get worse. After the private hospital got my blood work back they then sent me for an MRI and I was in surgery an hour later.

Well now there's something we can agree on!! The health service is in ****, and it's a **** place to work. If we could go half the way to improving it, doctors would be flocking to work here - we wouldn't have to chain them to the place, never, ever to see them and their expertise again once their 5 years is up.

ScumLord

ProfessorPlum wrote: »

Well now there's something we can agree on!! The health service is in ****, and it's a **** place to work. If we could go half the way to improving it, doctors would be flocking to work here - we wouldn't have to chain them to the place, never, ever to see them and their expertise again once their 5 years is up.

It is a much better idea to make young doctors want to work in Ireland. It would improve everything.

I don't think there's any party with the balls to take on the health service mess. They'll just play both sides while attempting to do as little as possible to upset people any further.

pocketkings

Scumlord, I'd like to tell you a bit about antibiotic prescribing:

You think that because you got three antibiotics in one place, and just one in the other, the latter is better care for some reason. But there are many situations where people need three antibiotics.

The obvious situation is that you show up with X wrong with you, where X can be caused by any number of organisms. What the doctors would do is take a sample (bloods, throat swab, etc) and send it to the lab to see what the actual bacteria causing the problem is. Since this can take several days to get a result, in the meantime they put you on an "empirical antibiotic regime" where they basically give you antibiotics to cover ALL the likely pathogens. Once the lab results come back, then they know exactly what you have, and can give you the correct antibiotic for that.

For example, you come in with suspected bacterial meningitis. This can be caused by a wide range of bacteria, strep pneumonia and nesseria meningitidis the most common. So to cover these, they give cefotaxime to cover n.meningitidis, vancomycin to cover strep pneumonia, and sometimes ampicillin as well, which covers listeria (common cause in children but less common in adults). The lab results come back, you have n.meningitidis that is penicillin susceptible, so they stop the drugs you are on and put you on benzylpenicillin.

Another example: you come in with bad pneumonia. This can be caused by all sorts of bacteria, hundreds probably. For this the guidelines say to treat with co-amoxiclav & clairithromycin. Co-amoxiclav is composed of two antibiotics, amoxicillin and clavulanic acid. These three will cover the vast majority of the possible causes. So this is another, common, situation where three antibiotics are given. Lab results come back, you have staph aureus, so they stop the drugs you are on and put you on flucloxacillin.

Note in both cases the drug you end up being given is not one of the initial three: this is because the initial three are broad-spectrum (ie kill loads of bugs) and the latter ones are narrow-spectrum (ie targeted to kill as few as possible, as long as that includes the bug that is the problem). They can't put you on narrow-spectrum drugs at the start though, as they don't know what bug they have to target. If your pneumonia was caused by strep pneumonia, strep pyogenes, H influenza, aerobic gram negative bacteria, legionella, mycoplasma pneumonia, etc then flucloxacillin wouldn't work.


My guess is that you went to the public hospital with something, they put you on three antibiotics empirically. By the time you were in the private hospital, the bug had been isolated and identified, (probably by the public hospital) and they knew what antibiotic was needed.

Also, there is no incentive that I am aware of to ever prescribe extra unnecessary antibiotics from either the doctor's POV or the hospital's. That's nonsense.

ScumLord

pocketkings wrote: »

My guess is that you went to the public hospital with something, they put you on three antibiotics empirically. By the time you were in the private hospital, the bug had been isolated and identified, (probably by the public hospital) and they knew what antibiotic was needed.

That's not the way it happened. It was 3 years ago the first time it happened. I went to the public hospital, had surgery and spent a week in hospital getting antibiotics.


The second time it happened was two years later, I went to the public hospital, informed them of the previous infection, they treated symptoms and sent me home with no antibiotics, they misdiagnosed me despite being informed of the previous infection, I'm assuming they didn't bother with blood work at all. Two days later I'm no better and symptoms are back. I find out the private hospital has a daytime A&E, so I go there instead. Within the hour they've blood work back that shows I've elevated white blood cells, they send me for an MRI, see the infection is massive, at this point I'm really sick and they send me in for surgery immediately. I spend a week in the ward recovering on their course of antibiotics.