Public or Private?

February 15, 2008

Do you have private health insurance? I do, as does over 50% of the Irish population. I have no problem in admitting that it offers a welcome safety valve in an otherwise chaotic system of healthcare. I can think of lots of other useful things to do with the money I spend on health insurance but I choose to make healthcare my priority. It’s not a decision I take lightly. I firmly believe that the way forward for our health service is a system of universal health insurance, funding a single tier health delivery model which promotes equity of health care. However as our health service is in such complete disarray, I feel I’ve no other option other than to continue to invest in health insurance. I’ve certainly had reason to be thankful for it over the years though it has proved at times, to be a bit of a double edged sword.

In late 2004, I was told that I needed some complex surgery carried out to arrest a chronic frontal sinus infection. I was under the care of a consultant surgeon who operated a private practice as well as a public service contract. With my health insurance policy, I’m fully covered for surgery in a private hospital with accommodation in a single room. However, my choice of doctors and hospitals is limited as I have a complicated medical history. On this occasion I was informed that the surgery would have to be carried out in a large public hospital where the necessary back-up facilities would be available. I was duly given a date for surgery and booked for post-op recovery in a high dependency ward. Two days before the operation, the hospital phoned to ask me to report immediately for admission. I initially protested at the stupidity of taking up a bed for two days pre-op but was told that a bed could not otherwise be guaranteed. I had no option but to agree to this crazy plan. By the time I had my overnight bag packed, the hospital phoned again to say that the bed was no longer available due to an admission from casualty. This process was repeated several times over the following two days until eventually, my surgery was cancelled due to the failure to secure a bed. The surgeon was furious as an operating theatre and a surgical team had been booked solely for my lengthy operation and it all went to waste that day. Frustrated by the restrictions imposed, the surgeon suggested that a stop-gap procedure be carried out in a small private hospital. I was duly admitted the following week and underwent some relatively minor surgery. However, this action also backfired as the surgery was unsuccessful and within months I had to return to discuss the bigger operation. The surgeon again insisted that the surgery should be carried out in the large teaching hospital and in order to secure a bed, he put special arrangements in place to allow me to be transferred to the nearby private co-located hospital, to recuperate. This was only possible because I had health insurance. It should not have been necessary.

I duly checked into the co-located hospital early on the morning of my operation and within hours, was whisked away to the operating theatre in the main hospital where I remained for the rest of the day. When I next came to, I was back in the private hospital in a shared room with three other women. I now had a sophisticated stent in my skull to facilitate drainage and a surgical wound over my right eye. I received good post-operative care and was discharged home feeling extremely lucky that all had gone so smoothly. About two weeks later, my post-operative pain began to worsen and I developed severe swelling around both eyes. I was asked to report to the busy A&E department in the main hospital where I was assessed and admitted. My health insurance again secured a bed for me in the private hospital and I happily settled into a 5-bedded room, secure in the knowledge that I was lucky to have a bed at all. Three days later, it was discovered that my surgical wound was infected with MRSA and thus began a lonely journey which continues to this day. The following week while I was longingly gazing out of the window of my isolation room, I spotted a woman I recognised in the car park. I’d shared a room with her in the private hospital a month previously, immediately following my operation. I waved frantically to attract her attention and she came over to chat to me through the open window. That’s when I learnt that her problem had turned out to be an MRSA infection and that’s when the penny dropped!

The airwaves are constantly buzzing these days with sad stories about the failures within the public health service but private hospitals are not the answer to the problem. They are selective and only serve to perpetuate the upstairs downstairs model of healthcare in this country. They do no offer A&E services which means that all patients requiring emergency treatment must be processed through the chaotic system in the public hospitals, regardless of their insurance status. Those with complex medical/surgical conditions generally cannot be treated in private hospitals because the medical back-up there is too limited. And anyone who takes out health insurance in the belief that they’ll be entitled to a single room, is in for a big shock if they are hospitalised. There is a huge shortage of isolation facilities across the country and single rooms quite rightly, have been prioritised for infectious patients and those who are dying. Our public health service is expected to provide all these service yet it’s on it’s knees through years of neglect and inadequate funding from the Government. Unfortunately, our Minister for Health continues to believe that the way forward is to promote the present unsatisfactory public/private mixture of healthcare by encouraging the development of co-located private hospitals. You have to question the wisdom of backing a policy that further perpetuates inequity of healthcare. We have a booming economy in Ireland but our health service is failing the most vulnerable people in our society. This is not about public versus private healthcare, it’s about saving lives.

The Hospital Patient

November 3, 2007

I was reading an interesting blog the other day and it started me thinking about life in hospital – from the patient’s perspective. This excellent blog is written by a medical student who details a first encounter with a ‘real’ patient. It was an insightful glimpse into the world of student doctors and clearly demonstrated how they learn from direct contact with patients. While ‘real’ patients are important for medical education, it’s also important to remember that patients are ‘real’ people too.

It has to be said that life in hospital is incredibly boring – the days can be endless and the sleep-disturbed nights are even longer. A hospital environment is alien to most patients – in fact it could even be described as ‘territorial’. From the moment a newcomer arrives on a ward, they become public property and remain on display for the duration of their stay. The boredom factor in hospital is such that a new admission provides a welcome distraction to the other ward occupants. Every detail is observed and scrutinised and before long, the interrogation will begin. “What are you in for? Oh, that’s terrible – my friend had that too!”. The new patient must divulge sufficient information to satisfy everyone’s curiosity and then they will be left in peace to settle into their ‘new home’.

The majority of patients in acute hospitals today are admitted through A&E where they will have been processed for many weary hours and often days, before being transferred to a ward. A small proportion of patients are admitted directly to a hospital bed to undergo elective surgery or thorough investigation and these are what are known as ‘elective admissions’. All patients, no matter how they arrive in hospital, are placed under the care of a specific medical or surgical team. Over the course of their stay, each patient will get to meet many variations of this team ranging from the most senior, the consultant, right down to the most recently qualified, the intern. Those with a complicated medical history may be put under the care of several teams and this inevitably multiplies the number of doctors seen. Medical students are an add-on ‘bonus’ in all teaching hospitals but only patients who are deemed to be a suitable case-study, will be asked to consent to undergo interrogation.

The ritual of ward rounds is another great source of entertainment for bored patients. While usually terrifying for the patient involved, they still provide great entertainment for the rest of the ward. The doctors swarm in and surround the bed of some poor unsuspecting individual who is then subjected to a barrage of questions, all delivered at an audible volume to the rest of the ward. The patient is then used as a ‘demo model’ before decisions are made and a care plan is put in place. The whole team then moves on in search of it’s next victim leaving behind a bewildered and often humiliated, patient. This is when the room mates come into their own. Within minutes, the other patients come to the rescue with reassuring anecdotes and invariably, the doctors will each be analysed in detail. No stone is left unturned! Patients in general are hugely protective of one another – everybody is in the same boat in hospital and it’s a natural instinct to look out for the welfare of others. This is particularly evident in the case of elderly patients who are unable to fend for themselves and who do not always get the respect or the attention they deserve due to short-staffing on the wards. Nurses too, are by no means exempt from a patient’s analytical skills. Favourites are quickly identified while others will be given nicknames appropriate to their behaviour. Humour is a great weapon in hospital – it often succeeds where reality fails.

There can be no doubt that patients will always be indebted to doctors for their in-depth skills and knowledge but doctors should never forget that patients are REAL PEOPLE who possess a unique talent to spot REAL DOCTORS ❗

A&E Trolley Dolly

April 28, 2007

I’ve done it again – another visit to A&E.

If you’ve read my last posting you’ll remember that I had surgery in the UK in March and I’m back in Ireland now recupperating under the care of a surgical team in a large Dublin teaching hospital. I can’t praise this team enough for their expertise and efficiency combined with real care and compassion. It was they who referred me to the UK for my operation as it’s not available here unfortunately, and now it feels good to be back in the care of people who know me well.

I knew before I’d opened my eyes yesterday that something had changed, this was a different sort of pain and I instinctly knew that I needed to seek help. Several phone calls later and I was instructed to report to A&E for assessment. I checked in, was assessed by a triage nurse and then joined the long queues in the waiting room area. I’m no stranger to this A&E department having been through it’s doors for emergency admission or treatment at least 6-7 times since surgery in the same hospital in July 2005. This was as a result of complications following that operation (more anon). I’ve definitely been here, done my time and got the teeshirt! Yesterday though I hit lucky. I was whisked through those double doors and onto a trolley in double quick time and as always, the staff were fantastic – at all levels of the ranks. It definitely helps to be a ‘regular’ though I wouldn’t recommend it! The place was heaving with patients everywhere, all cubicles were full and my trolley was lined up next to the nurses station. Having had my history taken (and most of my blood as well) I was examined and told that my fate depended on the lab results and so there was nothing for it but to make myself at home on my trolley and prepare for a long wait. One side of my trolley was up against a window of an examination room (which thankfully had a blind in place) but I counted five discarded drinking bottles of various types lined up on the windowsill at my elbow, obviously from the previous occupiers of my trolley. I loaded up as many as I could carry and staggered off to find a bin to get rid of this disgusting rubbish. That achieved, I took up residence and watched the world go by for about two hours. Nothing much has changed since my last visit here. Patients of all ages wandered around in various states of undress and mental incapacity, most of them in hospital gowns that were gaping open at the back. My heart goes out to the elderly in these circumstances – they seem so lost and vulnerable and confused in this busy environment. And what is it about A&E staff that they can so successfully avoid eye contact with patients? I’ve observed this trend over the years and they have it down to a fine art. It’s quite a skill you know to be able avert your eyes when patients all around you are looking for attention. It appears that there’s no eye contact with patients unless and until you’re next on the list for their attention. But the wait can be unacceptably long for some especially when in pain and discomfort. My luck was in yesterday. When my initial blood reports came back there was nothing indicating that I had to have I/V treatment and so I was released on oral antibiotics and instructed to report back at any time if things deteriorate further. There’s been a lot of bad press recently about A&E but sometimes it does work well and I have to say, the treatment I received yesterday was second to none during the three hours that I was in the hospital. The staff were very friendly and considerate but I was more than happy to wave them all goodbye, and that trolley, and return to my own bed, with my own drinking bottle!