Waiting Times. Doctor Shortages. Trolley Crisis. Healthcare reform this is a heavy topic for Christmas, but with all of it in the news, here’s what a frontline doctor thinks about the HSE’s Winter Ready Plan fail (I feel like I need to be more positive after my snarky Tweet to HSE today):
Warning: if you are one of my real life patients, parts of this will sound REALLY familiar. And if you are a regular follower, I’ve harped on about some of this before. Second Warning: as always when I ramble on about politics, the usual caveat this is all just my opinion.
Meaningful healthcare reform needs more than only funding to ultimately be successful (not that there is any sign of competent fund administration any time soon), but needs to include informed and empowered patients.
Like most Irish docs, I’ve also practiced abroad, including the United States. I practiced for a few awhile in a County Hospital in NYC. This hospital served the poor, in immigrant, the uninsured. But not in anyway that we would recognise here in Ireland. As a doctor, I was forced to turn away patients who were in desperate pain or in need of medical service. Not put on a trolley, not put on a waiting list: Turned away. They couldn’t pay and were not eligible for the VERY, VERY limited government schemes to help. I also had to find second-best tests or alternative second-line treatments for insured patients after the care plan put together by their team was denied by insurance companies. Not wait listed – denied. Patients with suffering from asthma or diabetes because they couldn’t afford the prescribed inhalers or insulin. And crowd-funding for basic chemo costs?? It is barbaric.
Back in Ireland, I am struck anew by how amazing socialist health care is. Is the HSE functional? Barely. BUT: Socialist health care is owned by the people, for the people. In Ireland, as a doc, I don’t have to say no to patients (wait for it? yes. but I don’t have to deny care.) The patient and I have wonderful autonomy to make decisions together about care plans and treatment. But I am constantly under pressure to prioritise use of those available resources for my patients in order of need.
Let’s be clear. Will more funding help? Yes. But, is this really going to matter if there is a doctor shortage? Hmm, not really — it’s why funding won’t necessarily help as much as you think. But let’s also be sane: NO functional health care system can function by offering unlimited resources to those that misuse or waste it.
To move forward out of a broken system, we will in some way need to also end the adversarial approach that it’s the patient versus the health care system. Patients should be empowered to take ownership and responsibility for their own health and our shared healthcare system, demand from our communities that resources are used in the best way, and become partners with healthcare professionals who equally want to see it delivering better care (remember, GPs/HSE staff and their families are patients, too!). I agree, that is only half of it. The other half DOES require competent administration and organisation of available funding and resources. But which half do you have more control over? To date, neither An Taoiseach or Minister for Health Simon Harris follow me, so those of you reading this are probably more likely to help make healthcare reform changes at a patient/grassroots level.
How does an empowered patient group partner with their healthcare professionals to work towards healthcare system reform? Here are 12 examples of the small ways patients can be part of the solution everyday, not just during the Winter Ready Plan. Every journey begins with small steps. Trust me, as a movement, these changes would likely add up quickly:
1. Cancel any outpatients appointment that you know you or a family member won’t be attending in a timely manner so that others can use it. Around half million outpatient appointments aren’t attended per year!!! Don’t ask your GP to “appointment shop” (send out multiple referrals to different OPDs to see which appointment you get first.) This adds to the waiting list, as you can well imagine.
2. Reduce Emergency Department (ED) crowding/wait times. #opentherightdoor whenever possible to reduce ED crowding and wait times. Consider using pharmacy, GP, practice nurse, midwife, public health nurse, allied health professionals, public minor injury unit services, (and if insured, private Medical Assessment Units) for your health issue, if appropriate. Very sick child? Fell off of a ladder? Chest pain? New mother panicking for any reason at 11pm? ED IS the place to go. ED is not a place to go because (and I am honestly listing real-life examples from Irish ED’s here, hand on heart, your neighbours did these things): You ran out of your regular prescription and need a refill. You want a third opinion for a non-urgent condition. You didn’t have the number for the out-of-hours GP so just thought the ED was as handy. You were at your cousin’s funeral earlier that day and realised that you haven’t had a general health check-up in a while. You want a medico-legal report for a court case. You want a plaster for a blister you got at the nightclub.
3. Free up an extra hospital bed for someone in need: Plan ahead for hospital discharge. When you or a family member are cleared for discharge, do your best to make arrangements for respite care or to go home if you are able, at time recommended for discharge, usually 11am. Someone is waiting for that bed in the ED on a trolley! Even “just one more night” for convenience adds up. In other countries, once you are medically cleared for discharge by admitting doctor, you must vacate the bed as scheduled or pay the actual cost of the bed overnight (depending on hospital/ward/acuity, an acute hospital bed actually costs a health service €800-1700/night).
4. Don’t let your chronic disease send to you the hospital or clinic: Failure to take medication as prescribed for conditions such as high blood pressure and asthma is estimated to cost the EU €1.5 billion/year! Finish your antibiotics. Check your blood sugar. Take your insulin. Do your physio exercises. Follow your healthy heart diet. If you don’t understand how to take your medication, when you should stop, or have trouble remembering, speak to your GP or pharmacist about options. I’ve worked in US where patients couldn’t afford their insulin or asthma inhalers, causing unspeakable suffering. Here, it’s affordable. Just take them. Please.
5. Consider using your insurance, if you have it. Private investment in healthcare isn’t a bad thing, though I think we all can agree that it could be done better. Bridges between public use of privately funded capital investment has serious potential beyond the inconsistent NTPF. Until the powers-that-be get it right, if you have insurance, consider using it to free up more public resources for those who have fewer options or resources than you do. (I meet many patients who have it, but have never even thought of using it.)
6. Don’t excessively drink to the point you harm yourself or others. Be a responsible human. Encourage friends and family members to be responsible humans. Teach your children to be responsible. Addiction is an illness, but not all drug and alcohol misuse, such as binge drinking, is addiction. The burden of drug, tobacco, and alcohol misuse on our health care system cannot be overestimated. Alcohol abuse accounts for at least 10% of our total health care budget. Seriously, you could buy a lot more beds with 10% of total funding! Tobacco costs another €500 million in direct healthcare costs.
7. Vaccinate your children. #vaccineswork. Get your annual flu vaccine to reduce transmission in our communities each winter. As I recently noted 2 weeks ago, 12, 362 patients had sought HSE services for vaccine preventable diseases. And that was before the current flu season has started ramping up last week with 143 admission for flu in addition to countless GP/ED visits. https://twitter.com/meathmamadoc/status/1203275956804292608… #getyourflushot #haveyoujabbed
8. Don’t call an ambulance unless it is an emergency. Everyday, sick patients lie waiting for urgent ambulances that are being diverted to non-emergencies. There is an urban myth that if you arrive in an ambulance, you will be seen more quickly in an ED. That is false. #mythbusting You will be triaged the same as everyone else, and then seen in order of urgency. If it is not an emergency, please consider calling a taxi, friend, or relative. Consider being that helpful friend or relative if you know someone has a minor illness or injury.
9. Be an informed and empowered patient. Get health advice and information for your family from trusted sources. Bad online advice doesn’t substitute for healthcare.
10. Attend recommended screenings: Breast, cervical, colorectal, blood pressure…it all adds up. An ounce (cent) of prevention really IS worth a pound (euro) of cure, and a lot less stress and pain. Let’s keep you healthy and out of hospitals and clinics.
11. Be a good neighbour. Look in on elderly or vulnerable neighbours or relatives, and offer small help or assistance. It can make a huge difference in their quality of life. Loneliness also has a seriously negative affect on our health.
12. Join a local walking group or other healthy lifestyle group. Weight loss and weight maintenance are not easy at all, but obesity is on the rise in Ireland and we approaching a crisis with childhood obesity. These have serious and lifelong health impacts. Direct healthcare costs of obesity to the Irish healthcare system are estimated to be between €400-500 million. It would be nice to redirect that funding to resources for long waiting lists, like scoliosis surgery or chronic pain clinics.
Will this fix healthcare? No, I’m not that delusional. But if patients as a group felt empowered to own their socialist healthcare resource use, it would make a difference in our community resources.
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