An Astronomy of the Real

An Astronomy of the Real.

 

Astromers get their kicks from looking at the stars. I prefer to direct my gaze in the opposite direction and look at reality, it is as interesting, and there are far more discoveries to be made there. When we look even further, beyond the immediacy of reality, on into the past, we see strange customs, behaviors and beliefs, strange dress and attire. Yet we must temper our laughter with the reminder that the future will find us as ridiculous as we find the past, perhaps even more so.

 

It is easy to point to the immense catastrophe that is the Irish health service, to its inequality, ineptitude, and its dysfunctional marriage of socialism and extreme capitalism. Every day there is reference to waiting lists, costs and inequality. One day we may grow tired of the same old analysis and finger pointing? Having worked in New Zealand for four years in a general practice training scheme, it is very easy to imagine how it could be so much better; and yet having had some experience in the Gambia in West Africa it is even easier to imagine how things could be much worse.

 

It is an interesting thing to watch a patient pass into the tube of an MRI scanner, or watch the fiber-optic image of an endoscope pass along someones bowel. One cannot help but wonder if human beings are so intelligent, if we can organize our intelligence so that it can thrombolyse and stent; how is it that the relatively simple task of governance, should remain so remote? Of course once the question is asked, the fun begins because everybody has an answer, and the answer usually coincides with a personal agenda. Yet it is those who have no personal agenda whom are best suited to provide a truthful unbiased answer. However without an agenda, without something to gain, what is the point in raising ones head above the parapet? Clearly (and indeed from personal experience) in the world of Irish medicine ones voiced opinions can mean the difference between a place on a general practice training scheme in Dublin, or perhaps having to take ones family to New Zealand.

 

A recent article in this paper highlighted the fact that doctors on training schemes felt 'under pressure' from their superiors to provide 'very positive feedback' on the forms used to evaluate their training. In Irish medicine a crucial ingredient to 'getting ahead', is towing the line and keeping your mouth shut. Much to the annoyance of the establishment however, there are always a few who are simply interested in 'getting by', rather than getting ahead. It is these people who are deemed to be dangerous, the 'loose cannons' to be silenced or simply ignored.

 

The question remains, how is it that we physicians of the modern world can describe the pathogenesis of a prion, and yet remain oblivious to the pathology that undermines our health service and our politics?

 

When I returned from New Zealand in 2009, I registered with the medical council and paid my yearly subscription. Three months later I was sent another bill for another registration fee, when I called to complain, I was informed that a medical council year runs from July to June, and despite the fact that I had just paid them in March, another registration fee was due in June! What could I do? Only pay this council of doctors who prey on doctors. According to an article in the IMT (May 16^th2012) the medical council pays 820k per annum in rent for its comfy offices at Kingram House and; “More than €60,000 was paid to staff by way of a bonus payment in 2010, among its 49 employees.”

 

Recently membership of a CME group has become mandatory for all GP's. The ICGP charges some 270 for membership to its CME scheme, it also bills the HSE for teaching, and allows drug companies to also pay for and sponsor each of the mandatory 'meetings'.. which usually involve a random speaker speaking on a general subject from the generality of medicine. It is absolutely impossible to garner what is gained from the entire process, other than maintaining an overdraft somewhere at the ICGP. The mercenary philosophy at the heart of the ICGP has reached dizzying heights in recent months with the announcement that the ICGP is to “open the membership door” to GP's who are practicing in Ireland but have no formal training in General practice. According to the college website the application fee for these 'back door' entrants is the modest sum of 7000.00 (no there aren’t any extra zeros!) Bear in mind college membership translates into a GMS list and as such the cost may not be as high as its seems. Of course when we read between the lines its 'Ireland for sale' and business as usual.

 

When I were a lad and was studying medicine at the RCSI, I was (and remain) utterly amazed how that noble institution can charge its majority of non-national medical students in the region of 50k per anum in fees. Three years of that training is conducted primarily at Beaumont hospital, where Paddy is not only the charitable guinea-pig but he pays the bills; from the toilet paper to the canulas, and the wages of the NCHD's who (out of the generosity of their hearts and the memory of their own inadequate training), provide the most valued 'training” for those who can afford a place at the registered Charity that is the RCSI.

 

From its private medical schools in Bahrain, to its new high end private nursing home in Drumcondra and its city centre property portfolio RSCI must be one of the most successful charities in the western world, (Vincent de Paul and the Samaritans should be taking a gold leaf from the golden book)

History will undoubtedly laugh at the ironies of Irish medicine, ironies that are clearly underpinned by a single defining philosophy. It is this same market ideology that defines the political modus-operandi of the state. Ironically we are very very clever at maintaining the singular stupidity which underpins most of our medical and our political woes. 

 

Recently a patient of mine told me that she bought a barbeque that was guaranteed for 25yrs, we both laughed when she reminded me that she is 73 yrs old, and the barbeque will likely be under warranty when she is dead and gone. In a sense our problems are not unrelated to the fact that we have perhaps lost sight of our mortality? Few of us like to be reminded that we will not out live the plastic bag in which we have carried our groceries home, and yet it is groceries and the materials we leave behind that defines much of our daily living. Perhaps a more lasting legacy would be a shift in our way of thinking? Perhaps instead of being governed by 'the markets' we might dispense with them and define a new philosophy, one that is compatible with something more than our consuming ourselves to extinction. 

Recently my wife and I attended a talk by the English philosopher Alain de Botton at Liberty Hall as part of the Dublin writer's festival. De Botton mentioned Joyce and how lucky we  Irish are in terms of our cultural heritage. I wanted to put my hand up at the end of the talk and ask Alain which did he think would be more likely to be found on a Dublin coffee table; a copy of Ulysses, or a dog-eared copy of the Argos catalog? 

 

We are indentured to the ideology of the markets, it is a primitive ideology that defines the institutions of health and politics. Unless we change that ideology and put a different bible on the coffee table, we shall remain as impotent as Bloom the astronomer, looking a skirt and shooting off at the stars.