There are few occasions in my career when I feel compelled to ask myself whether medicine was the right choice for me. No doubt many in the College and the Council would concur. Today was one such day, one where I not only question myself as a member of the Medical Profession, but also as a citizen of Ireland.
Tom is a 40yr old office worker, he and his wife Kate are the kind of soft spoken, gentle, introspective people who make General Practice a meaningful place to work. Three weeks ago Tom came to see me complaining of a tingling sensation down his left arm with occasional stiffness in the wrist. The immediate suspicion of carpal tunnel syndrome was somewhat borne out during the exam and Tom was referred for physio and given a short course of anti-inflammatories. Tom saw the physiotherapist for two sessions during the week.. however matters came to a head during the following weekend when Tom noticed that his speech was becoming a little slurred.
Of an anxious disposition Tom presented to a nearby 'Swift' clinic, and after being examined he was informed that he may have had a “slight stroke” he was advised to go to A/e and given a letter. Whilst driving himself to A/E his nervous disposition evolved into anxiety proper and with Olympian self control he endured the six and a half hour wait in Beaumont casualty, to have a blood test, be examined and ultimately reassured that it was unlikely that he was having a stroke and allowed to drive himself home.
On Monday Tom presented to my practice once again, with an unexplained and unresolved slurring of speech and persistent neurological symptoms in the arm. Fortunately Tom has VHI, this was unfortunately of no use at the Swift clinic, but we will come to the financial costs in a moment. I referred Tom to a Neurologist at a private Dublin hospital. The following week Tom went to see the neurologist, who organised an MRI scan and after examining Tom recommended that he have some bloods done “there and then”. Tom was asked to pay 350 euros for his 20-30 minute consultation with the Doctor. He was then informed that his blood tests would be an additional 300 euros. When informed the receptionist that the cost was 'a bit too much' and that he would rather have them done at his GP's he was informed that one of the tests was a 'special test', that could not be done at the GP's. When he asked if he could have just the 'special' test done and have the remainder at his GP's, he was informed that this might be possible? But that he would have to 'go through the public system to get the remainder his results ' and that this would greatly complicate things. Tom acquiesced and left the rooms of the neurologist after paying out some 650.00 euros for a 30minute consultation and some bloods. Although it is pure here say upon Tom's part he described his encounter with his consultant as being very formal and not at all friendly.. of course we only have Tom's word for that.
This was on Tuesday morning, on Thursday he had his MRI scan. On Friday Tom's wife called to say that Tom was quite unwell, and that she was very distressed and worried on his behalf. It is important to reiterate here that Tom and his wife have been my patients for quite some time that they are very nice people, who don't complain and don't present to the Doctor's unless there is something wrong, and have a resolute faith in the medical profession. I advise Kate to bring Tom to my surgery.
Once again this time on a Friday evening at 5pm Tom and Kate are in my office. On this occasion Kate is in tears, Tom has a hard time holding back his own tears, and I myself am emotionally shaken by the presentation. Tom has an envelope with his MRI films inside, he is pale upset, clearly hasn't been eating, drinking enough or sleeping well since he saw the Neurologist. After I examine him he asks me to look at his MRI scan which I do, whilst warning him that I am neither a radiologist nor a neurologist.
I do the decent thing and lie, I say that I can see nothing wrong with the MRI scan but that we will have to wait on the formal report and in the meantime we should try to deal with the other 'elephant in the room' which is our collective anxiety. I ring the private hospital on the off chance that the MRI might have been reported but of course the world of private medicine has gone home for the weekend.
I give Tom the only remaining tool in my arsenal of impotence in the form of a letter to A/E should his speech become worse over the weekend. I also give him my mobile number my refusal to take a consultation fee has the apparent effect of deepening Tom's anxiety, for which I give him a short term script for some anxiety pills.
Now for the Bills: First presentation to me €50, two visits to the physio €80, visit to VHI €125, return visit to me €30, visit to the consultant €650. Grand total €925 euros. Tom has been out of work for three weeks, if we count the cost of his medication and the fees I have waived Tom's symptoms have cost him almost one thousand euros. He must return to the Neurologist next week and was reassured before he departed that his next consultation would not be as expensive! This will undoubtedly bring the grand total to some 1200 euros of which he is entitled to a 60 euro refund from his VHI.
Tom and his wife will spend the weekend worrying, awaiting the diagnosis which they most fear; a cancer a brain tumour, multiple sclerosis. The professionals, like myself who have treated Tom will sleep quite soundly this weekend, oblivious to the pain Tom and Kate will endure, oblivious to their fears and the financial burden that has been placed upon them. This is modern medicine in Ireland, this is the predatory nature of the relation between the 'system' and decent, hard working good natured people.
It is a good thing that the Hippocratic oath has been dispensed with, else we might add cynicism to the growing vices of our profession.
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