Wake-up call

Some medical specialties are on the up but others may be in chronic decline, writes Maurice Gueret, who will visit Dickensian London — if he doesn’t sleep in

Maternity Woes

Though doctors are slow to admit it, hemlines in medicine follow the same trends of the fashion world. Prices remain high, but operations come in and out of vogue. Our medical specialties move up and down the pecking order every few years. I sense that cosmetic surgery is on the wane in Ireland. Certainly compared to Celtic Tiger days, when banks and credit unions helped to lift much more than overdrafts. Obstetrics and gynaecology has long been an attractive financial sector for young doctors. Maternity money offered to public consultants for simultaneous private care, can be mind-boggling. But it’s a very high-risk branch of instrumental and operative surgery. Insurance premiums are colossal. Any doctor entering the sector now can expect to experience plenty of mud-raking in print, and courtroom battles for years to come. I remember one late obstetrician confiding in me once that there was not a single member of his group who was not being sued at any one time.

Power or Money

General practice has hit rock bottom. In other countries, it’s a rewarding and varied medical specialty to work in. But general practice Irelandstyle in 2018 is Cinderella without a broom. Money doesn’t follow patients as politicians boast. It follows scandals, and GP scandals don’t make headlines. Except when local newspapers report that villages that have had a doctor for a hundred years now have none. Young Mr Harris is planning to offer GPs a new contract. If he really wanted to help, he should concentrate on offering them power. Power to decide on the most efficient and best-value care for their patients. GPs in the north east received a letter from their local hospital in May. It told them that the waiting time for public physiotherapy appointments has now reached seven months. This at a time when there are a few hundred private physio clinics dotted around Ireland. Many would cry out for new patients as they struggle to eke out a living. I suspect this minister does really care about the demise of family medicine. He should empower GPs to refer patients to services that deliver more care and fewer excuses.

Sleepy Medicine

If any of your school-leaving brood insist on doing medicine after this summer, sleep disorders is a growth area for the wired and Wi-Fi communities. There are few full-time consultants in this field. Most also do a bit of lung or respiratory medicine to keep the wolf from the door. Insomnia would be a common ailment to assess, along with serious snoring, sleep apnoea syndrome and early morning wakening. There is the Jekyll and Hyde effect of alcohol on sleep. Not to mention prolonged use of sleeping tablets, which maintains the very problem they were designed to help. I get a sense that many in the digital world are waking up less refreshed in the morning than they were going to bed. So don’t put your daughter on the stage or in the operating theatre, Mrs Worthington. Invest in her sleep laboratory instead.

Weekly Lie-In

While on the subject of sleep, you may have seen recent headlines saying a lie-in at the weekend is enough to save your life. The Journal of

Sleep Research published an interesting paper on the nocturnal habits of 38,000 adult Swedes. They found that sleeping five hours a night or less confers a higher risk of dying than sleeping six or seven. But the good news for early risers is that a single eight-hour sleep at the weekend can make the higher risk disappear. I enjoyed long weekend sabbaticals in bed as a teenager. But for yonks now, I have been a ‘five hours a night, seven days a week’ Thatcherite sleeper. If your column isn’t here next week, fear the worst.

What the Dickens?

Should I survive this latest health scare, I hope to get across to London for a new medical exhibition that runs until mid-November. The Charles Dickens museum is on Doughty Street, just a kidney stone’s throw from Great Ormond Street Children’s Hospital. This year, they have a special exhibition on the great writer as a man of science. Dickens was no stranger to medicine, having suffered an array of illnesses in his short 58 years. Doctors have long marvelled at his perceptive writing on the physical frailties of his characters. Pickwick Papers, was used to name Pickwickian Syndrome in the 1950s. Its Fat Boy Joe was obese, fell asleep on the job and snored raucously. I’ll tell you more about the exhibits if I wake for the trip.