Health tremors

Why is it becoming so difficult to secure same-day family doctor visits in Ireland, asks Maurice Gueret, who looks at tests Mrs Merkel may be having

Long wait

A new crisis has descended on GP care in Ireland. Same-day appointments are fast becoming a thing of the past as pressure mounts on family doctors to provide more and more, with less than 5pc of the healthcare budget. Probably the lowest allocation anywhere in the world. Patients with appointments complain that things run late. Doctors may be hiding their feelings in surgery, but if you read their late-night outpourings on Twitter, you see clearly that all is not well. From a very low base, the number of hospital consultants has more than doubled in the last 25 years. But on the GP side, the increase has been very small, and hasn’t even kept up with our population growth. In the last month, I removed 30 family doctors from the Irish Medical Directory in the Dublin area alone. Another pressure is that more doctors are now de-registering immediately after they retire. This is because of new requirements to document audits, attend lectures, meetings or study sessions, and provide evidence that they are insured to stay on the medical register. Each has a personal cost when there’s no income. We have an ever-growing population of retired and experienced doctors in Ireland, who may like to work a few days a month, or attend emergency situations. But in the wake of the Dr Shipman scandal, there was a rush of regulatory red tape on both sides of the Irish Sea. That lack of foresight in drawing up rules means that a valuable resource of seasoned family doctors was put out to pasture. Never to return.

Goat skinner

I have written before about my Granny Gueret, who grew up as Fitzharris in a public house that is now Domino’s pizza, in Ringsend. The seaside village has a long tradition of giving its men nicknames that would today be voted down as politically incorrect. My great-uncle, for instance, who had a spinal deformity since his cot days, was known as ‘The Hump’ Fitzharris. The most famous Fitzharris in Dublin (no relation) was James ‘Skin the Goat’ Fitzharris. A native of Ferns in Wexford, ‘Skin the Goat’ was one of the republican ‘invincibles’, and acted as getaway driver for the men who carried out the Phoenix Park political murders of 1882. I was reading recently on the Dublin Dockers webpage about some Irish merchant seamen who were interned by Nazis in the 1940s. Some returned to Hamburg to give evidence in war-crime trials. Conditions were quite dire. Executions, beatings, starvation and typhoid were commonplace. Five Irishmen died in one camp outside Bremen. One Ringsend captive was William Knott, and he testified in 1946 that the Irish prisoners nicknamed the labour-camp doctor as the goat-skinner. He told the court that in Ireland, the term was used to describe the very cheapest type of veterinary surgeon.

Mutti Merkel

Today’s Germany must be concerned about Angela Merkel’s tremors. Nobody talks about them much — not in public, anyhow. The initial bout in June, a few weeks before her 65th birthday, was put down to sun and dehydration. After the second bout, it was suggested that fear of having a bout like the first was the cause of it happening again. But since a third episode in August, Mrs Merkel has taken to avoid standing still for any great length of time. A chair is provided for her when national anthems are played. It’s likely that Frau Merkel is having tests to see what, if anything, is amiss. A neurology team would be asked to give her the complete once-over — testing the function of all 12 cranial nerves in the head, and the reflexes, movements and sensations in her limbs. A cranial MRI or CT scan would also have been requested, and a barrage of blood and urine tests for glucose, thyroid and copper levels. A separate radioactive PET scan is also useful when determining the cause. The downside of bad tremors can be social withdrawal; inability to do ordinary things like making tea; and the possibility that something more serious like Parkinson’s disease, or other brain conditions, is afoot. The best outcome is perhaps the diagnosis of essential or physiological tremor, a more benign and less progressive type of thing. Rarer causes include poisoning with toxins, or wasting of the brain (atrophy) as a precursor to dementia. Affectionately known as Mutti, the world’s most powerful woman offers rare stability in the EU, and is not due to retire as German Chancellor until 2021. It may be polite not to talk about her tremor, but it doesn’t mean we don’t wish her well.