From Dr Bones McCoy to Dr Google

Ever wondered why international chains are so keen to own Irish pharmacies, but less keen on family doctors? Maurice Gueret has been thinking on the matter

Deep Pockets

Chemist-shop names have changed beyond recognition since my first dose of scabies. Medical halls are rare as hen’s teeth — almost all are pharmacies now. It’s rarer now to see the name of the proprietor on a shop sign. A great pity. Ireland has just under 1,900 community pharmacies doing business. There are two big international chains, Boots and Lloyds, each with close to 100 shops. They purchased their way into Ireland, taking over existing outlets or small chains. Deeper pockets mean they often have first pick of juicy locations in new shopping precincts. In recent years, you’ll have noticed that many independents have grouped together for rebranding. Pooling resources allows them to compete with the pulling and buying power of chains. Some are in franchise operations with drug wholesalers. Others join more loosely together under a common banner. Hence the ‘We Care, You Care, All Well, Live Long, Better Now’ sort of vanities we increasingly see tagged on to traditional shop names. Patients don’t mind these indulgences, but the name of a senior resident pharmacist shouldn’t be lost on the customer. Increasingly, I fear, it is.

GP land

Allow me to cast an eye also on what was my own backyard of general practice. There are about 1,600 GP surgeries in Ireland, with perhaps 3,500 family doctors, assistants, trainees and locums servicing patients each day. It’s interesting how little movement there has been from international or Irish firms to take over GP practices. Only one operator that I know of, a local company called Centric Health, offers to buy the goodwill of well-established practices, introducing new doctors of their own, and allowing retiring GPs to wind down commitment gradually. Opticians, hearing-aid services and pharmacies have all been regarded here as ripe for takeover by corporate business. But general practice hasn’t felt the love. The simple reason is that profits are just not in it. They are no more attractive to takeover businesses than barber shops with stripy poles. There’s no shortage of international buyers and developers for new primary-care premises up and down the state. Juicy rents from the HSE and others are like manna from heaven. But the business model of the Irish family doctor fails to excite the upper echelons of finance.

Bones McCoy

Doctors are often asked at interview who or what motivated their interest in medicine. I had two answers for that one. The answer in job interviews was my late grandfather, a no-nonsense psychiatrist and governor of asylums. The pub answer, perhaps a truer one, was the influence of Dr Leonard ‘Bones’ McCoy, chief medical officer on Star Trek’s USS Enterprise. A new paper on the influence of science fiction on contemporary medicine reminded me of Bones recently. It mentioned his famous diagnostic machine, the tricorder, which was an all-purpose sensory probe that flashed lights and gurgled noises as it made a diagnosis. It was never wrong, and only ever failed Bones when he tried to use it on aliens. McCoy relied on it absolutely, and would complain loudly about primitive working conditions whenever his tricorder was not to hand. The paper went on to examine the downside of transferring all medical authority to machines, exemplified by the helplessness of McCoy when deprived of his advanced tools. A bit like taking the iPhone from a doctor today.

Dr Google

The author of the piece on Dr Bones McCoy is an American called Greg Beatty, an avid science-fiction reader who has a PhD in English. He had some interesting things to say about the ‘internet of things’, especially about how when you search for a pair of shoes on Google, the next time you log into Facebook, shoe adverts show up on your feed. He suggests that the internet is ripe for abuse in the medical realm and ponders this brave new world where all electronic devices communicate continually with each other. He imagines a situation where medical robots will interface with phones, cars, fridges, treadmills and grocery lists. Your smart house will delete things that are bad for you from your electronic shopping list. Or the shop will not allow you to buy it. Or your freezer will refuse to allow it in. Just as Bones no longer felt like a real doctor without his tricorder, Dr Beatty wonders whether people will still feel like people in tomorrow’s world. Dr Maurice Gueret is editor of the Irish Medical Directory drmauricegueret.com