A DEFENCE FORCES doctor has warned that chronic under resourcing of military medicine could cause wrongful diagnoses of military injuries.

Commandant Paddy Kelly spoke at this week’s conference by the Representative Association of Commissioned Officers.

In a wide ranging address he spoke of the importance to military personnel of having a doctor that understands the unique work of soldiers. 

He also said that the lack of specialist doctors could result in missed or wrong diagnoses. 

Kelly explained that there are a lack of nurses tending the force – with just two nurses working meaning that there are problems with wound dressing, suture removal and taking blood tests. 

The doctor said that the importance of in-house military doctors was revealed to him when a distressed soldier came to him following an Improvised Explosive Attack on a military vehicle that was on deployment abroad. 

He said that the soldier, like others at the scene, came under attack from a roadside bomb and machine gun fire on patrol in recent years on international service. A number of soldiers were injured and also suffered from post-traumatic stress disorder.

Kelly said the injured soldier had struggled to get help because of the difficulty of civilian doctors to understand the unique experiences and work language of soldiers.

The doctor explained that the soldier began to cry when recounting his story, out of relief.

“He felt relieved because we had a shared language and understanding, he knew that I understood his experience because I had served in (the specific mission) and knew the places he named and the actions that were expected of him.

“Not wanting him to face the frustration of explaining again and again the traumatic events of that day with other doctors, I arranged to follow him up for over a year, thereby establishing a trusting therapeutic relationship guaranteeing continuity of care, the efficient use of resources in order to restore his health and return him to meaningful work,” he said. 

The military’s Medical Corps recently raised the issue of a lack of a doctor being deployed to the UNDOF mission in Syria.

Kelly said that there are 24 medical officers in the Permanent Defence Forces and 13 contracted civilian posts which are filled by 13 doctors. Known as Medical Officers or MOs.

He said there are four MOs are specialists, three MOs are trainee specialists. Most of the civilian doctors are registered on the general register.

Kelly said that the need for doctors who are also soldiers, sailors and airmen, cannot be overstated.

“In my eight years of service, I have come to appreciate that members of the DF access healthcare through medical officers or civilian doctors on sick parade.

“Our colleagues and ourselves have medical problems framed within a unique social and cultural dimension – that being the military,” he added. 

Kelly said that the categorisation system of specialist and non-specialist medical officers is causing a risk to patients – he believes that an increase in specialists will reduce the risk and complement the work of civilian and military staff.

He said there is a critical need for an appropriately resourced military medical service which is staffed with specialists. 

“The government is rightly funding Sláintecare and has agreed in the Programme for
Government to extend private medical care to all members of the DF.

“However, without appropriately funded primary care specialist posts in the DF, there will be no means for our personnel to access secondary care.

“Without adequately funded specialist posts, there will continue to be delays in diagnosis, missed diagnosis and inappropriate referrals to secondary care which will not only wreak financial costs but also health costs,” he said. 

Nurses

Kelly also raises the issue of a lack of nursing staff and compares the fact that the Defence Forces has just two nurses full time on medical work compared to 100 nurses working in the Irish Prison Service.  

He said that the Department of Defence has refused to hire new nurses for the Defence Forces – and said that the outsourcing of nursing care will not help the situation.

“There are over 100 full time nurses employed in the prison service, the DF has two
army nurses left.

“In the Curragh, we no longer have nurses two days a week which means no bloods, no vaccines, no blood pressure monitors or dressing changes, no suture removals and the delays in operational readiness,” he added. 

A military medic treating a soldier acting as a patient during an exercise preparing for overseas deployment. Irish Defence Forces Irish Defence Forces

Kelly said the same issue exists in the physiotherapy section. 

The military doctor explained that due to the physical nature of soldiering that there was a serious need for this speciality.

Kelly also criticised the refusal by the DOD to honour a recommendation in the Commission on the Defence Forces that HIQA would monitor medical care.

The doctor called for the conference to pass his motion which called for reinstatement of Fixed Period Promotion to three years from captain to commandant.

He also asked delegates to back his proposal to immediately commence recruitment of permanent fulltime uniformed nurses and for a call for the Government to accept the recommendations in the commission report for HIQA to carry out inspections. 

Kelly also asked his colleagues to vote for reinstatement of specialist pay and for military  doctors to be placed on the specialist division of the medical register.

Kelly’s motion was carried unanimously by his fellow delegates at the conference and he said that the outsourcing of care as a fix for under resourcing would cause more problems than good. 

“Until medical care is provided in-house by appropriately qualified uniformed personnel, we will continue to see patient’s medical care poorly managed, serious diagnoses being delayed or missed and personnel remaining unnecessarily on sick leave.

“It’s this understanding that is required to optimise care for soldiers and it is this understanding which will keep tears of frustration at bay,” he concluded. 

DOD response

In response the Department of Defence said: “The entry criteria for medical officers are matters for military management and there is no requirement for direct entry medical professionals to be specialists.

“The Defence Forces have deployed a Medical Officer to UNDOF since 12 NOV 2022. Before that date, the Irish Medical Section including an Advanced Paramedic, had a designated Doctor on call from Ireland, and could avail of all UNDOF medical facilities.

“The medical services provided to members of the Defence Forces are kept under review and are now being considered in the context of the level of ambition agreed by Government for the Defence Forces recommended in the report of the Commission on the Defence Forces.”