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I AM A Senior House Officer. That’s a doctor who graduated at least one year ago. Senior House Officer is a stepping stone: you can work at this level for two years or ten years, depending on whether you get training or not. An S.H.O. handles a good deal of first contact work with patients, but in these situations it is always wise, and often necessary, to seek advice from a Registrar or a Consultant.
I work in one of the busiest Emergency Departments in Europe, and this year we only have four out of the required seven Registrars needed working here. These four doctors are my heroes: if they did not come to work, the wounded and dying would literally line the streets – I am not joking. There are three more available Registrar posts but, as of yet, no-one wants these jobs.
In an Emergency Department there are four categories of patients: Majors (very ill adults), Minors (fractures & wounds), Paediatrics (all major and minor children) and the “Resus” (patients who are at imminent risk of death, and need immediate resuscitation). In an ideal world, there would be a senior doctor and an S.H.O for each of these areas. In the real world, we often have half, or less than half, this number of doctors.
We Senior House Officers are not fit for all purposes.
Effects on the patients
Last Saturday night I left work in the Paediatrics room two hours after my shift ended. The nurse was left to look for a doctor to take over Paediatrics after I had already clocked two extra hours… Hours for which I know I won’t be paid.
I felt satisfied that the children I had seen had been properly taken care of. However, as I was leaving, a man approached me with his five-year-old daughter in his arms, asking me when she was going to be seen. He had arrived at 2.30pm… At this stage it was almost 8pm. Looking at the in-tray I saw that there were nine cases pending; at least six of which had arrived before 3pm. Emptying that in-tray was like trying to empty the ocean with a bucket.
What did I say to that man?
“I’m sorry, there are no doctors”.
No, seriously, I did.
Overworked staff
Why didn’t I go back, clock more free hours and help all of those children? If I did, I would have never got home. I would be giving HSE more of what it’s currently thriving on: overworked doctors filling in the gaps, for the lack of competence involved in providing an adequate staffing. So we let the children wait. We let the public call radio stations and give out about their hours waiting in hospitals. We let the truth come out.
That night after working in Paediatrics, I went home and cried. After only two weeks in the Emergency Department, this was the third time that I had cried. All day, every day, people give out to me about waiting, about the lack of doctors, and about not getting beds. I don’t have to ask why the other three Registrar posts aren’t filled.
False perceptions of Consultants
The public’s perception of Consultants is that they are ‘absentee landlords’, cashing in a lot of money for very little work. Sure, there may be a few who do fit this assumption – but certainly in the public sector, it is the Consultants who I’ve seen clocking in serious hours, struggling to keep this show on the road. They teach us, they keep their cool under pressure, and most importantly, they provide a safety net of knowledge and experience. As a Senior House Officer, I need their experience. There may be people in Ireland who would say that we don’t need Consultants, but I would argue that there isn’t a single working doctor who thinks this.
It is the Consultants who try to fight for better resources, and for more staff. Recently one of our Emergency Department Consultants phoned to complain when the Agency did not send a Locum-Registrar. We were left with just one Registrar, but the Consultant’s complaint amounted to nothing. Soon after this, a Resuscitation case came in – there was only the lone Registrar and the Consultant to look after that patient, leaving me to manage all the incoming Major cases by myself. And so it goes.
We have to work with what we have, there is no choice in the matter. We have to keep going.
Whenever a patient’s relative stops me to ask for a glass of water, I simply have to grit my teeth and comply. What I really want to say is:
“Can’t you see that I’m the only doctor here? This is an Emergency Department!”
– Dr Bríd McGrath
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Thank you Doctor McGrath,sincerely, thank you.
It doesn’t have to be like this.
Thank you Dr. Now what will the people who design and supervise this system from their offices safely away from A&E do?
Beautifully written.
Public sector medicine. Percent of medical services provided by the private sector in most first-world countries: 30-60%. In Ireland and the UK: 5%. Makes you think, doesn’t it. A quick Google search will provide revealing morbidity and mortality figures for countries which have majority public sector care v those with majority private sector care. Free at point of delivery or otherwise, it’s the efficiency and ethos of the providers which counts.
HSE: too many administrators, too few people who actually work.
After spending a serious amount of time just last night in an ER with my mother, I had to leave her there at 3 pm as I had to go to work myself a couple of hours later, at this time she had been assessed in triage but had yet to see a doctor having been there since 8 pm. Naturally i grumbled and moaned about the situation, not about the staff but the position they were being put into because of the lack of resources available to them, i can only say that my respect for the hospital staff in this country increased expodentially. Having witnessed the number of alcohol/drug related cases coming in by ambulance I can only say you could never pay me enough work in an ER. I second the opinion above. On behalf of myself and my family I thank you Dr. Brid and all the hospital staff for your dedication and hard work and I condemn the powers that be for the total fukc up the have made of the HSE.
Totally agree with you Elizabeth
This is getting beyond crazy. Dr. McGrath I can’t praise you enough for your stance and speaking out against the monstrosity that the HSE has become. In saying that I have to wonder are you yourself risking running afoul of your employers, they aren’t exactly very forgiving?
I’m a frequent patient of several hospitals so I’ve seen the deterioration you’ve described over the past few years, I’m sure anyone who’s had to use a hospital recently couldn’t help but notice it.
I honestly believe our Health Service has endured so many savage cuts in every area except the ones the one area it was supposed to, management, that it is now on a precipice. We’ve had politicians claim they’ve created a hiring freeze – only to create incredible profits for Agencies when staff have to be hired. We’ve seen several scares in the past couple weeks alone. You can be certain there’s dozens of other near misses in every hospital every day that we never hear about.
In other words we’ve been very, very lucky so far but that can’t last. Something will happen sooner or later, an accident, a system error, an outbreak. No matter what it is you can be sure of one thing, just like Minister Reilly only today suddenly realised the plight of doctors – and commissioned a report, when disaster happens they won’t admit it’s their fault, oh no. Some person, or persons, will be held responsible, reports commissioned and committees formed. Management will sort it out.
Management will not sort it out. Management of the HSE for the most part spends 7.5 hrs a day scratching their backsides, the other 0.5 or more on breaks. I have been in Dr McGrath’s situation while working in Paediatrics and the only way we eventually got management to sort the problem was when we refused pointblank to see any more patients (apart from Resus patient) until we got the help we needed. They held out for 3 hrs. James Reilly has worked in Medicine before, he knows what hours and conditions hospital doctors and GPs work in. And the reason that the hospital above doesn’t have the staff it needs is because despite knowing about the European Working Time Directive for 12yrs or more, the HSE hasn’t changed anything or put any supports in place and has cut wages. That means that doctors staying in Ireland are working the same hours, not getting paid of all of those hours, getting paid less for the hours they are paid for and not getting the same training because of shift work etc. If you aren’t going to learn anything and you’re going to be paid peanuts, you will move to a country where you are appreciated and paid and trained appropriately. The 3 registrar posts above are empty because there are no suitable qualified doctor willing to fill them. They have been talking about implementing the EWTD since before I qualified 10yrs ago.
When I said management would sort it out I was being sarcastic. Management will sort nothing out, they’ll sit around worrying about what level everyone is.
As for Minister Reilly and the rest of the HSE, they’ll do nothing either. Minister Reilly’s son is currently an SHO is one of the busiest A&E Departments in the country I’m told so if the Minister can’t, or won’t, improve the worsening situation for his son nobody will.
What really scares me about all this is that it didn’t just happen overnight, this could be, and was predicted as savage cuts were made to the health Service, and I don’t think they’re finished yet. This government seem to keep coming back again and again time after time to keep making more cuts. Why? Because they can, we allow them to. Sooner or later something will happen, it’s only a matter of time until it does but I suppose they’ve already paid a team of PR consultants to come up with various spin campaigns to explain a variety of screw ups.
Sobering
As one of the afore mentioned registrars I would like to commend Brid on an excellent, and sadly mostly accurate account of ED life in Ireland. One small correction. We have 3 of 7 registrars and one locum who is frequently available to us. We can not get staff despite the remaining posts being offered at locum rates. This is largely due to the working conditions mentioned.
@Eoin is it the hours or the pay, or maybe both? I assume the docs don’t have to work in the same conditions in other countries, maybe we should be looking at models of A&E elsewhere?
Really it is mostly the staffing levels for ED doctors, combined with the crazily overcrowded departments. Two resus level patients is a strain and three very difficult if they arrive at the same time. This is combined with knowing that the rest of the department is bursting with long waits, whilst you deal with the really ill patient(s). The situation is compounded by the number of GP referrals who do not need to come to an emergency department, sent due to the awful waiting time for outpatient clinics. One of my friends working in a smaller department in Australia has more than double the number of doctors working with him. There is also little light at the end of the tunnel. Many ED consultants in Ireland work 9-5 monday to friday with additional hours one day in three or four to make a 12 hour “on the floor” clinical shift. They are then on call for 24 hours one day in 3-4 and one weekend every 3-4. For all these extra hours they receive no overtime. In Australia an ED consultant can expect to have 3 times as many consultants working with them. The real question is why do any of us stay!
Having read that, I can only conclude that you and the other docs are superhuman and have such a commitment to your job that you stay.
Thank you. Really, thank you.
Working in emergency room is not just physically draining, it also mentally drains you. I work in a 50 bed ER 625 bed hospital. We have nurses, respiratory therapist. Pharmacist, social worker, nurse assistants and since its a trauma hosp we have 24 hr surgeons avail. We still have people waiting for up to 10 hrs sometimes depending on how busy it is. I think people just have to know when to go to ER, URGENT CARE or Family doctor. Feel like dying, 911 you’ll be taken care of in less than 4 min
Well written Brid. A lot of people will read this. Comment on it and then forget it. Its the way the health service is. Understaffed on the floor. Overstaffed in management and nothing will ever change unless all the staff, medical and nursing show the public what faces us every day.
@John agreed, people will read it, be horrified, then forget the whole thing. It is an eye opener to say the least. What should we do, go to our local politician maybe? (Genuine question) I often wonder why those who are so vocal about complaining in A&E don’t seem to protest or raise it outside. Maybe there is nowhere to go?
The staff are amazing on A&E, no exceptions. When you see what they have to put up with on top of their ‘normal’ duties it would make you want to pay them double.
@John agreed, people will read it, be horrified, then forget the whole thing. It is an eye opener to say the least. What should we do, go to our local politician maybe? (Genuine question) I often wonder why those who are so vocal about complaining in A&E don’t seem to protest or raise it outside. Maybe there is nowhere to go?
The staff are amazing on A&E, no exceptions. When you see what they have to put up with on top of their ‘normal’ duties it would make you want to pay them double.
Just spent all day in Crumlin waiting for a very minor op for my 4 yr old, who was fasting from 8pm yesterday. This was after spending 4hrs in Tallaght last night.
At 4.30pm the surgeon told me she couldn’t do it today as all the ‘available’ theatres were been used. And they didn’t have the staff for the other theatres that were lying idle!
She herself said she got no surgeries done today as she couldn’t get a theatre with staff
It is all a joke! A shambles! An embarrassment!
€300m wasted on the planning for the new children’s hospital but 4 theatres lying idle in Crumlin! Where is the logic in that!!!
Thanks Brid and John Duddy in the Sunday Indo. The fact the the Minister came out with his ridiculous statement about Junior doctors today as if it was suddenly news to him and asked us how he can help us when have told him exactly how and begged on our knees only for the HSE and him also to completely ignore us infuriated me. It was total propaganda today incase we do vote for strike over our appalling conditions!
you are right as usual jean, the minister should no better. Perhaps he should locum reg for a bit …
know even
Love that idea. James Reilly doing Locum shifts. Lets all pull together!
The pic is misleading. Corridors in our hospitals today resemble Mash on a bad day. No trollies
Thank you Dr McGrath. If all the staff work like you, we don’t have to wait very long hours. Thanks again for your dedication.
Sadly we largely do. The holes in the service are just that pervasive. There is a reason doctors go to Australia, New Zealand, Canada and even the UK. Money is not the most important of these, although it is better. Training quality and lifestyle are numbers one and two for most.
Brilliantly written. Sums up the disgracefully understaffed emergency depts all over Ireland. I am afraid to get sick in this country.
I’m a retired consultant . Everything said by these doctors is correct. They are grossly overworked and stressed. Working conditions are terrible generally in the Health Service but especially for ED doctors and nurses who are under intolerable strain. Their professionalism in filling gaps in taken for granted by the HSE in spite of the fact that many of these doctors are at breaking point. It appears that Health and Safety does not appear to apply to doctors and nurses. Foreign doctors will not work in these conditions when they can get better conditions elsewhere and so posts are vacant making the situation worse. In addition to NCHDs , consultants are leaving too or not returning from training abroad, leaving vacant consultant posts. I really do think the Health Services have been irreversibly damaged at this stage and I am very fearful about the kind of services that will be there in the future in my old age. We still have a very healthy Administration who are overseeing this mess. The Irish Medical Association have recently called for the Registration of administrators and manager as doctors are. I support this entirely. Doctors have stringent requirements for qualifications, continued education, ethics and personal accountability imposed upon then , in the interest of best patient care. So should administrators and managers who should be held personally accountable for services to patients.
When Bertie Ahern broke his leg and went to casulty you can bet he was seen quickly.
Not so the rest of us peasants.
Would like to know of any politicians family were in casulty lately, bet they get seen fast.
God be with the days Matron ran everything like a battleship in the theatre of war. All pulling together with a common purpose in a tough situation using teamwork. Money is important but lack of it is not the issue. The issue is that our hospitals are run like corporations – by spreadsheet from miles away. If the decision makers in the system were only one well-washed wall away from the patients we would have efficient community hospitals run with compassion for the patient.
No joking about the consultants, I’ve seen them put in hours that put many to shame!
Brid……. I have been there years ago and know how you feel. I would like to say that things will improve as you gain more experience but I think u know the answer to that. All we can to do is what you are doing right now…… Do our best and that’s all you can do. Remember, don’t let yourself get burnt out. Take care for yourself eh…… You are human….
I’ll second that, Bríd. We learn the hard way to take care of ourselves. Eat regularly and proper meals. The five mins you take to eat will not have any effect on the 10 hr wait the patients have and if you faint, you are no good to anyone. Keep drinking. Catch up on sleep when you’re off, laundry, housework etc can wait. And have that little cry every now and again. It’s cathartic.
I think the Nurses of this Country should get some recognition here too. In my own experience I’ve always been so impressed with what an amazing job they do ;)
Thank you Dr McGrath. Slowly the message is getting out that Irish healthcare is broken. Breakdowns in care are happening every day and patients are the ones suffering. We can only undervalue the people delivering this service in these conditions for so long.
Doctors in the hospital system for a number if years will tell you things have changed drastically. We are at breaking point.
Classic case of the dictatorship government in action no care for the people.
They dont care one bit this government but all you clowns wont do a thing.
@itis, i would have green thumbed you but for your description of the very people you should be agreeing with.
Poor use of words.
Seeing that it costs us, the citizens of Ireland, substantial money to educate these doctors, they should be required/forced to repay the State by working here for a required period.
It happens in a lot of countries.
Edmond, the citizens on Ireland are not funding the education of every doctor that gets their qualification here. You’re forgetting hundreds of mature students and graduates paying for their own fees. The fees that the state pays per year for a medical student to get through college is only marginally larger than what they pay for say, a maths student.
We cost you pittance, and we hold your health service together with our blood sweat and tears, looking after you and yours 24/7/365.
And you think we should be indentured servants on top of that? Wow. Good luck getting anyone to work in a system like that.
You can’t get the doctors to work in the system when they can leave as they wish, why do you think you could get them when you enslave them in a crap system?
Also, doctors don’t cost that much to train in Ireland – primarily because of the way 3rd level medicine courses work here, but also because there is no training as such, and any training that there is is offset by the fact that doctors work merciless hours.
@Edmond. We also paid for your primary and secondary education so clearly we’ll be seeing you down the ED someday soon helping with the portering, delivering samples etc. to repay the cost.
Your ignorance is breathtaking
Edmond, I’m a graduate medical student, paying close to 15,000 per year, so I owe the taxpayer nothing. I’ve worked in the HSE before and have seen how bad it is, why would we stay? The current situation is dangerous for patients and doctors.
Idiot. they work 100 hour weeks in great stress for low pay, what more would you like them to do? They are not leaving because they want to, conditions are beyond unbearable. And patients are suffering too.
Would you work 100 hours for no overtime?
Thanks Brid! Great article. And I agree with everything mentioned. Working in the ED, the workload is amazing. You go at maximum speed to get things done safely. In our ED we are very short doctors and other healthcare staff so sometimes the doctors have to do jobs of these- bringing the urgent cases to radiology, ECGs, etc. one of the doctors is leaving our ED and the HR/ man power have stated they are not being replaced as we “have enough doctors”. I love how sitting in their ivory tower they can tell us that, when last week waiting time was 10 hrs. We also have 2 very good doctors that cane with recruitment drive 3 years ago, were treated horrendously and are still being treated so bad that they don’t know will they stay as they are only getting temporary registration with Irish medical council. (Due up in September) so if they leave we are down another 2(experienced) doctors. Solution given? “We will deal with it when it happens” the staff of the ED doctors are made up majority of training schemes- GP trainee rotating through the ED, medical and surgical scheme trainees and the EMergency medicine trainees. Each of the trainees have a right to practice safely and get training (that’s in our contract and always overlooked!) and if that does not happen, the scheme will pull the trainees from the ED, which happened at my local hospital. You can’t blame then. I love my job but not the conditions and thanks Brid again for highlighting this to the public!
Doctors are FORCED to emigrate. They train for years to get to consultant level but there are no jobs that they can just walk into. The HSE has not created any new consultant posts despite our overcrowded hospitals. I know many young doctors in the states and Canada who would love to come home despite the conditions but there are no jobs. Lets get the HSE to wake up and restructure. Lets get our Irish doctors home.
Excellent. Well said
This is appalling. As posted above, management and HR staff work 7 hours a day with holidays and flexi-time, they are far removed form the chaos and short-staffing.
The problem is this: conditions are awful, doctors break down and leave the profession or the country, leaving staff shortages, putting the remaining staff under more pressure, until they break too. Huge numbers of doctors are leaving the country, quitting medicine or working part-time and the cycle goes one.
And, just so people know, junior doctors are very poorly paid, particularly for the hours and stress they face. Some people have the idea doctors are raking it in, which is not true.
Fair play sis, u always worked hard for what you got and where never afraid to say it as it is. It’s a sad day to see my home fighting for its basic healthcare.
So true. ED drs are amongst the hardest working and under appreciated in the health service… and that’s saying something! Thank you Brid for articulating this so well.
I think nothing will change :(
Excellent article Brid
Here here John!
Sad nothing will change,these cycles come after every few years and then knee jerk response
So what do we have to do to make the HSE actually do what they’re supposed to?
Well for starters we’re voting on industrial action in the next couple of weeks.
Great piece, but this seems to be a case of the more things change the more things stay the same.
How many years has this A&E crisis go on, and what has changed? I have been working in the health services for 15 years, and the story has always been of doctors on “1 in 3 call” and working too many hours. Some speak out, but then after 6 months move on to the next rotation, for which they need a reference. Like any job keeping the head down and doing more than you are paid for is what gets you the reference. on top of that caring healthcare professionals find it impossible to say no sometimes (wouldn’t you when you come up with someone who is unwell?)
On top of that is the constant theme being peddled by the media that there are too many admin staff in the health services. The amount of time spent by doctors, nurses, pharmacists and other health professionals doing administrative tasks that aren’t what they were trained for is huge.
There are huge changes needed, and part of that is planning. If we can’t have admin staff (the Emergency Department ones I know do a great job in making sure all the paperwork appears when it is needed – you can’t have healthcare without information – people are not machines that you can plug into a laptop and identify the problems)
Part of the problem is that healthcare, outside of public hospitals and their A&Es are run like a business, which means that the non-profitable bits all end up in the dumping ground and on the shoulders of the A&E doctors. You can’t get a GP after hours or on the weekend, and the out of hours doctors have no access to the information your GP has on you. The system is full of risks, so again, the patient has to go to the A&E where they know how to deal with risk (I.e. throw everything at it). On top of this throw in alcohol related problems, and the fact that nobody will stitch a wound now in case they get sued because of a scar.
The public health system is being collapsed.
Health care will be privatised and owned by the international bankers.
To this day I remember the final time I had to bring my dad to hospital. He was in the end stages of cancer and we had to bring him into the A&E as he couldnt get up. It was like a warzone, People in chairs all over the place. A doctor saw us and agreed he needed to be admitted but told us there were no beds and he would have to spend the night on a chair. We both knew that my dad wouldn’t be leaving the hospital again. I looked at her and said ” I know you have to care for everyone here, but I only care about the man you see in front of you. We both know that he is very sick and sitting in a chair is going to make it infinitely worse. Is there anything you can do to make him more comfortable?” She looked at me with such a sad look I really felt for her. ” Ill do my best”
1 hour later she came speeding down the corridor with a bed. ” Get him into this quick ” I have no idea where she got it but I am eternally grateful to her. BTW my dad still had to spend the night in A&E surrounded by junkies and the lost of society, but at least he could sleep
The Royal Oireachtas is overstaffed meanwhile the hospitals are understaffed.
Perhaps if there were medicine places in college courses more of Ireland’s doctors wouldn’t emigrate as soon as they had their degree.
Half of new docs emigrate.
If the country made the job attractive here, they would stay.
That means more money, better conditions, and better training.
No need to produce more docs until we have 100% retention.
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In support of the purposes explained in this notice, your device might be considered as likely linked to other devices that belong to you or your household (for instance because you are logged in to the same service on both your phone and your computer, or because you may use the same Internet connection on both devices).
Your device might be distinguished from other devices based on information it automatically sends when accessing the Internet (for instance, the IP address of your Internet connection or the type of browser you are using) in support of the purposes exposed in this notice.
The choices you make regarding the purposes and entities listed in this notice are saved and made available to those entities in the form of digital signals (such as a string of characters). This is necessary in order to enable both this service and those entities to respect such choices.
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