Comments on: Health is Wealth http://www.markingtime.org/blog/2007/04/16/health-is-wealth/ Mark Time. Gather My Thoughts. Talk to myself. Mon, 08 Sep 2008 02:31:26 +0000 http://wordpress.org/?v=2.0.1 by: Mark Waters http://www.markingtime.org/blog/2007/04/16/health-is-wealth/#comment-15164 Tue, 17 Apr 2007 08:10:23 +0000 http://www.markingtime.org/blog/2007/04/16/health-is-wealth/#comment-15164 It's a nice theory and one that I nearly bought into myself. However in reality it doesn't work like that. Specialisation requires centralisation and in a country with a dispersed population such as Ireland, centralisation of services has a detrimental effect in terms of patient access and patient outcomes. I agree that there is a place for specialisation but what we have now is specialisation gone mad with ever increasing divisions into new sub-specialities all of which seem to serve the needs of the medical profession and not those of the patient. The vast majority of cases presenting at hospitals can be handled by generalists and do not require specialist treatment. It would be nice if we could have a 'both-and' rather than an 'either-or' situation where we had specialists at centralised units and generalists dispersed among the population. However, specialisation is coming at the expense of generalisation. We are not producing enough general surgeons anymore. The creep of specialisation has now extended into services such as maternity and Accident and Emergency. I would not regard these as areas that should be centralised and specialised. For these services the most important thing is patient accessibility, that patients are within the so-called golden hour in terms of time to access. My local hospital lost its maternity facility 15 years ago and almost lost its A-and-E in 2004. Only street protests prevented it. There has been a continual rundown of services in the hospital to the extent that pretty soon they will be able to justify its closure on safety grounds. I do not live in an isolated rural area. The catchment area for this hospital is around 100,000 people. You say that you would rather a specialist than a 'jack of all trades'. The reality is that unless you are lucky enough to live close to a so-called centre of excellence you have no choice, you have no service, and you will suffer as a result. People have died that would otherwise be alive due to this policy. It’s a nice theory and one that I nearly bought into myself. However in reality it doesn’t work like that. Specialisation requires centralisation and in a country with a dispersed population such as Ireland, centralisation of services has a detrimental effect in terms of patient access and patient outcomes. I agree that there is a place for specialisation but what we have now is specialisation gone mad with ever increasing divisions into new sub-specialities all of which seem to serve the needs of the medical profession and not those of the patient.

The vast majority of cases presenting at hospitals can be handled by generalists and do not require specialist treatment. It would be nice if we could have a ‘both-and’ rather than an ‘either-or’ situation where we had specialists at centralised units and generalists dispersed among the population. However, specialisation is coming at the expense of generalisation. We are not producing enough general surgeons anymore.

The creep of specialisation has now extended into services such as maternity and Accident and Emergency. I would not regard these as areas that should be centralised and specialised. For these services the most important thing is patient accessibility, that patients are within the so-called golden hour in terms of time to access.

My local hospital lost its maternity facility 15 years ago and almost lost its A-and-E in 2004. Only street protests prevented it. There has been a continual rundown of services in the hospital to the extent that pretty soon they will be able to justify its closure on safety grounds. I do not live in an isolated rural area. The catchment area for this hospital is around 100,000 people.

You say that you would rather a specialist than a ‘jack of all trades’. The reality is that unless you are lucky enough to live close to a so-called centre of excellence you have no choice, you have no service, and you will suffer as a result. People have died that would otherwise be alive due to this policy.

]]> by: SK http://www.markingtime.org/blog/2007/04/16/health-is-wealth/#comment-15154 Mon, 16 Apr 2007 19:51:59 +0000 http://www.markingtime.org/blog/2007/04/16/health-is-wealth/#comment-15154 I thinking someone is misreading Chris Lyons meaning in the first paragraph. What is is saying is that if you are a specialist in a particular area you need to be seeing/treating cases in your area reasonably regularly to remain competent. If the hospital catchment area is smaller than about 200k then for common illnesses there won't be enough people there to ensure the level of care is adequate. And the it would not be efficient use of that specialists time to have them idle or working on areas they are not competent in. I would rather a consultant that is a specialist in their area and well practiced, that a "jack of all trades" who might only see my condition once in a blue moon. I thinking someone is misreading Chris Lyons meaning in the first paragraph. What is is saying is that if you are a specialist in a particular area you need to be seeing/treating cases in your area reasonably regularly to remain competent. If the hospital catchment area is smaller than about 200k then for common illnesses there won’t be enough people there to ensure the level of care is adequate.

And the it would not be efficient use of that specialists time to have them idle or working on areas they are not competent in.

I would rather a consultant that is a specialist in their area and well practiced, that a “jack of all trades” who might only see my condition once in a blue moon.

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