I'm a GP in rural Ireland AMA

[drdolots]

Not sure if anyone will be interested but it's a Sunday afternoon so why not.
I'm a GP in a small practice in very rural Ireland.I work with one other doctor,one nurse and one receptionist.I can imagine it's a pretty stark contrast to how things are run on the NHS so I guess -ask me anything ?(but maybe not specific medical advice because I hear MNHQ don't like that understandably,I will keep it general )
Oh and I have NC'd just Incase

@womaninthedark so yes any patient beyond 12 weeks except in the case of a fatal abnormality/risk of death to mother or baby will have to travel to England to have an abortion .In that's case I will put them in contact with Marie stopes and see them before they go and see them again once they return .The biggest issue with traveling to England is both the cost and the lack of aftercare so while change the cost I can offer free aftercare

I should imagine that's a vast improvement on when they had to keep it secret. Though I'm sure it would be much kinder to treat all cases locally, and I hope that one day women will be able to count on that.
Thank you for your answers.

I work in the nhs and think some people don’t appreciate how lucky they are to have it. I think some people in Ireland avoid the health system as they can’t afford it. Is there a happy medium for a health service, where has it right in your opinion?

What are some lifestyle tips you can give so I stay well?
Does your medical training men's you go,certain things that you mat not otherwise do? Such as eating for health etc?

Is the payment for under sixes higher than the regular appointment fee? I ask because our receptionist keeps asking me if I've applied for my under six card yet in a belligerent way!

How do you find working with PHNs and Home Help Coordinators, OTs etc? I work in the community myself and find that GPs can be a bit left out due to not being direct HSE employees. Would you be in favour of a HSE employed contract rather than the existing self employed contractor model?

@drdolots do you think the current model works and what changes would you like to see made. I am in Ireland as well but not living rurally and I think our gp system is in many cases the only part of our health system that seems to function properly. I can't speak highly enough of my gp practice they are absolutely wonderful. I honestly don't mind paying. My elderly parents are free, my young children are free and the excellent care I received during pregnancy was free so I don't mind paying for the rest.

@MegCleary@SparkyBlue I think the current model works very well. I have friends working in the NHS and they have extreme difficulty with a huge workload and a sense of entitlement among patients. However, that being said the cost of attending the GP is a deterrent.What I would like is a middle ground I would like to charge a small fee to medical card patients 5 euro a visit maximum of 20 euro a month with over 70s and under 12s being exempt. As this would weed out the time-wasters, which we do have an issue with, in general, private patients only attend with genuine complaints and I feel a small fee would make people think if they do need to see a doctor or not. I would also like to bridge the gap between private and public and offer subsidised GP visits to all(with the money from the medical card levies) and bring the cost of an appointment to around 30 euro. I would not like us to follow the NHS, the fact everything is free means there is less money being spent on life-saving care. In Ireland, we have access to many more medicines and expensive medicines are far more easily available than on the NHS even for public patients and I feel those who do need it get the treatment.

@tommycockles I'm very away that health is personal and there are levels to health. Everyone does not need to be a doin yoga at 6 am and eating only celery. I encourage to take small steps that fit into their lifestyle. In saying that im on the more extreme side of things. I love to sleep and I get 9 hours every night and I think that keeps me in health, but I realise that is not accessible to everyone. I walk for an hour every morning and then do Yoga once a week and a jog twice a week and thats it for exercise but it keeps me well.I would say diet is super important just natural whole foods, this whole movement of protein bars full of artificial sweeteners is terrible for us. In general, sleep, exercise, good diet unprocessed food, listen to your body and above all destress.

@kenandbarbie the way the under-sixes work is the GP gets payment for the year to see your child infinite times.I'm not sure how much this is as I don't do paperwork. So if youre child is healthy and you never visit them more money, but if you're in every day its less if that makes sense. It's a fixed payment no matter how many times you visit the same as medical card.

@kenandbarbie You have to pay for every visit if you don't have the u6 card for your DD. The Receptionist must think you're mad paying for visits which your DD can get for free if you apply for the card. It's free to apply. You can do it online once you have her PPS No. and nominate your Doctor.

Thanks I find it interesting as a resident of Northern Ireland,I did always wonder how it works. So have you no inclination of the NHS model? I live in a border county and we have a lot of “granny addresses” with people accessing care and education including people accessing the nhs for births etc I thought maybe the nhs was something the roi strives for ?

@TrixIr great question because of the two-tier system I feel as though GPs will have to remain as contractors as I feel otherwise would be chaos. However, that being said up until recently people like OTS and PHN were normally co-ordinated from secondary care which means GPs have very little to do with them, which leads to a lot of confusion. With the new primary healthcare system model which is being rolled out in some areas they are becoming more community-based at co-ordination level and I feel in theory this could be useful. I would love to have a scenario where I see a patient then I have a chat with the OT ,the OT then sees them and then we can c0-ordinate the PHN to visit them all from primary care and take some of the burden off hospitals.

@Ivechanged19 there is a misconception among Irish patients that the UK has things much better on the NHS. But if for example, you have rheumatoid arthritis in the UK you need to be almost crippled until you will be given a HIgh-tech medicine which is the gold standard of care however in Ireland these are much more accessible. I mean yes it's free but I think in Ireland people get better care I often see people on here not being able to get a GP appointment for months or only being allowed discuss one issue at a time. Also, I believe people should have to pay something towards healthcare something that is affordable dependant on income which is the case in Ireland. If people have to pay they can often be more responsible with their health.

Its interesting you give RA as an example as a friend of mine who is originally
From Leitrim went for her initial appointments in Galway and ended up signing up to her north address and getting treatment from the hospital here. I also can get an appointment on the day I ring my GP surgery as they have a GP who screens the calls every morning for 2 hours so each person is either offered phone advice,to purchase medication from pharmacy or have an appointment that day - I know every surgery is different but personally mine is great...I can’t say that for the rest of the nhs as I got an mri earlier this year - either 12 week wait or pay £190 - I paid but not everyone can. I do know there is a sense of entitlement because “we pay our taxes” and “worked all our lives” so why should we pay l,but I suppose that is how some people were brought up 🤷🏻‍♀️ I do think emergency care and long term
Illness should be free,with acute episodes occurring a charge and definitely that prescriptions should have some
Charge - I know a lot of people cross over to the north to receive them cheaper too !

I know what you mean OP. I lived in the UK for years and my DC were born there. Didn't get an epidural for either of them. I know an epidural isn't necessarily ''good care''. But the fact that we have to pay in Ireland makes patients more assertive. I used to feel obligated to be a bit more grateful for being seen in the UK, whereas in Ireland I'm not going to be ushered out until I feel 100% heard. Do you know what I mean OP? If you've paid 55 euro and the doctor suggests something that you've already tried, you're not going to stroll out without making that crystal clear. I had a medical card when I needed it and never felt my health was any the less important to the GPs. Breast clinics don't even know if you're on a medical card or not. I lost my medical card recently and I have health insurance now. Very basic health insurance, 47 a month I think.

@drdolots that explains it then! I was only in for vaccinations - free anyway! And with my older children I hardly brought them in at all, they're not sick much, the baby has never been ill yet!! (Touch wood)

I live in England, but think that my elderly parents and siblings, who live in Munster, largely have a far better standard of GP care.

Here, if I can’t make it to the GP surgery in the next village (one hourly bus in either direction at peak periods, two-hourly during the daytime) before 8 am and queue on the street until the surgery opens at 8.30, then wait inside for anything up to two hours, thereby losing a significant portion of a work day, I can call and be offered an appointment between a fortnight and three weeks away.

I have tried to switch surgeries to one close to my workplace, but I can only be accepted at the GP whose catchment I’m in, and that’s the one in the next village.

OP, thanks to you and the other GPs like you who are taking good care of my ageing parents. They’ve had some significant health concerns lately, and it’s very hard trying to help from a distance.

@Ivechanged19 it seems like you're surgery have a good handle on their system but this definitely isn't the case through out the NHS in general there is less demand on health services in NI due to a smaller population than mainland UK.12 week wait for an MRI isn't too bad but in my ideal health system if everyone contributed in a small way to primary care then secondary care could be much more well serviced.If for example patients payed 5 pound to see a doctor with elderly and children being free and free for those with long term illness (diabetes Parkinson's etc ) then it would reduce the demand as when people have to pay it makes people think maybe I don't need antibiotics for this cold an oxymoron in itself.I feel as though the NHS could raise funds with itself so that the wait for an MRI could be 4 weeks instead of 12.Obviously this is a dream and I think if it was implemented there would be riots.Also the Irish system is far from perfect and I'm sorry to hear your friend didn't get the treatment she needed I only speak to the experience of my colleagues.

@31RueCambon75001 yes definitely contrary to popular belief patients advocating for themselves is paramount .I think because healthcare costs in Ireland patients are more assertive however I would love to see GP charged being subsidized in the future as I think healthcare needs to be accessible to some people.I often see men especially who haven't seen a doctor in 5 years and have an ongoing issue but only see me when it's beginning to impact their life and it's often more difficult to deal with then .

@BrittleJoys thanks for your lovely post.I really feel for both patients and GPs on the NHs as the system is being run into the ground and is becoming unsafe for patients as they cannot access care at primary level.Then they have to present to A and E or end up in hospital because they could not see a GP.A friend of mine is a GP in the West Midlands and on a Sunday an old lady came to her house she knew it was inappropriate but she had being tried to get an appointment for three weeks but couldn't dial fast enough and was told by the receptionist to come down at 8 am and queue but she couldn't drive or walk as it was too far friend had to call an ambulance as she had double pneumonia.

Great idea for a thread.

Two questions :

How's your work /life balance?
Do you feel people are more stoic / tenacious with living in the country? Not snowflakesque?

I know a lot of people prefer to go to 'healers' rather than a qualified medical professional for treatment. Is it difficult to treat some people in your community or do you work in conjunction with natural healers?

Great thread, Thanks drdolots
I’m confused by 31rue though
Did you have to pay for epidural in the uk? Or do you mean we have to pay for gp in Ireland sorry