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With over 60000 people waiting for outpatient appointments in Coquitlam, flu season shortly upon us and covid-19 still very present, the hospital system in Ireland could be under severe pressure in the upcoming months. I'm joined by Dr Chris Lew, consultant and emergency medicine. Chris, good morning.


Good morning, Tony.


Now, here's the question. Before this pandemic began, the IDs were absolutely crammed with people, people on trolleys and so on. Where do they all go?


Well, that's the 64000 dollar question part. The fact that we were able to effectively reduce our workload in mid to late March by the order of 70 to 80 percent should give great pause for thought to politicians and policymakers everywhere. And it should, I think, prompt them to really, really drill down into the daily workload of our chronically overcrowded emergency departments. I mean, we know, for example, that about an up to a third of the people who come to the edes in the state every year are admitted, which means that two thirds are not.


So if you if you then delve further into that cohort to find that, you know, a lot of them could be preferably seen elsewhere. And, you know, I've I've had friends complain recently about the length of time they've had to wait again in the edes and in the city here in agony with injuries, waiting for hours because of the overcrowding. People, you know, absolutely baffled and bewildered by the overcrowding in, you know, in mid-August when they started to the people only got one third of the people need to actually to be hospitalized.


So two thirds are either, you know, told to go off and see your doctor, told to go home. There's nothing wrong with you. Or they get a cast and their break is treated, their X-rays and so on, and then they're sent home. Never admitted.


So the question is like, do you triage people by telephone like we've been doing for covid-19? Do you have injuries, clinics and like the V.A. swift care place kind of places? Is that how you do it? Is that how you clean up the edes?


Yes. Well, I mean, look, I think I mean, look, a little earlier was talking about the need to, as it were, turbo charged flu vaccinations in the state this particular winter because, you know, we just do not want to see co infection with flu uncovered. And you talked together about, you know, the idea of pop up clinics or vans going around the state as we had, as we all remember, those of us old enough to remember that the X-ray bands, you know, because it was TB was the great problem back then, you know, the the dormant TB that was basically asymptomatic.


And, of course, it's asymptomatic. You know, covid infection without the symptoms is the great worry. So I think we need to turbocharge that sort of process of prevention. We need to put proper facilities and vans out there that provide both vaccination and also a great deal of other care. We need, for example, proper facilities or vans that can provide scans to general practitioners. We need to get nurses out there to do more home visits. We need to have more community physiotherapy.


So, you know, there's a lot of things they can do. And I think probably the priority is to try and promote health care. I mean, you know, the vast majority of ailments are really self limiting. And, you know, if you have the Panadol, the ibuprofen, the honey, the lemon sleep and so forth, you know, the vast majority of minor illnesses will subside. Here's another thing. I mean, for years there's been this dichotomy between, you know, health insurance covered patients and public patients.


But I've long pursued a third way, which is to say to somebody who's faced with a two year wait for an MRI scan, let's say you do realize that you can get an MRI scanner for about 180 to 200 euros. And rather than, you know, waste, let's say, 52 weeks or 100, we have an forfend, you know, why not try and, you know, find the 200 euros to purchase the scan yourself? Because very often that MRI scan will be offer a huge reassurance to somebody that they haven't got something sinister.


And moreover, they can also find out whether or not they're likely to be a candidate for surgery. So there are many ways that we can be more imaginative in terms of self care.


So, for example, if I have an MRI scan, which I pay for myself, I will get that scan. It's my property and I bring it. Then if I'm a public patient, I bring it to the public system and say, this is it.


This is what's wrong with my knee or my arm or whatever it might be or my brain, whatever it might be. This is it.


Now, do I need to see, you know, general practitioners are flummoxed or are hamstrung because the patient that they may think well is a public patient. So he may have to go into the public waiting list, which, as we all know, is getting longer and longer. And we're talking about a year or two or three for some appointments and some scans. So, as I say, a third way would be that this is just one small example, a third way to get this.


And then the patient will lose themselves and know that, no, I'm not. You don't need to see an orthopedic surgeon for that minor issue with your disc or your cartilage in your knee. And, of course, you've already suggested another thing, which could be rapid access clinics. I mean, I've always said that, you know, they describe, you know, in medicine, they say surgery is trauma by appointment. I mean, and I've always felt that we should be able to have appointments for our trauma, our injuries.


So if you have a minor injury in Bykov or Brittas Bay, you know, today, you know, the vast majority of cases can wait till tomorrow or the day after to be seen. And I'd love to see the development of of clinics. So we have been doing them in Cork for years, you know, where the GPS can ring to the nurse practitioners or people like myself and book their patients into a clinic in a day or two hence.


And that's a much better way to operate than to have people piling into the waiting rooms of the emergency department.


Now, the final area I want to ask you about in terms of the overcrowding of the 80s, are drug and drink related presences. And, you know, because of lockdown, because the pubs are closed, clubs are closed and so on. Have you seen a reduction, a significant reduction in those attendances? Yes.


And in fact, again, I mean, there have been many blessings in disguise, obviously, with this COGAT. You know, despite the misery, you know, we've seen a reduction in toxic air pollution. We've seen a reduction in circulating diseases like flu because of all the hygiene. We've seen it largely an increase in vaccines despite the noise of so many boxes. And one of the one of the great blessings is we've seen a reduction in substance misuse because many people are unable to get hold of their normal drug of misuse during the lockdown and have decided after a week or two or three going without, you know, they've had their own sort of cold turkey withdrawal.


They say, hey, I don't actually need that, you know, cannabis, heroin, cocaine or whatever. So there's actually been a blessing in terms of Eddington's in terms of a very significant reduction in the number of alcohol and drug related presentations. So that's another good thing I read about in America this week is that apparently Zoome services for for addiction, sort of AA, but by Zoome have been very, very popular and I have turned out to be very, very effective.


And of course they're catering for people who are shy or very reserved about going to a meeting. So that's been another blessing.


We'd refer back finally to, I suppose, what GP's are doing and the fact that they have also been using technology for remote diagnosis and consultation. And, you know, perhaps that should continue because it allows the doctor maybe to have a look at someone's spots as well as hearing them being described by the patient.


Yes. And of course, people forget that, you know, in the 80s when I was a youngster and general practitioners picked up the phone and they thought they had an acute appendicitis in the surgery downtown, they rang the surgeon directly and then they were able to send the suspect to the appendix to to the surgical ward, for instance. And I think that should be revived. I think they should be far more telephone and telemedicine consultations. It should be far more electronic prescribing.


And again, another thing we've been doing and for for a number of years, that should be far more telephone review of patients once they've attended the ed, you know, a day or two or a week later to make sure that that all is all as well. And I think I'd love to see a revival of general practitioners ringing the consultants in emergency medicine in their locality to discuss the referral to triage the phone and send them immediately or maybe send them to my clinic in a day or two.


Yeah. Dr Chris Fluke, consultant in emergency medicine, thank you very much.