A different Dear John letter

Dr Paul Heslin writes an open letter to Minister John Gormley suggesting a very simple solution that could save money, the precious time of emergency care workers and many lives

Dear John, it is my understanding that to be green is to look at the bigger picture, the long view and the system at large. It is not about local interests at the expense of our children, not about mé féin at the expense of the country, and it is not about short-term solutions that easily become a patchwork quilt of band aid solutions that later begin to leak like a sieve. Do you recognise the health system?
Ultimately, green is about systems thinking. How is everything affecting everything else? To be green is to ask is there a better, more sustainable way of doing things that makes more sense at local and national level, using resources more efficiently?
I want to tell you, therefore, how you could make my life as a doctor, and the lives of many front-line workers in this country, much, much easier. The citizens will also benefit and ‘systems thinking’ will get the credit. Joined-up thinking. This is a green, efficient solution that will make a real difference to all our lives. The positive consequences are for everyone, at a crucial time in our lives when we are most vulnerable, when we are sick or when our house is on fire. Cost savings and efficiencies are just an added bonus. Let me explain.
House calls
I regularly do house calls. I regularly spend a lot of time driving around looking for the number of the house. Yet I can often get frustrated at the waste and thoughtlessness of the system in which we all participate.
Many homes have no number on their doors, yet the owners seem confused that the ambulance, doctor or fire brigade does not get to their house fast enough. Some have the house numbers painted over thoughtlessly, now with the same green or grey colour as the door, making the number impossible to see, especially at night. Some neighbours do not know the street names of their own new estates.
In Australia in general, and in Melbourne and Brisbane especially, I saw other ways of doing things. The number of each house was painted on the slipway between the road and the footpath on the right side as you enter the house. It could be seen easily and safely from the car.
Also, the sequence of numbers was printed on the phone or electricity poles and an arrow indicating where these houses were. In the US, the mailbox is on the sidewalk with the number of the house. I would add to these great systemic practices.
All houses, by statute, should have their numbers in a reflective and easily seen form, all of a minimum size and font, on the right side of the gate, rather than inside the closed, dark door patio. All estates should also have, by statute, a map at their entrance detailing the street names.
I appreciate that sat nav has made a great contribution to the work of emergency workers. But it does not help at the local level. There is more that must be done, and we doctors see it at the coal-face. People who want and expect an emergency service must also be more thoughtful about how to facilitate the workers who are trying to help them.
Bells that do not work. Dogs barking and not put away in a back room. Patients gone shopping. These are not ways to help the system flow. What about the patient who is feeling better, but does not tell the emergency service? The patient who could come to the clinic, but will not? A preventable delay at one house means a delay before we get to the next house-call.
We are all in this system together. Perhaps that extra half hour will make all the difference at this most vulnerable time of one’s life. Do you want an emergency service that arrives at your house late, even too late? Do you want staff arriving frustrated and snapping at you?
Efficient system
As a doctor, I want to get from house to house in the most efficient way possible. It is satisfying to be working in an efficient system that gives the best possible ‘flow’ and that gives the best possible outcome. It is not like the old days, before mobile phones and cars, when an urgent call to the doctor meant being seen over the following two days, rather than in the same hour; when doctors travelled by horseback, boat and sometimes plane!
In some countries, this is still the way, as in New Zealand and Australia. But we are fortunate in Ireland. We can do better. But to do this, we need ordinary people to make changes that will help the helpers.
Minister, you are in the most powerful position to effect change at the level of government. Mary Harney made one small step for man, when she brought in smokeless fuel in Dublin, by one stroke of the pen. This effected a massive change in the health of Dubliners, with savings in euro, health outcomes and lives. We are all still reaping the marvellous benefits of this change in the system.
Now John, your time has come. Local authorities must bring in these changes. Take the opportunity now with both hands and do the right thing. Imagine fire brigades, ambulances, doctors and gardaí arriving at your door when you need them, rather than wandering around lost in the estates of Ireland, wishing they had gone to Specsavers!