Tangled web of the blame game

THE agenda for the Irish Medical Organisation’s AGM and the choice of the Minister for Health as guest speaker were planned well in advance, but in the days leading up to it, the event began to resemble an ever-widening spider’s web and Micheál Martin a hapless fly heading straight for its sticky centre.

With the public health doctors' dispute deepening and the SARS crisis growing, it seemed the minister could at best hope to come away from the encounter with his wings dented and at worst, face a public devouring.

He might have been expected to tiptoe around the edges hoping not to get too entangled, but instead he torpedoed right through it, with a blistering attack in which he charged the striking doctors with putting lives at risk and accused senior managers of "total abandonment of responsibility".

The reaction of the IMO members, when the gasps of indignation had died down, was to suspend standing orders, table an emergency motion deploring the comments and threaten to escalate the industrial action.

The latter is a worrying prospect. If the action of less than 300 public health doctors can cause ructions, the support of an additional 5,200 of their IMO colleagues could create chaos.

It was to be expected that the minister's words last Friday would get backs up, especially as he was biting the hands that issued the invitation, but it is debatable whether threatening all sorts of retribution merely turned the IMO into the fumbling fly and the minister into the superior-strength web-spinner.

Public concern over SARS has become almost as scary as the prospect of contracting the disease itself.

In this state of panic, it is questionable whether public sympathy with the public health doctors can be sustained and whether it will extend to medical professionals in other fields.

The IMO did a good job of presenting a picture of public health doctors, unpaid martyrs to the cause, answering their front doors at weekends and taking phone calls in the middle of the night to do battle with suspected cases of meningitis and measles and other nefarious diseases that prey upon the country's children.

Beside them, the minister, one in a long line accused of ignoring their plight over nine increasingly frustrating years of negotiations, appeared variously inconsiderate, ill-informed and disinterested.

The timing of the dispute certainly does Mr Martin no favours. He could not have anticipated SARS, but he will have known that for some months now, with spending on health and dissatisfaction with health services increasing proportionately, some commentators have been referring to him as the Taoiseach-to-be who now won't be.

Much has also been made of the relative quiet from the rest of the Cabinet who, rather than worry about the barrage of criticism unleashed on one of their best and brightest, seem quite happy to let him take all the flak. But then, most of the Government was still off breaking open the last of their Easter eggs when the SARS issue hatched.

And if SARS does get a hold here, or if present fears about the disease get any worse, the doctors may find public understanding of their gripes wearing thin. In contrast, the minister who tried to goad them back to work and struggled, and some say blundered, his way through their absence may become the hero of the piece.

A more likely scenario than either a backlash against the doctors or the ruination of the minister, however, is the discrediting of both sides amidst the realisation that what appear to be rows over health services are more often disputes about industrial relations in the health services sector.

Three categories of health professionals GPs, hospital consultants and junior doctors are threatening action to back the public health doctors since last Friday's war of words.

All three have outstanding industrial relations issues with the minister. GPs are still angry at the U-turn on the extension of the medical card scheme after the last budget and consultants, squaring up for the renegotiation of their contracts, have also been threatening action over the introduction of a central claims agency to handle personal injuries cases against them.

Junior doctors, meanwhile, are close to getting humane working hours but fear they won't have enough training hours as a result. That issue has been to the Labour Relations Commission and back without final resolution.

When the SARS ballyhoo dies down and a review of the country's response to it is carried out, fingers currently pointing at the minister's office may be scratching heads in confusion instead. It was not, after all, the minister's fault that someone in a hospital decided to send home a Chinese woman possibly suffering from a disease that was bringing large chunks of the world to a standstill. To say it was is to suggest it is his job to personally scalpel open health graduates' heads and physically insert common sense implants.

Neither was he entirely to blame for GPs being left without surgical masks because, regardless of whether his department promised to dispatch masks or not, every surgery should have at least one in a bottom drawer somewhere or know a pharmacy where one can be bought.

He may share responsibility for the public health doctors strike and, after last Friday, he may also play a large part in its escalation, but whereas SARS continues to defy control, a strike can be started, stopped and postponed at will.

When it comes to the question of who could have done, or can do, more to respond to SARS, it is not just the minister but doctors in all areas of the health services who will have to be careful how they answer to the public.