In conversation with Dr Gerard M Crotty

Dr Gerard M Crotty, Consultant Haematologist, Midland Regional Hospital, Tullamore.

Dr Gerard Crotty is a consultant haematologist at Midland Regional Hospital (MRH), Tullamore, as well as MRH Portlaoise and MRH Mullingar, a position he has held since 2000. Previously he was a consultant haematologist in Scarborough and Leeds, Yorkshire, UK. His undergraduate medical training and internship was in Galway, followed by basic and higher specialist training in Dublin, and further posts in Glasgow and London. He has been very active in The Irish Hospital Consultants Association, serving as Council member 2008-2012, Vice-President 2012-2014 and President 2014-2016. He is actively involved with the Royal College of Physicians, and is a trainer for both basic specialist and higher specialist trainees, and served as Vice Dean of the Faculty of Pathology. In the day job in the Midlands, as well as clinical care and laboratory haematology, he is actively involved with postgraduate medical education and in clinical research, specifically clinical trials in haematological cancer.

Dr Crotty, why did you study medicine?

That is so long ago, I have forgotten some of the reasons! It was to be a specialist physician, definitely not a surgeon of any sort, and probably not a GP. The application of science to human welfare and a to be a respected expert were among the motivations.

As a Haematologist what aspects of your role do you like, and perhaps dislike?

I like the variation: lab and clinical work, consultation medicine, management issues and a wide enough view of the health service as we provide services directly to all consultants and GPs. A dislike: not many (especially in management) understand the multifaceted role, and so resources (especially help) often fall short of requirements.

What Minister for Health do you admire the most and why?

Choosing from among medical doctors who were Minister, Noel Browne, though of course long before my time, strikes me as someone who did what was right for medical care of patients and especially public health, despite opposition e.g. from the Church. He may have been a bit politically naive, though, but maybe many of the others are too politically cute and thus we have not got enough done!

If you were to describe the Irish Health System to an outsider what would you say about it?

Overly complex, with too many hospital sites due to political interference. As a result, not joined up, and over politicised.

Do you experience any difficulties in gaining access to new medicines for treating patients?
Yes, increasingly so, especially with new cancer medicines in my field as these will always be expensive. We are now falling behind other comparable countries. The on off nature of early access programs and the delay before reimbursement are making for a difficult environment at present.

How has this impacted your delivery of care to patients and do you have any suggestions on how quicker access may be gained?
Choice of therapy is determined to too great an extent by what is available this month as opposed to what is in long term best interest of patient. Recent initiative of working with several other small European countries may be of great benefit if we can get reimbursement in Ireland at the same time as the others.

You have held the role of President of the IHCA – what key change did you make during that time that you are most proud of?
I was honoured to serve as president of IHCA, though it was, and is, a difficult time for consultants, with increasing difficulties in recruiting new colleagues. Hundreds of consultant posts are vacant, or filled by locums, many not eligible for permanent consultant posts. There is huge deficit in capacity, reflected in record waiting lists and the scandal of our sickest patients waiting on trolleys in Emergency Departments. The change I am most proud of was raising the profile of the Association in the media, as well as making our voice heard in Oireachtas committees, submissions to government etc. I think there is much broader agreement now of the need to tackle the recruitment crisis, and the capacity deficit, even though much still needs to be done to even begin to get on top of these issues.

If you could be the Minister for Health what would be your top priorities for the Irish Health System?
Not a job I would seek! The priorities would be: Capacity, recruitment and simplification. We do need fewer sites doing much of the acute work. However, this can never happen safely or get public (or political) support if services are taken away without the enhanced service being made available in a larger centre. There needs to be substantial investment in staff and facilities on a sustained basis, with realistic plans to meet future demand.

What Health System in the world do you feel has cracked it in terms of delivering quality healthcare for patients?
France and Netherlands are often mentioned, though I have no experience of either. These and other Western European countries such as Germany have substantially more hospital beds and specialist doctors than we do. The UK is a bit of an outlier (though not by as far as Ireland) in this regard, and markers of capacity falling behind demand (e.g. patients on trolleys) are increasing rapidly in the UK (though still well behind Ireland), so we should not take the UK as a model.

You have interacted with many specialists from the Pharmaceutical industry – tell us what value they have brought to you and how can they continue to improve to support the work you do for patients?
In my specialty (haematology), almost all therapeutic advances have come from new licensed medicines or new ways of combining existing drugs (as surgical procedures play little or no role in treating haematological diseases). In some diseases, these advances have been transformative for our patients, in other more incremental. The various specialists I have come across, from those who support our clinical trial work, to those who provide medical information, to the promotional role of the representative, work within a highly regulated industry, providing innovative ethical treatments. Educational support and facilities to interact with leading clinicians in other countries, are most valued as these would be unlikely to happen with the direct support of the health service.

If you had not chosen medicine as a career what would you be doing?
I might have studied mathematics or physics (the only true science – everything else is stamp collecting – Ernest Rutherford) – Perhaps I would have made a fortune in financial trading and have by now retired to a beachside villa somewhere warm.

Who would you like to be stranded on a desert island with and why?
If it could be anyone living or dead, perhaps it could be a famous man, born on 25th December, who changed the way we think about the world… I refer of course to Isaac Newton! Back in those days, one man could be at the top of the game across all fields of science, or as it was called at the time, natural philosophy. In our specialised age, this is of course not possible, though I continue to find that insights from a variety of fields of knowledge can be brought to bear on our work in caring for patients.


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