Where the doctors and nurses still see the effects of the 1980s drugs crisis.
PRACTICE NAME: Rialto Medical Centre in south inner city Dublin.
ESTABLISHED 1956. Since then, 3 Generations of doctors from same family have worked to serve this community. Undergraduate and postgraduate teaching practice
PRACTICE PROFILE Deprived inner city community in South of Dublin, still dealing with fallout of the devastating effects and social consequences of the drug crisis which gripped the area in the 1980s There are a number of patients in the practice who have been treated by 3 different generations of the O’Kelly family.
STAFF PROFILE 5 doctors (all under the age of 40), 1 nurse, 3 admin staff.
PATIENT PROFILE 2,400 Medical card patients, 800 private patients
SUMMARY We provide patient centred care for this deprived community and look after our patients from antenatal care and childhood vaccines, acute and chronic management of illness throughout their lives and end of life care. We look after generations of families within this single practice.
IN ONE DAY:
Telephone calls: 146 (inbound and outbound)
Patient interactions at reception desk: 81
Doctors’ Consults: 65
Nursing Consults: 25
This is the diary of Dr Mark O’Kelly on a typical day at the practice
SOME DETAILS HAVE BEEN CHANGED TO PROTECT IDENTITIES
8.10 – Telephone calls to 3 x patients to discuss blood results
8.30 – Referral letter done to hospital. Form filled for patient
8.50 – Middle aged male – In for methadone treatment – prescription provided and urine tested. Also c/o infected ulcer on leg – Dressed and antibiotic coverage prescribed for infection.
09.00 – Elderly lady who is going for cataract operation. Anxious about upcoming procedure. Procedure explained, copy of medical records provided for hospital. BP checked and patient reassured.
09.10–10.00 Elderly lady with advanced dementia – Family meeting with consideration of acute issues and long term planning
10.0-10.10 – Young man – Hay fever
10.10.-10.30 – Young lady unwell – recent still birth and discharge from hospital ? Likely Ascending infection – Referral to Maternity Hospital
10.30-10.40 – Older man – Chest infection with Muscular pains – Treated and Reassured
10.40-11.00 – Man with abdominal pains and hand tingling – Tests arranged
11.20 – Middle aged lady – left arm pain and tingling in hand – Diagnosed with carpal tunnel syndrome – referral sent for surgical outpatients.
11.30 – Young man – Back pain – Advised and reassured
11.40 – Methadone Treatment – young man – prescription provided and urine tested.
11.50 Methadone treatment – Middle aged man – prescription provided and urine tested.
12.00 – Antenatal visit
12.20 –01.00pm Phone calls returned, Letters from hospital reviewed, Repeat prescriptions. Patient results reviewed.
01.00– 02.00 Lunch
02.00-02.30 – Practice Meeting with all staff
02.30-02.50 – Middle aged man coughing up blood – tests and follow up arranged
02.50-03.00 – Middle aged woman with Urinary tract infection & knee pain – treated.
03.00–03.20 – Young man with chronic migraine – Started on medications – follow up arranged
03.20– 03.30 – 3x Forms filled for patients
03.30-03.40 – Notes for Medico-legal case reviewed and released to solicitor
03.40 – Elderly woman with anxiety – listened and discussed – Social prescription provided
04.00–04.10 – Methadone treatment – urine checked and prescription issued
04.10-4.30 – Drivers licence medical completed
04.30–04.40 – Young woman with heavy menstrual bleeding – investigations arranged
04.40-04.50 – Elderly Man – Chest infection – Treated with an antibiotic and arranged for chest physiotherapy
04.50-05.30 – Long consult with middle aged woman with low mood – listened and counselled.
05.30-06.00 – Bloods reviewed, discussed cases with practice colleagues.