Pandemic could have been so much worse says doctor who has critiqued medical profession
Two years ago Dr Seamus O'Mahoney wrote presciently that health-service reform would only come about in the wake of a global pandemic; despite Covid's devastation, he now believes we got off relatively lightly
ON FEBRUARY 11 last year the World Health Organisation announced the name of a severe new respiratory virus as Covid-19 – just four days after Dr Seamus O'Mahony walked out of Cork University Hospital and into retirement.
O'Mahony, a consultant gastroenterologist and author of three medical books, had worked at the large teaching hospital over three spells, for 22 years. His 60th birthday was looming and he was exhausted. The thought of lie-ins past 5.30am and no more on-call bank holiday duties was enticing and he was looking forward to travelling more; perhaps speaking at a few conferences. Covid, of course, put paid to all that.
The irony of missing out on the biggest health story of his career isn't lost on him, but his feelings are ambivalent. He also admits to a sense of relief. And it's this honesty which makes his latest book – The Ministry of Bodies: Life and Death in a Modern Hospital – all the more interesting; as it dispels the myth that all doctors are saviours or saints.
“I missed the pandemic purely by chance,” says O'Mahony. “There was some talk at the time of a virus, but not much really.
“On one hand, I missed out on this huge global health story but I'm not sure going into a pandemic feeling tired and weary would've been such a great thing. I did volunteer to go back during the first wave but in the end, I wasn't needed. I will be volunteering though to help out with the vaccine roll-out and am looking forward to that.
“But truthfully, I was also slightly relieved. A friend of mine in Manchester died of Covid and he was just three years older than me. I was chatting to him on Zoom before Christmas and in January he was dead.
“He was just three years older than me. That put things into context for me as a health care worker turning 60.”
O'Mahony, who also worked for the NHS in England for 14 years, wrote The Ministry of Bodies during lockdown, based on notes he kept over the last eight months of his career. His first two books, The Way We Die Now, published in 2016, and the follow-up, Can Medicine Be Cured? (2019), were honest in their critique of the medical profession and provoked much debate.
His third book pulls no punches either, as he reveals the idiocracy of red tape; absurd general emails that waste valuable time; self-promoting specialists; the parade of self-destructive drinkers and drug addicts and the patients who believe they know better than the doctors or who self-diagnose with the help of Google.
Confidentiality is maintained throughout; with anecdotes based on amalgams of patients and colleagues he's met during his illustrious career. The doctors he admired and respected are presented as themselves, he points out, while those he disliked are disguised.
“I stuck my neck out with my first two books about the failings of medicine,” he says. “With this one, I could afford to be even more honest. I knew I was finishing up.
“It's much more contemplative than I was planning it to be and because I knew I was going, I think that gives it an extra dimension. I was able to write exactly what I wanted to write.”
The book is peppered with sometimes humorous, sometimes heartbreaking, anecdotes of patients who've been under his care. There's a young woman whose father likely had Munchausen's syndrome and a woman who'd hired a medium to pinpoint the cause of her pain. O'Mahony also talks about the patients who refuse to accept there could be a psychological reason for their illnesses and who insist on test after test in the hope of a physical cause.
“A huge part of the workload in primary care is the area of medically unexplained symptoms,” says O'Mahony. “But we see it in hospitals too; in gastroenterology and even more so, neurology.
“There seems to be a growing resistance in many people to accepting that some physical symptoms are psychologically driven. It's still stigmatised. No-one wants to hear that 'it's all in the head' and I understand that.
“Many patients want to hear a different explanation for their sickness, such as food intolerance.
“In the cases where their symptoms are psychologically driven, once you frame it in the right way; explain how there's a complex dynamic between mind and body, they tend to accept that. But it can be difficult to move forward if doctor and patient have diametrically different points of view.”
O'Mahony also believes, in the literal sense, the old proverb 'physician, heal thyself'. He says doctors need to practise self-care by managing their careers better to avoid what he sees as a pandemic of burnout among his peers. He says one way of doing this is take consultants off on-call rotas when they reach a certain age or to allow them to switch to management or mentoring roles as they hit their mid-50s. But he acknowledges that more consultants are needed, if this is to be the case.
“There is a problem within this profession of not managing our careers,” he says. “There is no recognition of the fact that you're not the same person at 65 as you were at 35. You don't have the same energy but you're expected to do the same job; to get out of bed in the middle of the night; to be in work at 7am on a bank holiday Monday.
“There is no built-in recognition of this in our professional structures and burnout is becoming a major issue among doctors, not just in Ireland and the UK, but globally.
“Also, doctors are very competitive people who don't like to admit to frailty or weakness.”
O'Mahony believes that by creating a working environment that appeals to the over-60s, more consultants will stay on in their jobs. Interestingly, he points out, the numbers of young people applying to medical schools in the United States has shot up by 20 per cent since Covid and figures have risen in Ireland and Britain as well.
“I'm not sure why this is,” he muses. “You wouldn't expect careers in nursing and medicine to become more popular not less since the pandemic, but that seems to be the case.
“Maybe it's because they're perceived as safe careers. But I do expect to see a lot of burnout and stress down the road for health-care staff who've worked through the pandemic. Maybe the young people going into health care aren't fully aware of this.”
In O'Mahony's second book Can Medicine Be Cured?, published two years ago, he wrote that reform would only come about if there was a combination of economic collapse, a global pandemic of an untreatable infection and climate catastrophe. His words proved premonitory.
“When I wrote that book, a lot of people in global health were discussing not just the possibility but the probability of a pandemic,” he explains.
“But what I got wrong was that I quoted an expert saying the worst-case scenario was a mortality rate of 30 per cent. And I didn't think it would be so soon.
“I know this is going to sound bizarre – we've lost two and a half million people around the globe, a huge number – but put that into context and compare it to other pandemics like Black Death or the Spanish Flu. Covid mortality has been relatively low.
“I think we got off relatively lightly. There are bigger challenges ahead for the planet; climate being one. But with Covid 19, I genuinely think it could have been so much worse.”
The Ministry of Bodies: Life and Death in a Modern Hospital by Seamus O'Mahony is published by Head of Zeus.