Wednesday, June 24, 2009

OAP Tuesday - and WEDNESDAY!

My father lived life to the full, lived it at a pace few would keep up with and lived a life less ordinary. But he was a man of his time and those who grew up in fifties Ireland and worked through seventies and eighties Ireland did see it all. He would have valuable advise for young families and business people in an Ireland that has changed a lot but is now affected by economic and international forces that we have been through before.
Dad emigrated to England as a young dentist and came back with my mother and a young family to Carbury in north Kildare to farm and set up his practice. His passion for horses led him to race ride until he was 45 years old. He rode at the Cheltenham festival on a mare he broke, owned and trained at the age of 43. My sisters and I had a rural childhood of freedom, fresh air, hard work, surrounded by cattle, dogs and ponies. My father began his day on the farm, then donned a suit and put in 8 hours in his dental surgery in Edenderry, then fed cattle and horses and walked his fields until dark, usually with me, the boy, by his side.
The advices that resonate every day, of hard work, of fair play, honesty, independence, have stood me in good stead. We took risks and chances, both he and I, in business and in life - with crazy horses on the racetrack and optimistic enterprises to remind ourselves that every failed plan or tumble at the last is just another lesson learnt. The voice that goes on in my head in every day dealings, to walk away, to hold counsel, to keep the cheque book closed or to speak out and support what feels right- that voice is his.
I remember two pieces of advice about business. The first was never to trust a Bank or let them control your affairs. The second was never to owe what you cant easily pay back.
I would say its a bit late to be giving some people those pieces of advice. The next thing he'd say would be - dont let the banks bully you when you are in trouble!- paay them back a bit and dont panic them by telling them too much!
I mention these sayings of his in tongue in cheek fashion as the reality of todays business climate for the SME sector is grim- as grim as the late seventies perhaps. My chairmanship of Kildare Chamber of Commerce has put me in touch with businesses staying open only by will power.
But will power is a much under estimated asset.
If Dad was around he would be just 66. He passed away on a sunny morning up on the Curragh on horse back on the gallops. I cant picture him as an OAP. But I do know that people like him lived with 50 % income tax and 17 % interest rates and worked through that to educate the generation here now and build the nation we have, such as it is, warts and all.

Groome Pet Vets now give OAPs one third off all Vet services on Tuesdays and Wednesdays.
If you are an OAP- you know thats the least you deserve!

Des Groome.

Thursday, June 18, 2009

Canine casualties of the property bubble...

We have a client in one of our clinics who shall remain unnamed in todays monologue. A big brash builders foreman who earned his first weeks wage under the benevolent conciliatory largesse of Ahern and who has now joined his first dole queue during the chilly and pragmatic stewardship of Cowen. In keeping with the time He collected four or five beautiful big pedigree dogs, rottweillars mostly. For good measure when the new house was built and fenced off he added three or four ponies until the healthy growing menagerie began to create healthy growing Vets bills. Wisely, an insurance policy was taken out for each dog so that the monthly premium to Allianz replaced the unexpected.
Pet Plan are a subsidiary of allianz Insurance Company who have the Pet Insurance market more or less to themselves. It is a problematic business. Insuring horses is a minefield as Irelands army of canny horse dealers would out smart and bankrupt any insurance company. Insuring pets is also not without risks as pur bred blue blood canines have their breed specific congenital defects which can be troublesome and expensive to treat. In fact some of these defects can be so wide spread ,such as hip dysplasia in the German Shepherd and Entropion in the Sharpei, that insurers request extensive examinations before accepting a dog or will simply insist on an exclusion clause in the policy for certain defects or conditions.
Our hero's first few years as a pet owner were uneventful as his pride of rottweillars grew as healthily as his bank balance. The new house was sold for one of those improbable sums of the halcyon peak era and a newer and bigger one with more room for dogs and ponies built next door. We didnt see our hero very often in the clinic but I made the occasional house call to the ponies and would often note that the wad I was paid from was matched only by the size of the newest tattoo on the arm.
Until last week, when he reappeared with a rottweilar I hadnt seen in a few years which now had a severe hind limb lameness. We admitted Jake, a 4 year old 52 kg male rotti, for sedation, examination and x-rays. A diagnosis of rupture of the anterior cruciate ligament of the stifle was made after the " draw test"- a type of manipulation of the stifle joint and a tell tale sign for cruciate injury.
Repair of this condition is by a surgical repair using a prolene ( a form of nylon) replacement for the torn ligament. The tricky procedure is then followed by lengthy rest, physio and then controlled exercise to test the new ligament. Surgery in a dog like Jake would be a three hour affair involving two Vets, two Nurses, numerous X-rays. Jake would stay with us for perhaps three days and need the best antibiotics available to us for up to ten days afterwards.
We gave a quote for Jakes total Veterinary work as an estimate of 750-950 euro; The final figure would depend on soreness/swelling post-surgery etc.
The owners bellow of anguish seemed out of character and a far cry from his ebullient old self.
I reassured him that Jakes insurance would probably cover this and went to make a call to Allianz only to be told that our hero had let the insurance lapse as the bills had only ever been in the region of 60 to 100 euro before and it had seemed a waste to be paying out for insurance...

Des Groome.

Saturday, June 13, 2009

Web of inclusion - or circus of confusion.

Sally Helgesen ,a US writer, in her book "The web of inclusion" described how a revolutionary way to organise work in the famous Beth Israel New York Hospital created a new philosophy of patient care and became a world wide movement. Breathtakingly simple, the new system assigned a single senior nurse, known as the primary carer, to each patient. This nurse would manage that patients hospital stay by forming a care team made up of everyone from housekeeping to Laundry, junior Doctor and Senior Consultant. The care team consult as one on the patients therapy or surgery with each part of the hospital chain connected together. Helgesen likened the system to a spiders web where the beauty of the whole structure depends on the links between each part. The benefits of Primary Care Nursing as this is now known are many; Trainees learn by involvement, Domestic staff develop pride in their work, The Primary Care Nurse bonds with the patient- and Consultants practice humility because, uniquely, they have to consult. The patient is treated as customer, guest, client and centre of attention. The model has been adopted by commercially focussed hospitals and those with a patient-centred ethos the world over.
Earlier this week I attended Blanchardstown Hospital to have an arthritic joint (a recent running injury to my right foot) injected. My appointment was for 7.30 am. I presented myself on time, filled in a number of forms and handed over my health insurance card to the consultants secretary. Some eight to ten others assembled simultaneously, likewise answering a 7.30 appointment, without any particular order to proceedings. I was called into a day ward after only a few minutes, given a cubicle and the usual flimsy backless gown, and told to undress and put this on. I mentioned that my big toe would be the consultants only focus today, hence there was hardly any need to undress, but was told by the senior nurse " It doesnt matter, its procedure". I was then asked to put my shoes back on and go to X-ray. I pointed out that my boots were painful to put on and take off and in any case the foot itself was the point of X-ray. The answer to this was " sorry, health and safety".
After the X-ray was taken I returned to this day ward clutching the film of my painful big toe. I had not by this stage seen my consultant or been given any indicator of when I would get my injection -a ten minute simple procedure in itself- so I mentioned to the nurse who appeared to be " in charge" that I had an equally important 12 o clock appointment with another consultant in St James hospital. A rare abundance of medical attention for me I can assure you, but an appointment I had waited for and would have to wait two months for again. I was reassured that I would be out by 11 and settled down to wait for the big toe man to call me.
Some two and a half hours later, at half past ten, this nurse reappeared apologetically to say I would have about another half hour wait and might need to cancel my other appointment. I considered my options for a few minutes and then reluctantly rang James' to explain my predicament. A very understanding receptionist promised to reschedule me, albeit to some time next month. Again I settled down to wait.
At five past twelve I rang my own receptionist to make other plans. My own efficient lady rang me back to say an orthopedic man in Clane would see me at half twelve next day. So I got dressed. At the ward desk I asked for my X-ray back and stated I couldnt wait any longer.
To the senior nurse who appeared gob-smacked I said " I am afraid this is probably one of the reasons why the public have lost faith in the HSE". A Student Nurse from meath whose dad was a farmer had chatted to me earlier about Aberdeen Angus cattle and Meath GAA while she brought me down to x-ray.I thanked her and said " Niamh, this is called voting with your feet- Some day I may be so sick that I have no choice but to put up with this ; but today I have a choice so I am not going to be treated like this and then pay out my own good money to the man".
As I limped out onto the corridor I got a surprise as the embarrassed consultant himself came out of a theatre door after me. He apologised for the delay with a defence that he had got bogged down in a surgery and hadnt been drinking tea in there.. I said, look, there is no argument, you are busy but so am I - I was here at 7.30 for a small procedure, it is not acceptable to have to wait five hours without warning, you cant treat people like that any more.
He was also told how disorganised the place was and how disrespectful it is to herd in your whole day list at 7.30 am with no order or communication- and in an off-hand manner to force me to miss another important medical appointment for no good reason.
He did apologise again profusely but in reality the loss of a private patient was likely the only thing to exercise him to rush into the corridor after me.
When Kildare Vet Surgery was built in 2004 it was built at cost to one person-me- to provide a service to animal owners, to work to a high standard, to become a local asset and social benefit, to raise the level of animal care in Kildare to a new level- and to be a commercial success.
We work to a mission statement - Aiming to provide excellence in Veterinary when you need it near you.
This mission statement is client-centred. Our success and survival depends on attention to customers. Excellence in Veterinary is something we strive for as we deliver the services the market demands.
If a client or their pet are unhappy with us in any way we can and must be told - and if we are not responsive to customers needs or wants then we dont have the right to that customers business.
Questions arise from that trip to Blanchardstown- Did the Nurses even bother to tell the consultant I needed to be out by 11? Did they place any value on my time and the wasting of my time? Did that consultant ever have to bother before about disrespecting a private patient or any patient?
Plainly they have a culture/ethos/policy of not treating patients like customers.
In fact they barely treat their patients as adult human beings as far as I could see.
If the HSE in Ireland or even just Blanchardstown Hospital were to adopt a client-centred policy, as Vets like myself who have to make a living adopt client-centred aims, it would have to be called patient-centred and would use many of the strategies of the Primary Care Nursing movement.
For this to happen, many more paying customers like myself will have to vote with their feet, will have to get up and walk out and will have to calmly face to face with these senior Nurses and Consultants say- I will not be treated like this and disrespected by you and your flawed system and your archaic hierarchy.

Des Groome