PATIENTS seeking treatment for disfiguring, but probably non-life threatening, ailments such as ingrown toenails, moles and cysts sit quietly in the waiting area of McDaid Surgical at Scally Place in Letterkenny.
It’s a Tuesday evening and local GP, Dr James McDaid, is busy at work in the weekly clinic which specialises in minor surgery.
“GP-based surgery is convenient, because people can go to a local setting and be treated by their own GP. It is also low cost, because GP services are cheaper than consultants’ services,” Dr McDaid explains.
Not only is it low cost, it is comparatively quick as the clinic has set itself the target of seeing and treating the person within four weeks.
“If you take a look at the waiting lists for minor surgery in Letterkenny (University Hospital) you’re looking at twelve months or more before you’re seen. The problem with all this waiting is that some minor health problems can turn out to be not so minor after all – skin lesions can be a sign of skin cancer, moles might not be benign.
“We’ve picked up some serious melanomas which, unfortunately, can have high mortality rates, but we’re very lucky to have such a good working relationship with the staff in the Histopathology Laboratory at Letterkenny University Hospital (LUH).
“If the news back from the lab is bad we refer the patient to Galway, to skin specialist Pauric Regan, or to Letterkenny if necessary. There’s such a huge demand for the minor surgery clinic at the moment that we’re looking at putting on a second night in the week,” Dr McDaid said.
The procedures carried out at McDaid Surgical usually involve local anaesthetic and they provide a diverse range of minor surgical procedures which include verrucas, toe nails, Intra-Articular Injections and suturing.
Fuss-free
In countries such as Australia and the US, it is common for General Practitioners to run clinics that are fully equipped for minor surgery, where patients can walk into the clinic and get the treatment they need, fuss-free.
While Dr McDaid runs a similar GP-led clinic for privately insured patients, the Irish College of General Practitioners (ICGP) believes GPs are being discouraged from offering minor surgery services because the level of payments from the General Medical Services Payments Board does not cover the cost of treating medical card holders.
If more GPs were encouraged to perform minor surgery, it would take pressure off hospital waiting lists, the ICGP says.
“Personally, I don’t think the HSE or the consultants in Letterkenny mind me operating the minor surgery clinic, given the length of the waiting lists,” Dr McDaid said.
Former registrar
A former Registrar in LUH, Dr McDaid worked alongside the late Dr Joe Hanley and the late Dr Jim Golden.
“It was the late seventies, early eighties and we had to deal with some terrible atrocities due to the bombings and shootings in Northern Ireland at that time. There was only two of us – Mr Hanley and then Mr Golden – and we worked long hours, but I got some valuable experience,” Dr McDaid said.
Married with three young children at the time, he then got an offer he “couldn’t refuse” from the late Dr Paddy Scally and his wife Maureen.
“To get the surgical experience I needed at that time would have meant going to England and, more than likely, America. And with a wife and young family it wasn’t really at option, so it wasn’t that hard a decision to make when Paddy Scally came calling in the eighties and I’m here since,” he said.
“My advice to anyone who is thinking of picking GP as a subject is that they should also pick a niche area of specific interest. I picked minor surgery,” he added.
Fear of system
Do we really have to crowd our hospitals with patients who have ingrown toe nails or a young child with a tongue tie?
“The fear of both the surgery itself and the accompanying battle to get through the healthcare system should never be underestimated. That wart or mole may look harmless to both you and I but it’s disfiguring to the person on whose face it sits,” he said.
“There is nothing like the satisfaction you get at the end of a night doing something that you love doing. When the person first comes in they tend to be quiet, reserved and more than a little concerned and yet it is with great relief that they walk out of here at the end of the night,” he said.
Patients attend McDaid Surgical from places as far apart as Killybegs, Donegal town and even Dublin.
“I removed an ugly wart from a baby’s back who came in to me from Dublin and, with that, I had three or four more people come down. I’m not taking over anyone’s patients. If their doctor doesn’t do minor surgery, I do and the demand is there,” he said.
“I have eleven (patients) tonight and there’s quite a variety (ailments) there. I had sixteen one night in order to keep my list to within the month, but that was too much,” he said.