Dr. Mark Murphy:

Medicine is underpinned by evidence-based principles. We have to do what the evidence and guidelines tell us to do. There are Irish guidelines and English ones. The NICE guidelines are a set of UK-based guidelines that most doctors around the world know. The NICE guidelines tell us how to manage anxiety. The first-line treatment for an anxiety disorder is usually psychological, including cognitive behavioural therapy and relaxation therapy. Unfortunately, that leaves us in a difficult position because mental health conditions exacerbate and get worse. We then might have to prescribe an anti-depressant which can be used for severe anxiety. We do not want to do that but after a few months we might have to.

The condition can get much worse, so that the person is really crippled. Maybe they have suicidal ideology and are really thinking about it. We will now have to refer this person to secondary care and yet they have resource issues, particularly for secondary care psychiatry services. At primary care, one intervenes at the lowest level of complexity. It is patient-centred and cheaper. It is extremely dissatisfying, as a GP, to be unable to do my job and to see the harm that happens to patients. Lives are lost or the quality of life is ruined because the system is not working.

My friends in Canada and Australia get the ultrasound the next day, so they are managing chronic illnesses. They get the psychologist to see a patient, as the psychologist is in the same building or nearby. They tell the patient to come back in a month, which is satisfying for us and ultimately better for patients.