Those who have been on this list for a while will recognise the concerns I raised over a
year ago about militancy and attempts to undermine Emergency medicine by cardiologists,
and this BMJ leader shows that the attitudes which caused my concern are spreading
rapidly.
This editorial is replete with inaccuracies and muddled thinking. After complaining that
'casualty officers' can't distinguish cardiac from non cardiac pain (Please! Medical SHOS
are so much better? I don't think so) they then go on to say that the service is office hours
only without suggesting how a patient presenting with exertional chest pain at 6pm on
Friday night can be helped. Indeed, they admit there is no evidence that such clinics make
any difference or that there is any evidence that rapid assessment leads to rapid
intervention.
Finally and quite outrageously, they suggest that our service may be supplanted with
protocol driven assessment of these patients by specialist nurses and technicians!
I am of the firm opinion that our speciality has to resist some of these crazy proposals. I
have previously sketched an editorial for the EMJ called "Milling the edge of Emergency
Care" after the practice of milling coins (putting tiny ridges in the edge) to prevent
clippings of gold being taken from each. We are sliding towards a European holding shed
form of care, with vascular surgeons wanting patients sent straight to their wards without
assessment, gynaecologists asserting that PV bleeding in pregnancy should be sent
straight to them and paediatricians developing walk-in clinics.
All these initiatives will undermine us still further, and we need now to assert that there is
one place for emergency medicine delivered by one group of resources, whether human or
material.
Best wishes,
Rowley Cottingham
[log in to unmask]
http://www.emergencyunit.com
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