Carol
You wrote...
^^^^^My argument is that we should not be asked to diagnose pulmonary
oedema or
inadequate analgesia, or cure pyrexia, or treat perfectly well patients
who
just happened to have been seen by a physio the previous day (all of which
I
have done at some time.) These do not require the specialist skills of a
physiotherapist.
Doctors set out criteria for referral to each other - what we are doing is
nothing new. For instance, the Referral Guidelines for General
Practitioners:
Which patients with limb joint arthritis should be sent to a
rheumatologist?
(Dieppe and Paine, 1994). This article details a pre-referral checklist, a
list
of what a rheumatologist is able to offer, and the question, "Is referral
always necessary?"
It goes on to say, "It is important that general practitioners are able to
recognise which people with musculoskeletal problems should be referred to
the
specialist, and that they appreciate how to make best use of the
resources."
For "general practitioners" read "hospital doctors," for "musculoskeletal"
read
"chest". We are the specialists, and need no less careful consideration
before
referral is made, even though we are cheaper than consultants!
Our on-call system may be well-funded, we may be responsive, but can we be
said
to deliver a quality service if nobody knows how to make the best use of
our
skills? I don't think that objective criteria limit our practice at all -
except that we won't get any more experience diagnosing pulmonary oedema
or
inadequate analgesia, or cure pyrexia, or....^^^^
...............................................
This is really fascinating, I think it's really interesting that we should
have such differing views. I've read your statement quite carefully to see
if I'm misunderstanding you, and I don't think I am. There are some areas
where you could open up a couple of new threads if you wanted
to...'specialists' for instance.
Getting back to your arguments however, why shouldn't we be asked to
diagnose pulmonary oedema? or any of the other respiratory problems that we
might deal with? We were granted autonomous status on the basis of being
able to differentially diagnose. If there is any doubt I would rather make
the decision to treat myself rather than on the basis of medical competence
(which in some areas falls woefully short). And who's talking about
treating perfectly well patients? Surely these should be at home?
The issues about criteria is understandable bewteen physiotherapists, just
like between the medical specialists you talk about above, but that is not
the same as between one profesional and the next. Tell me what referral
criteria you have in your department for OT? SALT? Chiropody? These
professionals need to make informed decisions about the patients they treat
based on a request for a professional opinion. If you start writing
criteria for each of these professions, for all of the various clinical
conditions they treat you will have finished just in time to start updating
them for changed priorities.
...and what if you are called to 'cure pyrexia' and you diagnose the
patient as having a respiratory problem the overworked HO missed, does that
then become an appropriate referral.
Great thread by the way, I've eaten out off this debate!
Dave Nicholls
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