Yes, 

How many AE depts. in "the future"?
How many AE consultants to provide 168hrs/weekin those depts?
Howmany SpR's to provide that number a) in five years? b) in 10 years?

J Paskins


>>> francis andrews <[log in to unmask]> 08/09/00 11:55am >>>
Cliff, I'll second this motion.

Francis Andrews FFAEM

On Wed, 09 Aug 2000 11:35:03 BST Cliff Reid 
<[log in to unmask]> wrote:

> Couldn't agree more, and it's a breath of fresh air to hear it from someone 
> other than a trainee. I began my A&E SpR training full of enthusiasm and 
> motivated by the belief that we were the experts in resuscitation and acute 
> illness and injury, that the specialty was moving forward with increasing 
> momentum, and that before long we'd all be doing RSI, ultrasound and so on. 
> Since then I lost count of the number of times my more traditionally minded 
> trainers in 3 different hospitals told me if I wanted to 'play' in the resus 
> room I should become an intensivist (it seems many A&E consultants would 
> rather 'play' in their office).
> 
> Despite clinical excellence being my own driving force I've come to the 
> conclusion that (at least in the eyes of the rest of the hospital) an A&E 
> department and A&E care are only as good as the last crap referral, and 
> round-the-clock senior availability is the only way we can become a 'real' 
> specialty. What good are highly skilled consultants and middle grades when 
> they're not in the department after midnight, and an unconscious patient is 
> referred for intensive care by an SHO without having their blood sugar 
> checked, or acute LVF patients are put on the wrong oxygen mask and receive 
> no nitrates before being put in the lift up to the medical unit? Orthopaedic 
> registrars are being called for anterior shoulder dislocations and surgeons 
> are assessing our patients with gastritis. We recently allowed a urologist 
> to do an A&E SpR locum.
> 
> I'm a specialist emergency physician and I'm damn sure when I'm on call 
> there's no-one in the hospital better qualified to deal with the breadth of 
> acute illness and injury than me. But like it or not I'm judged by the care 
> my department provides and at the moment my experience is of embarassing 
> inconsistency. It's no surprise that nearly 40 years after the Platt Report 
> other specialists still call it Casualty - a significant percentage of the 
> time (out of hours), that's what we still are. I KNOW there are resource 
> issues and I KNOW that our predecessors have made enormous progress in 
> developing the specialty into what it is today but the fact remains that 
> there is a large body of consultants who do not see their role as clinical 
> and who are opposed to increased intervention and investigation in the 
> emergency department, and who the nurses and juniors would not trust to look 
> after a sick patient anyway. This is not their fault - they're good people 
> who have been running single handed departments for years and couldn't 
> possibly have kept up to date in acute medicine and resuscitation, but it's 
> sad that some of them are SpR trainers and continue to oppose the consultant 
> based service the public deserve.
> 
> There we are, the taboo is broken in a decidedly unbritish fashion, but 
> hopefully some discussion will be provoked.
> 
> Cliff Reid FFAEM
> Emergency Physician
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> In reply to:
> 
> When the day comes
> and I am wheeled into hospital I would want the following;
> 
>     1. The doctor to be there ready to see me (i.e. not on the wards, in a
> clinic, etc. etc. etc.).
> 
>     2. I would want them to be fully trained or supervised closely by the
> fully trained.
> 
>     3. I would want them to be skilled across the full spectrum of acute
> clinical diagnoses and not rendered clinically hemiplegic (in this setting)
> by a narrow training.
> 
>     4. I would want the best resuscitator in the hospital.
> 
>     5. I would want them to have a "Stat" mentality not "later will do".
> 
>     6. I would want to be seen by someone with a particular expertise in
> acute illness (probably not a GP, no offence). I would want to be medically
> managed by someone best able to create a clinical picture from
> the mosaic of probabilities that come from my clinical features (probably
> not a nurse, again no offence intended). That means I would be hoping to
> see an A&E consultant with up to date well honed clinical knowledge,
> skills and judgement.
> 
>         Call me old fashioned (I am 41 after all) but this is what this
> patient/voter will want. I believe we can clinically justify the A&E
> specialist in the same way that GPs can be justified, for the same reasons
> that the RCP is promoting the Acute General Physician and even more so.
> Besides it would be so inefficient to have all those specialists sitting
> around or referring patients back and forth.
> 
>         In the meantime though I believe we must pursue clinical excellence.
> Currently in our departments, as you know, the best consistent level of
> patient care offered is that provided by the least competent SHO (or maybe
> nurse practitioner). Increasingly I believe this will not be tolerated, and
> with due respect to these SHOs (or Nurses) nor should it be. Without 
> question in my mind
> a career grade doctor based A&E service is the best option. We must trumpet 
> our
> strengths and our vision and raise our sustainable game. We are under sold
> (excuse the pun).
> 
>         As for Mr. Milburn and A&E I still can not truely grasp his vision 
> for A&E?
> I might need to explore further. I can tune into Clinical Governance but 
> this
> sounds a bit wishy washy and overly politically trendy and correct.
> At the moment its ideology waiting to be made concrete. A puff of
> conservative wind might blow it away, though some of it might stick. Then 
> what?
> We are here for the long haul with a genuine steady focus on patient care. 
> That is
> where I now reside. Let the politicians blow back and forth, I'm keeping my
> focus on the drive to clincial excellence and all that that 
> embraces.Fulfilling
> the requirements of my patients, staff and my professional bodies.
> 
>         If after all that they move away from the most efficient, effective,
> economical and currently abused system for managing these patients and kick 
> us
> out, then there really is no point worrying about it is there?
> 
>     You could always become a politician
>     (and rewrite the Platt report).
> 
> 
> Tony Good
> Consultant A&E
> Liverpool
> (at 3am)
> 
> 
> 
> 
> 
> 
> 
> 
> 
> ----- Original Message -----
> From: S A Hughes <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, August 02, 2000 5:59 PM
> Subject: Alan Millburn wants to do away with us!
> 
> 
> >I understand from my boss that the department of health thinks that A/E
> >should be delivered by nurses and SHO's and that emergency medicine
> >should be delivered by the specialties.
> >
> >He further tells me that plans include abolition of A/E as a separate
> >specialty.
> >
> >The sad thing is that I find all of this rather believable in the
> >current climate. If such plans exist, then I think we ought to be told
> >so that valuable time is not wasted in pursuing a specialty with a
> >limited lifespan.
> >
> >I would be very interested to hear the views of the list.
> >
> >What should we all do instead?
> >--
> >Stephen Hughes SpR Harlow
> ________________________________________________________________________
> Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com 
> 

----------------------
Dr Francis J Andrews MRCP
Lecturer in Intensive Care Medicine
Department of Medicine
University of Liverpool 

[log in to unmask] 



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