>From: "Jeremy Mayhew" <[log in to unmask]>


>A pharmacist could have dealt with this, or he could have gone to a walk in
>centre or GP OOH centre. NHSD would have advised, and would have run 
>through
>algorhythms to exclude more serious diseases. By providing such an 
>excellent
>service are you not sending out a message for them to do the same again? 
>And
>tell all their friends and family to go to A&E for minor illness?

Thanks for the compliment about the service.
It also included advice for future use of pharmacist as you indicate. And I 
hope he WILL tell his friends about our good service, as we could all use 
some good publicity nowadays. And I trust he will pass on my advice for them 
to also go to pharmacy in similar cases, unless they need GP/A&E advice.

>
>To be honest, the GP is a specialist at looking at minor illness, and
>winkling out those who have symptoms or signs suggesting more serious
>illness requiring hospital assessment. We are also better than A&E SHO's in
>deciding who nees antibiotics for otitis media, and which cases of croup 
>are
>safely treated at home etc, requiring less investigations to identify
>serious cases.
>

...Agree wholeheartedly. I consider A&E & GP to be two aspects of the same 
specialty, in many ways. Many of our SHOs acquire skills and training with 
us on the way to becoming GPs... I hope they will also learn in A&E how to 
give advice as I did and as GPs do a zillion times a day. Face to face.

>NHSD is not about looking exclusively at people requiring the services of a
>doctor. Its a step up from a family medical encyclopedia, combining advice
>to people who ring in on a variety of matters from complete trivia to MI's.
>Of course it gives a high satisfaction rate amongst responders - but that's
>irrelevant really.

YEAH! Irrelevant. Although I asm always seeking good PR for medical 
profession. Any good PR which comes NHSD's way will obviously be 
"confiscated" by the govt and used against the rest of the NHS.

>I believe that NHSD can provide a better safer service
>than some of my colleagues - and me when I am woken at 4am to give 
>telephone
>advice while half conscious!

So divert NHS funds to ensure 24-7 service by conscious GPs, not by a 
talking encyclopaedia.

>
>I agree 100% with Johns statement - once it was recognized that you were
>seriously ill it would be better to be seen by am expert emergency doctor -
>rather than a GP. It would also be better for the patient to go into a
>properly resourced A&E department, have all serious conditions recognised
>and treated prompyly, rather than be referred to the ward, see a ward 
>nurse,
>wait a couple of hours for the houseman, then wait a couple more hours for
>the SHO/ Re/ Consultant review, then another hour or two while the ward
>round finishes and the houseman to start "definitive treatment". From my
>experience at least, ward based emergency care was inefficient and
>appalling - if the resources were put into A&E then we could ensure that
>no-one leaves A&E without a proper assessment and treatment plan before
>going to the wards.
>
>Medical rotations are excellent places to learn endocrinology, cardiology
>and respiratory medicine, but emergencies should be dealt with by A&E and
>ITU. Surely the RCP should be told that emergency physicians already exist 
>-
>and should be placed firmly within the A&E department under direct control!
>Integration surely is the way forward?
>
> > A simple case, just to illustrate. If someone comes in to be seen 
>because
> > they say the have flu, I book them in and tell them what we will advise
> > should we find they indeed have flu after their
> > so-many-hours-wait-in-departemnt. I give them as much analgesia stat as 
>I
> > can make an excuse for + liquids + even a lozenge (I used to keep a box 
>in
> > pocket just for that) + advice sheet and THEN let them wait, which they
> > often don't. Now, one of them could also have an aneurysm... But they 
>can
> > stay and be seen - no-one gets sent home!
>
>So from what you say, you need GP's in A&E too, and because of 
>accessibility
>need an A&E or MIU in every town!

And, whoa!, we do have GPs in A&E as well as doctors and nurses with many 
overlapping skills, some of which these GPs help teach us.

>
> > Jeez... Aren't we all having an exciting week on the list this week?
>
>Sorry - I know its a bit dull

It is I who should apologise for misleading with this statement. I was 
serious, not sarcastic (for a change) - I actually am enjoying the thread, 
hence all theses long e-mails.

>, but surely its better to wake up to a
>significant threat / opportunity and shape its future rather than just hope
>it will go away? It will just develop without you and become even more
>unsatisfactory won't it?
>
>Finally, to answer Danny's point re stripping experienced nursing staff - I
>agree 100%. Surely a few years in NHSD will remove that nose for trouble we
>all get. Demand that NHSD nurses rotate through A&E on a regular bases to
>keep their clinical skills up to date - would that not help the recruitment
>crisis?
>
>I've given up giving up waffling and will write no more on this I promise!!
>(Even over the net I can feel the groans - who said you need face to face
>contact for the sixth sense to kick in?)

But thanks for the comments so far...

>
>Jeremy
>


>

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