>From: "Jeremy Mayhew" <[log in to unmask]>
>
>
>Hmmmm, sounds like you need some effective triage, available 24 hours a
>day...perhaps available from a patients home...to help them make the
>decision about where best to get help before they leave home.
>
>Maybe a telephone service....bloody good idea Doc, I wonder if anyones
>thought of it. We could call it NHS Direct or something....:)
>
>jeremy
>
Oops...
I have been a bit careless... Hope nobody I know saw that!
DISCLAIMER: If anything I wrote in my last message or anything anyone read
in it which I did not write seems to suggest in any way that NHS Direct is a
good idea or that it should be perpetuated or (please excuse me for even
saying it) expanded, then I beg of you - forget you ever saw it.
I personally am NOT of the opinion that minor illnesses should avoid A&E. I
am of the opinion that A&E should expand to care for even minor emergencies
and initiate treatment for conditions it cannot follow to the end. It should
interact a lot more with GPs to assist both sides in using each others'
skills and facilities. I see general practice and A&E as two wheels of the
same bicycle...
Along this analogy, the NHS direct is a repairable pot-hole!
I have tried getting through NHS direct as a patient; I have tried using it
as a doctor. I have found its telephone service about as useful as a
telephone service would be in deciding on which perfume to choose for a
present or which is the prettiest bunch of flowers to give the
mother-in-law!
My department has effective triage 24 hours a day! One of the reasons why it
is effective is because it avails itself of certain skills impossible to use
on the telephone, some of which are considered useful in medicine, at least
in the 2 books I read in my medical career...
1. Vital signs. Amazing things, them.
2. Eye contact. Really makes a difference.
3. A quick look at the patient. Yup, one of those looks with which, every
year that goes by, I believe I can see more and more and with which many
more experienced colleagues (doctors and ESPECIALLY nurses) are even more
dextrous.
You can get just about as much compassion from NHS direct as I am
intentionally expressing here.
Next we'll be resorting to newspaper columns to answer patients' questions.
I know some junior doctors and students who find it difficult to present a
case face to face despite questioning, so why should I expect a distressed
potential patient to do any better after holding on to a phone for a while.
Triage also allows you to make a problem minor by, say, stopping bleeding a
lot faster than a phone message would. Temporising this and other quick
aspects of a case often allows it to be re-directed at leisure.
Of course, some people might find they have taken an unnecessary trip to
GP/A&E when a telephone message could have given them all the information
they needed, instead of the triage doc/nurse providing it. But at least they
do not suffer potential harm caused by them unintentionally mis-informing a
telephone advice service about their condition through ignorance.
BTW, by what means and methods did the braniacs concerned ever come up with
the colonic idea that telephone advice had anything to do with being
"Direct". Surely they meant "cheap" or "quick" or "untraceable"...
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