Doc Holiday wrote:
> Often, with advice, patients decide they no longer wish to wait and might
> decide to leave or arrange a GP appointment. I had someone come in with
his
> son saying, I need to book him in because he needs paracetamol for his
cold.
> While writing up his booking-in slip, I explained it was not a
prescription
> medicine, told him where the pharmacy was and where he could wait to be
seen
> after he fetched the stuff and gave his son some. He said "what do I need
to
> see the doctor for, then?"
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?
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.
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. 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!
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!
> Jeez... Aren't we all having an exciting week on the list this week?
Sorry - I know its a bit dull, 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?)
Jeremy
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