This rather confirms my initial suspicions. Triage is essentially an admission of failure. We don't have enough medical
staff (or skill-enhanced nursing staff) to deal with the numbers coming through and so we try to ensure everyone sees a
nurse (Remember "hello!" nurses?) when the arrive. I worry that we are asking an enormous amount of this individual,
who after all is not properly trained to take a history, can be under extreme time pressure and having to make major
decisions on occasion. We haven't had an acute MI in category 4 for a while now, but poor decisions are being made all
the time, decisions that a doctor would never make. We have to make a decision soon, and that is whether we are
prepared to continue being an overflow for everyone else without insisting on more staff. We have seen an explosion in
the attendance rates of sick 'medical' patients over the past 3 years as has everyone else, and these patients take an
average SHO 45 minutes or so to sort properly. The standard "collapse ?cause" is a great example of the very difficult
patient to sort out as a large proportion can safely go home once a great deal of elimination of possible diagnoses has
taken place. I believe that we are right to continue to accept these, but not that we see people with minor GP complaints -
or indeed, minor complaints that nobody needs to see. We have to hand some ownership for people's health back to
themselves. Oh, and shoot all those blasted health and safety people in shops and schools who send people up, "just to
be on the safe side"!
Best wishes,
Rowley Cottingham
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