> Do we really need a consultant cardiologist to diagnose an acute MI, do
> we ask a consultant orthopaedic surgeon to diagnose our # NOFs? The
> ability to read an ECG should be possessed by all A&E trainees.
Indeed. The problem is that it is not. Remember, not all hospitals have SpRs, and certainly only a few have an SpR on the
shop floor for more than a few sessions a week. I have to provide a robust service, not wave a willy.
> We should also remember that thrombolysis is only a small part of the
> care of a patient with an MI and carries significant risks, even in the
> absence of obvious contra-indications. It IS sometimes safer not to
> strep! There are other options available in some centres (primary
> angio), and aspirin and beta blockade give a significant improvement in
> mortality even without a thrombolytic.
Again, you have spent too long in teaching centres. Work in the DGH environment for a bit, and try and ensure that you
provide a full service 24 hours a day. You will soon find that you have to compromise on all sorts of issues to retain the
support of your colleagues.
> Paul Leonard
> SpR Edinburgh
>
Best wishes,
Rowley Cottingham
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