>From: Robbie Coull <[log in to unmask]>

First point - I am sure, regardless of how many cardiac arrests you attend,
your acting as an instructor AND having the right mentality that comes with
that AND acting to dispell myths among candidates AND other factors,
probably compensates for mere numbers. I have certainly come across a couple
of "resuscitators" who prove that quantity is not a guarantee of quality.
This applies often to ex-members of ward-based resus teams (recent medical
HO/junior SHOs without ALS certs or even with) who arrive for their A&E jobs
and bring with them some amazing, well-entrenched bloopers.

And my last word on that issue, as one who is only a baby in the instructing
world, but with involvement in well >100 resus cases per year, I certainly
find teaching is an incredible self-educating experience. Now all I need is
a job that pays well enough to make locums as un-tempting as they are to
you...

But, on the following matter...

>I think your mistaking anonomysed data for confidentiality breaches.

--> NO, I'm not. I consider what a patient tells/shows/presents/etc to be
confidential. Simple as that. I do not have a problem drawing stats from
this information for educational purposes while maintaining anonymity.

>However, we have no duty of confidentiality to the pub landlord any more
>than we have a duty of confidentiality to the measles virus.

-->Now who's confused? The measles virus, nice chap though he might be, is
certainly "proven guilty" of the "crime" of measles. The pub landlord (and
my brother is one, so I know) often has fingers pointed at him for crimes of
his customers while being "not guilty". And, if this all sounds too "legal"
- good! It is... and thus none of our business.

>Our duty of confidentiality is to the patient (who was the victim of
>violence, whether s/he was partly to blame or not)

--> "My brother always says..." (sorry to sound GUMPish) that, in his
experience, most (not all) "victims" are merely losing perpetrators. I
summarised your ideas for him over a pint or too and he says to let you know
that he suspects, from his and his mates' experience, that you will come
across more guilty "victims" than ones who will correctly finger a guilty
pub lord.

>I'm assuming you use anonomysed data to audit your own performance and some
>of this is passed to the DoH to allow strategic planning to occur in the
>fight against disease (or tactical information such as public health
>issues).

--> Assumption correct.

>Violence is also a disease

--> Violence is NOT a disease, but a cause of disease in its victims. Tall
buildings are NOT a disease but can cause disease if people jump off them.
Violent behaviour may also be a symptom of disease IN THE PERPETRATOR, not
the establishment he was "diseased" outside of.

>but the instruments of prevention are not clean water and immunisation, but
>the police and the courts.

--> Now this is exactly what I say! Please notice the presence of "police"
and "courts" in your above statement and the absence of "doctors". I think a
consensus is developing on the list that we should leave it to them without
getting in the way unnecessarily. There's a difference between what we cab
get away with and what we should be getting into.

>Hmmm. What exactly is our job description? I think preventative medicine
>must be in there somewhere.

-->So are you going to start keeping statistics on the persons patients
claim assaulted them and send the top ten list to the police every year to
help with prevention? Or will you limit yourself to pub names only? I don't
think any legal mid would try to get far with our hearsay stats rather than
their own resources - so I consider that even if it was medically ethical to
give away the data, it would be legally useless.

If you wish to get into prevention, advise your patient to avoid places they
suspect are prone to violence, i.e. any place where one might find
intoxicated persons. Still, as many have said, and using your "violence is a
disease" theme... snitching on some of these pubs and closing them will
shift the violence elsewhere and you'll be dealing with smallpox next,
instead of measles.
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