I must be a senior doctor now, because I can no longer count my grey hairs.
The majority of our patients are not the resuscitation patients, (which of
course will get priority in any Triage system in A&E). We neglect the green
and yellow category patients at our peril, we are doing ourselves out of a
job in the long term. I'm thinking of the 57% increase in medical students
since 1997. This aspect of the service to the community may not be as
exciting but it still has to be done. My own son recently attended an A&E
department (at St.Elsewhere's) with a hand laceration to be told by the
Triage Nurse, "this needs suturing but it's a 5 hour wait, so we'll put a
dressing on instead".
The majority of departments need more resources (medical and nursing) to
achieve civilised waiting times for the majority of our patients. But if
Consultants back off from getting involved with the "minor patients", the
staff can see this as cherry picking. The subconscious message to the rest
of the staff is that these patients aren't important. This can demotivate
the workforce (I speak from experience). A demotivated workforce generates
long waiting times no matter how many staff you recruit.
Nurse Practitioners can help, but can't see all the patients. I helped
introduce them at the Kendal unit. They still need some support from
doctors, unless you limit the case mix of the patients attending.
I think it's all about getting the balance right, patients should be seen in
order of priority, of course. We should however be striving for a quality
service for all our patients (within the resources available).
Cliff Reid said, "EP who refuses to go to minors when resus patients would
be left to SHOs or
non-emergency specialists." I also spend my fair share of time in the
Resuscitation room, indeed I'm on a 1 in 2 first on-call for the Trauma
Team, but I still see the less exciting patients.
Keeping the debate going.
Ray McGlone
A&E Lancaster
----- Original Message -----
From: "john ryan" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, May 29, 2001 11:40 PM
Subject: Re: Cut legs n plans for 24hr emergency physicians
> Matt and Craig, Unfair !
>
> You have misrepresented the work that the BAEM council undertakes. The
> 'soundbite' that you have chosen was one regional representative's comment
> under item G of the minutes which itself was a discussion about the
Society
> for Acute Medicine.
>
> The paragraph you lifted from the minutes is;
>
> "Concern was expressed that with further development of A&E in acute
> internal medicine that A&E was losing its focus on the main work of
> management of minor injuries and its responsibility of training juniors
for
> work in General Practice and other specialties."
>
> This was a reference to the volume of work carried out in A&E departments
> and NOT an implication that "the main focus of Emergency Physicians should
> be on the management of minor injuries ??" as you suggest.
>
> Lets keep things in perspective please. The BAEM has clearly stated that
> the core work of our specialty is "The resuscitation assessment and
> treatment of acute illness and injury in patients of all ages by
> appropriately trained and experienced staff according to current national
> and local standards......."
>
> It is disingenuous to even imply that the BAEM would suggest moving away
> from the critical care aspects of Emergency medicine.
>
> John Ryan
>
>
>
> ----- Original Message -----
> From: Craig Ellis <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, May 29, 2001 10:16
> Subject: Re: Cut legs n plans for 24hr emergency physicians
>
>
> >>> [log in to unmask] 05/30/01 01:40
>
> >Extract from minutes of BAEM council, 11 Jan 2001:
> >'Concern was expressed ... that A&E was losing its focus on the main work
> of
> >management of minor injuries'
>
> Matt,
> Am I reading this right ? The BAEM believes that the main focus
of
> Emergency Physicians should be on the management of minor injuries ??
>
> This obviously reflects a major philosophical difference between some of
us.
> While minor injuries comprise a significant part of our workload - and we
> need to be competent and slick at managing these patients - does anyone
> really think that this is why we spend 5 years training to be a specialist
?
> Most of the current trainees I have ever spoken to are doing EM because of
a
> belief that its totally inappropriate for a really sick patient to be
> managed by a person who is in their second or third year out of med school
> and that these patients deserve senior initial management.
>
> This speciality will not continue to attract quality applicants if some of
> our seniors believe we are being trained simply to be experts in the
> management of minor injuries - we are that as well, and it is an important
> aspect of our work - but I would be stunned if the BAEM was suggesting we
> should move away from the critical care aspects of our job and refocus
> principally on minor injuries.
>
>
> Craig
>
>
>
>
>
>
> CCH Secure Mail Server
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