> But why should we have to choose, as a specialty,
> between critical care and minor injuries?
With you on this one (up to a point)- we're increasing senior staffing
rapidly. The question is what new work we take on, not what we drop- non
clinical work; unselected patients; review clinics (BTW, I disagree with you
on clinics- they can be fun, they allow development of a clinical specialty
without wrecking your home life and there's a lot of things that need a
second or third review but nobody else is interested in); critically ill
patients (or even all medical admissions) beyond the first 5 minutes; minor
ops or observation wards. (Alternatively, do we appoint more consultants but
drop other staff)
One question is of balance in experience and expertise. Cardiogenic shock,
say, is as complex, and difficult to treat as a twisted ankle. See
unselected patients and you'll see maybe 500 twisted ankles a year (more
than enough to maintain expertise) and 1 or 2 cardiogenic shocks (arguably
insufficient). If the emphasis is on early referral of sicker patients then
back to clearing waits, they are even less of a learning experience.
> I honestly believe that we are
> in the best position to manage the critically ill patients in
> the department - I don't think anaesthetists have the edge by
> any means - unless we hand it to them by default.
> I don't see us simply as a generalist - we are specialists in
> Emergency care
Couldn't agree with you more , Craig. I accept I may fall at one extreme of
the spectrum of opinion. There's a lot more to critical care than
anaesthetics- medicine, surgery, neurosurgery training are important too.
Can't put my finger on it, but that seems reminiscent of some specialty's
curriculum.
> Surely we are now
> heading for
> multiconsultant departments where there'll be seniors with a
> variety of
> "special interests and aptitudes", in which we can achieve
> real expertise in
> many areas, far beyond our traditional in-hospital
> colleagues' reach...
OK for clinics, teaching, admin etc, but what if your facial laceration
comes in on a day when the duty consultant has no relevant interest or
aptitude. Seriously, one problem I think we have a specialty (and why I
think this debate is important) is that we don't define what we're good at-
there are departments who hand on facial lacerations to plastic or
maxillofacial surgeons, extensor tendons (even Colles fractures) to
orthopods, as well as those who hand on critically ill medical patients at
an early stage even when a consultant is in the department. And let's face
it, can any one of us claim competence in the whole of the curriculum?
md
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