Dear Adrian
I trained via general medicine before going into A&E. I don't accept
your comments that people like me lack the interest or aptitude in
soft tissue injuries etc. I do enjoy the resuscitation side and have
undertaken further ICU training, yet I derive great pleasure from
'minor' injury work and have every intention of both supervising and
treating patients in the minors end of the department. I manged to
secure extra attachment time to enable further practical experience in
plastics during my training, having done the usual attachments. I
don't think this sort of work should be neglected by A&E consultants
or middle grades and limited follow up of these patients can be
rewarding and offer teaching opportunities. What does disappoint me
is the lack of teaching in this area to trainees (sorry Patrick but I
don't agree with you-time for the Faculty to make a start on this),
and I have attended a number of courses to try and remedy this such as
the Cyriax course for soft tissue injuries diagnosis and injection,
the ENT course run at the Royal National hospital etc. What did
strike me on these courses was the lack of A&E trainees attending.
There were GPs and physios on the Cyriax course (but no one else from
A&E, and apparently they rarely get anyone from A&E), ENT SHO & middle
grades on the ENT course but again, not many from A&E-although 1 A&E
consultant.
Yours, looking forward to the next facial laceration/colles etc
Francis Andrews
--------------- reply --------------
> I'm afraid I have to agree with Ray and Andy on this one, although I
enjoyed
> the provocative mail from Steve Meek!
>
> Call me traditional, but I feel very comfortable managing "minor"
injuries.
> I admit I'm not a natural physician, though I consider myself adept
at the
> really critical stuff, especially airways. But I do consider myself
the best
> person in my hospital to suture a facial wound in a kid, for example
(and
> provide the sedation), to reduce a colles fracture (plus
anaesthesia), or to
> interpret trauma radiographs. Don't get me wrong, I don't mean to
sound
> arrogant, there are dozens of other A&E seniors like me out there.
But I
> think it's important to acknowledge that we're very strong in these
areas,
> we've got more expertise than most plastic surgeons, orthopaedic
surgeons
> and radiologists respectively, with these particular acute injuries.
>
> These injuries are, I believe, challenging and these patients are
> deserving - we would be foolish to turn our backs on them. However I
do
> realise there are now many MRCP trained A&E specialists who may not
have
> either the interest or the aptitude in these areas (just as I don't
in many
> areas of medicine). But why should we have to choose, as a
specialty,
> between critical care and minor injuries? 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...
>
> I do however take your point about clinics - I detest them! Although
I do a
> lot of acute "surgical" work I try to offload the follow-up as much
as
> possible.
>
> Adrian Fogarty FRCS, FRCSI, FRCSEd(A&E), DA(UK)......sadly not a
hint of
> MRCP in sight!!!
>
>
> ----- Original Message -----
>
> > Forgive me being provocative. Many well trained
> > Emergency Physicians /A&E Doctors are clearly putting
> > lots of time & energy into these deserving patients -
> > but why?
> > Since pre-tibial lacs are well within the skills of
> > both senior E.D. nurses and practice nurses, doctors
> > in Bath E.D. virtually never see them. It is possible
> > to free yourselves up to see the truly sick patients
> > who need your skills by getting others to see the cuts
> > n bruises. Who knows..you might end up not needing a
> > clinic!
> > Can you all explain why you spend so much time and
> > energy on such unchallenging patients?
> > The purchasers will not be inspired by the idea of 24
> > hour Emergency Physicians providing round the clock
> > cover ....for pretibial lacerations
> >
> > Steve Meek
>
Francis Andrews FFAEM
Lecturer in Intensive Care Medicine
Department of Medicine
University of Liverpool
Daulby St
L693GA
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