on 17/6/01 11:37 pm, Adrian Fogarty at [log in to unmask] wrote:
> Besides I still
> feel Rowley's patient does not need admission, and I note the GPs on the
> list are agreeing with this approach, while the EPs are not! Fascinating...
I'm a GP, and I would have probably referred her (depending on exact
circumstances).
I think the difference you are seeing is maybe that GPs are supposed to
gatekeep and are even better at providing second "economic" care to protect
the hospitals.
GPs are trained to use time as a diagnostic tool. With good safety-netting
this is a very efficient and safe way to practice medicine. There are
exceptions though - conditions which if not caught early. threaten life,
limb, sight etc..
Recent new onset chest pain, such as described, is too high a risk area in
which to use time in this diagnostic way. No amount of safety netting is
going to help if the patient suffers a sudden cardiac arrest. Had the same
patient said they had the pain 24 hours ago, and had had none since, then
that would be a different risk profile.
Most GPs will see one SCA every 2-5 years, and most of these will not have
presented with chest pain prior to the event. So even with good reflective
practice, it may take a whole career for them to realise that not admitting
these patients for an MI screen is unsafe in a small proportion of patients.
Emergency physicians see far more and build up a portfolio of horror stories
much faster.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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