Close to the belt, but not below !
Carry on.
John Ryan
(list owner acad-ae-med0
----- Original Message -----
From: Taj Hassan <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, June 19, 2001 01:09
Subject: Re: Chest pain and language
> Continuing the debate:
>
> 1) Simon comments put very useful 'evidence based'
> flesh on earlier comments. In Leeds the 'ROMI'
> protocols on our Clinical Decision Units for this type
> of patient are as I mentioned earlier a 12hr rule out
> with TropI. We have chosen not to go down the road of
> Ex Test at the end of this time period due to
> resource constraints. Agreement with the cardiologists
> gives us early access to their clinics(and stress
> tests) for certain Trop negative patients with risk
> factors etc. Remember a significant proportion of
> patients are unable to perform an Ex Test.
>
> 2)As mentioned GPs may quite rightly manage these
> patients differently in the community. As pointed out
> though....an individual physician will practise
> according to experience, expertise and his/her view of
> risk (usually tainted by the last disaster that he/she
> was involved in).
>
> 3) I was particularly careful in my wording of what
> 'the mother' would have got and what one might want!
> We know there is a certain degree of courtesy
> (?preference) shown to hospital staff, their families
> and 'VIPs'. It might just be seeing them more
> quickly,getting them a bit of urgent physio or
> arranging an urgent angiogram...I am sure we have seen
> all of the above. That is THE REAL WORLD.
> I therefore find Adrian Fogarty's high moralistic
> stance and comments a little harsh.
>
> No need to shoot the messenger though...or more
> particularly be offensive in the actual language
> used... although from my reading of the board that
> seems to be his nature!!
>
> Is that allowed in the rules John (Ryan)??
>
> Taj
>
>
>
> --- Adrian Fogarty <[log in to unmask]> wrote:
> > ----- Original Message -----
> > From: "Dunn Matthew"
> > > In a lot of areas, most patients would go to their
> > GP with these symptoms.
> > > What made this patient come to casualty? Patients
> > attending cas with given
> > > symptoms are a different patient group to those
> > seening their GP with the
> > > same symtoms- there's something going on that we
> > can't pick up from
> > clinical
> > > examination or the tests available.
> >
> > I'm not convinced. Certainly in inner city
> > departments, we see pure and
> > simple primary care all the time. That's the whole
> > idea behind having GPs
> > practising in our departments. They approach
> > problems from a PC perspective
> > and sort them out quickly with less need for
> > investigation etc. They don't
> > CT every headache and don't "ROMI" every chest pain!
> >
> > Perhaps I was wrong to separate the GPs' and EPs'
> > responses Robbie, I now
> > note many EPs responding would also send this
> > patient home.
> >
> > Finally I get really pissed off by the "if it was
> > your mother" brigade. That
> > attitude is most offensive and clearly not an
> > intelligent way to practice
> > medicine, or a constructive way to progress an
> > argument. It implies some of
> > us operate in two modes, the ordinary "punter" mode
> > and the deluxe "mother"
> > mode. I frequently see my colleagues' mothers, wives
> > or daughters etc and I
> > don't treat them any differently (medically) from my
> > other patients. Their
> > only perk is that they get to see a consultant or
> > SpR, and they don't have
> > to queue for 4 hours, but their medical management
> > is no different.
> >
> > Adrian Fogarty
>
>
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