Send it in. Though I think you may also wish to think about sending articles
like that to things like the Health Services Journal. You may well find it
ends up with more influence in the "right" places.
Simon
Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
England
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Evidence based Emergency Medicine
http://www.bestbets.org
----- Original Message -----
From: Rowley Cottingham <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, September 18, 2001 6:13 AM
Subject: Re: Rapid assessment of chest pain
> Those who have been on this list for a while will recognise the concerns I
raised over a
> year ago about militancy and attempts to undermine Emergency medicine by
cardiologists,
> and this BMJ leader shows that the attitudes which caused my concern are
spreading
> rapidly.
>
> This editorial is replete with inaccuracies and muddled thinking. After
complaining that
> 'casualty officers' can't distinguish cardiac from non cardiac pain
(Please! Medical SHOS
> are so much better? I don't think so) they then go on to say that the
service is office hours
> only without suggesting how a patient presenting with exertional chest
pain at 6pm on
> Friday night can be helped. Indeed, they admit there is no evidence that
such clinics make
> any difference or that there is any evidence that rapid assessment leads
to rapid
> intervention.
>
> Finally and quite outrageously, they suggest that our service may be
supplanted with
> protocol driven assessment of these patients by specialist nurses and
technicians!
>
> I am of the firm opinion that our speciality has to resist some of these
crazy proposals. I
> have previously sketched an editorial for the EMJ called "Milling the edge
of Emergency
> Care" after the practice of milling coins (putting tiny ridges in the
edge) to prevent
> clippings of gold being taken from each. We are sliding towards a European
holding shed
> form of care, with vascular surgeons wanting patients sent straight to
their wards without
> assessment, gynaecologists asserting that PV bleeding in pregnancy should
be sent
> straight to them and paediatricians developing walk-in clinics.
>
> All these initiatives will undermine us still further, and we need now to
assert that there is
> one place for emergency medicine delivered by one group of resources,
whether human or
> material.
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
> http://www.emergencyunit.com
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