> A very good point Rowley, well observed.
>
> > Rarely does excessive waiting result from a dearth of doctors, but a
> dearth of nurses and space. If people cannot get
> > into a hospital bed they have to wait somewhere, and using our
> > Emergency
> Units as this storage facility impinges
> > severely on the care we can give the next patient.
>
> I'm a bit worried about this one though. The Audit Commission report
> very
> clearly defined two indicators of waiting, the time to see a doctor (or
> ENP), and the time to admission, transfer or discharge. As far as the
> former
> goes, clearly excess waiting does indeed result from a dearth of
> doctors (or
> ENPs). In every department I've worked in (around a dozen) the rate
> limiting
> factor has always been the doctors (but I'm not talking about waits for
> admission here).
The rate limiting step appears to be doctors, but in fact is normally space. For brevity and clarity I hacked a lot out of
my first draft, and I had commented that I get called if the wait exceeds four hours. I only very rarely find the doctors
stretched; it is normally the problem that there are trollies everywhere, including Minors, and this means that there is
nobody to help you with the next patient and nowhere to see them. So you try and see some, but get stopped very
quickly as the work you generate for the nursing staff overloads them once more. Having said that, there are times
when it is doctor overload and you can help there very effectively.
The second point, also cut out, is that the Audit Commission report very helpfully points out that most patients can
be seen by an SHO provided there is adequate senior support. Have you tried asking the Postgraduate Dean for more
SHOs? I asked Brendan Hicks, and he very politely declined, as the Secretary of State for Health's moratorium on
numbers of SHOs had not been rescinded! Back to Alan Milburn, then.
There are plenty of adequately qualified doctors with PLAB and several months clinical attachments trying to get
posts in this country - we have a very good young Columbian with us at the moment. He didn't appear last Monday,
and Tuesday he came in full of apologies saying he had to be away to work in the neighbouring town. I was initially
delighted, but then he told me I had misunderstood. He was working in a clothes shop to raise money. Now that's a
scandal.
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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