> The analogy with repairing a AAA repair is silly - and I dont think it
> reflects the point I was making. I wouldnt put assessing a
> needle stick in
> the same analogy with taking a AAA to OT. I could accept the initial
> assessment of a AAA.
Initial assessment of AAA, certainly. But then once I've decided the
treatment needed, I refer the patient straight to the vascular surgeons. OK,
maybe its a bit of a reductio ad absurdum, but not quite silly. The same
basic principle applies: I know the next stage of management, know there is
someone better than me at it and refer the patient to them.
>
> I dont agree Matt (obviously). We prescribe and administer
> all sorts of
> drugs infrequently with a whole collection of potential serious
> side-effects.
Actually, I don't think I do. What drugs are you referring to? If a drug has
common serious side effects I only prescribe it either if I prescribe it
regularly enough to be happy with my knowledge; if I am in some doubt, but
am the most knowledgeable person in its use; or in a true emergency (i.e.
major problems if a delay of over 20 miutes).
> Im not suggesting that if you have no experience or training
> with something
> that you should do it, but in my personal opinion assessing
> needlesticks,
> doing a basic risk assessment, +/- starting PEP and then
> refering to the ID
> or Sexual health for ongoing management for further care is
> core Emergency
> medicine.
Different populations possibly, but in my experience, patients are not happy
with my basic risk assessment here.
> There are obviously different philosophical approaches to
> what is EM, and
> where our boundaries are. I obviously see them slightly
> different to you.
>
> But I work in a
> hospital where we frequently see needle sticks - both in
> healthcare workers
> and other unfortunates.
This is probably the main difference, rather than one of philosophy. Even if
my department took on the entire PEP service, I'd see less than a patient a
year, which given the complexity of the situtation and the speed at which it
changes is (in my opinion) insufficient. If it was up to a case every week
or so, I'd revise my views.
Remember, however, that every consultant based service provides a 24/ 365
service (contractually) (even though I know it sometimes seems its just us),
so there will be a consultant available from your GUM service. To take on
this service, you'd have to be satisfied that you provide it better (pretty
unlikely); as well (not in my case, possibly in the case of some others) but
cheaper (probably); or not quite as well but acceptably (maybe) but with
some other benefits (not a chance)
> Basically, if you take on
> something for
> out-of-hours only, then there's something seriously wrong with your
> department and there's something seriously wrong with your colleagues'
> perception of your worth. Then you really are the other guy's
> lackey, and
> that's something our specialty's got to avoid!
Well put, Adrian. That was part of the point my somewhat rambling early
hours posting was attempting to make.
Matt Dunn
|