I must admit to being a bit surprised (again! how naive I am) at the 'dumb
GPs shouldn't be in clever A&E' thread.

I'm currently covering a primary care unit with attached ER in Northern
Canada - we each see about 25 patients a day in clinic and a further 15 a
day each in ER.  The two departments are distinct and switching between the
two 'population groups' becomes instinctive.  However there is significant
overlap of cases (with access and time of onset of symptoms being major
determinants of GP cases appearing out of hours in ER).

On one hand, the last time I did a New Year A&E shift (2 years ago) I saw
about 20 GP class sore throats that had called a 999 ambulance because the
out of hours GPs were overun.  I think I can safely say I have seen more
sore throats than anyone else in most A&E depts, and could even be
considered a 'GP Specialist' in that area.  I can safely see, assess,
explain a patient advice sheet, swab if in the mood, and pat on the
head/prescribe for a sore throat in my sleep!

On the other hand I frequently see acutely ill patients in clinic who happen
to have booked an appointment for that morning without telling anyone they
were category 2 (which takes me on to my pet topic of introducing triage
categories for all GP appointments booked over the phone...but that's a
different story - and yes I know they are a different sub-population from
the ones that dial 999 in the night).

In the UK, I don't throw my hands up in horror, run and hide behind my
practice nurse cowering and screech 'Get thee to A&E for thou art bigsick!'.
I get the o2/aspirin/defib/12 lead/thrombolytics out and treat as
appropriate while awaiting the 999 ambulance.

Also, when responding to 999 calls for the ambulance service, I feel I am
able to judge that there is a different patient population that dials 999
from the one that calls the GP out of hours (although the overlap is
increasing!).

I see no reason why an appropriately trained GP should not be a great
benefit to any A&E dept employing them and be able to alter their index of
suspicion to cope with the different patient population.

Harumph!

Robbie Coull
self-styled GP 'Specialist' certified for A&E work at the following levels:
Cat 5 Blue - savant
Cat 4 Green - guru
Cat 3 Yellow - have-a-go-hero
Cat 2 Orange - er....
Cat 1 Red - where's the rest of the team?


email: [log in to unmask]             website: http://www.coull.net


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