In a Utopian emergency healthcare system all patients would be vaccinated
against all known preventable commuicable diseases on presentation to the
emergency department. But guess what we dont have that. I can understand a
suggestion that would say we could vaccinate little old ladies with chronic
chest problems for the flu and maybe provide appropriate Hep b vaccination
for victims of assault where indicated etc.
Infections and emergency medicine are bed fellows. Vaccination is a first
cousin. Should we neglect appropriate healthcare delivery in favour of
territorialism ?
I dont know what the correect answer is but I understand a viewpoint in
favour of using the emergency department for opportunistic vaccination.
John Ryan
Dr John Ryan
----- Original Message -----
From: Goat <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, May 16, 2002 02:40
Subject: Re: Replacement of tetanus booster for adults
> I seem to be out of step with several others (Adrian, Matt, Nick - read
> on). Our little A&E department obviously enjoys very different working
> arrangements from the rest of the world. I agree this thread is rapidly
> drifting away from the list's intended use, so will contribute no more
> on this subject publicly after this. Very happy to entertain more
> discussion off list with any of you who feel strongly about the
> following.
>
> Apologies to Nick Jenkins for any perceived sleight in my email - none
> intended. I obviously misunderstood your email, but having just re-read
> it, I still get the strong impression you are questioning whether it is
> A&E's job to provide opportunistic tet vaccinations, much less
> Diphtheria too. I actually think you are quite right to question this
> and provoke searching questions about what jobs A&E should be involved
> in. I agree that providing routine immunization clinics is not a
> sensible use of A&E services, but I'm not sure that's what's being
> suggested.
>
> Matt Dunn feels that "not my job" is a part of good patient care. I'm
> sorry you feel that way, if only on the grounds that the patient or
> manager hearing this will hear "I could do it, but I'm not going to".
> The difference may be subtle but personally I find that "not my field of
> expertise" or "not something we're equipped to do" leads to much more
> fruitful negotiations with patients and managers alike.
>
>
> In article <003101c1fc64$c1af39e0$79a81e3e@AdrianFogarty>, Adrian
> Fogarty <[log in to unmask]> writes
> >A&E is clearly the dumping ground for just about everyone
> >these days
> You need to get out of London more, Adrian - we have a vacant post!
>
> You'll struggle to find anyone who says their A&E department is
> adequately resourced, but we're not alone in that. Ask any GP round here
> - they will read "GPs are the dumping ground....." in your above quote.
> That's precisely why the "not my job" argument (whether explicit or
> perceived) is unhelpful. The disastrous consequences of pitting social
> services against health should be ample supportive evidence.
>
> Post-exposure HIV prophylaxis and post-coital baby prophylaxis are
> examples of how this department has NOT just accepted "dumping"
> unquestioningly. Perhaps you think that our Department's goodwill is
> being hopelessly abused. All I can say is that if you look at the
> support we have from patients, in-patient teams and GPs locally then
> this approach has worked reasonably well for us.
>
> Having said all that, if we continue to be abused as a surrogate for
> adequate bed provision, I won't want to work here, or any other A&E
> Department for much longer (don't get me started on that one again!).
>
> Best wishes
>
> Gautam
>
> Dr G Ray
> A&E
> Sussex
> Reply to [log in to unmask]
>
>
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