----- Original Message -----
From: "Dunn Matthew Dr.
Subject: Re: 24 Hour 'Senior' Cover
> Probably not. We base our criteria on physiological parameters more (but
I'd
> guess we include mostly the same patients), and get called in maybe a
couple
> of times a week at most. I can't remember when I was last called in for a
> patient who didn't need an A and E consultant.
Fair enough, I didn't say the cases weren't worthy of us Matt, just that I'm
not prepared to provide this type of cover in my current department.
> Rather controversial statement there. While you might make a case for
> calling my department 'a rural DGH' (although technically we're in a
> teaching hospital in the middle of a town- albeit with a large rural
> catchment area) , I think Phil's department is in a large teaching
hospital
> not far from the centre of a major city. Logistics of coming in is a
reason
> not to provide cover?
Can be in London, many consultants live around 10 miles away from their
departments, that's 10 miles of city! I've worked in several other cities
where travel times are significantly better.
> What results in burn out is coming in at unsocial hours to
> work at basic grade level. Interesting work stimulates, working below your
> level burns you out.
> A lot of it is balancing the sides of your job- I don't spend many
evenings
> or weekends seeing unselected patients in the department (my staff grades
> are well trained and can do that perfectly well). I balance that with
coming
> in more for sicker patients. My time is a limited resource. I spend it on
> the patients who need it most.
You have a point there Matt, I guess I spend too much of my time seeing
unselected cases, with a lot of the consultant level stuff thrown in as
well. I still don't want to change back to a 9-5 timetable however, with
"on-call" responsibility to rush back to the department, but I could
certainly do with a little less of the unselected stuff!
> People who arent in A&E to deal with emergencies should QUIT. There are
> loads of trainees coming through just now who want to do true "emergency
> medicine". (Phil Munro)
I don't disagree Phil, I'm just debating the way we carry out this work.
Your model seems to be the traditional one, almost patriarchal, where the
consultant dashes in from home to save lives! I just feel emergency medicine
is moving away from that model, and we're gonna have to be there Friday
night at 10pm when the patient crashes; hell, we could probably prevent the
crash in the first place if we were there, rather than race in to clear the
mess up afterwards!
Adrian Fogarty
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