----- Original Message -----
From: "Maconochie, I K" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, July 20, 2002 9:46 PM
Subject: Re: Duty of care?
> Injury prevention is a topic too lightly dismissed but can be effective
e.g.
> the recognition of accident hot spots and then contacting road safety
> officers and police to effect change. I've been a meanie and several sets
of
> very elevated monkey bars have been removed from local playgrounds so
> diminisihing the number of supracondylar fractures from those post code
> areas.
Again, accident hot spots and clusters of injuries from certain playgrounds
are all important stuff, though I hasten to add that too much parochialism
on a list like this would be inappropriate. But the case Fiona mentioned was
neither of these things, it was a completely isolated and idiosyncratic
incident (nor was there an accident or injury). There were therefore no
generalisable lessons to be drawn from this incident or from its discussion.
It seemed to me then to be a completely inappropriate "topic" for a new
thread.
And Ian the list isn't moderated, but from time to time many contributors
complain about list content or style, and we are all entitled to our
opinions. I didn't at any point "impose" my viewpoint or "curtail"
discussion about this topic. I sent one brief critical message at the start
and was not intending to send any more if the topic continued. But various
contributors challenged my views, effectively starting a much bigger
"thread" within the original thread (which hardly surprised me). RC and RC
simply challenged, but Matt Dunn and Stephen Hughes actually used my
criticism to broaden the debate into whether we have such responsibility
outside our departments. On that level the thread has some merit, and
perhaps that's what Fiona was aiming for in her original topic, but then it
should have been presented in a more generalisable fashion. Topics that
begin with a specific and anecdotal point risk being shortlived and of
limited educational value, while more generalisable topics are more likely
to produce rich debate and controversy. It's all about asking the right
question...
As for my "social life", I am currently living in a council estate in
Kentish Town, one of the poorest boroughs in north London. I see behaviour
and incidents every other day that might potentially lead to an attendance
in my department. I don't believe discussing these individual cases would
help our specialty in any way, although I cannot object to discussion about
accident prevention generally. When you think of our work in terms of demand
and supply, we have limited power to influence demand for services, either
trauma or medicine, and we naturally concentrate on the supply side. But
where do we draw the line? Should our remit also include reduction in
coronary heart disease, lung disease and alcoholism?Speaking as an A&E
practitioner, with current resources and service configuration, I think not.
Adrian Fogarty
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