----- Original Message -----
From: "Dunn Matthew Dr.
> My scenario however is a little different. Trainees and NCCGs are at
> best a medium term solution (as we agree). This applies to all sizes of
> hospital, not just DGHs. In the long term most service will be provided
> either by non medical staff or by A and E consultants. Non medical staff
are
> cheaper for treating minor injuries/ minor medical problems; social
problems
> are best sorted out by people with community sessions (GPs spring to mind)
> so ultimately A and E consultants will have to justify their existence if
> the speciality is to survive. This could be done by taking on more
> 'observation medicine' but more and more protocols are being developed to
do
> this with decreasing medical input in terms of time. The only way forwards
> is down the acute medicine route. This is wide open to us at the moment.
Yes and no Matt. We are already heavily involved in acute medicine, whether
or not we have obs wards, with many of us spending half of our clinical time
in resus or advising on the "difficult" medical patient. So yes we need to
maintain the acute medicine component. But we also spend a lot of clinical
time dealing with difficult "minor" problems, at least we do in this
department; complex wounds, fractures, dislocations etc etc.
But returning to trainees, I think as a profession we must get away from
this blindly accepted premise that somehow service work is "bad" for them. I
have always maintained that trainees learn most from real clinical
situations, as long as they are supported and have ready access to a senior
opinion or other learning resource (textbooks, internet etc). All other
specialties work in this way, for example, surgeons and anaesthetists spend
their lives scrabbling to get to theatre to gain more experience. They
realised a long time ago that they can't learn their trade in a classroom
and I don't believe our specialty is any different. Other non-medical
professions also train in this way. This whole idea that when you see
patients you somehow suddenly stop training is nonsensical and should be
extirpated from our mindset!
Adrian Fogarty
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