We have UK senior SpR's here from time to time, and the two current two are
slowly driving me mad. The example's of refusal to deliver timely and
appropriate investigations abound from them - although I remember how much
worse it was when I was working in London. Several recent examples. A 70
year old woman (fit and well) in status following sudden collapse - "Im not
coming into do a CT because the result wont change management" - to hell
with the importance of diagnosis or the small(but still real) chance of
neurosurgically correctible lesion. Secondly a man with symptoms of renal
colic, + temp + WCC 17 + Tachy 105 - request for urgent CT to rule out
obstructed kidney. Refused at 3am - "not unwell enough - can wait for am" -
2 hours later on Norad having Urgent nephrostomy tube inserted - fortunately
now subject of a formal complaint from patients family - our end of things
well documented in notes - 3 phone calls to radiology reg - my SHO, me, Uro
Reg - all with refusal of radio reg to do it as HE didnt think it was
indicated. What can you say ! I could continue, but Ill stop with two. I
also request the Radiologist write their opinion in the notes, but have had
several refusals which I also document.
Our local trainee's will on occasion question an investigation (which is
absolutely appropriate) and we have a grown up discussion about it - but
never the absolute/no discussion refusal the UK SpR is so fond of.
Craig
>From: Adrian Fogarty <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: radiologists compromise timely emergency care
>Date: Fri, 13 Sep 2002 23:43:25 +0100
>
>No you are not alone, I'm sure you'll have many supporters on this List.
>Radiologists are a service profession (i.e. like laboratory services, they
>have no direct patient responsibility, instead they support other
>specialists), and I feel I have spent much of my professional life battling
>to get radiologists to perform necessary investigations. Just last week a
>radiologist refused to do a head scan on one of my registrar's patient as
>he
>felt it wasn't indicated acutely but could wait until the following day. I
>won't bore you with the clinical details, but I asked the radiologist to
>come and review the patient and document in the notes why he felt it was
>not
>indicated so that the patient could be sent home...the scan was done 30
>minutes later. That was a salutary reminder, if one was ever needed, that
>radiologists are not clinicians, and that radiologists do not take clinical
>responsibility for patients.
>
>Adrian Fogarty
>
>P.S. I have seen the same farcical runaround that you describe so well in
>your BMJ letter on many occasions, but things are gradually getting better.
>
>----- Original Message -----
>From: "mark nicol" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Friday, September 13, 2002 2:12 PM
>Subject: radiologists compromise timely emergency care
>
>
>Barriers to effective stroke care out of hours need to be broached-letter
>in
>BMJ 14sept02. Am I alone in thinking that delivery of timely evidence based
>care is frequently compromised by radiologists?
>markfnicol
_________________________________________________________________
Join the world’s largest e-mail service with MSN Hotmail.
http://www.hotmail.com
|