Lots of good points Marcello.
Waiting times, they're not just about waiting to see a clinician, as a
patient can often spend a further hour waiting for treatment from a nurse,
and don't forget a further hour waiting for pharmacy. See and treat, I
suspect, will try to resolve this fragmentation. It might actually force
doctors and nurses to work together as a real unit again. It's gone full
circle in my career; I started out working very closely with the minors
nurse, who used to prepare the patient for examination, set up for suturing
(for example), assist, do dressings, advise, document, etc. The modern A&E
nurse figures that this is a bit too "handmaiden-like", and she prefers to
let doctors work alone, while she keeps a polite distance*. I now call the
patient from the waiting room myself (if the patient's still there), find a
cubicle (if one's still available), prepare them for exam, bring them to
theatre, set up for suture, dress the wound, document, advise etc. And for
the things that need nursing input, there's further delay and inevitable
communication problems, as I rarely meet the minors nurse now! Basically I
spend well over 50% of my time in minors doing non-medical tasks that could
be done better by a nurse or an assistant. Now I wouldn't really mind this
if there wasn't a 4-hour wait just to see a doctor. Basically I could be
twice as productive if the culture could be changed back to the way it was
(points noted Ray). So to return to one of your points Marcello, there's a
definite role for the minors nurse in "see and treat", and I see it as right
next to the physician.
Other points: as our minors waiting times reduce we're going to see
interesting spin-offs and side-effects. On the positive side it's much
easier to deal with a "reassurance" case if you see them in 30-40 minutes
rather than 3-4 hours. Try telling a "punter" there's nothing wrong with
them after they've waited 4 hours and you'll get grief. But tell them the
same thing after 30 minutes and they're quite relieved! Secondly the "Bevan"
factor will kick in; as patients get wise to the rapid turnaround in A&E,
they'll not bother with their GPs anymore (and who would blame them);
they'll head straight for A&E, and this will tend to offset any advantage
we've gained.
Interesting times...
AF
* gender chosen purely for "poetic licence", if that's still allowed these
days...
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