Hello, good morning to all from Spain:
I want to send my first message to the list.
I consider that, it is certain, the doctor's work and of the nurse it should
be complementary and simultaneous. In many occasions, the doctor, thanks to
their academic and scientific preparation, he can carry out the work from
the nurse to the perfection, and the nurse, due to their experience, also
this qualified to exercise the medical work.
It only separates them the law, a normative one that in numerous occasions,
it is old and derailed in the time.
I believe that the moment has arrived of to unify and to supplement both
sanitary professions. To my it doesn't fit me doubt, both should be
complementary, mainly in the Medicine of Urgency.
But I trust that the step of the time and the change of mentality, inside a
society based on the equality, will achieve this goal so important for the
sanity in any dimension that was located. Plus still, in the Medicine of
Urgency.
Cordial greetings from Spain:
José A.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Adrian Fogarty
Sent: Monday, November 25, 2002 3:13 AM
To: [log in to unmask]
Subject: Re: See and Treat
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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