> > I take your point except that there is considerable
> > difference in what I can achieve in 10 minutes and
> > what the SHO's can! So my range of see & treat is
> > considerably greater than theirs. The greatest
> > discrepancy I find is in wound care. Wounds I can see
> > and suture in 10 minutes take the average SHO over
> > half an hour. [Fred Cartwright]
>
> I agree, but we're also much faster with (certain) majors. A
> straightforward
> abdo pain or chest pain will only take me 10 minutes, but an
> SHO 30 minutes.
> On the other hand, if you give me a slightly confused,
> slightly deaf, old
> lady, I'll probably struggle every bit as much as the SHO,
> perhaps more
> 'cause they can't get my accent! But I did say medicine was people
> intensive...
We find that as well (including accent problems I'm afraid). I think that's
why our policy of loading our consultants into the resus room has reaped
such dividends- critically ill patients particularly could tie an SHO up for
hours taking (often uniformed) advice from a variety of specialities,
getting things wrong and generally flapping (as I did when a SHO or junior
reg and hopefully do less frequently these days) whereas someone with more
experience can sort them out a whole lot quicker. Also, it is clear that
procedural stuff (particularly tricky suturing etc.) is fastest and safest
done by the most experienced person (even leaving aside the risks to the
SHOs themselves of handling sharp needles and instruments unsupervised and
with limited training). One of my concerns with trick or treat is that
getting your most experienced doctor seeing unselected patients not only
minimises the benefits of their experience on patient care but results in
less efficient use of their time in terms of speed of processing patients.
Matt Dunn
Warwick
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