> Sorry Matt but I have a serious objection to...[Renee]
If I may just clarify, Renee (on Matt's behalf!), I believe he is being
deliberately satirical in the message pasted below. Clearly he's not
implying that we pass on all difficult tasks to other specialties, including
inappropriate [sic] discharge by A&E juniors. Same goes for his treatise on
waiting times in the second paragraph, where I suspect he is merely
paraphrasing the Government's philosophy rather than voicing his own
opinion. In the third paragraph however, I believe Matt is being genuinely
himself, although I fear he makes far too much of this issue of skill decay;
some of us really don't need any more work to keep us up to speed, thank you
very much. Whatever...irony is always difficult to portray in an email!
AF
----- Original Message -----
From: "Dunn Matthew Dr.
> You pass on the difficult minors elsewhere. Anyone needs suturing that
can't
> be done by an extended role nurse- pass on to plastic surgery or whatever;
> fractures needing manipulation- ortho; seriously ill patients- inpatient
> specialities; patients who may not require admission- A and E juniors work
> up and take responsibility for inappropriate discharge.
> Yes, but it still improves your mean wait if you cut average waiting time
> for primary care minors (say 15% of attendances) from 120 to 100 minutes
> while increasing waits for critically ill patients (other than those
> requiring thrombolysis)(maybe 1- 2% of attendances) from 5 minutes to 30
> minutes.
> Actually, I'm not sure I agree with consultants doing it all that much
even
> in these circumstances. Unless you do more work, the more time you spend
on
> unselected minors the less time you'll spend on the difficult cases (both
> minors and majors) so your level of experience will drop (indeed,
increased
> consultant numbers without either increased numbers of difficult cases or
> increased involvement- for example by treating patients who go off on the
> wards as well as in A and E- will have this effect). There aren't really
the
> studies on the workload/ outcome relationships in A and E as there are for
> some other conditions, but I'd guess that some of us must be fairly close
to
> (if not below) the level where our expertise will drop off if we see fewer
> of certain types of cases.
>
> Matt Dunn
> Warwick
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