> from: Robbie Coull <[log in to unmask]>
> date: Sat, 12 Jul 2003 18:15:27
> to: [log in to unmask]
> subject: Re: New GP contract
>
> What IS your speciality, Adrian?
>
> Is it EMERGENCY MEDICINE? If so, then injuries older than 48hrs are rarely
> an emergency (I can think of a few dramatic exceptions, but for the vast
> majority this is true).
>
> Is it ACCIDENT MEDICINE? If so then you should be pretty quiet, since true
> accidents are rare (just joking...but I've got Richard Smith in my corner on
> this one!).
>
> Is it TRAUMATOLOGY - in which case any trauma of any duration is in your
> remit and I can foresee territorial beefs with ortho surgeons!
>
> Why can GPs not deal with trauma that is 48hrs old? In the vast majority of
> cases resuscitation is not required, and GPs deal with this stuff all the
> time.
>
> My job is PRIMARY CARE. That means I get to lay claim to whatever I like,
> so long as it comes to me first. If I get out of my depth, I refer to
> secondary care.
Fine, but my point is, why 48 hours? To use your argument, a 24-hour-old injury is no more of an emergency than a 48-hour-old injury. A 48-hour rule is idiosyncratic and makes no medical sense whatsoever, which is why I suspect it's politically derived.
Yes, I believe we are traumatologists, as well over 50% of the pathology we deal with is trauma, we have diagnostic services set up for the rapid assessment of trauma, our specialists have had extensive training in trauma management, and our whole infrastructure is designed around the management of trauma.
Fine, some GPs may have some expertise and interest in trauma management, but it strikes me that this is very much a voluntary and sporadic thing. At the end of the day my PCT can't rely on my local GPs to take on any of the injury workload, certainly not in any substantive and reproducible manner, and it seems inefficient for the occasional individual GP to try to do his bit in this area, so none of them bother, which is sensible. Sure, GPs may be able to order x-rays (in the local hospital), and they can get a second opinion (in the local hospital), so why not just send the cases to the local hospital in the first place!!!
But if you work in an area where you and your colleagues have an established interest in trauma management and provide part of the substantive service for trauma management, then I couldn't object to that continuing. What I do object to is the idea that somehow GPs should be pushed into taking on trauma management nationwide, (but just trauma greater than 48 hours old!), when we've got a perfectly reasonable system for dealing with trauma in this country already.
AF
|