An emergency is a condition for which delay of more than a 6 hours is likely
to cause significantly worse outcome. Much of what we do is not care of
emergencies. This is not a criticism.

As ever, apologies to those offended by the remainder of my post.

> "Emergency medicine is a field of practice based on the
> knowledge and skills required for the prevention, diagnosis
> and management of acute and urgent aspects of illness and
> injury affecting patients of all age groups with a full
> spectrum of episodic undifferentiated physical and behavioral
> disorders; it further encompasses an understanding of the
> development of prehospital and inhospital emergency medical
> systems and the skills necessary for this development."

Pretty broad definition of the speciality. It also lumps several words
together as meaning the same thing. Personally, I'd say that 'acute'
embraces 'emergency plus a bit extra; and urgent has a broader definition
still. I'd be loathe to drop the specific meaning of 'emergency' as a subset
containing the acuter and more urgent parts of 'acute' and 'urgent'.
This definition is also a bit like the WHO definition of health as 'Complete
physical, mental and social wellbeing and not merely the absence of disease
or infirmity'. Because it includes everything it becomes meaningless.


> ...a patient in an emergency condition (of any
> kind) is a patient who himself thinks that he is
> having a problem that is an emergency. It doesn't
> matter whether any doctor or other medical
> professional thinks that the present state of this
> patient does not represent an emergency at the moment.

The logical problem with this is: what is the emergency? i.e. what needs to
be done? In this case, what is needed is an opinion on whether or not it is
an emergency. Which of course by this definition it is, so the opinion is
not needed.
A patient may think that their condition is an emergency, but be wrong. Just
as a patient may think they have a brain tumour but be wrong. It is entirely
possible for the term 'emergency' to have a number of different meanings in
different contexts, but here we are discussing the specialised 'Emergency
Physician' meaning- presumably as a precursor to defining the range of
conditions for which we should be offering treatment.
I am not saying there is anything wrong with patients attending for
reassurance; just that if a patient comes up at 10 p.m. wanting their travel
immunisations because they're going on holiday next week, it should be
reasonable to say 'This is not an emergency. It is appropriate for you to
book an appointment with your GP.'

Matt Dunn
Warwick


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