<applause>
>
> In medicine we are seriously in danger of the politicians throwing the
> patient out with the bath water. Just as we write copious notes and
> perform "just in case" investigations to cover our backs now,
> politicians want "performance targets" and "audit" to cover their
> backsides. Medicine is no longer patient centred. All the studies that
> try to show that listening to the patient, comforting the patient, and
> treating their dis-ease has significant benefits are rubbished by the
> statisticians because they are too ill defined. Unfortunately people are
> ill defined individuals and so for some patients the best management is
> to keep them at home with pain relief, aspirin and perhaps a
> beta-blocker, for some it is aggressive pre-hospital thrombolysis and
> emergency angioplasty. For many a gentle ambulance ride in to a relaxed
> well staffed CCU where they are smoothly taken along their individual
> management path is the answer. Perhaps what the ambulance crews should
> be looking at with the acute coronary syndrome patients is aspirin, GTN,
> oxygen and EMLA at the i.v. sites unless i.v. pain relief or
> anti-arhythmics are needed immediately. Perhaps relaxing music in the
> ambulance saloon would be better than thrombolysis. Who has actually
> done a properly controlled clinical trial of traditional fifty years ago
> nursing versus the "you can't go on a bed pan now because I'm writing up
> your care plan" treatment that patients all too frequently get nowadays?
> When paramedics started putting up i.v.'s every trauma patient had
> normal blood pressures maintained. Now we realise this is not the best
> management. Just because we have the ability to give pre-hospital
> thrombolysis does not mean it is appropriate for everyone - and I'm not
> talking about contra-indications, I'm talking about the whole of the
> patient - the physical, psychological, social and spiritual aspects. How
> many of you have looked at your patients in these terms over the last
> week? Was it just philosophy we learnt and forgot in first year at
> medical school? Is the Emergency Department too busy to consider the
> patient as a whole?
>
>
>
> Please, we must stop trying to jump through hoops for politicians. They
> always have, and always will sh** on us from a great height. Patients
> have faith in us, and trust us, and are the ones who give us the
> chocolates, the flowers, the wine and the whisky. We need the right to
> explain their options, ask them what they want, and then allow them to
> have it, without the risk of being punished for not pushing them in to a
> pidgeon hole. My suspicion is that it might prove to be the cheaper
> option.
>
>
>
> Vic Calland
>
>
>
>
>
>
>
>
>
>
> ------=_NextPart_000_001C_01C38038.C52F6F50
> Content-Type: text/html;
> charset="us-ascii"
> Content-Transfer-Encoding: quoted-printable
>
> <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
> <html>
>
> <head>
> <META HTTP-EQUIV=3D"Content-Type" CONTENT=3D"text/html; =
> charset=3Dus-ascii">
>
>
> <meta name=3DGenerator content=3D"Microsoft Word 10 (filtered)">
>
> <style>
> <!--
> /* Style Definitions */
> p.MsoNormal, li.MsoNormal, div.MsoNormal
> {margin:0cm;
> margin-bottom:.0001pt;
> font-size:12.0pt;
> font-family:"Times New Roman";}
> a:link, span.MsoHyperlink
> {color:blue;
> text-decoration:underline;}
> a:visited, span.MsoHyperlinkFollowed
> {color:blue;
> text-decoration:underline;}
> span.EmailStyle17
> {font-family:Arial;
> color:blue;
> font-weight:normal;
> font-style:normal;
> text-decoration:none none;}
> span.EmailStyle18
> {font-family:Arial;
> color:navy;}
> @page Section1
> {size:612.0pt 792.0pt;
> margin:72.0pt 90.0pt 72.0pt 90.0pt;}
> div.Section1
> {page:Section1;}
> -->
> </style>
>
> </head>
>
> <body bgcolor=3Dwhite lang=3DEN-GB link=3Dblue vlink=3Dblue>
>
> <div class=3DSection1>
>
> <div>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'>You could say that there are only
> =
> a limited
> number of debates in medicine, and just like jokes, each new one is a =
> variant
> of the old core ones. I think this debate is actually focussed around =
> whether
> what the Government has set as targets really is the best management of
> patients. We have traditionally been taught against considering Fred =
> Bloggs as
> the “MI in bed 4”, but statisticians cannot cope with each =
> person
> being an individual with their own personal path through life. They
> must =
> take all
> MI’s proven by biochemical test, coronary angiography,
> electrocardiography etc as a homogenous group and subject them all to =
> exactly
> the same treatment because that has been shown to be statistically more
> effective than other treatments. We, as physicians, have to follow these
> protocols or guidelines, because if we do not then (i) our peers land
> us =
> in the
> shit because they want more expert witness work and (ii) our department
> =
> doesn’t
> get the money to treat people because we didn’t jump through the =
> burning
> hoop with the pom-pom on our collar. </span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'> </span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'>In medicine we are seriously in =
> danger of
> the politicians throwing the patient out with the bath water. Just as
> we =
> write
> copious notes and perform “just in case” investigations to =
> cover
> our backs now, politicians want “performance targets” and =
> “audit”
> to cover their backsides. Medicine is no longer patient centred. All
> the =
> studies
> that try to show that listening to the patient, comforting the patient,
> =
> and
> treating their dis-ease has significant benefits are rubbished by the
> statisticians because they are too ill defined. Unfortunately people
> are =
> ill
> defined individuals and so for some patients the best management is to =
> keep
> them at home with pain relief, aspirin and perhaps a beta-blocker, for =
> some it
> is aggressive pre-hospital thrombolysis and emergency angioplasty. For =
> many a
> gentle ambulance ride in to a relaxed well staffed CCU where they are =
> smoothly
> taken along their individual management path is the answer. Perhaps
> what =
> the
> ambulance crews should be looking at with the acute coronary syndrome =
> patients
> is aspirin, GTN, oxygen and EMLA at the i.v. sites unless i.v. pain =
> relief or
> anti-arhythmics are needed immediately. Perhaps relaxing music in the =
> ambulance
> saloon would be better than thrombolysis. Who has actually done a =
> properly controlled
> clinical trial of traditional fifty years ago nursing versus the =
> “you can’t
> go on a bed pan now because I’m writing up your care plan”
> treatment that patients all too frequently get nowadays? When paramedics
> started putting up i.v.’s every trauma patient had normal blood =
> pressures
> maintained. Now we realise this is not the best management. Just
> because =
> we
> have the ability to give pre-hospital thrombolysis does not mean it is
> appropriate for everyone – and I’m not talking about
> contra-indications, I’m talking about the whole of the patient =
> –
> the physical, psychological, social and spiritual aspects. How many of =
> you have
> looked at your patients in these terms over the last week? Was it just
> philosophy we learnt and forgot in first year at medical school? Is the
> Emergency Department too busy to consider the patient as a whole? =
> </span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'> </span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'>Please, we must stop trying to =
> jump through
> hoops for politicians. They always have, and always will sh** on us
> from =
> a
> great height. Patients have faith in us, and trust us, and are the ones
> =
> who
> give us the chocolates, the flowers, the wine and the whisky. We need =
> the right
> to explain their options, ask them what they want, and then allow them =
> to have
> it, without the risk of being punished for not pushing them in to a =
> pidgeon
> hole. My suspicion is that it might prove to be the cheaper =
> option.</span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'> </span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'>Vic Calland</span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'> </span></font></p>
>
> <p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
> Roman"><span
> style=3D'font-size:12.0pt;color:navy'> </span></font></p>
>
> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
> style=3D'font-size:
> 10.0pt;font-family:Arial;color:navy'> </span></font></p>
>
> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
> style=3D'font-size:
> 10.0pt;font-family:Arial;color:navy'> </span></font></p>
>
> </div>
>
> </div>
>
> </body>
>
> </html>
>
> ------=_NextPart_000_001C_01C38038.C52F6F50--
>
>
Best wishes,
Rowley Cottingham
[log in to unmask]
Visit the new and improved http://www.emergencyunit.com
|
