The difference, of course, is that childbirth is a normal event and is
designed so that the uncomplicated ones need no doctors or midwives!

I take your point with regard to minor injury management  Rowley and your
view would certainly be the message that our politicians would like us to
embrace.  Indeed it all sounds nice in theory - but in reality it'll take
many years for us to legitimately lose the minor injury work to non-medics,
if that's what we want to do.  Where are the nurses undertaking this work
going to come from? - we all know a handful who are really good at it - but
to handle a normal weekend's workload!?  Despite the years of training
before they reach us followed by the training that we put into them, look
how bad the SHOs are - but then we seniors supervise them and put safety
nets in place.  I personally think that this is a proper part of our medical
workload,  something that we can take pride in doing well,  and of course it
is the vast majority of our patients.  To hand that over to a group that can
be just about trained up to the standard doesn't strike me as us having
pride in this aspect of our work.

Agree with your point regarding the main thrust of the thread however - I
think that the acute physicians of the future are going to come primarily
from us with a relative trickle coming through the Physician pathway - and I
think we'll do it well and it's an exciting prospect -and that's me as an
ex-Orthopod saying it!



Nick Jenkins
A&E Consultant
Abergavenny
http://www.ae-nevillhall.org.uk



-----Original Message-----
From: Rowley Cottingham [mailto:[log in to unmask]]
Sent: 17 May 2004 22:43
To: [log in to unmask]
Subject: Re: Acute Medicine


I would take precisely the opposite view. Many of the people coming into
Emergency Medicine
now have the skills and interest to take on this important 4 to 24 hour
period. We do need to look to
protect our speciality - there are those who look to the Euro polyclinics
where nurses see all the
minor stuff and call people down from elsewhere for everything else. We are
probably kissing
goodbye to all the treat and street (Group 1) stuff, slowly but surely, much
as obstetricians don't
do uncomplicated deliveries. Our skills are in treating the seriously ill
and injured for up to 4 hours.
Our own figures show that Emergency Physicians are more prepared to send
patients home at
under 24 hours than Internal Physicians with a reduced risk of reattendance,
and it seems to make
sense for us to be looking after all those who do not require a specialist
intervention for up to the
first 24 hours and then handing off those who are not ready to go home to
the appropriate team for
further care.

> The main problems of the extension of the Acute Physician to immediate
> management of the medical patient centre around duplication. If you're
> going
> to have both acute physicians and EPs looking after the same sort of
> patient, then you need double the numbers. Working on the basis that you
> want readily available consultant assessment of every critically ill
> patient
> (which in many departments implies resident), you'll need a lot of
> consultants to get this. There's also a bit of an issue with trainees-
> there
> aren't that many doctors who want to commit to having a job that centres
> around coming in in the early hours for sick patients. If you split that
> number between two specialities (or if ITU emerges, three), then there
> may
> not be enough good candidates to go around.
>
> To the speciality, of course, use of "acute physicians" to deal with the
> sicker patients in A and E could be seen as a threat. Previous
> presidents of
> the RCP have suggested that the role of A and E is to deal with minor
> injuries (and the smallish amount of major trauma that is still found
> in the
> UK). Other countries have what are essentially "casualty departments".
> Removing the medical emergencies from emergency medicine would be
> disastrous
> for the speciality in terms of image and recruitment; and would be a
> gross
> waste of skills.
>
> I wasn't entirely sure of the run of the paper, though. I note they said
> that these acute physicians need not have MRCP. This suggests a certain
> degree of overlap, with medical emergencies being covered by a composite
> rota of EPs with an interest in acute medicine and acute physicians
> with an
> interest in EM. This seems eminently sensible as it would use the skills
> already available in a more efficient way (reducing the duplication one
> finds at present where sick patient gets treated by a different person
> and
> in a different way depending on where they are in the hospital rather
> than
> on their clinical condition); and would allow development of skills by
> those
> with an interest regardless of initial speciality background (and is
> also
> likely to be the only way "Hospital at Night" can be workable in the
> long
> term).
>
>
> Matt Dunn
> Warwick
>
>
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>


Rowley Cottingham.

Consultant in Emergency Medicine.
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