> Whilst this has obvious potential I do have a couple of difficulties
> with it,
> The first is actually getting the training to a standard that is safe,
> after all a 'miss' on a brain CT is not a miss on an ankle x-ray. The
> second is has anyone found a good answer to the what is and isn't
> operable. Without wanting to be disrespectful to our Neuro-surgical
> colleagues what they take to theatre does seem to vary form day to day
> and Dr to Dr. So if they don't have any strict operating criteria how
> are we meant to know?
> Hence our radiologists often say (and indeed did last night)
> 'Yes you can have this out of hours scan, but I wont report it. Just
> get the N-surgeon to look at it instead. If he has any difficulty get
> him to phone me'
And here is Darwin in action. Radiologists are so clearly trying to write themselves out of medicine
that sooner or later everyone else will cotton on and bypass them so that the need for radiologists
falls to zero.
In this example, the neurosurgeon is the one who has to decide whether to crack the head or not,
and so uses the scan to aid that decision process. It is no different (in his/her eyes) from what you
and I do with an ECG when deciding whether to thrombolyse or not. I do think that they have
criteria; I think that they aren't sometimes very good at explaining them. Just as most GI surgeons
won't nowadays touch an aneurysm, there remains a (huge) variation in what individual
neurosurgeons will/can do depending on their training. From our point of view it can seem
eccentric, and of course to the patient the outcome may be catastrophe/dramatic save, but I suspect
better internal consistency and decision making than we realise.
Rowley Cottingham.
Consultant in Emergency Medicine.
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