Hi Michael,
I agree with you that I would refer anybody that I truly thought had an ectopic
to Gynae - BUT - known pregnant patient loosing PV with some abdominal pain -
who can truly say NOT an ectopic in these days of litigation?
I have perused some of the web based literature on EPAUs before sending the
initial e-mail and one of the stated purposes of them is to pick up ectopics
apparently. Personally I find that these EPAUs certainly cause me a lot of grief
in that they have a finite number of appointments, that certainly do not meet
the demand that they have created. As you know, we do not just see a finite
number of patients in early pregancy bleeding PV or with abdominal pain.
Best wishes
Paul Bromley
Quoting Michael Hendry <[log in to unmask]>:
> paul bromley wrote:
> > Are others as confused as me as to the function of these units?? I
> > have had 2 instances this week where patients have rang NHS Direct
> > during the night to be told to p[op down to the GP in the morning and
> > they will get them seen very pronto that day at the EPAU.
>
> First off, and quite apart from the original question, NHS Direct
> shouldn't be raising the patient's expectations by saying what the GP
> will do the next day. This should be fed back.
>
> > Ring the
> > EPAU and I am told 'no appointyments for x days - where x is 3
> > upwards. The patient has great expectations that they will
> > be seen there and then that day and scanned, nad hence guess who
> > becomes the heartless non-caring villain - i.e. you guessed it!! I
> > even tried to lay it on the other day regarding abdominal pain and ??
> > ectopic, but was then told that this referral would have been
> > inapropriate anyway.
>
> If I thought someone had an ectopic I'd arrange a direct referral to the
> local gynae team.
>
> > Now if these units are not present to exclude
> > early ectopics, can someone tell me what they are there for?? If they
> > are there to scan the patient to re-assure them that they have a
> > viable pregnancy at a point in time, what happens the next or a few
> > days later when they have the same problems? Call me old fashioned,
> > but I think that you can be a lot more callous by scanniung these
> > ladies and giving them false hope, rather than an expectnat
> > treatment, holding oiff scanning and waiting a few days. The latter
> > management seems to be unacceptable these days. Can someone convince
> > me that the EPAU is the best way to go? If so, how do you tell the
> > patient without alienating them that their appointment for a scan is
> > in 3-5 days time? Oh for the days of poor sensitivity pregnancy tests
> > when you could have convinced them that it was a 'late period', and
> > the pre- EPAU days when you could see how things went for a few days.
> > I am quite happy for you to prove me wroing on this one, but I would
> > value the thoughts of others!
>
> Perhaps the EPAU should be conducting the triage on the patients, not on
> the GPs. It seems that the widespread creation of EPAUs has been done
> without due consideration for the level of unmet (patient) demand that
> they would uncover, and without planning for the expansion that would
> inevitably be required.
>
> >
> >
> >
> > Best wishes
> >
> >
> > Paul Bromley
>
> Michael Hendry
>
--
Best wishes
Paul Bromley
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