A usual lurker writes...
Well there's been lot of food or thought in the last few days on
these topics, so here's my 2c:
(1) The Wasting Time Issue
In my short six years of Emergency Medicine I was too late to
experience the halcyon days of nurses bringing me tea and doing all
the scut work. As is my lot as an SpR, I do end up photocopying
notes, fetching drugs, because after asking someone to do it for me,
I can't stand the following 20 minutes of me trying to do other
things while the patient keeps eyeballing me to sort out the rate
limiting step that's stopping them from getting out and going home.
But in the past year I've really changed my opinion about all of this
away from being-all-things-to-all-people - I stopped answering the
phone. I wasn't thinking of me, I was thinking of the PCT and
whether or not there were getting value for money by having the SpR
act as secretary. The hundreds of little things all add up and slow
everything down, all those minutes I spend looking for the
departmental patellar hammer/ auroscope /whatever or, another
annoyance, ordering bloods for nurses who can take bloods but aren't
allowed to order them, add up to what? 15 wasted minutes per shift?
That's probably an underestimation. If all doctors are affected by
processes/practices which waste 15 minutes/shift then multiply that
by the 12 docs who pass through in a 24 hour period and that's 3
hours wasted. Ergo, after three days nine hours, an entire shift has
been wasted. You can extrapolate your own maths. It adds up to that
fact that better processes has a similar outcome to employing extra
docotrs, and everyone wants more doctors.
(2) The ENP Issue
ENP's, the good ones are great, and the good ones are usually good
because they like autonomy and they like making decisions, but that's
also true for SHO's who do well in A&E. As has been pointed out
before, I don't see the benefit of having me constantly check ENP x-
rays or seeing uncertain clinic reviews, in fact it's a glorified
version of what RC seemed to miss in the first place: nurse calls in
patient, arranges x-rays and notes, doctor does quick review and
feeds back the information/plan to the nurse.
My main concern is that SHO's don't get experience dealing with
injuries as the ENP's and the Staff grades/SpR's have a better
patient/hour rate. However, as a consultant, if I was given the
choice between hiring an ENP or getting another doctor, I think I'd
choose a doctor.
Overall though, the important bit is what's best for the patient,
no? If ENPs offer a efficient, experienced care for a specific
patient-load that comes your way, then that's great.
(3) The who's-doing-what-role Issue
It's been interesting to see some of the resistance/antagonism about
handing over these new roles and responsibilities. As Emergency
Medicine people, haven't we been taking jobs off other specialities
for a while? Frontline management of ischaemic heart disease is a
little more pro-active compared to the days of the Casualty Surgeons
Association. And in this regard I have run up against antagonism
from other doctors: a radiologist who looked at a grossly positive
image from a FAST scan, but wouldn't use it as an indication for CT.
Recently, while trying to run a trauma call, one of those long-in-the-
job surgical regs told me that "I won't take any instruction from you
unless you put on some gloves and get your hands dirty", which is
annoying but amusingly oxymoronic.
(4) The maybe-we-work-too-hard Theory
I have spent the last 6 weeks on medical secondment and marvelled at
the relaxed pace of some of the clinics: multi-disciplianary
presence, defined roles for secretary/nurses/sho/reg/cons, three or
four new patients and a dozen reviews, observations actually done
when the pt arrives, notes left in the right place, cups of coffee
being offered all round, and for the most part a good experience for
the patient. Maybe we work too hard!
Jason Carty
SpR NELondon
www.netrag.co.uk
On 16 Aug 2006, at 16:43, Doc Holiday wrote:
> From : Craig Ellis <[log in to unmask]>
>
>> I think everyone would accept this is a public list with a public
>> archive.
>
> --> I agree fully. And it is evident how a fresh reminder of this
> has now toned down quite a few of the more bitter expressions. I
> wonder how many have rushed back through their archives to check on
> how they have expressed themselves and to make sure they know what
> (could be) coming in reply...
>
>> However joke or not, it is very poor form to suggest widespread
>> recirculation and goes against the spirit of discussion groups.
>
> --> Well, I must say that it was VERY obvious to me that it was a
> joke, especially as it clearly then indicated that it was. As such,
> I took it to be intended as a jovial reminder to all that this
> forum IS open and, as stated above, it seems to have worked...
> Agree that it would not have been good form to suggest it or follow-
> up on the suggestion IF IT WERE NOT a jest.
>
>> I think you need to get a thicker skin.
>
> --> I don't think we have evidence about skin thickness here. I am
> 100% sure that no-one here knows everyone who's lurking and, if you
> follow my train of thought, lurkers are more likely to be only
> lurking BECAUSE of skin thinness!!!
>
>> Some Consultants have issues with ENPs. You dont have to agree
>> (and I dont completely), but these are experienced Emergency
>> Medicine doctors and they have reasons for there views.
>
> --> I hope you mean "some consultants have issues with SOME ENPs" -
> surely it is only the poor medium of e-mail which made it SOUND as
> if they could be generalising to the whole group, the vast majority
> of whom they have never laid eyes on or apprasied... e-mail does
> this...
>
>> I am appalled you suggest they shouldnt be able to voice them here.
>
> --> Do not be appalled. It is evident that this was not suggested.
> In summary, it seems a reminder that:
> 1. This is a public forum
> 2. The fact that so many have rushed to condemn the MERE IDEA of e-
> mails being copied to others suggest that they know how easy and
> possible that would be.
> 3. If you stop and think you'll realise that the most likely people
> to ACTUALLY forward these inflammatory items are the ones who HAVE
> NOT suggested that they would, be it in jest or not, i.e. a lurker
> or some such
> 4. My 6-year old probably knows how to forward the worst bits
> WITHOUT it being evident who it was who forwarded them...
> 5. The rapid-fire reaction to this has probably made many sit up
> and take notice and will now INCREASE the likelihood of it being
> forwarded by anyone who, until now, was not sure of the potential
> for mischief this would have - they now KNOW we have people here
> worried about this...
>
>> The reality is that 15+ years of medical and emergency medicine
>> education and subsequent years of consultant experience gives you
>> the right to have opinions on those with considerably less
>> education and experience working in a Specialty and the
>> development of the Specialty in general.
>
> -> ... and the understanding, through experience, of what effect
> politically-incorrect statements will have on the person making
> them and the ones they are made about, REGARDLESS of factuality or
> truth. I think SpRs get taught this rather well at some courses
> when dealing with media relations, including the medium of e-mail.
>
> From: Jel Coward <[log in to unmask]>
>> my first wife was a nurse, my current one is a doctor - I like to
>> think it was an upgrade ;-)
>
> --> Sorry. Can't help you on that one. You'll have to decide!
> However, if it were not, then you'd be looking at the next possible
> "step up" and what would that be? Are we to believe that there
> could be anything above "doctor"?... Unthinkable... ;-)
> BTW, if either one of your wives is lurking here (or someone they
> know is) then I'd be googling for some flower shops that do
> deliveries just about now... ;-)
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