I agree about the problem with decision making. In past years at Lancaster
they used to work on their own at night.... some complained..... but the
more reflective ones did say that it helped with their decision making
process and gave them more confidence. If they were on their own now this
would mean lots of 4 hr breach reports.... because it is busier and because
"their metal has not been hardened in the furnace of life". There are of
course some juniors who still buck the trend.
Incidentally how many patients should a FY2 or ST1-2 see in an hour? The Way
Ahead says one an hour for FY2. By the way the question is not how many they
see but how many they should see perhaps to be signed off for the post.
Every patient is an "educational opportunity"..... the more you see the more
you learn.
Recently a senior Consultant said to me that he had signed off a
junior...... soon afterwards he discovered how many patients had been seen
by the doctor. He exclaimed that if he had known that he would not have
signed them off. So what is the minimum..... what is "the line in the sand".
Of course with the doctor seeing the average case mix.
Regards
Ray McGlone.... grumpy old man....
Lancaster
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 26 November 2008 00:06
To: [log in to unmask]
Subject: Re: non weight- bearing after fall
Our orthopods MRI them now. Haven't seen one for a while but I don't think
they go straight to 'pods without imaging (does anything?). They don't get
into our CDU if they're non-weightbearing so they inevitably end up with
medics for a while.
Not sure about cross-sectional imaging out of hours but, put it this way,
they probably wouldn't wait from Friday 5pm till Monday 9am for a scan. I
don't expect we have a policy for this, probably just worked out on a
case-by-case basis, i.e. using our old friend "medical common sense".
Speaking of which, do you think algorithms are eroding our juniors' ability
to make decisions? I sometimes play a "game" with my F2s when they present
me with a scenario with, say, two possible management options. If neither is
clearly superior to the other I will often say "Do whichever you prefer; you
decide" but then find that's usually met with a look of dismay or horror.
But it's not their fault; it's just the way they've been brought up. And of
course I don't mind that with my F2s - who are otherwise very sound - but
I'm starting to see that trend with some SpRs now. Maybe too much
supervision is a bad thing?
AF
----- Original Message -----
From: "mark nicol" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, November 25, 2008 2:03 PM
Subject: non weight- bearing after fall
Can I pick other peoples brains on who looks after those patients with
fall and pain in hip AND
non weight bearing AND
initial hip pelvis Xray= no fracture.
do they get admitted under A&E or ortho while awaiting diagnostics,
do they get MRI or CT scan,
do u usually only get scan 9-5 mon to friday, or does you radilogy service
provide 24hr service !?
I attach my current algorithm, but value your feedback
mark from macc
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