On Wed, Apr 21, 2010 at 12:57 PM, Geoff Schrecker
<[log in to unmask]> wrote:
>
> The problem with this is getting the doctor, do you pull a doc out of
> consulting every time you get a call and someone says they have a
> chest pain. What if the docs are on visits?
>
Ah, sorry, I had forgot about the visit thing in the UK ;-)
I guess what I was thinking about is what we do here. If someone
comes in with chest pain, we see them - the same way that we deliver
their babies if they come in in advanced labour, or resuscitate them
if they have suffered major trauma (or try to at least ;-)
.....and our days are booked with 30 patients. Sometimes some have to
be re-booked - it happens (we have no access targets and virtually no
complaints). What we try to do (rather than run complex complaints
procedures, or count meaningless points from recipe based medicine, or
fight with a PCT, or have our computers run by others) is to provide
care at all levels to all people (well - perhaps not _all_ levels,
wasting huge chunks of the day doing social work visiting patients,
whilst working out how to deflect someone who turns up with acute
coronary syndrome at the office, is not a level that gets provided ;-)
What I fail to see is why I would want to deflect some of the most
important (and often 'fun') medicine.
I am not being critical of anyone. I am bemoaning what I think has
been some de-skilling (and now non-skilling) of primary care docs in
the UK, in some (many) areas of medicine. I think it is sad for the
docs and for the profession.
We have had a few UK VTS trained folks through here, and I have been
embarrassed by the level of training in anything acute, and some,
somewhat reticent to shoulder the responsibility for complex
management. They are _better_ at the soft skills than their Canuck
counterparts, that is true (on the whole), and quite good at chronic
disease management and non-acute psychiatry.
I have also been surprised by a notion of 'I'm not trained to do that,
so I won't (must not) do it' .......even when not doing that thing
endangers life.....and a willingness to write that in the
notes........ and then an expressed entrenched belief that that action
was correct.....after all the GMC told them so. Something has
become disconnected in allo that.
I must also say that I am not talking about current company - in case
anyone knows who is working here :)
Rant over :)
jel
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