I agree with this standard as an aspirational aim. For far too long
has the ED cohort of patients, including the sickest and most complex
cases in medicine, been looked after primarily by doctors with
woefully inadequate skills. I also believe that many middle grades are
indeed not sufficiently experienced to look after high risk patients
unaided.
The practical difficulties in achieving this aim should not prevent us
from acknowledging and addressing the problem.
Best wishe
Chris Kirke
On Thu, Dec 9, 2010 at 8:07 PM, <[log in to unmask]> wrote:
> I think it's part of a move towards a US style system of having every
> patient signed off by a fully trained doctor which is no bad thing. It would
> be difficult to achieve with current staffing, but if it becomes an accepted
> standard, it would drive consultant expansion. I do however have certain
> concerns about how we would fill these posts. I have just been sent an
> advert for a (presumably hard to fill) post in Brisbane: 8 consultants; 36
> medical staff total; serving a population of 165,000; paying £217,000 a
> year. It is difficult for a UK hospital to compete directly with that
> offering an increasingly first on post; less job variety and a substantially
> lower salary, so it is not hard to see why trainees with an interest in
> Emergency Medicine are choosing to emigrate. I also have some concerns about
> the shift in the type of patient we will be seeing as consultant. While
> there is much to be said for having consultants reviewing all high risk
> patients prior to discharge from the patient's point of view, a move to a
> higher proportion of time being spent on this type of work will not be as
> attractive to everyone as (for example) dealing with critically ill
> patients and the rewards are few: most of the patients who you decide are
> not fit for discharge will usually turn out eventually to have nothing wrong
> with them. The other issue I can see is that this is that rare thing: a move
> to increase rather than decrease the number of emergency admissions. I can
> see commissioners having a bit of a problem with the paradigm shift of
> having to think that avoiding admissions is not actually always a good
> thing.
>
>
>
> Matt Dunn
>
> Warwick
>
>
>
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