Paul Robinson wrote:
>
> In article <[log in to unmask]>, Dr Alan Hassey
> <[log in to unmask]> writes
> >TOO accessible! Much of the crap should be screened out by a triage
> >system, leaving
> >doctors to deal with the rest, doing what we (in primary care) do best -
>
> Three points:
>
> 1. Most people are very selfish when they are feeling ill or worried
> about their own health or survival. This (particularly) includes overtly
> pleasant patients, the ones who want to be friends, medical and nursing
> colleagues.
Exactly - time to educate!
> 2. There are still exceptions. Only last week a farmer's wife requested
> a routine visit after morning surgery. She had fallen and fractured neck
> of femur at 6pm the previous evening. After 16 hours painful immobility
> she apologised for making a fuss.
This is NOT a good visit - she needed referral to Cas / orthpaedics. GP
visit
will add nothing to this - except hand-holding etc. Fall & immobility =
ambulance NOT visit....
> 3. A traditional view of general practice, which may be enshrined in the
> primary care led NHS (depending on what that means ), is that one role
> of the generalist (GP or primary care physician) is as gate-keeper.
> There seems to me to be an irony in delegating this role to another
> group: unless of course the triage nurses undergo 3 year VTS scheme and
> pass a test of 'minimal' competence at the end of it.
>
I never said this....We can gate-keep perfectly well by delegating care
of
minor illness to nurses - there is a growing literature to support this
approach too. We can still maintain overall control - particularly for
all
referrals (emergency, urgent & routine). I have not made any proposal
for
delegating this - rather the opposite - I said we should concentrate in
the
areas where we are trained and particularly skilled > history,
examination,
investigation, treatment (+- referral)
--
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*Alan Hassey email [log in to unmask] & [log in to unmask]*
* http://www.midwife.demon.co.uk/ >>>>>> PGP public key available*
* GP, GP Trainer & GP Computer Adviser (NYHA), Skipton, N. Yorks.*
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