-----Original Message-----
From: Carlos Arturo Perez Avila <[log in to unmask]>
To: INTERNET:[log in to unmask] <[log in to unmask]>
Date: 27 September 1999 18:02
Subject: Willies
>I understand your position. You are not alone in thinking this way. I feel,
>personally, that the sooner we move to a consultant based service the
>better we will be.
>
>SpR, bless them, contribute to less than 30% of the service provision in my
>view. Want to go on many training courses and days and spend a lot of time
>studying and reading and not in the sharp end of thing. Some of us as a
>result have to spend a lot of our time, quite enjoyable, at the coal face
>with our SHO's. Some of our consultant colleagues do not like this but my
>narrow minded view is that is why I study medicine to see patients, and if
>I specialised in A&E is to see ALL types of A&E patients not just the
>selected few which have an interest, which ever that may be.
>
>I am all for a consulatnt based servive with some SHO's and SpR's who can
>then be properly trained in what they want.
>
>My main concerned is that the porfession appears to be very divided as to
>what their individual roles as consultants should. Their range goes from
>american stayle consultant run department to "I am a consultant I will be
>in my offcie supervising!!!!"
>
>What do people think.
>
Dear esteemed colleagues
Over many months I have read all the messages from this mailbase. I do find
it very disturbing to read comments that both demean SHOs and recently the
SpRs.
One may be tempted to ignore that the present set of SpRs contain a cohort
of experienced doctors (as opposed to the green ones who took the shortest
quickest route to a SpR programme within a couple of years of leaving
medical school). I am aware and do acknowledge Danny McGeehan’s comments on
the subset of doctors within the grade but we appointed them so we have the
responsibility to train them or kick them out. It is arguably easier to
train so we must get on with it.
In the 5 years that a SpR trains to become a consultant he must change from
an experienced SHO to a consultant. The idea being that at the end of 5
years when he/she takes up post as a consultant there is also the experience
at sitting in the office not contributing to the queue busting that the SpRs
are expected to do.
-Yes, consultants sit in the office doing nothing useful to help the poor
nurses and SHOs keep the waiting times down. They also do not see enough
patients to make mistakes and have complaints made against them. They
pontificate when their juniors make errors resulting in complaints and/or
litigation. Consultants should do 56 hours of shift work and then do the
paper work (audit/research/management & meetings etc) on their own time.
I of course do not believe this! But if a consultant starts to criticise his
juniors for being in the office attempting to practice critical appraisal,
working on audits, writing up clinical topic reviews, working on a research
project etc (which he/she is also doing on his/her own time at home as is
part of the expected training), then he will lose the trainees support.
I think, and only time may tell, that if we move (as is the government's
agenda) to cheap consultant based posts (Senior casualty officer role), it
would kill off the present consultant cohort within 5 years. I was at a BAEM
conference in Cardiff a few years ago and Kenneth Calman indicated in a
round about way (for anyone paying attention at the time) that we would move
to a consultant provided service. He said in response to a question on who
will be treating the public.
“ I know who I would want treating me”.
So before anyone trains SpRs to become super SHOs (senior casualty officers)
and ignores the aspects of training that helps them to pass the FFAEM (as
opposed to repeating the work that got them their FRCSEd (A&E) equivalent)-
think very carefully.
SpRs need to feel respected for the hard work it takes to become one. They
should contribute to the quality of service to a greater extent than the
quantity. Their training needs should be given equal priority to the service
needs of the department. It may require set service and management shifts
etc to achieve this. If you are not prepared to address equity of training
and service needs (Nick Jenkins!) then have a staff grade because you are
choosing an SpR to make up for not being able to get another SHO, which is
dishonest to the SpR and yourself. Look at your trainee, not only at the
RITA and decide does he/she need more shop-floor experience or other
experience to complete his/her training and help them through the FFAEM? If
you don’t know then you should not be a trainer
As for the future, who knows? I am quite willing to be part of a consultant
provided ( also called 'based') service for 3 times the present salary and a
retirement at 55yrs on full pension. Look at the burn out rates in the U.S.
and ask if you want that. I would prefer to have a consultant led service
with it's diversity of shop floor work, management, audit, research,
prehospital work etc. These are only some of the reasons that make it at
present the most exciting speciality to be in.
We need to have strong people representing us and take a solid stance
against external forces (yes, mainly the government) from pushing us in
directions we do not wish to go. We need individuals with the testicular
fortitude (A role for Danny McGeehan I feel!) to draw a line in the sand and
in good management terms learn to say No!
John Chambers refers to it being incorrect to use the term inappropriate
attendees. There are inappropriate attendees if your service is set up to
deal with Accidents and Emergencies especially if there is a perfectly good
primary care (GP) service available 24hrs a day. Please do not say my GP
colleagues are deficient because if they were they would recognise it and
correct that...not expect A&E to fill in for them. Duplication of service is
wasteful (and dangerous from a communications aspect). I do respect that
these patients are not inappropriate in their own minds and do not condemn
them for attending, but a 'spade is a spade'. I am not G.P. trained but if
we are to take on this role and deny inappropriateness then I think I feel a
year in General practice is mandatory. Will this additional training be part
of the 5 years or extra?
The one reassuring thing is that the militant cohort of junior doctors who
have improved juniors work conditions (and you better believe it, if you
have not grown up through all the changes) will be consultants soon and they
are unlikely to take any rubbish.
On a personal note, I have never been fortunate to pick and choose cases
and in my service driven region always exceed the BAEM recommendations on
numbers to be seen. Training? Guess who the JCHTA&E sent to visit us and
what they recommended Carlos??
During my time as a junior I have seen about 20,000 new patient contacts in
A&E; the details of which in the later years I keep on a database. When I
was younger queue busting was macho and sorting things out at night was
exciting. Now boring boring boring because that is all that I do as a SpR.
No involvement in management due to service commitment means I could be the
greatest SHO on earth but in 16 months if I pass the FFAEM what kind of
consultant will I be? I do not know? I don't think all the experience or
both my MRCP and FRCS is much use unless training is balanced. Yes let the
inexperienced play superheroes and action men and feel important by seeing
more patients than anyone else. But let the experienced SpRs broaden not
stagnate their professional development.
Incidentally, none of my friends in America or Canada in Emergency medicine
stand around waiting to be consulted. They work very intensively, so do not
be disrespectful to your brother doctors of a different nationality (Steve
Meek). I am willing to take on new ideas,( I am all for it!), but the
issue is on whether logistically we can take it on , not whether we are
clinically competent to do so. We know that the next generation (avoid
references to Star Trek please) are hungry to do so (me included).
I have said too much.
Derek Keith Sage
SpR A&E
Presently Public health fellow
Cambridgeshire Health Authority
Peterborough
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