This would have to be the most intelligent reply i have read about the subject and that includes some heated stuff the Australians are getting into on our own list!
Although I do disagree violently with the career grade statement.!
You either believe in yourselves and want a complete consultant service or a second best one.
Shane Curran
Director
Ed
wagga Wagga Base Hospital
Wagga wagga
NSW
Australia
-----Original Message-----
From: anthony good <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Wednesday, 9 August 2000 12:19
Stephen,
Snip.
I think your concern Stephen does need addressing because I can see
where you are coming from. How would you though as a particularly well
informed patient want to be managed in the acute sector? When the day comes
and I am wheeled into hospital I would want the following;
1. The doctor to be there ready to see me (i.e. not on the wards, in a
clinic, etc. etc. etc.).
2. I would want them to be fully trained or supervised closely by the
fully trained.
3. I would want them to be skilled across the full spectrum of acute
clinical diagnoses and not rendered clinically hemiplegic (in this setting)
by a narrow training.
4. I would want the best resuscitator in the hospital.
5. I would want them to have a "Stat" mentality not "later will do".
6. I would want to be seen by someone with a particular expertise in
acute illness (probably not a GP, no offence). I would want to be medically
managed by someone best able to create a clinical picture from
the mosaic of probabilities that come from my clinical features (probably
not a nurse, again no offence intended). That means I would be hoping to
see an A&E consultant with up to date well honed clinical knowledge,
skills and judgement.
Call me old fashioned (I am 41 after all) but this is what this
patient/voter will want. I believe we can clinically justify the A&E
specialist in the same way that GPs can be justified, for the same reasons
that the RCP is promoting the Acute General Physician and even more so.
Besides it would be so inefficient to have all those specialists sitting
around or referring patients back and forth.
In the meantime though I believe we must pursue clinical excellence.
Currently in our departments, as you know, the best consistent level of
patient care offered is that provided by the least competent SHO (or maybe
nurse practitioner). Increasingly I believe this will not be tolerated, and
with due respect to these SHOs (or Nurses) nor should it be. Without question in my mind
a career grade doctor based A&E service is the best option.
We must trumpet our
strengths and our vision and raise our sustainable game. We are under sold
(excuse the pun).
As for Mr. Milburn and A&E I still can not truely grasp his vision for A&E?
I might need to explore further. I can tune into Clinical Governance but this
sounds a bit wishy washy and overly politically trendy and correct.
At the moment its ideology waiting to be made concrete. A puff of
conservative wind might blow it away, though some of it might stick. Then what?
We are here for the long haul with a genuine steady focus on patient care. That is
where I now reside. Let the politicians blow back and forth, I'm keeping my
focus on the drive to clincial excellence and all that that embraces.Fulfilling
the requirements of my patients, staff and my professional bodies.
If after all that they move away from the most efficient, effective,
economical and currently abused system for managing these patients and kick us
out, then there really is no point worrying about it is there?
You could always become a politician
(and rewrite the Platt report).
Tony Good
Consultant A&E
Liverpool
(at 3am)
----- Original Message -----
From: S A Hughes <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, August 02, 2000 5:59 PM
Subject: Alan Millburn wants to do away with us!
> I understand from my boss that the department of health thinks that A/E
> should be delivered by nurses and SHO's and that emergency medicine
> should be delivered by the specialties.
>
> He further tells me that plans include abolition of A/E as a separate
> specialty.
>
> The sad thing is that I find all of this rather believable in the
> current climate. If such plans exist, then I think we ought to be told
> so that valuable time is not wasted in pursuing a specialty with a
> limited lifespan.
>
> I would be very interested to hear the views of the list.
>
> What should we all do instead?
> --
> Stephen Hughes SpR Harlow
>
