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> ----- Original Message ----- > From: "Rowley Cottingham > > Hang on a minute, I don't abrogate my responsibility, I'm resident for > most > of my on-call for Christ's sake! And I know you haven't worked here > since > the early 90s Rowley, but I would need 400 to 500K just to get a small > flat > in Hampstead! Many London consultants live 30 to 40 minutes from their > workplace - that's just too far to play a useful role in individual > trauma > cases. Hence I believe we have to be resident to make any useful impact > for > these patients. I realise of course that a different approach may be > valid > in rural areas. My point was based on this remark you made, Adrian: >Your idea may work in a rural environment, but "dashing" to work for >critical cases doesn't work very well in London. The surgeons can get away >with it but the A&E staff would miss the boat. Also you've quoted papers >about surgeons' performance, but they all examine "in-house" surgeons. Living 30 to 40 minutes from the workplace is what helps the Government push for Consultants being resident on call and that is not at all a good idea as I show below. You can't have it both ways. You cannot say that the service is not available because "you would miss the boat" and then that London Consultants (not specifically you) live too far away to be useful. I agree absolutely with Phil that we need to be there - or, at the very least, have a proxy who works to our teaching and system such as a competent and well trained staff grade. I state quite clearly that the buck stops with me for the trauma care of a patient until I have formally handed over to the admitting team. If we went to being resident on call we would be back at the 6 Consultant department stage, with the dilution in experience per doctor I originally flagged concern about. This is because the Working Time Directive would ensure that we got time off after a night on call. I do not need to be available (or on the shop floor) at night to deal with the ankles and the drunks. I do need to be contactable. I do have to be there for a small but easily-defined group of patients as and when required. PS Did you know 'polemos' means war? 8-) Best wishes, Rowley Cottingham [log in to unmask]