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Getting experienced A&E Consultants on the shopfloor outside office hours will improve the supervision and training of our juniors. More importantly it will improve the service to the patients. The A&E service at the moment has one big Achilles heel i.e. inexperienced SHOs changing jobs after 6 months. The SHOs seem to be getting more inexperienced or perhaps I'm getting old! I still remember doing a pre-reg job in A&E at the (Royal) London Hospital 21 yrs ago. My only shopfloor senior cover was a first year SHO. The one time I saw the absentee Landlord Consultant in the department I asked him a clinical question and he said he didn't know. I remember sighing with relief on the last day of that job. It's only when I met a keen Australian A&E doctor that I saw the possibilities. A&E Consultants that are in post at the moment can't hope to cover all evenings and weekends, but they can start moving in that direction slowly. Thus we can then demonstrate the "gaps in the service" and argue for more Consultants to cover more evenings. Rome wasn't built in a day. However if A&E Consultants stick to a 9-5 service the expansion will be in Staff Grades. I'd agree that Consultant cover has to be different in a rural hospital compared to the big cities. Living in a "one horse town" I can walk to work by the canal, so if I want to get in fast it's 5 minutes, but London is a different planet compared to this. Might be advertising a third post later this year, anyone want to share the horse? Regards Ray McGlone A&E Consultant Lancaster ----- Original Message ----- From: "Ruth Brown" <[log in to unmask]> To: <[log in to unmask]> Sent: Tuesday, January 23, 2001 7:26 PM Subject: Re: Consultants for ATLS at night > Rocky, completely agree with you and very concerned that we are selling > ourselves, our families and our specialty short. If the country wants > experienced senior people present, which I am sure all will agree will > optimise patient care in direct and indirect ways, then the government need > to be prepared to train and employ many more of us. In the meantime, we > should do what is right for us personally, and agree what is possible > within our local conditions. If our department recruited at least 10 more > appropriately trained consultants, I would be more than happy to do a > resident session (if I could also guarantee time off afterwards). > Meanwhile, I will continue to do a late once a week, stay long hours and go > grey but at least stay sane and walk out when I know my tiredness will not > benefit patients. > Ruth > > At 18:38 23/01/01 -0000, you wrote: > >Listen, people, all this talk worries me greatly. Why should we settle for > >different conditions than other consultants who do not come in unless a reg > >asks them to do so. > >The alternative is for us to agree to be resident for extended periods, with > >APPROPRIATE levels of staffing. In Leeds, they have agreed with the Trust > >in principle to be there 9am to 9pm every day if there are EIGHT > >consultants. For 24/7 cover there would be SIXTEEN consultants. We all > >have a life outside medicine - well, most of us do. Lets cut out the crap > >and demand fair treatment. > > > >Rocky > >----- Original Message ----- > >From: "Adrian Fogarty" <[log in to unmask]> > >To: <[log in to unmask]> > >Sent: Tuesday, January 23, 2001 2:01 AM > >Subject: Re: Consultants for ATLS at night > > > > > >> ----- Original Message ----- > >> From: "Doc Holiday > >> > Rowley, Adrian, etc... > >> > Would it suit you both, as a compromise, for a consultant to be within > >> 30-40 > >> > mins away at home, available for advice by phone and to come in for > >> NOTHING > >> > LESS THAN A MAJOR INCIDENT and for your good ol' registrars to cover > >> nights > >> > on site. > >> > I have no stats to back it up, but I'm sure many would agree that a > >> > registrar can be trained (by consultants during day hours) past mere > >> > ALS/ATLS to exert the necessary controlling influence/motivation over > >the > >> > multi-disciplinary team. And new registrars can accumulate experience in > >> day > >> > shifts, with consultants on site, before undertaking their nights alone. > >> > >> Yes Doc, I don't really want to be resident 24 hours either, and I > >probably > >> don't need to be at the moment, but being resident until midnight reaps > >huge > >> benefits for the service I believe. Our recent London-wide audit showed > >that > >> trauma is commonest in the capital at 7.30pm, remaining frequent until > >> 1.00am. And these patients don't come neatly packaged by HEMS, as HEMS > >> doesn't fly that late. I only do one evening per week (and one weekend per > >> month) but this, combined with attending at resus for the rest of the > >week, > >> is more than enough to keep me "sharp". Having 6 consultants would make a > >> huge difference to the quality of our service for the remaining nights but > >> would not dilute my experience by much - I'd still do my one evening per > >> week, and help with some resus during daylight hours. And although I'm a > >> believer in a systems approach, I do agree that having a consultant (or a > >> senior SpR) leading a trauma case makes a big difference to how it runs. > >The > >> same goes for any critical "resus" case. > >> > >> Your views, Doc, on registrars running trauma at night is a little > >> old-fashioned i.e. the service fodder view. We can no longer fill our > >> departments with registrars just to keep the service running - that's what > >> consultants should be doing, and registrars should be there for training > >as > >> much as for service. If your department has 6 registrars then it should > >have > >> at least 6 consultants. And what's the point of having all those trained > >> guys if they all knock off duty at 5.00pm? I'm not saying consultants > >should > >> be queue busting in minors at night, hell no, but they should have a > >greater > >> presence in the department out of hours to supervise SHOs (and SpRs) and > >to > >> run the critical cases. And phone call advice from home is a complete > >waste > >> of time; SHOs will do anything before disturbing a consultant at home, and > >> when they do phone you, advising about a patient you haven't seen is a > >very > >> risky business indeed. > >> > >> I don't think we can get away from this type of working pattern, not if we > >> want to be taken seriously by our colleagues and by the government. The > >> smaller units and the rural units may be able to avoid this type of > >working > >> pattern for another 10 or 20 years I suspect, but the larger units in > >urban > >> areas are already changing the way they work. Nevertheless I realise these > >> views are not welcomed by many of my colleagues... > >> > >> Adrian Fogarty > >> A&E Consultant > >> Royal Free Hospital > >> > > > Ruth Brown FRCS FFAEM > Consultant in Emergency Medicine, > King's College Hospital, London UK >