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>For what it's worth, I think Sam's management is >excellent, but I'm afraid I would, in practice, not >admit and attenuate the - supposed - anginal symptoms. >In the community. >Iain. some very interesting replies on this thread. I can understand some of you thinking that my management was too defensive and that is one discussion, but it is scary that some think it is the right management but still wouldn't do it because of the pressures on the system. Is it really our place to be modifying our management of patients not on clinical grounds but on the basis of "the system is under too much stress"? If we take this to its logical conclusion we will NEVER get an increase in the capacity of the system and the emergency service provided by the NHS will become second rate rather than high quality but you might have to wait. I know many would argue it is second rate already -- the only way to get a better service is to keep admitting the people who need admitting and demonstrate that we need more capacity (and better use of resources eg acute chest pain units) if we roll over and down grade our management then the government will continue to keep us on a drip feed financially. It is not up to us to sort out the funding problem for the government by doing our patients a disservice and in the process putting our necks on the medico-legal line. I will continue to institute what I consider optimum medical management for each of my patients it is then up to the management structure to sort out the implications of that, unless of course they are prepared to come out and PUBLICLY tell us to start giving sub-optimal care in order to relieve the pressure. -- Sam Waddy