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I must admit to being a bit surprised (again! how naive I am) at the 'dumb GPs shouldn't be in clever A&E' thread. I'm currently covering a primary care unit with attached ER in Northern Canada - we each see about 25 patients a day in clinic and a further 15 a day each in ER. The two departments are distinct and switching between the two 'population groups' becomes instinctive. However there is significant overlap of cases (with access and time of onset of symptoms being major determinants of GP cases appearing out of hours in ER). On one hand, the last time I did a New Year A&E shift (2 years ago) I saw about 20 GP class sore throats that had called a 999 ambulance because the out of hours GPs were overun. I think I can safely say I have seen more sore throats than anyone else in most A&E depts, and could even be considered a 'GP Specialist' in that area. I can safely see, assess, explain a patient advice sheet, swab if in the mood, and pat on the head/prescribe for a sore throat in my sleep! On the other hand I frequently see acutely ill patients in clinic who happen to have booked an appointment for that morning without telling anyone they were category 2 (which takes me on to my pet topic of introducing triage categories for all GP appointments booked over the phone...but that's a different story - and yes I know they are a different sub-population from the ones that dial 999 in the night). In the UK, I don't throw my hands up in horror, run and hide behind my practice nurse cowering and screech 'Get thee to A&E for thou art bigsick!'. I get the o2/aspirin/defib/12 lead/thrombolytics out and treat as appropriate while awaiting the 999 ambulance. Also, when responding to 999 calls for the ambulance service, I feel I am able to judge that there is a different patient population that dials 999 from the one that calls the GP out of hours (although the overlap is increasing!). I see no reason why an appropriately trained GP should not be a great benefit to any A&E dept employing them and be able to alter their index of suspicion to cope with the different patient population. Harumph! Robbie Coull self-styled GP 'Specialist' certified for A&E work at the following levels: Cat 5 Blue - savant Cat 4 Green - guru Cat 3 Yellow - have-a-go-hero Cat 2 Orange - er.... Cat 1 Red - where's the rest of the team? email: [log in to unmask] website: http://www.coull.net CONFIDENTIALITY NOTICE This document may contain confidential information belonging to the sender which is protected by the physician-patient privilege and should only be read by those persons to whom it is addressed. If you have received this e-mail in error, please notify the author. Please also destroy and delete the message from your computer. Any form of unauthorised reproduction, dissemination, copying, disclosure, modification, distribution and/or publication of this e-mail message is strictly prohibited.