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> I don't do terminalisations or tendon repairs. What is it that makes people > think these are appropriate A&E interventions whereas other operations > should be referred to surgeons? ----- Original Message ----- N.B. Trying not to be offensive to anyone, especially Cliff Probably the same thing that makes people think that alcohol intervention programs, exercise stress tests and dvt protocols are part of A&E and not for referral to medical teams. We all have different interests within our chosen specialty and with its surgical history there are bound to be 'conflicts' with its increasing medicalisation. As long as we are able to look after our core workload (and personally I include minor injuries/illnesses within this) any extra work we do shouldn't be a problem. I came in to A&E because I enjoyed seeing trauma, sick medical patients and minor injuries. I am not particularly interested in dodgy chest pains, ?DVTs and minor illnesses but its part of the job so i do it to the best of my ability. The specialty has changed since I set off on the path to being a consultant and I must be prepared to change the focus of my work but I am dissappointed in the situation that sees groups of patients who others are not interested in being labelled as inappropriate attenders, not worth of specialist input or effectively removed from the collective conscious of the specialty. > Am I not a proper A&E consultant if I don't have these minor surgical > interests? This thread is really making me feel rather australasian. Of course you're a proper A&E consultant if you don't have these interests Cliff, but I'm still a proper consultant (or hopefully will be) if I do and I can't FAST scan an abdomen or don't regularly carry out RSIs on trauma patients. I strongly believe that one of the biggest threats to our specialty comes from within. We are so busy fighting amongst ourselves about what our core skills are or what we should be called that we stand divided and hence we can fall. As a specialty we are capable of managing almost anything that is thrown at us and we should be proud of this. Some of us cope with our skills directly, some by ensuring the right person with the right skills is there and others by inventing solutions some of us would never have thought of! We are a great specialty and should support each other. Simon McCormick Locum Consultant P.S. I've started to cry now so I'll go and lie down in a darkened room.