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----- Original Message ----- Now, NICE guidelines. Our Radiology manager has agreed to most of the indications for scan within one hour but has objected to :- a) Knocked out plus age>65 b) Knocked out plus on anticlogs. Note that this is the manager because the radiologists have so far declined even to talk about it. How goes it in the rest of the country? [John Paskins] Well that's very interesting, John. Perhaps you should point out that a normal CT in such patients will generally allow their safe discharge. Is this particular manager aware that any resource savings with respect to imaging will probably result in resource usage with respect to beds? Of course, if your trust doesn't have a bed problem then this is a reasonable approach to take. Most trusts, however, do have severe capacity problems with respect to beds, and most would sensibly opt to scan and discharge where possible. Or is this particular manager simply suggesting that you don't scan them but send them home anyway? This, in particular, needs to be clarified (see below). Managers may not be scared of doctors, but they are sure as hell scared of lawyers. [Tom Hughes] Spend lots of money now to fully implement guidelines or possibly spend lots later if something goes wrong! [Fred Cartwright] Quite! But it's not just a matter of taking the attitude "what the hell, I'm insured, aren't I?". Certainly, managers do not have to bear the triple burden of responsibility that doctors do, i.e. civil litigation, criminal prosecution and GMC censure, not to mention our ethical responsibilities! But perhaps management should be gently reminded that, while they may be indemnified against civil damages, it remains unclear as to whether other actions might result from their reckless or dangerous management decisions... Adrian Fogarty