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I agree that they are very useful but need
policing carefully.
We too have a Physio Practitioner working in
clinic with us - and I consider that controlled and planned review by senior
doctors offers good patient care.
I am concerned that the dismissal of our
role in follow-up or soft tissue clinics is simply a demonstration of a worrying
developing attitude in some quarters of our speciality – that EM is all
about Acute medicine - and the walking (“minor”) case-load is less
important – managed by ENPs!)
I have seen enough so-called “minor”
patients maimed by inexperienced doctors in our departments to believe it
essential that there is senior involvement – in the department wherever
possible – and in early follow-up. I also feel that there are many
patients who do not fit into other in-patient specialities areas – eg in
my hospital we run the OP burns service.
(On the down-side there is always going to
be a temptation for the clinic to be used as the repository for the
diagnostically destitute patient – to quote someone I once knew!)
Mark P
It would be a sad
day if we lost Review Clinics!
They need to be very
carefully regulated and policed as to what is brought back – if this
occurs, they are actually very rewarding for clinician and patient alike.
Juniors should know that if they bring back chronic diarrhoea or back pain then
they will be on permanent nights!!
We have joint
clinics (no pun intended) with a Physio Practitioner. The major outcome is that
large joint injuries get early access to expert advice and do not clog up Ortho
clinics. The patients don’t have lengthy waits for physio and get a
thorough examination of their joint at an early stage to rule out severe
pathology – this isn’t possible when they first present to the
department due to pain. They are therefore getting a swift quality service.
Could this be done elsewhere? Not without a major upheaval in service delivery.
We try to operate a
one-appointment-then-discharge-or-refer system to limit the amount of returns
thereafter. In addition, we get a tariff for these attendances from our PCT so
it isn’t charity work.
I remember
witnessing a large University hospital department in another region halting all
clinics. The result was that patients voluntarily re-presented at all hours of
the day and had to wait all over again to be seen by a junior doctor who still
hadn’t a clue. Simple fact – knee injury that needs an MRI is best
organised by a consultant in a morning in a controlled manner rather than never
being considered by a junior late evening!! As has been mentioned in another
email – we could just send all of these patients to Ortho Clinic but then
they would become overbooked and we would be regressing to being a sign-posting
specialty.
In summary, Review
Clinics are good but only if there are strict criteria for what is eligible.
From:
Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 18 March 2009 21:10
To: [log in to unmask]
Subject: Re: Emergency Department
Review Clinics
We removed them
about 4 years ago under pressure from the then CEO to ‘free up Consultant
time’. There have been good and less good outcomes. Good is that we are
no longer seeing vast numbers of people with grade 1 ankle sprains etc that
people couldn’t believe would get better. Bad (sorry; less good in
nu-speak) is actually quite a long list. Firstly, although we say we don’t
have review clinics stuff still gets brought back; mostly cellulitis for iv
antibacterials which gets to see a junior who isn’t brave enough to stop
it…and so it gets brought back again. It is now uncontrolled without a
listing of what we will see. Scaphoids (90% of which aren’t, of course)
now clog up fracture clinic and see the F2 there who can’t interpret the
Xray either so they all get MRs… (I exaggerate a bit; if they see one of
the hand surgeons they get a brilliant service) and we have also lost the
teaching about disease healing that we used to have. Everything is focused on
the here and now, and the guillotine of the 4 hours. I do miss the stuff we
used to see like the furuncoloses, the pretibial lacerations and the weird
stuff nobody else knew much about as they didn’t see it or recognise it
for what it was like panniculitis. On balance I think I’d quite like them
back.
Best Wishes,
Rowley.
From:
Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Steve Meek
Sent: 17 March 2009 23:24
To: [log in to unmask]
Subject: Re: Emergency Department
Review Clinics
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north
If you've whittled it right down to only scaphoids,
I suggest they're easy enough to pass on to orthopods if you really have to! |