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I enjoyed the postings and debate following Craig Lewis's quandry as to how best to deal with a bit of interspeciality tension in the Resus room. I totally agree with the comments made by John R, Jason and others.....more seniors on the floor ....multidisciplinary approaches....etc. I wonder if the answers to the question gave a bit too much of a macro perspective and thought I would share with you a few ideas from my own experience as to a more immediate solution. 1) Next time you get a patient up to ITU....cardiac , trauma or other...follow them up by trying to be there for the ITU round the next morning, or just visit the next morning. After a few weeks you will almost certainly have built some degree of rapport with the medics and nurses up there. Slowly the snide remarks aimed at A&E begin to be eliminated and the same time you pick up genuine 'faux pas' on the part of A&E. This can progress to suggestions about a joint audit meeting of working practices, M&M etc...Eventually leads to joint guidelines as mentioned by the other postings. The key is to understand on their home ground and then be understood...sorry ......management speak! 2) On occasions middle grades ( or even senior SHOs) from certain specialities as we all know will enter Resus and pass openly hostile remarks about the care given. Sometimes we nip it in the bud, other times we let it ride.....my personal view is that at some early oppurtune moment that person needs to be taken aside and gently, politely, CLEARLY told that such behaviour is intolerable and that issues that need to be raised should occur in a different environment. Having the A&E bosses there helps of course as mentioned by others. 3) A third strategy which has certainly helped me is to have a video in the Resus room. It not only helps to improve team dynamics but will make other specialites behave. One particular centre where I worked, the Clinical Director of ITU(should have known better) felt the need to make silly remarks about my consultants. I suggested that he needed to turn his head slightly so that the camera could get a better profile although the microphone was picking everything up. He changed tack completely and was reassuring me abou how well he got on with everyone in A&E.............I didn't have the heart to tell him the thing wasn't on ! Hope that was of some help Craig. regards Taj === Dr Taj Hassan Dept of A&E Medicine Leicester Royal Infirmary NHS Trust _________________________________________________________ Do You Yahoo!? Get your free @yahoo.com address at http://mail.yahoo.com %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%