Continuing the debate:
1) Simon comments put very useful 'evidence based'
flesh on earlier comments. In Leeds the 'ROMI'
protocols on our Clinical Decision Units for this type
of patient are as I mentioned earlier a 12hr rule out
with TropI. We have chosen not to go down the road of
Ex Test at the end of this time period due to
resource constraints. Agreement with the cardiologists
gives us early access to their clinics(and stress
tests) for certain Trop negative patients with risk
factors etc. Remember a significant proportion of
patients are unable to perform an Ex Test.
2)As mentioned GPs may quite rightly manage these
patients differently in the community. As pointed out
though....an individual physician will practise
according to experience, expertise and his/her view of
risk (usually tainted by the last disaster that he/she
was involved in).
3) I was particularly careful in my wording of what
'the mother' would have got and what one might want!
We know there is a certain degree of courtesy
(?preference) shown to hospital staff, their families
and 'VIPs'. It might just be seeing them more
quickly,getting them a bit of urgent physio or
arranging an urgent angiogram...I am sure we have seen
all of the above. That is THE REAL WORLD.
I therefore find Adrian Fogarty's high moralistic
stance and comments a little harsh.
No need to shoot the messenger though...or more
particularly be offensive in the actual language
used... although from my reading of the board that
seems to be his nature!!
Is that allowed in the rules John (Ryan)??
Taj
--- Adrian Fogarty <[log in to unmask]> wrote:
> ----- Original Message -----
> From: "Dunn Matthew"
> > In a lot of areas, most patients would go to their
> GP with these symptoms.
> > What made this patient come to casualty? Patients
> attending cas with given
> > symptoms are a different patient group to those
> seening their GP with the
> > same symtoms- there's something going on that we
> can't pick up from
> clinical
> > examination or the tests available.
>
> I'm not convinced. Certainly in inner city
> departments, we see pure and
> simple primary care all the time. That's the whole
> idea behind having GPs
> practising in our departments. They approach
> problems from a PC perspective
> and sort them out quickly with less need for
> investigation etc. They don't
> CT every headache and don't "ROMI" every chest pain!
>
> Perhaps I was wrong to separate the GPs' and EPs'
> responses Robbie, I now
> note many EPs responding would also send this
> patient home.
>
> Finally I get really pissed off by the "if it was
> your mother" brigade. That
> attitude is most offensive and clearly not an
> intelligent way to practice
> medicine, or a constructive way to progress an
> argument. It implies some of
> us operate in two modes, the ordinary "punter" mode
> and the deluxe "mother"
> mode. I frequently see my colleagues' mothers, wives
> or daughters etc and I
> don't treat them any differently (medically) from my
> other patients. Their
> only perk is that they get to see a consultant or
> SpR, and they don't have
> to queue for 4 hours, but their medical management
> is no different.
>
> Adrian Fogarty
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