> they then go on to say
> that the service is office hours
> only without suggesting how a patient presenting with
> exertional chest pain at 6pm on
> Friday night can be helped.
This seems a remarkably common problem- another specialty sets up a service,
but expects A and E to provide that service out of hours (usually with no
funding)- especially with nurse run services which are difficult to cover
out of hours (Also, on a national basis, documents coming out saying certain
things should be transferred to A and E with no A and E input to the
documents- the Galasco report on head injuries and the GU medicine people's
report on out of hours HIV prophylaxis are good examples; whatever you think
of the validity of their conclusions). Also, as juniors' workload is cut
from other specialties, there seems to be an expectation that A and E will
take on much of the HO/ SHO work (it doesn't require any special skills, so
casualty can cope with it)- although, IMHO, we bring a certain amount of
this on ourselves by describing ourselves as generalists rather than
specialists in emergency care and complex soft tissue injuries.
> Finally and quite outrageously, they suggest that our service
> may be supplanted with
> protocol driven assessment of these patients by specialist
> nurses and technicians!
Although, to a certain extent we bring this on ourselves- if we work to
protocols drawn up by other specialties, then the argument is there that a
technician working to protocols does as good a job as a consultant working
to the same protocols and frees up money to appoint consultants in other
specialties (to make up protocols)
> have previously sketched an editorial for the EMJ called
> "Milling the edge of Emergency
Sounds interesting. Please send it in.
> All these initiatives will undermine us still further, and we
> need now to assert that there is
> one place for emergency medicine delivered by one group of
> resources, whether human or
Although this will become easier when we define the specialty better i.e.
establish and have it accepted by other specialties what we do because we
are the best at it, rather than because other specialties don't want it (or
even 'This doesn't require the skills of XXX specialty. A and E can look
Not too uptight about what we get called, though. It's what we do that
matters. Most people accept that orthopaedic surgeons do things other than
straightening children; GU medicine people branch out in AIDS care (and
still get called 'pox doctors' with no ill effects). The biggest problem
with this editorial was not the terminology, but the concept that A and E
doesn't know how to deal with chest pain, but should continue to deal with
it out of hours under the guidance of protocols from other specialties.
I've not come across any other specialty working to clinical protocols drawn
up entirely outwith their specialty (but could well be wrong on this one).