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ACAD-AE-MED  September 2001

ACAD-AE-MED September 2001

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Subject:

Re: Emergency Medicine Boundaries

From:

Fred Cartwright <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Tue, 18 Sep 2001 16:06:51 -0700

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (76 lines)

--- Adrian Fogarty <[log in to unmask]> wrote:
> But you don't really believe that emergency
> physicians should have the
> monopoly on all emergencies, do you? I think that's
> nonsense personally.
> Take an example, similar to those you've mentioned.
> We have always accepted,
> for example, that obstetricians should look after
> their own emergencies,
> normally in >20week pregnancies. Turning now to the
> early pregnancy bleeders
> you mention, we do very little for them now, no more
> than a technician or
> ENP could do. I see early PV bleeders in my dept on
> a regular basis. It's
> formulaic; check the os, check the adnexae, check
> the blood group, book a
> scan! Where's the satisfaction in that? And then the
> O&G people take over in
> daylight hours! That hardly elevates us to something
> special, does it? We
> sweat at night and weekends and the O&G people do
> all the sophisticated
> stuff on Monday morning. It'd be much simpler if all
> the PV bleeds were sent
> straight there in the first place, I'd have no
> objection to that. And even
> if you could argue that we start to scan 'em
> ourselves, we could never
> really take on long term follow up on this type of
> specialised patient. The
> same goes for many so called "emergencies"; if they
> slot neatly into someone
> else's system, it makes much more sense for them to
> take over early.
>
> OK that's one particular example, but I cannot see
> the point in our
> specialty looking for more work when we're already
> struggling with the work
> we've already got!
>
I think Rowley's point was more to do with letting
other people decided what we should or shouldn't look
after. The trend with this is that we look after all
the boring stuff at night and weekends that nobody
else wants to bother with, post coital contraception,
HIV prophylaxis, to name but 2, while they keep the
interesting stuff. I have no desire to become someone
elses dogsbody out of hours.
The other trend I've noticed is that it is getting
increasingly difficult to get other specialties
interested in emergency care at all. I'm fighting a
running battle with our physicians to get more senior
input into medical admissions as with protected
teaching/study time, clinics etc. it is getting
increasingly difficult to get a med reg anywhere near
A&E. The UK model of emergency care provision is not
universal and in the US & Australia much more work up
of these patients is done by emergency care
physicians, BUT with appropriate resources. I spent 2
months in Philadelphia last year in an ED with the
same annual attendance as ours and they had 30 odd
attendings (consultant/experienced middle grade
equivalents) to our 3!
As to the work load I agree that we don't want to
overload ourselves anymore, but I think we need to be
more selective and start dropping/refusing things that
are best done by others/elsewhere.

Fred Cartwright.

__________________________________________________
Terrorist Attacks on U.S. - How can you help?
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