Well,  as has been pointed out,  the argument's not necessarily a
territorial one - more who is appropriate to take that particular
responsibility.  I speak purely as I run my place and wouldn't dream of
suggesting to others how they should run their places - but I feel that I'm
providing a good quality service to my A&E patients by dealing thoroughly
with their A&E problems whilst keeping the waiting time down to 2 hours or
so for the walkers.  If my Department dabbled in things which were more
expertly dealt with by other specialties not only would that individual
patient be getting a poor deal but I would consider it unfair to the other
patients left waiting - or is that why various Departments traditionally
have several hours' wait?.  Vaccination is a public health issue - A&E don't
make decisions on it's appropriateness in the global sense,  so are we happy
to just do others' bidding and dish it out? - especially when it involves
infectious diseases that are nothing to do with the presenting complaint
(diptheria in this particular case).  My staffs' time is better spent
providing care to those that need A&E care than attempting to provide what's
needed to allow for informed consent on diptheria immunisation in a patient
who has presented with a wound.
Nick Jenkins
A&E Consultant,  Abergavenny
http://www.ae-nevillhall.org.uk

-----Original Message-----
From: John Ryan [mailto:[log in to unmask]]
Sent: 16 May 2002 10:06 PM
To: [log in to unmask]
Subject: Re: Replacement of tetanus booster for adults


In a Utopian emergency healthcare system all patients would be vaccinated
against all known preventable commuicable diseases on presentation to the
emergency department.  But guess what we dont have that. I can understand a
suggestion that would say we could vaccinate little old ladies with chronic
chest problems for the flu and maybe provide appropriate Hep b vaccination
for victims of assault where indicated etc.

Infections and emergency medicine are bed fellows.  Vaccination is a first
cousin.  Should we neglect appropriate healthcare delivery in favour of
territorialism ?

I dont know what the correect answer is but I understand a viewpoint in
favour of using the emergency department for opportunistic vaccination.


John Ryan


Dr John Ryan
----- Original Message -----
From: Goat <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, May 16, 2002 02:40
Subject: Re: Replacement of tetanus booster for adults


> I seem to be out of step with several others (Adrian, Matt, Nick - read
> on). Our little A&E department obviously enjoys very different working
> arrangements from the rest of the world. I agree this thread is rapidly
> drifting away from the list's intended use, so will contribute no more
> on this subject publicly after this. Very happy to entertain more
> discussion off list with any of you who feel strongly about the
> following.
>
> Apologies to Nick Jenkins for any perceived sleight in my email - none
> intended. I obviously misunderstood your email, but having just re-read
> it, I still get the strong impression you are questioning whether it is
> A&E's job to provide opportunistic tet vaccinations, much less
> Diphtheria too. I actually think you are quite right to question this
> and provoke searching questions about what jobs A&E should be involved
> in. I agree that providing routine immunization clinics is not a
> sensible use of A&E services, but I'm not sure that's what's being
> suggested.
>
> Matt Dunn feels that "not my job" is a part of good patient care. I'm
> sorry you feel that way, if only on the grounds that the patient or
> manager hearing this will hear "I could do it, but I'm not going to".
> The difference may be subtle but personally I find that "not my field of
> expertise" or "not something we're equipped to do" leads to much more
> fruitful negotiations with patients and managers alike.
>
>
> In article <003101c1fc64$c1af39e0$79a81e3e@AdrianFogarty>, Adrian
> Fogarty <[log in to unmask]> writes
> >A&E is clearly the dumping ground for just about everyone
> >these days
> You need to get out of London more, Adrian - we have a vacant post!
>
> You'll struggle to find anyone who says their A&E department is
> adequately resourced, but we're not alone in that. Ask any GP round here
> - they will read "GPs are the dumping ground....." in your above quote.
> That's precisely why the "not my job" argument (whether explicit or
> perceived) is unhelpful. The disastrous consequences of pitting social
> services against health should be ample supportive evidence.
>
> Post-exposure HIV prophylaxis and post-coital baby prophylaxis are
> examples of how this department has NOT just accepted "dumping"
> unquestioningly. Perhaps you think that our Department's goodwill is
> being hopelessly abused. All I can say is that if you look at the
> support we have from patients, in-patient teams and GPs locally then
> this approach has worked reasonably well for us.
>
> Having said all that, if we continue to be abused as a surrogate for
> adequate bed provision, I won't want to work here, or any other A&E
> Department for much longer (don't get me started on that one again!).
>
> Best wishes
>
> Gautam
>
> Dr G Ray
> A&E
> Sussex
> Reply to [log in to unmask]
>
>