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
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
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
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!).
Dr G Ray
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