No, the majority come from the most populous area which is within 50 kms from the department. 

-----Original Message-----
From: Adrian Fogarty [mailto:[log in to unmask]]
Sent: Saturday, 3 September 2005 04:36
To: [log in to unmask]
Subject: Re: Sacphoids


Ah, but could the fact that many of your patients live several hundred miles 
from Bunbury WA have something to do with that?!

AF

----- Original Message ----- 
From: "Howes, Marten" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, September 03, 2005 1:42 AM
Subject: Re: Sacphoids


our local GPs follow them all up. They also follow-up all non-operative 
fractures and dislocations. We see no review patients.

Dr Marten C Howes MRCP(UK) FFAEM FACEM
Staff Specialist
Emergency Department
Bunbury Regional Hospital
Bunbury 6230
Western Australia

Tel:  +8 9722 1561
Fax: +8 9722 1019

mailto: [log in to unmask]


-----Original Message-----
From: Doc Holiday [mailto:[log in to unmask]]
Sent: Saturday, 3 September 2005 01:55
To: [log in to unmask]
Subject: Re: Sacphoids


Who does your follow up then ?

I've alsways wondered  where the 'we don't do review clinics' places send
the stuff that other depts follow up

----------

Well, of course, my answer must begin with the protest that these are not
"my" sacphoids. If I regarded them as mine, then I would be stuck with
taking care of them... i.e. it's not a case of someone doing "my" follow-up.

Who do I send them to? I classify fractures as those which need follow-up
and those which do not necessarily. The latter get no follow-up unless it
becomes necessary. I classify fractures which get follow-up as those which
rrquire a generalist and those who require a specialist. Those which require
a generalist, get told to go to one, i.e. a GP (e.g. minor terminal phallanx
tuft fracture). To answer your 1st question, patients with fractures which
require specialist follow-up will be seen by a fracture specialist (usually
orthopaedics, but in some places for some hand fractures it's plastics).

As for your 2nd question... One of my criteria for finding a permanent post
was a department without ANY clinics. I don't consider EM should extend
beyond the first visit intentionally if I can help it. Sometimes I cannot
help it, but I'm NOT going to invite it. One of the things I want in my
professional life is NOT to see someone again for the same problem. Not
because it's "bad", but because it's not what I fancy and I'm happy there is
a specialty for people like me. I have no issue with others who DO want to
have follow-up clinics. I have even spent a few months in such a department
during my training period (I was made to do it and kept it to a minimum,
which was 6 months). So I have "tried" it. To be honest, it was the only
time in my life to date when I actually enjoyed an audit - I did one which
showed that over 90% of cases seen were inappropriate and two thirds of the
rest could have also been seen elsehwere (mainly fracture clinic) just as
well and many of these were scaphoid fractures or suspected ones... But,
again, this does not mean that mine is the only way to run an ED - it's
merely my preference and others are welcome to theirs.

Now, before you ask, if/when I DO fancy seeing someone again, whether for my
own interest or in order to provide an "after" for a junior's interest, then
I still do not need a clinic - in fact, having a clinic would probably get
in the way! Say a case is seen by an SHO and I want him/her to see the case
for a follow-up for his education, then I find a time when the SHO is on
duty AND I am too, then check to see whether the patient can come at that
time. We make a note in the patient's records and tell the patient to advise
reception upon return that it's for such a review so that the new chart is
attached to the old one. If there is a designated clinic for this condition,
then I expect it is highly unlikely that both I and the SHO will be there at
one time, which is also convenient for the patient and ONLY IF we were then
it would be as good as what I can do without a clinic. As a final note, by
the way, the patients we DO make this special arrangement for are VERY
pleased with the special treatment.