I can understand why you were frustrated working in a Department like that Fiona, but I don't think those type of conditions are representative of all UK Emergency Departments. My current place of work for example we run all our own cardiac arrests, traumas, thromobolyse MIs and in general certainly do a hell of a lot more than act as a triage service. 

There are without doubt many problems but I love working in Emergency Medicine in the UK and think we're entering a very exciting period of change as a specialty. The current up-coming generation of Emergency Physicians seem very pro-active and there's a huge amount of enthusiasm and motivation to make changes and take the specialty forward. It's great to be a part of that. 

I can understand why Aus/NZ hold so much appeal, but if we all left and went over there then there'd be no-one left to treat the patients here! I also know many who've been to Aus and felt that whilst there are many things they do better there are significant problems as well. 

The only way we're going to continue to improve things here is by making a commitment to UK Emergency Medicine and actually start trying to address the problems that we all love to moan about!

Ed

Dr Ed Valentine
SpR Emergency Medicine and Critical Care

[log in to unmask]
Mobile: 07748 303324

On Thu, 20 Nov 2008 21:53:01 +1100
 Fiona Wallace <[log in to unmask]> wrote:
>I think the big difference is that as a doctor I feel more in control of my
>working environment here than I did in the UK. There is no stream of
>government edicts and targets, and while there are a fair number of
>administrators in my hospital, I know what they all do and there don't seem
>to be any 'clipboard wielders'. I've got to know many of the local GPs to
>chat to on the phone, even if I rarely get to meet them. Radiology and
>pathology access is excellent. 
>
>I get to diagnose and treat patients, whereas when I was in the UK all I
>seemed to be was a phlebotomy service for the inpatient teams - we didn't
>even get to thrombolyse because the cardiology nurses were apparently much
>better at diagnosing MIs than senior ED staff. Arrests were managed by the
>medics and trauma by the surgeons and I began to wonder whether my role was
>simply to spend the rest of my working life managing sprains and
>lacerations.
>
>Now I run a department seeing about 24 000 a year; on trauma bypass but we
>still get the odd multitrauma falling out of the back of a ute. Admission
>rate is between 16-20%. I do all the admin, rostering, review all results,
>run the teaching programme, teach on the RMO postgrad course, assist with
>university of Tasmania exams and study days, and am starting up a part 1
>teaching program for the senior RMOs who are planning an EM career. We're
>having a complete rebuild next year with significant expansion, and no way
>of reducing workload while this happens, which will be 'interesting'. And
>we're about to get medical students too!
>
>If this might appeal to any of your colleagues, please pass on my email.
>Always looking for enthusiastic staff to join the team, either on short term
>contracts or to be sponsored for residency.
>
>And as for poisonous wildlife - I was about to rebut the slur on Tassie when
>I remembered the copperhead that was sitting on my doorstep when I came home
>last week. In fact, it's not so much the snakes - it's the blasted scorpions
>that keep getting into the bathroom...
>
>Fiona.
>
>-----Original Message-----
>From: Accident and Emergency Academic List
>[mailto:[log in to unmask]] On Behalf Of Derek Sage
>Sent: Thursday, 20 November 2008 6:14 AM
>To: [log in to unmask]
>Subject: Re: getting out
>
>Nothing here tries to kill you through its bite or sting. And nothing tries 
>to eat you.
>It is easy to tell whether a snake in Tasmania is poisonous or not -They all
>
>are!
>
>I am surprised though that anyone stays in the UK in emergency medicine. 
>Australia and New Zealand are superior when it comes to working in emergency
>
>medicine and the lifestyle!
>
>Derek
>
>----- Original Message ----- 
>From: "Fiona Wallace" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Wednesday, November 19, 2008 11:18 PM
>Subject: getting out
>
>
>> Hey - don't go there - come over here instead!
>>
>> 4 day working week...Mediterranean climate...5 bedroom houses for STG150
>> 000...advertising shortly for consultants and staff grades...
>>
>> Our summer is better than their summer, too.
>>
>> Fiona.
>>
>>
>> Dr Fiona Wallace MB BS MA
>> Director ED
>> Mersey Community Hospital
>> Latrobe
>> Tasmania
>> Australia
>>
>> [log in to unmask]
>> [log in to unmask]
>>
>>
>>
>> -----Original Message-----
>> From: Accident and Emergency Academic List
>> [mailto:[log in to unmask]] On Behalf Of Derek Sage
>> Sent: Wednesday, 22 October 2008 11:09 PM
>> To: [log in to unmask]
>> Subject: Re: 3hr stretch target v 4hr target
>>
>> Treating a backlog in the emergency department by having a time target 
>> only
>> replaces one problem with another and destroys the specialty of emergency
>> medicine.
>> A patient's temperature is a marker of something being wrong and we accept
>> that treating a figure (temperature/fever or time) is not the same as 
>> fixing
>>
>> the underlying problem. In fact it can be dangerous to assume that fixing
>> the target is a 'healthy outcome'. It is an indicator and politicians and
>> some clinicians have lost sight of this fact. If the temperature is raised
>> or the time in ED is excessive look for the cause and fix it/them and do 
>> not
>>
>> assume fixing the time equates to fixing the cause.
>>
>> Yes it has given the ED more resources and 'power' but at what cost. The
>> dumping of 'out of hours' work by GPs and the 4 hour target will suck the 
>> UK
>>
>> tax payers money up for no real health gains- only political ones. And now
>> that the UK taxes are bailing out banks, the UK can ill afford it!
>>
>> In New Zealand we are not neurotic and it is so much better a place to 
>> live
>> and work. All you guys in the UK should try it. Being from the UK and 
>> having
>>
>> 'jumped ships' I can say as a matter of fact.
>>
>> If you are interested in coming to NZ I will be happy to assist (anywhere
>> here is better than damp, grey, overcrowded, violent, drunken Britain)
>>
>> Enjoy your winter in the UK (-Our winter was better than your summer)
>>
>> -Derek Sage
>> 'Specialist' in Emergency Medicine
>> Tauranga Hospital
>> Tauranga, Bay of Plenty
>> NZ
>>
>> ----- Original Message ----- 
>> From: "Adrian Kerner" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Wednesday, October 22, 2008 11:52 PM
>> Subject: Re: 3hr stretch target v 4hr target
>>
>>
>> I am so pleased I do not have to deal with all this political [small p]
>> stuff any
>> more! I can now sort patients out; investigate and manage appropriately
>> without worring about a clock!!
>>
>> I'm in New Zealand [3/12] and the care is pretty good. Yes, targets have
>> been great to focus on what is done, but what  has become of the Emergency
>> Care doctor? You have become sign posts and sold out to a little 'p'.
>>
>> Best wishes from down under....enjoying the warmth and cosy life
>> style....feel
>> the air......
>>
>> Adrian Kerner
>> 'Specialist' in Emergency Medicine
>> North Shore Hospital
>> Auckland
>> NZ