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--- 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? Donate cash, emergency relief information http://dailynews.yahoo.com/fc/US/Emergency_Information/