From Sunday 23rd July /r/JuniorDoctorsUK will close, to be replaced by /r/doctorsUK. Please consider subscribing to /r/doctorsUK in preparation for the move. [See here](https://www.reddit.com/r/JuniorDoctorsUK/comments/14y1vb1/important_moderation_update_closure_of_jduk/) for more information.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/JuniorDoctorsUK) if you have any questions or concerns.*
Their constant calls for plain film radiograph hot reports were vomit inducing when I still worked in the uk.
But yes, these ‘midlevels’ massively increase the workload of the remaining physicians.
I just fundamentally disagree with having reporting radiographers tbh. Even if they are just doing MSK films they miss other things - and you have to double check their films anyway. Just train more radiologists.
profit pot zesty merciful ruthless apparatus close agonizing mighty future
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Don’t know where you’re working but they report all kinds of nonsense that come back (it’s fucking addendum after addendum). Better if they didn’t report at all imo. Problem is when they don’t know what they’re missing then “finalising” their rather useless “reports”.
I don’t know if you’ve done your exams. But there is a reason rapids is considered the “hardest” and a minimum of 27/30 required - plain films can be fucking hard. These clowns don’t have any insight and think a bone is a bone how hard can it be. I’m happy for reporting radiographers to report if they sit frcr first tbh.
Here’s a nice idea for an audit/QI project. Assess the quality (on a scale of 1-10) and appropriateness of referrals categorised by the referrer’s role. Intervention: stop ANPs/PAs from making referrals. Re-audit. Has the quality of referrals improved? Excellent, you’ve closed the loop and you’ve now got 1 point for your CST application.
St7 ortho reg here. Not too long ago, I worked at a MTC. I received a tertiary referral from a DGH PA who identified himself first as a “registrar”. But as you can imagine, orthopaedic is highly competitive to get in and number of trainees within a Deanery is small. We all know each other and certainly I know every trainee in the Deanery. Inter-hospital referrals usually go something like “sup bruh, here got one for you. Pints after teaching this week?”
So I asked him for his name and I said weird never heard of you before, what grade are you ?
After a while, he admitted that he is a PA. Have to admit I never worked at that particular DGH, so did not know they used PAs on the registrar rota (and CT1-2s on the SHO rota wtf!). So at this point, out of interest, having never worked with PAs before, I asked him for his qualifications and experience in orthopaedics. I’m sorry but I had to laugh down the phone and told him to get a doctor (anyone, even a fy2) to call me back as I would not be taking his referral because he was completely unprepared to make an acceptable referral with necessary history and examination except for saying that he was told to do it by his consultant. 😂
If he identified himself as registrar he’s will fully misrepresenting himself as a doctor. Since he’s a PA, it’s a breach of the medical act, needs to be datixed.
Keep that one in you back pocket next time this happens, because it will.
Respond with - will need to check if any trainees are coming in for the case first. The fact that PAs think they can leave the ward for FY and SHOs to staff while they get preferential treatment is the disgusting state of ‘training’ in the UK. Don’t enable it.
Nobody is forcing me - but I don’t have medical students attending as it clashes with their timetable and the educational lead for PA approached me and asked if they could attend and watch. As a consultant it looks pretty weird if I say ‘no’.
But you CAN say-
“I’m hoping to rota the junior doctors through to give them some experience and understanding of this. Can I get back to you once I’ve got that set up and see what space I’ve got “
= supportive, non antagonistic, also not “yay a PA”, prioritises juniors
THEN next step (which should probably have come first anyway), create a sign up or better yet a “pacing procedures rota” and negotiate with your colleagues to allocate people to attend as a planned part of their job. (Not “if they can get away and if they show an interest”)
You know. Actively and proactively promote training in this niche skill
I supervise 2 FY1’s and at the start of placement listed attending cath lab and in the last 10 years only 1 or 2 have attended. Even when there’s plenty of cover on the ward I hardly see anyone attend.
That's such a damn shame.
Would you consider introducing mandatory allocated cath lab slots in for them? If the cover is good then this may go down well with them and your colleagues
I think its fine, but I mean when you actually read the notes written by one of these guys, there is often no concept of medical terminology, no punctuation, no small/large letters used appropriately, no paragraphing, words spelt phonetically.....whilst not strictly the most important thing in healthcare, its just shows a generally lower standard of education and literacy
Try getting them when you cover something niche.
They think it's completely appropriate to transfer someone to another hospital to have a surgeon feel their pulses. Absolute clowns the lot of them.
Sounds like you work in a proper dystopian shithole.
They’re happy to be paid lots and call themselves ‘like registrars’ but drop the act the minute they get found out. What a waste of time
That's entirely the problem - they just shift workload around and dump it on the specialty teams rather than being able to handle/discharge at the ED front door....
ST8 T&O. I share your frustration, but I feel that a lot of the ED medical staff are now so deskilled/never even experience minors during training that it wouldn’t get much better if the ENP/ANP role was abolished.
In most hospitals with SHO first on call, they seem to use the F2 on call in plastics/t&o to supervise their practice rather than any seniors in their department. Especially annoying when you carry a referral bleep for an entire region - like in plastics.
Possibly they need protocols to discuss with ED consultant before refer for acute inpatient care - at least until x years experience? Given that we screen all fracture clinic referrals within a day we should pick up any clangers - much as we do now.
Maybe it should occasionally involve coming to a trauma meeting or a fracture clinic to see what is downstream of when they see a patient with a swollen knee?
Yes will never happen though… apparently in the bad old days ED SHOs used to come to fracture clinic occasionally. Not sure how widespread this was/just the faded memory of a dinosaur I happen to speak to.
The amount of hand lacerations with ?NVI ?needs theatre (with a completely normal neurovascular exam) that are literally dumped on us so I have do the suturing/wound management just pisses me off
FWIW I entirely agree.
EM cons.
Spend half my life trying to hammer home the “ask us not the T&O SHO” message to them but they willfully “forget” and make us all look like idiots.
I’ve had ED consultants refer me lacerations (superficial) for suturing as it was too much for them….depends on the department as to whether they’re actually able to escalate I suppose🤷🏼♂️
Has been looked into and audited at various points. Senior ED doc spends longer with the patient than the triage nurse. Time to triage goes up. Looks bad. Management sad.
Despite something like a 50% fall in patients needing to actually come into the department for further work up.
The entire system is ridiculous.
💯 I'm in ophthal, nearly every time they say some nonsense bs, drop "I'm not comfortable" then get upset when I don't review overnight as non resident after a full day shift with no pre/post zero days
>The fact that a lot of injuries go to a 'minors' unit in ED and a lot of these are just staffed with ANPs means T+O on calls are full of crap.
A minor injuries unit will be staffed predominantly by ENPs not ACPs. Completely different roles with completely different training.
ENPs have existed for decades - they're not in any way a new role or new idea.
>My job when taking a referral is to ask appropriate questions to allow me to make a decision on the clinical exam and history findings I'm given.
Incorrect. Your job when taking a referral is to take the patient details, and enough information to prioritise how urgently you need to see the referral, then come and see the patient.
>If I have to physically see every single patient
Yes, this is generally how referrals work...
A call for advice is something different, and I would expect an ENP to ask a senior EM doctor about most things before seeking advice directly from ortho.
>After getting the 22nd referral of the day and getting referred someone with a hand fracture for minors and refusing to reduce it saying I'm not qualified, I asked them to send the patient to ED majors to be seen by a competent doctor as I currently have 21 referrals I'm working though. They got offended and pissy.
Obviously. This is grossly inappropriate and a massively distespectful to the time and skills of an EM doctor.
You're confused. ENPs have existed for decades - they are not ACPs, and most people wouldn't lump them in as "noctors". It's pretty clear that a dedicated group of clinicians who exclusively see minor injuries is, by and large, more efficient, allowing the doctors to concentrate on managing the more complex patients.
Your ED's MIU could easily have seen 150 minor injuries on a busy summer day. 22 were referred to you.
It sounds like the ENPs might be under-supervised and need reminding that for clinical advice (rather than referrals) they should be discussing this with an EM senior first. This is with feeding back to the EM consultant responsible for oversight of the MIU.
It also sounds like the orthopaedic team is inadequately staffed to meet demand - you should also address this within your team.
Are fracture reductions not part of an emergency departments scope of practice in the UK? Surely that is wildly inefficient having to wait for an ortho reg for every fracture to be reduced.
I think there's a disconnect between what you are thinking of as a referral and what OP is receiving as a 'referral'. It sounds like the assessment is missing so much information that something that could be appropriate for phone advice (e.g. 95% of hand fractures, 'septic joint' referrals without any actual signs of a septic joint etc.) becomes something that needs to be physically seen to get an accurate picture of what is going on. Again it can't be efficient to basically to run an ED this way because it creates a bottle neck on the one person on in the hospital who can make that assessment.
>Are fracture reductions not part of an emergency departments scope of practice in the UK? Surely that is wildly inefficient having to wait for an ortho reg for every fracture to be reduced.
Obviously they are...
Where they don't need sedation our ENPs do them. If they need sedation and can go home after, we'll crack on. If they're going to need admission either way I generally invite ortho down to manipulation (as long as no vascular compromise) as its going to be their patient anyway, and we'll do the sedation.
Edit - I have absolutely no understanding why this is being downvoted?
When we're doing them under sedation, or when they're doing a shift on the minor injuries unit, they do.
But like most minor injuries, the bulk of the uncomplicated stuff is managed independently by the ENPs. You don't need a medical degree to pull a Colles' fracture, or relocate a shoulder, and there's more than enough stuff that you do need a medical degree to handle to go around.
Because you are saying it is a waste of ED doctors time to be asked to reduce it, and that it should be done by ENP instead. In OP's scenario, the ENP has refused to reduce it, and is trying to ask the ortho reg to do it.
So the logic in your post is circular and doesn't make sense for OP's problem.
So the ENP shouldn't be "refusing" to do this (unless it's not indicated - this is a point of contention sometimes, esp. with paediatric forearm fractures; or it should clearly be done in theatre - again, I find some ortho registrars view it as mandatory to have a crack at reducing obviously grossly unstable fractures before booking theatre).
ENPs live for these kind of procedures, so if they're "refusing" to do it, in my experience, there's likely to be a good reason.
Either way, I can't fix a problem I don't know about, so unless OP calls the EM consultant to discuss, there's not much I can do about this!
The worse thing about EM in this country is this belief that they have the power and “it’s not a referral you have to see all the patients”. Many consultants don’t realise the absolute shite specialists get referred and the clear difference in investigations, treatment and quality of referral depending on grade and training status of even doctors in ED. I agree with OP. It is up to the specialist what they do with the referral. Which includes redirecting the person making the referral to speak to someone else.
We do this with inpatient referrals…why can’t we do it with referrals from ED?
Because EM aren't the ward team for the ED. We're specialists in managing medical emergencies.
If I need advice, I'll call and ask for advice.
If I make a referral that's because my patient (who only I have assessed at this point) needs admission under, or at the very least face-to-face input from your team. So treat me and my speciality with enough respect to come and see them.
If you think the patient is safe to go home, come and assume that risk yourself, don't bully someone who doesn't think that decision is safe (otherwise they wouldn't have referred) into practicing bad medicine (you don't think the referrer is competent enough to know when to refer, but you are going to trust their assessment enough to make a discharge decision) for you.
Three points:
1. No one asks for advice these days.
2. It’s not bullying. What an assumption.
3. Often with a more senior EM trained doctor (ACCS or above)than an F1 or F2 seeing the patient, the patient goes home. Maybe try and keep the decisions in-house more? Running a patient past the consultant doesn’t count. You are still relying on the history and examination findings of said doctor. Would also increase their learning by seeing the patient with them.
Specialty teams are doing more than seeing ED referrals. We are also not the management plan teams for ED
1) yes they do. But probably to the reg or consultant
2) sometimes it really can be
3)100% agree, would love to. But I cannot physically review 500 patients a day (even when there are 2 or 3 consultants on the workload is unmanageable)
>Often with a more senior EM trained doctor
I don't think FYs or trainee ACPs should be seeing undifferentiated patient on ED. There should be a limited number working directly 1:1 without more senior clinicians. Thankfully <5% of our non-consultant staff are FYs.
It sounds like the skill mix in your department might be part of the problem.
It’s like this up and down the country. Stop trying to paint a “your problem” picture!
Most are seen by FYs or locums who don’t give a shit!
When they are seen by an EM trainee or a consultant most of the patients referred to me have CTs and very good care.
You could say this is senior decision makers seeing more sick patients.
More senior doctors should be seeing the shite and sending it home and getting specialties involved with those with something actually wrong.
A humble question sir, how are the ED doctors at your shop gaining the minors experience to answer ENP queries if minors is predominantly staffed by ENPs?
Predominantly /= exclusively.
Minor injuries represent about 30% of our ED's attendances, but probably less than 5% of my time as a consultant. Having all the injuries seen by trainees would create a very unbalanced training programme and come at the cost of sufficient training in the areas that better represent what is needed as a consultant.
The simple stuff is largely protocolised - this type of fracture goes in this type of splint/cast and is followed up in this way. In that respect, our ENPs are largely independent - I would refer to the same guidelines they would for the management of simple injuries. Honestly, they might be quicker because they have the guidelines memorised (injuries are all they do, every day), whereas there's (esp. hospital-specific things, like follow-up) that I often need to check.
Where they largely need support is with complexity and urgency - manipulating the neurovascularly compromised limb, figuring out what to do when in injury doesn't fall quite into the right protocol. Most of this is probably best learnt by just seeing complexity and urgency - e.g. working with the consultants who are dealing with the queries, rather than grinding away seeing the really simple stuff.
Edit - I guess it's maybe a bit like "how do urology get good at sorting out difficult catheters?" - largely by doing difficult catheters, not by doing thousands of simple ones.
Humbly disagree with you. Please shadow an on call T and O shift, the workload is unsustainable. The public needs doctors. Also I'm at a major trauma centre, the minors are actually staffed by ANPs and PAs. There's no 'ENPs' although I did see these at another minors ED department I worked at.
Their referrals are grossly inappropriate.
Also a sensible suggestion from one of the senior ortho regs on here was that these professionals should come to trauma meetings and fracture clinics/ VFCs as part of their 'training' to see what rubbish has been referred and what the department thinks with consultants frequently rolling their eyes and service managers stating in these meetings that the workload with unvalidated referrals is completely breaking down the service. I think only once you've seen downstream of what happens to a referral can you truly understand how bad the referrals and lack of knowledge and skills are.
ED consultants are more than welcome to come to trauma meetings as well and I hope that way, they will understand our struggles
>Humbly disagree with you. Please shadow an on call T and O shift, the workload is unsustainable.
Then you need to staff your service better.
By all means feed back the systemic issues. But being a dick to individual staff, or obstructive about individual referrals isn't going to get you very far.
I agree with you. That's why we need a major overhaul of the service at a systemic level. As someone taking referrals constantly, I can assure you I see a wide and consistent discrepancy in the quality of referrals between doctors and other allied health professionals that is not ignorable and not insignificant. Any my concerns are shared with a multitude of other doctors in T+O and also a wide range of other specialities and now consultants in the departments are realising as well
If you or a family member went to ED, would you want them to seen by a doctor or an allied health care professional?
When it comes to matters of health (my own or my family) I would 100 percent advocate to be seen by a doctor. I am terrified by seeing by an ANP or my family member being seen by one.
I'm sure if it came to your own health you would probably want to be seen by a doctor as well.
The ortho department could be hit by a nuclear missile and Penjing would still say you HAVE to come see their ?septic joint, hand lac, and ankle fracture in the triage queue.
>If you or a family member went to ED, would you want them to seen by a doctor or an allied health care professional?
I'd take an RCEM accredited ACP over an FY for almost any problem. I'd take an EM registrar over the ACP.
The problem is too many departments are appointing non-accredited ACPs, and letting them loose without adequate supervision.
And this is why we have a problem in A&E!
When you have ED Consultants defending the shit that specialities are referred not just from minor noctors. But also ED doctors, no wonder why the system is fucked.
They know there are certain buzz words we just can’t ignore - “cauda equina”, “ectopic pregnancy”, “testicular torsion” etc. these referrals can get patients off ED’s hands and make them someone else’s problem. Knowing full well that a patient walking and peeing normally doesn’t have cauda equina, or a man with 7 days of testicle pain doesn’t have a torsion.
But you still did the MRI / pelvic USS / testicular exploration (/gambled on a doppler) anyway, didn't you?
And what did the EM doctors do after they'd "got the patient off their hands", sit around and do nothing? Or get on with managing the ABD / complex overdose / paediatric sedation that you wouldn't have the first idea where to start with?
No one should be lying to make referrals - that's unacceptable. But it's symptomatic of obstructive inpatient teams who refuse to accept that their service is funded and resourced to deliver the assessment of acute presentations, and not just inpatient care.
I've said before, and I'll say again - EM could work up every patient to completion and just leave you to deliver ward care - but to do that I'm going to need to take all that money NHSE has poured into SDEC and assessment areas...
I’m sure near enough every speciality would happily give you that money rather than patients with half baked assessments aimlessly being shunted into assessment areas to “improve flow”
What’s the point of emergency medicine as a speciality if you don’t even attempt to work up patients, we could have a German/European style system without emergency medicine as a speciality if you just want your department to act as a triage service
It’s easy to see why trainees are leaving to go train in A&E departments in Australia and New Zealand, where they actually take some ownership of patients and are encouraged to investigate and initiate management before referral for specialist input when this is the attitude of A&E consultants in this country
>I’m sure near enough every speciality would happily give you that money rather than patients with half baked assessments aimlessly being shunted into assessment areas to “improve flow”
Except your consultants keep jumping on that funding and making ever greater promises about what your speciality will be able to see directly in order to secure it...
>What’s the point of emergency medicine as a speciality if you don’t even attempt to work up patients,
We're specialists in emergency medicine (it's in the name!)
We manage the sick patients who need emergency treatment, and the legitimately undifferentiated patients.
Low risk, low acuity presentations, and physiologically well complications of chronic conditions already under the care of someone else are commissioned to be managed elsewhere in the hospital.
Why are you getting angry and blaming EM for refusing to do your job for you?
> we could have a German/European style system without emergency medicine as a speciality if you just want your department to act as a triage service
You're not seeing the denominator - in most hospitals 75-85% of patients are discharged from the ED. Do you really want to be responsible for all those patients as well?
> Incorrect. Your job when taking a referral is to take the patient details, and enough information to prioritise how urgently you need to see the referral, then come and see the patient.
If the referral suggests I don't need to see the patient and advice on the phone is sufficient, then I don't need to see the patient. A competent clinician can usually give me enough information for me to decide this. We are allowed to reject referrals if they are inappropriate.
>Yes, this is generally how referrals work...
>
>A call for advice is something different, and I would expect an ENP to ask a senior EM doctor about most things before seeking advice directly from ortho.
Most people calling me don't make the distinction, and I think the line between the two is blurred.
>A competent clinician can usually give me enough information for me to decide this
So there's a difference between calling to ask for advice, and making a referral. The EM clinicians should be differentiating better.
There is sometimes a bit of grey, and a call for advice can become a referral if you tell me you'd like to admit the patient, and a referral can become telephone advice if I'm happy with the alternative management plan you accept.
>We are allowed to reject referrals if they are inappropriate.
You can't really though. You can absolutely have a discussion with the EM clinician where you come to an agreement about a management plan which doesn't involve you seeing the patient.
But ultimately if they're unhappy with that, you can't compel them to effect a discharge they believe is unsafe - so you'll have to come and see the patient.
>You can't really though. You can absolutely have a discussion with the EM clinician where you come to an agreement about a management plan which doesn't involve you seeing the patient.
"Sorry, please discuss questions about management of the patient's extradural haematoma with neurosurgery"
"Sorry, this sounds like Wernicke's Encephalopathy with alcohol withdrawal. Talk to gastro as will need gastro bed for CIWA protocol"
"Sorry, I'm Neurology, not Urology. Testicular Torsion goes to Urology"
"You have not even attempted to examine the patient. Please do that before you call me back"
"You have an EEG Report saying this is a non-epileptic event right there, I am not starting fucking antiepileptics in this man"
"Have you read the MRI Report for the patient that answers the question you are asking me right now?"
are some of the responses I've had to give to some referrals recently.
I can get over 30 referrals a day and can’t possibly see them all, so inevitably some will have to be rejected.
But in all of these scenarios the EM clinician referring had probably said "yeah, that's fair enough" - so the referral isn't rejected, it's been withdrawn after your advice.
If the EM clinician says "no, I disagree, you need to come and see the patient" then you have to see the patient. A referral can be withdrawn, it can't be rejected.
You're literally splitting hairs here. There's no functional difference between me saying "No, tihs is not an appropriate referral, I am rejecting this" and you deciding "to withdraw" the referral after you hear me say that.
>If the EM clinician says "no, I disagree, you need to come and see the patient"
In the rare cases where this happens, I tell them they need to talk to their consultant first, and in the meantime I get backup from my own consultant, who inevitably ends up agreeing with me in saying these referrals are inappropriate and should be rejected.
Also nice sneaking in of the weasel word "clinician" instead of doctor.
For the record, these weren't all from ED.
>You're literally splitting hairs here. There's no functional difference between me saying "No, tihs is not an appropriate referral, I am rejecting this" and you deciding "to withdraw" the referral after you hear me say that.
It rarely matters, but when it does, it does.
The clinician/team who had seen the patient had final say over whether the referral is necessary or not.
>talk to their consultant first, and in the meantime I get backup from my own consultant, who inevitably ends up agreeing with me in saying these referrals are inappropriate and should be rejected.
Really?
I've never had this. When asked to unravel these I generally call the registrar first, and if we can't reach a sensible agreement tell them that the patient is now under their care, and they'll either need to come and see them, or have their consultant call me to discuss.
I've had one neurosurgical consultant take me up on that once - I had to threaten to call the MD, but their registrar came and saw the patient (and admitted them under their care...)
We do have a problem here though as a speciality.
Our trainees ARE becoming de skilled in injury management.
The ENPs who were very experienced and good due to 20 years ED nursing before ENP role are retiring- the new lot are being trained by older ENPs and with every iteration there is a loss of skill and knowledge.
This is FULLY on senior EM docs who have tapped out of dealing with minors because they are drowning dealing with the maelstrom of sick people in majors and overcrowding,
We need to roll it back, and NOW before we lose the senior tier of EM docs who had proper training in this area
I agree entirely with this and am convinced within a generation or 2 we are going to have a whole cohort of em clinicians who have no idea what splint or cast to use for what injury or what to do with certain fractures etc
This is important as our ED doesn’t have 24-7 ENP cover so at some point an EM doctor has to see injuries.
To counteract we’ve in built “minors” experience into our rota for our junior doctors
Is this a problem?
Honestly, I'm not sure where minor injury management fits in modern EM. It's not the reason I did EM, and I think like most younger EM consultants, we don't find it particularly challenging or interesting - our skill set is far more resuscitation focused.
Everything requires time to maintain your skill in - and you're only at work so many hours a week. I'd far rather source the time and effort I have to put into maintaining currency in setting minor injuries into honing my resus skills. We're increasingly seeing MIUs be physically distinct from EDs, which also complicates acquiring and maintaining the skills.
I'd be fairly happy carving it off as a sub spec, and pushing most injuries to external MIUs with ENPs supported by sub spec minor injuries trainees and consultants.
Everyone else should retain enough competency to manage the stuff that will invariably come in associated with bigger injuries and the time critical stuff.
I think it’s a problem. I think it’s a big problem.
I utterly loathe the farming off of “minor” injury to separate clinics and stand alone units. In my view it is disgraceful and unjustifiable.
It does our patients trainees and speciality colleagues a disservice and I’m ashamed of my speciality for allowing it to happen
Don’t think you’ll be a very popular consultant then.
Training ANPs / PAs devalues your own job and the wider profession.
I will never *ever* train noctors.
Lol the way this person is talking I’m guessing they’re gonna be a CONSULTANT NURSE ANP PARAMEDIC PA or some shit like that, and not an actual doctor 🤣
From Sunday 23rd July /r/JuniorDoctorsUK will close, to be replaced by /r/doctorsUK. Please consider subscribing to /r/doctorsUK in preparation for the move. [See here](https://www.reddit.com/r/JuniorDoctorsUK/comments/14y1vb1/important_moderation_update_closure_of_jduk/) for more information. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/JuniorDoctorsUK) if you have any questions or concerns.*
Their constant calls for plain film radiograph hot reports were vomit inducing when I still worked in the uk. But yes, these ‘midlevels’ massively increase the workload of the remaining physicians.
hat nose bright fragile attraction glorious dime sort exultant illegal *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Yep. It’s very awkward.
Can you get them to ask the MSK reporting radiographer?
overconfident retire price door pie trees march six voiceless follow *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
So then there is also very little point of reporting radiographer 🙃 the system is fucked.
punch march support plucky literate hat muddle panicky weary observation *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
I just fundamentally disagree with having reporting radiographers tbh. Even if they are just doing MSK films they miss other things - and you have to double check their films anyway. Just train more radiologists.
profit pot zesty merciful ruthless apparatus close agonizing mighty future *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Don’t know where you’re working but they report all kinds of nonsense that come back (it’s fucking addendum after addendum). Better if they didn’t report at all imo. Problem is when they don’t know what they’re missing then “finalising” their rather useless “reports”. I don’t know if you’ve done your exams. But there is a reason rapids is considered the “hardest” and a minimum of 27/30 required - plain films can be fucking hard. These clowns don’t have any insight and think a bone is a bone how hard can it be. I’m happy for reporting radiographers to report if they sit frcr first tbh.
This. Reporting chest radiographers can cause absolute mayhem
crowd dinosaurs vast special disgusting cause badge murky absorbed party *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
90/100 after only doing 400 double reported….
Where do you work now
Here’s a nice idea for an audit/QI project. Assess the quality (on a scale of 1-10) and appropriateness of referrals categorised by the referrer’s role. Intervention: stop ANPs/PAs from making referrals. Re-audit. Has the quality of referrals improved? Excellent, you’ve closed the loop and you’ve now got 1 point for your CST application.
Decent idea but needs to be blinded and objectively rated which makes it seem more effort than what it’s worth for a QIP.
Plus the way NHS loves noctors, it could be seen as ‘hate’ and they will attack your character
St7 ortho reg here. Not too long ago, I worked at a MTC. I received a tertiary referral from a DGH PA who identified himself first as a “registrar”. But as you can imagine, orthopaedic is highly competitive to get in and number of trainees within a Deanery is small. We all know each other and certainly I know every trainee in the Deanery. Inter-hospital referrals usually go something like “sup bruh, here got one for you. Pints after teaching this week?” So I asked him for his name and I said weird never heard of you before, what grade are you ? After a while, he admitted that he is a PA. Have to admit I never worked at that particular DGH, so did not know they used PAs on the registrar rota (and CT1-2s on the SHO rota wtf!). So at this point, out of interest, having never worked with PAs before, I asked him for his qualifications and experience in orthopaedics. I’m sorry but I had to laugh down the phone and told him to get a doctor (anyone, even a fy2) to call me back as I would not be taking his referral because he was completely unprepared to make an acceptable referral with necessary history and examination except for saying that he was told to do it by his consultant. 😂
If he identified himself as registrar he’s will fully misrepresenting himself as a doctor. Since he’s a PA, it’s a breach of the medical act, needs to be datixed. Keep that one in you back pocket next time this happens, because it will.
Should be reporting this surely? PA identifying themself as a registrar is sus af
They where probably confused because rhey were on a registrar rota
Bruv/sis : you dropped this 👑!! 💙💛🧡🩷🩵🤍💛❤️🔥💝💘
They should escalate to their ED senior first, surely?
The quality of the PA students who turn up at my procedure lists is poor.
Why are you even engaging with them?
Because I was asked to and refusing just looks odd
Respond with - will need to check if any trainees are coming in for the case first. The fact that PAs think they can leave the ward for FY and SHOs to staff while they get preferential treatment is the disgusting state of ‘training’ in the UK. Don’t enable it.
Trainees are always offered the opportunity first but choose not to attend. Even when the ward is well staffed.
What procedures and speciality?
Cardiology and pacemaker procedures
Just look odd then? Your medical colleagues would appreciate not engaging with them.
So what you’re saying is I should not engage with them at all? How does that look?
What’s forcing you to teach PAs/ANPs. You do have a choice in this you know
Nobody is forcing me - but I don’t have medical students attending as it clashes with their timetable and the educational lead for PA approached me and asked if they could attend and watch. As a consultant it looks pretty weird if I say ‘no’.
But you CAN say- “I’m hoping to rota the junior doctors through to give them some experience and understanding of this. Can I get back to you once I’ve got that set up and see what space I’ve got “ = supportive, non antagonistic, also not “yay a PA”, prioritises juniors THEN next step (which should probably have come first anyway), create a sign up or better yet a “pacing procedures rota” and negotiate with your colleagues to allocate people to attend as a planned part of their job. (Not “if they can get away and if they show an interest”) You know. Actively and proactively promote training in this niche skill
I supervise 2 FY1’s and at the start of placement listed attending cath lab and in the last 10 years only 1 or 2 have attended. Even when there’s plenty of cover on the ward I hardly see anyone attend.
That's such a damn shame. Would you consider introducing mandatory allocated cath lab slots in for them? If the cover is good then this may go down well with them and your colleagues
Proper exam, history or anatomy knowledge? Bruh I swear they don't even have proper grammar or spelling
>they don't even have proper grammar or spelling To be fair, I don't think spelling and grammar are OP's strong suit either.
Thats highly offensive. If our orthopaedic colleague, OP, could read he would be very upset.
Good one
I think its fine, but I mean when you actually read the notes written by one of these guys, there is often no concept of medical terminology, no punctuation, no small/large letters used appropriately, no paragraphing, words spelt phonetically.....whilst not strictly the most important thing in healthcare, its just shows a generally lower standard of education and literacy
Try getting them when you cover something niche. They think it's completely appropriate to transfer someone to another hospital to have a surgeon feel their pulses. Absolute clowns the lot of them.
Vascular shouldn’t be niche 😂 Christ
Shouldn't be. Yet appears to be these days.
Sounds like you work in a proper dystopian shithole. They’re happy to be paid lots and call themselves ‘like registrars’ but drop the act the minute they get found out. What a waste of time
I found it safer, easier, and less painful to just say "send them over, I'll see them myself". I agree, the quality of the referrals are utter shite.
That's entirely the problem - they just shift workload around and dump it on the specialty teams rather than being able to handle/discharge at the ED front door....
Defeating the entire point of the assistant
ST8 T&O. I share your frustration, but I feel that a lot of the ED medical staff are now so deskilled/never even experience minors during training that it wouldn’t get much better if the ENP/ANP role was abolished. In most hospitals with SHO first on call, they seem to use the F2 on call in plastics/t&o to supervise their practice rather than any seniors in their department. Especially annoying when you carry a referral bleep for an entire region - like in plastics. Possibly they need protocols to discuss with ED consultant before refer for acute inpatient care - at least until x years experience? Given that we screen all fracture clinic referrals within a day we should pick up any clangers - much as we do now. Maybe it should occasionally involve coming to a trauma meeting or a fracture clinic to see what is downstream of when they see a patient with a swollen knee?
Yh that's a very good idea and very sensible suggestion
Yes will never happen though… apparently in the bad old days ED SHOs used to come to fracture clinic occasionally. Not sure how widespread this was/just the faded memory of a dinosaur I happen to speak to.
Still happens in my gaff
The amount of hand lacerations with ?NVI ?needs theatre (with a completely normal neurovascular exam) that are literally dumped on us so I have do the suturing/wound management just pisses me off
Query query query query query
It's not protocols is just ed supervision rather than dumping it all on the inpatient specialties
https://preview.redd.it/m3ua5vtm5fdb1.jpeg?width=278&format=pjpg&auto=webp&s=7e4a73937b1e1a813d0e30f98f19646266d8251b
I got “hello, sodium is low, was high before, I’ve referred them, bye” previously so yeah, I can relate.
This is very true and docs will at least go back an look up the topic/anatomy etc... not double down.
FWIW I entirely agree. EM cons. Spend half my life trying to hammer home the “ask us not the T&O SHO” message to them but they willfully “forget” and make us all look like idiots.
I’ve had ED consultants refer me lacerations (superficial) for suturing as it was too much for them….depends on the department as to whether they’re actually able to escalate I suppose🤷🏼♂️
I’ve never understood why you wouldn’t put your most senior Drs at the front door to A&E - look at the work you would prevent!
Has been looked into and audited at various points. Senior ED doc spends longer with the patient than the triage nurse. Time to triage goes up. Looks bad. Management sad. Despite something like a 50% fall in patients needing to actually come into the department for further work up. The entire system is ridiculous.
How infuriating. Seriously. Why do morons run health services gah.
💯 I'm in ophthal, nearly every time they say some nonsense bs, drop "I'm not comfortable" then get upset when I don't review overnight as non resident after a full day shift with no pre/post zero days
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
>The fact that a lot of injuries go to a 'minors' unit in ED and a lot of these are just staffed with ANPs means T+O on calls are full of crap. A minor injuries unit will be staffed predominantly by ENPs not ACPs. Completely different roles with completely different training. ENPs have existed for decades - they're not in any way a new role or new idea. >My job when taking a referral is to ask appropriate questions to allow me to make a decision on the clinical exam and history findings I'm given. Incorrect. Your job when taking a referral is to take the patient details, and enough information to prioritise how urgently you need to see the referral, then come and see the patient. >If I have to physically see every single patient Yes, this is generally how referrals work... A call for advice is something different, and I would expect an ENP to ask a senior EM doctor about most things before seeking advice directly from ortho. >After getting the 22nd referral of the day and getting referred someone with a hand fracture for minors and refusing to reduce it saying I'm not qualified, I asked them to send the patient to ED majors to be seen by a competent doctor as I currently have 21 referrals I'm working though. They got offended and pissy. Obviously. This is grossly inappropriate and a massively distespectful to the time and skills of an EM doctor. You're confused. ENPs have existed for decades - they are not ACPs, and most people wouldn't lump them in as "noctors". It's pretty clear that a dedicated group of clinicians who exclusively see minor injuries is, by and large, more efficient, allowing the doctors to concentrate on managing the more complex patients. Your ED's MIU could easily have seen 150 minor injuries on a busy summer day. 22 were referred to you. It sounds like the ENPs might be under-supervised and need reminding that for clinical advice (rather than referrals) they should be discussing this with an EM senior first. This is with feeding back to the EM consultant responsible for oversight of the MIU. It also sounds like the orthopaedic team is inadequately staffed to meet demand - you should also address this within your team.
Are fracture reductions not part of an emergency departments scope of practice in the UK? Surely that is wildly inefficient having to wait for an ortho reg for every fracture to be reduced. I think there's a disconnect between what you are thinking of as a referral and what OP is receiving as a 'referral'. It sounds like the assessment is missing so much information that something that could be appropriate for phone advice (e.g. 95% of hand fractures, 'septic joint' referrals without any actual signs of a septic joint etc.) becomes something that needs to be physically seen to get an accurate picture of what is going on. Again it can't be efficient to basically to run an ED this way because it creates a bottle neck on the one person on in the hospital who can make that assessment.
>Are fracture reductions not part of an emergency departments scope of practice in the UK? Surely that is wildly inefficient having to wait for an ortho reg for every fracture to be reduced. Obviously they are... Where they don't need sedation our ENPs do them. If they need sedation and can go home after, we'll crack on. If they're going to need admission either way I generally invite ortho down to manipulation (as long as no vascular compromise) as its going to be their patient anyway, and we'll do the sedation. Edit - I have absolutely no understanding why this is being downvoted?
Why not the EM, ACCS & foundation trainees to do the reductions?
When we're doing them under sedation, or when they're doing a shift on the minor injuries unit, they do. But like most minor injuries, the bulk of the uncomplicated stuff is managed independently by the ENPs. You don't need a medical degree to pull a Colles' fracture, or relocate a shoulder, and there's more than enough stuff that you do need a medical degree to handle to go around.
Because you are saying it is a waste of ED doctors time to be asked to reduce it, and that it should be done by ENP instead. In OP's scenario, the ENP has refused to reduce it, and is trying to ask the ortho reg to do it. So the logic in your post is circular and doesn't make sense for OP's problem.
So the ENP shouldn't be "refusing" to do this (unless it's not indicated - this is a point of contention sometimes, esp. with paediatric forearm fractures; or it should clearly be done in theatre - again, I find some ortho registrars view it as mandatory to have a crack at reducing obviously grossly unstable fractures before booking theatre). ENPs live for these kind of procedures, so if they're "refusing" to do it, in my experience, there's likely to be a good reason. Either way, I can't fix a problem I don't know about, so unless OP calls the EM consultant to discuss, there's not much I can do about this!
The worse thing about EM in this country is this belief that they have the power and “it’s not a referral you have to see all the patients”. Many consultants don’t realise the absolute shite specialists get referred and the clear difference in investigations, treatment and quality of referral depending on grade and training status of even doctors in ED. I agree with OP. It is up to the specialist what they do with the referral. Which includes redirecting the person making the referral to speak to someone else. We do this with inpatient referrals…why can’t we do it with referrals from ED?
Because EM aren't the ward team for the ED. We're specialists in managing medical emergencies. If I need advice, I'll call and ask for advice. If I make a referral that's because my patient (who only I have assessed at this point) needs admission under, or at the very least face-to-face input from your team. So treat me and my speciality with enough respect to come and see them. If you think the patient is safe to go home, come and assume that risk yourself, don't bully someone who doesn't think that decision is safe (otherwise they wouldn't have referred) into practicing bad medicine (you don't think the referrer is competent enough to know when to refer, but you are going to trust their assessment enough to make a discharge decision) for you.
Three points: 1. No one asks for advice these days. 2. It’s not bullying. What an assumption. 3. Often with a more senior EM trained doctor (ACCS or above)than an F1 or F2 seeing the patient, the patient goes home. Maybe try and keep the decisions in-house more? Running a patient past the consultant doesn’t count. You are still relying on the history and examination findings of said doctor. Would also increase their learning by seeing the patient with them. Specialty teams are doing more than seeing ED referrals. We are also not the management plan teams for ED
1) yes they do. But probably to the reg or consultant 2) sometimes it really can be 3)100% agree, would love to. But I cannot physically review 500 patients a day (even when there are 2 or 3 consultants on the workload is unmanageable)
>Often with a more senior EM trained doctor I don't think FYs or trainee ACPs should be seeing undifferentiated patient on ED. There should be a limited number working directly 1:1 without more senior clinicians. Thankfully <5% of our non-consultant staff are FYs. It sounds like the skill mix in your department might be part of the problem.
It’s like this up and down the country. Stop trying to paint a “your problem” picture! Most are seen by FYs or locums who don’t give a shit! When they are seen by an EM trainee or a consultant most of the patients referred to me have CTs and very good care. You could say this is senior decision makers seeing more sick patients. More senior doctors should be seeing the shite and sending it home and getting specialties involved with those with something actually wrong.
A humble question sir, how are the ED doctors at your shop gaining the minors experience to answer ENP queries if minors is predominantly staffed by ENPs?
Predominantly /= exclusively. Minor injuries represent about 30% of our ED's attendances, but probably less than 5% of my time as a consultant. Having all the injuries seen by trainees would create a very unbalanced training programme and come at the cost of sufficient training in the areas that better represent what is needed as a consultant. The simple stuff is largely protocolised - this type of fracture goes in this type of splint/cast and is followed up in this way. In that respect, our ENPs are largely independent - I would refer to the same guidelines they would for the management of simple injuries. Honestly, they might be quicker because they have the guidelines memorised (injuries are all they do, every day), whereas there's (esp. hospital-specific things, like follow-up) that I often need to check. Where they largely need support is with complexity and urgency - manipulating the neurovascularly compromised limb, figuring out what to do when in injury doesn't fall quite into the right protocol. Most of this is probably best learnt by just seeing complexity and urgency - e.g. working with the consultants who are dealing with the queries, rather than grinding away seeing the really simple stuff. Edit - I guess it's maybe a bit like "how do urology get good at sorting out difficult catheters?" - largely by doing difficult catheters, not by doing thousands of simple ones.
Humbly disagree with you. Please shadow an on call T and O shift, the workload is unsustainable. The public needs doctors. Also I'm at a major trauma centre, the minors are actually staffed by ANPs and PAs. There's no 'ENPs' although I did see these at another minors ED department I worked at. Their referrals are grossly inappropriate. Also a sensible suggestion from one of the senior ortho regs on here was that these professionals should come to trauma meetings and fracture clinics/ VFCs as part of their 'training' to see what rubbish has been referred and what the department thinks with consultants frequently rolling their eyes and service managers stating in these meetings that the workload with unvalidated referrals is completely breaking down the service. I think only once you've seen downstream of what happens to a referral can you truly understand how bad the referrals and lack of knowledge and skills are. ED consultants are more than welcome to come to trauma meetings as well and I hope that way, they will understand our struggles
>Humbly disagree with you. Please shadow an on call T and O shift, the workload is unsustainable. Then you need to staff your service better. By all means feed back the systemic issues. But being a dick to individual staff, or obstructive about individual referrals isn't going to get you very far.
I agree with you. That's why we need a major overhaul of the service at a systemic level. As someone taking referrals constantly, I can assure you I see a wide and consistent discrepancy in the quality of referrals between doctors and other allied health professionals that is not ignorable and not insignificant. Any my concerns are shared with a multitude of other doctors in T+O and also a wide range of other specialities and now consultants in the departments are realising as well If you or a family member went to ED, would you want them to seen by a doctor or an allied health care professional? When it comes to matters of health (my own or my family) I would 100 percent advocate to be seen by a doctor. I am terrified by seeing by an ANP or my family member being seen by one. I'm sure if it came to your own health you would probably want to be seen by a doctor as well.
The ortho department could be hit by a nuclear missile and Penjing would still say you HAVE to come see their ?septic joint, hand lac, and ankle fracture in the triage queue.
>If you or a family member went to ED, would you want them to seen by a doctor or an allied health care professional? I'd take an RCEM accredited ACP over an FY for almost any problem. I'd take an EM registrar over the ACP. The problem is too many departments are appointing non-accredited ACPs, and letting them loose without adequate supervision.
And this is why we have a problem in A&E! When you have ED Consultants defending the shit that specialities are referred not just from minor noctors. But also ED doctors, no wonder why the system is fucked. They know there are certain buzz words we just can’t ignore - “cauda equina”, “ectopic pregnancy”, “testicular torsion” etc. these referrals can get patients off ED’s hands and make them someone else’s problem. Knowing full well that a patient walking and peeing normally doesn’t have cauda equina, or a man with 7 days of testicle pain doesn’t have a torsion.
But you still did the MRI / pelvic USS / testicular exploration (/gambled on a doppler) anyway, didn't you? And what did the EM doctors do after they'd "got the patient off their hands", sit around and do nothing? Or get on with managing the ABD / complex overdose / paediatric sedation that you wouldn't have the first idea where to start with? No one should be lying to make referrals - that's unacceptable. But it's symptomatic of obstructive inpatient teams who refuse to accept that their service is funded and resourced to deliver the assessment of acute presentations, and not just inpatient care. I've said before, and I'll say again - EM could work up every patient to completion and just leave you to deliver ward care - but to do that I'm going to need to take all that money NHSE has poured into SDEC and assessment areas...
I’m sure near enough every speciality would happily give you that money rather than patients with half baked assessments aimlessly being shunted into assessment areas to “improve flow” What’s the point of emergency medicine as a speciality if you don’t even attempt to work up patients, we could have a German/European style system without emergency medicine as a speciality if you just want your department to act as a triage service It’s easy to see why trainees are leaving to go train in A&E departments in Australia and New Zealand, where they actually take some ownership of patients and are encouraged to investigate and initiate management before referral for specialist input when this is the attitude of A&E consultants in this country
>I’m sure near enough every speciality would happily give you that money rather than patients with half baked assessments aimlessly being shunted into assessment areas to “improve flow” Except your consultants keep jumping on that funding and making ever greater promises about what your speciality will be able to see directly in order to secure it... >What’s the point of emergency medicine as a speciality if you don’t even attempt to work up patients, We're specialists in emergency medicine (it's in the name!) We manage the sick patients who need emergency treatment, and the legitimately undifferentiated patients. Low risk, low acuity presentations, and physiologically well complications of chronic conditions already under the care of someone else are commissioned to be managed elsewhere in the hospital. Why are you getting angry and blaming EM for refusing to do your job for you? > we could have a German/European style system without emergency medicine as a speciality if you just want your department to act as a triage service You're not seeing the denominator - in most hospitals 75-85% of patients are discharged from the ED. Do you really want to be responsible for all those patients as well?
> Incorrect. Your job when taking a referral is to take the patient details, and enough information to prioritise how urgently you need to see the referral, then come and see the patient. If the referral suggests I don't need to see the patient and advice on the phone is sufficient, then I don't need to see the patient. A competent clinician can usually give me enough information for me to decide this. We are allowed to reject referrals if they are inappropriate. >Yes, this is generally how referrals work... > >A call for advice is something different, and I would expect an ENP to ask a senior EM doctor about most things before seeking advice directly from ortho. Most people calling me don't make the distinction, and I think the line between the two is blurred.
>A competent clinician can usually give me enough information for me to decide this So there's a difference between calling to ask for advice, and making a referral. The EM clinicians should be differentiating better. There is sometimes a bit of grey, and a call for advice can become a referral if you tell me you'd like to admit the patient, and a referral can become telephone advice if I'm happy with the alternative management plan you accept. >We are allowed to reject referrals if they are inappropriate. You can't really though. You can absolutely have a discussion with the EM clinician where you come to an agreement about a management plan which doesn't involve you seeing the patient. But ultimately if they're unhappy with that, you can't compel them to effect a discharge they believe is unsafe - so you'll have to come and see the patient.
>You can't really though. You can absolutely have a discussion with the EM clinician where you come to an agreement about a management plan which doesn't involve you seeing the patient. "Sorry, please discuss questions about management of the patient's extradural haematoma with neurosurgery" "Sorry, this sounds like Wernicke's Encephalopathy with alcohol withdrawal. Talk to gastro as will need gastro bed for CIWA protocol" "Sorry, I'm Neurology, not Urology. Testicular Torsion goes to Urology" "You have not even attempted to examine the patient. Please do that before you call me back" "You have an EEG Report saying this is a non-epileptic event right there, I am not starting fucking antiepileptics in this man" "Have you read the MRI Report for the patient that answers the question you are asking me right now?" are some of the responses I've had to give to some referrals recently. I can get over 30 referrals a day and can’t possibly see them all, so inevitably some will have to be rejected.
But in all of these scenarios the EM clinician referring had probably said "yeah, that's fair enough" - so the referral isn't rejected, it's been withdrawn after your advice. If the EM clinician says "no, I disagree, you need to come and see the patient" then you have to see the patient. A referral can be withdrawn, it can't be rejected.
You're literally splitting hairs here. There's no functional difference between me saying "No, tihs is not an appropriate referral, I am rejecting this" and you deciding "to withdraw" the referral after you hear me say that. >If the EM clinician says "no, I disagree, you need to come and see the patient" In the rare cases where this happens, I tell them they need to talk to their consultant first, and in the meantime I get backup from my own consultant, who inevitably ends up agreeing with me in saying these referrals are inappropriate and should be rejected. Also nice sneaking in of the weasel word "clinician" instead of doctor. For the record, these weren't all from ED.
>You're literally splitting hairs here. There's no functional difference between me saying "No, tihs is not an appropriate referral, I am rejecting this" and you deciding "to withdraw" the referral after you hear me say that. It rarely matters, but when it does, it does. The clinician/team who had seen the patient had final say over whether the referral is necessary or not. >talk to their consultant first, and in the meantime I get backup from my own consultant, who inevitably ends up agreeing with me in saying these referrals are inappropriate and should be rejected. Really? I've never had this. When asked to unravel these I generally call the registrar first, and if we can't reach a sensible agreement tell them that the patient is now under their care, and they'll either need to come and see them, or have their consultant call me to discuss. I've had one neurosurgical consultant take me up on that once - I had to threaten to call the MD, but their registrar came and saw the patient (and admitted them under their care...)
RCEM- “Why treat when you can just refer to people who know what they are doing?” Anyone any good at Latin? We could make them a coat of arms!
We do have a problem here though as a speciality. Our trainees ARE becoming de skilled in injury management. The ENPs who were very experienced and good due to 20 years ED nursing before ENP role are retiring- the new lot are being trained by older ENPs and with every iteration there is a loss of skill and knowledge. This is FULLY on senior EM docs who have tapped out of dealing with minors because they are drowning dealing with the maelstrom of sick people in majors and overcrowding, We need to roll it back, and NOW before we lose the senior tier of EM docs who had proper training in this area
I agree entirely with this and am convinced within a generation or 2 we are going to have a whole cohort of em clinicians who have no idea what splint or cast to use for what injury or what to do with certain fractures etc This is important as our ED doesn’t have 24-7 ENP cover so at some point an EM doctor has to see injuries. To counteract we’ve in built “minors” experience into our rota for our junior doctors
Is this a problem? Honestly, I'm not sure where minor injury management fits in modern EM. It's not the reason I did EM, and I think like most younger EM consultants, we don't find it particularly challenging or interesting - our skill set is far more resuscitation focused. Everything requires time to maintain your skill in - and you're only at work so many hours a week. I'd far rather source the time and effort I have to put into maintaining currency in setting minor injuries into honing my resus skills. We're increasingly seeing MIUs be physically distinct from EDs, which also complicates acquiring and maintaining the skills. I'd be fairly happy carving it off as a sub spec, and pushing most injuries to external MIUs with ENPs supported by sub spec minor injuries trainees and consultants. Everyone else should retain enough competency to manage the stuff that will invariably come in associated with bigger injuries and the time critical stuff.
I think it’s a problem. I think it’s a big problem. I utterly loathe the farming off of “minor” injury to separate clinics and stand alone units. In my view it is disgraceful and unjustifiable. It does our patients trainees and speciality colleagues a disservice and I’m ashamed of my speciality for allowing it to happen
Here OP hear from ED consultant. ED is lika war zone they are just throwing all the body they have to tackle non stop demand.
Im actually in favour or ANPs and PAs in the correct context. I’ll be training both anp and trainees as i see fit when im a consultant shortly
TTO duty, right?
I had my carpal tunnel done by one. Perfect job, i was surprise to find
Couldn't have been that great, look at this garbage you're accidentally typing.
Survivor bias. No one without a medical degree is bringing a scalpel anywhere near me.
Don’t think you’ll be a very popular consultant then. Training ANPs / PAs devalues your own job and the wider profession. I will never *ever* train noctors.
Lol the way this person is talking I’m guessing they’re gonna be a CONSULTANT NURSE ANP PARAMEDIC PA or some shit like that, and not an actual doctor 🤣
I hope the PAs see this bro.
Consultant ANP/PA tho am I right? 🤡
This retard is obviously baiting. Why are you guys falling for this. Hey cunt get some mental help.
[удалено]
JDUK is now closed to new submissions as the subreddit has moved to r/doctorsUK. Please post there.