So we need double the number of A&E consultants? I don’t think so.
The reason A&E is knee-deep in whinging patients is because most of them don’t have anything wrong with them. They’re only there because they rang NHS Dire, and some nurse or spotty work-experience yoof reading from the wrong list decided that the caller’s unfocused sense of unease and general dissatisfaction with the twenty-first century might actually be an indication of acute meningococcal septicaemia.
What we need in A&E are more scary, middle-aged proper nurses to tell them to f-off and stop bothering doctor. And then, once you’ve kicked out the inadequates and malingerers and sent them back to the GP (or to be more exact, the practice nurse, now it’s impossible to actually get an appointment with the GP), you can employ more proper doctors in A&E. And what I mean by ‘proper doctors’ is radiologists.
Clinicians spend their lives moaning about poor access to imaging facilities, and this will matter even more now that medical students spend all their time in empathy workshops instead of learning anatomy, and qualify with the clinical skills of a golden retriever. None of them will have a clue what’s wrong with their patient until we have worked our radiological magic, so here’s what we need to do.
Having wittered on for most of my career about how radiology needs to be at the centre of the hospital, I have changed my mind. It needs to be at the front door, staffed by radiologists who are now the only generalists in an age of super-specialisation, and equipped with the finest that Siemens, GE et al have to offer. Clincians would only be allowed to see a patient once we have decided that he might actually benefit from the skills of a specialist in non-infective interstitial diseases of the left lung.
This would save enormous amounts of money. No need to equip sections of damp corridor with rusty trolleys and put up signs saying ‘Clinical Decisions Unit’ in order to circumvent the four-hour A&E target. The clinical decisions will all be made by people sufficiently good-looking, clinically gifted and technologically equipped to undertake that role. No more patients hanging around in beds waiting for scans or results of scans, and no more hapless SHOs (or whatever they’re called now) sent into the dragon’s den to ask radiologists to perform unnecessary investigations requested by their bosses for reasons which escape everyone.
There - job done. We’ve saved all the money we need to pay the bankers’ bonuses and clear the national deficit, and saved countless lives in the process.
Oh, wait a minute. Have just realised that this will only work if we use ‘proper’ radiologists (yes, of course like me). I had forgotten that the ABCFY1s or whatever will be coming directly into radiology after 20 minutes experience on a dermatology ward in the West Midlands, and won’t actually be any more clinically savvy than any of the other clincians.
Bugger.
Come on Bob, come off the fence. Tell us what you really think
I’m not sure you’re ready for it, Jerry.
Hmm, Bob are you suggesting everyone gets a CT head/neck/chest/abdo/pelvis on arrival in A&E Majors? or would it be on the ambulance entrance (ignoring the rising cancer rates in the ambulance crews)?
Surely someone actually has to talk to the patient to work out which bit needs what imaging?
Certainly radiology is key to diagnosis and management but there is more to life than strange and angry people inhabiting dark rooms and biting the heads off FY-whatsits
It would probably work as most radiologists are very good at saying NO!
It would probably save the NHS millions.
Surely someone actually has to talk to the patient to work out which bit needs what imaging?
You’d think so wouldn’t you DocMonkey? Unfortunately, many of the requests we get under our present system would suggest that this vital step is often omitted, and the forms completed instead by a Random Request Generator.
But you’re in danger of taking me too seriously. Although I deliberately overstate the case for (hopefully comic) effect, it does make sense to concentrate radiology facilities physically and logistically at the front end of the hospital. If patients were jointly assessed by the A&E doc and the A&E radiologist and imaged appropriately, most of them could be turned around and sent home, or admitted to the appropriate clinical team, rather than being admitted to random holding beds, and then occupying those expensive beds for days on end while diagnoses are sorted out.
Bob Bury - I am one of DNUK’s regulars so don’t worry, I’m not taking you too seriously
I think more radiology knowledge among juniors would help and think that I have become a better doctor by talking to the radiologists I work with and learning from what they tell me about what different imaging can tell about what problems