On 16/04/2006, at 12:01 PM, Ian Haywood wrote:
Oliver Frank wrote:
are probably intended by their funders to provide mainly secondary
care,
do also provide primary care by allowing anybody to walk in to their
emergency departments and be seen for problems that could have been
treated often better and usually much more cheaply in primary care
settings such as general practice.
No,
The funders (especially the Feds) insist, by legislation, that any
H. sapiens who
presents at an ED must be seen by a doctor, no matter how trivial
Triage nurses can triage, but
cannot send a patient away, ever. The hospitals would love to
change this rule.
Generally the numbers of ED presentations who really could be
managed in [urban] GP is barely 10%
Having worked substantially in both Emergency and General Practice in
recent years, I would say that the figure of 10% of patients
presenting to Emergency Departments being able to be managed in
General Practice is very low and incorrect. It may reflect a view of
Emergency Medical staff that general practitioners are incapable of
more than taking a blood pressure and writing repeat prescriptions
for medication prescribed by specialists but that is in fact not the
case. General practitioners would generally be able to manage all the
category 4 and 5 patients more efficiently and more cheaply if only
they were properly resourced to do it. I would say the figure is more
like 30-50% of patients presenting to emergency departments could be
managed more effectively in general practice but recognition of this
would have some negative impact on the funding applications by
emergency departments; this would be an unfortunate circumstance as
emergency departments are also under-resourced for the job they are
being asked to do.
In rural practice of course, it is often the same doctor seeing the
patient in the local emergency department and in a reasonably
equipped surgery where the delivery of care to category 4 and 5
patients would be essentially identical.
Usually these people never get into a cubicle and are seen quickly
by the intern/junior resident,
My experience of working and teaching in emergency departments is
that one of the striking differences between junior and senior
doctors is the speed with which they assess and manage patients. I
have seen junior doctors tied up for hours with category 4 and 5
patients.
so cheaper is very debatable (viz. the hourly rate of an intern in
Vic is $21, less than a cat B consult)
plus the triage nurse, the nurse aid, the clerk etc - overheads in
the emergency department which quickly inflate the cost compared to
barebones general practice.
they are not a big issue in EDs, in particular are not a source of
overcrowding.
Patients presenting to a nearby emergency department with urgent
problems such as earache in a child who have to wait 5-8 hours to be
seen would not necessarily agree that such patients are not a source
of overcrowding.
Most present after-hours when (in fairness to the patient) GPs are
not available,
because there is no funding for GP after-hours clinics.
However, the primary care so provided is dis-continuous and
generally crap: that's the big issue IMHO.
Occasionally the care is excellent with good referral back to general
practice but that is the exception unfortunately.
Alex
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