Alexander Bennett wrote: > On 16/04/2006, at 12:01 PM, Ian Haywood wrote: >> 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 > > _______________________________________________ > Gpcg_talk mailing list > [email protected] > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > > __________ NOD32 1.1490 (20060415) Information __________ > > This message was checked by NOD32 antivirus system. > http://www.eset.com
Very good summary Alex and I could not agree more. Figures would be at least 40% of presentations and I speak from experience having working in EDs in two states and a territory. The rest of yor assessment is also spot-on T Dr FM Janse van Rensburg BSc MBChB FRACGP FACRRM General Practitioner Personal: http://spaces.msn.com/members/thinus _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
