I've just completed a decade of practice in rural family/emergency
medicine, and I'm heading back to a full-time urban ED practice much wiser
and more humble than when I left there. I've been involved with teaching
EM topics in the Society of Rural Physicians of Canada for several years.
Your post makes some sweeping generalizations about sending physicians
from individual cases you have received -- always a slippery tack to take
talking about colleagues who manage lower volumes than a specialist, but
have no choice in the matter.
Yes, it is necessary to find ways to help low-peds-volume docs better
manage sick kids. But it is very important to appreciate that individual
examples of apparent poor management usually have a much more complex story
behind them than receiving nurses and physicians realize. I can think of
dozens of reasons for some of the stories you mention (lack of ambulance
transfer funding, over-tired physicians doing excessive on-call, lack of
experienced or appropriately trained nursing staff, penny-pinched budgets
making it hard to purchase Broselow tapes, angry parents who refuse
intervention -- all kinds of barriers to perfection). One thing you can be
dead sure of: the vast majority of sending nurses and physicians faced with
sick kids are caring, concerned and would love to be able to meet tertiary
care standards of perfection every time.
We need outcome studies (how many kids really need ambulance transfer?),
better peds emerg CME, better funding for nurses and physicians, better
access to EMS, better feedback from receiving hospitals for our transferred
kids, and much more understanding between rural and tertiary care
providers. How about rotating specialty residents through rural hospitals
with rural preceptors?
Ooops, I've gone and ranted again. Darn, I hate it when I do that.
[log in to unmask]
National Chair, Rural & Small Urban Committee
Canadian Association of Emergency Physicians
On Saturday, June 27, 1998 5:36 PM, MARTIN I HERMAN
[SMTP:[log in to unmask]] wrote:
> I am boarded in PEM and have been in practice of emergency medicine since
> 1986.. I have worked in mixed ED's and most recently in a children's
> hospital emergency department.
> >From my vantage point , I have been amazed at the number of times a
> pediatric patient is sent to me after having been handled in a less than
> ideal manner.
> PS, I was irritated by Bukata and Hoffmans remarks on the last issue of
> They have not seen the pitiful care kids are getting by their ER
> We can all do better and should strive for that..
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