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Re: 'See and treat' is great - if your'e a General Practitioner

Dear Editor

In today’s society people want everything instantly, including their medical care. See and treat provides that instant access to ‘primary care’ with no need to wait. Do Castille and Cooke[1] really think that anyone will wait 3 days to see their General Practitioner (GP) when they can pop in to the emergency department and see a doctor instantly 24 hours a day?

The public perception of see and treat will be that it is acceptable to come to the emergency department instead of going to your GP. This at a time when we are trying to persuade the public that only emergencies should come to emergency departments.

As a specialty we have been struggling for more than ten years to be recognised as emergency doctors whose specialist interest lies first and foremost in the management of the emergency be it adult, child, medical, surgical etc. The minor injuries that are emergencies constitute an interesting and often valuable sub-specialty but are not our raison d’etre. Trailing behind minors are the primary care cases and the triage category fives for whom we are now trying to resource a priority ‘see and treat’ service. This has got to be the diametric opposite of emergency medicine and as such should not be a part of any major plan on reforming emergency care. The concept of see and treat is reasonable but if it is to work, we must totally isolate it from the emergency department and make it a primary care service, run by primary care doctors.

If we continue our blinkered charge ahead with this initiative then emergency departments running see and treat effectively will simply become rapid access primary care centres. I’m sure the government will be very pleased and that local GP’s wont mind but it will be a mortal blow for emergency medicine.

It is interesting that there seems to be a rumour going round that only those who have not tried 'see and treat' are complaining about the negative effect it has on job satisfaction. For the record, I am currently doing 'see and treat' and my job satisfaction during these periods is negligible.

References

(1) Castille K, Cooke M. One size does not fit all. View 2. Emer Med J 2003; 20: 120-122

Send letter to journal:
Re: See and treat

Dear Editor

Thank goodness, monitoring week is over. We've reached our 90% and retained our stars. Nobody is going to loose their job and the department has pulled through intact. All the extra experienced locum staff can go home, and we can get back to normal.

It felt bizzare not to have a waiting room full of frustrated patients. To have patients thanking us for seeing them so quickly. A happy feeling that everything was under control and the department was able to work swiftly, effectively and efficiently.

The concept of triage has become a necessity of our time. Many emergency departments (EDs) are overwhelmed by the number of patients to be seen, so a system of prioritisation has to be used to ensure patient safety.

With the provision of adequate numbers of experienced medical staff a see and treat policy can be operated safely and effectively. I disagree with the concept that the junior staff should be left to deal with the minor injuries,whilst the senior staff are directed to the more serious cases. Inorder to run an effective safe department there must be a move away from the majority of the workload being taken on by Senior House Officiers (SHOs). This is an outdated and unsafe way to run an ED. The majority of complaints arise from patients in the minor injury category, who in general would be better treated by a trained experienced health professional.

The role of the SHO is in part service to the department, but receiving adequate training and supervision are important aspects of their time in the ED. This requires high middle/senior grade staffing levels.

I believe that aspiring to a maximum 4hr waiting time is a positive move. A see and treat policy is possible and safe with an appropriate mix and level of experienced and trained medical staff. It leads to high levels of patient satisfaction and a pleasant working environment.