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Emergency medicine or accident and emergency?
  1. Ian K Dukes
  1. Emergency Department, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK (Ian.Dukes{at}dudleygoh-tr.wmids.nhs.uk)

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    Editor,—What is emergency medicine? Is it the speciality that provides “The care of emergency patients . . . by specially trained doctors who deliver a wide range of services for all patients presenting to a separate emergency department” including “The initial assessment and early treatment in resuscitation, trauma, medical and paediatric emergency” and “ acute parts of “medicine” in its widest context including medicine, surgery, anaesthesia, paediatrics (and) psychiatry”?1 Or is it a subspeciality of general medicine responsible for the assessment and admission of acute adult medical conditions?

    The Royal College of Physicians2 has named the latter “acute medicine”, yet confusion about the distinction remains.

    I have reviewed 10 successive editions of BMJ Classified (14 October 2000 to 16 December 2000) in order to identify all job advertisements for “emergency physicians” or doctors to work in “emergency medicine”. Further study of the advertisements allowed me to establish which of these posts were to work in (accident and) emergency departments and which to work in medical assessment/admission units and/or general medicine (table 1).

    The results of this study show that the majority of positions in “emergency medicine” (11 versus 6) are in fact to work in acute general medicine.

    I believe that it is now time for our speciality to adopt the name emergency medicine, to bring us in line with our colleagues in the USA, Canada, Australia, New Zealand and the Far East. If we do not, we are in danger of losing the title altogether to a subspeciality of general medicine. If this were to happen, we would be stuck with “A&E” which, along with its predecessor “casualty”, belong firmly in the last millennium.

    Table 1

    Number of advertisements for “emergency physician” or “emergency medicine” by grade and speciality

    References

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