Editor's Choice: ED and GP patients

Causes of Emergency department crowding are complex, but the proportion of ‘inappropriate GP patients’ has often dominated the debate. Recent Australian research suggested that ∼10% of patients could be classified as appropriate for general practice, whilst demonstrating that the preferred government methodology doubled these figures.

In this issue, Harris and McDonald investigate the case-mix of patients attending ED, GPs, a walk-in clinic (WIC) and an out-of-hours (OOH) telephone service. There was a similar case-mix of presentations to the WIC, OOH and GP, with the only difference being respiratory illness presented more frequently to GPs. Injuries were 12 times as likely to be seen in ED, whereas non-traumatic musculoskeletal conditions were twice as likely to be seen in GP practice. Patients were also 4 times more likely to present to ED with chest pain suggestive of myocardial ischaemia as compared with non-ED sites.

These findings, although based on a small sample of a highly diverse population, demonstrate that patients are making relatively sophisticated choices. This paper highlights that, rather than concentrating on the blunt tools of “reducing ‘inappropriate’ attendances”, governments need to take note of Gerry Fitzgerald's comment that there are “…not general practice patients or ED patients; there are just patients, who need medical care”, …