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The BMA says what is happening in these departments reflect system-wide pressures with doctors struggling with unprecedented demand and inadequate resources. The association says this requires a NHS-wide solution. What do you think? Retired Belfast GP Lewis Miller gives his thoughts:
The organisation and delivery of emergency medical care is the major problem facing the NHS. Chief executive of the King’s Fund Chris Ham has likened current emergency medicine departments to operating under battlefield conditions.
My limited military medical training emphasised the importance of triage which, of course, originated on the battlefield. Who better to do this work than GPs who spend much of their time deciding who is really ill and who is not. Triage is difficult and should be done by experienced staff. Some of my most difficult clinical decisions involved the management of hot, cross kids.
Experience is vital. Last year, a critical incident was called at our major emergency medicine department when junior medical staff were overwhelmed. Seniors were called in around 9pm and by midnight the crisis was over.
Patients cannot be admitted if others are not discharged. Joined-up thinking between medical and social organisations and between primary and secondary care will facilitate this process, although this must be in actuality rather than in theory. We have had combined medical and social care administration in Northern Ireland for decades yet our emergency waits are the longest in the country this winter.
Working in emergency medicine is hard, stressful and of low professional esteem. One way to attract the best individuals to this work is to significantly increase their pay.
Crisis implies both danger and opportunity. We can solve this problem by working together and ignoring tradition and political territory.
Do you agree with Dr Miller’s solutions? What do you think is the answer to the crisis in emergency medicine?