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The art of medicine
Is there a nephrologist in the house?

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I was fortunate, earlier this month, to be invited to Oldenburg in Germany to accompany (in the capacity of team photographer) a group of British Red Cross volunteers to a pan-European first aid challenge.

As I watched the team deal with a host of horrific simulated injuries, I was reminded of a scene that I, long before I joined the ambulance service, had dealt with on the street.

A drunk had stumbled, striking his head against the kerb and was lying unconscious, his airway occluded.  As I tilted his head back, my ungloved fingers slipped in his blood soaked hair and vanished into the open fracture in the rear of his skull. 

Cursing my situation, I was thrilled when a young, enthusiastic woman bounced up to me and introduced herself as coming from the surgery opposite.

"I'm a doctor - is there anything I can do?"

I looked up at her with pleading eyes.

"Do you have any spare gloves?"

"No...sorry...what's the problem?"

"He's got a hole in his head."

She stood over me for a moment, glancing left and right at the surrounding crowd, her smile diminishing.  From the corner of my eye I spotted her slide her hands into her pockets and gently back away.

I never saw her again.

And here's the problem.

Is there a doctor in the house? On the plane?  Driving past?

There might be, but let's bear in mind that they may not be the best person to deal with the emergency incident playing out in front of them.

Chances are there's an EMT, or a devoted first aider in the crowd too.  There's someone who's accustomed to dealing with the patient in whatever situation they find themselves in, to working with the equipment that's to hand. 

A person who isn't thinking in the long term, who isn't considering definitive care, but is concentrating on stabilising and comforting the unfortunate soul until an ambulance arrives.

I don't mean to doctor-bash.  I'm just asking that we recognise our areas of expertise. 

Me?  I'm a paramedic.  Prehospital medicine is my game. 

Put me in a GP's office and ask me to assess chronic conditions?  I'm lost.

I'm a terrible oncologist...really...it's embarassing.

And that's how you'd expect it.

Surely we're all modest enough to recognise that we have our own areas of strength and weakness and play to them?

So why, then, do we still howl for "a doctor" as though that title covers every eventuality?

Why don't we cry for "anyone who can help?"

Because they may not be the same person.
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Nickopotamus wrote:
Worse is the doctor that thinks they're the person who can help, when they're not. The doctor who barges in and takes over, and often doesn't realise that they're way out of their depth until it's too late (or if they do realise, try their best not to show it). As healthcare workers, we all must realise when our skills can help, but equally as importantly recognise our limits and when it's best to defer to someone else, and who that someone else is.
28/7/2009 10:55 AM BST on bmj.com
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WerGis wrote:
Doctors save patients, EMTs/paramedics save doctors
28/7/2009 2:37 PM BST on bmj.com
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Odysseus wrote:
I agree to an extent. I have saved several lives by the roadside and in the last few months a country GP in Oz saved a boy's life with a brace and bit from his tool shed. Lateral thinking is what we're good at...or is it temporoparietal?
30/7/2009 12:38 PM BST on bmj.com
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Kal wrote:
Hah! Roger, I am *stealing* that.

"This job just needs a little temperoparietal work..."
31/7/2009 10:30 AM BST on bmj.com
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