Subacute Care Surgery (was trauma activation and stratification)

[Ronald Gross]

" But the fact stands that emergency medicine developed
(initially) to fill a vacuum left by surgery"

Karim,

Let me first congratulate you on your ability to dance with the best of
them.  

With respect to your statement, quoted above, I will have to take as
much umbrage with that statement as the rest of your "rant".  Emergency
Medicine is not, in fact, the bastard stepchild of the irresponsible,
lazy or otherwise poorly motivated surgeon who chose to relinquish
"control" over the acutely injured patient with a perfectly normal left
adrenal to someone who has nothing better to do with his/her time,
regardless of which side of the Pond you are talking.  Emergency
Medicine just happened to grow to fill the vacuum in the Emergency
Room/Department left by the family practitioner who wasn't adequately
trained in the more advanced acute management of acute medical and/or
surgical emergencies.  In addition, with the increasing need for medical
care in an increasingly larger segment of the population that is
under-insured or uninsured, the ED has become the newest version of
those folks' primary care physician's office, and cares for everything
from the common cold to DKA, and a cut on the leg to a traumatic
amputation.  

In fact, the system will dictate who is going to respond to the trauma
patient, and at what level that response will be.  If you want to be a
left adrenal laparoscopist, then you will practice in an institution
that will support that sort of practice, and that level of care.  If, on
the other hand, you have chosen to care for the acutely injured as your
full time calling, then you will go to an institution that is set up for
that sort of care, and demands the commitment needed from all concerned.
 YOur entire premise merely goes to support the regionalization of
resources and care, and levels of care should be designated according to
the resources that each hospital/medical center decides to allocate. 
The fact that physicians have now decided that they can holding
hospitals hostage and demand obscene amounts of money to take call from
home, and oft-times still not come in when requested is, as I see it,
disgusting and entirely OUR fault.  That sort of behavior by our
surgical sub-specialists (and I am sorry to say, some of our general
surgical 'colleagues') is, simply put, immoral and unethical, not to
mention just downright disgusting.  It is our fault that we have let it
happen in the first place, and allow it to continue to happen.

OK, I'll shut up now.  My meds should kick in any minute now........   
;-)

Take care,

Ron


>>> "Karim Brohi" <karim at trauma.org> 10/4/2006 4:19 PM >>>
OK, it's possible I overstated the case for the sake of a little
argument
(the list has been rather quiet recently!) but there are trends here
which I
believe are important.  First, clearly if you are a member of this
list,
attend trauma conferences, or are an attending at a level 1 trauma
centre,
chances are that you are committed to trauma/emergency care and you are
not
the subject of my ranting.  However if you consider the whole body of
surgeons I think the picture looks less rosy - whether you are in the
UK,
South Africa, Australia or the US.  If you do not work in a Level 1/2
trauma
centre, if you are a resident planning on going straight in to private
practice, if you are a laparoscopic left adrenal surgeon, I don't
believe
the same zeal for trauma or emegency surgery is present.  If I am
totally
off base, then I happily stand corrected, and certainly I was
exaggerating
to make the point.  But the fact stands that emergency medicine
developed
(initially) to fill a vacuum left by surgery, and some specialties
(witness
cardiothoracics) are retreating to the operating room.  We need to make
sure
trauma or acute care surgery doesn't go the same way.

Karim 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of KMATTOX at aol.com 
Sent: 03 October 2006 23:49
To: trauma-list at trauma.org 
Subject: Re: Subacute Care Surgery (was trauma activation and
stratification)

In a message dated 10/3/2006 4:08:52 P.M. Central Standard Time,
karim at trauma.org writes:

1.  Because over the last 30 years surgeons have abdicated from the
care of
the  emergency surgical patient.  &
 
This has not been the experience of the vast majority of the hospitals
around the world
 
k



2. Because it's cheaper to have one resuscitation area in a  hospital.


What are you talking about?   A resuscitation area is a  resuscitation
area.

and the person who needs resuscitating after major trauma  really needs
a 
surgeon, at least in the eyes and experience of virtually every 
evaluation
which 
has occurred during the past 30 years.   
 
k
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