13 Feb, 09 | by BMJ
My practice recently revamped its provision of short-notice medical appointments by transforming the Emergency Surgery into the (so far so good) Rapid Access Surgery. In essence, patients can now no longer pitch up to the practice between 11 am and 12 noon and definitely see a doctor regardless of their complaint, or lack thereof. This apparent erosion of choice has in fact seen the replacement of the dichotomous old system, which offered only routine and emergency appointments, for a myriad of appointment options: 24-hour access, 48-hour access, minor ailments being addressed by the nursing team and routine appointments. There are now more ways to see the doctor than means by which senior bankers can avoid saying sorry.
The key individual in the smooth functioning of this new look system is the triage doctor: a senior medic who literally sifts through the cohorts of coryzal patients either physically or via the telephone and prioritises their requirements. The ‘best’ triage doctor thus far (i.e. the least porous gateway to services) has been the snow. The largely unwelcome snowfall across London played an unexpectedly welcome role in patient education by showing many people that most symptoms will improve in a couple of days – the healing role of the passage of time.
A couple of Saturdays ago, whilst wandering through the Wellcome Collection‘s newest exhibition entitled ‘War + Medicine’ I learnt that the current process of triage is much indebted to the work of Nikolai Ivanovich Pirogov, a Russian field-surgeon during the Crimean campaign. The exhibition vividly captures the strange symbiosis between medicine and warfare during the modern age. The more ways that humanity conjures up to destroy and maim one another, the more advances are made in preventing the seemingly inevitable.
It was certainly sobering to note that 4/5ths of the combatants who died during the Crimean War did so by succumbing to disease rather than as a direct result of battle. Highlights for me included discovering the role of Dr Seuss in dispelling Japanese propaganda amongst American troops during the second world war; the marvellous oil on canvas by Charles Burleigh depicting recuperating Indian soldiers from World War I who were housed in the opulent Royal Pavilion in Brighton as ‘the oriental style of the venue was considered to be an appropriate setting’ and the thankfully now unavailable ‘Malingerer’s Guide to How to Appear Ill’ issued to British troops stationed in Italy in 1944.
The exhibition runs until this Sunday. I have my General Practice Vocational Training Scheme to blame for introducing me to the wonderful Wellcome Collection. You can blame me. Or a banker. Which reminds me, I may well have to turn down my bonus this year.
Tauseef Mehrali is a GP registrar