All that “GP stuff” in the Emergency Department

“We are just FULL of GP stuff today. We’re pretty much just running a GP clinic” you say, with a big sigh and roll of the eyes.

You’re an emergency nurse or maybe a doctor. You’re frustrated because you are working your butt off, haven’t had a lunch break or time for a wee and still people are waiting for hours and hours to be seen. The ambulances keep arriving and you’re irritated by the patients who are adding to your workload that don’t need to be here at all.

I know the stuff you’re talking about. It’s all those simple problems, the non-urgent problems, the tedious and uninteresting problems. You’re talking about the triage category 4s and 5s that don’t have a life threatening illness and can wait while you and I attend to all the exciting, high acuity, real emergency stuff. You’re talking about the sniffles and rashes, the UTIs and ankle sprains and fitness-to-work certificates. Sometimes, they get punished with a “therapeutic wait” to teach them a lesson that they really shouldn’t be here.

I know, I know. When it’s really busy, I get frustrated too.

Could most of those patients be adequately dealt with by their local GP? Absolutely! Should they? Almost certainly! We know that general practice is a far cheaper and far more efficient way of delivering the care that those patients need. We also know that patients have better outcomes when they have the care of a regular GP that knows them.

But – I really hate it when you call it “GP stuff”.

I hate it because you are equating the speciality of General Practice with simple, non-urgent, straightforward. As opposed to the sexy and interesting work of real emergency medicine, of course.

Now, potentially, a junior doctor overhears your comments. She is trying to decide what she’ll be when she grows up and begins to believe that GP is simple and uninteresting. She thinks that perhaps she should pursue a more worthy speciality.

The reality is, that while GPs do see plenty of simple and straightforward problems, they represent the rare moments of breathing space in a day filled with incredibly complex consultations.

Because while you think “GP stuff” is coughs and colds, what it really is is picking the one case of meningitis out of the thousands of febrile kids. It’s walking the tightrope of conflicting medication effects in patients with chronically failing organs. It’s taking the journey with yet another too-young person diagnosed with cancer. It’s desperately trying to find a mental health service with the capacity to help a patient with escalating suicidality. It’s the STEMI and status asthmaticus and cyanotic baby which turn up on the doorstep and need help, urgently.

It’s the stuff that baffles you in the ED, when you shrug your shoulders and say “I don’t know what’s going on, but you’re not dying today, go see your GP if you don’t get better”.

It’s 15 minutes to sort it all out, without bloods, without scans, without a casual second opinion from your friend on the flight deck, without the opportunity to spend 10 minutes googling it if you have absolutely no idea. It’s fricking hard.

It’s also cute kids and cheeky old ladies and cancer remissions and dramatic breakthroughs and good saves and hilarious stories and joy and laughter and light. It’s finding out what happens next. It’s stopping the sickness before it starts. It’s wonderful.

But simple? Occasionally. Straightforward? Rarely. Uninteresting? Rarer still.

So please don’t give that impressionable junior doctor the wrong idea of what GP is all about. And don’t let that attitude be perpetuated in your department – the tribalism doesn’t help anyone.

And there’s definitely no place for the kind of disparaging comments that get directed towards patients for choosing to come to the ED. Unfortunately, not everyone can access or afford the timely and appropriate care that they need in the general practice setting. What’s more, we can’t expect patients with no medical training to know whether or not they should come to the ED. If they’re worried, they should come.

If they truly come with a quick and simple problem, be thankful for the mental break in your own busy day, but remember that what you do in the emergency department is not general practice. Your priorities are different, your skills are different, your approach is different.

At the end of the day, there are no “ED patients” and “GP patients” there are just patients who need care, wherever they happen to be. Let’s all remember that our words have power, and to use them respectfully when talking about the work of our valued colleagues across the medical spectrum.

 

 

Further reading:

Nagree Y, Camarda VJ, Fatovich DM, et al. Quantifying the proportion of general practice and low-acuity patients in the emergency department. Med J Aust 2013; 198 (11): 612-615.

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9 thoughts on “All that “GP stuff” in the Emergency Department

  1. Great piece Pen

    I really dislike the “therapeutic wait”. At best it is laziness, at times it shows a total lack of empathy and a hint of malevolence. Not cool.
    As a senior Doc, running an ED we know that the “GP stuff” is inevitable, constantly present and a large slice of the Job.
    We need to teach our juniors how to do it excellently. This is where we can teach consulting skills – the most important skill of all!
    I also think that getting people seen, sorted and home is vital for my brain to function. If there are 20 in the waiting room when the septic, psychotic trauma patient arrives it is really hard.
    If you love Resus- an empty WR gives one time to focus on the stuff we Tweet about & love. Personally I find the WR-pressure to be stressful when we have sick pts in the ED.

  2. I somehow understand and share the feeling of things on GP practice. Although, there’s not always the case, when it comes to see patients who prefer to attend ED instead of a GP and disenchanted by not being able to get treated appropriately.
    Don’t get me wrong, I respect GP practice and I believe that you do a great job dealing with multiple conditions, but in many ocassions the referrals that we receive in ED could be managed in the GP setting without overcrowding ED departments.
    In my view people should be educated to not attend ED for non life threatening conditions, instead visiting their own GP.
    On the majority of the cases people attend ED because they feel much safer and in better care of attention, with more tests and resources available to investigate in the acute setting.
    Unfortunately, for those ones working in ED increases stress and work overload specially on the weekends where most of the GP practices are closed. Hence, everyone criticises General Practice and makes it look unappealing.
    On the other hand, I strongly believe that the Health system needs to be changed in order to give more centre care for patients and highlight the differences between GP and Emergency care.

    • Yep – you make some valid points. I guess I’m pointing out that we need to criticise the systems rather than the people within it who are just trying their best.
      Thanks for the comment.

  3. These comments are very true. We are patients and should be treated both with courtesy and dignity and not feel as some of staff are doing us a favour. Every Job or vocation has stressful times but if you really want to do the job you do do it with empathy and efficiency
    and not waste energy being resentful that people are taking up your time at work. Take a break you are entitled to.

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