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Tue Nov 27 15:27:25 GMT 2007

Dr Ahmed,

I have no illusion about healthcare in the U.S, virgins in heaven or
elsewhere not withstanding. The question is about 'availability' of
resources and organisation. The skill set required of surgeons is matched to
what the situation asks for. The NHS has the capacity to organise its trauma
care better, a start should be to divert poly trauma to nearest designated
centre rather than the nearest hospital.

Although, you exhort the skill of the 'general surgeon' in an isolated rural
setting in USA. The patient is already at a disadvantage arriving in a
hospital not equipped to receive such cases, regardless of the skill of the
surgeon. Further, if such rural surgeons only deal with 1-2 poly trauma
cases / year, it is unfair to expect exemplary outcomes. Finally, in
settings where there is no prospect of experienced help, what would you
expect any surgeon to do?

Saboor Khan
Coventry
UK

On 11/27/07, Ahmed, Naveed <NAhmed at cchseast.org> wrote:

> Dr Khan,
> To believe that every injured patient that is brought in the emergency
> rooms around the world, especially poor urban hospitals in US, have
> access to  a vascular, thoracic and a urologist is like counting virgins
> in heaven. A general surgeon should be able to provide damage control in
> all/most scenarios, otherwise he/she has no business taking trauma call.
> Naveed
>
> -----Original Message-----
> From: Saboor Khan [mailto:hpb.surgery at gmail.com]
> Sent: Monday, November 26, 2007 12:49 PM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: Trauma Care in the UK
>
> Dr Hardcastle
>
> Although the structure of general surgical training in the UK is
> changing, until recently prior to being appointed a trainee typically
> spent a minimum of 8-9 years in clinical training (+ 2-3 years of
> research), rotating through all the various specialties and electing to
> sub-specialise in the last two to three years (whilst still taking call
> for general surgery, including trauma), much like a 'fellowship'. The
> bad old days of 'open ended' training are thankfully over! That said,
> the newly appointed consultant is expected (indeed trained) to deal with
> abdominal emergency surgery.
>
> There is no formal requirement for critical / intensive care training
> becuase these units are manned by dedicated 'intensivists', who are
> mostly anaesthetists by training. However, critical care and emergency
> surgery (including trauma) are vital parts of all surgical post-graduate
> examinaitons, including the exit exam. Finally, it is compulsary to have
> attended the 'Care of the critically ill surgical patient'  ( as well as
> the
> ATLS) course and increasingly trainees rotate through critical care.
>
> 'Trauma Surgeons' per se do not exist in the UK, unlike the U.S or other
> countries. Trauma patients arrive in the Accident and Emergency
> department, and in the medium to large hospitals are attended to by a
> trauma team with multi-specialty representation. The organisation of
> trauma care in general can be better organised, as discussed in this
> thread.
>
> The 'exposure' to penentrating truama is very low indeed and perhaps
> that's the reason why you get so many requests for experience. Having
> expert vascular on-call round the clock is a welcome development, which
> I have no doubt improves outcome for the great majority of vascular
> patients.
>
> You make some 'interesting, comments in your e-mail, and paint a
> picture of surgical training in the UK that I do not recognise, i.e., a
> newly appointed consultant, unable to assess, manage or operate on
> surgical patients outside of their narrow field !
>
> There is increased emphasis on sub-specialistation, but that's a world
> wide phenomenon in some guise or another- resources permitting? I am a
> bit puzzled, what is your definition of a 'general surgeon'?
>
> Best Wishes,
> Saboor Khan
> Coventry
> UK
>
>
>
>
> On Nov 26, 2007 4:47 AM, Hardcastle, Tim, Dr <tch at sun.ac.za>
> <tch at sun.ac.za>
> wrote:
>
> > Mike
> >
> > The other challenge that now exists in the UK is that there are less
> > and less true "General Surgeons"; the majority of the "Trauma
> > Surgeons" are mainly orthopaedic trained, while the GIT surgeons
> > subspecialise even before they finish what we would know as residency.
>
> > They qualify not as "General Surgeons", but as one of Breast-Endocrine
>
> > / Upper GI / Colorectal or Hepato-biliary surgeons. Vascular is also
> > seperate now. This leads to young consultant surgeons who have little
> > idea of the overall patient and the care of trauma in particular. Add
> > to this the lack of a formal ICU requirement in the post-grad training
> and you see where some of the deficiencies lie.
> >
> > For this reason we in South Africa are inundated with requests for
> > people to do three month mini-trauma-fellowships to get some
> > experience in General Trauma care.
> >
> > Regards
> > Dr T C Hardcastle
> > M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA) Senior Surgeon / Senior
> > Lecturer: Surgery (Trauma and ICU) ATLS  instructor and DSTC Cape Town
>
> > Course Director Intern program Coordinator: Surgery M.Med (Emergency
> > Medicine) Executive Committee member Clinical Head (Director): Diana
> > Princess of Wales Trauma Unit Division of Surgery (General) Room 4064
> > Department of Surgical Sciences Tygerberg Hospital / University of
> > Stellenbosch PO Box 19063 Tygerberg 7505 Western Cape South Africa
> > e-mail: tch at sun.ac.za
> > Cell: +27824681615
> > Office: +27219389281 or 4911 pager 0302
> >
>
>
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