The season is back into full swing for disgruntled curmudgeons noising off in the newspaper letters column. 2018 is barely two weeks old and already I’ve appeared three times. I might even be The Herald’s prolific correspondent of the year to date. I’m not sure that’s a good thing. Do I want to join an elite group? There he goes again, banging on… Usually I write about medicine. Heaven knows there’s plenty to talk about just now. I read something that causes me to splutter into my cornflakes and call for pen and ink. By “pen and ink” I’m being figurative. Actually I go on-line and fire off an email and there’s the rub. It’s very easy to say something intemperate in the heat of the moment. It’s happening all the time on social media. Everything from mild bad manners to vicious bile. So I’ve made a resolution never to fire off a letter unless I think I have something constructive to say. It’s no good saying somebody’s latest idea is a bad idea, unless you can come up with a better one.
I check the paper the day after publication in search of rejoinders. There may be nothing, or there may be a letter of support. I keep thinking somebody will write something along the lines of, “Dr Campbell really needs to wake up and smell the coffee. Does he live in cloud-cuckoo land or what?” Hasn’t happened yet. Sometimes I think I write deliberately to provoke such a response – but surely not; I’m as thin-skinned as the next man. I happened to look at The Herald on-line after my second letter of the year – the only time I’ve ever looked – and somebody did remark that Dr Campbell was talking a load of old cobblers. I can hardly say it was an offensive remark but it did highlight for me an important difference between remarks in print, and remarks on twitter and the like. Printed remarks are liable to contain an assertion backed up by some semblance of argument, otherwise they are unlikely to be published. Remarks on social media are unedited and are likely to be short assertions with no back-up. Accordingly I have made up my mind never to look at such sites. I would say to anybody who is being upset by personal remarks on any site: shut the site down and never, ever revisit it.
So I carry on banging on. I make no apology for repeating myself. Newspapers have a short half-life. I think it was Bernard Levin who said that his carefully crafted columns were wrapping up the fish and chips by dusk. If you want to make an impression, you really do need to stick with it for the long haul. If you think your words of wisdom are going to change the world overnight you are likely to be sorely disappointed. I’ve been trying to influence the debate about emergency medicine for years but as far as I can see I am making little headway.
I find the level of public debate about emergency medicine to be extremely cringe-worthy. The BBC keep using archaic expressions like “Casualty”, “Accident”, and “A & E” that the rest of the English-speaking world stopped using a generation ago. In the mid-80s the newly formed Australasian College for Emergency Medicine decided to dump all these terms because they were associated with the baggage of slummy, underfunded, under-resourced, underperforming hospital departments. At that time, “Casualty” was the name of the BBC’s flagship medical soap, and it still is. But look up the word “casual” in Chambers.
Casual kaz(h)’u-al, adj accidental: unforeseen: occasional: off-hand: negligent: unceremonious… casualty department, ward a hospital department, ward, in which accidents are treated; casual ward formerly, a workhouse department for labourers, paupers, etc.
You can see why people think of having to spend time in such an environment as even more of a calamity than the pathophysiological insult that has put them there in the first place. What a disaster to become a “casualty”! No wonder everybody wants to get the “casualties” out of this s***hole (to use a word much in vogue, allegedly) as fast as possible. 95% within four hours, or God help them.
The Australians and the New Zealanders realised the nomenclature had to change. You will never hear an Australasian, or an American emergency physician refer to a patient as a “casualty”. It is the most dehumanising word in the emergency medicine lexicon.
“Accident” had to go too. There is no such thing as an accident. A road crash is like a heart attack or a stroke in that it has an aetiology, pathogenesis, morphology, and clinical outcome. It is only when you believe that, and stop thinking that things just happen out of the blue, that you can make a difference.
I well remember the day in Auckland we took the “A & E” sign down and replaced it with “Emergency Department”. All of us who worked in the department would answer the phone not with “A & E” but with “ED”. The other hospital departments were initially rather scornful and dismissive, but we persisted and actually it only took a week until everybody knew we were the “ED”. Similarly we stopped saying “RTA” (Road Traffic Accident”) and started saying “RTC” (Road Traffic Crash”) and I remember the satisfaction when I first heard a paramedic handing a patient over to us from an “RTC”.
Here meanwhile, the newspapers are still droning on about “casualties” in “A & E” waiting more than four hours to be “seen”. It’s like a report from a dressing station at Passchendaele.
Of course it is untrue that patients in the emergency department wait four hours to be seen. They are all seen immediately, by a triage nurse, who prioritises each patient’s level of acuity according to a triage scale which, depending on the institution, will be something like
Triage category 1: to be seen by a doctor immediately
Triage category 2: to be seen by a doctor within 10 minutes
Triage category 3: to be seen by a doctor within 30 minutes
Triage category 4: to be seen by a doctor within 60 minutes
Triage category 5: to be seen by a doctor within 2 hours.
I am not the only correspondent to have written in to point out that the media’s use of the word “seen” is misleading and, frankly, sloppy. Doesn’t make a whit of difference. Yet I don’t intend to give up. Why else would I write this blog? May I invite you to banish the terms “accident”, “accident and emergency”, “A & E”, “casualty”, and, worst of all, “cas”, from your vocabulary? If you hear other people using these terms, please politely correct them. Patients are seen promptly, and cared for, in the Department of Emergency Medicine. Will you join me in this?
As Winston said, “Never give in. Never never never never never…” I will keep scribbling.
And another thing…