Noctors, doctors, and rules

doi:10.1136/bmj.b3872

Published 22 September 2009, doi:10.1136/bmj.b3872
Cite this as: BMJ 2009;339:b3872

Letters

Ottawa rules, OK?

Noctors, doctors, and rules

The first 150 words of the full text of this article appear below.

The example of 6 year old Tarquin falling off his swing andbeing referred for reassurance radiography of the ankle by anurse in accident and emergency is a bad example of showingthe difficulties in implementing the evidence based Ottawa anklerules.¹ If the nurse practitioner (or noctor, from the phrase"not a doctor") is unable to deal with the family’s concernaccording to the protocol, she should not solve the problemby irradiating the child unnecessarily.

If the family concern continues despite the protocol havingbeen followed and radiography not being warranted, the patientshould be referred to a doctor who is able to allay the parentalfears by explaining the situation with the risks and benefitsof radiography.

Allowing nursing staff to over-ride set protocols will leadto overinvestigation with its known potential risks. If thepolitical will is to replace doctors with noctors, Hippocratesis still . . . [Full text of this article]

Trefor J Roscoe, GP principal¹, Sarah J Roscoe

¹ Sothall Medical Centre, Sheffield S20 1HQ

Trefor@nhs.net

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