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Have we reached crisis management in outpatient clinics?

BMJ 1998; 316 doi: (Published 14 February 1998) Cite this as: BMJ 1998;316:635
  1. David Sellu, consultant colorectal surgeon
  1. Middlesex

    I have just finished a typical outpatient clinic for patients with general and colorectal disease. I arrived at 8 30 in the morning and did not leave till 1 30 pm—officially the clinic runs from 9 00 am to 12 30 pm—and, with my registrar, saw 46 patients, more than half of them new. In a smaller clinic, which I acquired against considerable competition from other users, we see 18 patients.

    What pressures are there on my clinics? I receive on average 52 new general practitioner and internal referrals each week, a third of them marked urgent. This number is over four times more than five years ago, and continues to rise steeply. I also have hundreds of patients to follow up, including those undergoing tests, those previously treated for cancer, and those requiring outpatient treatment for conditions such as haemorrhoids and complicated inflammatory bowel disease, some in the last category indefinitely. As the genetics of cancer becomes better understood, more people present for screening. I estimate that one in 10 new patients will need to remain in the system for the following five years

    I have six hours a week to do all this work, a time limit imposed by the need to cater for other consultants and by the shortage of nurses. For all new patients I take …

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