Intended for healthcare professionals


Inversion of emergency pyramid

BMJ 2003; 326 doi: (Published 08 March 2003) Cite this as: BMJ 2003;326:553

Scheme does not address real problems

  1. Bruce J Finlayson, consultant, accident and emergency medicine (
  1. Norfolk and Norwich University Hospital, Norwich NR4 7UY
  2. Royal Free Hospital, London NW3 2PF
  3. University College London, London WC1H 9QU

    EDITOR—I do not think the sentiments in the letter by Cooke and Castile reflect the views of most consultants in emergency medicine.1 The “see and treat” concept was developed at a single hospital and worked well there. It has not been subjected to critical appraisal or peer review.

    I have serious concerns that diverting senior clinicians from treating ill patients will be detrimental. It is a waste of years of training and expertise to concentrate the most experienced medical resources of an emergency department on patients who have the least serious conditions—some of whom, one could argue, should not be there at all. I find the term “the faded idea of inappropriate attendance” inappropriate in itself. I think this is an expression of political correctness.

    I tested a similar scheme in my own department in 1999, as a run-up to Millennium Eve. I …

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