Are accident and emergency attendances increasing?BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3677 (Published 07 June 2013) Cite this as: BMJ 2013;346:f3677
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Appleby makes a masterly dissection (fig.2) demonstrating conclusively attendancs to type-1 units have NOT increased over decades. Instead he clearly shows that the rise is entirely due to the newly included statistics from type-2 and type-3 units (including walk-in centres).
Could it be that patients are simply doing what they were encouraged to do ? ie - Assume a right to 24-hour Tesco-type shopping , as PM Blair suggested, at a plethora of walk-in centres to bypass GPs, as Lord Darzi created ?
Further dissection between type-2 and type-3 should answer the question.
Strangely, apart from my now avoiding any out-of-hours working, my daytime GP workload has certainly NOT decreased. Maybe Appleby can shine some much needed light here too ?
Competing interests: I am a GP
The phenomenon of an increase in Accident and Emergency attendances(1) might be an example of Sutton's law. William Sutton is the gangster credited with the saying "because that's where the money is", when asked why he robbed banks(2). Likewise, as a result of the perception that "the clinical examination is dead"(3), discerning patients might be deserting their general practitioners and flocking to Accident and Emergency(A&E) departments because they recognise that A&E is the gateway to where high-tech diagnostics are to be found. Accordingly, the perception that their own doctors are not performing the clinical examination expected of them might partly explain why patients themselves have lost faith in the clinical examination, and this sense of disillusionment might have contributed to the accelerated stampede to A&E.
(1) Appleby J
Are accident and emergency attendances increasing?
(2) Rytand D
Sutton's or Dock's law
New England Journal of Medicine 1980;302:972
(3) Patel K
Is clinical examination dead?
Competing interests: No competing interests