David Oliver: Conveyor belt medicineBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m162 (Published 30 January 2020) Cite this as: BMJ 2020;368:m162
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Conveyor belts are good for some but by their nature they are linear. When patients are obviously unwell with one clear significant diagnosis then they probably work. However most doctors know this is a minority of patients. Acute presentations need time and a non linear approach to separate the wheat from the chaff. This includes a thorough contextualisation and iterative constant revisiting of the issues. As I say to myself with some presentations, “You might have a serious problem early in its development....or you might just be a bit stressed!” Many people with non -serious issues can end up on the conveyor belt because the initial view was inappropriately “ that it might be serious” and the system denies the chance to say, “whoops that view was wrong!” Conveyor belts tend to preclude early revisiting of issues and deny the chance to the patient to have their needs re-assessed and downgrade the response. Conveyor belts are terrible at saying, “You know I thought you had X which would have been a worry but actually you probably have Y which is not a worry and we don’t need to do anything and importantly you don’t need to be in a hospital for Y.” Conveyor belts are also self justificatory with conveyor belt patients acquiring markers that justify them being on the belt independent of the needs of the presenting issue: investigation, cannulae, imaging, gowns, concerned relatives arriving etc etc.
Answer: much more early senior assessment and re-assessment to make sure the conveyor belt is going to be of any benefit or relevance and not going to actually make things worse. The potential to unclog hospital pathways is significant. Clogged conveyor belts can lead to “mid brain survival medicine” with the clogging leading to an increased dependence on the conveyor belt just to stay safe. The solution applied is the same as the aetiology of the problem!
Competing interests: No competing interests