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Dabblers and Poachers: Who is to Blame?
CORRESPONDENCE
Guidelines for Letters to the Editor Annals welcomes letters to the editor, including observations, opinions, corrections, very brief reports, and comments on published articles. Letters to the editor should not exceed 500 words and 5 references. They should be submitted using Annals’ Web-based peer review system, Editorial Manager™ (http://www. editorialmanager.com/annemergmed). Annals no longer accepts submissions by mail. Letters should not contain abbreviations. A Manuscript Submission Agreement (MSA), signed by all authors, must be faxed to the Annals office at the time of submission. Financial association or other possible conflicts of interest should always be disclosed, as documented on the MSA, and their presence or absence will be published with the correspondence. Letters discussing an Annals article must be received within 8 weeks of the article’s publication. Published letters will be edited and may be shortened. Authors of articles for which comments are received will be given the opportunity to reply. If those authors wish to respond, their reply will not be shared with the author of the letter before publication. Neither Annals of Emergency Medicine nor the Publisher accepts responsibility for statements made by contributors or advertisers.
0196-0644/$-see front matter Copyright © 2008 by the American College of Emergency Physicians.
Dabblers and Poachers: Who is to Blame? To the Editor: I was dismayed if not embarrassed at the “Dabblers and Poachers” label applied to nonanesthesiologists performing deep procedural sedation in the News and Perspective section of the September issue of Annals.1 As a specialty, we (anesthesiologists) long ago tore down the fences, invited the poachers in and continue to actively train, employ, and empower a group of paraprofessionals (nurses) to, in some cases, take our place. The department of anesthesiology at my institution (and I suspect this is the case in many places) is not resourced to respond to every case requiring a rapid sequence intubation or procedural sedation for a dislocated hip reduction in the emergency department. As a result, just as the intensivists have done in the critical care arena, emergency physicians have taken it upon themselves to learn, teach and competently employ the techniques and services anesthesiologists cannot or will not. I simply fail to understand how a specialty that in many settings has made a practice of training and employing others to do much of our work can now accuse other physicians of “dabbling and poaching” when they have simply filled a void we could not or would not address. William James Phillips, MD Emergency Medicine University of Mississippi Medical Center Jackson, MS doi:10.1016/j.annemergmed.2007.10.029
682 Annals of Emergency Medicine
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The author has stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. 1. Flynn G. “Poachers and dabblers?”: ASA president’s incautious comment riles emergency physicians. Ann Emerg Med. 2007;50:264-267.
Upholding Patient Autonomy To the Editor: Dr. Simon’s article in the October 2007 issue of Annals attempts to provide emergency physicians with a systematic approach in order to address patients who are refusing care in the emergency department (ED).1 To illustrate his approach, Dr. Simon presents the case of an otherwise healthy 82-year-old man brought to the ED and found to have “an intact 8 cm abdominal aortic aneurysm.” The patient was informed that this aneurysm would be fatal unless treated; however, the patient refused any care and wanted to go home stating that he “did not like physicians.” Furthermore, the patient “acknowledged that he therefore would probably soon die but would not discuss the issue or give family contacts.” We disagree with Dr. Simon on the next appropriate action. Following a thorough attempt to communicate/educate/negotiate with the patient, we would let this patient go home against medical advice, provide follow-up Volume , . : May
Guidelines for Letters to the Editor Annals welcomes letters to the editor, including observations, opinions, corrections, very brief reports, and comments on published articles. Letters to the editor should not exceed 500 words and 5 references. They should be submitted using Annals’ Web-based peer review system, Editorial Manager™ (http://www. editorialmanager.com/annemergmed). Annals no longer accepts submissions by mail. Letters should not contain abbreviations. A Manuscript Submission Agreement (MSA), signed by all authors, must be faxed to the Annals office at the time of submission. Financial association or other possible conflicts of interest should always be disclosed, as documented on the MSA, and their presence or absence will be published with the correspondence. Letters discussing an Annals article must be received within 8 weeks of the article’s publication. Published letters will be edited and may be shortened. Authors of articles for which comments are received will be given the opportunity to reply. If those authors wish to respond, their reply will not be shared with the author of the letter before publication. Neither Annals of Emergency Medicine nor the Publisher accepts responsibility for statements made by contributors or advertisers.
0196-0644/$-see front matter Copyright © 2008 by the American College of Emergency Physicians.
Dabblers and Poachers: Who is to Blame? To the Editor: I was dismayed if not embarrassed at the “Dabblers and Poachers” label applied to nonanesthesiologists performing deep procedural sedation in the News and Perspective section of the September issue of Annals.1 As a specialty, we (anesthesiologists) long ago tore down the fences, invited the poachers in and continue to actively train, employ, and empower a group of paraprofessionals (nurses) to, in some cases, take our place. The department of anesthesiology at my institution (and I suspect this is the case in many places) is not resourced to respond to every case requiring a rapid sequence intubation or procedural sedation for a dislocated hip reduction in the emergency department. As a result, just as the intensivists have done in the critical care arena, emergency physicians have taken it upon themselves to learn, teach and competently employ the techniques and services anesthesiologists cannot or will not. I simply fail to understand how a specialty that in many settings has made a practice of training and employing others to do much of our work can now accuse other physicians of “dabbling and poaching” when they have simply filled a void we could not or would not address. William James Phillips, MD Emergency Medicine University of Mississippi Medical Center Jackson, MS doi:10.1016/j.annemergmed.2007.10.029
682 Annals of Emergency Medicine
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The author has stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. 1. Flynn G. “Poachers and dabblers?”: ASA president’s incautious comment riles emergency physicians. Ann Emerg Med. 2007;50:264-267.
Upholding Patient Autonomy To the Editor: Dr. Simon’s article in the October 2007 issue of Annals attempts to provide emergency physicians with a systematic approach in order to address patients who are refusing care in the emergency department (ED).1 To illustrate his approach, Dr. Simon presents the case of an otherwise healthy 82-year-old man brought to the ED and found to have “an intact 8 cm abdominal aortic aneurysm.” The patient was informed that this aneurysm would be fatal unless treated; however, the patient refused any care and wanted to go home stating that he “did not like physicians.” Furthermore, the patient “acknowledged that he therefore would probably soon die but would not discuss the issue or give family contacts.” We disagree with Dr. Simon on the next appropriate action. Following a thorough attempt to communicate/educate/negotiate with the patient, we would let this patient go home against medical advice, provide follow-up Volume , . : May