Review of a general practice attachment for accident and emergency training.

General practice secondments are being increasingly undertaken by specialist registrars in accident and emergency (A&E) medicine. This paper describes how two A&E trainees arranged general practice secondments and the experiences gained. There follows a discussion of the benefits to the general practice and trainees involved, together with a contemporary consideration of the interaction between general practice and A&E services in the UK.

Violence in the Accident and Emergency Department.

Crimes of violence are recorded increasingly frequently, including those involving health professionals. We reviewed records of violent incidents kept for a major Accident and Emergency Department over a ten-year period. Details were recorded in a Violent Incident Book by all grades of A/E staff, and separate records were kept by hospital security officers. A total of 407 incidents were recorded. Numbers, rank and sex of staff assaulted, types of assault, injuries received, weapons used and characteristics and disposal of perpetrators were recorded. Many were young males who had been drinking: others were regular attenders, of whom three subsequently died and one convicted of murder. Nurses and male doctors appeared to be at the greatest risk of assault and receptionists at the least risk. Recording of violent incidents and subsequent prosecution seemed inconsistent, and may have reflected the lack of a code of practice in this area. Suggestions are made about preventing, predicting and dealing with violence, and its aftermath, in the A and E department, including the use of security officers and closed circuit television, waiting room design, the recognition of body language and signs of alcohol or substance intoxication. The importance of staff support after an assault is emphasized, including immediate and long-term counselling, provision of legal advice, criminal or civil court action, victim support schemes and the workings of the Criminal Injuries Compensation Board. Free legal advice for staff assaulted at work should be included in the terms of service of NHS staff.

Dealing with 'difficult' patients--what goes wrong.

Tactful management of difficult situations can avoid the risks of violence. Being aware of non-verbal signals and using counselling skills helps GPs handle highly emotional patients. In the street or in the home, common sense steps will help protect doctors visiting patients. Recognising our own feelings is important too.