Postgrad Med J 86:745-746 doi:10.1136/pgmj.2010.112672
  • On reflection

What is an emergency?

  1. John Launer
  1. Correspondence to Dr John Launer, London Deanery, London Department of Postgraduate Medical Education, Stewart House, 32 Russell Square, London WC1B 5DN, UK; jlauner{at}

The word ‘emergency’ has always been a contentious one. For as long as I can remember, hospitals have tried to deter anyone who wasn't ‘a real emergency’ from attending their casualty departments. Indeed, they changed their name to ‘Accident and Emergency’ to emphasise this, although everyone still uses the older name anyway, or just ‘A&E’ which somehow lacks the same force. In the same way, general practitioners (GPs) have for decades urged their patients not to turn up without an advance booking unless it was ‘an emergency’. They have trained generations of surgery receptionists to use forms of words designed to separate the deserving from the apparently undeserving—mostly to no avail, or at the cost of creating considerable bad feeling among patients.

During the last dozen or so reorganisations of the National Health Service in England, several variations of first contact service have been introduced to try and tackle the perceived problem of patients who want to see doctors when doctors don't think they should. One of these is the phone advice service run by NHS Direct (recently threatened with abolition but then just rebranded). This seems to have increased the workload in the system by advising people to consult their GPs, just as they might have done in the first place. Similarly, walk-in centres were set up to give patients easy access and take the pressure off both GPs and hospitals, but they have rather muddied the waters by giving patients the explicit message that it is fine to expect immediate attention …

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