‘Tone-deaf’ instruction on treating patients criticised by emergency doctors

Group calls on Royal College of Physicians to withdraw instruction to hospitals not to have trainee doctors examine long-waiting patients

Emergency doctors have called on a medical training college to withdraw a “tone-deaf” instruction to hospitals not to have trainee doctors examine long-waiting patients.

The Royal College of Physicians of Ireland (RCPI) should withdraw its “ill-considered missive” on the use of medical trainees in emergency departments and “focus on the needs of patients”, according to the body representing emergency doctors.

Patients can end up on a trolley waiting for admission for up to three days, according to the Irish Association for Emergency Medicine (IAEM), which described the situation as a “national scandal”.

Its intervention marks a further widening of a row that erupted after the RCPI last week instructed hospitals not to allow medical hospital trainees review patients in the emergency department (ED) until staff there have seen them.


The RCPI’s Institute of Medicine, which is responsible for training over 500 medical doctors in hospitals, threatened to remove accreditation from any hospital where senior house officers are evaluating patients before they are seen in the ED.

Contradicting this instruction, the HSE then told hospitals across the country to ensure specialist teams from outside emergency departments are available to review patents experiencing long delays in EDs.

HSE chief clinical officer Dr Colm Henry pointed out there are “significant concerns” over current levels of overcrowding and this is a safety risk for patients in hospitals nationally.

In this context, the HSE wants to ensure that longest-waiting ED patients are at least seen by a junior medical trainee rather than no one in the short term.

On Friday, the IAEM pointed out that 20-30 per cent of ED attendances needed admission, the vast majority for medical rather than surgical reasons.

“This tone deaf circular comes at a time of unremitting, unprecedented demand, manifested as excessive wait times to be seen by a doctor for patients presenting to our hospitals with an emergency or urgent medical problem.”

“Unfortunately, it would seem that RCPI has very inappropriately targeted these important patient-centred patient safety developments in their threats to hospitals of withdrawing medical trainees. It must be remembered that such trainees and training programmes are actually funded through the HSE by the taxpayer.”

The RCPI declined to comment further on the matter on Friday.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times