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The senior doctors' union is unimpressed with what it calls a "petty point-scoring" open letter Southern District Health Board management has sent Dunedin Hospital emergency department staff.
In the letter, the board said "long-standing serious relationship problems" with some senior doctors must be resolved if the emergency department's new observation unit is to work properly for patients.
"We need to be able to engage with ED medical staff in a mature way. To that end we are looking for leadership from senior doctors as we work through rostering and staffing issues which concern us all."
The letter said two senior health figures - Ministry of Health chief medical officer Dr Don Mackie, and national emergency department target champion Prof Mike Ardagh - were helping improve relationships between managers and doctors.
The board released the letter to the Otago Daily Times after sending it to staff yesterday morning. It follows a letter last month from senior doctors in which the doctors told the board they could not provide adequate cover for the observation unit as there were too few of them.
The two sides cannot agree on how many specialists the department needs, a situation that led to clinical leader Dr Tim Kerruish stepping down in March.
While he continues as a specialist in the department, it still has no clinical leader and the board has made no discernable progress towards appointing one.
The letter acknowledges improvements in the past year, which cut waiting times.
"However, there are real issues with the ED and we need to collectively work through these if we are going to make the department work for the community we serve."
The letter urges the ED to be flexible about adopting new models of care, including recognising the role of nurses and relationships with other departments, both of which could be enhanced for the sake of patients.
The letter also warned against airing problems "through the media".
Although not mentioned, one of the troubled relationships to which the letter alludes is likely to involve specialist Dr John Chambers, who faces possible disciplinary action over a media interview earlier this year. He is yet to learn whether he will receive a formal first warning.
Contacted for comment, Association of Salaried Medical Specialists executive director Ian Powell said that rather than soothing the situation, the letter risked "aggravating" matters.
The board was engaging in "petty point-scoring", and should not have sent an open letter without first advising the union.
"[The managers] need to learn to work collaboratively. It does not seem to be in their DNA to work collaboratively."
He claimed the DHB was trying to drive a wedge between senior doctors and other ED staff.
He found "offensive" an implication in the letter senior doctors were not as dedicated as nurses and other staff to maintaining a safe and efficient emergency department.
Concern over that inference prompted managers to clarify part of the letter yesterday, a spokesman said. It had never been the intention to suggest senior doctors were not "extremely hard-working", he said.
The open letter was signed by patient services executive director Lexie O'Shea, nursing and midwifery executive director Leanne Samuel and patient services medical director Dick Bunton.