Once again, “Three health boards fail to hit A&E waiting target” (The Herald, September 23). Emergency departments should not bother to report this useless, and indeed dangerous “key performance indicator”. The easiest way to get 95 per cent of the patients out of your emergency department in under four hours is to stop practising any medicine: restrict your practice to triaging the patients to an appropriate destination where they can be properly looked after.

Most Scottish hospitals operate an apartheid system at the front door. Patients sent in by GPs go to an acute assessment unit (AAUs); patients who front up unexpectedly go to the emergency department. While the emergency department is encouraged to dispose of its patients as fast as possible, many AAUs can hold on to patients for up to 48 hours. What this tells us is that most Scottish hospitals do not really regard their emergency departments as being a part of the hospital at all. They are merely outlying dressing stations whose purpose is to protect the hospital from too much exposure to reality.

The four-hour rule is why emergency medicine cannot recruit enough doctors in the UK and why junior doctors are leaving for Australia and New Zealand in droves. As one of them said to me from New Zealand the other day: “Here, I get a chance to exercise my skills. I get a chance to be a doctor.”

Dr Hamish Maclaren,

Fellow of the Australasian College for Emergency Medicine,

1 Grays Loan,

Thornhill,

Stirling.