Abdus Salam Khan, MD FACP – June, 2016
Emergency medicine is very important field amongst the disciplines of medicine and because of relatively new field its role is still being defined in Pakistan. It is important because it deals with all sort of medical problems in all ages of patients and is time restricted, which makes it complex to practice. It also deals with the issues that are mostly non-medical so its role is more wholesome than just confined to medical decision making.
When patients are seen in the emergency department, a lot depends on symptomatology then diagnosis based treatments. As opposed to clinic or OPD patients, the population seen in the emergency department is more sick and at times unstable, time sensitive and does not come with labeled diagnosis. This makes the job of emergency physician a sensitive and highly complex. Strategies of the emergency care have to be developed and should be independent of the regular or usual medical care.
What may work with one age group will not work with the other age group, and similarly with one situation to the other. It becomes utmost important to have tools created or pathways made for the safe and effective treatment of the patients in emergency department. Although the ways of practicing medicine don’t change but they have to be adjusted. How should be adjust those ways will be by utilizing EBM or evidence based medicine.
Evidence based medicine has made its ways into the usual practice because of its role in providing safer and relevant care to the patients. Our patients coming in the emergency department deserve the same level of safety as with the other disciplines of medical care. So we need to practice based upon EBM or evidence based medicine.
Evidence based medicine has two important aspects that make it successful. First creation of evidence and second its compilation in a meaningful form that is easy to be practiced. Both are equally important and cannot be ignored. Unfortunately we in Pakistan lack in both aspects in all areas of medical practice, and so emergency medicine similarly practiced in a physician based way. This means the decision making is dependent upon the skillset of the physician delivering the care. It makes it everything but reproducible and does not lead to safety as a common denominator and level will vary each time the care is delivered.
It is about time that we should start documenting our practice in a standardized fashion so we can create our own evidence to fulfill the first and most important aspect of evidence based medicine. This collected evidence should be available to everyone to be utilized in practicing the field as well as adding their own evidence to it, making it either stronger evidence or negating a previously held evidence. This is the only way we can progress and be safe, and this is how we will be able to define standard of care based upon our society in terms of diseases as well as matching resources.
The way we deliver healthcare in Pakistan is mostly Physician dependent and not evidence based, and when we apply the evidence, it usually is coming from a different population set than our own. It just fills the knowledge gap but does not pertain well to the patients base that we deal with and results in either unfavorable result or unusual individual practices by different physicians. Yet as we don’t have a research culture it does not translate into enough evidence for the physicians to follow the practice as standardized care.
We need to enhance research, documentation and the care in order to help physician community of Pakistan develop relevant evidence based ways of delivering care in all aspects of medical care including emergency medicine.
You can reach me at erdoc@shifa.com.pk