Abdus Salam Khan, MD FACP Oct 2019
Coming out of the leadership summit in Emergency Medicine, we worked collectively to develop a roadmap for all of us to come to one page and improve the care and make it safe for the patients. Emergency Physicians from all over the world with Pakistani background and the national leaders gathered together in a workshop and then into the summit to come up with the well thought out document for the future of emergency medicine in Pakistan.
The struggle of emergency medicine is ongoing for the past 20 years and mostly it is confined to the private tertiary care hospitals. The reason was the issue on ownership and the mindset of people towards the emergency care and emergency departments across Pakistan. Now that the training of emergency medicine is happening in both private and public hospitals it is important to have a joint strategy and combined roadmap to progress further.
We looked at the emergency care and its dynamics in four different domains to sort it out in the best way:
- 1. Emergency Care system design.
- 2. Quality standards in Emergency Care.
- 3. Staffing strategies.
- 4. Education, training and research.
These domains were carefully selected so that the roadmap should result in maximum impact and will establish the basic standard for the emergency care throughout Pakistan. We took opinions of all stakeholders and presented the document to the government officials. The basic reason to present it to the government officials or the national decision makers was to get them involved in the highest level for the maximum impact. The gap identified between need to have about 12000 to 15000 trained emergency physicians to a current situation of locally trained 9 doctors, and it should be filled through training and education as outlined in the document.
The summit identified that the public sector hospitals can be the game changing resource if utilised in a methodical way. There are about 100 DHQ hospitals in the entire country and they all have the emergency departments which provide a broken system of emergency care. We need to concentrate on these hospitals as they are the key to improve our system. Each one of these district level hospitals get their patients from surrounding small government hospitals or private clinics and hospitals not capable of providing appropriate care. By staffing the emergency Department with competent and appropriate number of doctors, nurses and paramedics we certainly make sure sick patients are taken care of by competent staff.
This will raise quality of care as well as satisfaction level and trust on the system. At that point the already working force in the emergency departments will pose a very real and interesting scenario. The government should create a system to utilize those already working doctors in emergency Department and also make sure that there knowledge and competence is upgraded to match the patient load presented to our emergency departments across the country. Currently doctors working in the emergency Department see their job as a dead end for their career and so most of them work in the transition mode utilizing the emergency Department as place to wait for better times. By creating a pathway these doctors can patronise the place of their work and only then the quality of care would improve. The possible solution could be either by CPSP in the form of 2 years MCPS program or by various universities offering certification and diploma programs in emergency Medicine.
Through unconventional thinking we can create a win win situation for all. The doctors working in the emergency Department would have a better plan for their career as well as improved care for the patients. This way the patient satisfaction would also increase and the trust would return to the doctors in hospitals and potential decrease in violence.
I am hopeful that by reaching out to government in different forums and reaching out to president of Pakistan we have helped them create a much needed road map which is not a very expensive or difficult proposition. The community of emergency doctors see it as a great opportunity and is willing to work at all levels with government to improve the level of care in the emergency Department across Pakistan.