The most challenging part of health care is providing emergency care. As it pertains to time-sensitive issues and all varied presentations. People who come to the Emergency Department face double vulnerability, as they are sick and cannot wait to see the specialist or their own doctor in the clinic, and on the top of that they are managed in the Emergency Department by untrained providers and an incompetent system.
Our healthcare system comprises of private hospitals, public hospitals and institutions, armed forces institutions, and some corporate run hospitals and institutions. The Emergency Department is the integral part of the most bigger hospitals and is usually managed as per the old system of care. A change is already occurring in the healthcare arena and some of the hospitals have started adopting the updated ways of providing emergency care.
Some hospitals provide emergency care as well as do the training of new emergency physicians. The rest of the hospitals continue to provide emergency care in the old fashion way. For the last fifteen years, the struggle to change the emergency care in the Emergency Department’s of Pakistan has created a momentum in a positive direction.
The agents of change include:
1. Emergency Departments where there are training programs:
These Emergency Departments serve as an example of the newly developed Emergency Medicine initiative in Pakistan. They treat patients with good satisfaction and consistent quality and also train other physician in Emergency Medicine.
2. Pakistan society of Emergency Medicine:
All concerned physicians and nurses working towards establishing Emergency Medicine in Pakistan created Pakistan Society Of Emergency Medicine (PSEM). The idea is to promote Emergency Medicine at all levels through workshops, seminars, simulations, and conferences. Also involving key leaders and lobby at the government level to raise awareness and change mindset regarding EM.
3. Overseas physicians of Pakistani descent
This is an awesome resource for the Emergency Medicine in Pakistan. Becoming more active and helpful in the last 10 years although they contributed all along for the betterment of Emergency Medicine. Both online and physically, doing lecturing or hands-on, they provided an excellent medium of learning to all interested doctors and nurses.
4. College of Physicians and Surgeon’s Pakistan:
The college is the main institution that provides PG trainees with the system of training and it also contributed to the evolution of Emergency Medicine in Pakistan. Recognizing Emergency Medicine as training was a remarkable step in the history of Emergency Medicine Since 2011 a significant number of Emergency Medicine trainees have finished training and have become emergency specialist.
In the last 10 years, the struggle for Emergency Medicine in Pakistan resulted in some important achievements. The healthcare community has started realizing the value of emergency care and also the fact that a trained person should be dealing with emergency patients.
Now we are at a crossroads as we have made some progress yet the main bulk of people still are stuck with old thinking and this is causing inertia. This inertia can only be overcome when the people in other medical specialties understand the role of emergency care and support our cause. People need not to see it as turf war, but to see it as a complementary partner providing timely help to the patient. With a new mindset the patient care will definitely improve and the quality of care will also become better. Similarly, the focus of emergencies will be appropriately dealt by competent physicians both in the emergency or pre-hospital care domain and then by the respective specialist at the hospital.
The big public institutions need to catch up on this standard of care and let competent and trained emergency physicians and nurses deal with all emergencies. It is strongly felt that to improve the outcome and increase patient satisfaction, the emergency department needs to be under command of trained emergency people. The earlier we develop this realization, the faster we can work for the fulfillment of our goal. And the goal is to have
“A trained emergency physicians in each Emergency Department of Pakistan by the year 2025”
I convey this message to all stakeholders including patients to raise voice and demand a trained person in each Emergency Department. The task is daunting but not unsurmountable. Our combined energy one day very soon will result in changed dynamics at all emergency department across Pakistan.