As emergency physician we deal with time sensitive issues where a lot depends upon our skills to think and act in quick fashion. We develop same skills to act in a defined way so we are able to provide good quality care which is all encompassing and timely. We also are concerned regarding patient’s length of stay in ED as it is directly related to patients satisfaction and quality of care.
Multiple times we face problems with patients and their attendants utilizing their position in society to affect the medical decision making and in significant number of times it increases clinical risk to the patients. We deal with scores of people who claim to be doctors or close to become doctors and try influencing our judgment. Other time people use their position in society and try to run us over.
This phenomenon of influencing the care of a loved one in time critical scenarios needs to be seen in a very critical way and addressed appropriately by respective authorities for review. It is not easy to make decisions in emergency department and people have to be trained to do that. It requires years of training to be able to handle emergencies.
Also the family members have an emotional stake in the process of decision making regarding their family members or friends and so, they could be involved in the process of coming to a decision and their wishes respected, but they should not be allowed to make decisions for the patients. It is even more important when these family members or attendants are physicians themselves. Their state of mind cannot be trusted to produce unbiased and medically prudent decisions.
Unfortunately our culture in Pakistan is such that we have no choice but be over ruled by the attendants due to the way they conduct. We face academic, verbal and physical threats and also abuse to the extent that we are being bullied and cornered.
This whole scenario is detrimental to the system of emergencies care and so produces risk to the patients who is at the center of it and is most vulnerable.
We need to educate ourselves and be respectful. We need to let the emergency staff deal with the situation even where we feel that the level of care does not match our expectations. There are ways to deal with it. Jumping into vulnerable situation is not the most prudent things to do at that time.
My own take on this is also the message of today, and is that we need to be proactive and develop the system of care. If we don’t develop a system we eventually have to face this reality in an awkward way.
As supervisor of emergency medicine and director of emergency department I know the state of emergency care in Pakistan. But breaking the system further down or un due criticism will not get us any where. Building institutions improving calibers and creating systems, are the solution that are sustainable and bound to improve the situation and level of care.
As always I can be reached at askhan65@yahoo.com.