Abdus Salam Khan, MD FACP – April, 2016
A family brings their mom to the emergency department after she becomes unconscious at home only to be told that she is dead. Now the family has tough time accepting this fact and they become very aggressive asking doctors to bring their mom to life. Another family is told that the father is having a heart attack based upon their evaluation, and the family calls people across the globe to get advise before taking any decision. Yet another family tries to dictate doctors in the emergency how to treat their patient, and when doctors don’t comply, they yell and curse doctors for being incompetent and force them to alter the treatment to suit their liking.
These and countless similar other instances happen as a daily occurring in emergency departments across Pakistan. I ask myself frequently why? And when will it stop. The more I look at it the more I realize that this is a mindset and unless this mindset is changed, it will never stop. So what is the mind set and is there any logic to it. To most of your surprise this mind set is created by the doctor community rather than patients themselves or their families.
Our system of healthcare is such that we have expert doctors with world class education and experience, but we could only see them through appointments and in the day time. Then we have budding consultants who are also available like that on appointment, and ofcourse they go an extra mile by giving their phone numbers to the patients and are available on the phone when called. But what happens when the patients get seriously ill? These top notch doctors are either not available or available on the phone. This leads to a huge dilemma for the family. Where to take these sick members of the family and still be able to get good quality treatment. Emergencies or A&E departments are there but are they trustworthy? Is this a good time to take our loved ones there and come back home safe? These are the questions that come to mind and remains unanswered till the whole episode is finished.
In order to provide safer care the family knows that it has to be aggressive and it has to be on guard. Why? Because the healthcare community chose to put the weakest link for the most delicate and most important task. You ask any doctor in the emergency department of any typical hospital in Pakistan and they will tell you that either they are there to learn the skills (of course unsupervised) or that they are appearing in some examination and needed to work till their result is out or they will tell you that they are here because they could not find any job anywhere else.
The ill member of the family has to be protected from the ills of the healthcare community, yet has to managed by doctors in emergency. That’s where they use all the resources at their disposal to avoid a bad outcome through the hands of the emergency doctor. So phone calls starts: who, where, how… admit to ICU direct, admit to any ward or do whatever it takes to skip the emergency department and its junior and non-trained doctors. And mind you, it is the middle of the night or may be off hours. Those telephone works, the senior doctor joins this task of preventing this ill person from the hands of junior and untrained emergency doctor who is perceived as sharpening his skill on the people coming to the emergency department. This telephonic consultant at times takes matter into their hands and start dictating what the treatment should be, and at other times the family does the same.
Can I blame them, probably not, but I disagree with the approach and would tell straight that it is counter productive behavior. It makes it even more unsafe for the patient and results in bad outcome. The definitive solution is to have trained physicians stationed in emergency departments across Pakistan working in consultation with the senior doctors who are available round the clock. But sadly enough rather than fixing the problems we try finding shortcuts and then blame the system. The emergency departments require trained people to provide safer care. Majority of the problems will be resolved if trained people are put in the emergency departments rather than just upgrading the instruments and equipments.
So to answer the question that what a patient should expect in emergency department. I will tell you if the family can get attention of a trained physician and his/her best decision making, then even the worst outcome will not hurt as much. No one expects any miracle in emergency departments, but I tell my residents that the miracle they can produce is to treat their patients as they themselves wanted to be treated like. Respect and communication are the keys to better healthcare and especially emergency care delivery. Developing a team in emergency department is the key to the better care delivery. And that’s the things which brings consolation is the minds of the relative of the patient who had a bad outcome.
By starting the training the College of Physicians and Surgeons has taken a very important step and it can lead to the dream of “A trained emergency physician in every emergency department of Pakistan by year 2025”. This is a very realistic goal and also a long due one. Through this goal we can improve the outcome of not just life threatening illnesses, but also avoid situations turning bad to worse by having right intervention at right time. Once we get into this routine we will gain the trust of the patients and relatives and there will be less stress on job.
I can be reached at askhan65@yahoo.com