Abdus Salam Khan, MD FACP, Oct 2012
I have defined the current situation in the last post, which gives us the whole scenario of emergency care in Pakistan, lets explore the next logical step. This step is basically defining what we actually want and why we like to change the current system of emergency care.
Let us examine it so we all can understand this phenomenon:
Diseases or healthcare issues can broadly be classified into following categories:
- Diseases or conditions that threaten life immediately.
- Diseases or conditions that threaten life in a relatively short span of time if left untreated.
- Diseases or conditions that have a potential to threaten life if not treated or atleast looked at by healthcare professionals.
To further elaborate for the understanding of people let me give you examples of each by giving you scenario.
- A person develops a chest pain and is not able to breath. His ECG done shows that he is having a heart attack, and his heart rhythm is not proper. This is the example of the life threatening situation.
- A person is coughing blood and at times he is short of breath. On getting a chest X-ray, he was told that he has TB. This is the example of condition that threatens life with some time in hand to treat.
- A person develops a headache and when checks, his blood pressure is elevated. This is the example of the third situation when there is no immediate danger to life, but the condition needs to be looked at by healthcare professional.
All these patients are unable to decide for themselves the best course of action for the sickness they are dealing with. All three of them needs an immediate attention from the healthcare professional. It is logical that all three kinds of patients should come to the emergency department and get the attention they deserve. But the sad part is that our emergency rooms are not ready to deal with these patients.
Looking at the emergency rooms across the country, what we see is casualty medical officers with no training in emergency medicine seeing the patients and treating them. In institutions with training capability, the situation is not much different, except that there are specialty physicians who are on call and they come and see the patients when called by the CMO. The casualty medical officer takes a brief history and either treats the patient then and there or call the specialty physician to take over. Patients presenting with obvious issues or problems get the attention of the specialty quick, but the people with ambiguous complaints are seen by different on call teams before an appropriate person from all the on call teams looks at them.
Our population’s health has been at stake due to this system. Incompetent people with no training in emergency medicine see the acutely ill patients and prescribe them with inadequate or incomplete treatment. Medicines with wrong indications are used, with no regards to safety for the patients and drug to drug interactions. This all results in harm to the patients through the hands of the people that were supposed to help them. Rather than decreasing the burden of disease, they contribute to the burden by either ignoring the signs of escalation of a problem or disease or having no clue about the disease. This results in wastage of precious time for the diagnosis, thus aiding in worsening of the disease process.
From small cities and towns patients come to the cities to get proper treatment, costing them huge sum of money. The cost of this problem is staggering, but mostly undocumented and thus easily ignored by the healthcare professional. A significant part of this problem is due to the inadequacy of the treating physician at the village or rural level. This results in either people themselves are not satisfied and come to cities for a second opinion, or the doctor refers people inappropriately thus increasing the burden of the patients financially. Sometimes these same physicians wrongly satisfy patients and they only get to a bigger place so late that they are told nothing could be done at this point in time.
It shows now that the real issue is the lack of emergency medicine trained physicians and that puts all the citizens of Pakistan at stake for inappropriate and inadequate level of care.
It is the calibre of the physician that is at the center of the issues, This results in inadequate treatment and thus adding to the burden of disease. The same phenomenon put strain on the shoulders of big city hospitals, and thus rendering them inefficient because of dealing with the extra loads of patients.
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I will be waiting for your comments. You can always reach me at askhan65@yahoo.com