Having worked in the Emergency Department in both the Government as well as Corporate set up, I have noticed marked differences in the way ED protocols are percieved by clinicians from other specialities.
In the Govt. set up appropriate management including practical procedures done on the patient were always appreciated and encouraged.
Was this because we helped to save some time and effort for the "other" specialists is an open question.
In a private set up such practical procedures eg. POP application,reduction of dislocations,chest tube insertions etc. are frowned upon by the concerned consultants as they feel we are treading into their territory of management( and fees probably!).
This is one of the reasons we are not getting enough support to branch off as a separate speciality.
What"s everyones take on this?
Edited by webmaster on 18-07-2007 00:51
This is one of the unique challenges of EM development. An immediate
friction to new emergency physicians here is airway management.
It is traditional here to call the duty anesthetist whenever airway maangement is required. There will be hard time convincing the management & consultants of the hospital to put this trust in EM physicians. But it is definitely possible.
Endotracheal intubations, nasal packing, CV line placements, FAST ultrasound scans, chest tube insertions, etc, all cost money. And specialty depts will want to cash in on this. But EM is always known to be time critical. Any sensible EM physcian will not wait for even a few seconds to put that ET tube in neither will he wait for 1 hour for a tube thoracostomy.
This kind of anti EM tendencies is not seen in EM depts with high patient load or in non corporate set ups.
The worst are small hospitals where every procedure is profit. It will be
hell for the EM physician there where he will never get to do a procedure.
We have to accept that we really are eating some of their money. BUT, they (consultants & admininstrators) will have to understand that patient care is what will improve dramatically. When this is seen, EM will be respected.
And this is really happening. Believe me!
Edited by webmaster on 18-07-2007 00:52
Most corporate hospitals usually market their consultants imaging and lab facilities.
A consultant marketted for is specialization in say chest medicine, endocrinology or something as exotic as midgut surgeon or vertigo specialist... will have expectations from the hospital for admissions, referrals and procedures.
An ED physician in a corporate hospital conducting a life saving procedure or discharge a dizzy patient without an elaborate referral will have to face the wrath of the consultant and a representative of the administration.The fact that this does not happen in a med school or in a govt hospital is evidence that these clashes occur cuz money promised is not delivered.
At the risk of sounding like a madman shouting at the rain, i believe its the system, rather the mindset that needs to change.
tell the management this...
market the hospital as a whole with all possible specialities and the asurance that a patient sent here, whatever be the emergency, will be triaged, treated, disposed or admitted under the appropriate speciality.
Know that the best specialist in an emergency arising due to any known or unknown human illness is the Emergency Physician. He/she is trained in performing all procedures within the scope of the speciality of emergency medicine and is always present in the ED, not requiring to be called from blissful slumber to perform a procedure.
This way you can boast of a hospital with all specialities and a competent department that will deliver the patient to the appropriate speciality alive or keep alive till the speciality gets there.
A dead patient in the right speciality is not of use to anyone
Consultants will have to adapt. They should be told that a procedure maybe done in an emergecy in the ED by the ED physician either to preserve life or ensure comfort and that they will be called on for his specialist opinion and any further procedures. this will reduce expectations.
A well trained ED physician is a value added service any corporate hospital can provide to its patients. A department dedicated to the cause of saving lives and to deliver care quickly will make a difference in patient comfort and hence ensures superior patient satisfaction.
About a patient wanting treatment in a corporate hospital... should he be uncomfortable or die while waiting for a specialist. If he can afford the treatment , he probably can afford a lawyer too.
Dr. Bevin D'Silva
Dept. of Emergency Medicine, Apollo Health City
Hyderabad
Edited by webmaster on 18-07-2007 03:11
imuwithash, visit www.emergencymedicine.in or better still get in touch with EM depts in south india, cmc, apollo hyd, srmc, etc
Edited by webmaster on 18-07-2007 00:53
Healthcare system and its provision in India is evolving rapidly. Though some of the private institutions boast of state of the art equipment and facilities, it is only available to the very privileged... For the majority of the middle class, accessing this so called 'state of the art facilities' only means parting with their ancestral home or land or wife's jewellery!!!
I donot intend to blame these hospitals. Let us face it, they haven't invested millions to just run a charity. The managers would look at it purely as a business enterprise. And rightly so!!! Also, if not for some of these private institutions, we would still be talking of DPL rather than FAST(see other forums in this site!!!). Being very much a business model, it is hardly surprising that the concerned specialists or managers guard their territories...
At what point does self service stop and philanthropy start??
Why is it not then that the government invest more in at least the teaching hospitals? Or is it that the vested interests really donot want this to happen? It is anyone's guess!!!
I donot think for once that emergency medicine is all about 'putting in tubes and lines' or doing fancy procedures. Rather than take a cavalier approach, I guess one has to first first build good working relationships with other specialities. Meaningful, time critical interventions have to be incorporated in the departmental/hospital guidelines. I guess this has to come from the hospital big-wigs... Having a very strong emphasis on training and tight clinical governance, one could build a very strong department.
Let us remember that our specialty is still at its infancy in our country. Things would evolve... before that we need to constantly prove our credibility to other specialities, patients and more importantly ourselves.... The future is only bright!!!
Edited by maroju on 09-02-2008 16:09
