CHALLENGES IN EMERGENCY MEDICINE

30 SEP 2010

CHALLENGES IN EMERGENCY MEDICINE
Author: Dr Shafi Ejaz T M      

Emergency medicine encompasses a broad and complex field of medical practice, which demands astute clinical skills, thorough knowledge of human physiology and disease, decision-making capability and interpersonal skills. Most developed countries have well established emergency medical units and many have succeeded in taking health care to the next level, which is to ensure that any individual requiring life saving interventions have access to advanced health care at the earliest. India however has certain specific issues, which need to be addressed before the specialty is streamlined.
   India, being the seventh largest country in the world, is also the second most populated country in the world. The multi cultural, ethnic and social backdrop, coupled with poverty, lack of formal education and also the fact that 80% of the population lives in rural areas make it reasonably difficult to deliver quality health care services all over the country. India has enormous limitations in infrastructure and finance which handicaps health authorities in implementing emergency medical services on a massive scale. Coupled with inhospitable terrains and topography in many parts of north- eastern India, it becomes a significant if not insurmountable challenge.
  Another major obstacle in the path of developing targeted high efficiency service systems is the fact that the population of the country is largely ignorant towards the need for such a specialty. Hence outreach programs are required on a massive scale to educate the enormous population on why emergency care increases the probability of survival and hospital discharge.
  A unique predicament of practicing ER physicians is the fact that they have to perform technically complex and advanced procedures in the out of hospital settings, at times in extremely dangerous and hostile environments. This is in sharp contrast to the ‘behind closed door’ approaches by other medical specialties. Hence practice of emergency medicine comes under unwanted critique, mostly at times from people who know next to nothing in advanced resuscitation.   
 India is also a country where age old established methods and hierarchy is given paramount importance. Coupled with the fact that despite best resuscitative efforts, survival and discharge with good neurological outcome remains poor in arrest patients, the medical fraternity in India is reluctant to recognize EM as a specialty that is worth pursuing. The fact that other independent specialties have to be involved during the course of treatment makes the Indian medical fraternity believe that emergency medicine is more of a gateway rather than an actual specialty. This is not the case in developed countries where professional ego takes a backside to the fact and most important principle that treatment for any patient is a team approach and every person involved, whatever is the stage, contributes significantly to ensure the betterment of the patient.
 The phasing out of general duty medical officers by ER physicians is in its infancy in India and it will take quite some time for the patients to understand that a specialist is actually treating them. Newer licensing regulations to ensure that full-fledged ED support is mandatory before a hospital can function will help address such issues. Lack of funding is another concern, which needs to be addressed.
 The practicing ER physician in India has to put in a high degree of effort to ensure that he practices EM according to the currently accepted evidence based medicine, or else he stands at risk of overwhelming critique from other specialties.
  The future practice of medicine in India will also be most likely litigation prone; hence the need to substantiate your clinical decision with evidence based practice will be necessary. This is not a system which is practiced in India.