A colleague just reminded me of one of my favourite letters published in The Courier Mail, Queensland, Australia on May 04 2008. It pertains to the workings of the emergency physician. For more information on emergency medicine and waiting times – read Primum Non Nocere…
Dear Potential Patient,
I WORK in a public hospital emergency department, so that means any time you are in my part of the world, you are potentially my patient – you, your family, your friends.
Tomorrow could be the day that a bad thing happens to you and your life is changed forever. That heart attack you knew was coming sooner or later, the crash on the freeway, the toddler found face-down in the swimming pool. Tomorrow, you could be rushed to my hospital – and I’ll be doing my best to help you.
But, as your doctor, I have to warn you: things are not good.
I’m a Queenslander born and bred and have worked in public hospitals since 1982. I am a specialist in emergency medicine. My team and I save people’s lives for a living. We are good at it, and enjoy it. We deliver first-class emergency care to Queenslanders and those visiting (yes, tourists, I’m your doctor, too). I’ve travelled enough to know our state has a fantastic emergency response service and I’m proud to be part of it. Queenslanders expect it and you deserve it.
So what isn’t good? Put simply, our emergency departments – the place every ambulance rushes to – are already clogged with people. You’ll notice that from the time you arrive. It may be some time before we can find a space for you. Only the sickest people get immediate attention: the ones who can’t breathe, the ones who are unconscious.
If that’s you tomorrow, I’ll see you as soon as you arrive and I’ll use my skills and experience to stop you from dying, work out what’s wrong with you, give you the immediate treatment you need and then move you on to another doctor who specialises in your kind of problem. You usually don’t remember me, but I don’t mind. If I smile when I see you in the hospital kiosk next week, it’s because I like seeing a good result.
For everyone else – I’m sorry about the wait.
We try to be thorough and that means taking time with every patient. When it is your turn you will get the same treatment. But although year-on-year more people are seen in emergency departments across the country, that’s not the only reason we’re clogged with patients. A bigger problem is that we can’t get people out of the emergency department.
Hospitals (public and private) often have no available inpatient beds, no available intensive-care beds, or no available coronary-care beds. Often, very sick patients stay in my emergency department until a bed somewhere comes up. Sometimes that takes hours or even days. They stay in the beds we need for the people coming through the door. We don’t have rubber walls. Somebody has to suffer.
Patients on trolleys are in the corridors, and there they stay until a free bed is found. Sound dangerous? Sure is. I am making life and death decisions in an overcrowded noisy chaotic environment, and it is your life or death I am deciding about. No wonder we’re both stressed.
As your doctor, I warn you that when you come to my emergency department tomorrow your experience may not match All Saints with a neat solution after 47 minutes plus ads. I will do the best I can to keep you alive and get you where you need to be. That’s all I can do.
Since you are going to be my patient tomorrow, I have requests for some of you:
- TO THE 28-year-old salesman whose car hits a tree after the party tonight: You can’t drive better with a few drinks under your belt. And don’t take your mate’s girlfriend for a spin; after tomorrow, she’ll never look the same again.
- TO THE 78-year-old male retired railway worker with chest pain: I know your GP is very familiar with the medicines you take, but I will need to know in a hurry and sometimes it’s hard to get through to the GP. Please make a list of your usual drugs and keep it up to date.
- TO THE 42-year-old businessman: Don’t tell people you’re going to kill yourself if you don’t mean it, especially if you’re drunk. It will take hours before I can talk sensibly to you and, yes, you do have to stay in my department all that time. And you have to have a blood test. Really.
- TO THE 19-year-old student, nine weeks pregnant and bleeding: We know how upset and worried you are. We’ll get you into a bed soon. But mostly, what happens will happen, whether we get you into a bed or not. But we’ll still try.
- TO THE 85-year-old retired coalminer and respiratory cripple: We have the technology to pull you back from the brink over and over, but it’s like skipping a stone – each skip is shorter and lower than the last and eventually there’s not a lot to be gained from skipping again. When a few more days or weeks aren’t worth the needles, the tubes, the masks and the whole carry-on, let me know. Say you don’t want to do it any more. I will look after you. But don’t wait until tomorrow, because by then you’ll be on the brink again and too starved of oxygen for me to listen to you. No matter what you say then, I will resuscitate you. You need to tell it to your loved ones now. Then tomorrow, when you tell me you don’t want to be resuscitated, that you want comfort measures only, I can check with someone who knows you and I will do my best to follow that wish.
- TO THE 35-year-old female shop manager with recurrent abdominal pain: Please see your GP again before coming to us. Yes, we deal with belly pain, but your GP is well on the way to discovering what is wrong with you. Please persist with him or her. If you come to see us we’ll just have to start all over again.
- TO THE 21-year-old male: Don’t inject speed. If you act psychotic we will need to treat you, even if you don’t want it. Please don’t hit us, bite us or spit on us, we are only looking out for your best interests.
- AND finally, to the 53-year-old Queensland Health senior manager: We are drowning down here in the emergency department. I am your doctor, too, and I am tired of waiting for the problem to be fixed.
Quality emergency care is critical for all of us. It’s in everyone’s best interest to get my department cleared and functioning optimally. I want space, I want staff who can do this job well, and I want time to train them. The situation needs some action now. We are all at risk.
To other doctors: I am your doctor, too. Please help me when I ask you for help with a patient. I’m not doing it to spoil your day. I’ve got other patients and there’s nowhere else to go.
Politicians and powerbrokers: I am your doctor, too. I know you have private medical cover; I know you have a good GP and other specialists who look after you well. But tomorrow it may be you who collapses while walking the dog or it may be you collected by the BMW that lost it on the corner. No one is going to check for a private health insurance card. They’ll bring you to me and I’ll be your doctor then. How prepared and capable do you want me to be?
To all of you who are my patients: I am doing the best I can under the circumstances. I can’t save everyone. I can’t be right every time. I won’t be able to get to you as quickly as I would like, and nowhere near as quickly as you would like.
And please be understanding. It’s hard enough keeping you alive without being abused while I’m doing it.
The doctor’s identity has not been revealed by his request.
from the edge
BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Associate Professor Curtin Medical School, Curtin University. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |