FACE TO FACE
This Romeo is bleeding but the Old dog can’t see it. This I have borrowed from Bon Jovi but the feelings for specialty of Emergency Medicine in India is my very own and similar.
I am disappointed for the first time in my journey towards success of EM in India. 100 years back Tagore wrote a short piece on Education in India delivered by British Schools. He has painted a grim picture of Indian Graduates roaming with medals and certificates for jobs in British Merchant offices in this very particular critique named ASONTOSHER KARON ( The Cause of Dissatisfaction). The EM graduates in India are now facing quite a similar condition.
Since beginning in 1998 we have always starved for Full time EM programs and we did achieve that with help of UK Colleges / US Universities / Deemed Universities in India. We now have state of the art full time residencies producing graduates who are capable of running independent ED in an evidence based manner.
But then why are we struggling? I see graduates struggling between CEOs OR HODs offices asking for jobs with appropriate ranks and compensation. I can tell you there are number of reasons behind this
1. Emergency Departments are still medical post offices for fast track courier of patients to wards or ICU. There is no need to apply brain according to many.
2. Hospital Budgets does not include a section for Emergency Medicine where work can be managed by young cheaply available residents or Old Guys on the fence who are just doing shifts.
3. The sign called EMERGENCY is enough as level 1 evidence of good emergency care and everything else is just mere extra burden to the hospital. The state of the art cathlab or a N (N=2/3) Tesla MRI is actually a smart investment instead of a good functional ED.
4. One Napoleon (READ NEPO) can bring all the difference as he/she is just a phone call away all the time. He/she can do TELEMEDICINE and bring excellence to Emergency Medicine. This NEPO if PHOREN RETURN then he/she is probably more marketable than the department itself.
5. The rest of the department is disposable as there is always a high degree of attrition and people do move on for better opportunities.
So what are Emergency Departments in India? The best corollary I can think of is probably a railway junction. Where there is a station master yet there is no sense of ownership. The difference is there is no separate budget like railways and there is always an overload. When we were kids one used to ask us what is the difference between station master and school master; the answer was One minds the train and the other trains the mind. As a teacher of few residents of EM I think I should train people as well as mind them the reality of EM in India.
There are also problems lying within the system. Let me elaborate on this a little bit
1. Emergency Departments in India has grown up as support to other specialties and therefore the so called chiefs are actually chefs. Chefs who prepare the patients to be treated by others and not taking independent decisions.
2. The people who are on top of the departments does not want to adopt TEAM approach ( Together Everyone Achieves More ) rather they block the entry of youngsters who can be possible threat to their chairs.
3. There is no sense of Evidence Based Medicine and Academic or Clinical excellence in whatsoever form exists in such environment. A strong wind of CHALTA HAI attitude actually drive these places.
4. People achieve short term goals and things like BLS ACLS (These courses are actually important to set standard of resus in healthcare) are considered summits like Mt Everest which are worthy to be mentioned as department activities towards academic Emergency Medicine.
I can keep on mentioning the reasons but what these all are leading to is OZONE DEFECT.
We are degrading the respect for our specialty.
Young ER Physicians on the march are getting fatigued.
Potential Residents are turning skeptical.
And all these are leading to a vacuum in our next generation ER physicians. Do we ever think who will treat us when we will land up on the same bed in ER?WE NEED TO ANSWER ALL THESE QUESTIONS FACE TO FACE…………………………….
FACE TO FACE
RABINDRANATH TAGORE
Day after day, O lord of my life
Shall I stand before thee face to face
With folded hands, O lord of all worlds,
Shall I stand before thee face to face.
Under thy great sky in solitude and silence,
With humble heart shall I stand before thee face to face.
In this laborious world of thine, tumultuous with toil
And stand with struggle, among hurrying crowds
Shall I stand before thee face to face.
And when my work shall be done in this world,
O king of Kings, alone and speechless
Shall I stand before thee face to face.
Comments
Well said.But then the problem is not just limited to an emergency department.Its part of an even bigger spectrum,part of a disease known as hoarding...sounds strange??let me explain.When you have a country where even the exploited exploits,you can be sure of one thing...all the people are hoarding whatever they can grasp(read -lay thier hands on)whether they can use it or not to any good.People in other disciplines have absolutely no role in emergency medicine,but they want to hoard the resources of this department as well..for what,they or god alone knows.People in other departments are not willing to let go off this hoarding activity of thiers,because it is an old habbit- and as they say,habbits die hard.The problem is that even most of the newer generation doesent shy away from making a 'cut n paste'of this tradition...i believ it takes a lot of courage to break away from the bad of tradition,not everyone can do so.A hospital in Guwahati claims to have an emergency department and a trauma centre manned without an emergency physician...that is what is true for the rest of the country as well..so who bells the cat??I guess the only answer is pressure..it has to be a uniform ,sustained pressure from people in our department itself..pressurising other people to stay off..not everyone will but some will..and then we can hope to see the light of the day...tathastu
sanjay
I think nothing good can be written than what you have mentioned.
It is also worth mentioning that we buy new car models to comfort and value our lives, with all latest gadgets in it but we never think of valuing our lives when it comes to reducing the illness years if we are not handled by an expert evidence based Emergency physicians. We just think the other way around , either sitting in a comfortable car of new model will never make us sick or we can buy the mind in an Emergency (when time is limited). There everyone is "mistaken". EVERYONE has to pass through this road of EM at some point of time in their lives, but who makes people feel that WE as "Evidence Based Emergency trained physicians" are not waiting for people to get ill but are waiting on door step to help them when they get out of their luxury cars and have no time to spare.
I follow your post regularly and I fully understand the problems with EM in India ..
Here are some of my solutions
I think ultimately in a business a simple rule works
1 CUSTOMERS Are NEVER WRONG .........in order to be acceptable we need to create a need among customers ie patients for trained EM personells ...The need needs to.be created by corporates by publisizing their trained EM physicians
2 I think every EM course must put good emphasis on USG abd and USG obs because there is always a need for people capable of doing it when our radiologists are sleeping or is not available simply knowing FAST won't do in Indian svenario
3 every EM doctor in India should be trained in Critical care medicine as well because EM isnot yet a developed field in India but even the small hospital in the small lane has an ICU ..with not enough icu trained docs ..most md medicine guys don't know how to opetate ventilators
4 EM physicians must be ready to settle in small cities where trained docs are needed
5 MEM should be renamed MD (EM) keeping in.mind the love affair of indian patients with the designation MD. ..ok I know it won't be MCI recognised.
I know my points don't appear ethical ....but beileve me it ll work . I can say this from my experiance as a CMO of Multispeciality hospital in a tier 2 city in India.