Many non-ED MOs somehow complain that ED MOs not doing their jobs. Especially dealing unstable patients. Let me clarify:
1. If a patient came in BID or clinically and hemodynamically unstable, it’s the job of ED MOs to stabilize the patient, given that it’s medical cause. If it’s surgical, obstetric, orthopedic causes etc etc we call our respective colleagues to come help out. We can’t do cesars or laparotomy in ED. Sometimes we call up our Anesthesia colleagues to help out with difficult and failed intubation. A lot of times ED MOs were questioned/queried/bambooed/scolded/blasted why they did not call the primary teams FAST ENOUGH, although we can stabilize patients on our own.
2. If a patient has been in ED for a while, reviewed by the primary teams and ICU team, then the patient starts to collapse before being transfered to ICU or wards, ED MOs have to attend TOGETHER WITH THE PRIMARY TEAM to stabilize or resuscitate the patient. It’s not that we don’t know how to do it, but patient collapsing in ED has more medicolegal impact than those who already transfered to the wards. Don’t believe it? Ask the very senior ED MOs how many internal/external queries, court proceedings they have to attend for these cases. Sharing the burden is what’s required nowadays.
3. Intubations. The ED MOs usually handle emergency intubations and crash intubations. Occasionally we will call our specialists, or ICU colleagues to help out in difficult and failed intubations. But elective intubations decision (low GCS, anticipated deterioration, pre-op, pre-transfer), by right must be decided and done by the PRIMARY TEAM. We can help out certainly, but decision must be the primary team’s. Why is this so? There has been many complains that ED MOs unnecesarily intubating patients, especially medical patients. Usually when we refer to primary team, the respond would be “you nak intubate ke tak nak?”. Nope that decision isn’t ours unless patient collapse before our eyes. Come review that patient, make a decision, we can intubate for you if you want.
4. Referrals. Once we decide who the primary teams are, you must certainly come and review after being called. Not simply “ask medical team or that team to review first” or “trace blood investigation, xrays, CTs blablabla first then call me”. For red zone patients you must come within 5 minutes, for yellow zone within 30 minutes. There’s an official circular for that you know, ED decides who the primary teams are. And if you think need referral to other teams such as medical or ICU, by right that is the PRIMARY TEAM’s jobs. But somehow that responsibility shifted to ED MOs. It’s because the primary team doesn’t come review or late review, you all complain ED not doing CT lumbar la, ED xbuat cerebral angio la, ED xbuat itu ini begitu begini, ED missing this and that. LESSON: COME SEE THE BLOODY PATIENT and don’t make decisions over the phone.