oh Emergency Department Medical Officer!

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.


3 thoughts on “oh Emergency Department Medical Officer!

  1. Interesting blog you have here. Seems like you were my HO before in AE HKL. I’m a MO there. I may not agree with everything you say in this blog but you do have a point here. Referrals are done for a reason and the receiving team must come review the patient. I find it very unprofessional when they shout over the phone and insist on every investigation being done and traced prior to coming. Sometimes clinical judgment is enough to make a diagnosis. If I can make a diagnosis without those investigations, I will refer as needed. But then again sometimes the receiving MO needs the investigations to justify his/her diagnosis to their specialist.
    Maybe, just maybe its because their specialist don’t trust their clinical judgment? Or they are just covering themselves from future scolding in wards? “I kid, I kid 🙂 , or am I?”
    I understand ward management is very different from ED management. Specific and detailed investigations are not done in ED due to time constraints. Thats usually why friction happens. If the receiving team can just understand that and manage accordingly, all will be fine.

  2. salam efenem..a very good blog indeed..i have been following you quite sometimes.. i am going to graduate ED posting pretty soon, then going to my last posting which is surgery..anyway, i am still in dilemma which field should i pursue during my mo.. i just want to know how is it like being a mo in ED posting because i was thinking of being an ED MO..is it tough being in emergency department?? please kindly share your experience..thank you.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s