Practical steps for the emergency medicine improvement and the leadership issues… The final thought.

Abdus Salam Khan, MD FACP
December, 2012
No discussion or plan is complete if it does not generate an action plan or does not give any road map and the practical steps. We end our emergency care series with what I perceive as a workable plan. I have tried my best to formulate things based upon world norm, educational advancement and ground realities. I have also tried to identify the stakeholders and the beneficiaries, and also the objectors. I am hoping that this document will serve to stimulate a discussion among the stakeholders so people who want to change this emergency care system in Pakistan for good, would come to a consensus.

What we have known all along and still feel is that this field can only establish when young physicians feel that they have a future in it. If we don’t educate them then they will never opt emergency medicine field as a valid career path. In this regards College of Physicians and Surgeons Pakistan has to play a pivotal rule in steering people in this direction. It will also happen when young physicians see jobs and positions appropriate for the training and degree that they will acquire.

In the case scenario of job creation and service structure, the Federal and provincial Governments have a significant role to play, as they have a responsibility to the young doctors as well as to the citizens. They can bring the change quick by making it mandatory to have a qualified emergency physician in emergency rooms across the country. Society of emergency Physicians Pakistan also has a role to educate physicians and be ready for this exciting new role if the change materializes. Academic institutions and teaching hospitals should take lead in training physicians and start emergency medicine training programs.

At this time only Shifa International and Agha Khan Hospital are the only two hospitals who are recognized for the training in emergency medicine for the FCPS part II. We need to increaser that number and have more institutions take lead on this. Another option is to have a short term certification for the willing physicians that will serve to improve the level of care in the short run. T the same time, we need to improve the caliber of the nursing staff. As the system and the SOP developed would be helpful and by the time we have raised the caliber of the physicians and nurses up to the mark, we can start working on the other important aspects of emergency care.
What future should look like.

Now that we have covered the ground regarding the level of care and also the realities facing the emergency care level in Pakistan, and also being realistic about the human capital, money constraints, lack of resources and other educational hindrances I am still hopeful that our future is very bright. What I expect in future is to see the following.

1. Emergency medicine trained physicians. This is a phenomenon that has already started and emergency trained physicians coming from Pakistani institutes and hospitals trained at the local level will be coming into the practical life. Although scarce in number, but as the production has started, we will see a trend of increasing numbers in the future. We expect that soon in bigger cities the emergency departments will be managed by emergency medicine trained physicians, and ten we will start seeing a trend towards rural and sub-urban areas.

2. Circle of Emergency care. I would like to see a trend of peripheral hospitals getting aligned with the tertiary hospitals in the cities. This can be called a circle of emergency care. This circle will ensure that the people that are referred to the tertiary hospitals are referred appropriately and to the appropriate level in appropriate fashion. The other advantage is that due to the big hospital exposure this peripheral area hospital will be improved in care delivery.

3. Policy level change. Once we have enough trained physicians in emergency medicine we expect a policy level change in public sector hospitals to move in the direction of hiring emergency medicine trained people for the emergency rooms across the country.

Although I can go on and on, as these fundamental changes are relatively easy to bring and is not just a wishful thinking. In the end I like to encourage CPSP (College of Physicians and Surgeons Pakistan) and the SEPP (Society of Emergency Physicians Pakistan) to take a leading role and try to achieve this goal. Medical care and especially emergency medical care should be a priority and a right of each and every citizen. Let us work to give people the best emergency care in Pakistan.

This concludes the series on Emergency care in Pakistan. It will serve as guiding document for all the people who want to have an insider look into the emergency care system of Pakistan. It is a basic document and by any means not a complete account of the emergency care in Pakistan.

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