Emergency Medicine Specialists: What We Do

Nov 16, 2014 News

(The perspective of Dr Zulfikar Bux, Head of GPHC’s A&E; Asst. Prof. of Emergency Medicine)

What makes an emergency room doctor a specialist in the field? That may be a reasonable question to some since, after all, we can be seen as doing some paediatrics when we take care of a wheezing child, internal medicine when we assess a 58-year-old man with chest pain, obstetrics when we evaluate a young woman with bleeding in pregnancy, yet other doctors with specialties in paediatrics, internal medicine or obstetrics will do so as well.

Dr. Zulfikar Bux

What sets the emergency doctor apart is that we specialize in the resuscitation of the acutely ill patient, the evaluation and treatment of the undifferentiated patient, and a working knowledge of nearly all fields of medicine.
Let me explain these three concepts so that you can understand why to be the best emergency doctor possible, one must undergo specialty training just as a surgeon, a pediatrician or an obstetrician.
First, we are specialists in resuscitation. More than any specialty, we are confronted with a steady flow of severely ill patients on the brink of death that we must catch and stabilise before a more complete workup can be performed. This is a challenge, as we must start treating the patient before we know what is causing their suffering.
Specialists in emergency medicine, through their studies and practice, understand what are the most likely causes of a patient’s grave illness and the drugs and procedures most likely to be life-saving. Many studies have been conducted that help guide our interventions, yet much is still to be learned, and that is where the training and experience of the specialist in emergency medicine will help give the patient the best chance of survival.
Second, we specialise in the undifferentiated patient. This is in contrast to what we learned in medical school. Indeed, we learned that when a patient has appendicitis, she needs a surgeon to remove the appendix. However, the patient does not present to the emergency room reporting she has appendicitis but rather that she has abdominal pain, perhaps some vomiting, and occasionally the pain is in the right lower part of the stomach where the appendix is located.
However, especially in a woman, there are many other structures in the same area such as the ovaries which can also be the cause of pain. The emergency doctor is specially trained to think about illnesses that cross between different specialties and choose tests to help determine the cause of the patient’s pain.
Research in emergency medicine considers patients who present as we see them as “abdominal pain” or “chest pain” rather than as “appendicitis” or “heart attack”. That makes a big difference in how we approach our patients.
Third, we have a working knowledge of nearly all fields of medicine. We must know how to approach patients who present to the emergency room with any illness. We may not know every last detail and we may not be the ones to perform the definitive treatment as in the case of appendicitis, but we are the ones who can make the diagnosis and stabilize the patient until the definitive treatment. No other specialist is trained to manage heart attacks and snake bites, asthmatic children and septic elderly patients, manage an airway and take care of a fish-hook injury.
So how do we get there? We have been fortunate to have the cooperation of the Vanderbilt University Department of Emergency Medicine since 2002. In 2010 we launched a Masters in Emergency Medicine residency training programme. It is closely modeled on US programmes and has been adapted to Guyana, but the requirements for graduation are very similar. Dr. Nicolas Forget from Vanderbilt University has been the director of the programme since that time.
During the three years of our residency, we work the same amount clinically as the non-resident doctors, but also have classes weekly. We must read the complete textbook. We have research projects, protocol developments and more. It makes for a busy three years, yet I have discovered that I am even busier now, one year after graduation!
What is very important is that in addition to learning emergency medicine, the residency provides a robust training in leadership. Since this programme is for us Guyanese, we must also develop our skills to lead emergency medicine to continuously improve the care we deliver for our fellow citizens at their time of greatest need.
Moreover, we are available 24 hours a day, seven days a week, to address any emergency that walks through our doors at the Georgetown Public Hospital Corporation.