Sunday, June 25, 2006

The role of emergency cardiac and medical services

Recently we heard of severe problems in the emergency medical services in US hospitals. In a way, this is not surprising. Many medical illness cannot be exactly predicted, especially when their etiology is not know. Even when etiologies are know, it is difficult to predict sudden excerbations and crisises, because excerbations and crisises is sometimes due to failure of the human bodies reserves or resistance. Therefore some medical illness presents gradually while many others present suddenly in an emergency crisis. This can put a tremendous strain on emergency room personnel and hospital cost.

The fact that there are "ideal medical guidelines" to guide litigation lawyers, in case of medical care disputes, does not help. The "ideal-must provide" level of care pose a great strain on healthcare cost and hospital cost. The cost of care in ER is very high and one can almost never make money on ER services. Therefore the recent USA study that shows more medical centers closing their emergency room, is very worrying, as you can never predict emergencies and so ERs are going to have to be always on a standby.

We cardiologists need the ER very badly in taking care of AMI. We need to give the heart attack victim their aspirin and (in some centers) the triage to angioplasty or medical treatment. The long waiting queues presently experienced in many USA medical center ERs (some with wait-time of a few hours) means that many emergencies may not be treated properly or in-time. This gets even more difficult as cardiologist are calling for the setup of special heart attack hospital so that heart attack victims can be treated quickly and expertly allowing us reduce heart attack mortality and morbidity.

That this is happening in an advanced country like the US is interesting but what is ths situation locally? The Private Healthcare Facilities and Services act, asks that all clinics resuscitate patients. They will in most instances be refered to ER in medical centers, often General Hospital ER or occasionally private medical ER. So far, we have not hear of any local medical center closing their ER. We certainly hope that theER remains open, so that patients who require emergency care will get ER care.

The Ministry of Health, Malaysia, expressed a premise not so long ago, about treating "true medical emergencies" without first asking for terms of payment and this must be carefully thought over. Right at the outset we must ensure that true emergencies are better defined. Otherwise, non-emergencies may masqurade as emergencies, whether intentionally or not, and put a severe strain on the host medical institution, from patient abuse. Remember, the law now mandates that we must treat emergencies without asking for anything thus making the hospitals bear greater risk, after all someone has to pay for the shiny new equipment and fantastic drugs which we use.

It is true that we should attend to genuine emergencies without asking for payment up front. Yet we are all very afraid of the abuses. It is true that the hungry should be fed yet restaurants are not required to stomach credit risks and feed hungry people. It is true that the poor should enjoy more charity yet banks are not required to hand out money, at least not the banking institutions I deal with. It is also true that professionals should use their skills to build the nation yet even lawyers, who owe a greater debt to society, are not actually required to defend for free no matter how dire the need. Why then are doctors, hospitals and the medical industry as a whole singled out?

No comments: