Monday, August 28, 2006

Basic Emergency Medical Care

One issue in particular has been bugging me since 19th May 2006, when we began negotiating the new PHCFS Act and Regulation with the Ministry of Health. The new Regulation requires Private clinic doctors to attend to all medical emergensies whenever called upon to do so, and it also carries a compulsory list of equipment for private clinics. A GP will see this as increasing his costs but a more important worry is how one can manage an acute emergency in their small practices.

What if they check and my equipment is inadequate or not functioning well, will I be put in jail? Presently there is no requirement to stock up any equipment except what is required in the practice. Malfunction of equipment in a non emergency context means sourcing a replacement. Emergency equipment, like anything else, will malfunction over time, even if left unused and unopened. Who is responsible?

What if the patient should die. Will I be blamed? Various American states carry "good samaritan" provisions in their law books where the caregiver is protected. Issues such as implied consent, legal liability, amount of care required by law and so on are still very murky in the local context.

What about fake emergencies, to get your attention quickly (queue jumping is a big problem in Malaysia as our highways will show), or even worse, fake wee hour emergencies that turn out to be staged robberies or kidnappings. Even the son of the former health minister was kidnapped once before. If the government cannot protect the family of the health minister from kidnapping then how will it guaruntee the protection of doctors who are required to expose themselves to reckless risk under a badly thought out law.

Recently, a 18yr old student was slashed and died, probably from exsanguination (everyone knows this word now thank to CSI). We are all saddened by this heinous crime. On the heels of this, the mass media started a campaign to blame the GPs who allegely did not want to help. Somehow the newspapers forgot to look at other passers by. Interestingly enough the law in Germany requires that everyone pass a first aid course before obtaining a drivers license. If you then pass by an emergency and do not stop to help, you have commited a crime. Here, we forget about training our people but decide to unfairly tax just one segment of the population who chose to obtain training.

Neither reporters nor the uniformed personnel (possibly a policeman!!!) gave help. In fact it was alleged that the uniformed person prevented the on-lookers from relocating the boy to a hospital. He instructed that the boy should not be moved. The reporters then went on to mention that two clinics were about 300M and 800M away, out of sight of the incident.

Now picture this. You are in an area where a boy can be slashed for no reason except theft. It's an area which is so unsafe that not only one boy got slashed that night. We now hear that there were others who have been attacked. In fact, when the police cornered these rascals, they did not raise their hands and follow, the papers tell us that they attacked the policemen. So what we have here is an area with hardened criminals terrorising the people. Someone comes to your clinic, visibly frantic, and blurts out that you are to follow him 800M away to a location which is unsafe. In hindsight, the location was clearly unsafe, someone died there to prove it. The question now is, what would you do? The answer clearly seems to depend on whether you are a doctor or a part-time superhero.

The newspapers were clearly not prepared to settle for Clark Kent so now they bitch about how doctors didn't pull their undergarments onto the outside of their white coat and go dashing off to save the day.

Now let us return to our first question, should a GP take on all emergencies, or refer them quicly to the nearest medical center/hospital. Ask another way, do we expect all GP clinics to be a full medical battlestation, able to cope with all medical emergencies, or if we say some emergencies, how then shall we define those basic emergencies. To any patient, when I feel terrible, it is an emergency. Can we make a list of equipment for basic medical emergency care without first defining what is basic medical emergency first.

Perhaps some commentors would like to list down what they feel is a bona-fide emergency. This is an important issue and I wish the newspapers hadn't been so quick to hang all doctors on the front page without benefit of a fair trial. Doctors must be prepared to meet an emergency and it's something I hope to cover on this blog soon.

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