I have just finished my 3-month posting with the National University Hospital’s Emergency Department (EMD) as part of my Orthopaedic Residency programme and I thought I would like to share with you what a junior medical officer in the EMD does daily.
One key difference between being in the EMD and being a doctor in the wards is in the working times. In the EMD, we work in shifts, and the shift timings are very varied – you may be required to work from 8am – 4pm, 9am – 5pm, 11am – 7pm, 3pm – 10pm, 4pm – 11pm, or 5pm – 12mn, and sometimes even the night shift which runs from 9pm – 8am. The shift system ensures that there is always an overlap of doctors who are on duty so that there will never be a lapse in the continuity of care in the department. In contrast, ward doctors work “office hours”, which are not as fixed as shift hours in the EMD, coming in as early as 5am and staying till as late as required. Shift timings in the EMD may vary from day to day, but thankfully with some excellent manpower planning, we are usually still able to get adequate rest in between our shifts. However, we rarely get to leave right on the dot once our official shift hours are over, as we are required to tie up all loose ends and settle any outstanding matters before handing them over to the doctors who are taking over the next shift.
The EMD plays a key role in the initial management of patients in any hospital. When a patient is first admitted into the EMD, it becomes the duty of the doctors in the EMD to carry out a preliminary consultation with the patient and to conduct initial investigations on the patient through tests such as blood tests and X-rays. Frequently, patients also come in very sick and require immediate resuscitation and treatment to stabilise the condition. Once those have been completed, the doctors in the EMD will then determine one out of the following possible dispositions for the patient:
- Discharge – the patient may be immediately discharged if the doctor deems that the patient is fit to be so discharged. Patients with minor ailments such as the flu can be treated outpatient and discharged safely;
- Follow up – the patient may be suffering from slightly more complicated conditions and may be referred to a polyclinic, the patient’s own GP or other specialists, to follow up with further medical treatment;
- Admitted – the patient may be suffering from a serious illness or injury and will have to be admitted into the hospital for further investigation and treatment.
In this sense, one can also say that we are the gatekeepers of the hospital. Challenges arise when patients with multiple medical problems are admitted into the EMD and subsequently planned for admission into the hospital. The doctors in the EMD must then decide which specialist department would be the most appropriate one to admit the patients into for further management, time being of the essence. To make such a decision, a multitude of factors have to be taken into account, such as the severity of each medical problem and the relation between each of the medical problems, and it is seldom a straightforward matter. In addition, we work very closely with the specialists of each department who are usually in the wards. Each department has a specialist on call each day whom we can call for assistance in more challenging cases. In situations that require immediate specialist attention such as in a cardiac arrest, the cardiologist on call will also be on standby in the EMD to receive the patient together.
Lastly, given how the EMD functions and operates, doctors in the EMD rarely get to follow through with the patients whom they see as these patients would usually already have been handed over to different specialist departments and out of the EMD’s care. However, in practice, most doctors in the EMD would want to keep track of the progression of the patients whom they have seen. They will therefore keep and review their notes later in the week to see if their initial diagnosis and management of the patients had been adequate. In this way, the doctors in the EMD are constantly learning from each of their past patients.
Of course, the emergency department is not just made up of doctors. Nurses, pharmacists, physiotherapists, medical social workers, health care coordinators, patient service assistants and many other health care professionals all play essential roles in getting patients in and out of our doors.
All in all, I strongly believe that the National University Hospital’s Emergency Department is one of the best medical departments which I have worked in. The senior consultants are always present to guide the junior doctors and any patient would be rest assured that they will receive top-notch healthcare at this hospital. For medical students, I’m sure you will experience and enjoy the camaraderie of this department, with everyone being willing to teach you a thing or two amidst the chaos. While you are here, do remember to get your “black book” signed by Prof Shirley Ooi and Prof Peter Manning!