Thursday, 12 February 2015

From a Learner to a LifeSaver: The Journey of a Responsible Emergency Physician !


From the Desk of Sagar Galwankar, MD

 “Life is a journey and we are always evolving” – I have always been aware of this reality.

There has been never a time that I have felt that “This is the final frontier, I have gotten all I wanted”. I feel no one feels that way. The day a normal human feels that way, humanity has Transcendented reality.

Today being a qualified emergency physician I often have to fight death for my patients. Sometimes I fail sometimes I don’t, I never felt I won. This is because like birth, death is also real.

Why did I become an emergency physician?

Many reasons:

I came from a family of two generations of physicians and I saw my teacher die on the road from the lack of emergency care. I got enamored when I saw the TV Show “ER” and I could not come to terms that my country India did not have emergency services.

This was 17 Years ago.

My tryst with destiny began and I faced many challenges in this journey.

When I started working to bring EM to India way back in 1998 the interested stake holders were the Corporate Hospitals. Corporate hospitals were interested in developing Ambulance Based Emergency Care so they could get emergency patients to their hospitals. There were private hospitals who wanted to start their own courses so they could have a stable supply of “Casualty Department” Doctors. By the way “Causality Department” was the old name for Emergency Department in India. Leaders assumed themselves to be Emergency Experts recognizing the opportunity to fame.

Emergency Medicine started with fragmented personal interests coming together. My vision was different. It was to develop Emergency Medicine in its whole sense which included Academics, HealthCare, Policy and Public Health. I was more bothered about my patients. I cared more for them and their right to correct care at the correct time.

I decided to come to America and get trained as an Emergency Physician. I decided to take the hard pathway of Learning the skill and implementing the change because Mahatma Gandhi always said “Be the Change you want to be”. I could not see myself being in a position to advocate myself as an Emergency Physician when I did not train to be one. India had no qualified EM Physicians who were formally trained hence I looked to the United States Education System to support my endeavor.

I was lucky to have the eye of Dr. Kelly P O’Keefe the Director of University of South Florida Emergency Medicine program who decided to take me as his student of Emergency Medicine.

I began my journey to be a Student.

Today I share with you what I have believe are the responsibilities of being a student and going on to be a quality patient care provider.

 Once a student always a student:

This is a fact a Physician should never forget. We are always learning. Science Changes, Times Changes, People change. We should be aware and adaptive to change. This is in the best interest of our patients.

Be a Dedicated Learner:

Dedication to learning is the Step to Caring.

When we learn we practice what we learnt. If we learn correctly we will practice correctly. If we are dedicated to learn that will translate to our patients. Better Care impacts how our patients fare.

Learning a Self-Activity:

In environments where EM is developing the expectations from teachers cannot exceed the knowledge they have about the new field. This is a challenge to the Pioneers of Emergency Medicine which are the new students in a new specialty like EM. Extra efforts to learn have to be taken. The onus of learning in such a situation now falls on the young shoulders of the new students.

Maximum Utilization of the Student Training period which is 1000 Days (3 Years) should be made by these students.

Every teacher teaches something. Listen, Watch, Verify, Discuss, Self Satisfy and Learn are steps which I say are crucial to being an expert.

The Textbook is your best Teacher:

Mastering the theory is very important to perform. Getting your Fundamentals Right is most important. Challenging the Fundamentals and changing them by Innovating Research comes much later. As a student master the textbook and then try to practice what you learnt.

Use Different Sources:

Journals, Internet, You Tube, Videos, and International Conference Proceedings are important resources to learn and help you groom yourself.

Believe in what you have chosen and give it your 100 %

Taking up the challenge of EM which has no teachers or Novo Teachers is the biggest challenge which as a student you have picked up. Now Win In It. The best way is to study, study and study. Use the 1000 Days to learn correctly.

EM is not Procedures, EM is not the number of patients you see:

EM is not about the above. The above are a part of EM Care but that’s not complete EM. EM like every specialty has pathways, protocols, and principles. Those don’t come by reading, those come by practicing.

Environments are always conducive to Change:

There are times when students may feel that the environment which is being offered to them is not conducive and does not allow them to practice what they read in the textbook.

Try to use your knowledge to first care for every patient you see and then try to bring the change.

I will give you an Example:

I returned to India after getting Residency Trained and Board Certified in America in Emergency Medicine. I started working at a Private Hospital in Mumbai to develop Emergency Medicine.

I had my protocols for ordering Labs and Investigations for sets of patients with chest pain.

Well guess what: The Cardiologist did not agree. Every Cardiologist had a different view point.

What did I do, I Said lets come up with a Unified Protocol?

The cardiologist said “We should be called for every chest Pain”.

I said Give me in writing what you want the ED to do and all Cardiologist Sign off.

They gave me a protocol which said do the Trop and EKG and call them.

I said ok and asked them in how much time can you come. They said 10 Minutes.

I said OK.

Well this where we get all the data. They were always delayed. When asked what about Pulmonary Embolism or Pneumothorax or Thoracic Aortic Aneurysm Rule out, they said well there is no ACS.

I said then what about other diagnosis.

Can you discharge the patient as safe?

In 48 hours I had the control of the Chest Pain Program.

There is no need to argue, there is no need to have discontent.

Every Protocol is still a protocol.

Get it established and then modify it “For the Benefit of the patient”

Emergency Medicine secures the patient and starts the care for the patient. Hospitals have realized that. It’s time that the other specialties realize the same.

Getting their buy in will ensure the existence of EM.
 
Environments in Transition where EM is new, continue to face the maximum challenges to change.

The ego of the career specialists from other fields is higher than Mount Everest. They are used to being called for every small thing and the fact that the Physician in ED is a traffic officer and not a Real Doctor.

Well things change when hospitals and administrators commit to establishing Emergency Departments lead by Leaders who believe in EM.

Getting their buy in of other specialties will ensure the existence of EM.

Knowledge and Confidence are key to effective Leadership:

Strong Knowledge and Confidence to Care in the ED are biggest showcases for leading the change in Challenging Environments where EM is in Transition. Knowledge comes from learning and that too learning continuously.

Thus concluding:

Don’t depend on others to teach you, Each One Teach One

Don’t blame others for you not learning.

Keep your eyes, ears and senses always open to learning. Knowledge is everywhere just try harder.

A good student is one who is well studied hence can debate and verify. Blind Adaptation of what is taught is also wrong.

Be committed, be dedicated, be loyal – You will always be Royal.

“God helps those who help themselves”

It comes down to being a student of science, a sustainer of solutions, and a sculptor of semantics.

I have always believed in the above hence continue to learn …………

 

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