Guarding the Specialty of EM in India ~ A call to Action by Qualified Real Emergency Physicians !

By Vimal Krishnan Pillai, MD, FACEE                                                                                Principal Secretary, The Emergency Medicine Association 

India is at Cross roads of conflict when it comes to Emergency HealthCare.

The Health Care Industry in India is booming with Corporate for Profit hospitals mushrooming across India …thanks to Investments in India’s HealthCare.

The culture in India is that every MBBS Physician in India aspires to be a specialist. There are around 65,000 MBBS seats in India and only around 20,000 PG seats

 Due to the staggering difference was a constant struggle to achieve some sort of an accredited qualification after MBBS.

This also gave birth to a corrupt pathway where non-accredited courses were designed and marketed for monetary gains. These could be anything from paid Fellowships to any type of non-accredited courses.

Even though there are clear guidelines on what should be quoted as a qualification, there are numerous non- accredited courses thriving here due to regional heterogeneity in medical education and the challenge to govern, regulate and track healthcare providers enforcing the rule was tough.

With the rise of International Investments in HealthCare, like the west the expectations from these investment driven hospitals to prove Quality Emergency Care 24/7 grew.

The campaign to get EM Recognized by the regulatory bodies like Medical Council of India (MCI) and the National Board of Examinations (NBE) as a specialty was only was realized after 2009.

Running a Competent for profit Emergency Department needed committed and qualified Emergency Physicians.

That was the elbow gap when vested forces started manufacturing non-accredited Training Courses which are illegal in India.

If unconfirmed estimates have to be believed there are over 1000+ Medical students who have been lured into such courses.

The unregulated manner in which these malignant and corrupt courses have mushroomed has left the academic community in India stunned.

There has been massive anxiety as regards the factors under which such Unrecognized Training Programs are conducted at hospitals without permissions.

Physicians not recognized or qualified to be Teachers are impersonating the role of being trainers and are conducting training programs using the most vulnerable patients presenting to the Emergency Departments as training subjects without governmental permissions.

Physicians/ Institutions/ Associations not permitted to train are handing out qualifications.

These factors raise a lot of ethical and patient safety concerns.

There are all sorts of Certifications in India without prior permission of the Government of India. These Certifications are also causing a lot of confusion and disharmony for the regulatory agencies.

In this era where Government is moving towards One Nation-One Admission-Uniform Training- One Examination- Standardized Model there will be a dire need to immediately regulate and discipline these irregularities.

It is sad that Emergency Medicine has emerged as a front runner in this misconduct as this is a new specialty and the violators are misusing the brand value of Emergency Medicine to fulfill their selfish motives.

The violators try to justify their actions saying that they are doing “Capacity Building”. They forget that when it comes to be being certified as a SPECIALIST …there has been a system in place for India since independence. The Medical Council of India and The National Board of Examinations have that role well mandated.

CAPACITY BUILDING to improve Emergency Care by training physicians to better care is one thing but to assume and impersonate training programs and award non- accredited masters or degree is grossly illegal.

It is a known fact that India needs Specialist not only in EM but in every field. The worst fear is that If EM Violators continue to foster then other specialties will try to do the same and India will be flooded with Surgeons, Physicians, Pulmonologists, and Intensivists with all sorts of certificates.

It’s a Pandora’s Box which will spring open if this misconduct is not stopped.

At One hand Indian Hospitals are boasting of being a Medical Tourism Destination and one the other hand they are involved in irregularities.

I am a firm supporter of Governmental control of HealthCare and Medical Education.

Violations like these grossly undermine the authority of the Medical Council of India and the National Board of Examinations.

The Government is working hard to improve HealthCare at large and standardize the Medical Education system…..

The Emergency Medicine Irregularities have emerged to be its biggest hurdle.

Violators are fooling the medical fraternity and community while the government accredited degree holders MD/DNB face the uncertainty of being in a job market where non-accredited training and certifications are being doctored as the standards for qualification and quality care.

The future of hardworking post graduate qualified MD/DNB Emergency Physicians are in danger if steps are not taken to one and for all discipline the violators.

No Country would allow this indiscipline or forgive the violators.  India is no different!

I call upon my Fellow MD/NBE PG Students and Qualified Emergency Physicians to unite in this struggle against this fraud where the Authority of our Accreditors (MCI/NBE) is undermined and a mockery of Academic Emergency Medicine is being made.

The Time is now before it’s too late !

 Jai Hind !

 

Mergers, Acquisitions, and Physicians

From The Desk Of ~ Sagar Galwankar, MD

As I read the media there is never a time that I don't get aware that some group is buying some group or merging with some group.

Merging and Acquiring hold the same meaning : It means Reorganization of Resources and Finances for Better Performance and Stronger Position in the Competitive Landscape.

Each of the above words narrows down to only one thing - SROI - Strategic Returns on Integration- Which is a nicer acronym for Financial Growth.

Financial Growth for the harvesters and the investors who steer these initiatives.

The real question is : Where does it leave US (the emergency physicians) and what is our future in US (the United States)

In this aggressively reorganizing industry called EMERGENCY HEALTHCARE , I see ourselves being repositioned to be skilled laborers. We the laborers have a highly competitive growing segment  called the  Mid Level Workforce.

EM is going through a phenomenon called LEAP FROG.

The IT industry evolved from large computers to a stage of internet in phones. It evolved and expanded.

We in EM are now straight away a part of this technology driven Industrialization without going through phases of evolution. We have become a small part of the the capitalistic revolution.

We have leaped the cycle of Evolution in this capitalistic revolution, I just hope like the cycle of life evolution , we don't face extinction.

 Care and Cost Balancing is driving the industry productivity. 

Customer- client satisfaction is a metric for stability.

We as a speciality have to evolve with this leap and be aggressive to change, we should think and act to stabilize our present and sustain our future.

The specialty we love needs to live on and live in itself.

The time is now and Optimism is the first phase of evolution.

Fear to not sustain is the key to effectively sustenance.

Creating and Encouraging Thinkers and Innovators to come up with solutions coupled with implementation of strategies nationally are steps which can change things for a better future.

Rethinking Leadership and transforming Education And Innovation for a progressive tomorrow which is in sync with  the changing landscape is the need of the hour.

Change is inevitable & we are all able, let's work to make it stable !

Just thought , hence shared !

Good Karma is a Great Investment !

Yesterday I ended working the Hurricane Shifts. 

Patients came to  the ED With clean cut non emergent complaints.

I was a little taken aback until one of them after giving a long list of complaints 
softly said - " I am afraid of the dark"

That left me thinking - the ED is definitely not a happy place to be, the ED is 
not where I would wish for anyone to be , 
it's only when someone feels that they have no one or they 
will find someone who will care for them that they turn to ED.

Patients genuinely believe they have a problem and they come to us, 
and they confidently know that we will care for them and
WILL SEE THEM whatever their complaints are.

Regulations, Legal Threats and Metrics may be ruling us but over and above all these 
challenges ..... it's is the faith of these patients which keeps our specialty going.

I also get worried when I see patients seek pain medications and they come 
for non emergent complaints .... but thinking further ... 
who created that sense of security for them ..... 
the system did and we as a physician specialty did it ! 

It is challenging that we have to face so much 
pressures in terms of patients per hour etc and still balance satisfaction scores .....
 I will say that ..to perform and be calm in stress is not easy.

There is no one solution for what we are going through , 
but definitely there is one solution .....
 let's start thinking that we are the only ones who 
can help those who need our help and we have 
only a certain number of Of hours in which we can make a difference.

To be on the other side of the bed is not easy ..... 
when you make it easy for someone .... it does make a difference.

Good Karma is a great investment.

On another note .... 
our soldiers defend our nation and freedom no matter what it takes ...
 they are at the front lines of defense .....
we are the front lines of Health Security for our citizens 24x7 .

Our patients take it for granted that we will care for them and the EM system is solid ...
 that's a good thing !

Just Thought .... should share !

Stay Blessed ! 

It’s all about the Encounter……, but what about Metrics?

There have been waves of changes which are happening across the world of emergency care. Different nations approach emergency medical services differently.

The one thing that continues to remain common is the patients their pathologies and the metrics which govern the operations of emergency departments.

In accountable cultures the patient experience is a key feature of the emergency department visit. Physician salaries and insurance payment for clinical care are tightly tied to the satisfaction level of the patient once the care provided has been availed. It is more like an evaluation you give after you avail a Telephone customer service. There is also a lot discussion which suggests that Good Patient Experience in the Emergency Department leads to lesser complaints and lesser legal problems.

On the other hand we have the massive pressure of metrics. There are different metrics in different cultures and different nations. It’s all about the financial logistics which drive sustainability.

So the demands on the Emergency Physician are tremendous.

Let’s look at the parameters of this perspective:

Emergency Departments are getting overcrowded:

That is good for the specialty but also a reflection of the strength of primary care available. Hence when patients seek Emergency Care for primary Care pathologies….there is a strain on the system. Seeing patients fast, screening the life threatening pathologies out from the waiting room and maintaining pleasant patient experiences becomes challenged.

Emergency Department Metrics:

Metrics and Measures drive the working of a Modern Emergency Department. How many patients are seen per hour per physician, how many CT Scans are ordered, How many tests are ordered, how soon were antibiotics, aspirin and life saving measures instituted etc. These are benchmarks and may like these to which an Emergency Physician has to strictly adhere too or there may be no employment…

 Patient Experiences:

With the existence of above pressures which include seeing patients fast, evaluating them and treating them safely, and maintaining the numbers for meeting core measures and metrics the Emergency Physician is responsible for making the patient experience a satisfying encounter.

There is a lot of thrust on the above Marker. I am well aware that hospitals and health system are hiring 5 Star Hotel Hospitality Gurus to create Hospitality Training Models for health care workers.

How does one welcome the patient, how does one behave with the patient as soon as the patient car hits the gate of the hospital, till the time the patient goes home.

It’s all about Communication Skills….. That’s what it comes down too.

But what about Emergency Life threatening Conditions, Critical Life Saving decisions Scenarios, a critical environment where things change within seconds…..

Emergency Departments and Emergency Patients are different from Primary Care Patients and Clinic practices.

I firmly support that compassion is key to patient care and it’s all about communication skills BUT different things are done differently in different situations.

It’s good to be inspired from the airline industry to design a Safety checklist for healthcare and it is good to be inspired by the hospitality industry to introduce customer satisfying protocols….but in Emergency Health Care…. We have real patients…. Not Air Travelers and definitely not the crowd which visits resorts and beach hotels.

The psychological mindset is totally different on either sides… patients and providers.

We have to work on Safety norms which consider the culture of Acute Decision Sciences at the same time the Communication algorithms have to be modified into a systems approach.

Physicians have to be kind to their patients and communicate with them and also meet the metrics.

Greeting patients, updating them about the plan and also appraising them of the test results and the future course of action is key. Closing the encounter by telling the patient what you are going to do …discharge or admission and details of the process are key.

If you haven’t been able to appraise them then apologizing and then appraising them is of help…. But again this if put into a process will definitely change the way we deal with our patients.

The process needs to play a role because metrics and overcrowding are key factors and just assuming that Patient Experience is directly equal to Physician Communication Skills is not completely correct.

The whole culture of communication has to start from the time patient arrives in the ED. If the patient expresses the slightest concerns then the team member has to activate the physician of the concern and that should be addressed and documented.

Documentation is key and Communication is also visible via the documentation in the chart.

There will be patients who are tough to deal with … but again it’s all about the skills and not getting emotionally hijacked is the key.

All this needed intense training and an ongoing commitment to improve oneself. Taking the feedback on patient complaints positively and the advice of your colleagues and nurses positively is very important for personal growth as a human being.

Treat you patients like you would like to be treated……. My Teacher taught me that and I continue to practice the same !

  From the Desk of                                                                                                                                                                                         Sagar Galwankar, MBBS, DNB, FACEE (India), MPH, Dip. ABEM (USA), FRCP (UK)

PokeMon Emergencies : A Call for Public Health Safety

From the Desk Of:
Sagar Galwankar, MBBBS, DNB, FACEE (INDIA), MPH, Dip. ABEM (USA), FRCP (UK)

As I went to work I saw few of my colleagues discussing about this new app called PokeMon GO.

This is a Freely available Video Game played via a downloadable app. 

This allows players to capture digital creatures at real locations synchronized with GPS. The GPS Activated locations are called POKESPOTS and the players can capture and gain points called XP. 

There are various awards and rewards by playing this game. 

This has a lot of implications. 

There is massive Public Frenzy and craze and as I had guessed People are trespassing and many accidents and injuries are anticipated when driving walking as people continue to play  and not pay attention.

A New Era of Public Safety Threat has emerged and reached a whole new level !

I recently read this article: http://www.foxnews.com/tech/2016/07/14/death-by-pokemon-public-safety-fears-mount-as-pokemon-go-craze-continues.html

Were we not glued on enough to the Smart Phone on Social Media and video games ?

Were we not disconnected enough that Messaging became the New means of Communication ?

Were we not lonely enough that animated characters are the new friends ?

Technology can with advances but also came with Public Health Threats.

Smarts Phone created a new platform and era of STAT COMMUNICATIONS and UPTODATE INFORMATION.

That brought the Public Health Threat of Civil Safety as Social Media played an Open Access Platform with information about who is doing what and when.

It also brought to light the Road Safety issues where crashes happened while Texting.

It brought to light the violation of privacy of people in the world.

I believe that Mass Frenzy is a phenomenon which has often been the single most important factor to heightened ignorance and accidents.

Travel on Roads as a Driver/ Rider or Pedestrian, Walking at Home or at work and not focusing on what you do will cause a fall/crash and injuries are more severe than ever.

I have seen patients who have got insomnia as a result of sounds and rings of social media and their addiction to see the phone asap.....like a Pavlov Rat.

This Digital Plantation of Revolutions have brought a new age of humans who have isolated themselves to find solace in their single trusted friend.....their smart phone.

Video Games are the new friends introduced by this trusted friend.

There have been many news which have already started reporting injuries and accidents and I soon think we will have to ask for every car crash / and fall .....Were you playing on the SmartPhone ?

The answer may just be YES.

I think its time that Public Health Social Marketing Strategies highlight the urgency to design initiatives to break this addictive unsafe habits of SmartPhone Mania....so Public Health can be safer than before !

When people's mind is fixated on one thing then that is what drives their lives. 

Texting, trespassing and all the crashes falls and accidents with the above apps proves that these are sane people who are conditioned to commit themselves to this public safety risk and hazards..... this is much bigger than just a Habit.... this is addiction and the single biggest Mental Health Challenge to Public Health.

"For The Patients" ~ Lets talk about Headache in Adults !

From the Desk of Sagar Galwankar, MBBS, DNB, FACEE, MPH, Diplomat. ABEM, FRCP

The Patients who come seeking Emergency Care...."My Emergency Patients in My ED" is all that has mattered since years as it is because of them that I am a EM Doc and this specialty called EM exists.

I see lots of Social media Posts trying to be to become Education Materials. I see EKGs being discussed on social media. Nowadays they are the new classrooms.

So lets talk about symptoms which need lots of thinking and are High Risk.

This series will be called "For the Patients"

Today I will discuss HEADACHE.

Headache is one of the common symptoms when patients come to the ED.

Headache can be a Presenting Complaint when the patient arrives. "I got a Headache" and sometimes when patients are being evaluated at bedside for some other symptoms they can add the complaint "..and I also have an Headache"

History takes paramount importance when a patient complains of Headache as a Primary Symptoms or a Co-Symptom as a part of a Series of Complaints.

Always evaluate Headache keeping a 360 Degree approach.

Always address Headache. via your Thought process, History taking and Clinical Exam.


Vital Signs take a Lot of Importance and ask for them as you immediately prescribe pain medications to treat the PAIN.

Temperature, Pulse, Blood Pressure, Respiration, Pulse Ox, and Bedside Glucose are key stat Bedside Parameters which guide you to a story. Order an EKG Stat and read it.

Remember:  Gender does matter ! Pregnant Females & Females who do not know they are pregnant can come to the ED. Being Pregnant Changes the way you will evaluate these patients. Having abdominal pain, Hyperemesis gravidarum vaginal bleed can come with an headache and evaluating for abdominal emergencies and Ruling out Ectopic Pregnancy at the same time deciding about CT Head and Headache work up is a complex issue. They can also have HELP Syndrome or Eclampsia also can start with Headache.

Age is crucial before Young Female with Headache and Cold and Cough is different from a 50 Year old with Headache and Blurry Vision.

History taking should include: When did it start, how severe is it from a scale of 1-10, any other symptoms of Dizziness, Focal weakness, Gen weakness, Vision changes, neck pain, Syncope Seizures, Nausea, V omitting Diarrhea, Chest Pain, SOB, Neck Pain/Stiffness, Dizziness, Vertigo have to be ruled in or ruled out.

Past History of DM HTN CAD CVA Cancer HIV Hep B Hep C are important.
Is patient on anticoagulants also is key history point.

Some Cluster approaches are:
Fever, Tachycardia, Headache, Neck Pain: Here Headache can be as simple as a Viral Fever or as severe as early meningitis or even a URI if Cold Cough Sinus Tenderness are present.

Headache could be a early Bleed (Subarachanoid) or even a CVA when patients have vasculitis, Bleeding disorders, Hypertension , DM.

Headache can be due to Glaucoma or due to Otitis Media or even early Temporal arteritis.
Headache can be segmental along a nerve for a early developing Zoster.

Syncope, Fall, Seizure, Loss of Sensorium, Altered Mental Status with Headache all can be indicating a worse diagnosis  than how the Headache presented.

Post Ictal Phase can present as Headache.

Another con-founder: MI/ACS can also present as an Headache so can arrhythmia or PE. So EKG Trop are Important.

There have been cases who have presented as an Headache and when you do labs there has been Low Hemoglobin and patient has a GI Bleed and the Immediate anemia has caused an headache.

Be very particular and alert when Patients says "Headache is what brought me to the ED"
On the other hand there is tons of Literature of approach to Migraine in ED.

Its very important that you read the literature as there are various combinations of medications used to break the migraine.

When a patient says "I have a Migraine attack" you still have to approach it as an HEADACHE.

Sometimes patients present with Neck Pain and Stiffness and we disregard it as "Slept on wrong side or Neck sprain". Evaluating for Cord Compression and keeping Dissection and SAH as a differential is equally important as much as ACS/MI or even a Retro pharyngeal abscess in a URI patient.

What it comes down to is:

Vitals, Past History, Med List, Clinical Co-Symptoms, History of Complaint, Detail Clinical Exam to include total undressing of patient Neuro Vascular HFN HEENT Exam and Lab Results is crucial.

Overdose and Drug abuse are important historical points which can indicate Cocaine abuse or even overdose unintentionally on paracetamol ibuprofen trying to self medicate with Over Counter Medications.

CBC, LFT RFT Trop EKG UA Tox Screen and CT / MRI ESR are a part of the work up in ED.
In a patients with Hypoglycemia or Hyperglycemia Ketoacidosis versus Toxicity v/s sepsis or infection has to be kept at back of mind.

In HTN emergency headache can be because of raised BP and Raised BP can cause headache. Treating both is important but also is important ruling out cardiac pathologies a CT Head and look for Posterior Reversible Encephalopathy Syndrome.

I have also read reports where patients were on anticoagulants and had neck pain and when MRI was done it has Hemomyelia into the spinal cord.

There have been cases alcoholism where patients wake up with headache in ED but they dont know that Methanol or Toxic alcohols were also drunk and they have an Headache.

Being very aggressive to rule out meningitis and SAH and using Spinal Taps with Clinical Co relation is important in the ED.

Patients often return post spinal tap with headache and at this time Blood Patch becomes a choice after you have ruled out any other cause or pathology.

Patients also have headache after Nitro given for Chest Pain.

Fever can exacerbate Headache and Hunger can do that too.

A TIA can be presenting as Headache being one of the Co-Symptoms.

Documentation:

Always Document in detail the history the clinical exam and the plan for ordering tests and meds and chart your thought process and notes as you reevaluate the patient.

That helps and maintains the continuum of care at the same time maintaining standards of care.
Discharge is a crucial part. Here too Educating the patient and giving return instructions is key.

Do not Disregard or Less regard HEADACHE. Its a Part of the PAIN PATHOLOGIES which can cause PAIN if ignored.

Patients have Pain , treat it first but work it up and decipher the cause then treat the cause....  FOR THE PATIENTS !

EM or Critical Care, EM & Critical Care, EM-Critical Care, Critical Emergency Care or Emergency Critical Care- What’s the Right Choice for a Real World Emergency Physician in India ?

From the Desk of Sagar Galwankar, MBBS, DNB, FACEE (INDIA), MPH, Diplomat. ABEM (USA), FRCP (UK)

In my recent conversations with young residents who have graduated with an MD in Emergency Medicine and others who hold various kinds of Non Accredited MD in EM, Certificates, Rogue Masters in Emergency Medicine or Pseudo Diploma’s in Emergency Medicine I have come to realize the harsh truth about what these young trained physicians visualize themselves or rather where they are in today’s era.

We must accept the fact, that in India the majority of jobs for physicians lie in the private sector. When it comes to Emergency Medicine, Hospital Based Practice is the natural course for the career of an Emergency Physician.

Keeping this economic opportunity alive is the best a system can do to keep a specialty alive.

There was a time that Dermatology was the last choice for majority of graduating young physicians and today thanks to the economic growth of cosmetology and aesthetic medicine, Dermatology has suddenly become the top field of choice for new graduates.

There was a time Emergency Medicine departments were called Casualty Departments. This was in 1996 when I first saw the vision for Emergency Medicine and sowed the seeds for its development in India. Today Emergency Medicine boats of having many Father’s but these fathers were nowhere when I started my journey to bring EM to India. “Success has many fathers failure has none”

Anyways, when I started to convince the hospitals to start EM back in 1996, I was mocked and called the “Messiah of Worthless CMOs (Casualty Medical officers).”  It has been a long journey and today every private hospital tries to canvas and market its Emergency Services. The rise of healthcare and the demand and the brand of EM has gone up.

I question whether the economics has become equally lucrative or not for the job market. I will defend the later. Rogue Certifications and Diploma’s and the modus operandi run by many organizations to conduct non accredited courses across private hospital emergency departments led by one or two pseudo leaders (who don’t have any experience at education) has defeated the theory of categorical evolution of a specialty. Today these Non-accredited Programs are run by a Head of EM (who is also mostly having a non-accredited degree) and this head recruits up to 15 students per year by misguiding them that “One Day Their Certificate/ Masters will be recognized”. The students who join these courses haven’t made it to conventional MD/DNB programs nor have they decided to take the International Pathways to USA/UK. They pursue these Non-accredited programs as an option which will add a Few Letters after their MBBS. It would be nice if these letters had UK or USA with them. Whether these Letters really are recognized oversees or not is another story…because what do the patients realize anyways?

So here we are …..We have started these mass training programs across the network of biggest employer for EM … the corporate hospitals. These students generate high fees and income from an erstwhile Casualty now called an ED and also cost way less because it is now operated by a Ring Master called a “Head”. The “Head” Safe Guards his existence by showing this Operandi as a way of productivity for the hospitals.

I have previously discussed how holding conferences or awarding oneself also helps preserve this “Mirage of Image” for these leaders towards the employers and the young physicians who they want to mislead.

What Happens to these graduates once they gets their Diplomas, Masters Etc. The job market is congested with leaders/ Heads or will soon get congested with these pseudo courses. This is because the so called EM Leaders have fed an easier money making option to the employers.  There are no jobs and if there are any, they are low paying like even less than 1,00,000 per month with an expectation that in return for the title of the “Head” you are expected to run the the Operandi of Training which is become a Norm across the Private Hospitals in India.

It’s a vicious Cycle.

You do what you are taught and what you learn, you learn wrong, you do wrong. The people who do wrong believe that they are right and that’s why they do it !

The Premise “INDIA NEEDS EMERGENCY PHYSICIANS” is correct!

Well India needs Nephrologists, Cardiologists too. Why don’t we pick up all MD Medicine Doctors who know how to do Dialysis and give them a DM/DNB in Nephrology and so also all those who practice Diabetology a DM/DNB in Endocrinology. This cannot happen as every specialty has to evolve and that too with the evolution of healthcare services. By giving a viable option of cheap labor money generating non accredited training program to the largest employer of the specialty of EM, the growth of EM and the academic advantage to Emergency Physicians is gone with the wind.

So what are the options?

Critical Care is the only one which is viable.

Today Critical Care has been able to safe guard the job & Salary economics for its constituents, thanks to the structured growth of this specialty in India. CCM and its structured growth is in a way one of the deterrents to growth of EM because all that is expected from the EP is wheel the patient to critical care. The hospital makes more money if patient lies critical in the critical care unit rather than be stabilized in the ED.

This has given rise to idea that Emergency Physicians can handle critical care or rather emergency physicians are critical care physicians anyways. These students are made to believe that they are getting an Post Graduation in Critical Care with a Title of  EM.

Critical Care is a vast, labor intensive, high knowledge specialty which needs intense training. When you go to a CCM Meeting you realize the different sub specialties in CCM from Neuro to post-surgical critical care, trauma critical care, toxicology critical care  etc.

In India Specialties like anesthesia, chest medicine and internal medicine have made inroads into CCM. Physicians who have training in CCM even today work hard to gain knowledge and very few boast that they know all the sub specialties in CCM well.  

I have heard EM Leaders make callous statements like “what do critical care guys do ?” “Just give inotropes, antibiotics and monitor outputs from GI GU and feed via NG Tube/Peg Tube”

This is wrong and a total disregard for a specialty which is so crucial to healthcare.  CCM Experts do much more and definitely know tons more than emergency physicians. EM Physicians are expected to be trained in handling all emergencies. In India they are definitely not trained in Peads EM.  They can arrogantly boast and lie to themselves and others but fact is they are not trained…that’s the truth. When these misguiding leaders continue to misguide these young physicians that CCM is  EM and EM & CCM are one specialty….. I would call upon CCM Specialist to be cautious. There may be chance that Rogue Mafia will now invade CCM Centers with a Cheap Labor Hiring Operandi like they have done in EM.

 There is a big myth being floated to start EICU (Emergency ICU) so that money can be generated by labelling an area in ED and calling it an ICU. I have confirmed news that these model has started.

I would call upon CCM to safe guard its specialty by cracking down on these rogues. There are many failed Intensivists who have found home in Emergency Medicine. Their hospitals have given them leadership positions to head their Casualties where they too run the Training Operandi.

They need industry support to run these marketing campaigns like Conferences and Award Syndicate. The money is in Critical Care, so guess what……start floating the idea that EM and CCM is one…start training programs to match this myth and encourage graduates to work in CC Units and make CCM their future. Even conferences on EM in India now have partnerships and sessions on Critical Care…. A step to infiltrate a Structured Specialty.

In all these mess……We forgot why we were here…, we were here to provide EM Care to our patients, we started this specialty when CCM was already in existence and now we are coming a full circle to say EM is same as CCM. Yes Emergency Physicians can undergo more training (up to 3 Years) to gain adequate knowledge to staff a CCM Unit but to lead a CCM Unit it will be years. CCM is vast and a lot needs to be learnt. It is the same way Now days Heads of EM are appointed as soon as they confirm that they can operate the modus operandi ….and they always know CCM is there to back them up…

I urge my fellow interested youngsters to question all those who offer to guide them, check their credentials, ask around, talk to different people, explore whether you will have a good job career, don’t get emotional, you have worked too hard to be misguided by a few who are there because their job Is to generate cheap labor and safe guard their positions……

I want all who read my blog to understand that speaking the truth, hearing the truth and accepting the truth is better than to live in a False Reality....there will always be an explanation and a perspective.... the fact is ... is that perspective REAL ?

I believe in the truth and if its the truth.... its Real...I do not deter but I just speak it out !

The future is better when the present is good….and when it involves many then a few cannot reap its fruits…and if few are reaping its fruits …… many are not getting and will not be getting what they deserve……..That’s oppression by false motivation….

Till then the patient continues to seek Emergency Care……..expecting the best,  trusting what is being handed out…..well there is always Critical Care to back the ED anyways !