I was in training. For two months, familiar routines, work assignments and fixed reception hours in the usual workplace were replaced by the primary emergency room of the small hospital’s medical emergency room – a rapid and very tangible iteration of broad internal medicine.
Younger and enthusiastic colleagues support the old one and show where to find pm and the latest guidelines for dealing with various ailments, and get an introduction to using ultrasound. Why wasn’t this learned from a college anatomy course and then included as a normal part of a patient’s examination alongside a stethoscope?
Weeks go by, you feel some warmth in your clothes. Oddly enough, I thrive best in the emergency room: being part of a team where all categories and professional skills are needed and working together to help a patient is satisfying.
Over time, a certain research pattern crystallizes:
- Patients with acute illnesses
- Patients who think they are sick (“sickness is feared, and they are found healthy”)
- “Di gamle” who leads a itinerant presence between inadequate municipal interventions and brief care sessions where they receive either a drip, questionable Selexid or a Furix injection (or all together), and between them on their way home by ambulance or on their way back to the hospital in a car first aid
- Those who applied but did not make it to the appropriate care institution or received the correct assessment. Here they may be considered “to be called” but not told when to visit or the visit is so anticipated that they won’t make it until then.
It becomes clear that there is a lack of an important health care link between the health center and the emergency department and that accessibility is a clear lack. Most patients can be helped by seeing their doctor at the appropriate time in the health center or during the subacute reception activity in the various specialized clinics of the hospital.
Where are the flaws? There were not many doctors in our country. Are we still a victim of the NPM? Can we just apologize and say something is wrong with the “system”? The medical profession should have every opportunity to design the best way to organize health care. The pandemic has shown how healthcare can be done from a purely medical perspective – is anything else heavier?
I am risking a few suggestions for better care of our patients.
- Primary care is the foundation of health care and must be given opportunities to be able to carry out its mission. The vast resources focused on major hospitals in recent decades have not cut any waiting lists for care. It is unreasonable for the concentration to continue, with the addition of cumbersome management and logistics. Expand Primary Care!
- In line with the ever-decreasing number of care places, hospitals must shift to more reception and day care activities and the opportunity for rapid return visits and sub-acute visits. This requires a change of focus and modus operandi where inpatient care is relevant only when it is necessary out of necessity.
- Compulsory consultation? OK, but perhaps a mandatory phone call to the emergency room/sub-specialist from a fellow district who is considering a referral to the emergency room. If the patient can be admitted to the front desk within two days for an evaluation, the patient (possibly green during triage) can avoid spending half a day in the emergency room and will likely be sent home from there.
How do we doctors want health care to work? If you are sick, how would you like to get a quick and accurate assessment of your illnesses? Research and education are an absolute necessity, but they must not end up in opposition or in the way of patient appointment. The ball is in the doctor’s court, regardless of whether it is a private reception or a public level. Time to do something about it?!
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