Emergency medicine (EM) is a fast-paced, team-oriented specialty that could create a tremendous impact on patients. The 24/7 nature of the emergency department forces emergency physicians to admit or consult uninsured or under-insured patients—many of whom have complicated medical or social situations.

In addition, the emergency physicians often function under the constraints of limited time, limited resources—diagnosing and managing the acute, undifferentiated patients. Considered as a vital part of the hospital – deemed as the “safety net” – emergency physicians treat everyone who comes through the door. In spite of that, they are sometimes undervalued.

Donned in a red shirt and a jet black jacket, Dr Alzamani Mohammad Idrose hurriedly ushered me to a couch at the lobby of the Malaysian Tourism Centre (MaTiC)—where he had earlier delivered a talk on high altitude sickness (one of his medical areas of interests). As part of the Merdeka de’ Everest 2007 medical team, Dr Alza is certainly no stranger to the topic, in which he shared further insights into high altitude sickness with a group of mountain climbers during the talk. We scooched over for a chat with Dr Alza, a Consultant Emergency Physician and Disaster Medicine Specialist at Hospital Kuala Lumpur (HKL), to get a better understanding of what his job as an emergency physician entails—and more importantly, what keeps him going, despite the constant challenges and obstacles in the field. 

Dr Alza shared further insights into high altitude sickness with a group of mountain climbers.
Dr Alza shared further insights into high altitude sickness with a group of mountain climbers.

Caring for one undifferentiated patient at a time

Having practised in the Emergency Department (ED) for almost 20 years, Dr Alza points out the importance of how EM doctors “need to be on their feet all the time”.

"My training is that I cannot choose patients. I cannot choose when they come, and I cannot choose what disease or they have," says Dr Alza, in a solemn voice.

“When patients arrive at the emergency department, they are undifferentiated, coming from all walks of life.”

As first-line providers, emergency physicians are responsible for initiating investigations and interventions to diagnose and/or treat patients in the acute phase, co-ordinating care with physicians from other specialties, and making decisions regarding a patient's need for hospital admission, observation, or discharge.

"Nobody knows what they have for sure, until we go through with them, establish the diagnosis, and initiate the treatment and management. After the diagnosis is made and the management has begun, only do we pass them on to the definitive doctors, depending on the nature of the emergency," he explains.   

"I handle it case-by-case. First, establishing the diagnosis, then initiating treatment and stabilising the patient," he adds.  
   

A 'doctor-of-all trades': Saving one life at a time

Within a few hours of an EM doctor's shift, he or she can reduce a shoulder dislocation, evaluate a suicidal teenage, manage a multiple trauma moving vehicle collision, place a chest tube for a tension pneumothorax, and evaluate a 3-year-old for abdominal pain.  

The scope of EM is wide—so wide so that it requires a broad field of knowledge and advanced procedural skills, including surgical procedures, trauma resuscitation, advanced cardiac life support and airway management. “It is not wrong to say that they have to have the life-saving skills of many specialists as they might have to suture a complex laceration, treat a heart attack or work-up a pregnant patient with vaginal bleeding,” enlightens Dr Alza.  

Dr Alza further details a few hours of his daily shift, depicting the urgency and fast-paced setting of the ED.  

"Multiple resuscitations can occur at the same time! I would have to go from one patient to another, sometimes to even organise for a patient to enter an OT, while transfusing blood for another. There are many things going on at the same time. Simultaneously," illustrates Dr Alza.  

On busy days, it is very common to see all hospital beds and trolleys filled up.  

“In that situation, we also have to juggle our patients – moving them around quickly, working very closely with our nurses in the hospitals," explains Dr Alza, with an undertone of appreciation for his colleagues.

Dr Alza (R) went undercover to understand his colleagues' work by experience. Photo credit: The Star

Dr Alza (R) went undercover to understand his colleagues' work by experience. Photo credit: The Star

Driven by positive transitions of patients

Dr Alza also believes that the EM practice is beyond the four walls of the hospital, because "we have to be around to provide assistance, even before the patient comes to the hospital, and what happens during trauma or disaster incidents."

As such, EM doctors are exposed to high level of stress—often managing many critical patients at one time. Death of patients is also frequently encountered, along with patients who are victims of child abuse, rape, or other terrible situations.  

It is widely speculated that emergency physicians have one of the highest rates of burnout and shorter effective careers. However, according to the 2008 American Medical Association Physician Masterfile, the emergency physician attrition rate is only 1.7% per year, lower than 2% – 3% average of other specialties.

Dr Alza believes that this is because EM doctors "focus on the things that can be changed and will not spend time on things that cannot be changed."  

Despite the high stress levels, having to deal with difficult patients and physicians, and being on-call during weekends and holidays—most emergency physicians do find joy in doing what they do.  

"We find joy in transition patients. For example, when someone is nearing death from the loss of too much blood, has his or her heart beating again, with the blood pressure returning; or someone who comes in screaming from severe pain, and is comforted after our interventions—we find joy in that," explains Dr Alza.  
He continues, "Every patient who comes in the emergency department and shows that positive transition, makes us happy.”

“That is why we are still there, despite all the insanity," says Dr Alza, with a smile.  

To those aspired to be emergency physicians, Dr Alza advises that "you need to do something that you are truly passionate about. It does not even have to be my discipline of medicine. It could be cardiology, nephrology, psychiatry, so on and so forth. We are in an ecosystem of needing one another and that we respect one another's specialty.  

"So, go look for your passion. And if you do not have much of a choice, you can still look within that specialty to ‘create’ that passion. Find meaning and purpose in whatever you do—and it would give a sense of accomplishment and satisfaction."  MIMS

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Sources:
http://www.medscape.com/viewarticle/750482#vp_1
https://www.aamc.org/download/47352/data/specialtydata.pdf