In the first letter titled “I will be your doctor“, he talks of the crisis facing Australian Emergency Departments - specifically the problem of access block, where new patients arriving in the Emergency Department cannot be seen or treated because ED space is taken by patients waiting for in-patient beds.

Patients on trolleys are in the corridors, and there they stay until a free bed is found. Sound dangerous? Sure is. I am making life and death decisions in an overcrowded noisy chaotic environment, and it is your life or death I am deciding about. No wonder we’re both stressed.

In the second letter “Five steps to a cure” he outlines 5 ideas which he hopes will help tackle the growing problem.

Queensland in particular is experiencing a growth in population. As reported by the Courier Mail, the population has increased by 100,000 in the past two and a half years, but the number of hospital beds has increased by only 900.

I have finally learned that there are some patients I probably won’t be able to help medically and that it’s actually cruel to let them think otherwise. For instance, the patient with the low back pain that’s been to seven neurosurgeons (had three operations), been to the Mayo Clinic and to innumerable chiropractors, who looks at me and says “I need to get better”, what’s causing the back pain? Realistically, what can I offer that a myriad of specialists couldn’t? Oh, I’ll do the entire LBP exam, do a history looking for zebras and other horrible causes of back pain, and occasionally I’ll want to do some tests to rule out an emergency.

Often with these patients, what they want is not purely “medical” (i.e. a diagnosis or cure). There is a hidden agenda - fear, isolation, stress, strained coping mechanisms, breakthrough pain, grief, being at the end of one’s tether, etc. Sometimes the patients themselves haven’t thought about exactly what led them to present to the ED that day!

Sometimes I start the consultation by summarising their entire previous medical history in front of the patient. This shows that I am aware of their case, and really builds a trust and rapport. Patients appreciate the impression that you have already taken the time, care and effort to find out everything about them.

Then I cut to the chase by directly asking what exactly they want from me today.

This sort of direct questionning certainly helps to crystalise in both the patient’s and the doctor’s minds what their expectations for the consultation are.

With a better understanding of the patient’s expectations, both doctor and patient are in a better position to negotiate a realistic end-point for the consultation. By identifying hidden agendas early in the consultation the Emergency Physician can focus the consultation on delivering precisely what the patient needs at that crisis point in their chronic illness, rather than offering what he assumes is needed.

1. Too much exogenous insulin. This can be accidental or intentional.
2. Too little food intake, such as due to vomiting.
3. Increased metabolic demands such as occurs during strenuous/unaccustomed exercise or illness. Patients who have taken their normal insulin dose are not able to then modulate/reduce insulin levels during exertion as would normally happen in healthy individuals.

Hopefully there will soon be some interesting content here, but in the meantime why not have a look at About EMEDology.com for some information about this site.