fredag 25 april 2014

The Dinner

För ca 10 år sedan var jag på middag på en internationell konferens i akutsjukvård. Runt bordet satt jag plus 4 andra akutläkare från USA samt en dansk anestesiolog. Anestesiläkaren berättade om hur det fungerade i Danmark på det universitetssjukhus hon arbetade på:

- At our facility in Denmark, the orthopedic surgeon is the trauma leader, as most trauma patients will need orthopedic treatment, she explained.
- Interesting, the Americans responded, in the US, we have trauma surgeons at the bigger institutions, although most trauma at medium and small sized hospitals are run by emergency physicians and the surgical consults can be called in. But what if the patient requires a thoracotomy or a chest tube or similar, does the orthopedist take care of that?
- No, of course not, then we call the thoracic surgeon, our Danish physician explained.
- Well in the US emergency physicians are trained to do thoracotomy and other procedures, as the surgeons might not be readily available, especially off hours.
- So who does the airway management in Denmark?
- That is the anesthesiologists responsibility, she replied.
- Well in the US, as emergency physicians, we do all our airways, not only for trauma...but an anesthesiologist should be good I guess...What about the FAST exam, who does that? In the US emergency physicians are trained in ultrasound...
- Oh, in Denmark, we have the radiologist do the ultrasound exam and they are a part of the team.
- Ok, well I guess that sounds ok... (the Americans secretly doubted radiologists would be in house for any reason after hours and weekends, knowing their radiologists back home, but this was not discussed further...)
The Americans sat for a while contemplating this new unheard of world of difference, before one of them put forward another question:
- What about in a community hospital setting where you don't have all these specialists in house at night? Who cares for you then?
- Oh, then you are toast!!! Those patients have no chance. Community hospitals rely on junior physicians with minimal training and experience and they can not care for the really sick patients.

Akutsjukvård som specialitet vänder sig inte mot andra specialisters kompetens, vi vet att utnyttja andra läkares kompetenser när så behövs. Systemet med kompetens på akutmottagningen vänder sig till befolkningen som en lösning för att alla människor, dygnet runt, var helst i landet och oavsett symtom, ålder eller kön, snabbare ska få likvärdig kvalificerad hjälp och bedömning i akuta situationer.

Att anpassa akutsjukvården efter patienternas behov är ett paradigmskifte för svensk sjukvård, som sedan 1970 försökt anpassa patienterna efter läkarna på akutmottagningen. Det är kanske därför vi som akutläkare ofta möter en rad blandade reaktioner ifrån kollegor. Vår specialitet lämnar sällan någon oberörd, varken läkare eller patient.