Doctor P. Uksas. Photo: VU MF
“Working in the Emergency Department is probably the most dynamic work in the medical sector,” said Paulius Uksas, one of the first emergency medical doctors in Lithuania. The doctor maintains that the situations when there is no time to sit down or take a comfort break, occur on a regular basis during the time on duty. This stressful work routine requires a lot of endurance, patience and physical strength, but as the doctor likes to joke, the shift will eventually end.
Work full of stereotypes
“Emergency care has always been the place for all ‘medical mavericks’ – doctors who had some problems or who challenged authority. They had to withstand the flow of patients to the hospital. In the past, this might have been the case – an emergency department was like a place of ‘exile’. However, over time, it has become a representative place of a hospital, on which the patient’s satisfaction with the quality of the services and the prescribed treatment going forward, largely depends,” said Dr Uksas.
The doctor says that time slowly changes the prevalent attitudes, both in the hospital and in our society. Although in Lithuania, emergency departments in most hospitals are called hospital “Reception”, this has been changing for some time now. “We don’t just receive patients here, we provide emergency care and, if necessary, admit them to hospital”.
“Patients in the age range of 40–50 usually come for emergency care services to receive initial examination and diagnostic services, emergency care, and health improvement. They come to the Emergency Department without the intention to be admitted to hospital and usually want to continue treatment at home. Older patients expect to be admitted to hospital immediately, because this was the practice in the past, when by following the one-stop-shop principle, a decision was taken there and then to admit to hospital and they were kept in hospital for a week, and fed, etc. But if a person can take pills, he can do it at home, under the supervision of their relatives or social workers,” the doctor further explained.
According to Dr Uksas, the perception of the functions of the Emergency Department has also changed. This is no longer the department where a patient is admitted or not admitted to the hospital, but a department for emergency care and a decision on what to do next in each particular case. “The perception is slowly changing, people will adapt to this over time. This system should function well in the future in cooperation with GPs where an individual treatment and tracking plan for a patient will be prepared,” he said.
Doctor P. Uksas. Photo: VU MF
When patient expectations exceed the possibilities
“About 30% (and sometimes more) of patients we receive, are not eligible for emergency care. These are the patients for whom, according to the guidelines in the Minister’s order, there is no urgent need to go to the Emergency Department. In this case, we provide accelerated consultancy services by fixing what the polyclinics had to fix – after all, if a polyclinic does not have one or another specialist doctor – the belief is that the Emergency Department can fix everything,” commented the doctor, ironically.
The mission of the Emergency Department is not to provide health care advice or accept patients in order to reduce the waiting lists at polyclinics. “An more reasonable individual will wait for their turn on the waiting list of a polyclinic and receive services in the normal course of things, but there are those who try to make their way by screaming or other interventions. There are also some bizarre situations where patients come for a health check, others just want to check their sobriety, and yet others arrive in the middle of the night to be comforted because they can’t fall sleep. The variety is endless,” Uksas noted.
When asked, whether they get more gratitude or complaints from patients, the doctor replied that the Emergency Department gets more gratitude: “Lithuanians are not the kind of people to express their gratitude officially, in writing – they are rather discrete – but when we get angry, we certainly will not forget to complain in writing. Most complaints, however, are unfounded, usually emotional in nature, due to unmet expectations. I used to get somewhat angry, but now I realize that you can’t please everyone and I try to justify them, because their health or the health of their family members is the most important thing and everything can be justified for the sake of receiving medical help. However, some of the cases we have recently heard about in the media are altogether unjustifiable.”
Doctor P. Uksas. Photo: VU MF
Among the first to complete emergency residency in Lithuania
“I can see that the need for this specialty is gaining momentum. While studying in the new residency study programme we did not know what we would end up doing or how society, employers, like-minded people, other employees of the department or doctors of other specialties would view us. We didn’t know if we would really be needed as specialists or whether this specialisation would work,” Dr Uksas added. He was among the first specialists to successfully complete emergency medicine residency studies at the Faculty of Medicine at Vilnius University.
Today it is clear that the specialty of emergency medicine doctor has worked and the specialists and doctors from other departments are happy it has been established. Their work has become simpler to a certain extent: “With the arrival of this specialty, the examination of the patient in the Emergency Department has significantly accelerated. Unlike specialist doctors, we can consider things more broadly. An emergency doctor assesses a patient holistically, and if any pathology is determined, we can direct the patient to the appropriate specialist. The case is resolved.
What was it like before? A person admitted to the Emergency Department would go to a traumatologist, an ophthalmologist, a neurosurgeon, neurologist, and so on – the path was very long. One doctor might write that the patient has no problems on his side of specialisation, the other doctor might feel the same. Finally, a third or fourth doctor might diagnose something, but still direct the patient to a fifth specialist, only for the patient to be returned to the fourth specialist for the case to be resolved. Lots of confusion! Just think what it looked like to the patient. We, doctors of emergency medicine, can handle all this chain on our own. It requires a lot of knowledge, but it creates great added value for the patient, saving time for both them and all other patient care workers,” the doctor explained.
Doctor P. Uksas. Photo: VU MF
If you want to just test this specialty, perhaps it is better not to start
“This specialty reflects my personal character – I don’t like monotony very much,” Dr Uksas admits. There are days when the Emergency Department also has to face a standard routine, but these days are far fewer than in the regular hospital departments: “Every workday, every day being on duty is different. No two days at work are ever alike.”
However, the doctor admits that the residency studies and work are complicated. “They demand certain character traits, so those who would like to enrol in emergency medicine residency to test it or to test themselves should not even begin, because they may be disappointed. This is not the most beautiful or tidy specialty, the work is hard, but not boring. It will never be easy, comfortable or attractive,” Dr Uksas added.
The doctor believes that the emergency medicine residency study programme and subsequently the workplace are suitable for those who are interested in differential diagnosis and diagnosing diseases: “There are many cases that are obvious. However, some conditions require a lot of effort to diagnose. The result brings considerable pride and satisfaction – we diagnosed the disease! Afterall, nearly all the TV series that most medical students and staff know by heart are about emergency care. Apparently there is something in this job that makes it very appealing. While we, as the primary unit in the hospital, are often forgotten, the opportunity to help the patient, to determine the diagnosis, pays off.”