Traditional emergency room (ER) medical treatment used to be a collaborative effort between different hospital departments. From the time patients check in to the ER, to their hospitalization, recuperation and discharge, treatment was jointly provided by specialists in different fields, such as internal medicine, surgery, pediatrics and gynecology. This was good both for taking care of patients and for training specialists. This has changed, though, with the establishment of the ER specialist system in the 1970s in the US, and independent specialists monopolizing ERs have become the targets of lawsuits from surgeons unhappy with the situation.
Since 2007, ERs in the US have been beset by overcrowding and the quality of treatment has deteriorated. Hospitals sometimes hire medical students and disguise them as patients in order to assess the quality of ER services, resulting in the dismissals of erring specialists. As a result, there have been calls in the US to reform the ER treatment system, including further sub-categorization of specialties.
The training of clinicians in Taiwan lags behind that of the US. The quality of ER care in Taiwan is poor in comparison and numerous doctors have been found guilty of negligence.
Patients who have no channels for filing their complaints vent their anger on medical workers. Unfortunately, this has not spurred ER specialists to examine their performance and seek improvements.
Instead, they get angry and think of the patients and their families as violent mobs. The specialists have asked the Taiwan Joint Commission on Hospital Accreditation to conduct a review of hospitals and force them to rebuild their ERs and set up two security gates with guards around the clock.
If patients had to go through two security checks, that would have a serious impact on emergency treatment.
Admittedly, some drug addicts in Taiwan frequent ERs to ask for morphine injections, claiming physical aches and pains as a pretext, and doctors who do not do as they are told are attacked. To deal with such violent behavior, all hospitals need to do is place warning signs that read: “Warning: Drug addicts who disturb public order will be sent to the police immediately.”
As for drunk patients who are escorted to the ER for treatment, that is not an issue of social order, but a matter of acute alcohol poisoning, so there is no need to call security guards.
Occasionally, gangsters might fight their way into an ER. If that is the case, a security guard will not be able to do anything and police should be informed. Medical disputes in which protesting families of a deceased sometimes carry coffins and burn paper money in the hospital can be resolved by reforming legislation governing medical disputes and strengthening the authority of the police.
There have also been cases where fraudulent insurance brokers harass ER doctors with falsified disability certificates and on very rare occasions an impulsive patient might physically attack a doctor. All these are issues that the government should resolve once and for all.
When I was studying at the University of Chicago in 1975 and reported to the school hospital, I was first told to go to the security office and have my personal file set up and an identification badge made. The hospital had a security office to maintain safety and order, and this includes the ER, patrolling the hospital and handling emergency situations.
Taiwan has blindly followed the US’ ER specialist system. A serious discussion of the issue and improvements are needed.
I call on President Ma Ying-jeou (馬英九) to pay greater attention to the rights of Taiwanese who seek ER treatment. He should promptly appoint a minister without portfolio to form a special team, invite the heads of the Department of Health, the Research, Development and Evaluation Commission, the Ministry of Education’s Committee on Medical Science Education, medical specialist associations and hospital associations at all levels to carry out an investigation.
They should form groups to inspect the ER systems in Singapore, Hong Kong, Japan, the UK and the US in order to reform Taiwan’s ER system.
Hsieh Yen-yau is deputy superintendent of the Koo Foundation Sun Yat-sen Cancer Center.
TRANSLATED BY EDDY CHANG
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