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Are We 5 Minute Doctors??Dr. William WilsonImagine a busy ER , bustling with patients, haggling attendees, screaming nurses , amongst all this chaos

A casualty doctor, harassed by it all, after seeing as many as 3 patients in 5 minutes he calls the respective specialities..

To Orthopaedecis , doc there is a patient with fracture leg ! To Gastro there is a patient vomiting blood , To Ophthal there is a patient who cannot see!

In a matter of less than 5 minutes 3 patients seen and disposed, isnt this what CASUALTY medicine is all about !

Once again the day is saved by..

Or did you think it was effective history taking swift examination and even quicker ability to come up with a management plan ??

The other day I spent 5 minutes in the chaotic TRIAGE trying to identify the most serious of: abdominal pain of the 10-12 patients with similar complaints10-12 cases of fever

In the ED5 minute wash of the wounds of a young biker under the influence

Another 5 minutes (if youre lucky )in settling the agitated (read drunk) attenders about the hows/whys/whats of the patients condition.

I was alerted by the moans and groans of a pregnant lady rolled in , along with nervous husband , mother , father/sister/uncle/godfather and even more agitated neighbours!..

SHE WILL DELIVER NOW,SHE IS DELIVERING! Quick hand wash, gloves jelly and a PV later I realized she was far from it.Young girl patiently waiting for someone to see her.

Abdominal Pain and had low BP ,

She appeared very cagey , with her cold clammy limbs and persistent tachycardia,

Starting her basic treatment , I pried more into personal history

A potential ruptured ectopic requiring immediate surgical intervention???

The next step was even more difficult explaining to her the nature and seriousness of her condition . surely all this would be a simple 5 minute job ...right ??

CRASH CART !!

Jumping to my feet I ran towards the resuscitation bay only to find a rather comfortable middle aged man complaining of headache.!

The team looked around and breathed a sigh of relief.

CASUAL-TEA!!CODE BLUE

CODE BLUEArrest in the ward !Quick assessment with brief history, Multi-tasking with intubation, ABG, Getting the 5 Hs and 5 Ts ..Shockable or non shockable rhythms , keeping a cool calm collected head to be a team leader, Sometimes just 5 minutes that decides whether someone lives or dies ! The entire roller coaster of emotions free with daily adventures of being an Emergency Physician.

In the wards/ICUMyriad of cases ranging from different specialities After pulling through my shift of 7 or 12 hours ( i can hear the internal med residents go thats all 7 hours ?) I go to the wards and ICUS to spend another 5 minutes reviewing the cases that I admitted , going through the case sheets , Checking if my provisional were along the right track, have fruitful discussions with the doctors of the ward ,adding and contributing to their management plan.

22 yr old IT professional comes with two day history of vomiting , diarroea, and mild abdominal pain. Treated outside with Tab ciproflox day2 No change in symptoms

VITALS : Stable only signs of dehydrationPlan : basic investigations + fluids + admission

Follow up in ward : shifted to ICUFollow up in ICU after 48 hrs : EXPIRED !No case is easy and basic !

Working on stable side or stable cases doesnt mean you can chill out!!

Impossible to diagnose but always good to know!

Basics such as Vitals on transfer, keeping differentials broad!5 minutes that is where we started right ??

Sometimes for a patient with a serious trauma the 5 minutes you get, to intubate and put in an ICD is the difference between him being alive or not..

SOMETIMES

5 minutes is all you get in the ED for history/examination/diagnosis and treatment.

5 minutes is all you get to explain / comfort/console /reassure /the worries /doubts and problems of the attenders and relatives.

5 minutes is all you get to convince the desired speciality in his own medical language the urgency of the consult (without losing your cool!)

5 minutes is all you get to spend with some enthusiastic undergraduates to teach during your work!

SOMETIMES

5 minutes is all you get to find the cause of the arrest !!

5 minutes is all you need to follow up your cases in the wards and ICU's to learn from your own mistakes

5 minutes is all you need to fulfil the social responsibility by educating the paramedics about the basics which can save a life

SOMETIMES

And after all this, in 5 minutes, the attenders / patients forget about the difference you made in the so called 5 minutes you got with them !

As I let my thoughts run loose I dream about the 5 minutes I might get with policy makers and govt officials and present to them the number of changes which we can make better EMS , green corridors and what not !

and till I get there...

"The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep."