People in all lines of work talk of the job-related challenges they face, but most would readily admit that what they contend with pales in comparison with the challenges dealt with on a regular basis by Dr C C Lau. As chief of service in the Accident and Emergency (A&E) department at the Pamela Youde Nethersole Eastern Hospital in Chai Wan, he and a team of twenty-six medical staff working in rotation treat over 400 patients a day for anything from cardiac arrest to minor stomach complaints.
Although Dr Lau describes the department as a "tense elastic band at full stretch", he never fails to respond to the challenges the job brings and has even learned to embrace them. He recalls that, when he was a student, there was no structured emergency medical service in Hong Kong. Doctors were deployed as needed and regarded emergency medicine as a temporary post, but not an area in which to build a long-term career.
Dr Lau originally saw things the same way. After graduating from medical school, he spent two years in the emergency department before going on to complete a three-year training course as a general physician. However, instead of continuing along that road he decided to return to where he believed he could make a real difference. "Emergency medicine is more challenging," he says, adding that A&E work teaches medical professionals how to rely on their knowledge, skills and instincts to diagnose quickly and correctly and with limited investigations.
Each day will bring completely new cases, requiring doctors and other medical staff to use the full range of their training in life-threatening situations. They must make split-second decisions and, if necessary, be ready to perform surgery on the spot. "Even a cardiologist may not respond as quickly to a patient in cardiac arrest," Dr Lau notes. With so much going on, the A&E department is also the perfect place to gain broad experience and Dr Lau recommends that junior doctors spend at least a year there as part of their training. "After doing that, any doctor will be able to manage with ease in a general clinic or on the battlefield," he says.
While television shows such as ER and the recent popular Hong Kong series Healing Hands have sparked interest, Dr Lau says these depictions of the emergency room are "no more than 20 per cent accurate". He points out that quite a few of these fictional cases are included only for their dramatic element, but adds that the actual level of stress is higher than shown on TV, especially for the junior doctors.
In the real world, the daily routine normally involves two senior and four junior doctors being on duty from morning to late evening. When conducting an examination, they must be fast and accurate and always remember that a patient initially complaining of dizziness might have nothing serious or could be suffering from stroke, an acute heart attack or massive internal bleeding.
Some doctors find it difficult to adjust to the stress of the A&E department in the first few months. They must get used to non-stop nine-hour shifts, frequent nights on duty, and being on 24-hour reserve call. According to Dr Lau, those who do best in such an environment have "an open, quick and responsive mind, good interpersonal skills, the motivation for continual learning, and are decisive and hard-working." There are about 14 vacancies a year among all the A&E departments in Hong Kong, but the total number may vary.
Though some find it hard to handle the pressure, Dr Lau has spent his whole career in the department and believes it has given him a unique way of helping people. "Not everyone is equipped with the ability to relieve the pain of a dislocated shoulder or revive a patient suffering from an acute heart attack," he says. As a further example, he mentions one recent case of an old lady who complained of nothing more than vague chest discomfort, which is one of the commonest non-specific presentations to the A&E department. Trusting to instinct, however, Dr Lau decided to perform an ultrasound scan (echocardiography) of the heart after routine physical examination and found a tumour - a very rare condition. This speedy diagnosis no doubt helped to save a life.
Even with his hectic round of clinical and administrative responsibilities, Dr Lau has found time to assume the presidency of the Hong Kong College of Emergency Medicine. This body was formed nine years ago to govern the training of emergency medicine specialists in Hong Kong.
Outside work, Dr Lau maintains a keen interest in photography and spends as much time as possible with his family. However, he is forced to admit, "If your wife expects you to be home every evening and weekend, forget about emergency medicine as a career."
Standard operating procedure
- Emergency medicine requires special qualities and the
ability to handle stress
- It provides excellent training for medical staff who must
learn to diagnose accurately and react quickly
- Training and instinct come together in dealing with emergency
- Each day can be guaranteed to bring new challenges and