What are the primary recommendations for duty doctors in emergency cases?

Primary Recommendations for Duty Doctors in Emergency Cases

Duty doctors must prioritize patient welfare above all else, respond promptly and expertly without prejudice to all emergency presentations, and maintain readiness to provide care even during disasters or resource-constrained situations. 1

Core Professional Obligations

Immediate Patient Care Responsibilities

• Embrace patient welfare as the primary professional responsibility, placing it ahead of personal interests and needs 1, 2
• Respond promptly and expertly without prejudice or partiality to all patients presenting for emergency care, regardless of ability to pay 1
• Provide care to all patients presenting to the emergency department, as access to emergency medical care is a fundamental right 1
• Communicate truthfully with patients and secure informed consent for treatment, unless the urgency of the patient's condition demands immediate response 1, 2

Clinical Decision-Making Standards

• Make diagnostic and therapeutic decisions based on potential risks and benefits of alternative treatments versus no treatment 1, 3
• Diagnose and treat patients in a cost-effective manner while ensuring cost containment does not impede proper medical treatment 1, 3
• Practice only within your scope of training and expertise to avoid unnecessary harm; seek consultation when problems exceed your capabilities 1, 3
• Maintain detailed clinical records documenting the reasoning behind clinical decisions, especially when deviating from established guidelines 2, 3

Emergency Department Operations

Patient Flow and Responsibility

• Each patient must have a clearly identified physician responsible for their care at all times 1
• Transfer of responsibility between physicians must be clear to the patient, family, staff, and documented in the medical record 1
• When discharging patients, ensure clear transfer of responsibility to the admitting or follow-up physician, communicated directly to the patient when practical 1

Communication Requirements

• Cooperate with the patient's primary care physician to provide continuity of care that satisfies patient needs and minimizes burdens to other providers 1
• Support development of systems that facilitate communications with primary care providers, consultants, and others involved in patient care 1
• Maintain open channels of communication between health care providers to optimize patient outcomes, though immediate intervention may precede discussion when patients require urgent care 1

Disaster and Mass Casualty Response

Preparedness Duties

• Assist your institution and community to prepare for disasters as part of your ethical obligations 1
• Continue to work during disaster situations despite personal risks 1
• Use all available methods to protect yourself, your family, co-workers, and patients from risks during emergencies 1

Crisis Triage Principles

• When resources are overwhelmed, make triage decisions to benefit the greatest number of potential survivors 1
• Classify patients according to both their need and likelihood of survival when patient numbers and injury severity overpower existing resources 1
• Focus health care resources on patients most likely to benefit with reasonable probability of survival 1
• Make patients with fatal injuries and minor injuries as comfortable as possible while they await further assistance 1
• Be prepared to assume the role of crisis triage officer to allocate scarce resources when necessary 1, 2

Staffing During Crises

• Care should be provided by the most experienced clinicians available, with assignments based on staff abilities and experience 1, 4
• Under crisis conditions, staff may undertake duties outside their usual scope of practice, but must be supervised and supported by experienced clinicians to ensure patient safety 1
• If patient surge exceeds available critical care specialists, intensivists should supervise non-intensivist physicians 1, 4

Quality and Safety Obligations

Continuing Competence

• Engage in continuing education activities to maintain knowledge and skills necessary to provide high-quality care 1, 2
• Participate in quality assurance activities and peer review to detect patterns of inadequate care 1, 3
• Support development of scientifically based practice guidelines to assist in providing quality care 1

Error Management and Reporting

• Report colleagues who practice under the influence of drugs or alcohol, have untreated mental health disorders, falsify medical information, or demonstrate intellectual dishonesty 2
• Communicate errors in patient care openly, including any consequences that have resulted or may result 2, 3
• Report unexpected occurrences involving death, serious injury, or risk thereof to appropriate authorities such as hospital peer-review bodies 2

Violence Prevention and Safety

Protecting the Care Environment

• Protect yourself, staff, and patients from violence and teach EMS personnel under your supervision to do likewise 1
• Use restraints only when there is reasonable possibility that patients will harm themselves or others, never for punitive or vindictive reasons 1
• Frequently reevaluate the need for restraint of emergency department patients 1

Vulnerable Population Protection

• Diagnose, treat, and properly refer suspected victims of abuse and neglect, including partners, children, and dependent adults 1
• Report domestic violence to appropriate authorities as permitted or required by law 1

Common Pitfalls to Avoid

• Never allow financial self-interest to affect patient care decisions 2
• Do not practice outside your training and expertise, as this creates both harm and liability 2, 3
• Avoid using nurse practitioners, physician assistants, or trainees as emergency physician substitutes without adequate supervision and patient consent 1
• Never disrupt paramedical personnel who are under base station medical control when responding to prehospital emergencies 1
• Do not allow cost containment pressures to compromise proper medical treatment, though you should be knowledgeable about cost-effective strategies 1, 3