The practice of medicine at a district hospital emergency room : Middelburg Hospital, Mpumalanga Province

Abstract

BACKGROUND: The aim of this study was to establish the type of clinical work done by the doctors in the emergency room at a district hospital in an underserved area. The findings of the study would assist the management in planning for training, recruitment and allocation of medical and nursing personnel. METHODS: This was a prospective and descriptive study undertaken in the emergency department of Middelburg Hospital in Mpumalanga Province, South Africa. The subjects were patients who presented to the emergency room during the period of the study, in January 2005. RESUSLTS: The findings of this survey show clearly that Middelburg Hospital in Mpumalanga receives patients with life-threatening and non-life-threatening conditions in the emergency room every day. The top diagnoses made during the one month of the study were assault-related injuries, motor vehicle accident-related injuries, respiratory tract infections, lacerations, soft tissues injuries, gastroenteritis, fractures, poisoning, hypertension and parasuicide. CONCLUSION: The challenges of practising at a district hospital are that a practitioner has to be knowledgeable and skilful in a wide range of disciplines. To remain in touch with the changing environment of medicine, one has to keep on learning and sometimes attend refresher courses far away from the place of work. The rewarding part of the practice is that many junior doctors benefit from the experience of the senior colleagues, who teach them basic skills. A practitioner wishing to work at Middelburg Hospital should be skilful in managing common trauma patients, patients with complicated medical conditions, e.g. diabetes mellitus and hypertension, and in managing acute poisoning, respiratory infections and gastroenteritis. In other words, the practitioner must have adequate diagnostic and therapeutic skills.