Ten Commandments of Emergency Medicine

1. Your first duty is to minimise the danger of death or deterioration in your patient’s health, to relieve their distress and to arrange for their appropriate disposal. Worry about distress and deterioration, not diagnosis
2. Be meticulous, legible and logical in your clinical notes. This will help everyone else involved in the patient’s care, initially and later
3. Wash your hands before every patient contact. This is the simplest way of reducing disease transmission
4. Only undertake investigations in the ED if they are going to alter the immediate management of your patient. You may need to justify your actions (e.g. ordering x-rays or blood tests) to the individual patient (and family), in a clinical governance setting and in a court of law
5. Be evidence-based, logical and cost-effective in your prescribing. Don’t prescribe adverse reactions and unnecessary expense
6. Follow the WHO recommended “analgesic step ladder” in relieving pain, i.e. (i) Paracetamol; (ii) Ibuprofen, (iii) Codeine-Paracetamol combinations (iv) Opioids. Only in unusual circumstances should alternative medication be provided (e.g. NEVER use Pethidine unless discussed with your consultant)
7. Only undertake procedures whose benefit to the patient outweighs the hazard: e.g. Plaster of Paris should not be badly applied when a simple splint might do. And don’t give medication intravenously when normal gastrointestinal function exists, unless there are special indications
8. Get advice or a review whenever in doubt: this means asking senior medical and nursing colleagues and communicating your plan of care to the nurses and your registrar
9. Arrange follow-up for every patient: e.g. by their GP, if no other follow up arranged. The easiest way to reduce error is to ensure that all patients who come to the ED are reviewed medically at least once thereafter
10. Treat the patient, not the test

Dr Chris Luke, Prof. Stephen Cusack