Dr. Stephen Thomas on Emergency Medicine's Past, Present and Future
A chat with the Associate Editor of Tintinalli's Emergency Medicine: A Comprehensive Study Guide
Dr. Stephen H. Thomas, MD, MPH, FACEP, is Professor and Chairman, Department of Emergency Medicine, Hamad Medical Corporation and Weill Cornell Medical College in Qatar. He is Emergency Physician-in-Chief at Hamad General Hospital.
Dr. Thomas is on the advisory board of AccessEmergencyMedicine.
AccessMedicine: What inspired you to study medicine, particularly emergency medicine, your specialty?
Dr. Thomas: My interest was in the acute interaction with the patients, whether it was trauma, cardiology, septic shock, overdose or anything else. One reason emergency medicine has worked out well for me is because it’s a broad fount of knowledge more of a breadth of knowledge than a depth. We are in a position where we ought to be able to handle just about anything for the first hour or so. We know how to straighten out a broken nose, but we don’t know how to operate on the nasal passages. We take care of the stabilization and initial care. That’s been very appealing to me and it’s how I ended up in emergency medicine.
AccessMedicine: Where did you study and how did your fellowships and faculty roles build across your career?
Dr. Thomas: I went to Louisiana State University. There was no emergency medicine course there, but I was interested in the evaluation and care of acute patients, ill or injured. I also had some interest in air medical transport, Helicopter EMS (HEMS). That brought me to North Carolina where I did my training in emergency medicine. I also did a fellowship as a HEMS Physician.
From there, my journey went to Boston. I had an additional interest in mathematics and statistics, so I studied at Harvard University and got a master’s degree in quantitative methods at the public health school at Harvard. I spent about 17 years in Boston, after which I left to go to Oklahoma to learn how to be a chairman. I spent five wonderful years in Oklahoma with a new medical department. The next step was a bigger step: to try something new in the Middle East. That’s how I ended up in Qatar.
AccessMedicine: You are working on an innovative new emergency medical hospital in Qatar. How did you come to be part of this project, and can you share some details about it?
Dr. Thomas: Qatar is getting ready for the World Cup in 2020 and it’s going through an enormous process of building an academic health system, surrounding the hosting of the World Cup. That was what brought me to Qatar, because they were looking for somebody with my background. I report directly to the minister of health as the emergency medicine person for the country. It’s a country of almost three million people and we run a significant number of emergency department visits—about one million per year across four sites. They were looking for someone to bring an American style. That’s how I ended up in Qatar.
I don’t know if there is any other bigger emergency department. We’re opening in just a couple of months. The ER has five floors, with offices on the fifth floor. The rooms are enormous and even so, depending on how one counts the rooms (not counting 10-15 stretcher bays), we have about 250 beds in the ER over four floors. It’s huge: 30,000 m². It’s beautiful. It will be a good place to take care of people. Everybody in Qatar who needs emergency care can show up to the front door and we’re happy to take care of them.
AccessMedicine: How does technology play a role in this project?
Dr. Thomas: Technology has been a big part of the project. It is incredible! We have technology that is as good as what we had at Massachusetts General Hospital, where I spent most of my career in the United States. We have 25-30 state-of-the-art ultrasound machines and state-of-the-art fiber optic equipment for looking at and working with airway management. We have excellent surgical tools. We do see an awful lot of trauma, including a terrible number of car accidents, so there is a lot of blunt trauma. We see fingertip amputations, tendon repairs, and many other injuries. If it’s in Tintinalli’s Emergency Medicine, we do it. We have excellent instruments for that sort of work. Our surgical lighting has TV cameras in it. We are really given all the technology we need to do the job.
AccessMedicine: As the third-busiest ER in the world, what are the targets and goals around patient care versus speed of treatment?
Dr. Thomas: In the UK there is a lot of emphasis on a four-hour benchmark to make a disposition decision on patients who come to the emergency department. We don’t quite have that four-hour target in Qatar. We see about 45,000 patients a year which makes us, according to a recent World Health Organization report, the third-busiest emergency department in the world!
When you are pushing half a million patients through in a year in a single department it’s not going to be easy to see them all quickly. We do follow efficiency outcomes very closely with our superiors at the ministry of health. We get to everybody on average within around 45 minutes. We do pay a lot of attention to operational parameters in the current ER. In the new department we will have the same target to move people in and out expeditiously and I think we’ll be able to do this better in the new building.
I’ve spent a lot of time talking about (efficiency outcomes) in Massachusetts and Oklahoma. Now I’m in Qatar, which is about as far away from the United States as you can get, and we’re still talking about the same goals. I meet my friends from the UK and they think of the same goals, so when in terms of global emergency medicine and what emergency medicine physicians are thinking about, it’s in some ways the same everywhere.
AccessMedicine: What’s the unique perspective you bring to theand what drove you to be a part of it?
Dr. Thomas: If someone asks if you would like to work on a product that can really move the ball forward, then the answer is: yes! I do think it’s important for us in emergency medicine to have the ability to look things up. There are products out there not written by emergency medicine people. They are written by those that may be more knowledgeable when it comes, for example, to pneumosepsis. But only emergency medicine people really know the priorities and proper steps to take in the emergency room.
I like the idea of AccessEmergencyMedicine as a way for someone who is busy or preparing a lecture to look to as a primary resource. What does our definitive textbook, Tintinalli’s Emergency Medicine, say about how to take care of pneumosepsis? There is real value from being able to get accurate reliable information quickly – it’s why I joined the advisory board. We used it in Boston, we used it in Oklahoma, and we use it in Qatar. It’s a nice way to spread the recommendations from our specialty’s definitive textbook so that anybody with an internet connection can get that information. I use far more than I use the physical textbook and I suspect that’s the case for a lot of people.
AccessMedicine: How have you seen the process of studying medicine change over time?
Dr. Thomas: Number one: the flipped classroom is an example of how the burden of learning seems to be shifting from the instructor to the student. Number two: the methods for learning medicine are quite different. If someone needs to learn how to do a procedure in emergency medicine, they can go, for example, to procedure video on how to do a particular wound repair. That’s different from when I went through school, where we looked at textbooks. But it’s one thing to look pictures of something and it’s another thing to watch as the skin flap get moved over and you can really see how a z-plasty works. I mention this because it’s something we rarely do in emergency medicine, but it might be something that you need to do when you are repairing a certain type of wound. For those things, enhanced educational techniques like video learning and animations are particularly useful.and pull up the
Tintinalli’s Emergency Medicine, 8th Edition, is available on AccessMedicine and AccessEmergencyMedicine. New, online-only chapters from the forthcoming 9th Edition are available exclusively on AccessEmergencyMedicine.