Health, wealth and emergency medicine in the 21st Century, with Simon Carley

Health, wealth and emergency medicine in the 21st Century, with Simon Carley

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Guest post by Stevan Bruijns from AfJEM

I caught up with Prof Simon Carley who will be presenting a keynote at the Emergency Medicine Society of South Africa’s annual meeting in October 2017. As well as being an accomplished public speaker, Simon is probably best known as the Senior Editor of the St.Emlyn’s blog and podcast. His day job includes being a professor of Emergency Medicine, consultant in emergency medicine at the Manchester Royal Infirmary as well as consultant in paediatric emergency medicine at the Royal Manchester Children’s Hospital amongst other things.

I asked Simon a few questions about his upcoming keynote.

What are the key message(s) from your talk?

I’ve been asked to talk about how the pattern of disease is changing in emergency medicine and how that’s going to affect how we practice and thus where the challenges are in developing the emergency physicians of the future. We could look at this in many ways of course. New diseases, politics and technology could change many aspects of how we practice but I’ve been asked to bring some of the lessons we’ve learned about changing pathologies in Europe and the USA to the conference as my friends and colleagues in South Africa are really seeing the impact of the sort of common presentations we see. I think there are three main messages to take away which I hope to illustrate through us all reflecting on change and some clinical cases:

  1. Population and practice are intimately linked in emergency medicine (and population is changing fast),
  2. Affluence brings new diseases and difficulties to the door of the emergency centre (and they are rising fast),
  3. The emergency physician of the future will not just need to be an algorithmic resuscitator, but rather an expert in understanding and communicating uncertainty, complexity and expectation.

Why is this an important message?

In all honesty it should not be that surprising and yet it probably is to most of us. As emergency physicians we tend to practice in the moment. We deal with the patient or problem in front of us for surprisingly short periods of time. In reality major change is all around us and the external pressures on our services are constantly influencing the highs and lows of our systems. As educators and practitioners of the future we need to think about how we adapt and adjust to make sure that we are fit for purpose for all our futures. To do that we need to understand what it will mean to be an emergency physician amidst an ever changing world. On a world level more people now die due to the effects of over-eating as opposed to malnutrition. This is an incredible achievement for humanity and yet it brings a myriad of problems for medicine. As emergency physicians we risk being swept away on a tidal wave of apparent success, tinged with the pathology of excess and affluence.

How does this message relate to African emergency care?

Africa is a real mix of patient populations that are developing at differing rates. This is a real challenge for emergency physicians. We are also seeing life expectancy rates undergoing phenomenal change as a result of anti-retroviral treatment and better living conditions/ health care (for some but clearly not for all). The populations that are doing well are increasingly living long enough and well enough to develop so called diseases of affluence. It is unclear whether the impact on this for clinical practice, societal expectation and the distribution of resources will lead to a narrowing or widening of the health care gap. As emergency physicians we are likely to be the first to know, the last to be consultants and the most likely to shoulder any adverse burden. The message for African emergency care is very much that geography and life opportunities (for whatever reason) are going to be the major determinants of health for some time to come. The inequity of opportunity and access to healthcare combined with the rising expectations of increasingly connected societies will challenge us all.

What can we do?

We need to prepare ourselves, our systems and our young aspirational trainees to a future where emergency medicine cannot be practiced by algorithm and flowchart. The emergency clinician of the future must know the evidence for their practice, but more importantly must know what to do when the decisions are more complex and uncertain than any algorithmic approach to healthcare might suggest


Join us for the whole conference next week or just come for the day. Details at

Follow Simon on twitter: @EMManchester


by Stevan Bruijns (ed)