What is it like to work as a senior doctor on the emergency ward?

Mr Brunschwig, you are the head doctor of the emergency ward at Zollikerberg Hospital. Tell us what characterises your work?

I have various tasks. Basically, I can say that it is "our" job - I say "our" and not just "my" because we are a team - to treat the patients in the emergency ward as well, safely, quickly and correctly as possible.

My job as head of the medical team is to supervise the assistants, junior assistants and senior physicians and to support them in treating patients. Of course, I also look after many patients myself, but more importantly, I discuss the results with the assistant doctors so that we can decide on further diagnostics and treatment. Another task is that we - including my senior physicians - plan the processes for the patients as far as possible. This means that we visit them from the outset and as early as possible, have a brief discussion with them, possibly carry out a specific examination and then make a plan for how treatment should proceed in an emergency so that we can reach our goal as quickly as possible. I also do a lot of ultrasound examinations and so-called punctures and minor operations. These are the tasks directly involving the patient. There are also strategic functions as well as communication and collaboration with nursing and other departments in the hospital, such as organising and improving processes in the emergency ward.

Your day is very varied, to say the least - you have to be able to cope with that. In your opinion, what skills and qualities are ideal for working in an emergency department?

The emergency department is certainly not the ideal workplace for everyone. You have to be aware that you're under a lot of pressure on a day-to-day basis. It's often very restless and also very loud. Many tasks have to be completed at the same time: Enquiries, phone calls - an incredible number of phone calls - and lots of people want to talk to you or need information, including patients, relatives, but also doctors and carers. It's almost impossible to sit down and think something through or consider it in peace. You often have to switch from one situation directly to the next and back again. This requires a certain level of composure and resistance to stress and anxiety. I'm good at keeping an overview and prioritising. In our team, we always try to take the day with a sense of humour, maintain our good mood even in difficult situations and concentrate again and again in order to then briefly slow down and concentrate on the next thing. A day like this can be exhausting and quite long, but often also satisfying.

Yes, we take your word for it and we are so grateful that there are people like you and your team. Let's take a closer look at the emergency ward at Zollikerberg Hospital: What range of services does it offer?

We offer good medicine at our hospital and try to proceed with reason, foresight and empathy right from the emergency ward. We are very responsive to patients' wishes. We are open to all patients, from birth to old age and with all problems. We accept virtually everything: Injuries and illnesses of all kinds, we cover all organ systems, and we also offer a lot of gynaecological services. What we don't specialise in so much are a few specific areas: For eye emergencies, for example, we are very happy to have an eye clinic nearby; and for children, we are also very happy to have the paediatric permanence here at the hospital. In the case of very serious accidents, we are not approached by the ambulance service, but otherwise you can come to us with anything. Wherever possible, we try to work together with the specialists - the fact that we have so many in-house means we can cover a lot of ground.

You have already been working as the head doctor of the emergency ward at Zollikerberg Hospital for 10 years - and will have done so for 11 years in 2023. How has your job changed over the years?

Yes, a lot has definitely changed, albeit gradually. There is certainly a lot more to do today, and the demands of both patients and clinics have increased. But the trust of the medical teams at the various clinics and I think also the GPs in us has also grown, it has to be said. Collaboration beyond the hospital, with other hospitals and emergency departments, has developed in a new way - something that didn't exist at the beginning. Then we have continued to expand in recent years: more jobs, more doctors, more senior physicians, more nursing staff - since COVID, we have also had to grow spatially and have created additional space. In the meantime, we have also remodelled or renovated the emergency ward twice. The first time was a major remodelling so that we could also adapt the processes, and the second time we renovated a few things - that was a bit tedious because we were literally in a building site for a few weeks.

The media is currently reporting that Swiss emergency wards have been at their limits for some time for various reasons - a rush of patients, a shortage of specialists, viruses. How are you coping with the onslaught?

First of all, I have to say that there has actually been an increase in patient numbers in recent months. What used to only happen on isolated days is now our daily bread. The situation around us, in other hospitals, is also very tense. This is why patients are increasingly being referred to us from other emergency departments. It is also true that patients have increasingly had to expect waiting times in recent months, which used to be the exception rather than the rule for us. Nowadays, there are always situations in which patients, depending on their complaint, can sometimes sit in a chair in the corridor.

Yes - how do you manage that? The most important thing is that we can discharge patients quickly from the emergency ward. If they go home, it's relatively easy, but if they have to stay, then you need very good structures in the background - and fortunately we have them here at Zollikerberg Hospital, so that we can get patients from the emergency ward to the wards relatively quickly. It is crucial that patients are transferred within four hours if possible. We have strengthened our team in terms of personnel: we have one more assistant doctor to treat patients during peak times. And we are planning to introduce a "fast track" over the course of this year, where patients with minor cases can be treated more quickly. Fortunately, even before this big rush, since last summer we have taken tasks that do not fall directly under emergency medicine out of the emergency department and distributed them across the hospital - for example, check-up appointments - so that they do not block the space and staff in the emergency ward.

Speaking of the "rush of patients", another reason often cited is that more and more people are calling the emergency services or going to hospital with minor injuries. Do you think this trend can be reversed, and if so, what measures can be taken?

I don't think it's possible to turn back the clock. Instead, we need to look ahead and consider how we want to reorganise ourselves. This will be an exciting challenge for healthcare policy. The Health Directorate has made initial attempts with educational work. We need to start at school and introduce a health subject - but that is a very long-term prospect.

To be honest, the reasons for the "rush of patients" trend are not one hundred per cent clear either. The idea of the "family doctor" almost no longer exists today. People are moving around more, GPs are no longer working as long and often part-time. I admit, I don't have a family doctor myself (laughs). And to be honest, I hardly know anyone from my generation who has a GP. It's something you only get when you start to have complaints. And then the problem quickly arises when you're ill: how do I get to a doctor's appointment? There are also many more permanent practices today, which is certainly in line with the trend. Another challenge is that people want to go to the doctor at off-peak times. And this is offered by both the permanent practices and the emergency centres.

As a patient, you should consider whether it is actually an emergency before going to the emergency room. But what actually constitutes a medical emergency, i.e. when should everyone contact the emergency services?

There is extreme medical necessity: for example, if someone suffers a heart attack or stroke or has severe breathing difficulties or a more serious injury. In general, however, it's a very difficult question and a dilemma - including mine. I've also had patients come and call me, which turned out to be unnecessary afterwards. In many cases, you simply don't know enough in advance to be able to say whether it would have been necessary, you can only say for sure in retrospect. In my opinion, however, most patients are not so wrong when they think they need to come in. Of course, there are many cases in which a GP could have helped. But it's not that easy to get an appointment when you're in a hurry. That's why it's not wrong to go to an emergency once too often.

Can you say whether there is such a thing as the "most frequent emergencies" or is it always a mixed bag for you?

It's very mixed, but at the moment infections, pneumonia and, above all, flu clearly dominate; we also have COVID, but less so. In addition, there are always a lot of patients with heart disease and currently a lot of falls. There tends to be more older people; it's just that the older you get, the more susceptible you are to illness and falls. The whole situation is often more difficult for older people: they can no longer look after themselves at home, especially if they are alone.

Let's come back to you: how do you personally deal with stress or stressful situations and experiences?

I've got into the habit of cycling to work every day - January isn't exactly the best month for it. My journey to work takes about 25 minutes, so it's not forever, but it's enough to clear my mind. As a team, we do debriefs. I think the most important thing is that you can talk to colleagues, even if it's only for a short time. Sometimes you would prefer to talk at home, but of course you can't because of patient confidentiality and a lack of medical knowledge. I prefer to talk to colleagues here at the hospital. It's also part of the job to experience situations or experiences professionally with a certain distance. But I know that junior doctors often have a guilty conscience when something doesn't go so well or has been very difficult or sad, and they worry terribly - but you can actually get used to that and distance yourself emotionally. Which doesn't affect the patients, we are always very empathetic with them.

I would also like to say that we here in the emergency team have fun. It may be strict and sometimes difficult, but it is very important to me that my employees enjoy their work and are motivated to come to work. This may seem paradoxical to some people, but it's important that we enjoy our work. Most of the feedback we get from patients is also very positive. I think most people feel comfortable with us - both the employees and the patients.