Its been eighteen years (I can’t believe it!), but I assumed the role of medical student again.  I “puppy-dogged” Dr. Daniel while he worked a shift at the only public Emergency Department in this city of 100,000 people.  Like a medical student, I knew "nothing", I couldn’t speak the language, I knew where nothing was, I served no real purpose, and the nurses thought the fact that this clueless American doctor was following their doctor around was, “cute”.  The ED here is a true emergency “room” on the side of the hospital with four adjoining rooms (rarely used) for procedures and/or private exams.  They see all comers.  They average about 150 patients per day.  They have seen over 300 in one day and as few as 80.  There is ONE physician working who also acts as house doctor for all urgent concerns in the 87 bed hospital.  The general practice docs rotate shifts in the ED (there are no docs who work only in the ED) and work as much or as little as they would like.  I don’t know if they are paid extra for their time in the ED compared to working at one of the government clinics in town, where they spend their other time.  The patient volumes in these clinics are proportionately similar (large).  In the ED, they usher back 3-4 patients at a time from the waiting room and they sit together in the emergency room on chairs.  Exams are few and tests or treatment are ordered based on a few questions, asked loudly by the doctor from behind a desk in this pretty public room.  Considering the patient volume and the limited space, the medicine practiced was very good.  As in the states, many complaints in the ED are relatively minor and these are moved through quite efficiently.  There is absolutely NO paperwork for those patients discharged home.  Patients admitted have three or four initial orders written (meds) and they are moved immediately to a hospital room, before any testing is completed.    They transfer critical patients to Belem (about five hundred miles) on a plane that is owned by the government and flies twice/day.  An unconscious, 42 y/o woman with a bleeding type stroke (subarachnoid hemorrhage) was waiting for her departure.  They have no ventilator equipment in the hospital for ED use.  Outside the OR (where only brief surgeries are performed), nobody gets put on a respirator.  This one procedure saves thousands of lives in the states’ EDs and is not found here.  Their narcotics (strong pain medicine, used liberally in the states) were contained in a shoe box sized container and consisted of four medicines.   Did I say there was NO paperwork?  I’m still recovering from that one.  Doctors that just practice medicine?  I have some friends reading this who will need to be pinched.  Over all, it was a neat experience.  I’ll definitely go back and I’ll write further impressions when I do.  The whole system here (government run, total care for no pay, with concurrent private pay tract) intrigues me but that is for another blog.