To ask what A&E docs do when they are not with patients?

[coffeeforone]

I recently spent a night in the children’s section of my local A&E, and spent some time observing the docs/nurses work whilst DS was asleep on a monitor.

There were 4 nurses and 2 doctors sat behind a long desk (plus a registrar that seemed to pop in and out occasionally - busy elsewhere I assume).

It wasn’t especially busy. We were there for 6 hours and in total about 5 or 6 children came in and were seen by one of the docs (after waiting about 3 hours). After triage, we waited about 3 hours to be seen by a doctor. It seemed like they had an awful lot of paperwork/discussions, but didn’t have much time to consult with the actual patients. I did wonder what was taking up all their time. AIBU to think they could have had a more efficient system?

I think they have to deal with a backlog of paperwork from the patients who have gone before you

Writing up detailed notes
Checking results of tests
Onward referrals
Discussing management of patients
Training on the job
Looking up protocols
Checking and rechecking medication timetables
Ongoing patient monitoring
Bed management
Arranging transfers to wards or outward transfers
Handover to ward staff

Need me to go on ?

At our hospital paeds doctors are also responsible for the SCBU / NICU, including all of the above list but for the babies in special care.

Do you really need to ask? Can you not imagine the huge workload and responsibilities of a hospital doctor?

I just wonder what the waiting times would have been and how they would have coped if there had been double the amount of children there.

One of the doctors at one point said “I’ve got 2 in my queue waiting to be seen” then went on to describe, in detail a friends wedding plans for 20 mins or so. I can only assume she was waiting for something first before she could see one of those two little ones.

Congratulations OP, I guess you've solved the NHS's staffing and funding problems all in one bout of uninformed observation. Well done.

Seriously, I get that you mean well, but can you not see the arrogance involved in deciding, as a completely ignorant outsider, that "they could have a more efficient system"? Do you think that nobody ever thought of seeing if things could be more efficient?

Where I used to work some of the senior A&E doctors also covered wards. Our FY2 and registrars used to get called down for trauma/medical with suspected neuro or spinal involvement. You wouldn't know they also had a 32 bed ward/HDU to cover though! There's rightly a lot of collaborative work between specialities and if the speciality ward is busy can take a long time to pass messages back to A&E etc.

A lot of A&E doctors will also spend a significant amount of time in resus, majors etc.

There just seemed to be a lot of waiting around doing nothing - hence the I efficiency I observed. I’m only saying what I observed.

aren't doctors in a&E responsible for a&E patients only?

There was a registrar that was also covering wards - he was only there about 30% of the time. The other 2 docs never left.

What an unpleasant thread. I'd love to see you try and handle an A&E shift. More to the point, I'd love to see you do it day after day, night after night and not lose your sanity, especially given you wouldn't even allow yourself the odd non-work related conversation with your colleagues.

The major treatment/resus section was separate. The docs never went there

But as you said earlier, waiting for results of blood tests or scans?

I had to take my son to A&E for a problem he is already undergoing investigations for. We had to wait for someone from the team he is under to finish in theatre before we could be seen. The doctors don't just work in A&E, they have their commitments in the hospital. The paperwork you assumed they where doing could have been essential to many other patients in their care.

I’m always amazed when I go with my dad to the cardiac clinic & when he’s been admitted, to realise the same nurse is there at clinic at 8.30 and she’s then on the ward at 8pm still working and still working as I leave.

To be working at 8.30 she must have got to the hospital etc before this time.

you wouldn't even allow yourself the odd non-work related conversation with your colleagues.

Not in earshot of patients that have been waiting for hours and still haven’t been seen - we were one of the two patients she needed to see

My A& E experience was eye opening. My husband had appalling treatment (or lack of) but that aside I was at the amount of time people (junior docs? Nurses?) spent googling information! Their screens were on show and they were copy and pasting from google/ medical online encyclopaedias into patient notes. Seemed madness.

Crikey OP you could get a job as one of those Change and Efficiency Consultants.

Your post screams ignorance. Shame on you.

I've always been strangely appreciative of waiting in a and e for hours. Generally it means you aren't in a life threatening condition and are likely to go home.

I don't know what they do whilst they sit at a desk, but I'm understanding that they have a massive work load, they've been there for hours too, they don't get a decent break, they have a life outside of work too, and they are going to be doing their best to make sure me or my family get well and home asap.

When my lovely dad was very poorly, one doctor pushed him to the scanning department himself because he couldn't wait any longer for a porter, he didn't have to do that. The majority of them will be doing stuff like that.

I imagine that like teachers (which I am) the paperwork side of the job is bigger than the obvious actual purpose of the job.

I was in children's hospital when I was 15 and for a couple of days I was the only one in. I did ask the 2 nurses whether it was annoying having to look after one person but they said that they were pleased as otherwise they'd be off to the adult wards and it meant they could get on with jobs that needed doing (as well as caring for me).

There just seemed to be a lot of waiting around doing nothing

Probably waiting for the results of tests or obs, so that timely treatment decisions can be made. There probably are efficiencies that can be made in cutting the turnaround times for some of those tests, as long as we're prepared to invest several billion for marginal gains.

That doctor probably also went to the toilet at some point during her shift, even though there were children waiting. Maybe even TWICE.

Why don't you spend some time learning about what it's like to work A&E? There are dozens of good blogs and articles written by people who work there. Then you might understand the pressures and challenges and not just be blathering about how they stand around talking.

maybe it would be better if not filled with non emergency cases?

coffee, doctors and nurses are entitled to breaks. They enable them to perform their job in the optimum way.

More frequently than not though, they will work through them, often unpaid, when that’s what’s needed. If you saw a doctor who was lucky enough to be taking their break that day, just bear in mind that often they probably don’t.

Actually YANBU. If a doctor sat at a desk in front of patients, declaring she had patients waiting, and then spending 20 mins discussing a wedding then that should be addressed.
Whether it was her break or not is immaterial, it is extremely unprofessional and should be pointed out. It’s easy for staff to forget that they are being observed. It’s one thing doing paperwork and another socialising while patients wait.
Send a polite email to your PALS service OP, will do the juniors in question no harm to be reminded that at a public desk they are under constant view and should behave accordingly.

FGS give over. If you were so bothered by it did you approach the desk and ask why you were waiting?