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 don't think the registrar was just floating in and out, they may well have been the senior on call doctor, seeing many sick people, talking to families, all sorts of things. The nhs have helped you many times.

Sorry by ‘floating’ that’s what I mean’t - looking after at least one other wars or dept.

*ward not wars

I think it's near on impossible to explain to people who don't work in the NHS how complex the work is. Those staff sitting around could have been waiting for an number of reasons as many others have very ably pointed out.
I have been a nurse for 30 + years and there are a few things which strike me every day.
Generally the public and marvelous and understanding - even if you can't find them an in patient bed and have to explain why (cuts).
However, there is a significant section of society who feel entitled to abuse staff, complain about their treatment if they do not get exactly what THEY think they need (as opposed to what professionals think)
We are all tired beyond belief. I love my job and my Team but I am beyond exhausted by the constant demands, lack of breaks, shortages of staff and the whole world (including Hunt) that think they know better than us what the NHS should do.
Targets are getting in the way of us actually doing our jobs. For every person I see for an hour, I have about 2 hrs of paperwork and endless chasing up.
The reason there is so much apparent faffing is that (in my sector anyway) is that there are competing priorities and lack of resources. Different departments want x, y or z or a has to be repeated. I was once told I could not admit a patient because of a piece of paperwork that was not done. I promised to do it as soon as I got home (Community based, and yes, I work at home all hours doing paperwork). The patients condition was life threatening. that's how ridiculous it can be.
So please give us a break. We are all doing our best.

This is an unpleasant thread. Ok as a nurse with experience in ED and paeds I'd like to point out the following... children need observing, for hours otherwise there would be no point in them being there and they could have gone to the GP... junior drs need their work over seeing by seniors so when a dr said he had two to see... that doesn't mean they haven't already been seen by SOMEONE.. who probably requested observation/medication (which takes TIME to work before further progress can be made)

Oh and if they were discussing someone's wedding so what? They're people too... I can assure you if there was an actual emergency that wouldn't be happening so please be grateful that you were in the right place and that people are working to the best of their ability.

It's loads harder to want to do your job with smiles and ribbons when you know someone is complaining about every little thing you do.

Oh and OP the time you were rushed in before was an actual time critical emergency... can you see where I'm going with this?? When you were actually in need people moved faster

Appreciate the NHS saving my life so don't care if they sit down updating patients notes or whatever. They were there for me when I got to hospital in an ambulance and were there for me for the next few weeks when I was recovering from sepsis.

I've read most of this thread and appreciate there's been a lot pointed out about the various strains that healthcare professionals have. I think what really irks me about it though is the implication that having a chat between colleagues is somehow completely taboo and unprofessional.

As a junior doctor I've now worked in (counts) 14 different jobs over 5 years. It's difficult moving all the time and getting to know how a department works, who people are, what's going on in their lives. When shit has really hit the fan and patients are in extremis, it's been the departments with strong team work that have fared best in my experience.

Even if it's just being able to remember that nurse's name, and having it stick in your mind because she was chatting to you about that wedding she's going to the other day, it really does help when you're stuck together trying to not let a patient bleed to death. And it helps even more if, at the end of that stressful and draining episode you can say to the person you're working with "God, that was awful. Are you ok? By the way, how was that wedding you went to?"

OP I'm sorry that you were inconvenienced by your long wait. I'm glad your DS was ok. I am not at all sorry to hear about the chat that your doctor had, even though you were waiting (and it's A+E, there are always people waiting).

OP do you know if it was the medical registrar or a paediatric registrar who was on duty. Believe me they will definitely have had at least one other ward to look after. Is it a big hospital.

OP at the end of the day, you chose to take your dc to A&E, you keep saying how it was only a sore throat, but you CHOSE to go to A&E to have him monitored, so they then had no choice but to do that. If I recall correctly from your last post on this same thing, they advised that your ds be admitted but you didn't want to as you were tired and wanted to go home. You have not mentioned that in this thread that I have seen, so I am not sure where that fits into the events described here, however you must see that the junior drs needed a reg review prior to discharge because your sons heartrate was abnormal? I know you feel this is normal for him because your dh has the same issue, however this absolutely does not make it normal at all.

The juniors were absolutely correct in their actions here.

I am sorry that you were kept waiting for hours, for a seemingly minor complaint (in your eyes), that you CHOSE to go to A&E for

Frog soup - so one comment from one doctor then? I actually think he had a point. There are other non doctors on the thread who have nice things to say about us so maybe your massive problem with doctors is to do with you and not with them.

Ok well what I meant was that the same doesn't go for doctors. It was a typo. Must mean I'm as think as shit so yeah the op is probably right and I'm sure her intelligent insights can save the nhs if only those arrogant doctors would listen.

@frogsoup

You’ve misconstrued what I said.

My comment was a direct response to a catty non-apology the original poster had given. My comment on her intelligence was I relation to her apparent belief that the cattiness of her non-apology would go in-noticed.

I made no comment on the relative intelligence of doctors. You’ve applied that yourself. The reality is that I’ve worked with some spectacularly smart doctors and some pretty thick ones. I reckon I’m somewhere in the middle. Hopefully.

I often have to phone doctors , other depts, gp's etc for an answer to a fairly urgent question , if they have to call me back , I can be seen 'sitting about ,chatting' because I darent move away from the phone in case I miss their call or get caught up in something else that I can't get away from when they do call.

I also find that the complaints are inversely proportionate to the severity of the illness.

While as I work within the NHS I know there is a lot of bureaucracy and rubbish that goes on, but bloody hell, when shit hits the fan there IMHO nothing better. The worst day of my life so far resulted in a trip to A&E with a fitting 8 month old. Ran through the doors with a blue lipped baby, the receptionist didn't even ask for info, just shouted for help and both medics and nurses ran out and grabbed us and we were straight into resuss. I'm prob rambling as still find it difficult to talk about, but DFO from the disparaging shit talk about staff who are doing their damndest to help.

Agree shake. When I was very ill the ambulance arrived within 10 minutes and although I was out of it my Mum said I was taken straight through to resus, and a dr came rushing out to meet her/ me so when you actually ARE an emergency they are marvellous!!

Attending hospital is the only time when waiting is a good thing and the fewer people that you are seen by the better .

Re: talking holidays, weddings, etc.

I think unless you've been in a position where you're involved in death on a day-to-day basis at work, you won't understand the critical need to maintain normality. You need to be able to deal with a death or a rough job and start talking about random life events with a colleague, or have them make a joke or something, because otherwise you'll go crazy.

We go into healthcare because we care. If we can't have the banal, silly conversations when there's nothing immediately emergent requiring our attention, our mental health will suffer, and then what use will we be to patients?

I waited in A&E with DD1 for hours, first in the waiting room, then she had blood drawn, then for hours in a bay with her. It just didn't cross my mind to monitor the staff, I was busy coping with her. Nor did it cross my mind to bitch about how long we were kept waiting.

Well, we found out the reason later on. She had leukaemia. Glad I never wasted energy getting worked up about what the staff were up to. Had far more important things to worry about.

You're a real piece of work, coffee.

I bet it wasn’t 20 minutes on the wedding anyway.

There would be a thread somewhere: My colleague drones on and on about what she’s done at the weekend for ages....

This thread has flashed me back to the worst day of my clinical career.

It was a busy bank holiday Monday - typically a crunch time in ED as GP surgeries have been shut for almost 3 days.

A child came in having had a cardiac arrest at home. We attempted to resuscitate them to no avail. My registrar then broke the news to the poor parents who broke down in a totally heart rending way over their child's body.

The whole team, 3 nurses, 1 paediatric reg, 2 SHOs were all really upset. We had a waiting room full of minor patients but decided that we needed a short break to gather out thoughts.

Several people smoked so we took drinks out to the smoking shelter (there were a few nurses left covering Paeds ED and doctors never get cover for breaks so we all still had our bleeps on). We were having a chat (current buzzy terminology would be "hot debrief") and a little cry when one of the parents whose kid was in minors came over and totally lost it.

Shouting and screaming about how long they had been waiting, that we had the "fucking cheek" to be standing out there having a laugh (no-one was laughing I assure you).

It has always stayed with me. As has the poor kid who died, I think of them every year over that bank holiday weekend and it was more 15 years ago.

I'm now a consultant. Today I grabbed a sandwich between patients, in my clinical environment and didn't even get to the loo. I worked 30minutes past my scheduled finishing time. And that was an "early" finish. I don't usually get to leave for home until at least an hour after I'm meant to.

There is NO slack in the system and people are resigning in droves. 5 of my consultant colleagues have headed off to warmer climes in the last 12 months. The pay really isn't as good as people think, we have huge costs just to continue in practice (mine exceed 3grand/ annum) which is tax allowable but otherwise not reimbursable in any way, our CPD costs are massive and again most,y paid out of income and we are all working huge amounts of unpaid overtime, the reduction in other staff groups is just pushing more and more stuff onto doctors especially consultants eg, today I had to porter two patients from the ward to theatre as the ward nurses were too busy to bring them. Waiting for a ward nurse to be free would have delayed my list (and the rest of the theatre staff) even more and meant we finished even later.

I like my job but it is not the job I thought I would be doing when I finished medical school.

It is usually a nurse who looks for specific things. @coffeeforone

"I made no comment on the relative intelligence of doctors. You’ve applied that yourself."
Nope, that was someone earlier in the thread. But yes yes to encountering some super clever doctors and some thick ones - that's much closer to the reality than the 'all doctors are intelligent by definition' guff upthread.

Random, I have no massive problem with doctors. I'd have three dead kids, two dead parents and be dead myself without timely emergency NHS intervention. I do have a problem with the idea that all doctors are superior saintly saviours that can do no wrong. The idea of arrogant doctors in fact comes not primarily from this thread but from direct experience, in particular, if you want specifics, from doing training sessions with new registrars on the experience of being a parent of a child on PICU. Some of the questions I get are quite frankly jaw-dropping in their combination of ignorance and arrogance, and in their assumption of my rank stupidity as a non-medical professional. I DON'T say that all doctors are like that, they aren't, but by god they certainly exist, and not just the odd one either.

'As has the poor kid who died, I think of them every year over that bank holiday weekend and it was more 15 years ago.'

I'm so sorry. DD1 died in ICU and we went outside with her two doctors after she passed away (it was not sudden or entirely unexpected). I think of them often and so admire their ability to carry on working after having to see so much of that.

@opinionatedfreak what a horrible time for you all, while we we getting asked to step back and let the medics work the person in the bed next to us was throwing abuse at the nurse in with him that his rights were being abused as hed not been offered a sandwich. People are shit at times.