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?

Opinionated - after the surgical grand round, which would cover the whole hospital and often take all morning, we would all sit down with a cup of tea and divvy up the hundreds of jobs it had created. But we had to be careful not to be seen carrying the tray of teas as we had to walk through a waiting area and often patients would complain that we were sat around drinking tea while they were kept waiting for their appointment, not realising that firstly we were not the doctors they were supposed to be seeing anyway, and secondly it would be the only fluids we were likely to take in that day and we would probably finish hours after we stopped getting paid to be there.

I have both worked in the NHS as a staff nurse and use it (more than I would like) as a patient and as a relative. I like to think that I understand both sides.

I have both received and witnessed fantastically amazing care, good care, good enough care, so so care and woefully inadequate care leading to life threatening mistakes. On one of these occasions the staff were doing their very best but were seriously over worked and a mistake happened. On the other occasion the dr was adamant that he was right, refused to explain or consider anyone else's opinion and almost caused the death of my relative (and our complaint was upheld) and I was in seeing a senior consultant during one appointment. 2 minutes into my appointment his mobile rang and a dr started discussing another patient (I clearly heard her name and all the details of her illness). My consultant spent 10 mins discussing this patient, put the phone down, and immediately drew my consultation to a close despite barely having said hello to me. I was literally trying to discuss my own condition as he was showing me the door. The lack of care led to an adverse drug reaction that 7 months later I am still be treated for. I understand that he was under too much pressure, couldn't concentrate on 2 patients etc and probably would have been better if he had excused himself, answered the call and then continued with me. I'm not trying to antagonise anyone here but am trying to show that not all patient experiences within the NHS are positive and some may be harmful.

In the vast majority of these cases better communication would have improved the patient experience immeasurably. In the OPs case, despite the rights and wrongs, it would have taken 30 seconds for a nurse to have explained that they were waiting for a senior doctor to review her son and make a decision. It's the not knowing that causes the frustration and worry - is something serious wrong, have they forgotten about you etc and in most jobs client/customer facing staff are told not to have private conversations where they can be seen. The number of times I've waited at a reception desk in hospital while the receptionists have chatted about their weekend, their cat, their next door neighbour - situations like this simply upset already worried or stressed patients.

Just yesterday I made a 2 hour trip by public transport in rush hour to attend an outpatient appointment. Got there to be told "oh we've moved your appointment to next week"! No point in taking it out on the receptionist but I then had to travel another 2 hours home, book another day's leave from work next week, wasted £10 fare yesterday and pay again next week. Someone simply could have phoned me to tell me that my consultant had cancelled their clinic.

I'd imagine they WORK THEIR FUCKING ARSES OFF. Not RTFT.

You are not as clever as you think you are...we’ll continue to help you and your family, no matter what gross personality defects and lack of appreciation you seem to possess.

Wow this comment by PaddyF0dder, and the fact that another dr on this thread laughed at it, absolutely proves the level of disdain that some medics show their patients.

I truly am shocked.

There there. Try not to smash your monocle.

@SweetieBaby

Seriously though, you’re misconstruing my post. It was in response to a passive aggressive non-apology the original poster had made further back in the thread. It has nothing to do with some sort of perceived disdain you think doctors have for their patients. I do, however, have a huge level of disdain for ignorance and entitlement.

@sweetiebaby really? Do you get what was written? Go on, tell me- what job do you do where you can have someone assault you, tell you they fucking hate you, spit in your face, then get to have you continue to give you top class treatment?

@coffeeforone
I was also sad to read your IWBVU followed by how you actually don't think you are.

V. Passive aggressive.

And of course you were seen quickly after a head on crash whilst pregnant. You'd been triaged as urgent. When you attend A&E and are triaged as non urgent you will be deprioritised.
And unless you are a qualified clinician you cannot seriously know what they were talking about all the time. Mind You, you do seem to have all the answers...

I don't have disdain for my patients. I turn up at work everyday and treat loads of them to the best of my ability. Many of them are great lovely people. I do this job because I love it and I love treating people, especially in general practice where I also get to support people in lots of other ways and not just medically. It is actually very insulting to tell me I have disdain for my patients.

I do have disdain for people like the op who receive good care and look for things to moan about and completely ignore the hard work hcps put in to provide care for them and their families - she is not one of my patients though. I would feel disdain for anyone moaning unfairly about any profession. People who are rude to waiters and retail staff etc. Some people just look for things to whinge about and think the world revolves around them.

Yep random our hospital has just opened visiting hours up to 2-9, now getting multiple complaints we are not offering meal provision to visitors on the wards....

They play solitaire.
Minesweeper if they are consultant level or above.

What, no FreeCell?

Shake, is there a restaurant they can go to, i am not surprised by your comment at all, it'll be ward based toilet facilitiet, extra headphones for the tv and phone chargers next.

I prefer candy crush personally

God he really does need to come out doesn't he?!

As an aside, I really want one of those villas

I suffer from anaphylaxis.

We do have a separate children’s A&E but trust me, when I come into A&E, by ambulance, as a priority 1, all those people “chatting” and “googling” move and give me the emergency care I need whilst still monitoring everyone else.

You child was being monitored - he didn’t need anything else.

I don’t go to resus or HDU. - I go to normal A&E and then to the A&E ward which is monitored (very proudly) by the same staff,

Trust me, when a patient had NEEDS they are there instantly

Come on shift, get handover of patients currently in ED - why they're there, what's been done, what needs doing, potential plans. Get a handle on other areas they're covering (PICU, NICU, wards - either physically or on call for a newbie on their first rung on the ladder). Discuss nursing/HCA staffing, potential problems on the shift, safety huddle (what are our key issues, how will we avoid them, how is the shift going to run). Chase updates on any tests, review or get a report from triage nurse of any new arrivals, request beds, x-rays, bloods, review x-rays, bloods, check treatment plans are within protocol, answer questions/bleeps from other nurses/doctors in the hospital, prepare cases for teaching days (often doctors will go from a night shift to Teaching day or case conference), prep presentations for grand round teaching, complete prescription charts, NEWS reviews, sepsis charts, cannula monitoring, admission paperwork, discharge letters, notifications to social care/safeguarding if required, usually one (or more) will have a crash bleep to respond to cardiac arrests (depending on size of hospital may be for whole hospital or select wards), arrange patient transfers to specialist units, including booking transport and escorts, prep and administer medications, take bloods, liaise with bed managers as to who's going where, monitor patients status in x-ray/MRI/CT areas, receive red phone (ambulance incoming with v v poorly patient) calls and alert relevant team, if a trauma centre/helipad be prepared to receive them too, check crash trolley, check supplies in resist/cubicle areas, monitor fluid balances, infection control checklists, prepare and give handover to incoming doctors...well, that's some of what I've noticed anyway, and I'm sure there's plenty more besides. I'm sorry OP, there's a lot of faults in the NHS at the minute, but a doctor taking some time to be a human being is not one of them. And I am fully prepared to be told I am unreasonable for sticking up for colleagues who seem to be at the focus of everyone's wrath when they're doing their damnest to keep everyone safe. Oh and I forgot infectious disease notifications and precautions advice.

shakeyourcaboose I qualified as a staff nurse in 1993. Totally understand about abuse etc at work. I also understand that patients, not unlike doctors, are also human. That they get scared, stressed, upset and anxious and that sometimes these emotions affect how they react. I think sometimes HCP lose sight of how their behaviour might be interpreted by others. I have seen, as a nurse not a patient, several doctors and nurses sat at the nurse's station laughing whilst a dying patient's relatives sat at a bedside. Now, not unreasonable that HCPs were having a well earned 5 minute break, team building, moral support. Also not unreasonable that a family, going through possibly the worst experience of their lives, would be upset by this behaviour.

Ultimately, the HCPs are under a greater duty to behave in a professional manner.

PaddyF0dder - I didn't misconstrue your post. I read it on page 9. Patients don't owe doctors, nurses or any other NHS staff anything. There is no excuse for anyone, in any job, to be treated with aggression or rudeness but I don't agree that patients should have to act indebted towards the people that provide healthcare.

Patients should feel allowed to question HCPs, to be an equal partner in their care and to have their views taken into consideration. That doesn't mean that patients have the right to scream abuse, assault or threaten doctors. Of course it doesn't. But drs are not infallible. They make mistakes and sometimes those mistakes have devastating consequences for the patient. The risk of some of the attitudes exhibited here is that some people will be discouraged from asking perfectly reasonable questions of their dr because they fear being found lacking in intelligence or having gross personality defects as apparently that is the view of some doctors towards their patients.

HCPs need to be able to step back from situations and to try to understand why patients, or the relatives, are behaving in a certain way. Abuse shouldn't have to be tolerated. Nor should patients be expected to doff their caps and tug their forelocks. Doctor/patient partnership should be an equal one.

And patients should appreciate that their actions have consequences e.g..pitch up an hour after your admission time you might have to wai to be seen.

Except the patient that complained in that situation was a HCP who I really expected to understand that during an operating the list the surgeons and anaesthetists are... um... well.... carrying out operations and can't just trek to the ward when the late patient arrives in the middle of someone else's operation.

Well, of course and unless the error was due to the hospital I would expect the patient to behave decently when the above reason was explained, politely and professionally.

In the same way that I behaved decently yesterday when I turned up for my OPA, having travelled 2 hours to get there and wasting a day's leave, to be met with a shrug of the shoulders and a disinterested explanation that the clinic was cancelled. Inside I was annoyed and pissed off but I am not one to yell and scream. To be honest, the receptionist didn't handle it well and no doubt would not have got the same reaction from a different patient. At the very least she could have apologised and tried to look a bit interested, even though it wasn't her fault.

Random

Please, please tell me you're not going in to work tomorrow. You are not fit to work. Yes, we beat ourselves up about ringing in sick (I suffer from presenteeism with the best of them), but when you are truly not fit for work, you must not do so. Particularly in the post Bawa Garba era that we have seen what happens to people who try to cope with the impossible.

Do you know about the coroner's question? Ask yourself, if the worst happened, a patient died, and it went to inquest, and they asked you if you were fit to be at work, could you say yes? If the answer is no, then you must call in sick.

I know you can't be one of my trainees, but if you were I would tell you the same. We have been in the position of one of our trainees having a threatened miscarriage. We took turns acting down to SHO to cover her nights, with a different consultant oncall from home in case another pair of hands was needed. Because it is our job as consultants to find a way to cope. The trainee's job is to tell us if they're not fit to work.

Call in sick.

I’m a junior doctors. There are a few issues here already mentioned:

1. The paperwork takes ages and ages. Much is hand written. Stupid antiquitied computers. Things in triplicate. Different it systems that don’t talk to each other. Different passwords for different systems. Having to change computers mid way as only the one in the corner prints but the patient data is only saved on the one in the middle etc. carbon paper! Fax machines! It takes hours to discharge a patient/order blood tests or do anything really. There is NO admin support for juniors, we type and file our own stuff. All of This is stupid and inefficient and needs to change but this costs money.
2. There are no offices for junior doctors. For example I work with 16 other juniors (any grade below consultant). We all share one office with one desk and computer and chair and a microwave and tatty sofa. No printer.This is our office/break room/canteen. Some days we all have letters to write about patients but we have to queue up to use the computer! There is no where away from patients we can go do the paperwork or discuss patients in private. This actually beats some jobs where the junior docs don’t have anywhere to hang their coats! I used to get asked often why I was carrying bag and coat with me from patient to patient - well I don’t have anywhere to leave it I said - patients couldn’t believe me. (Someone will now mention the mess - these aren’t free - I refuse to pay £15-20 a month for the privalage of my employer providing me with a coat hook and a kettle)
3. When holding the crash bleep (goes off in cardiac arrests and to attend difficult births) we are not supposed to leave the department as it’s to far to run back. Out of hours we are not covered for breaks - as in there isn’t anyone we can give the bleep to as there are only two of us on for Peads/neonates (sho and Spr) so to take out breaks we Have to take them in department - I.e I will be on my break in front of patients because I’m not allowed not to be!
4. After the recent case where the junior doctor was convicted of manslaughter after a Yong big very sadly died you will find doctors discharge a lot slower. I’m not risking going to prison for not following guidelines even if I’m 100% sure your child is well. If the guidelines say HR below X before discharge then below X it’s gonna be.

I’m glad your son is ok btw

Sorry * young boy (called Jack)
(Stupid old phone and fat fingers)

@SweetieBaby thank you for that very humane and decent post. I wish every HCP were as emotionally literate and thoughtful as that.

I remain extremely uncomfortable with the way the OP was insulted and derided by doctors on this thread for asking a polite question.

I completely accept that some patients act unacceptably towards doctors, but equally I suspect that many doctors have not the first clue how frightening, disorientating, disempowering and undignified being ill in hospital can feel, especially when you aren't a doctor and don't in fact have much of an idea how hospital systems operate.

The OP did not really ask such an unreasonable question imo, and there were some enlightening answers which she has in fact taken on board.

NHS staff, no matter what job role- nurse, doctor, physical, OT, Lab tech, medical secretary, domestic staff, maintenance, etc etc etc are worth their weight in gold.

I won't say a lot I wanted to say as others have already said it.

I do know how frightening it is frogsoup as I have been a patient. I had life saving emergency surgery a few months ago.

I always bear this in mind when treating my patients and empathise with them as much as I can.

This is however beside the point as the op was not frightened, she was having a dig at staff because she felt that they didn't work quickly enough for her tastes. She has been told universally by several posters including and actually mostly by NON DOCTORS.

You however have made this thread all about you and your personal beef with doctors and tried to make out that a load of doctors have attacked the op, where 1. mainly it has been non-doctors and 2. They have simply been defending doctors against the criticisms levelled towards them by the op rather than attacking the op.

You also seem to be basing your summary of a thread with several hundred posts one one single post from a doctor in which they are vaguely disparaging to the op (but actually quite amusing) and spectacularly missed the point about what they are trying to say despite them explaining. You seem to have completely ignored all the other posters who have mentioned their positive experiences and still concluded we are a bunch of arrogant arseholes who treat their patients with contempt.

If this is how you evaluate your experiences in real life then I am not surprised you have a negatively scewed view of the nhs and doctors. I suspect that will never change.