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’ve debated long and hard about posting here as it’s clearly been an emotive thread.

I will start by saying that I have a huge amount of respect for the work doctors do. It sounds horrific - and I’m one of those bankers mentioned elsewhere on this thread who earns great money for less effort. It’s true - I do.

I’ve seen some great medical care recently and some not-so-great. I recognised what the OP was saying - but I also think there’s an easy solution, which doesn’t cost anything but doesn’t seem to be used consistently.

My dad was blue lighted to A&E on the Friday before Christmas. It was, of course, carnage. I envied nobody working there - in particular the nursing staff. We were there for hours, but after the initial blood tests etc... saw a doctor who I suspect was a reg who was very clear about what they were doing (ie monitoring and waiting for bloods) and how long it might take to get results and decide on next steps. We were then left - but knew what was going on and didn’t bat an eyelid as we saw the same doctor chatting about Christmas plans with a colleague. I do wonder if we would have felt the same if he hadn’t volunteered the information about what they were doing.

I didn’t experience that same treatment when I was admitted earlier this year. I don’t mind - and wouldn’t post about it if this hadn’t come up - but the experience can be stressful if you don’t know what’s going on... and a lot quick chat through next steps would have helped me.

As an aside, there aren’t many posters up in my hospital about the different doctors and their roles and responsibilities... though I have seen them. I also wonder if the most junior doctors who haven’t yet got the experience to make decisions could position this with patients at the start so they know that they will need to wait for a review by a registrar (if that’s the case) before they proceed. I was starting to clock that someone very junior was seeing me - any question I asked was fobbed off, vague. It would have been so much easier if she’d said that she was doing an initial assessment which she’d discuss with a reg later (assuming that’s the case).

These are tiny things but if doctors have the time to do them, it could make a difference to the number of times they are chased for updates. Maybe it’s been tried before and it makes no difference, or maybe we are at a stage where the system is so stretched that even this is too time-consuming to do so.

I’m horrified that so many go to work when they are plainly not fit to do so. I couldn’t do it - and it is clearly a testament to your commitment.

Random- I am glad you are a little better but I was sorry to read your updates. Best of luck with the exam.

I so agree with your sentiment above. Communication would solve so much of this unnecessary animosity and I do believe there is a culture in medicine that needs to change with the times. We've all seen the threads on GP receptionists probing why we need appointments. Of course, it's because they have to triage but an explanation to the patient would make that so much more acceptable. Times have changed and medicine/the NHS must change with it. Everyone is a consumer, they 'pay for it' and want answers. Having said that, hell would freeze over before I'd take on a doctor's job. They work within hideous confines where guidelines and fitness to practice threats are everywhere.

The key issue I see from these posts is that the parent was sent to A&E by 111 because there were no gps available. More and more people are ending up at an emergency service because the grass roots which would stop this is grossly underfunded.
I have mental health issues which, due to this underfunding, means I am regularly using what I deem to be stupid amounts of resources - because I cannot get the treatment I need at earliest, most cost effective level.
When I cannot get to see my gp for over a week the chances are I will end up in crisis using up police, ambulance, possibly itu and one to one nursing resources plus a hospital admission. The total cost of just one such episode (and there have been many) would not only fund the basic treatment i need but for many other people, and provide more doctors so patients could be seen etc
Personally I struggle to see how the powers that be (govt) can be so short sighted but then govt is now focused on 5 year elections and doing anything that might improve things massively in time but at a short term cost does not happen.
And then I ask them why they are not allowed to let me die as I wish ( which would save all this ridiculous cost) but apparently that is not allowed either, even tho it is acceptable to let people die because you sanction their benefits
The entire problems our nhs sees are down to the govt so please rant at them not the people who work so hard in such horrendous circumstances.
How soul destroying must it be to treat a patient who has attempted suicide many times and know that what you are doing is the equivalent of a sticking plaster over a broken bone and in all likelihood you will see them again and again until potentially the worst happens and you have to be the one to tell their child that even after 5 years of supposed mental health intervention the resources were not there to treat them.
So OP please complain to the correct place about the lack of gps which is ultimately why you spent 3 hours waiting in hospital.

I did not write the above comment, have reported it.

As far as the arrogance of doctors goes, I'm not sure I've seen any of it here. Encountered plenty in real life - newly qualified doctors (as someone from the RCGP rather bluntly put it "the ones who haven't killed anyone yet") & fresh-minted Reg's who think Consultant is suddenly within their grasp can be a nightmare. Not all of them, clearly. Many of them are lovely. Most of them, in fact. But like any profession, you'll get some who want a slap. With half a brick in a sock, for choice. With doctors I think it feels particularly awful because they're privy to huge amounts of personal information, see us at our most vulnerable, and we need to be able to trust them. Doctors, almost subconsciously, get held to incredibly high standards - & failing to meet them feels like a betrayal. Though you do, as I mentioned, get some who are just Utter Arses. Often because they can't cope with the idea they're not the cleverest person in the room. Thankfully good consultants are over that one & Professors are generally quite excited to have someone to talk to about stuff who won't have heard their pet theories/already read the papers on things, but can still follow what they're talking about reasonably well. (Though that can get a bit Grim Times if they forgot we're talking about My Actual Body, not just some abstract concept...) There are also lots of lovely people who will do things like come & check on me after I've had my NJ tube placed, because they were the one to set that in motion & they wanted to see how I was doing after I almost laid out half the staff in the endoscopy suite because sedation turns tiny-fairylike peaceful person into fearsome-fighty creature with far more strength than you'd expect & literally held my hand the next day when the tube had to be withdrawn by 20cm because it had kinked. Or the Reg who came in not simply on his day off, but on Eid to fix my NJ as an emergency because an x-ray had showed it coiled in my stomach. There was no space on anyone else's list & if it wasn't done on the Friday I would have had to be admitted over the weekend (at least), so this doctor sacrificed not "just" his day off, but one of the most important religious festivals he celebrates, to provide me with the best possible care & outcome.

@randomuntrainedcuntowner
You're welcome - hope you've taken advice of PPs on your return to work: consider that they'll not love you if they need to find a bed for you, & there's a risk of that if you go back to soon. Won't somebody think of the bed managers?
Also, totally understand you wanting a space for medics; but fear you would be plagued by: 1. people coming to whinge at you about how they can never see their GP/any & all other failings of the NHS; 2. the online equivalent of people accosting you at social events wanting medical advice; & 3. weirdy ones masquerading as medics, because weirdies gonna weird. (I mean, yay doctors & all that, but larking about pretending to be one is odd. Never mind the oddity of a mere box of badgers, this is badgerworld, running a special discount day for badgers, on some kind of badger festival where badgers everywhere come out to, er, do badgery things [I'm from Inner London, ok, not terribly au fait with the ways of badgers]. I don't think actually full-on illegal despite the protected title thing though, because of the set-up & possibility of claiming it's a fiction not a deception. [Have we a lawyer handy who actually knows?])

@coffeeforone
Your DS's temperature coming down in A&E certainly suggests that he might have been physically too warm at nursery & at home as well as having a fever. Nurseries are generally kept very warm; & most people keep their homes warm too. The advice not to strip children off if they've a fever means not to leave them wandering about in a nappy/their undies (depending on age) - it's ok for them to be in lighter clothing than is usual for the time of year, and really important when you put them to bed that you think about a quick swap off bedding to something a bit lighter/cooler than usual if they sleep under a thick duvet/several covers/usually have a wheatbag in their bed/you tumbledry their sleeping bag right before bed or have it in the hot press so it's warm. Might also just be he needed a few doses of the calpol & calprofen to start bringing his temperature down. If your DS has never been feverish before it's understandable you might panic & not think through the steps of it being most likely he's the same cold you & your DH have, then checking the NHS website to see what they advise about when to seek help. You don't mention any symptoms beyond fever, & certainly your OP & following posts gave the impression it was only that that caused you to call 111 & go to A&E, so apologies if it was something else that triggered your call. As I said in my earlier post, 111 doctors will always err on the side of caution, especially with a child so young. Not having enough OOH doctors to be able to see you IS an issue - that's a sign your OOH service is hugely overstretched & underfunded & that absolutely is something you should complain about! As well as the OOH service not working properly, it means that people are being directed to A&E when there's no clinical need for them to be there, which costs the NHS a huge amount of money in addition to increasing pressure on departments by burdening them with more patients. Once in a while, of course, the virus WILL be (for example) meningitis & the patient will need hospital treatment. If they've been seen at a set time by OOH they can then be transferred immediately to receive the necessary care. If they/their parents (depending on age) get fed up with waiting & decide it's just a cold after all & they'll go home without seeing anyone... that can have tragic consequences. So please contact your MP & tell them that your local OOH services is so overstretched they'd no appointments available at 2100 (was it? or was it earlier you rang? sorry, my phone doesn't like tracking back through the thread) & were having to direct patients to A&E, putting extra strain on the department. Paeds may have been quiet (in minors) while you were there, but the lack of OOH appointments means that adults will also have been redirected to A&E. It helps the NHS if people keep contradicting that shitehawk Hunt's claims everything is just grand/would be just grand if NHS staff just worked harder (or whatever his lie of the day is) & of course we've sadly no longer got Stephen Hawking to keep battering away at the buckeejit with his devastating use of truth, facts & logic. It was my local hospital the fecker went right to the High Court to try to close (after trying some other very underhanded tricks, including a very disingenuously-worded survey with a ridiculously short response time, available only in small[ish] print, in English, in a Borough with a large EAL population, lots of elderly people, & a level of literacy that means the survey was going to be incredibly difficult for a lot of people to respond to) because he was so furious at not getting his own way. People would literally die trying to reach the other two hospitals they expected to take on the patients from Lewisham (never mind the fact KCL's A&E can barely function with its current patient levels); & they'd die from not making the journey (Lewisham is a transport hub; KCL & QE are incredibly awkward to get to - people might be able to just afford the cab fare to Lewisham, or someone might be willing to drive that far, or they could cope on the bus; for me, for example, KCL = 3 buses & over an hour IF everything is joining up). Oh & all this was because QE, the PFI hospital was failing, so obviously the answer is to close the well-performing A&E that's just been refurbished... my cats would make better health ministers, so. They're good at snuggling the most inflamed joints (well they'll be warmest) & they'll help with respiratory physio. Well, mine. Not sure they'd do anyone else's. But cats for respiratory physio could be a thing - would help with number of cats needing adopting, too. And they help with blood pressure regulation & managing stress levels. On which note, I suspect it becomes very clear that - despite the ministrations of said felines - I've yet to sleep & am somewhat silly with it. Serious about you contacting your MP though. If people don't speak up - & make it clear that they see these issues as part of the systematic underfunding of the NHS, rather than being in some way the fault of the medics concerned - it becomes that much easier for the erosion & undermining to just keep on. The NHS needs people outside it to say that they see what's happening & it's not ok & needs to change.

Ach, how can it be 0437? Please PLEASE let me sleep now...

Oh hell's bells & buckets of blood. I saw the posts before mine & didn't want to just feck off but my reply deleted itself & I'm now so tired I literally cannot see, so apologies in advance for any wild typos...

@theftbyfinding
Are you ok? Have you been hacked, or "just" left your MN account open where someone else (an adult with whom you live, presumably) could go posting [godawful] things under your username? Hope if the latter they've not also read anything you'd not want them to (I've not A/S to see sort of stuff you post, so don't know what you usually talk about, nor if whoever posted that first post has been elsewhere) - so awful to have your privacy violated & somewhere you feel safe flipped into a place of uncertainty like that.

@6catsandcounting
I'm sorry you're so unwell at the moment; & also that you're not currently receiving suitable care
Is your GP aware that your crises are [often?] precipitated by being unable to get an appointment & thus seeing things decline? Have you discussed any ways this might be managed? Would a weekly/fortnightly GP review work? That should be manageable even at a surgery that has a policy of on-the-day!only appointments. Really worries me the crisis team don't seem, from what you've said, to have given you their details so you can contact them when in crisis & thus hopefully avoid becoming so acutely unwell. Do you have a CMHN? You don't sound as if IAPT would be a terribly suitable treatment option given how short-term it is, but maybe you could discuss it with your GP? I'm really hoping that you're on the waiting list for some kind of secondary care - it's important to make sure they're aware of crisis visits to A&E & any sections etc: they might not be able to see you any faster, but it is vital that they are aware of how urgent it is you be seen. If you've not been referred for any kind of secondary care, ask to be. This clearly isn't something that can be GP-managed, it needs more specialist input. And that's ok. It's ok to ask for that & to advocate for yourself. If you were developing arthritis you'd want a rheumatologist's input now. Just because it's your mind that's going a bit wonky rather than a bit of your body, that doesn't mean you shouldn't approach it in the same way. You're not well; that's not your fault; you need treatment to get better; recovery takes time & isn't simple. While you're waiting for NHS care, you might be able to access some talking therapy through your local Mind; or the BACP Directory lets you look for private psychologists near you - their profiles will say if they offer concessionary rates. It might be worth exploring in case you can afford someone's low-cost rate (or they can suggest someone whose rate you can afford). And now, brutal as this might sound - if you kill yourself, it will be an act of extreme selfishness. I understand you're in pain - I hear you & I'm not dismissing that. But if you kill yourself, your child will grow up without you; & they will, on some level, blame themselves for your death. As will everyone else in your life. One of the best descriptions I've heard of early mother loss is that it's not something you get over, it's a grief you learn to live with. My mother died - very suddenly - when I was 10. She had brittle diabetes so I'd had some truly terrifying experiences with her - I was about 6 when my father was working away & her blood sugar level dropped so suddenly she had a seizure. She was slumped against a wall & although she was tiny she was still too big for me to move & all I could do was put a cushion behind her head as she beat it against the wall. I could spell my Road name from toddlerhood & knew exactly what to tell ambulance control (& how to drag a chair to the door to open it to let the parademics in if they arrived before a grown-up with a key). So however much you think you've scared your child by being unwell, please believe me, you won't be somehow saving them via suicide. You'll leave them confused & cast adrift. And they'll blame themselves for not seeing it & not saving you; & they'll blame themselves for not being [a good] enough [child] that their mummy would stay with them - oh & there will be children who will tell them you killed yourself because you didn't love them. And however many people promise them that's not true at all, mummy loved them very much, but she was very VERY unwell... that idea will stick, insidious & twisting-painful.

Please PLEASE don't think I mean to be cruel, or to just have a go at you. This isn't even so much for you as for the bit of your mind that tries telling you They'll All Be Better Off Without You. This is here as an external voice to remind you that's not true at all. Thinking it doesn't make you a bad person or a bad mother - it's just a part of you not being well. So you mustn't beat yourself up for having thought it, nor for the times you think it in future. I just ask that you try to hang on to my voice, reminding you that the voice saying "killing yourself will fix everything" (or similar) is a big fat liar & you've not to believe it. Because I can promise you your child needs you & to grow up without you would be heartbreaking for them; & I know for a fact that pretty much everyone you know would be blaming themselves - my father's best friend committed suicide over 30 years ago now, & he still struggles with the What Ifs.

Please PLEASE try to be gentle with yourself; & please talk to your GP &/or CMHN & see if there's any way for you to access some additional care & support. You deserve it.

theftbyfinding

When critiquing the writing of others, it does generally help if your own is correct.
You're quite correct a medic didn't write that paragraph. But given I've never claimed to be one I don't think that's news to anybody. Apart from you, apparently...

Crikey....

So my slant as an outsider. I have spent the last 6 weeks in and out of hospital with my son and so have have plenty of time to make a lot of observations and listen to a lot of conversations.

We have been admitted 3 times to one hospital and twice to a specialist London hospital on the back of those admissions. I would say that pretty much every single medic that we have come across in that time has been patient, kind and hard working. I have been beside myself with worry at 2am and had a lovely nurse trying to help me calm down when she could have just got on with whatever she was doing, wonderful paramedics in the ambulance trying to reassure me when they were at the end of their 15 hour day with another 2 hour journey to deliver the ambulance back and get home, seen at the end of a day by a gorgeous paediatric consultant who was so hungry as she hadn't had any lunch but most of all was just very thirsty - I honestly could have cried in her room, she was so kind and took so much time with us and felt like that. The list is endless, it really is endless.

I have also been immensely frustrated with the clerical side of the system which has meant 8-12 hour waits in paediatric A&E with the same problem, no transfer of notes, all phone calls between the two hospitals with the inevitable loss in translation that happens in these instances. Having to go for blood tests via A&E taking up to 12 hours as totally understandably we are bottom of the list priority wise as my son has developed a chronic condition - started off as acute - but here we drop between the lines. I have questioned with the admin staff the necessity of going to this dept for these tests but have been shrugged off as it just being how it works despite the fact that they now know what's wrong with him we still have to go through this ridiculous procedure.

I am a staunch advocate for the NHS, think we are truly blessed to have it in this country and have spent the last couple of days reading through this thread very carefully. I want all the doctors and nurses, health care assistants, cheerful breakfast ladies, ward cleaners and kind porters to know how grateful I am to them that they choose to work in such a thankless profession - from some quarters it would appear - I have literally cried from relief at their kindness and concern and also worry so much at how many feel so unappreciated and overworked that they are leaving the profession in droves.

To all those feeling like they are banging their heads against a brick wall on this thread, please do know how much many of us appreciate you so very much

tulips that is a lovely post. It is how I feel too. My dc became very ill and bar one singular doctor the people who have looked after him, our gp, other gps, hospitals, intensive care for a week, were amazing.

Re the admin, I think PFI has much to answer for.

sweetie I think that paddy was reacting to a post from the OP which said she had been U but didn't come across as very sincere and seemed sarcastic and arrogant (along the lines of "I am clearly being unreasonable to think that 2 junior doctors and a senior doctor should have realised that my baby was fine and sent us home more quickly").

I think paddy's post in that context was understandable, and it isn't just doctors who have such sentiments - I think that many people who work with the public and encounter difficult people from time to time or put up with difficult people anywhere will have felt the same from time to time.

What has struck me about this thread is that people who work in clinical roles within the NHS have a lot of knowledge of how the NHS works (obviously). The criticism of the OP seems to boil down to that she does not know the ins and outs of how the NHS works, she is insufficiently grateful and even that she has somehow wasted NHS resources for taking a sick child to a service that treats sick children.

It is frustrating to wait for hours and hours and not know what you are waiting for or when you will be allowed to leave. I waited for over 5 hours at an eye casualty unit recently - similar situation to the OP - I was sent there by a GP, there were only a few patients, no obvious order anyone was being seen in and no information. After several hours I asked someone politely when I might be seen and they told me. I had to actually follow this person into another room in order to get anyone to talk to me. There was no receptionist and no obvious person to ask.

I was worried on and off for most of the time that if I went to the loo or to buy a sandwich I would miss seeing the nurse/doctor. When I finally did see the doctor she was helpful, efficient and nice. It took her less than 2 minutes to confirm that I had the problem my GP had thought I had (but didn't have the equipment to confirm) and to prescribe.

I'm afraid I did complain about the lack of information to PALS afterwards as for most of the 5 hours I was watching an elderly lady in a wheelchair get increasingly distressed and dehydrated as she didn't know how long she would be waiting or how she was going to get home. I wanted to get her a drink but I didn't want to make her need the toilet as it wasn't obvious how she would get to one.

It took the person I spoke to perhaps 20 seconds to explain roughly how long the wait was and how it worked. A whiteboard from the pound shop would have done the job!

It must be very hard working in the NHS at times but just because you feel attacked (understandable given the media, rude patients, etc) doesn't mean everyone is attacking you when they are trying to get information or aren't being sufficiently grateful in the right way.

The fact is there is actually no alternative for most of us other than to use NHS services so it's a bit much to expect the users to consider the entire service beyond criticism, improvement or comment.

@MarieVanGoethem Thank you for your kind words. I do have a CPN and secondary support but am going thro a particularly long very bad patch; it is so hard to fight constantly for what you need when underneath you really really just want to give up. Ds is the only reason I am currently fighting - he has been thro so much it seems I should at least try to limit that if I can for as long as I can.