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?

Believe me op, if that dr could have went ahead and reviewed those patients she would - after all, then she would have been able to take herself off the ward for a proper break. Why wouldn't she choose to do that?

I expect this was an unusually quiet night and so they were probably taking their time and enjoying the lack of pressure for once.

I can assure you, this little snippet of 'observation' is absolutely not reflective of A&Es across the country

To answer your op, you appear to be referring to paeds. In my hospital, the paed reg covers the neonatal unit, the childrens wards, PICU, a&e and maternity ward/delivery. Not too hard therefore to figure out how they manage to occupy themselves

I hope ds was ok

I think it’s a fair enough question. I always wonder these things as well.

I just wonder how the cogs turn in hospitals and how things get done and how and which order and when. It’s pretty interesting!

Unkess they are finding info off Natural News or Whale.to then I don’t see the issue fruit.

Rather than than guessing about a condition they don’t have much experience about and I’d guess that cutting and pasting is probably quicker than typing all the information out.

Nurse here. 'Admin' for each patient can literally take an hour or two per patient. Firstly you may need to look up each patients medical history and prescribed medication (obviously some patients may be able to tell you this verbally, but even in those cases you will need to write it down on their hospital paperwork). Then you have to spend time phoning and liaising with different departments to organise medical investigations and transfers. Then there's the time needed to look up test results on the IT system. Then once patients have been seen you need to write a discharge / transfer letter to send to the patients GP to let them know what has happened to the patient during their admission. And that's only for 'straightforward cases where we don't need to liase with social services or similar to organise post discharge care, or report safeguarding concerns etc.

They play solitaire.

Minesweep if they are consultant level or above.

FruitBat you mean they were researching.

Most of it is done online now.

I’m doing a healthcare degree and most of the medical journals and books are online. Sometimes Google is simply a quicker route to get to them, sometimes it’s not.

There’s a VERY big difference between what a medic can get hold of online and what Joe Bloggs can google and find on Wikipedia.

Welcome to the digital age.

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

Yes maybe the inefficiency lies with NHS 111. At lease 3 of the 6 children (including us) were not urgent emergencies and were directed to A&E by 111 docs. The others were an injured foot and an allergic reaction.

They’re not robots.

I was a nurse, retired early partly due to people like the op. One shift I was on was so busy I had no time to write up my notes. Finished my shift, handed over to the late shift and began my notes (in my own time, unpaid).

I was sat at the nurses station, writing my notes when a relative came up to me and screamed in my face was I going to get off my lazy arse and answer bells.

For all you know some of the doctors/nurses where doing as I did.

No wonder we have a recruitment crisis in the nhs.

I was in A&E last week with my elderly dad last week and 2 doctors and a charge nurse had to spend a good chunk of time trying to get a drug addict who was under the influence to not play with a lighter he was trying to set light to his jacket with. That pissed me off way more than if staff had been having a chat amongst themselves.

Well put it this way. They are among the brightest students in the country, much clever and harder working than you, and then, instead of choosing to be bankers or lawyers and getting paid millions, they choose to take a comparatively shit salary in order to work incredibly long hours and deal with arsehole members of the public and get appalling treatment from the government.

They put up with all of that when they could go and get an easier job for at least double the money and fewer hours, out of a sense of duty and care for people.

So whilst the detail of the job is beyond your comprehension, since you have no idea what their job involves, why not give them the benefit of the doubt and trust them not to be dicking about and wasting time?

It’s ignorant ‘I don’t know it therefore it must be easy’ fools like you that make doctors leave their profession and me think we should scrap the NHS because people don’t deserve it.

Their screens were on show and they were copy and pasting from google/ medical online encyclopaedias into patient notes. Seemed madness

People always say this because they don’t know what they’re looking at.

Google isn’t just a search engine, they provide solutions to organisations including providing online managed desktops for Hospitals and Universities. You think they are googling, often they are using the hospitals systems and the hospitals systems contain a lot of information that can be ‘googled’. So a lot of what is coming up in their google searches is information which would not come up in a google search done by the average man in the street, instead it contains paid for information from medical journals, pharma information, databases for toxicology etc, etc, etc. Loads of medical resources are online.

And copy and paste, when done carefully, is actually a great time saving measure. Why on earth would you retype all the info rather than copy and pasting?

Pressed post too soon! I’ve been spent way too much time in a hospital over the last 3 months to grudge medical staff any rare moment of downtime they get

So, OP, you're complaining about not being seen fast enough and then complaining thar 111 sent you needlessly and you shouldn't have been there. Have I got that right?

How do you know the circumstances of why all the other children where in A&E? My son didn't look injured, walked in you wouldn't know he had a problem. Yet he was kept in for bloods, scans and other eats and his care is still on going. I didn't discuss why he was there with anyone other than the people caring for him so others in the waiting room more than likely assumed it wasn't an urgent case.

OP I think in the main doctors and nurses do an amazing job, but in your situation I would probably have very subtly asked a nurse what the wait was, just so I knew, so that I wouldn't sit stewing. They may have been junior doctors and waiting for supervision or the go ahead?

I can't comment on any individual hospital or department, but I think the NHS in general is massively inefficient. However, I fear it's a common feature of a nationalised industry and a service that is perceived as being "free".

If, for example, there was a small charge to see a GP, it might deter people from going to the Dr for the slightest little thing (I have known people who go to the GP every time they have a cold, demanding antibiotics, for example).

Next tine why don’t you just ask them what they are doing? Or, even better, share your suggestions for more efficient working - I’m sure they’d appreciate your insights.

Yeah I've worked in A&E as a doctor before and we just sit on our arses doing jack shit. 😏

Seriously though, my A&E department was like a war zone and I would regularly go a whole shift without eating, drinking, pissing or sitting down. What do you want them to do, run around screaming and waving their arms around to convince you they are doing something?

Yabu

A&E doctors don't just cover A&E, I'm a midwife and know that our paeds cover maternity, SCBU, children's ward and A&E children's patients. Our obs and gynae doctors cover maternity, gynaecology ward and any A&E admissions for gynae related problems. I assume other specialities work the same way.

Maybe they have a wee and a brew...

OP, you say your child was asleep, on a monitor. so presumably a doctor had fitted the monitor on and the monitor was, erm, doing what it was supposed to be doing, ie monitoring. I wonder what your post would have been if the doctors had come over and woken your sleeping child

Dear MN, I recently went to A and e with my child . My child was so unwell they fitted a monitor, then after an exhausting day my LO finally fell asleep (still with the monitor, so cute, I took a photo) . Then one of the Drs came over and insisted on waking my LO up. They weren't busy so I think they could have let my Likkle babe sleep on, what do you think?

Painting their nails and catching up on MN.

Kimmy I love your post. I think people forget that medical doctors are incredibly intelligent and could earn far more money if they did something non-vocational. They could be paid a million a year and I wouldn't bat an eyelid.

I might get lynched, but I speak as someone on the 'inside'/ on the front line who has also more recently been a user of the NHS for kids and parents.....

It is infuriating to watch doctors and nurses sitting at a desk when you are waiting for one of them to make a decision that affects you. There is a large amount of waiting for blood/ imaging results but there are two main reasons why the apparent 'time wasting' is increasingly evident: doctors' rooms have been converted into manager's offices/ clinical spaces, so they have nowhere to 'be' while waiting for results or writing up test requests etc. The second, and bigger issue, is that vast amounts of autonomy have been removed from lower level doctors. For example on a surgical ward when I started training, the following was not unreasonable: patient noted to have a mild fever and cough on the morning ward round, registrar asks for some bloods/ septic screen to be done. Registrar and others disappear into theatre for the day (obviously can't answer bleeps while scrubbed either). Junior doctor (F2 equivalent) would do the bloods/ order the chest Xray as an early job, check everyone's results by mid-morning and start antibiotics at lunchtime if the results indicated it. Nowadays, the junior doc has to wait for the phlebotomists to do the bloods (handful of plebs for entire hospital, so the bloods get to the lab later), get results by mid-afternoon and then generally has to wait for a senior to agree before instigating appropriate antibiotics......this would generally be done after the team comes out of theatre, so if lucky, the antibiotics are started in the evening....

i.e. the people who have the autonomy/ are prepared to take the responsibility don't have the time and so you don;t see them, and the ones who have the time don't have the authority and are left with nowhere to be and less and less that they can do.

There are also fewer and fewer enterprising juniors who will go find someone who can give them an answer and instead choose to wait till they see them next.

Do not mean to denigrate the hard-working juniors and nursing teams, but the 'system' is becoming so difficult to work that effectiveness is being eroded because of the fear of taking resonsibility - not least because training is being dumbed down.

Rant over