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?

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

Nope it was the triage nurse that fitted the monitor (as she couldn't get the temp sats monitor to give a decent reading). He wasn't seen by a doctor of more than 2 hours.

Fruitbat1980 would you prefer they were running down to the library between patients?

OP it can be frustrating waiting when you don't know what's going on but a million things happen behind the scenes. Often people are chatting and filling things out at the same time, or while on hold on the phone for example.

If you can't see their screens, you can't assume they're not working.

I'm not the sort of person who thinks that doctors must never be questioned at all. I always ask questions about medications, diagnoses etc. However, I have never been in A&E and felt anything other than admiration for the work that goes on there.
Even if a doctor/nurse doesn't do everything exactly right on a given day, they have trained for years for the dubious honour of dealing with other people's blood and guts, while possibly being abused and assaulted. They have stood up and taken it on and I freely admit that I wouldn't.
I have been in a situation where I was waiting to be seen and my condition deteriorated suddenly. My husband just politely asked a receptionist how much longer the wait would be. A nurse (I think, I was only just conscious) looked at me and I was seen within a minute or so.

I'm afraid as an organisation the NHS is terribly inefficient - I know firsthand.

Difference is a qualified medic would know what they were googling. It's not random.

I am definitely not A&E bashing but a few years ago my son attended with a suspected arm fracture. There were only 3 children in. He was triaged by one of the 2 nurses. Another boy came in an hour later and was triaged by the other nurse. He also had a suspected fractured arm. He then went off to x-ray. Another hour on we hadn’t been for an x-ray. When I queried I was told that the doctor (who was busy with another baby so fair enough)

had to approve an x-ray. I asked why the other boy had gone for an x-ray as he hadn’t been seen by the doctor. Apparently the nurse he had seen could authorise x-rays and ours couldn’t. After further discussion the other nurse re-triaged my son and sent him for an x-ray 2 hours after we arrived. She had been sitting there throughout. As it turned out my son did have a fracture and the other boy didn’t. Total madness.

You do know people generally work through breaks? Maybe they were reviewing films/reports/results whilst chatting. Maybe they were just having a bit of their break and a coffee while chatting. Who knows. Unless you are prepared to do what is a really shit job (been there, done that) don’t complain.

Also, if you think you can revolutionise the system feel free to do the job and crack on with it.

I'm well aware doctors work insanely hard. But moving slightly off the point, this kind of comment 'They are among the brightest students in the country, much clever and harder working than you' pisses me off. From my interactions with medics, I do actually think that some of them not-so-secretly believe that their patients are all stupider than them, because all the cleverest people are there studying medicine. A friend of ours was an FRS and university professor by age 30 but STILL got royally patronised by the consultants when discussing his care. It was pretty astounding. Likewise I have three kids qith asthma, and whenever I refer to some terribly complicated medical term like 'sats' or 'recessing' I invariably get asked if I'm a medical doctor. No, I just pick information up, like a normal, intelligent, educated human being...

As an NHS employee (not A&E, other department) it can be hugely frustrating to have to spend time in the office chasing up something when you have a queue of people waiting for you.
But as an example if you're trying to get through the massive amount of paperwork required to discharge someone and there is a piece of information missing from their notes, e.g. details of a treatment received in a different department, then you spend the next 30 minutes trying to chase up the required information needed. And the reason the info is missing is not because of someone incompetent, it's usually because someone has just done a 14 hour shift and is dead on their feet and overlooked writing one thing down out of the 500 separate bits of paper/ computer work that have to be completed these days.
Of course, while we are being put through to someone on the phone we may have a little small talk with someone else in the office but I think this keeps us sane.

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.

Thinking about it I actually think this was the case here. The registrar that was popping in and out was making all decisions - checking everything etc, while the other two docs appeared to be stuck idle a lot of the time.

When we asked if DS could be discharged, the doc said she need to check with the registrar when he got back from ward (we waited 90 mins). DS's temp had reduced to 36.6, breathing was fine etc. the two docs had examined him and said sore throat and mild cough. Chest/ears were clear was clear and almost sure a viral infection - but they didn't have the authority to discharge...?

Actually I think the OP has a point.

I am a big supporter of the NHS. I’ve been treated by amazing staff working through breaks/after their shift to ensure they provide a good service. Who listened to me and did their utmost to treat as well as they could.

I’ve also had cause to complain to PALS and have my complaint upheld. (I received an excellent, considered response to my complaint).

Like any organisation there are good staff and bad staff, good systems and bad ones. Supporting NHS staff in general doesn’t mean you’re never allowed to question what is going on.

OP. The thing is no-one but you could have changed what happened. A quick, polite word rather than sitting festering when the wedding conversations were going on would have been good.

This has made me really angry, so I am leaving.

coffee I was in A&E on Saturday and the consultant didn’t want to discharge me until the nurses had given the go ahead.

So not just to do with hierarchy so to speak, but making sure everyone is on the same page with each patient.

Were you ever here in the first place @TheTab?
Such helpful input. A flounce. Really gets the job done.

I worked in A&E for 9 years and still work in acute care. Work ebbs and flows. Sometimes (more frequently these days) it's crisis management, a barrage of seriously unwell patients alongside others with less severe but still important to them issues. Other times it calms. The crisis is more persistent currently, and staff don't dick about. I was still seeing sick patients for 2hrs after my shift on Sunday (so 14hrs in total).

When it's calm staff often do relax a bit. Many moons ago I remember using urine bottles as Skittles and bowling down the majors corridor on a particularly quiet night shift. I can assure you that no longer goes on, it's never that quiet anymore.

There are times when, when it's quiet things get missed because staff have relaxed a bit too much, but something soon crops up to get everyone going again.

I completely understand why you find it annoying hearing personal chat when patients are waiting. However as others say there are often good reasons for waiting (for instance a kid comes in vomtitng and has been given diorylyte to sip little & often and staff need to see if it stays down, it makes no difference if they are seen quickly or not by the Dr as they still need to trial the fluids). And staff should be allowed to be a bit relaxed when it's rarely quiet as long as patients aren't at risk.

Can nobody else see the irony of someone who says her child didn't need to be in A&E complaining they weren't dealt with fast enough?

Maybe the doctor need need a senior review to discharge your child, that's the safest thing to do and not their fault. It doesn't mean they sit around doing nothing, what would you like them to be doing. Its a shame doctors arent given an office where they can work in peace and quiet and be able to have a bit of privacy. Hope your child is ok but dont bash junior doctors.

Seriously OP. You have no idea.

Basically what kimmyschmidt said above.

But also - what you see on the surface is the tip of the iceberg. Behind that doc popping in and out is an entire team of staff - an entire lab producing results to order that then need to be interpreted and perhaps discussed and cross checked. That doc may well have two in her queue in the area you’re in but maybe she’s covering another ward as well. Or maybe more. Maybe she’s dealing with a complex case in another booth which requires her to go back every half hour or so and reassess.

When we took ds to A and E recently (he couldnt breathe, pretty scary) we were seen immediately by a doc who had run across the hospital to get to us (children’s A and E was through roadworks and we didn’t feel we had time to negotiate them so we went to adult A and E.) he was swarmed with docs while they stabilised him.

And then, yes, we were popped in a side room and waited a few hours - because once ds was breathing again and perked up a bit other cases took priority. I wouldn’t have dreamed of being arsey or complaining about it,

A and E is massively stretched
You are not qualified or experienced to fully understand what’s going on in A and E - that’s very clear from your googling comment.
Priority goes to urgent cases. Urgent is the kid in a car crash, the kid turning blue as they come in and the kid bleeding out.

Everyone else waits.

This has made me really angry, so I am leaving.

But TheTab, you've only just arrived! Take a moment to calm down.

coffeeforone

"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"

You don't actually know what you would and wouldn't do for sure since you're not an A&E doctor and clearly have no real idea what they do other than not seeing your child as fast as you wanted them to.

You're assuming she wasn't waiting on something regarding the other child and that she was just having a personal conversation because she's...I dunno lazy? Or doesn't give a crap?

This thread probably should have been titled "Why don't A&E doctors see my DC and I are more important than anyone or anything else so we shouldn't have to wait for anything!!!" 🙄

Thank you everyone who has taken the time to explain, particularly unicorn.
OP is obviously placated by that explanation.
FWIW I’m wondering what coffees support network is? When it comes to things like fever (not a sports injury for example), if you don’t have people around you who are able to say “yes s/he is unwell but honestly, it’s just a childhood illness*. Neighbour, friend, your own mum/Dad, sibling, partner you panic and ring 111 just for some reassurance.
I’m wondering if this happened to the OP and she was sitting there by herself in A&E vascillating between feeling grateful DC was ok therefore didn’t need seen quickly, and maybe wishing she hadn’t even rang 111.
She may well have felt isolated and that’s why the Drs letting off steam chat got to her.

I've wondered this myself. Recently had to take my son to hospital where we waited 8 hours to be seen. Doc said yep that needs glue then waited two more hours for a nurse to do it. She took less than five mins. Why didn't the doc just do it and we'd have been gone.

Bit of a mean thread. YABU.

So much!often covering the paeds ward, liasing with staff in their hospital and other hospitals, arranging transfer of really sick children, catching up on notes , writing the current notes, reviewing test results etc etc etc