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?

It is likely that all my seniors only care about the fact I am not in today. I started bleeding yesterday but still went in yesterday afternoon on what was supposed to be my rest day because the ward was busy. Blood pissing down my legs today though so don't want to scare the patients or make a mess. Sorry about the thread derail, but not feeling the most rational today and threads like this boil my piss after the weekend I've had. Think a name change is in order after the personal info I've shared though.

Do you know what, I had to wait all day yesterday for my gp to call me on the duty list. It was mildly irritating, and obviously a stressful time for me, but I know she probably had a crazy busy day dealing with umpteen other patients, and I realise that the world doesn't revolve around me. So I decided not to post a moan thread about it on mumsnet, but instead thanked her sincerely for her time and advice. It was after 5 so I suspect she was working after her shift finished, as was I.

And no I don't have anyone with me, my partner is in France.

Sometimes 111 does direct to the out of hours GP service (or a nurse or paramedic), but the 111 service is not run by doctors and people advised to attend A&E by 111 aren’t being advised to do this by a Doctor.

@Nestofvipers are you saying that when an NHS 111 adviser, said a doctor would call us back, the person who called us back was not a doctor?

I know that last year when I was readmitted after surgery went wrong and spent 36 hours in a&e because there were no beds, 72 hours in theatre recovery because there were no beds and then 2days on a gynae Ward (my surgery was digestive system) a lot of the doctors' time was taken up trying to find me in the hospital!

Their care once they found me was exemplary.

Coffee you took your son in with a high temp and asked for him to be seen in A&E by an A&E doctor.
He was. He was put on a monitor and observed.
How quickly did you want that to happen ?
You started a sequence of events that have to be followed through.
You can't just say "oh well actually I regret coming here I think we'll go now please".
YOU wanted your son monitored. The doctors were concerned about his high temp and followed the correct protcol before a safe discharge could take place.
How dare you criticise the very people you asked for help for just doing their job !!!

coffee unbelievable lack of empathy.

If it was a docror calling you back they would have introduced themselves as a doctor, i don't think they man the phone lines.

Yes OP, the juniors on the ward who were waiting for their registrar should have gone against the hierarchy and ignored the fact that the registrar has far more experience and sent your child home anyway.

They should have also thrown the computers out of the window anyway, left the department full of children that didn't need to be there and rushed to majors, and took a shit on the bed manager's desk for taking too long to find beds.

YABU and haven't a fucking clue.

@Nestofvipers are you saying that when an NHS 111 adviser, said a doctor would call us back, the person who called us back was not a doctor?
No. As I said in my post previously, 111 isn’t staffed by Doctors, but in some areas you access the out of hours GP service via 111. You will have spoken to a Dr, but they’re not part of the 111 service, all 111 have done is redirected your call to the OOH GP service and you’ve been put on their list for them to call you.

The last time we went to A&E with DS we were waiting for 3 hours to be seen. I was very grateful for the wait. The time before that we were seen immediately by a team of 6 after arriving by ambulance with a non-responsive baby (he's fine now!). I'd take that 3 hour wait any day as it was reassuring.

The doctors and nurses will be dealing with cases you don't see come in.

@randomuntrainedcuntowner it’s shit isn’t it. People wonder why morale in doctors is so low. It’s because we work so hard and still it seems that many people don’t recognise it. I’m sorry about your miscarriage. I’ve had 2 miscarriages while in work. One on a weekend on call where I just got on with it. One recently where I passed the sac and had a huge bleed in resus while seeing a patient. A kind nurse helped me clean up discreetly and brought me something to drink while I waited for bleeding to ease off. Probably looked to others that I was just lazing about- I’m a subspecialist so had only that one patient to see (cover numerous hospitals, mostly phone advice). I’d usually have gone home but obviously needed to wait a little while.

I’ve been a patient and a doctor. Being a patient is really hard. I can understand why people get frustrated waiting around as they don’t understand all the waiting around. They don’t see us begging a radiographer to do a scan, or talking to families, or sometimes just taking a short breather after a really draining cardiac arrest. Often if I’m sitting in a+e I’m waiting on a family to come in to break the worst news for example. If they are coming in 10mins I wouldn’t start a new assessment first unless really urgent- as I will want to properly prepare to do a good job of the discussion.

We aren’t looking for medals, but I do sometimes wonder if we do our profession more damage by just getting on with things.

Random, so very sorry. I hope all the NHS knockers feel thoroughly ashamed of themselves. Be kind to yourself yourself. .

I'm so sorry paranormal about your losses. I am feeling incredibly guilty about being off today but the ward I am on is horrendous and I know I won't leave on time and I just couldn't face it. My blood pressure dropped a couple of times yesterday and I'm even worse today so I have decided to just remain horizontal and drink plenty!

I too was looked after by a lovely nurse who ushered me into the treatment room and took my bp for me and brought me water when I looked particularly puce! 84/54!

Your son's symptoms were vague. It could have been something or nothing. Thankfully it wasn't something serious this time but no one should be blaming you for seeking help.

Every doctor up to consultant is in training. The two doctors you are talking about will have been quite junior. They do not have the experience, and therefore the authority, to discharge patients. The reg is the person who looks at all the information up to that point and says "stay" or "go" based on their more advanced experience and knowledge. Gathering the info needed takes time. Time means waiting. It may look like nothing was happening but that nothing was actually something.

standing around doing nothing

Oh God I've heard it all now. Goady fucker.

@randomuntrainedcuntowner I took 3 days off as developed endometritis from retained products and needed IV antibiotics and ERPC, dropped haemoglobin to 9 (from 14) and felt really guilty. Isn’t it terrible that we feel we can’t take time off at such a stressful horrible time.

Don't feel guilty about being off, rest up and look after your own health for once. Ive seen doctors faint on rounds,and in the middle of the night as they hadn't sat down, eaten or drunk for hours, it's a bloody hard job, most of us appreciate all the hard work fellow h.c.p. do, there will always be the complainers where nothing is ever right.

I personally didn't read it that the OP was criticising the staff, but more the system. The UK has some of the best trained medical staff in the world, we have some incredibly skilled surgeons, wonderful hospitals, etc. And the fact that it's all free at point of service is wonderful.

However, it is not normal to wait 3 hours in A&E for a simple problem. I live in a major European capital city and have attended A&E at various points with and without kids. I have never, ever had to wait up to 5 hours like I remember doing in the UK. Even on a busy Friday evening my DS was seen within an hour and we were home within 3. Not to mention the fact that there's a brilliant out of hours system here, so that when my kids have been ill at the weekends I can see a doctor within a 5-10km radius of where I live, rather than cluttering up A&E with my non-emergency case.

NHS staff are great. The NHS system - not so much.

I remember when I worked as a HCA in A+E (now qualified and still working in critical care but not A+E) and was standing at the computer sorting some bits on our system - basically discharging patients from the minors screen, putting them in a different location - all whilst fiddling the figures like we were taught so we didn't get charged for a 'breach'. A relative approached me and said "why don't you do some work instead of standing around PRETENDING to be busy?".

We were in the middle of a staffing crisis. I was IN CHARGE of minors as a bloody healthcare assistant. I was being 'supported' by 2 agency nurses, neither who had worked in A+E before, neither who knew how to triage, neither could bleed patients, put in their cannulas, perform 12 lead ECGs, put back slab platers on, do burns dressings, close pre-tibial lacerations. I did ALL of those jobs for every single patient that day, including liaising with the bed management team, referring them to different teams. Those two nurses gave patients drugs and helped to transfer them. I don't begrudge them, they got a great pay rate for little work. That comment from that relative tipped me over the edge and was one of the many reasons I left an unsafe A+E department shortly afterwards. Working in A+E is hell on earth..I did it for 5 years and recently returned there for a placement and nothing had changed.

Comments like that and threads like these are what make A+E staff give it up. Quiet days are a rarity, staff are allowed a chat. Granted they perhaps went on a bit more than they should've but if that's what helps them get through their shift and their patients are safe then I can't see much of an issue.

@randomuntrainedcuntowner I'm so sorry for what you are going through, and really sorry if this thread has upset you further,
Please take some time to rest and recover.

You clearly work under immense pressure, completely different to the situation I observed. I honestly was only saying what I observed overnight which at the time was a very quiet children's A&E.

Sorry again for your loss.

Thanks everyone. Sorry about the rant. Pregnancy loss is a weird one as you have this awful thing happening to you but it's something you don't feel like you can tell people - hence the oversharing (anonymously) on here! 😂

By the very nature of a&e, there can be dead time while patients are having tests, results are being waited for, onward referrals and admittance are organised then a sudden flurry of activity when everything happens at once.

I wouldn't begrudge anyone in a&e having a bit of a breather during a relative hiatus in a 12 hour shift.

WIshing you well random don't rush yourself back

It's ok. I have been frustrated in the past by seemingly inefficient care in hospitals/gps prior to being a doctor. It is only since becoming one that I realise that everyone is trying their best (I have honestly never known an nhs employee who isn't), in a horrendously overstretched system with a growing population with increasingly complex needs. Not to mention litigation culture. Kids always need senior review before discharge (they do in my hospital too) because if a junior discharges a child and something goes horribly wrong...