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?

Random don't you dare feel guilty about putting yourself first for once. One of our F2s collapsed on night duty once and ended up in HDU. All anyone cared about was how inconvenient this was and who was going to cover her shifts for the rest of the week.

Don’t feel guilty random - I only took two days off when I had a MC because I felt so pressured to go back in.
I was a liability (thankfully my end of the medical science business doesn’t do too much harm to patients if I’m having an off day) because I was still bleeding heavily, in pain and just in no fit state to do anything useful. I should have taken more time off for sure.
Mc is just shit shit shit. I’m so sorry - take care of yourself.

coffee glad your DS was well enough to go home. Note your comments to random.

Suggest if, and I hope for your DS there isn't another, you should find yourself having similar thoughts in an A&E you contact the PALs section for the hospital and relay your observations/concerns. This will allow the hospital to review and address your comments either by explaining what lay behind your observations and maybe cause you to reconsider your conclusions, or to bring about change, if it is found that staff were not following procedure etc.

It's not perfect, and neither is any one individual working there. But generally the job they do, combined with the current pressure is amazing.

So this:* They could be paid a million a year and I wouldn't bat an eyelid*.

Have my first for your assumptions.

@JWIM
Yes I totally agree with you on the lack of empathy. Particularly as she’s keen to point out she’s pregnant herself (not having a miscarriage) and expects us to empathise with that.

random I’m really sorry to hear you’re going through this. Kind of makes you wonder why you bother going to work when you really shouldn’t when people are as unappreciative as the OP. I’m not sure why many people forget that doctors are human with emotions and not machines. The media are particularly guilty of this.

Don't worry I didn't post for sympathy. Just trying to illustrate that we are human beings, not machines.

Everything OP has said sounds totally reasonable. It's really indicative of a problem in our society that it could possibly be seen as unreasonable to make observations about the NHS.

Screaming that the NHS has no problems and is a perfect system filled with perfect people won't actually improve things you know. Most NHS staff probably are really good people. So that has to be squared with what OP saw, which isn't unusual. Bad individuals, mismanagement, the effects of chronic and drastic underfunding? It was something, whatever it was. And the more you insist it's fine and more than we deserve, or that OP was somehow the problem when she did everything she was told to, the worse it will get.

rina: no that's right. But:

It's not perfect, and neither is any one individual. But generally the job they do, combined with the current pressure is amazing.

Everything OP has said sounds totally reasonable.

It's reasonable that the most junior doctors should ignore procedure, go rogue, and not wait for their registrar before discharging her child? It's reasonable to expect doctors to constantly be attending to her child? It's reasonable to expect doctors to not be checking for bloods/X rays/referral requests near the computer they come through?

What problem though? The op managed to speak to a 24hr on call service and was quickly and thoroughly assessed and observed and reviewed by a senior doctor and discharged safe and well. Some parents in other countries would give the right arm to have that kind of care, free at point of delivery, for their children.

For God's sake don't encourage her to go to PALS and waste yet more NHS time and money.

But the OP has done nothing positive about the situation described, just whinged about it.

I can answer "I've got two in my queue waiting to be seen" comment.

What th Doctor means is he/she is waiting for department doctors to see two patients in the queue. In other words he/she has already seen the patients but is waiting for the people they were referred onto to see them. That is a waiting game as those doctors may also be busy.

And fwiw, waits in A&E in American hospitals are just as bad, and you get presented with a bill for tens of thousands of dollars at the end of it. I had a patient who had moved from the US. He was a manual worker with no insurance as he couldn't afford it. He got something in his eye at work, went to the ER as it was swollen, waited hours to be seen, examined and give antibiotic eye drops (you can buy them over the counter here for a couple of quid). The bill was thousands and he ended up declaring himself bankrupt because of it.

In response to Rina.

I blame the media too. Someone who has never worked in a patient facing role within the NHS just can not understand how things work. If the media are saying "this, this and this is going on" that is what people are going to see.

"Lazy nurses deny elderly patients drinks"

Random patient/relative sees nurses refuse to give a drink to a confused patient. The NHS is shit: confirmed.

Reality is (hopefully) patient is fluid restricted, or fasting, or awaiting SALT input.

for random what a shit situation.

I’m going to give coffee the benefit of the doubt, she was worried about her DS and then over tired and has pregnancy hormones in the mix; plus I think it’s easy for written language to be interpreted differently from what was intended.

Fwiw I was taken via ambulance to hospital last month. It took 3 hours to come. Evidently they prioritised - other people must have needed ambulances more urgently than me.

At hospital I was seen within 20 minutes and a cannula was put in within another 10 and treatment commenced. For people who are actually in a serious condition everyone else has to wait. DH said wait times were listed as 6 hours that day. So here I was prioritised over others as my need was greatest.

And that’s the crux of it. Staff are working hard. If you have to wait, 99% of the time it’s because of a genuine unavoidable reason, not because staff are being “stuck idle”. Are there inefficiencies in the system? Almost guaranteed. But people are generally doing the absolute best they can within that and if they have some personal chat while they work or on a short break, good. It probably means they’ll be in a better mental state to treat the patients in their care.

Maybe it was a quiet night, maybe the doctors had been on duty all day, it's easy to criticise but you dont have all the facts and your posts make you sound like you were just out to find fault. Glad to hear your son is okay, let's wish all the other kiddies in there that night are also ok.

And can I just add as someone who has worked in Ireland and the UK- the waiting times in the UK are much shorter than Ireland at least. In Ireland it wasn’t unusual to see a patient on Friday in a+e and see them still there on Monday morning sadly.

I can answer "I've got two in my queue waiting to be seen" comment.

What th Doctor means is he/she is waiting for department doctors to see two patients in the queue. In other words he/she has already seen the patients but is waiting for the people they were referred onto to see them. That is a waiting game as those doctors may also be busy.

I think in this case she was waiting to see us. We were definitely one of the two (she mentioned DS by name), but hadn't seen him yet.

OP another off sick Dr here, feeling guilty for not being at work ( despite BP of 98/50 and heart rate of 116 ).
I have been that paediatric registrar and believe me, you wanted to wait for the reg to at least see the obs and the baby before discharging home.
Why did you even call 111 ? Presumably because you know that high temperatures in young children can indicate life threatening conditions which develop rapidly (meningitis is the obvious one but other sepsis also) rapidly as in hours. The ongoing tachycardia (raised heart rate) after the fever settled would have earnt your son a full 4 hours observation from me- sorry if that upsets you and no I wouldn't have admitted but I would have kept in A&E as long as possible to see which way it was going.
I would put money on the fact these inexperienced A&E docs (and/or the peads nurses) had spoken to the reg and been told exactly that.

Glad your Ds is better and hope your pregnancy goes well

This was not an OP written off the back of a full night in A&E last night, so tired, worried, pregnancy hormones maybe, but 'I recently spent a night ....'. I would have thought having had some time to reflect on the experience in A&E might have offered coffee a positive perspective as much as the negative one described in the OP.

My brother was declared dead in resus at our local A&E at 6 am, the staff waited for our family to arrive to take us to the family room and break the news and discuss what they'd tried to do to save him, for almost an hour. At 7pm that same day, I was in resus, tetany attack/hypocalcemia due to the shock (existing condition) and the same staff were there and remembered me from the morning and were kindness personified. I can't praise them highly enough.

There will be inefficiencies in the system of such a monolithic organisation but it's not the fault of the frontline staff.

Well clearly she has reflected, and clearly she still thinks it's a negative experience... Otherwise she'd have posted a glowing and grateful OP.

Just because you think it was a positive experience, doesn't mean the OP has to see it that way.

Still wish do you have the horrible chesty virus that's going round? I was still febrile and tachy after a week of doxy - ended up with another week of clarythro and some steroids and had to take 8 days off in the end, but I was ill for 4 weeks and still not right now. Think I had a bit of a cap tbh. That's partly why I tried to soldier on yesterday, already feel bad/judged for having taken that time off recently.