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 am glad that the OP's DS was checked and discharged and hope that gave the OP some comfort at the time. May the OP's future encounters with the NHS continue to end as successfully.

And I doubt that, had the OP felt it had been a positive experience, they would have posted about it here.

Random I'm going to sound like your mum now. Please don't feel guilty about not going to work and looking after yourself. We need our doctors to be fit and healthy, you're no use to your patients if you're unwell and tired out. Think about what you'd tell a patient and take your own advice. You're only human, you don't have to be Superwoman.

Lecture over.

No, it's a bit of a mystery, don't want to post too many details....if I had a pound for every junior who's suffered a MC secondary to the stress and endless viral infections involved in doing their job in early pregnancy I'd be a rich(er) woman. I wish I'd taken more sick leave in my pregnancies TBH the NHS will get its money worth out of you later-take care

The paeds reg will also have been covering resus on a night shift. Your wait would have been even longer if a sick child came in.

Gosh OP, I don't see why you thought the doctors should discharge you sooner just because you were all tired and you're pregnant. Your son was safe, had been checked and you didn't need to worry about him. The registrar was rightly prioritising patients that needed more care.

I've spent a lot of time in A&E and children's wards recently as my six month old was born critically ill and has had surgery. We honestly prefer the times when we have had to wait as we know that he isn't too bad. Once we were admitted on to a ward within ten mins of arrival - that's when you need to worry.

Also, we would definitely cause a lot of paperwork. DS had his surgery at a specialist hospital 100 miles away so often the docs have to phone them as well as access his hospital notes. His condition is rare, so I'm sure they also have to google and check medical journals. All of this could result in staff looking like they are doing nothing whilst actually they are making sure they have the right information to treat a patient.

Oh, and my son would look perfectly normal to a bystander. But a cold usually results in a stay of a week or more in hospital.

The hospital doesn't revolve around your family OP.

“If you haven’t written it, it hasn’t happened” therefore there is a lot of writing going on

Writing up detailed notes
Checking results of tests
Onward referrals
Discussing management of patients
Training on the job
Looking up protocols
Checking and rechecking medication timetables
Ongoing patient monitoring
Bed management
Arranging transfers to wards or outward transfers
Handover to ward staff

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They have to have a period of time where you’re observed to check your symptoms don’t get worse or to make sure you improve before making the decision that you’re ok to send home. And yes that can require waiting for the senior on to do that, who will also be covering the wards and NICU. There may be a sick child on the wards, and your stable child may not be the priority. So it may look like the more junior docs may be doing nothing much (they are, you have no idea how long admin takes), but they may also be waiting for the reg to reappear.

@Stillwishihadabs

You're probably right. Why would your body choose to keep a pregnancy going when you are under such physiological and mental stress? Not surprising really.

Indeed Radom. Did you know that airlines "ground" their staff as soon as they know they are pregnant ? But front line NHS staff ? No, you'd be laughed out of town, nights, weekends, long days or go through the hassle of sick notes and occupational health. When in reality most pregnant women can manage a sit down 9-5 (or 10-6 in the early stages). I was resuscitating babies of less gestation than the one I was carrying at 3am in my second pregnancy (I told the SHO to bleep in plenty of time as I couldn't run that fast- at 32/40) when you think about it , it's a scandal really....

Given the responses it appears IABVU to be dissatisfied by my experience.

I think it may have stemmed from the NHS 111 doctor saying - I don't have any OOH appointments this evening, its probably a viral infection, please do definitely go straight to A&E and a doctor will be able to check him over and confirm there. I was naive to think that a single (albeit junior) doctor would be able to do this in A&E (like a GP or OOH doc would for a viral sore throat), and if nothing serious we could go home and not waste any more of their time. I was prepared to wait a few hours to be seen but i certainly didn't realise, that after that it would take three doctors, a certain number of hours monitoring and senior doctor sign off for a sore throat. Totally unrealistic expectations on my side.

@Stillwishihadabs

I know. I am not precious, I think pregnancy is not a disability and people should work. I took a year out of medical school to have dd and took on various temping roles and worked til the day before my elective section.

But 13-14 hour shifts are inhumane. I am a GP trainee and can't wait til the day I never have to do another bloody on-call shift. I was literally sprinting up stairs to arrest calls and giving chest compressions on my knees on the floor. The pregnancy loss is probably nothing to do with this but I wish I had taken things a bit easier now.

But coffee - most people who attend hospitals are sicker, or potentially sicker, so will require a more thorough assessment. A GP is equivalent to a hospital consultant in terms of training so of course they can assess and discharge you. A junior doctor may just be out of medical school so will need a senior review. They were just doing their job in trying to keep your child safe and well. If they hadn't I'm sure you would be the first to complain. And you clearly don't think you're being unreasonable because you still keep trying to justify yourself.

I will ask my missus, she is a nurse, she did a 12 hour and 30 mins shift yesterday, she had her first break after 9 hours, she was properly sat on her arse not fancying a break for 9 hours

Yes coffee I think it would have been better had your expectations been managed, what did the nurse say when she set up the monitoring ? also if you are pregnant you could/should have asked for something to eat or drink for your nausea, the staff are busy and the hours pass quickly for them (slowley for you) . GPs are much more experienced than A&E doctors and have probably seen less critically unwell children than the registrar, so may well have sent you home (might have sent you in to A&E tho). Anyway good luck in your pregnancy let's hope we don't see you in A&E again too soon.

Yes Random in some ways I think it's worse if you are on a rotation in my second pregnancy I had existing relationships which I could call on for cover (eg staying in ressus for x-Rays) who knew I was pregnant before the seniors and HR (managed until 24 weeks that way). I hope you rest up and get the support you need.
Am signing off now as have a invasive diagnostic procedure booked for 2pm and don't want to be late.

Hang on a moment coffee - you & your DH both have colds at the moment: did you not think it most likely your DS just had the same thing? Had you made sure that he'd had plenty of fluids & wasn't wrapped up too warmly? How long did you give the calpol & the calprofen to work? I know calpol says it starts working in 15 minutes, but you don't generally see a noticeable reduction in fever for around 30 minutes, sometimes more. The same is true of Calprofen. Even the OOH doctors who call back from 111 exercise extreme caution - there's a reason the service 111 replaced was known colloquially as NHS redirect: the one time what sounds like a cold is actually meningitis is the end of your reputation & perhaps your career, to say nothing of the potential outcomes for the person who is unwell. Small children can decompensate ridiculously quickly, too, so medics will be even more risk averse with them; & there is a certain level of trusting that a parent will have a reason to feel/be seriously concerned, even if they can't necessarily articulate it.

For the future, the NHS advice on when there is a clinical need to seek emergency treatment for children with fevers is:
• babies under 3 months with a temperature of 38C or higher
• babies 3-6 months with a temperature of 39C or higher
• your child develops a red rash that doesn't fade when a glass is rolled over it
• your child has a seizure (febrile convulsion)
• they're crying constantly and you can't console or distract them, or the cry doesn't sound like their normal cry (a high-pitched or unusual sound when crying)
• the fever lasts for more than 5 days
• your child's health is getting worse
• you think your child may be dehydrated (symptoms include: feeling thirsty; dark yellow and strong smelling pee; feeling dizzy or lightheaded; feeling tired; dry mouth, lips and eyes; & peeing little and less than 4 times a day)

Poor A&E experiences are things like the times when paramedics/triage nurse ignore important information. So in the first instance you're left writhing in pain in a packed waiting room until you have an epileptic seizure; & in the second, you somehow manage to walk to the minor injuries Unit with one hip almost fully dislocated, the other grinding out of place, your spine feeling like it's being levered apart & altered sensation in both legs. But in the former case I was then moved to recus (& a few hours later had my appendix removed & the mess from a burst ovarian cyst cleared up); & in the latter I was moved to majors & received appropriate treatment. In neither case, once I was in the right place, did I mind it taking time for decisions to made or me to receive treatment or test results to come back. The A&E experience where a registrar used something I'm allergic to was less stellar, mind you... I have complex health needs so unfortunately have to access A&E, while not regularly, more than the norm. It being quiet while you were there, coffee, means that the team had a chance to catch up on the paperwork from when it will have been busy earlier on. Just after school seems to be a rush time for paeds A&Es, as all the bumped heads & twisted ankles & sore wrists come in. As PPs have already explained, they'll likely have been covering other areas; they've to wait for test results; & they'll be monitoring over set periods of time. It's a constant juggling act - & as PPs have also noted, often junior doctors don't have that much autonomy. As for expecting them to ignore your DS' heart rate on your say-so... they can't afford to assume that tachycardia is irrelevant even if it is reported as normal for a patient - I've had about a billion ECGs done on the basis of tachycardia, despite my confirming it's normal for me. (Though Magical New Medication should mean that's a thing of the past, which is all very exciting....)

paranormal & random I'm so sorry for both of your losses I was at a seminar on Thursday where one of the speakers talked about the fact as soon as she learns that anyone in her Trust is pregnant she starts working on reorganising things to try & protect them & prevent miscarriage caused by work. Apparently quite often people try to insist they don't want/need any kind of special treatment (understandable, especially with the issues around women's career progression being held back by having families) & she will overrule them because she's seen too many miscarriages result from careers in medicine & won't be part of a culture that contributes to causing them. The other speaker at the seminar is in her early seventies (I think, she's my third cousin, and she's certainly the youthful-looking genes) & said she had all of about 2 weeks off after having her children (who are in their thirties) - she didn't dare take any longer. It's awful things don't seem to have moved on that far. (Frankly I suspect Carol Black only retracted her statement about medicine basically being ruined by the number of women entering the field because she got the job as Principal of Newnham College. Very glad I left [just] before she arrived...)
There are so many amazing medics who've cared for me at points where I've been anywhere from A Wee Bit Poorly to Deaperately Unwell; & I've also friends & family who're doctors of various sorts, so the whinging about them does tend to make me Ragey. Feck knows I've had some genuinely crap care in my time (though that's mostly to do with one location with a v toxic nursing set-up where bullying patients was not just accepted but actively encouraged) but what matters much more than the buckeejit who stuffed up my gastro care was the amazing care I finally received (& he provided much unintentional hilarity, too: still
waiting for his groundbreaking research on how the gut can be damaged by the diet of others via the process of osmosis ). Most people who complain seem to be talking about not getting what they wanted when they wanted it though. Or things that are the inevitable result of underfunding &/or understaffing, but they blame the staff who're frantically trying to make up for those things. And I suspect I may have stopped making sense a while ago, because migraine. And as I can no longer see & need all the sleep, I'm shutting up...

And you clearly don't think you're being unreasonable because you still keep trying to justify yourself.

In my last post i said it appears IABVU...I was naive to think that........Totally unrealistic expectations on my side.

As you say, the two A&E doctors that were there were not in a position to make decisions. I now realise that I was wrong to expect them to be able to discharge DS after they diagnosed. So actually, everything fell on that poor registrar who was running round the hospital while the junior staff were waiting for him with their hands tied. I'm sorry i got it so wrong.

@MarieVanGoethem

Thank you. 💐

@MarieVanGoethem nursery gave calpol at 3.30pm (temp 40.3), we gave nurofen at 6pm (temp 40.2), calpol again at 7.30pm (temp 40.2). Temp still 40.3 at 8.15pm so we called NHS direct (rightly or wrongly).

It did however reduce once we actually got to A&E so in hindsight..

@KochabRising @Stillwishihadabs @retirednow @Paranormalbouquet

Slightly off topic, but should we start a medics thread? Seems to be a few of us on here. Would be nice to have somewhere to rant anonymously as FB etc aren't anon. Would need to be careful about confidentiality etc of course though.

@Fruitbat1980

“My A& E experience was eye opening. My husband had appalling treatment (or lack of) but that aside I was shock at the amount of time people (junior docs? Nurses?) spent googling information! Their screens were on show and they were copy and pasting from google/ medical online encyclopaedias into patient notes. Seemed madness.”

Medical staff are required to use specific terminology in patient notes in order for it to be correctly clinically coded for treatments and procedures. Incorrect codes means incorrect billing to the CCG which means incorrect payments to the trust.

I’m not surprised they’re googling medical sites in order to get this spot on. They’ve probably been hammered from above to get it right and considering the thousands of codes you can have which alter by changing one word it’ll never be something you simply remember.

random I’m afraid I’m Not That Kind Of Doctor 😁

I should get a T shirt with that on...

Scientist working in clinical trials / used to be a developmental/ cancer researcher.

Incidentally, one big factor that kicked me down the scientific/trial/industrial path was seeing just how bloody awful junior doctor conditions were (this was back in the good old days before Working time directives were around...) I’m afraid it’s a decision that seems better the more time passes and the more pressure is put on staff and the NHS is run into the floor.) :(

The whole "issue" probably arose because there were no ooh appointments available, that is not the fault of the doctors or the 111 team. It's because there are widespread staff shortages in the nhs and thecommunity. The hospital doctors and nurses were doing their job, keeping your son monitored and following protocols to keep him safe. Now you have seen what it is like, maybe you're best directing your frustration at the people responsible fo the state of the nhs.

Re viques post I missed the monitor bit!! So, OP, I think you can safely assume that the doctors were observing your LO for a period of time, ie the time you thought you were just being kept waiting, before then sending you home. Doh.