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?

Working time directives mean nothing I'm afraid! I was doing up to 69.5 hours a week in one job I worked on when doing my gmc survey thingy. Still not quite as bad as the bad old days though, but from speaking to other GP colleagues even though they did horrendous hours they were less"busy" as there were more of them around. E.g they would often get to sleep at night in between bleeps. Nowadays we run on such skeleton staff with Rota gaps all over the place so we barely get to sit down on a night shift, let alone sleep!

I have spent many hours (days and nights) in children's A&E. Some times it has been absolutely manic and the poor doctors are running around looking completely shattered. On other occasions its been much quieter and they've been able to stand about and have a chat with their colleagues.

Isn't this normal? Some days I am busier than others at work. Some days more people are sick than other days. It's life!

I have nothing but admiration for the doctors that work in children's A&E.

Oh I know - you guys don’t really follow EWTD at all. This was back in the 90s when there were literally no limits at all

Apparently it averages out or something, however I can't think of many occasions where I have worked fewer than 48hours a week, so I'm not sure how that works! 😂

@Random I trained in Ireland- believe me, the EWTD makes a big difference! I was doing 30-36 hour shifts as med Reg at 26 weeks pregnant which was hell- we certainly weren’t less busy in 2012. But it doesn’t mean that 13 hour shifts should be rest free- night shifts and days on call are still very hard going and should be recognised as such. I don’t think that just because I worked crazy shifts that my juniors should do the same as a matter of course.

www.bma.org.uk/advice/employment/working-hours/ewtd

Yes rinceoir I believe you - I definitely couldn't have coped with the bad old days I don't think! I just can't wait til I'm a GP. Don't get me wrong GPs work very hard, but whilst I love the buzz of the hospital I just couldn't do it forever!

Inwas in a&e recently. My junior doctor wanted to look it my eyes using particular equipment in another room...one of the other doctors was in there having a kip

Having a kip, wow, what's that

@amyboo

Yes that's very nice in theory and my trust is apparently compliant, but in practice they tweak things to get around it...

"The Directive reduces the working week to an average of 48 hours (as I mentioned I regularly do more and it doesn't feel like I regularly do less to make up for it but they maintain we do. Not to mention the fact I regularly work after my shift officially finishes) and there are further regulations relating to break periods and holiday allowance, such as:

11 hours rest a day and a right to a day off each week (again this is an average, I have regularly worked 12 days in a row as they give you "rest days" in lieu - this week I did not have a day off as I worked the weekend and had to come in on my rest day)
A right to a rest break if the working day is longer than six hours (nice in theory but if it's busy I have frequently been without a lunch break)
5.6 weeks paid leave each year. (If you can book it. I have known A&E trainees not taking all their annual leave as the rota won't allow it and they are too short staffed)

@Iwanttobeanonymous

Just imagine how exhausted that doctor must be to actually fall asleep in work.

I think you're forgetting that the two children the doctor described as waiting to be seen would already have been triaged and assessed, so they were in no way severely ill and needing to be seen immediately. The doctor could have been talking about waiting to see them once their test results had been sent through, or the doctor could have such a backlog of paperwork to complete that it was impossible to see the two children until previous patients notes had been written up.

Never assume OP. You have no idea what's going on in situations like this, have no idea how the rest of the day has been and quite frankly, unless you're an A&E doctor or nurse (which I think we can safely establish you aren't by the ignorance in your post) you have no idea how a hospital is ran and what procedures are in place in each department. As PP have mentioned, doctors are (shock!) humans just like the rest of us. There is no way the two colleagues would have been having a catch up if the department needed them to be attending critically ill patients, or if the department was full of patients waiting.

Try an 8 hour shift in A&E and then come back and update us on your views

@coffeeforone

Christ your attitude stinks. And don’t think for a moment that your passive aggressive “clearly I was wrong” schtick goes unnoticed. Anyone reading that can tell you’re still having a go. You are not as clever as you think you are.

As a hard working NHS doctor, can I just say that... we’ll continue to help you and your family, no matter what gross personality defects and lack of appreciation you seem to possess.

That’s how it works. You’re welcome. Glad your kid is ok. Sorry for the terrible imposition we placed upon you. I hope that, in the decades to come, you somehow find the fortitude to recover from your unimaginable ordeal.

Exactly random, at least let's hope they were only asleep

@PaddyF0dder

😂

The midwives/nurses on my post natal ward were sat down a lot but they were busy writing notes, organising things, ringing other wards, ordering tests etc etc. You could hear them chatting and laughing but they did it while they were doing work. When I got my maternity notes it was full of notes from the midwives observing me.

Is there any other job in which you’d be happy for people to work 12.5 hour shifts, making life and death decisions, without a break? Any other job where you wouldn’t be allowed to discuss your wedding plans with colleagues? Has it crossed your mind that maybe those 2 children waiting weren’t emergencies and the dr figured they’d have a break while at the rare moment it was relatively quiet before all hell broke loose?

Honestly, you don’t deserve the NHS.

Well said @PaddyF0dder 👏🏻

And I retract my comments about giving Coffee the benefit of the doubt. As Paddy rightly points out it’s obvious that OP really doesn’t think she’s been at all unreasonable in her annoyance. There’s just no helping some people.

Having worked in paeds ED along time ago, I've seen a child discharged home with a high heart rate despite fever having reduced because the parents didn't want to wait because it was late at night. The doctors had wanted to observe the child for longer but the parents sadly thought they knew better. They brought that child back the next morning needing full CPR resusitation. It was awful for everyone involved and I will never ever forget that child.
That is why, OP you had to wait and be glad and thankful for the wait!!!

Drs and nurses are humans, working in ED is one of the most stressful jobs you can do. If the staff spent a few minutes longer than was appropriate, chatting about their personal lives, maybe it was because they needed that time to mentally decompress after a resus that had happened before OP arrived at the ED. It is very hard to go straight from resus and telling parents their child has died, to seeing a child with a simple sore throat.

OP, you don't think there is a danger that if a doctor is working 13-14 hours shifts and doesn't allow themselves a break in concentration during that time that they might eventually become less able to think clearly and make the right decisions? I wouldn't want that to happen when it was my child in A & E.

You said it. Paper work. You also don’t see a lot of what goes on behind closed doors. The most serious cases will come through the back. There will also be patients who require attention out back somewhere. That place is like a worm hole-it just goes on and on. Much more to it than can be seen from the waiting room.

coffeeforone i’m just grateful when I attend A&E and my child is well enough to wait. I’ve been there when they aren’t and get rushed through. I know which i’d choose.

your attitude stinks
You are not as clever as you think you are...we’ll continue to help you and your family, no matter what gross personality defects and lack of appreciation you seem to possess.

I'm sorry this has come across as a bit of a personal attack. I was only describing what I observed, and I've accepted I'm wrong to have these views of the NHS.

FWIW a few of my close colleagues used to be doctors and they don't say their current job is more or less stressful...the challenges are just different.

Oh and just to add to my earlier post, I really wish people wouldn't judge or moan about wait times in A&E. My DS has asthma and our longest ever wait on arrival to be seen has been about 3 minutes.

You may then see him playing in the waiting area as if nothing is wrong. Actually he is pumped full of salbutamol and steroids and they are waiting to see how he reacts. He has to be clear for a full 4 hours before he'll be discharged and can go down hill very quickly and end up on oxygen and a drip.