To think this is why our A and E are failing?!

[DaisyLilyFlower]

Currently in A and E with suspected ectopic pregnancy (told to come here from 111) and current wait is around 4 hours, already been here two.

I’ve been sat by triage next to the reception desk, so not deliberately being nosy but in the last hour two patients have come in with

One with an ear infection
And another with a ingrown toenail

Cannot believe it! Reception asked them both if they’d been to see GP or rang 111, tried overnight pharmacy etc and both said no!
I do not doubt that both of those conditions are extremely painful, but I sort of can’t believe that people turn up to A and E without trying other methods first?

I’m probably just being wingy as I’m in pain and the wait is long and ABU, but I guess my question is,

What’s the worst thing you’ve seen at a and e?

Also Name change as don’t want this linked to my other posts but reg poster.

Everyone has the apocryphal stories of people rocking up to A&E with a broken finger nail.

The problem is these get magnified and mask the much commoner problems of getting a GP appointment (several weeks' wait around here, before the pandemic), no dentists taking on NHS patients, mental health services non existent, people not registered with a GP at all due to homelessness and temporary accommodations.

A&E is the only place left for many.

@Longingforatikihut

I work in hospital labs. Boxing day is my most frustrating day of the year for a&e work. So many 'query heart attacks' and abdominal pains. I want to stand at the doors to a&e with some tums and prune juice telling them to come back in half an hour if they still feel ill.

Unfortunately, people with chest pain often delay seeking help over holiday periods and have worse outcomes as a result. I’d rather people sought help in a timely manner than drank prune juice.

Being able to use the limb doesn’t always mean it’s not fractured. My friend broke her arm and didn’t see a doctor for two weeks. Would have looked like a time waster to an onlooker but it’s not like GP can do X-rays so when she saw gp they sent her to a&e.

It’s worth remembering that more often than not what anyone has overheard from other patients in A&E is self diagnosed so that ‘ear infection’ could well be a perforated eardrum as a pps example and the ‘ingrown toenail’ may be indicative of a much more serious issue. The patients themselves don’t actually know what’s wrong with them but may have been in agonising pain for days or longer, unable to get a GP appointment and feeling fobbed off with advice to take OTC meds that might as well be smarties for all they’re doing for the pain.

You’re always going to get some people who definitely shouldn’t be there but that’s kind of built in to a one size fits all Public Health Service.

Spend long enough in an A&E department and you will eventually see people from every walk of life, all backgrounds and with every physical, mental, intellectual or emotional issue ever diagnosed. That will obviously include people with mental health issues who genuinely think their tiny cut is a serious issue, people of below average intelligence who don’t have the ability to judge their own medical needs, those who have serious but not necessarily medical problems that may mean they show up at A&E as a safe place, and many more besides. These things are a symptom of wider problems with the services available to the public, they’re not the cause of those problems.

I’ve no doubt it must be frustrating for the people working in this stressful environment day in, day out but it seems to me that the role of those who are supposed to be providing and administering this services has gradually expanded to include being gatekeepers of the service at every stage! Backed up by the sort of public moral gate keeping so often seen on MN:

PROTECT THE NHS!! NEVER USE IT!!

Financing the services needed and then properly signposting those to the public is the answer. People who are scared and in pain are going to seek help and so they should or would we really prefer that someone risks ignoring a potentially serious medical issue for fear of being seen as a time waster and a nuisance?

I went with a sprained ankle but I didn't plan to! The system didn't work right for me.
I twisted my ankle badly and after hobbling on it for a couple of weeks it was still painful and swollen so I phoned 111 for advice - 111 told me to go to my GP within 6 hrs, my GP did a phone appointment then sent me to urgent care. Urgent care had no triage of their own so I had to queue up in A & E to be triaged - then queue u again when I was sent to urgent care.
It was just a sprain, as I suspected.
If the practice nurse had just seen me, I could have avoided a 4 hr wait in hospital to be told I didn't need an x-ray.
There must be lots of people in this same situation. If GPS were properly funded the we wouldn't have such long queues at A & E.

I have only attended a&e once, and that was because the walk in centre (rightly) sent me. But had I been able to access reasonable primary care I may never have ended up there. Prior to ending up in a&e I had attempted to access healthcare four times in the preceding 2 days and was unable to. So instead of a course of antibiotics I had 3 hours in a&e, 4 nights in hospital and an operation.

My sister went to a&e because her 2 month old hadn't drank a full morning bottle. He was absolutely fine and our mum had told her not to go to a&e. But, the underlying reason she went was because she had PND which went undiagnosed and untreated because her midwife and GP both refused to see her. I'm really glad she did (despite technically being a time waster) because the hospital doctors recognised the PND immediately and were able to ensure she got proper treatment for her own health.

Went to A&E once after a serious burn. I hadn't want to waste there time, so waited overnight and went to the GP in the morning, who was horrified and sent me straight to A&E, and it was decided later on had to move to a more serious burns hospital.
When I got there there was a queue, and when they realised who I was (GP had called) I wqsbrished straight through. I wouldn't have considered myself an emergency and told them that, and they said pretty much everyone who was in the waiting room should either be at their gp.

I observed at least 4 people who were there from very minor traffic accidents, who had been told to go to hospital as it would bump up their insurance claim.
I even heard the Dr ask them if it was for part of a claim and they said yes, I assume so they knew they could speed it along.

There was a guy with a sore thumb, someone with a very mild allergic reaction and one woman with a very serious reaction to botox.

I think it is hard, because ultimately if your GP won't see you are your having a mental health crisis or in pain then can you really criticise.

I don't think people know about the help you can get at pharmacies and the difference in minor injuries units
But the people who were there for compensation reasons really pissed me off

While being on placement in a&e , mum arrived with son. He had grazed his need , basically gravel rash . Was asked if she had been to a chemist to get a plaster. No. She wanted him seen and a doctor to clean the wound and put a plaster on.

Personal experience, daughter is epileptic. Had a bad seizure , vomiting etc.
Drove her to a&e. Sat waiting and a post man sat next to us. Bitten by a dog. He was called before us. He wanted my daughter seen before him as more serious. They refused and said he would loose his place and be put back of the queue.
Finally seen and admitted. While on the ward was seen by her consultant. He was fuming as he was hearing the same story off parents.
She was then placed on open access to children's ward if it ever happened again. We would bypass a&e and be triaged on the ward.

My sister reported this phenomenon when she took her DD to A&E with a broken nose. I didn’t believe her.

But then I was taken to hospital with acute appendicitis and while I was lying on a trolley being checked in I could see everyone in the waiting area. Apart from one builder with a damaged and swollen ankle, everyone else looked like there were on a day out. It looked like a station waiting room - people chatting, laughing, eating food.

Whoever denies that the NHS is at breaking point at the best of time is either blind or lying.

Of course there are time wasters, but the lack of access to GPs and other supports is atrocious.

Yes people stopped going during the pandemic, including patients who needed help and parents who really should have brought their children.

While I don't disagree that people abuse A+E, I find it odd that the receptionist asks why they are here. Surely that's the job of the nurse who initially sees you and decides how urgent it is?

@WrongWayApricot

My neighbour told me his a & e story a few years ago. He had twisted his ankle and 3 days later thought he should get it x rayed. I was sympathetic but I feel if you've walked on it for 3 days it's probably not an emergency. Although I did know someone that broke their ankle and didn't know until later in the evening, so I could be wrong.

Ear infections can be really bad though so I wouldn't think that was strange or time wasting. And the ingrown toe might have been stubbed today and got really bad?

I fell last year and twisted my ankle was persuaded to go to A&E 5 days later, went reluctantly because I could walk on it although it was painful only to find out it was broken and was then in crutches and a moonboot for 6 weeks. It was comments like that above, if you can weightbear it can't be broken that put me off going initially. It was a nurse on my family who eventually persuaded me it needed an x ray.

I broke my finger and it was badly twisted, so legitimate visit to A & E. The woman sitting opposite was there because she’d noticed her skin was starting to grow over her earring, at the back of her ear. 🤷‍♀️

@LigPatin

My son in law had no idea he had such a serious issue - he turned up because he had a pain in his leg and got nowhere with his GP.

Of course there are piss takers but the majority of people who 'appear' to be there for a minor reason may simply be at the end of their tether in trying to get someone to listen to them, or get an appointment at a time they can manage, or any number of other reasons. They may also have rung 111 - every time we have rung them for any advice they have said go to A&E - even when we did not think it necessary.

Hope you're feeling better and have been seen OP.

For what it's worth, I agree with you. The issue is that people see A&E as an escalation point for when their GP is unable to give them an appt/time/the right drug etc when really it's two completely different services. If it's not an accident or an emergency, they shouldn't be there regardless of what's going on with their GP. It just extends the waiting time for the rest of the people there.

I have a chronic condition that when it flares up, I need A&E help to prevent a major health incident. I was there once waiting in the corridor next to minors to be moved to a bay. There was a 20ish year old lad in there with sore biceps ... he'd started lifting weights two days before. Honestly, all respect to the A&E workers, how they dont scream is beyond me!

Normally I would agree but at the moment a lot of GPs are redirecting patients.
DH had an attack of gout last Friday, he used the my GP service to ask for Naproxen which he is usually prescribed for gout. He had a missed call from the surgery on the way home with no message. Rang back to be told the surgery hadn't called his query was waiting and should be dealt with by Tuesday. He asked if they could just do a prescription to be told, no and to ring 111 or go to A and E if it got worst. We ended up getting a private prescription but you can see how some may go to A and E in desperation.

Paramedics face the same thing day in day out. That is a huge cost to our NHS.

I’ve only been to A and E once - for the same reason as the OP, and I didn’t come across anyone who liked they ‘shouldn’t’ be there. Trying to get a gp appointment is a nightmare. NHS 111 have been useless on many an occasion in my experience. An ingrown toe nail and ear infection can be extremely painful and unfortunately going to A and E is the only way to guarantee you’ll be seen and sorted without being dismissed or pushed from pillar to post. I wouldn’t blame someone for going to A and E if they’re in serious pain.

It looked like a station waiting room - people chatting, laughing, eating food

Any time I was there with DC (one of whom was practically an A&E season ticket holder) you would have seen me laughing and chatting. Its what parents/companions/friends taking people into A&E do to try and support the patient during the endless waits. Other children might be there because in the emergency there was noone else to take them.

I always took food as well because of the inevitability of being there for many hours as we waited in each successive area. Are people supposed not to eat for the many hours of waiting?

I think it’s a bigger problem at the moment with our local GPs being harder than ever to access. I recently rang my GP surgery to ask for a routine appointment with a GP not even an emergency one. She said they weren’t offering those at the moment and she suggested going to Urgent Care which is based at our local A&E. I couldn’t believe it. The receptionist was telling us to take a very non urgent point to A&E. We didn’t and I wish I could have reported that to the A&E department somehow.

@TheMethodicalMeerkat hear! hear!

For many, A&E is the place of last resort. In my area the OOH choices are A&E (an hour by bus plus a 25 minute uphill walk) or Urgent Care (2 hours by bus plus a walk). If the patient's ailment comes on or worsens outside of office hours those are their choices.

My neighbour told me his a & e story a few years ago. He had twisted his ankle and 3 days later thought he should get it x rayed. I was sympathetic but I feel if you've walked on it for 3 days it's probably not an emergency.

Back in the first lockdown I slipped on the stairs and landed in a heap at the bottom.

We were in the middle of the first wave, I thought “oh, it’ll be fine” and didn’t want to add to the pressure at my local hospital

2 weeks of hobbling around later it’s still extremely painful and swollen so took myself off to be checked. I’d broken a bone in my foot.

A few years ago DD hurt her wrist when came off a horse when it threw in a dirty stop in a jumping lesson. DD got back on, finished the lesson then went and mucked out/filled haynets/water buckets/etc.

A few days later she complained that her wrist was still really hurting and it felt weird to bend - took her to get it checked - she’d broken her wrist. She’d been going to school and going about her business as normal.

I once went to AnE for what I considered to be a minor infection and it turned out to be sepsis and I was kept in for a week.

So I do think unless you're a doctor you don't really have any right to comment on what you think is serious or not.

@joystir59
Regarding the cut and dog bite, A&E would be right for cuts - most practice nurses don’t do stitches these days. Dog bite would depend - if it needed stitches A&E, but if not (and assuming it wasn’t on Friday night so you’d have to wait until Monday), it would probably have been better to ring GP as soon as you were bitten - they could have given you antibiotics and checked if your tetanus jab was up-to-date.

@AMillionMilesAway
I imagine it’s to speed the process up - that way the triage nurse won’t have to spend valuable time asking loads of questions as he/she’ll already have the information on the system.