I typed a huge reply and then it disappeared! Name changed for this as although I’m no longer a surgeon (as will become obvious from the end of this post) I haven’t lost the habit!
I’m sorry this has happened to you. I can understand how frustrating it is to be passed around from pillar to post. Different parts of the body are a bit of a grey area as to which specialist they come under. Especially with an abscess where it can be difficult to tell how deep it goes and what structures are involved. Getting multiple teams to see it means that they’re being thorough and the team best suited to removing it will be the ones looking after you minimising the risks of complications (there are a lot of nerves and vessels in the groin that you want somebody experienced to be able to work around!). It’s a bank holiday weekend though so everyone will be on minimum staffing which means getting these opinions can take a while.
I promise the doctors aren’t doing nothing. I don’t want to be self indulgent but I’ve been a surgical SHO in a district general. On a weekend I had to do the following -
Ward round of current patients plus jobs. Also responsible for covering these patients if they deteriorate (so if they become septic, develop chest pain, start bleeding etc). Also need to review the new patients from overnight with a consultant.
Clerk all new admissions - come up with a plan, order and chase investigations, prescribe medication (you’d be surprised how many people don’t know what they’re taking so this requires negotiating NHS IT to look at their GP records and hope they’ve allowed access/are up to date etc). ED are under pressure to get people through in the 4 hour time period so you can be constantly fielding calls from them. I’m also taking calls from GPs re admissions/wanting advice for patients they’ve seen. Medical specialties are also calling for advice (eg we’ve admitted somebody with a stroke but they’ve also not opened their bowels and we’re worried about an obstruction).
Prep patients for theatre - liaise with theatre bookings, anaesthetics to see if any jobs need doing pre booking (and if you’re having an operation on a weekend it’s an emergency - these patients are often quite sick so there’s a lot to be done), consenting the patient (potentially talking to their relatives if they are delirious, have dementia etc).
Go to theatre - an emergency laparotomy can take 5 hours, all this time I’m not on the wards and all my jobs (from quick, can you prescribe some paracetamol jobs to urgent patient with chest pain jobs are building up). I remember coming out of a difficult case once to 4 new patients to clerk (some of whom were probably too poorly to have been transferred out of ED to the surgical assessment bay with no doctors present), 2 urgent scan results to action (both patients now needing to go to theatre so needing an anaesthetic review, slot booking, consenting etc), a ward patient who I was 90% certain had developed a stroke and an angry relative shouting at the nurses because I’d been hiding away ‘on my fucking arse all day’.
At the weekend you usually have the SHO (myself) and a registrar- the registrar is in theatre, reviewing my patients (as I’ve had no formal surgical training you really want an actual surgeon to see you!), going to ED to try and clear the referrals list. For all of the above jobs - I’m the first and only call.
It’s a constant juggling act - impossibly for one person but we’re expected to not drop a single ball. Constant bleeps from bed management asking why you haven’t discharged patient X yet (because you had to go to a trauma call in ED and then take a septic patient to theatre and haven’t had five minutes to do the paperwork but this is irrelevant to them). Surgical nurses are amazing and would have normally taken admission bloods for me, got a list together of most sick to least sick but they’re still reliant on the doctors for the plan and are as frustrated as we are (plus they’re playing bed jenga to get patients admitted - an even more difficult task right now due to Covid-19).
I also wanted to do a good job for my patients and explain what was happening, answer questions etc. We also tended to have end of life patients who I wanted to check on and make sure the nurses were happy with their medication/did anything need tweaking. Ultimately this is why I quit - I couldn’t see how I could work any harder (regularly went 12 hours without a break) but I was still letting patients down.
If a patient self discharged then I’m afraid my first thought would probably be ‘great, one less job’ (I feel awful writing that). If you phoned to come back I would send you to ED as I have no idea what state you’re in and they’re a safe place to wait (if you turned up septic they can start antibiotics, fluids etc) if I’m stuck in theatre/with another patient etc. I wouldn’t even have the ability to admit you directly to our ward as the system would say no (and you will be discharged from the system) - if it was quiet I’d tell ED to refer you straight up when you arrived but it’s a bank holiday weekend - it won’t be quiet.
Basically we need more doctors by the NHS is being run into the ground and there’s no money. I’m not the only person in my year at medical school who has left medicine (I won’t be the last). Even more have gone overseas. It’s not as simple as putting more staff on at the weekend as then we’d be even shorter in the week. There simply aren’t enough of us as a result of decades of underfunding. We know it’s rubbish, we know it’s frustrating.
I really hope you get sorted - I appreciate your concerns about work but I don’t think this is going to be sorted for you by tomorrow. Please go back to ED - be prepared to wait (bring your overnight bag) and be prepared to go through the process again. Have something to eat - odds of you being in theatre within 6 hours on a bank holiday Monday for an abscess are slim. I hope you’re on the mend soon.
We have no flexibility of slack in the system. It’s not good enough but it’s what the general public have voted for.