To think 70% of people shouldn’t be in A&E

[PrettyPleaseXo]

Recently I was admitted in excruciating pain to A&E due to kidney stones. Over the time I was there it got progressively busier as expected and there was corridor care (I was stuck in a corridor without pain relief and crying in pain for two hours) and ambulances backed up out the door.

When I was discharged and went back out through the A&E reception/wait room I couldn’t help but notice
that 80% of the people sat there looked perfectly fine, chatting etc and didn’t appear to be in either an accident or emergency.

AIBU to think that unless you’re seriously unwell, in acute pain or have an injury that needs immediately addressing you should be turned away from A&E and told to go
to the GP instead?

Poor medics, damned if they are careful damned if they dismiss things and people die. You could have been the 4th.

Some people probably look fine on the outside but are not actually fine.

Back in the days when doctors covered their own out of hours on a rota (so my local surgery had six doctors and they'd each do a couple of days on a rota) my one year old had a bad cold, as the day went on it got worse and I phoned and receptionist told me there were no appointments. I pushed so she spoke to a doctor and came back and said no one would see me. I said fine can you just let the on call doctor know it will be an emergency before midnight so I will be calling him out. I was told to bring baby down.

So I got the frozen treatment from receptionist and left sitting for ages. Got called in to the doctor who was very frosty. He listened to her chest, looked at me and apologised and said I was right. Sometimes mother does know best.

Mine is great, I'm sure others are.

My local a&e won't give you paracetamol, I was there with GS after a sports injury, x-ray was clear so they said elevate and take paracetamol. I was advised to go to the 24 hr Asda in a neighbouring town when I said I didn't think I had any.

For three days off work they could just self certify. Even for a week.

I’m sure plenty of people shouldn’t be in A and E (or need it be) but I don’t think k other punters waiting are the best people to judge that, for obvious reasons.

Well firstly, an associate isn't a medic. They're not fully qualified in the same way and unlikely experienced.

And to clarify, he made me feel I was in massive danger and must attend a and e or die, which was not going to be the case according to someone whose time I ultimately wasted. If a doctor had seen me in the GP surgery, I probably wouldn't have ended up in that queue, taking away from things that needed dealing with there and then.

And maybe I could have been the fourth, but youve ignored the details about the associate not realising it wouldn't be the case without other symptoms I didn't have, and extremely unlikely without other significant risk factors that did not apply.

I've been in A&E 6 times over the last 12m.

1-3 with my son, who wouldn't have 'looked unwell' especially. We walked in.
He was 19 & in acute Heart Failure from PeriMyocarditis. 5 days in High Needs.
Ongoing issues (had to go back into A&E via ambulance twice)

2nd with my Dd, who wouldn't have 'looked unwell'. She is Autistic & would have been hiding her suspected broken hand under her jacket. Needed X-Rays.

Last time I was sent direct (no ambulance availabe) by GP, suspected Cauda Equina (needed emergency MRI which GP couldn't do)

It's not always obvious to an outsider (or even a HCP) what is / isn't 'going on'.

sorry - FIVE TIMES - (it just feels like 6!)

I agree.

My son had an intussusception which is when part of the bowel telescopes in on itself which can cause a bowel obstruction as it did with him. This is usually found in babies and toddlers aged between 3-18 months.

My son was 8 years old at the time. They didn't check for it because it is incredibly rare in older children, I wish they had. By the time they had finally accepted it wasn't appendicitis or gastroenteritis, he was going into septic shock and ended up having a cardiac arrest due to multi organ failure. The surgeon was adamant he wasn't a surgical case, he was very wrong.

If they had checked just a few hours later, he likely would've never had a cardiac arrest. Thankfully, he survived but he is now disabled due to their delay because 8 year olds 'never' have intussusception.

I took him because the paramedic ordered us a taxi to go there. When I say severely underweight, I mean starving. It did turn out to be an eating disorder, we didn't find that out until the next time I took him to A&E, because the first time the doctor discharged him because his blood sugar was up, because the paramedic had managed to get him to drink orange juice and eat jam on toast.

I think taking your DC to A&E because they're literally starving to death is a good enough reason, but hey ho.

This is an issue to take up with your GP practice who are responsible for supervising PA referrals, just like all other recommendations. Either the supervising GP agreed with the referral or wasn’t supervising properly.

Medic doesn't just mean a doctor, in the forces for example it also means paramedic. The point is he is a health care professional, he did what he thought was right and I think I'd rather have a referral and find out I was OK rather than being dismissed and finding myself dead a short time later. I guess you can take your pick.

Exactly but there seems to be a movement to discredit physician associates ( no need for the passive aggressive 'physician associates') Same with nurse practitioners, I've never seen a physician associate but I have been treated by nurse practitioners more than once and I've found them excellent.

My child had a “bad cold” one time and the GP called an ambulance. It might have been a bad cold to me but it was a serious health emergency to the GP who spotted something more sinister.

And maybe had a chat with a neighbour.

There are , I work in one. It’s a family day out for some people.

We do this when the waiting room is very busy.
It certainly works.

Last week , dh had made it to the 3rd waiting room where there was also a large room with recliner chairs, people on drips. A family turned up with 3 boys and 3 adults to visit!. Boys were running around just being a nuisance. Nurse then decides to chuck out every who wasnt a patient. I went for a coffee ended up going home and dh came home by himself once he had steroids and they felt he wasnt going to get worse which wasnt ideal.

Thinking about this more, with regard potential skin cancer. I wonder if HCP could be bypassed completely and a picture uploaded directly to an NHS AI reader as a first step?

The GP tried to send me to a&e the other week
i was 9 days post endo surgery, and had a UTI (from the catheter and I’m prone to them) and my pulse was a bit high (it always is) and I’m neutropenic
I’ve been neutropenic for the best part of a decade so ended up on antibiotics with a promise of a&e if I felt more unwell
But if I did have to go, I would have looked fine

Yes - remember all the fuss when nurse practitioners were introduced? We were all going to die apparently. Now they are mainstream, cover many minor conditions and have specialisms, just as specialist pharmacists conduct prescription reviews/minor ailments.

My practice which by UK standards I’d say is quite good has had a PA for about 15 years. She is an expert in child development, childhood ailments, managing and supporting some of the medical conditions which are common in children with signficant special needs etc. The other GPs routinely call on her specialist knowledge. Her door is clearly labelled “Physician Associate” and she chooses to have Ms on the door nameplate with her PhD listed at the end to avoid confusion. If she sees a child who may need the GP she can fast track them into the GP diary.

This model works well and is used in some of the European systems which regularly outperform ours.

If GPs are using them unsupervised or as cheap labour that is a problem with poor practice, not the model.

We went to the local pharmacy yesterday for DHs COVID jab. The pharmacist was lovely and no queues, in and out in two minutes. When baby GC was visiting and had a fever 111 directed my son to the pharmacy, again very efficient and dealt with quickly.

So much ignorance spouted on here. You don’t need to be in crisis to go to A&E with an ED. You can look normal and be near death.The first time my daughter was admitted with anorexia I didn’t even realise she had it. I’d taken her in for something else however her bloods were so awful she was immediately whisked off to high dependency. We’ve since been in and out of hospital including A&E many times, frequently ordered to by CAMHS. I use the Marzipan list for guidance. Many of the thinks to look out for wouldn’t be obvious to bystanders or MNers who think they’re medical experts.