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?

But every time I’ve used 111, they’ve basically always just gone straight to telling me to go to a&e even when I haven’t thought that necessary.

My OH was diagnosed with incurable, but treatable, cancer around 7 years ago. He's on permanent drug chemotherapy, is immunocompromised and both the cancer and drugs affect his bones and organs!

The "helpline" he was given to the cancer nurses in the oncology department which the haematologist told him to ring with "any problems" is completely useless. Most of the time it's an answerphone and they can take 3/4 days to ring back, even during working hours. No hope at all of anyone answering it in the evenings, weekends, nor bank holidays. When they finally ring back, answer is always one of two options - if it sounds serious, they tell him to go to A&E, if it doesn't, they tell him to talk to the consultant about it at the next monthly consultation (by phone of course!). They've never once actually "done" anything, given any advice, etc. What is the point of them!

Same when he's phoned 111 in desperation when the cancer nurses havn't got back to him - the moment he mentions his cancer diagnosis, their advice straight away becomes "go to A&E".

Until you get into their system with a long term serious condition, you don't realise how crap it all is, especially when it's month after month, year after year.

What if you don't have an urgent treatment centre? Lots of areas don't!

OP, even the top medical professionals in the world can't tell whether there's something wrong with someone just by walking past them in a crowded room. If you can do that, then you need to offer your skills immediately. Resolving the NHS crisis could be down to you.

Your way: the most experienced doctor has to speak to everybody. They are (Like my son) professionals and will do a diligent job. They will burn out within a few hours.
The NHS way: the experienced doctors get to treat the sickest people. They burn out after a few years.

Yep.

and if they could get a GP appointment they probably wouldn’t be there.

I wonder how many people are sat in A&E because the GP has sent them, when there really should be a way of dealing with these ‘inbetween’ issues, leaving A&E for the genuine emergencies.

Exactly this, I needed blood tests but if the results were bad I needed urgent treatment so the go doing them and waiting a week for the results wasn't going to work. In A&E I was chatting to others, 2 others were in the same boat, needed urgent blood test that no where else could provide. Others were waiting for xrays, that could have been dealt with by referrals and appointments but there is no facility for that. So we all found ourselves sat in A&E for hours. None of us wanted to be there, it wasn't a jolly night out. I would have much preferred to be able to go somewhere get a blood test done and get a call in a few hours time with the results and be called in for treatment if needed. It's not the patients fault for using the only methods available to get help.

We have an urgent treatment centre that used to be a minor injuries unit. Now, if you have a minor injury that needs an x-ray or stitches, you have to go to A&E.
The urgent treatment centre is always busy, presumably because people can't get GP appointments but I wonder how many people at A&E would previously have been seen locally.

The GP surgeries no longer do blood tests that are requested by the hospital. You have go to hospital to have the blood taken, which is bloody frustrating. There's hardly any car parking (and it's a minimum of £4.75 to park), and getting there by public transport is 3 buses from where I live, or two buses and a train.

3 times over the past 2 years my family have had to go to A+E for treatment - suspected broken ankle, actual visible broken arm and a fall injury with gash in eye. Each time we have gone to the GP and/ or local walk in centre for treatment and each time the walk in centre has refused to treat us and sent us to A+E. Apparently the walk in centre 'doesn't have an x-ray machine' (it does but only operates during very limited hours!) and/ or 'doesn't treat head injuries' when all we needed was stitches for the gash (which A+E tried to send us off after 8hrs without even stitching until we pointed out the only reason we were there was for the very much needed stitches which they then did). None of these injuries could have been treated at home BUT none of them needed A+E either! And don't get me started on the triage process - wait to be told you need xray, to then wait for doc to tell you need xray, to wait in xray queue to then be told the doc hadn't hit enter on computer (despite doctor having walked us to xray and verbally handed us over to xray tech) so I was told to go find doctor myself (in a huge hospital!) to get them to hit enter on computer so xray tech could do xray, to wait for result of xray from doc to then wait for nurse to actually do the cast. Over half that time could have been saved with more efficient process....

I think those who think people are attending cos they can’t get a GP appointment on the day are lucky to have a good GP. In my area people wait months for an appointment, including 2 people whose problem turned out to be cancer.

when I went to a&e I probably looked fine, able to sit up and talk but triaged and in resuss (sp) wishing 10 mins …

In lots of European countries, they have "street corner" clinics that have small x-ray machines to deal with minor breaks etc. They'll bandage minor sprains and cuts etc.

In the UK, GP surgeries do less and less.

The last time I went a couple of years ago for a severe ear infection, the GP couldn't even find an otoscope to look in it! He first frantically looked through the desk drawers but couldn't find one. Then phoned, who I presume to be another GP, to ask if they had one, but they couldn't find one either. Then he disappeared for ages, presumably rooting through the drawers in the other consulting rooms. After a long time, he came back proudly waving one around, but then realised he didn't have any of those little plastic hygiene covers to put on it, so off he went again. But then he came back deflated - apparently they had none in the entire building, so he just prescribed anti-biotics anyway on the assumption it was an infection, though he couldn't check, but told me to make another appointment if it didn't clear up as they'd "ordered" some hygiene covers so someone would be able to look in my ear next time! It's utterly shambolic - my 10 minute appointment took about 45 minutes in total - not because of my "complicated" conditions, but because of their incompetence!

ED nurse here, you are clearly mistaken! Around 60% of patients we see could be seen by a GP. They arrive with colds, which don’t even need a GP a pharmacist can give them advice. We’ve had them come in with false nails hanging off I kid you not! , The clue is in the name accident and emergency, however the issue is the lack of GP appointments leading people with every day illnesses attending ED, taking staff away from those who really need care!

I had to go to A&E twice last year with gallbladder issues. Both times I was triaged on arrival. I'm sure if there was nothing much wrong with me, I'd have been sent away at that point rather than asked to wait.
So I don't really see how you can think that most of the people waiting don't need to be there. I can't imagine anyone goes to A&E for the fun of it.

Could not agree more.

I was with my kid for suspected broken bone) once (it was and they needed a cast). We were at a paediatric A&E. So there were many kids running around and playing but others are right you can’t judge by eyeballs, so I over heard the conversations between the nurse and parents). The place wasn’t big and the door was left open.

One parent had brought their three year old in because they hadn’t poo’ed in a day. Hadn’t given them more juice, or fibre but brought them straight to A&E.

Another kid running around I overheard their parent on the phone ‘yeah I’m still here I know he’s just had this cough today but it will be days to see a doctor so it’s just easier’. Kid did indeed have a cough and he did cough once or twice for about two seconds in two hours.

Third kid and I quote ‘yeah I think he just has a cold but tonsillitis is going around so I thought that I would check’ .

The abuse of the system is real. I get people can’t see a doctor when they need to but none of these even warranted that. Eve the amount of posts here you read about people going to the doctor for the most minor of things is ridiculous and then they don’t like what the doctor has said (because effectively there isn’t anything wrong) and want further advise is worrying.

When you make something free at the point of use and you add in entitled people etc this is what you get.

I have never been to A&E without these kinds of examples.

Of course a suspected fracture needed to be seen in A&E! Why would you think otherwise? It needs an x ray and a cast putting on, so fits the the criteria! So not sure what your comment is about, same with stitches, generally facial stitches are done by plastics to minimise scarring!

But some people could be waiting a bloody fortnight to get a doctor appointment. In what world is that kind of timescale acceptable

At my local hospital, they use A&E to give druggies their methadone rather than the local pharmacies. I went last year with a severe ear infection in the middle of the night. It was full of drunks and ghouls wanting their fix. Mixed in with genuine people in need of course. Disgusting.

I've been through A&E a lot. The day my Mother died, she danced around the bed with the nurse. I'd taken her in via A&E hoursbefore.

My DP seemed well the day he'd had his heart attack. When he had constipation he was fobbed off for three days, he was treated terrible in A&E because he seemed well. Twelve hours later he had life saving surgery and was in Intensive Care.
People go in for pain relief. When I used to go to A&E with my partner, we'd take a meal deal. You can't tell by looking at people how well they are.

You just can’t tell by looking at someone. I looked absolutely fine (and I didnt even feel that bad!) when I went to a and e last year but I had a strange feeling I had an ectopic pregnancy. I didn’t have any typical symptoms- no pain, no bleeding, dark lines on tests , no shoulder pain nothing except a feeling that something was in my tube and some odd nerve pains down my leg on that side. When they scanned me it was literally about to burst they said I’d got there just in time and they were shocked at my presentation as they only usually see people in a lot of pain by that stage

These numpties need triaging at the door and turning away (sorry, re signposting) to self care, pharmacy or GP before they even get a chance to sit down.
Can't believe your unit isn't doing that already, most do.

Where do you want emergencies to go in the evening/ on the weekend?

we’ve been to A&E over the years mostly when the GP was closed. if something major happens out of hours (bitten/ grazed by dog, pressure on chest, dislocated wrist, under skin haemorrhage) I call 111 and more often than not they send us 🤷‍♀️ tbh I went straight to A&E for dislocated wrist and haemorrhage but both happened at night/weekend. Otherwise I’d have called the GP with it

and in those cases we’d sit in the A&E looking fairly healthy

Tbf, some of them MAY be there for shits… 🤣

There was talk go getting GP practices working weekends and later in the day, but this hasn’t happened, we used to have 2 walk in services near us, 1 burnt down 10 years ago, after finally agreeing to it being rebuilt, it’s in planning stages now. We really need more minor injuries resources and specialist centres for the elderly who end up in A&E as they cannot get to see GP and leave it too late.

I’m an ICU Dr.

There are people who look fine in the waiting room who end up with me on a life support machine. They crash. if they hadn’t turned up when they did, looking ok, I would never have met them. They’d be found dead at home.

There are also people who cannot get to a doctor any other way. ED is the last line for many many things, including the problem of access to doctors.

Don’t let decades of poor management and inadequate funding of public health systems make you turn on other members of the public who need medical care.

This. Access to GP's now is largely restricted to the elderly, young and chronically ill. If you are outside these categories in some urban areas it can literally be impossible to secure primary healthcare. I don't blame people for getting desperate if they've had a health issue for weeks/months.