To think some things should just be turned away from A&E?

[ifallinlove]

I saw a channel 4 video about a day in a&e during the heatwave.

The first guy seen was a bloke who had decided to walk across hot tarmac to get food while at the beach and now had burns on the bottom of his feet.

He said he had “forgotten to get shoes”. I’m sorry but it’s been 35 degrees for at least two weeks now. There is no way on earth that you “forget” to put shoes on. He made the decision to do it and now sought emergency care.

AIBU to say things like this should be redirected to minor injuries and the appropriate referrals made from there? It’s his own stupidity taking up a bed in a&e!

My father was chatting to his wife in A&E the day he died. You can’t always tell.

I think that doctor got his qualifications from Temu.

You are being ridiculous. A&E is medical care triaged based on need, not on how the injury occurred.

Some people are very stoic when it comes to pain and illness.

I am sure the NHS would be delighted in employing you as some sort of on the door triage medic... being able to tell someone is not unwell by seeing how chatty they are.

No they are not medically trained. You have to extra training to triage. There is good reason to have someone senior on the front door to try and head people off who don’t need to be there.

OK, you asked so here’s the full story. Sorry it’s long.

My DH visited his GP three times in 2 months with shoulder pain, a cough and breathlessness. Each time GP said his chest was clear on examination. Wouldn’t even refer him for a chest X-ray.

He was unwell a week later so we went first to the walk in centre. Triaged by a nurse, diagnosed with a trapped nerve as the cause for the shoulder pain, referred to physio and given pain killers. No X-rays or scans of any kind, didn’t see a doctor.

A fourth visit to the GP a week later because the pain and shortness of breath was much worse, and he really wasn’t looking very well by this point. He was tired, lethargic and grey. GP endorsed the diagnosis of trapped nerve and offered to try to speed up the physio referral. Said Xray wasn’t necessary because it was clear what the problem was, and gave him stronger pain killers.

We visited A&E twice after that because we couldn’t get a GP appointment, and he was much worse. Each time the advice was the same - trapped nerve, wait for the physio referral.

A week later, well before he could be seen by physio, he had a fall and fractured his femur and was blue lighted to A&E. He had a chest xray and scan to make sure he was fit for anaesthetic. Nothing was picked up as amiss with the chest xray or the scan, he had surgery to pin his femur and was discharged ten days later, once he was self reliant. They didn’t address the shoulder pain or other symptoms because the assumption was that it was a matter for physio and the referral had already been made.

Less than a week after discharge he was coughing and breathless and GP came out to the house and examined him. Said his chest was fine after examination with a stethoscope. When things didn’t improve, again we went to A&E with the same result as before.

A few days later he collapsed. Blue lighted to A&E and the on call doctor said he had one of the worst chest infections he’d ever seen. Actually tried to shame me as to why I hadn’t at least called the GP and when I explained the chain of events he clammed up and avoided my questions. DH was transferred to HDU then progressed to ITU on a ventilator as by then he had pneumonia in both lungs.

Five days later he was sent for CT because he wasn’t responding to treatment. CT scan showed a large tumour in the top of his lung, which was deep seated and long standing. It was responsible for setting up the infection and was inoperable - and by that time had spread to his lungs, spine, bones and brain. He died a few days later.

The cancer was a ‘pancoast’ tumour. In the top of the lung, sitting on a nerve, which is what caused the pain. I later learned that the shoulder pain, coupled with cough and breathlessness, along with eye problems reported to the GP (and dismissed) are classic symptoms of this kind of tumour. The GP missed it four times, and A&E/walk in missed it a total of five times.

After his death I asked for a consultation to find out more. The consultant wouldn’t agree to meet me and I was given an hour’s consultation by someone who clearly wasn’t medical, but admin and had some of his records. I wasn’t allowed to view them directly and my questions were answered in vague terms so I took legal advice.

The solicitor secured some of his records which showed that the tumour was on the routine chest Xray before surgery on his leg. It wasn’t well defined so had been missed, but it was there. It was also suggested that due to the circumstances of the fall that caused the fractured femur, A&E should have investigated further. The femur is the strongest bone in the body and the fall was minor. It suggested that the cancer had spread and weakened the bone.

I really only wanted to get things straight in my head for my own peace of mind, and although the legal adviser thought I had a good case against the NHS for negligence I decided not to go ahead. Profiting from his death didn’t sit well with me and suing the NHS wasn’t who he was. I felt I had to respect that, but going forward, I now don’t trust GPs at all and I feel that the other NHS services involved let him down badly. It was only when we got to the professionals involved in the highest levels of care in HDU and ITU that we got to the bottom of things, and by then it was too late.

But burns over a certain size do need to be seen in a hospital setting, they can be serious.

What would someone on the door look like? Would people be queuing outside?
How much time would they get with the triage person? Surely they would need access to your medical record too.
It seems like a big responsibility. Someone rocks up with severe back pain, and the triage medic tells them to go home and take painkillers. It turns out to be something very serious that needed immediate attention.

Absolutely incorrect. We both needed to be seen urgently and we had both been sent their by our GPs

Your assertions are so utterly ignorant.

Yes I remember DS playing away with toys and chatting and (now ex) DH having a tantrum saying he clearly didn't need to be there.... An hour later DS was in HDU

Interestingly exH is one of those people who is always very dramatic and noisy if he is ill

Self inflicted injury is not a reason not to treat someone. The injury is the important bit, not the brains of the patient.

Which is why minor injuries is perfect.

I’ll always remember a trip to A&E in my early 20’s… My dog has skanked an empty tuna can out of the bin and placed it carefully next to my bed so I got up and stepped straight in to the jagged edge. Huge C shaped cut on the bottom of my foot that was spurting blood like a fountain. Called my parents. My DM said ‘It better be bad as she was sending my dad’ He turned up took one look at the murder scene in my flat, went white as a sheet and said ‘I’m taking you to your mum..’

We got to spend 6 hours there , they actually had to come and change the dressing a couple of times in the waiting room as it just wouldn’t stop bleeding. By your standard it was my own fault and I wasn’t entitled to have it fully cleaned out, a tetanus shot, and dressing. Yes it was an idiot move on my part but without that urgent care it could have progressed to something far worse

Medics treat people on the basis of medical need not a personal judgement over whether they deserve it because ‘they brought it on themselves’.

My son was significantly unwell. He had a bowel obstruction, sepsis and cancer yet was chatting to me in A&E and playing on his ipad.

He had a cardiac arrest later on that same day for 17 minutes and almost didn't survive. Some people can absolutely be very, very unwell but appear fine.

If you have one where you live, or they are open when you burned yourself.

BTW, if you attend minor injuries with something minor but it is self harm, they will send you to A&E anyway, because they do not deal with MH stuff.

It's unhelpful to give the impression that attending A&E with a minor injury is wasteful or somehow immoral, taking resources away from those who need it.

Everyone needs to understand what resources the NHS has in their area and use them as directed, in line with the intentions of those running the services. In my area, if I go to the NHS website and look for facilities to deal with minor injuries, I am signposted to the local hospital's A&E department - there is a list of where to attend with a minor injury, and you're told to attend the nearest place listed. The A&E department is on the list.

It's also understandable for people who are travelling to an unfamiliar area of the country to be unfamiliar with the arrangements in the area they're visiting. A&E departments are generally bigger, better known and better signposted.

Also, people may not know whether a particular issue is minor or part of a bigger problem.

I agree, OP, but for reasons given here, it would be a brave medic who turned these time-wasters away.

There needs to be a minor injury unit available 24/7 - to keep the people with a cut finger out of A & E - and the govt needs an information campaign to deter people from wasting resources.

It's not so much the patients in A & E as the hangers on, taking up seats, ordering takeaways and generally being a pain. A & E need to employ massive 6 foot 5 bouncers to ensure that each casualty has a maximum of one person to accompany them. You can't expect health professionals to deal with difficult, violent and anti-social people -it needs to be an intimidating and burly man.

So @CoffeeCantata when my 17 year old son was in A&E for hours after shuttling between UTC, the Eye Hospital and back to the main A&E he would allowed only one person with him in the 15 hours he was there and no food? The only way they could admit him was via A&E so we waited hours for a bed.

So yes sometimes there were 2 of us with him, sometimes we ate food and sometimes we sat and chatted in the 15 hours we were there.

He looked absolutely fine and you would assume by looking at him that he was a time waster. He was rapidly losing his eyesight which is an emergency even if it is pain free. He spent nearly a month in hospital and is under the care of 2 different hospitals and is now legally blind.

You cannot tell how serious a condition is by looking at someone nor how much support they need.

You're right - that was too sweeping!

But people bringing in whole extended families, which does happen, for what is basically a night out for them, should be stopped.
Yes - of course, 2 people - I can see that makes sense in many ways. Apologies.

I see you've apologised but just by way of another example -DH often comes with me if DS needs to go to a&e because my physical disability means I will deteriorate but also I need to be there as DH is a step parent so doesn't have PR (plus I know DS medical history inside out)

Thank you

My sister presented at a & e last year with panic attack symptoms which included chest pain. She had to be forced to attend as she felt foolish being there because of a panic attack and that's not a good use of a and e time.
It wasn't a panic attack she had had a heart attack and spent a week on the cardiac unit. She was there smiling and laughing and looked a picture of health in A & E.

On the other hand i took my daughter up to minor injuries the other week for a limb X Ray after a fall. Seemed ok but reduced movement and not improving. I mentioned this to a few people and got the same response of "oh I forget that's there, I would have gone to a & e". Our minor injuries is in a small former cottage hospital. We were there for 1.5h and then home again. It could take us that long to find a parking space at our local a & e

I think we should charge then maybe people would be more reluctant to turn up to AE

but if it serious and bloods and urine shows nothing then you end up back in AE by ambulance then it’s hard to see difference with what serious and what isn’t

A lot of people would die if you introduce a charge.

That's not acceptable to the majority of voters in this country.