Working in A&E in 2017 – a doctor’s viewpoint

Without the dedication of nurses, doctors, physios, radiographers, pharmacists and porters of all nationalities, the NHS simply would not exist.

A North East doctor

I have been working in the NHS for 18 years.

I used to love my job.

I used to enjoy the thought of going to work.

I used to sit in the car on the short journey to the Emergency Department and look forward to the day ahead- the teamwork, the buzz of the department, the challenging cases that would pose diagnostic dilemmas, the different patients from all walks of life, hearing their stories as I stitched their wounds, or holding their hand explaining a life changing diagnosis, or the death of a loved relative.

This enthusiasm has somehow been lost along the way.

My friends have noticed it; I have noticed it.

I now have a lurking sense of dread when I think of the up and coming night shifts, the waiting times, the work intensity, the inability to provide good care, simply because of the numbers of patients in the department.

We are continually improving the way we work. We are striving to become more efficient, having implemented new systems to provide better and more effective care to ambulatory patients (medical and surgical), frail elderly patients and to aid quicker discharge. We are streaming at the front door, to identify the best place for patients to be seen, whether in urgent care centres, urgent GP appointments or in our Emergency Department. But this will only get you so far.

We need more space, more rooms, more staff, more time to see patients. But of course this all costs money.

My colleagues are some of the hardest working and kindest people I have ever met but staff moral is at an all-time low.

The department is full, the corridors are full, the resuscitation room is full.

It is not full with people who should have gone to their GP, it is not full of young patients with minor issues, it is full of unwell patients with severe acute medical and surgical problems, many of whom are elderly with complex medical problems and health needs.

As senior medics, we should be seeing and assessing these patients, teaching the more junior members of the team, educating the nurses and reviewing patients to assess if they are suitable for discharge or not. Instead we are pushing trolleys with patients on round the department, or desperately trying to find a space to see an elderly patient with chest pain who is in the waiting room as there are simply no rooms anywhere, or phoning wards and pleading with them to find any space at all to admit the patients from our department into.

This is not what I went into medicine for.

The waiting time this morning in the Emergency Department was 11 hours.

Elderly patients are apologising for attending- they have heard the stories on the news about A and E departments being overcrowded and they delay turning up with their acute pancreatitis, or their heart attack as they don’t want to be a burden.

The inpatient beds are full- full with record number of patients that need admitting, and patients who are ready for discharge but do not have the social care and support to ensure a safe discharge. We, as an A and E department are therefore continuing to look after medical and surgical patients who should be on a specialist ward. We simply cannot continue to do our own job and look after these patients who would otherwise be on the ward. The department is so busy, we often do not have time to clean patients who are incontinent, or simply sit with patients and reassure them if they are frightened, or answer their questions fully about a new diagnosis. The work intensity is such that we are exhausted and deflated. This is unsustainable.

Somewhere, somehow this has all gone terribly wrong.

We are deep in the midst of a crisis. How much longer can we go on like this, before the system breaks completely….?

6 months ago, my colleagues and I joked that it could not possible get any worse as we arrived onto a shift with a 6 hour wait. How wrong we were. Now we wonder- how much worse will it get?

And yet, somehow we continue. We continue to turn up to work. We continue to smile and apologise (again) to patients for the long wait. We continue to care. We continue to support colleagues, patients and relatives through difficult and emotional times.

I’m not sure how much longer we can do this.

Last week I explained to an elderly woman, as I held her hand, that she was dying and probably would not survive through the night. Her family were at her side and she bravely accepted this with a smile and a peaceful awareness that it was her time. I tried to ignore the controlled chaos of the rest of the department and sat with them as I explained the diagnosis and the end of life care that we would provide. Despite the sadness I am reminded in these situations what a privilege this job is. I am reminded of the excellent care and empathy that the nurses and doctors around me continue to provide, despite the intense pressures of the department. These small positive reminders, through the emotional sadness and the daily struggles, make me realise we must continue – for without the dedication of nurses, doctors, physios, radiographers, pharmacists and porters of all nationalities, the NHS simply would not exist. We cannot let it fail for those who need it most.