Tuesday, 22 April 2008

Minor injuries and mundane crap

After a rather long time without blogging I'm feeling the urge to rant again...

I'm now working in A&E and as the most junior doctor in the department seem to find myself banished to minors most of the time. Working in minors makes me very frustrated because I'm convinced that at least 80% of the patients I see don't actually need to be there. I have identified 3 main reasons for this:

1. Patients don't realise that the 'A' of A&E stands for 'Accident' and the 'E' stands for 'Emergency'. Feeling 'tired all the time' is neither an accident nor an emergency, neither is leg pain which has been going on for 2 years.

2. It is too difficult to get a GP appointment

3. NHS direct - They should change their name to 'Covering-our-arses Direct' or something similar. There is absolutely no point in calling them because all they ever do is suggest people go to A&E 'just to be checked out'. A classic example would be a patient I saw today with a stiff neck. No history of trauma. No neuro symptoms. Just woke up with a stiff neck. Called NHS Direct who told him to go straight to A&E. Another man a couple of days ago was told to come in because he had a rash despite the fact that he was completely well in himself. WHY???!!!

If people just used their brains before coming in I think admissions would drop by about 50%. All they need to consider is 1. what's the worst thing it could be and 2. what do they want us to do about it. People don't seem to realise that a painful knee with no history of trauma or injury is NOT going to be broken therefore they don't need to go to A&E but could just wait a couple of days and see their GP. So many people come in comlaining of symptoms that have been there for quite a long time but have made no effort to see their GPs. For example a man came in today who'd had chest pain for a week. Why on earth do you put up with something for a week then suddenly decide it's urgent enough to have to go to A&E??

I really feel like we should just be sending patients like this home and telling them to see their GPs. If we keep going through the motions of assessing them they'll never learn. People won't get the message that they're wasting our time with trivial rubbish if we keep being nice to them and don't tell them off for it. I have even seen such classics as a broken nail...