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...

8 comments:

Totty Teabag said...

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??

That's an easy one. You put up with the pain for a week hoping it will go away. It doesn't go away, it gets worse, so you phone the surgery to ask for an appointment and are given a date a week away. When you ask if there is anything earlier, they say no....go to A&E if you can't wait...

Anonymous said...

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??

Because they go to the GP/NHS direct and when they say its chest pain its panic stations, straight to A&E, sometimes even by ambulance if the GP is REALLY worried that he might mis-diagnose and be sacked if his patient has a cardiac arrest in the street outside the surgery.

effwhatdoctor said...

Unfortunately GPs are always worried they might get sued or sacked or whatever so react by passing the buck to A&E to cover their arses. There are lots of good GPs but a significant proportion seem to lose any clinical accumen they ever had after a few years of being outside a hospital. Lots of the chest pains they send in are very very clearly NOT cardiac (e.g. pain over pec muscle following lifting paving slab, muscle tender on palpation, pain reproduced on lifting up arms) but they send them in anyway rather than taking a proper history or examining the patient.

Anonymous said...

Re: NHS Direct. I now hate it when our baby or my wife have anything wrong with them. My darling wife phones NHS Direct, who then ask the same bunch of questions several times as we get escalated through the various levels of NHS Direct job creation, wait for a call back, explain it all again to nursey, who then tells us to go to A&E to be on the safe side. I sigh everytime, as I know we're wasting everyones time, but my wife insists we have to go as a the "NHS doctor" on the phone said so.

If we could get a GP appointment in a sensible timeframe we would do that instead, but if you think something is mildly urgent (think hot baby screaming with a rash), it's hard to phone the GP and hear the reception nazi say "sorry, nothing today, you'll have to ring back tomorrow morning and hope there's something available".

I know you are all trying very hard against a tide of bureaucracy and understaffing. You are appreciated. It's the hassle of getting to see anyone qualified that frustrates us.

(posting anonymously as my wife reads my blog and i am a coward.)

Anonymous said...

Patients don't realise that the 'A' of A&E stands for 'Accident' and the 'E' stands for 'Emergency'.

OK - so can you explain what an 'A' is and an 'E' is - as precisely as possible?

And what about 'urgent care'

What is the difference between urgent care and an accident, and again, between urgent care and an emergency

Anonymous said...

Patients don't realise that the 'A' of A&E stands for 'Accident' and the 'E' stands for 'Emergency'.

OK - so can you explain what an 'A' is and an 'E' is - as precisely as possible?

And what about 'urgent care'

What is the difference between urgent care and an accident, and again, between urgent care and an emergency

Anonymous said...

Patients don't realise that the 'A' of A&E stands for 'Accident' and the 'E' stands for 'Emergency'.

OK - so can you explain what an 'A' is and an 'E' is - as precisely as possible?

And what about 'urgent care' ?

What is the difference between urgent care and an accident, and again, between urgent care and an emergency?

whiskey said...

Ooo i recently went to hospital after suffering abdominal pain and vomiting for over three weeks. I regualarl visisted two different GPs fo this problem and was told it was nothing to worry about. The Consultant at A'n'E diagnosed peritonitus within 5 mins and from the scans and bloods estimated that i had been suffering from peritonitus for two weeks. Both the Consultant and I were well pissed with my useless GPs.