Shropshire Star

The secret doctor: I love my job but we're in a crisis

The pressures faced by A&E staff go far beyond over-crowded waiting rooms and busy shifts.

Published

As our NHS Insider tells us, the reality is far worse than the figures.

From being punched in the face by a frustrated member of the public, to not finding a moment in a long shift to go to the toilet, one doctor has opened up to Weekend about an average day trying to save lives.

Only very recently did the UK's leading emergency medicine consultant, Dr Clifford Mann, predict that the number of additional patients visiting A&E this year could fill "eight or nine extra emergency departments".

As if that wasn't enough, staff like our Insider are also faced with the trivial matters of the public, who clog up the A&E waiting rooms with issues that could be sorted by an appointment with a GP.

Here, she tells us what life is really like in the NHS, and what emergencies the service is really up against.

I've been a doctor for three and a half years now and have spent two of them working in A&E. First and foremost, I do love my job. In fact it's not so much a job as a vocation, a calling some might say.

And it has to be. Sometimes it's so tough that it takes a lot not to give up and do something both physically and emotionally less taxing.

I have worked in several different hospitals and there is one recurring issue which is dominating the work of doctors and all healthcare professionals: we are at breaking point.

The number of patients coming into A&E has rocketed and we are seeing the highest numbers of patients we ever have. This, combined with an increasing elderly population with many conflicting and difficult to manage health complaints, means we are stretched far beyond our resources allow.

On top of this we have numerous patients using our resources who do not really require them - the alcohol abusers, the young fit man with a sore throat, a girl with period pain.

I, for one, am very worried about how patient health and safety is going to suffer because of this, and also for my own physical and mental health along with that of my colleagues.

To give you an idea of what I mean, this is an account of my typical night shift:

21.45

I arrive to work 15 minutes early to wolf down a sandwich. I don't know when I'll next get to eat or if I'll get a break so you need to start with a good 'breakfast'.

I'm tired already having not been able to sleep all day (working shifts is horrific for any sleep pattern) so tea and coffee are a must too.

Every time I walk into the department I try to assess the current situation we're in. Tonight we are using our overflow bay already, it is very noisy and there are patients on trolleys lining up waiting for a space to be seen.

The worst thing is that it's always the elderly ones who end up on a trolley - often with no nurse to attend to them - while the young, for whom people have unnecessarily called an ambulance, are sitting laughing in their cubicle while playing YouTube videos on their phones.

It's extremely busy and my first patient has several serious lacerations to her hand from a broken plate. It takes me almost an hour to fully assess these wounds and treat them with sutures. This is a case I would usually enjoy but I just feel guilty about having taken so long on one patient when so many are waiting, but I am determined to do the job properly.

It takes another hour afterwards to get a simple X-ray because there are no porters to take her there as we are so understaffed.

23.00

I go to see a 91-year-old man with bleeding from the rectum. I take his history, examine him and take five minutes to have a chat with him and make him a cup of tea.

I'm aware that there are patients waiting but sometimes I think it only takes a small gesture to let people know you care and they aren't just a target on a board. He thanks me and apologises for being a "nuisance". These are exactly the patients who should be coming to A&E and it is a pleasure to look after him. If only other people, particularly some of the younger patients, were so appreciative.

Just as I am finishing up a nurse rushes in and says she needs help in triage. I had been planning on a toilet break - but over the years have been used to not being able to find time to go.

I run to triage and find a young patient having a massive nosebleed. It is hosing blood. This can be life-threatening, so we quickly canulate him, take blood and I pack his nose with a device to stop the bleeding.

It does stop and I am so thankful as we have no more space in the resuscitation room, which is where very sick patients are treated. I quickly explain to him that I will be back to see him later and find my next patient to see.

I know he is safe and okay at the moment but I also know he will need regular reviews to check for further bleeding.

00.00

The breaches are mounting up by now. We have four hours to see a patient and decide whether to admit them or not. This is really hard as sometimes we might be given a patient who already has three and a half hours on the clock so we have half an hour to assess that patient and make a decision. Decision making gets easier the longer you work in A&E but for the doctors who have been qualified for only just over a year, it is terrifying. The number of times I have seen them go home and worry all the next day about a decision they've made is frightful. They know what they're doing but things are so pressured and rushed sometimes, and by 5am you're flagging, and you start to question yourself.

Just as I am about to pick up another patient to see, the red phone rings. This is for emergencies which are due to come in. There is a 74-year-old man, usually fit and independent, who has collapsed on the street and is in cardiac arrest.

His heart has stopped. Myself and two of my colleagues go to resus to prepare for his arrival and allocate our roles. By the time he has reached us his heart has been restarted by the paramedics and we get to work trying to stabilise him and treat whatever the underlying cause might be. We diagnose a massive heart attack and start appropriate treatment.

As soon as I get chance I take the time to go and talk to his family to explain what's happened and the severity of the situation. Breaking bad news is difficult to do as it is but with the time constraints I worry that I am not as clear as I should be in my explanations.

You go through a range of emotions with them as you see them react to the news. It's hard to come out afterwards, but you have to pick yourself up again and carry on with the rest of a long and busy night shift. What's worse is when I take them to see him. There is chaos in resus with a drunk girl mouthing off all different profanities. How can somebody live or die with dignity in an atmosphere like this?

01.00

For the next hour I see three patients in quick succession. All are unnecessary attendees to A&E. I see a patient who is having trouble sleeping and has run out of sleeping tablets - she asks for a prescription. I try to explain to her in my most polite but firm manner that she can go to her GP in the morning and this is no accident or emergency. She slides off looking very disgruntled, filling out a feedback card (another method to reach those annoying targets).

Society is so consumerist these days; they expect to be able to turn up, tell us what they want and leave. I wish they'd realise that I've been training for over 10 years for this, to have the privilege of treating actual sick people.

The next patient is concerned about a mild headache which has resolved by the time I get to her. She didn't take any painkillers until she reached A&E! She is discharged once I have comprehensively ruled out anything serious. I do ask myself though, why can't these things at least wait until morning?

Since when did people stop having common sense or the ability to look after themselves? The third patient I know well. He often visits this area to see his friends, gets very drunk and then turns up to A&E for a sandwich and a bed for the night. He has sobered up when I arrive to see him so I certainly won't be admitting him.

Between patients I quickly pop my head in to my patient with the nosebleed. He has stabilised to a point which I'm happy with so I write up some notes on him.

I'm starting to feel quite dry in the mouth now and a little light headed. I go to have a drink but am stopped by three different nurses on the way asking me to present various drugs, check ECGs and ask advice. Finally I make my way to the water machine... and it's empty.

02.00

We are working well as a team tonight. We have pulled together and have reduced the number of patients waiting. Not everyone is feeling so well supported though. I find the surgical senior house officer in the back of a corridor in A&E. She is clearly upset and has been crying. I don't know her very well but I try to comfort her and we have a quick chat. It hasn't gone unnoticed that she's having a rough night - she's inundated with patients in A&E and also has some very sick patients on her ward.

She is the only doctor on for surgery tonight in the whole hospital and I can see she has the weight of the world on her shoulders. The A&E sister has been shouting at her for not seeing her patients quick enough while she has unsuccessfully been trying to save a dying patient on the ward. My heart goes out to her - she is doing her best, and her best is good enough but she's just so overwhelmed that she feels she's not coping.

I give her a quick pep talk, make her smile and we head back to A&E where I give her a hand with some small, but necessary, jobs for her patients. If there's one thing A&E teaches you, it's how to be a team. I finish those jobs and see a few more patients who are quick and easy to sort out but never should have come in the first place.

03.00

The red phone rings again. It's a 54-year-old lady who has has a very severe infection which can lead to death.

She arrives and I am ready to assess and treat her. In the middle of doing this my nurse in charge turns up and starts shouting at me that some of my patients are going to breach soon and that I need to start making decisions. It's really difficult to concentrate on my patient with this going on and I feel don't feel her behaviour is appropriate.

I try to stay calm and ask her to speak to me about it later, at which point she shouts louder. It's not her fault, she's stressed. She too is overwhelmed by the sheer volume of patients and lack of resources.

My patients who are soon to breach are all safe and well treated but unfortunately I am torn away from a very sick patient to fulfil a target that makes no difference to those patients in clinical care.

I do everything I can for my septic patient and run to sort out bits and bobs with my other patients so I can fully focus on what my job should actually entail.

The bureaucracy is never ending. Fortunately I know my resus nurses well enough to know that my patient is in safe hands and when I return to her she is already improving.

04.00

I'm definitely getting tired now. The running around plus lack of food and drink is taking its toll. A kind healthcare assistant offers me a cup of tea for which I am extremely grateful. In some hospitals they don't allow doctors to drink hot drinks on shift. I grab a sandwich from my bag and shovel it down. I would love to say I can set a good example with a healthy nutritious meal but there just isn't time to sit down and eat properly. The patient flow into the department is slowing down a bit now, which is something and I see two more patients in between checking on the others and trying to keep them all updated on their test results and what's likely to happen.

05.00

I call a patient in who is reporting back pain. This is another common complaint we see in A&E which could be sorted out at the GP surgery. However this case isn't quite as straightforward.

We go into a cubicle and he starts insisting that he have morphine. He won't tell me anything about his back pain and after a bit of probing I find out that he is an intravenous drug user who uses heroin and also is on methadone.

I explain to him as nicely but firmly as possible that we cannot provide him with morphine and that he needs to see his community drugs team. There are many community services in places for all types if patients to prevent them needing A&E in the first place.

At first he begs me at which point I maintain my stance. He then starts to get very angry and stands over me shouting and wildly gesticulating. I must admit, I am afraid. I am cornered by a 6 ft 7in man and I can't see my way to get out of the cubicle.

I try to defuse the situation by telling him I will speak to my senior in the hope it will placate him. The last person I annoyed by refusing them morphine punched me in the face.

I managed to escape and call security only to find they are understaffed and have no-one available. I don't really want to go back in there so I explain to my registrar the situation and he joins me along with a couple of male nurses to escort the patient off the premises. But this isn't our job - we aren't trained for this and going to work to help people should not have to put us at risk.

On learning he won't be getting any morphine he runs into the department shouting and swearing and then throws himself on the floor. Fortunately the one security member we do have turns up at that moment and successfully manages to escort the patient away. I would be more than happy to assess any aches and pains he does have but I don't think I should be made to feel threatened in my job.

I have now wasted a good hour of my time trying to sort out this aggressive patient and document exactly what's happened. I now need to get back to work.

06.00

Bring tied up for so long has meant that once again I am behind on the decision-making for the rest of my patients. I make a few referrals to specialities and try to get up to date on all the paperwork for my patients so far. I don't want to have to leave it to the day team when I looked after these people. With a new day starting, a flurry of new patients have arrived so I need to get started on those. I see a patient having a heart attack, a severe kidney infection and an elderly person with diarrhoea. All are fairly straightforward and all need to be in hospital. It's just a shame they had to wait so long behind other people who didn't need to be seen.

07.00

It's the final hour of my shift and I'm completely exhausted. I'm on autopilot now and just feel glad to almost have finished and survived the night. I finish up bits and bobs and help do some tests for patients who have arrived recently and will be seen by the day team.

At 7.30 we have handover where we must remember and recount every patient we have seen in the department and are grilled about their management by our consultants. It's a useful learning exercise generally but it starts to lose its appeal when your brain doesn't feel like it's functioning anymore. We're allowed to go and I just think "thank god, that's over". But I do have six nights more to go....

So there it is, a fairly typical night on A&E. Once I finish I realise I still have audit work which the department requires me to do - it really is never ending. Once I've done that, I'll only have to sit in traffic for an hour to get home, if I'm lucky.

I might seem like I'm moaning but I actually love my job and could not be a bigger advocate of the NHS. I know it could be better because I can see the faults but I also know that most people working in it, certainly in my department, are doing their very best in difficult circumstances at the expense of their own free time, health and family life.

Some weeks I work 90 hours which after I take off all the mandatory fees I have to pay to be a doctor (GMC fees, BMA fees, exams fees, courses, legal indemnity) equates to around £10 an hour. With £30,000 still in student debt I wonder how I'll ever pay it off.

The constant exams, unsociable hours and audit work means that I'm missing out on things that are really important to me like friends and family. However I do know that this system can work, when we pull together and work as a team and when we are not so overwhelmed we're at breaking point. Sometimes I wonder why I do it, but then someone, some patient comes along who reminds me exactly why I do.

If people could take more responsibility for themselves and have slightly more common sense it would make things a lot easier for everyone, and free up vital resources that the sick people actually need. So please think before going to A&E.

If that all sounds bad the following night was crazy - a suspected Ebola case, which fortunately turned out to be malaria, several stabbings, three doctors down and a six hour wait minimum.

Sorry, we are not accepting comments on this article.