Blogpost by Dr Emil Shehadeh
“Common Sense, a Rare Commodity in the NHS?”
Why are we having to wait longer in A&E?
A 27 year old man came to see me with chest pain. His pain was not related to activity; it was made worse by a deep breath; He had no cough or shortness of breath; he was tender when his chest was compressed and worse when he raised his arms. It was obvious his chest pain was musculoskeletal and not cardiac.
His condition was explained to him and he was advised to obtain pain killers from the chemist. He went on his way happy and reassured.
What Would Have Happened in A&E?
My trainee, who had been working in A&E, told me that had my patient gone to A&E, he would have automatically had an ECG, blood tests and a chest x-ray arranged by a triage nurse, before he was seen by a doctor, all of which are costly and un-necessary. And because the nurse is busy carrying out these futile investigations, she can not give treatment prescribed by doctors. Therefore junior doctors have to step into the nurses shoes and do nurses’ work. This means the doctors will see fewer patients, who have to wait longer.
And We Wonder Why There are Long Waits in A&E
What took me 5-10 minutes in general practice would have taken approximately 1-2 hours in A&E. Why? Because our hospitals have lost this not-so-common quality once known as common sense. For whatever reason, we are carrying out more and more un-necessary investigations, which, apart from wasting money, lead to congestion in the system.
Why? Fear of being sued is one reason. But perhaps we are compensating for lack of experience, lack of senior doctors in A&E, with investigative tools! Now we know that only 50% of trainee emergency doctors stay in that speciality and reach senior positions. Why? Because it is not a rewarding career. It is highly pressurised due to understaffing and high public expectations, poor supervision by senior doctors and poor remuneration.
How Dire Is The Situation?
In some A&E departments, there is senior doctor cover only 50% of the time. It seems NHS managers will commission reports, form committees, employ business consultants and waste money on all sorts of business endeavours. However, they will not do the obvious and provide more senior cover. If money is the issue, the above has demonstrated that they are wasting precious money because they are failing to provide enough senior cover. The cost of failure far exceeds the cost of good care.
The Untouchable Public
Do patients have anything to do with long waiting times at A&E? My trainees, most of whom have worked in A&E, tell many stories about time wasting by some members of the public, who have nothing seriously wrong with them, but insist on seeing a doctor. Irresponsible drinking is another big problem. Many patients use A&E as an alternative to general practice, as they consider hospitals to be the centres of excellence compared with general practice, walk in centres or minor injuries or even pharmacists. Some fail to attend their GP appointments a few times before they decide to go to A&E!
What Should be Done
The NHS needs to provide more senior cover in A&E to prevent wasteful investigations, free nurses to nurse, and junior doctors to be doctors, all of which would ensure more patients are seen more quickly and managed more effectively.
As for the public, we need to act more responsibly.