The Great A&E Debate

I was unfortunate enough to be one of those adding to the workload of our local A&E department last Thursday night. A high temperature and some flu-like symptoms had me kicking and screaming my way down to Good Hope Hospital’s Emergency Department. It doesn’t seem much of a reason to be going but as a chemo patient, any sign of an infection can become potentially life threatening as the drugs wipe out your immune system (just ask the 20 million posters dotted around the chemo ward).

On arrival to the majors waiting room, I was distraught to find that the much talked about crisis seemed to be in full swing here. There were trolleys containing mostly sick elderly citizens crammed in every nook and cranny in the corridors and the waiting room was full. I overheard one person complaining they had been there for 5 hours already. It was 10pm and the thought of waiting 5 hours whilst feeling like shit had me in tears. people were still coming through the door in their droves after me and had what they thought was their battle plan. One woman loudly announced that her mother would have to be seen urgently as she had a medical condition (don’t we all love).

However, luckily for me, less than 30 minutes later I was called through to triage. I could feel the daggers thrown in my direction as this seemingly healthy young whippersnapper trotted ahead of everyone else. I resisted the urge to shout back ‘get yourself a good dose of cancer if you want this treatment’.

I was treated quickly, efficiently and without judgement (I couldn’t help feeling like a fake being there with a temperature). After being hooked up to IV antibiotics, I was moved into a cubicle for them to decide what to do with me next.

Whilst in my cubicle, my naturally nosy behaviour went into overdrive as I earwigged into all the conversations going on around me. The elderly gentleman next door to me epitomised why our A&E departments end up in crisis. The conversation went as the below…

Doctor: Why are you here tonight? What is wrong with you?

Patient: I don’t know really, I feel a bit weak and my ankle hurts a bit

Doctor: How long have you felt like this?

Patient: About 2/3 years

Doctor: But it’s got worse at some point tonight I assume as you’re here, so what bought you here tonight?

Patient: Cue long monologue about how he’s not able to look after his roses and do the housework as much as he used to and no he does not feel any worse tonight.

Doctor (trying to hide his exasperation): Does your stomach hurt? (No), do you have any pain going to the toilet (No), any difficulty breathing? (No). Tell me about your ankle, why does it hurt?

Patient: Long monologue about an ankle operation several years ago.

The decision was to admit this patient as they couldn’t assess clearly if he needed any treatment as he wasn’t able to answer the questions straight. He didn’t really appear to have anything wrong with him. He could have easily have been seen by his GP.

A nurse told me that all the patients that had come through A&E needed medical admission that night, but it did make me wonder how many of those where like my man next door. In the case of the elderly, it seems difficult to send them home, especially if they’re unable to respond directly to a question asked and instead want to spend time telling you about their garden, rose-bush, dog, cat etc…

As the early hours were creeping through, relatives of the elderly sick were getting irritated at hanging around and were hounding the staff for an answer of whether they would be admitted or not. As soon as they got the answer they were looking for (which was yes, they were). They were off and didn’t want to wait to see if a bed had been found and get their relative comfortable.

Unfortunately, these people then become our ‘bed blockers’, seemingly medically fit not to need hospital treatment but not able to answer the right questions for our doctors to be confident enough to send them home. It is then that they have to go through the channels of assessing their social and care status and start the process of making sure they are looked after outside of the hospital.

So, it’s easy to see what happens – lots of people in + not enough people leaving = hospitals fit to burst.

What is the answer? Well in my opinion it’s part re-education and the need for the NHS to make GPs more accessible.

Our modern lives mean that people refuse to wait for an answer these days and will go to a place where they can get an instant answer or treatment which at the moment is A&E. It does seem crazy that in the days of ’24 hour everything’ that our local GPs have dug their heels in and refuse to work anything other than a business hour day (and don’t you dare try to phone during your lunch break as you’ll get a shitty answer phone message telling you to piss off they’re eating).

From what I saw, I get a feeling that a person feeling vulnerable and maybe a bit under the weather will take themselves off down to A&E as at least they’ll get someone nice to talk to, a bit of attention, maybe a cup of tea and a comfy bed for a few nights. It’s important that these people know that A&E is what it is – for Accidents and Emergencies only.

Myself: I was deemed fit to go home at 5am Friday morning after I made it clear that I wouldn’t be staying the night, ready to be back for radiotherapy at the QE 11am the same morning!

PS. An update on ‘Burngate’ for you, my butt cheeks have progressed from David Dickinson tan to David Dickinson sunburnt from a 10 hour session on a sunbed. 15 more sessions to go!

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