UKH

Spent nearly 10 hours in A&E on Tuesday, managed to get out at 5.30 am. It wasn’t particularly busy with about 15 people before me. 
There was one doctor working all night with no emergency interruptions. His average time dealing with patients was 10 to 15 minutes but then he was in his room alone for between 30 and 45 minutes before fetching notes for the next patient. So sometimes he only saw one patient in an hour. By 2.00 am there were a lot of grumblings in the waiting room. 
Is this an average rate for seeing patients and what could he have been doing for 45 minutes in between?
I did wonder if they may have brought in an extra doctor. Would this have been possible. I counted 17 doctors leaving the tea break room at about 11.00pm. 
I’m not making any judgement here but it would be nice to hear of an explanation/excuse from someone working in A & E

You might get more luck in the pub in terms of specific responses. It’s the sort of thing where people might be wary of falling foul of their employers social media policies by posting reflections on their work on a searchable public forum. 

Yeah.

If we can pay some doctors to be doctors maybe?

Hope you're on the mend!

If I’m ever badly damaged enough to need A&E but it’s not a life/death matter, I’d far rather be seen by a doctor who has had their tea break than one who has been worked to the bone.

If you had been waiting for 10 hours you’d probably be happy to be seen by one of the cleaners. 

Was this an A&E or a minor injuries unit? Never been in an A&E with less than 4-5 doctors on duty...

Which A & E was this?

The secret to A&E is, no matter what you are there for, say that in the process you hit your head. That way you are prioritised as head injuries trump everything else. Not that I condone this practice....LOL

And Sandrow. 
Barnsley Hospital A & E, walked in, not by ambulance. 
 Don’t know where the ambulance patients were taken as everyone in the waiting room walked in. Several also walked out before being seen but after several hours you reach a break even point, if that makes sense. 

Kinda sounds a lot like you are though. I'm sure it was a frustrating experience, but pinning it on an individual doctor with no idea what he was actually doing seems unfair.

Yes obviously pain doesn’t factor into that. 
My wait involved three blood pressure tests ( every four hours) and  three pain relief tablets. 

The purpose of my post was to try to understand what he might have been doing during the 45 minute breaks. 
I may have expressed frustration but not blame. 

Nope, makes no sense to me. If you’re bad enough to think you need to go to a and e you should wait. Perhaps they where just time wasters?  I’ve known people go to a and e for total trivia. 

I wonder if they keep you there to see how you progress and as a added bonus the folk with ingrowing toenails (or less) give up and go home, sensible approach I think 

There are a few possibilities to help make sense of these observations.  One is that you are talking about minors - the 'fit to sit' area.  It is usually staffed with junior doctors in training, so some of the dead time is writing up case notes, conferring with the supervising doctor and reviewing the medical records and test results onscreen.  Depending on where they were in the training cycle, supervision may well be very careful to support good learning.

As an illustration, my last two A&E episodes have been in majors and one with a deep leg wound.  The junior doctor treating me was great, very enthusiastic and keen to stitch me up.  Consultant popped in, discussed the proposed treatment plan and asked a couple of questions about cleaning the wound adequately as it went down to the bone.  I was admitted and had the procedure under general anaesthetic, followed by a couple of days of IV antibiotics.  They all have to learn somehow.

A different door. This is what the staff were up to. 

There's an awful lot of stuff happening beyond the direct patient contact for one single patient. E.g. organising investigations, following up on investigations as they come back, liaising with other teams for advice etc. The doctors may be spinning many plates regarding more than one patient.

The guidelines for emergency department staffing published by the royal college of emergency medicine suggest that 0.5-3 patients per hour is about the going rate for doctors, with those working in minors at the upper end.

https://rcem.ac.uk/wp-content/uploads/2021/11/RCEM_Medical_and_Practitioner...

There may have been lots of other things going on in the background in terms of the other staff members, there are often lots of different areas within ED depending on how someone is bought in and how unwell they are.

Yes they probably thought that after 10 hours you were fairly serious. Also you had reached the maximum charge in the car park. 

One patient an hour is about par for the course (varies somewhat depending on whether its majors or minors). Remember for every patient seen they need to review previous history, arrange investigations, review results of those, make referrals if required and then document all of that including writing both notes and a letter. Depending on their stage of training, they may also be discussing cases with a more senior doctor. You probably want them to have a break at some point so they're not so fatigued they can't see or think straight at the point they see you.

The explanation for seeing 17 doctors leave the tea break room at 11pm is almost certainly that you saw the evening handover (many A&Es run three overlapping 10 hour shifts in a 24hr period). So half of those doctors will have been going home. Of the other half they will have been spread over multiple areas in the department - a few in Resus (as you observe, your doctor wasn't distracted by emergencies, so somebody else must have been looking after those), a few more in Majors (you describe being in a waiting room of 'walking wounded', sicker patients and most ambulance arrivals go elsewhere), somebody will have been more senior supervising and supporting the rest, leaving just your chap plugging away on his own in what sounds like Minors.

As others have said, it sounds like you were in the "Minors" section of A and E. This is where people who have walked in and been assessed by the triage nurse as stable enough to wait are seen in an A and E department. This does not necessarily mean their problem is not serious and might include things like a wound that needs stitches, abdominal pain in an otherwise well-looking patient and head injuries in a patient who is likely to be able to be discharged.

Depending on the size of the department, there is likely to be other sections. This might include "Majors" (generally where people who are likely to be need to be admitted or have urgent symptoms like chest pain or suspected stroke are assessed), "Resus" (for the extremely unwell) and other areas. The other doctors you have seen will have been working in these areas. When I worked in A and E, I met quite a few people upset about their long waits. Some people do get to "skip the queue" in A and E and these are people who are very unwell - just try and be grateful that you're not in their shoes.

In terms of the long gaps in between seeing patients, I do not know how senior the doctor you saw in A and E was (quite possibly not very). Modern medicine can be quite litigious and complaint-heavy. There is therefore a not unreasonable expectation that before seeing a patient you should have reviewed their past medical history, looked at the results of any tests they have already had and looked at their observations and triage notes. After seeing the patient you are expected to thoroughly document the encounter, because the default legal standpoint is to believe the patient and not medical staff unless there is contemporaneous medical documentation. In addition, the doctor seeing patients in the waiting area may have had to wait to ask more senior medical staff for advice. This may not necessarily be because they did not know the answer - many departments have policies which require their junior doctors to discuss certain problems with a senior (e.g. everyone with chest pain over a certain age must be discussed with a consultant). The senior doctor probably had a queue of other people waiting to discuss things with them, possibly whilst also managing their own unwell patients.

I am sorry that you had to wait 10 hours in A and E. I would suggest that the most practical thing you could do to improve the situation would be to complain to your MP. The NHS has been systemically underfunded under our current government and the semi-collapse of the social care system has had a catastrophic impact on hospital bed occupancy, which puts massive back-pressure on A and E. It is very telling that the government's response to the NHS performance falling on key targets (e.g. the 4 hour A and E target for assessment and then admission or discharge) has been to get consider getting rid of the targets!

I'd agree with what several posters have said above

The type of doctor that would be staffing the "minors" department that you were in overnight would likely have been one of the most inexperienced - if an "FY2" that would mean about 18 months out of medical school. It could be even less - at a local one you could have been seeing someone 6 months out of medical school.

Of course this is if they were actually a doctor. It could be a nurse practitioner, a paramedic, or a physicians associate.

They'll take about 30mins-1hr per patient - this is normal.  There's a lot of unseen work that goes on - organising and interpreting tests, referring to other departments and actually writing up the notes. If they're inexperienced they'll probably need to discuss a lot of the cases with a senior doctor.

The priority in the department will have been the people who have arrived very unwell and will be in the other sections. That's where the other doctors will have been.

And this is why I've been off the forums for so long. 😒

Words fail me.

Well the don't actually but I'm trying not to type a tirade of abusive expletives at the fukwittery of such advice.

Thank you for the sensible replies. I wasn’t really blaming the doctor in A & E, if anything I was blaming the administration, who were probably tucked up in bed. 
Now knowing that the timing here is not unusual I realise the blame lies with governments for letting the NHS get to this state, along with other public services. You have to experience the bad to realise how good it could be. 

In reply to The Lemming:

Not even accurate either, by my experience. I once had a head wound and went to A&E with a bashed head and cut open scalp.  I was seen within an hour by a nurse who said "that'll need gluing" (presumably meeting the then target for seeing people quickly).  Unfortunately, it was a Saturday afternoon - lots of drunks and football / rugby injuries. so I was left to stew for 8 hours in the waiting room.  I then saw a doctor who immediately said "that needs gluing" and the nurse I saw much earlier glued it within 5 minutes! I muttered about why could this not have happened when she first saw me, and she said "well at least we now know there wasn't a delayed concussion"!.

You should have skipped A&E and gone to your local joiners shop

And when the truth comes out you'll be re-triaged and back to the waiting area you go. 

Triage, by the way, is most definitely not a game you want to win.........

It is a question that it is worth thinking about and giving the right answer if you are in a fit state to do so.

I spent 9 hours in A&E after a blow to the head 18 months ago. I had said no when the receptionist, triage nurse and at least one other nurse later on asked if I had been unconscious/knocked out.

My initial memory was that I got hit on the head, got up off the floor, rode the quad back to the farm and got a lift to hospital.  When I went back to the scene to tidy up later and pieced together what had happened I realised that there was a significant period of time during which I had no idea what I had done and that I had obviously moved/walked/crawled at least 50 feet from the point where I was hit to the point where I could remember getting up off the floor.

Triage must be a really difficult job with some patients talk8ng their injuries up, some talking them down and others inadvertently giving totally wrong answers.

That office might well have another door out into another wing, and every patient will result in admin and or phone calls to other departments if they are being moved through, or need another department to treat them. Even doctors often seek advice from specialist units, not necessarily in the same building, so again more phone calls. If you believe they were sitting there with their feet up, you are deluded.

Our tax is lower than much of europe, we fund healthcare less per person than most of europe(or as a % of gdp). We've spent the last 30 years voting for parties who cut taxes, but promise it'll be fine. Now we have struggling state services in every sector and masses of national debt. This isn't likely a coincidence. 

Not my experience. I was seen in A&E including triage, x-ray and by the doctor within 3 hours when I broke my collarbone.

It took 6 hours when I suffered a concussion.

Which is totally different to what was being suggested upthread, which was lying to try to get prioritised over more seriously unwell patients.

Nobody is going to criticise anyone for giving an accurate history to the best of their ability.

There is a world of difference between your injury and Supersteve’s advice to “Game the System” just to get home a bit quicker.

Staff get bogged down with stuff like this more often than you think, and those that really need help have to wait even longer before they can get help. Sometimes that help may come just a little too late and it becomes “Game over, no more credits”.

That is kind of why I said that it is worth giving the right answer.

I haven't been in A&E for years and years, luckily, until we had someone crash into and write off our car in 2020. As we had children in the car, we had to have them checked in A&E and to be fair we were quite rightly put the back of the queue as we all seemed to have only superficial injuries. I saw a child clearly badly ill being carried straight past us at one point, perhaps delirious and on the edge of consciousness, and I thought good grief thank god our children are ok. 

I did want to say what a good experience we had with 111 the other day - head injury by my 10 year old - they rang back within 30 minutes and took it all very seriously. Finally said we didn't need to go in but had to watch for further vomiting and confusion, I was actually very happy that 111 was an option that suited us well.

I know the NHS is struggling but I wanted to say that locally, both urgent services and our GP are very good still. We even all have an NHS dentist, although not sure for how much longer.

Don't forget the growing divide between rich and poor; the super-rich have got richer. 

My experiences over the past few years have been:

- scraped off the road by an ambulance and fed through the whole system at St George's.  9 hours from beginning to end, during which time I was scanned and x-rayed and examined and tested  As various very painful parts calmed down, it emerged that the pain in my spine was due to the inhaler in my jersey pocket digging into my back.  One final check that surprised me was for my heart as one indicator was high. All finally agreed that this was probably due to the recent one-sided car/cyclist contest that I had lost badly.   As above, triage is one race you don't want to win. I was finally discharged into the night, wearing only cycling shoes and a hospital gown (all other clothing having been cut off me), with a parting comment of 'Miraculous escape'.

- nasty, full thickness cut to my elbow (fell off a route and smacked my elbow on the way down).  Arrived at 8pm and was advised I'd probably be seen at about 5am.  Went to the all-night chemist and got busy with antiseptic and a spider's web of steristrips instead.

- spectacularly swollen knee.  Arrived at 9am, x-rayed, given a big velcro and plastic leg brace for a cracked knee cap and told to go the fracture clinic the following day.  Out by 1030am.  The fracture clinic disagreed with the diagnosis and told me to keep it until it got better.

As far as parking charges are concerned, I always think "Thank you for providing somewhere to park and for not giving me an American medical bill".  Don't look a gift horse in the mouth.

Yes. That isn't really directly related why a person might encounter a queue in A&E.

I'm very much in this camp. Every time I find myself forced to play 'hunt the parking spot' I think how much harder it would be if those who are able to walk from off site, or travel by other means weren't incentivised to do so. 

And yes I'm as guilty as anyone for wanting to park as close as possible for free, but at one local hospital even with very high parking charges the challenge is getting a space. Free parking would make this even more difficult, and on those occasions when I really need a parking spot cost isn't my primary concern.

Depends on the year when you start measuring:

https://www.statista.com/statistics/872472/gini-index-of-the-united-kingdom....

Nail on head.

There were probably loads of doctors running around like nutters getting the emergency cases out of the ambulances while those who walked in are really at the bottom of the list for seriousness.

Also, one could argue if you can walk in, sit around for ages and then decide to call it a day before seeing someone then you probably should have gone to a minor injuries unit if possible.

Well, that's where the money is going, rather than into the NHS. So, yes, it's very relevant. Austerity hasn't reached some people; quote the opposite.

The office was a consulting room and there was only one door. 
I never suggested that he was sitting with his feet up I merely stated his prolonged time between seeing patients and asked if this was normal to which someone gave an explanation.

"On a go-slow in A&E?"

Suggests deliberate action not to see patients as fast as possible, surely?

Perhaps I should have added “were they” before the subject title. 
In any event they were going slowly, I just wondered if this was normal. 

Really not true with something like a TBI though. I nearly left. I'm still unwell with it two months later and absolutely was right to have been seen. But after 6-8 hours with your phone almost dead, on your own, not even having been triaged, rationing your water, confused, upset and wondering how you'll get home at 1am if you can't think straight, you begin to wonder if it's better just to leave. After that story of the woman who was found unconscious under her coat, I can't say I would feel particularly safe there if I had passed out. That could have been me, or the person next to me.

No it doesn't. The Gini coefficient is useful but simplistic and in any case doesn't measure what the Captain says.

https://www.prospectmagazine.co.uk/ideas/economics/39791/rebottling-the-gin...

A couple of years ago, I broke my left Fibula, just proximal/above the ankle on Carin Toul. I got myself back to the car park at Linn of Dee. Stayed at my accommodation overnight (bunk house), and drove down home the next day, and luckily didn't get noticed or stopped on the way getting out of the van as a driver walking strangely, going for a pee etc.

I went to Peterborough A+E at ~9-10pm and got out at ~8.30 in the am. I didn't complain as I could see that at times the staff were near their limit (I should have put they're shouldn't I :-}    ).  I was seen after a couple of hours and radiographed circa 5am, and apologized to, as my submission form had not been put in promptly, by accident, at the time of request, so I had had to wait longer. I didn't complain about that. When staff are trying to do things quickly sometimes mistakes or omissions are made, and it wasn't life-threatening.

Like someone above, I'm glad that we don't have an American style system. I once got charged a bomb in North Carolina for a bad bite wound by a squirrel, and I was supposed to be covered by insurance in the first place.

Sadly after 14 years of the current party in government and their political decisions, such things are no longer "Never Events" but rather the new norm that has become acceptable in every hospital up and down the land.

Remember this at the next General Election.

During my 10 hours one doctor was seeing patients at the rate of 1.5 hours per patient. Four nurses were sat in a glass fronted office and judging by the number of patients in the waiting room when I left, they had triaged about a dozen people in the 10 hours. They also did a blood pressure test every four hours and administered painkillers. If they were at their limit then so be it. 
By saying a couple of times that you didn’t complain you seem to be saying that I was complaining. I did say in my OP that I wasn’t making any judgement and wondered if this situation was the norm. 
I seem to remember at some point the government saying that people in A & E should be seen within 4 hours ( sorry if I’m wrong ) but not sure if this is by a receptionist or a doctor. Either way I wouldn’t swap our NHS for any other. 

Are you aware that a 'go slow' is a specific, planned and deliberate type of industrial action?

Googled definition = '...a form of industrial action in which work or progress is deliberately delayed or slowed down.'

I guess this is why you're copping some grief on this thread.  Your title is questioning whether the A&E staff are deliberately working slowly as some sort of industrial action?  Is this actually what you meant the title to imply?

I was saying that I did not complain, as I could see that they were very busy, at least when I first got to the hospital. Plus I know that when people are tired, or have multiple things in mind, then they are more prone to make simple, albeit bureaucratic, mistakes. I was making sure that no-one here would assume that I was complaining. I was just saying that these things can happen, and that sometimes complaining will put staff under more pressure, which does not help them, or the patients.

I was not impugning your approach or attitude, as being a complainer.

The service was undoubtedly slow but I didn’t mean to imply that this was deliberate as in some union action. I’ve had no experience of A & E for about 40 years so wondered if this was now the norm and if another doctor could have been conscripted in to alleviate the backlog. I was hoping for feedback from some medical workers, which I got. 
Due to ailments I am sometimes on a go slow at the climbing wall but this is not industrial.