NHS doctor reveals reality of A&E shift as fresh strikes launchedSource: British Medical Association
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00:00 The waiting room in the emergency department is full.
00:02 We've got patients being sent to see general practitioners to take the pressure off ED.
00:06 Today I'm on call. I'm going to be on duty on the ground for about the next 12 to 13 hours.
00:11 On call or on take, sometimes called full duty, is that piece of work where the emergency is coming to hospital
00:17 and I and my team are responsible for figuring out what's the matter with them.
00:20 I've just finished that handover and something similar to a ward round.
00:25 Now five and a half hours of pretty concerted activity.
00:29 All these patients I've seen have been in the resource room in the emergency department,
00:33 in majors in the emergency department, and really sadly, increasingly over the last few years,
00:39 they're in chairs in the waiting area.
00:42 The proviso I've had with NSA is that we really are offering services where I work which are safe,
00:48 but are they as good as they were a few years ago?
00:50 And sadly the answer is no.
00:52 And I've been in the hospital since 8am and only now, five and a half hours down the line,
00:56 am I going to pay any attention to the new patients and the doctors who are looking after them.
01:00 It's about 6.30 in the evening now.
01:02 Again, the intervening time is mostly spent in the emergency department.
01:05 The waiting room in the emergency department is full.
01:08 We've got patients being sent to see general practitioners to take the pressure off ED.
01:12 We've got patients going to the same day emergency care,
01:14 which is an important way of getting patients the care they need as early as possible,
01:19 whilst preserving the inpatient bed base for people who really need to be admitted.
01:23 So there's really busy, difficult decisions about where people go and what treatment they have.
01:28 It's about 7.20 now, and really getting to a very busy part of the evening
01:31 for the medical team in the emergency department.
01:34 I started the day by talking about these 17 patients I was seeing in the morning who weren't in the right place.
01:40 Now a number of those patients will have presented to hospital yesterday afternoon and early evening.
01:44 I'm seeing about half of my patients in chairs.
01:47 They're on drips, they're having infusions, they've got complex symptoms.
01:50 I've got a patient who's hypotensive and needs to get him into a bed because he's quite poorly.
01:57 We're under quite a lot of pressure. The whole system's under quite a lot of pressure.
02:01 It's funny how we become ever so slightly, sadly, desensitised to it.
02:06 You get used to the environment you're working in.
02:08 It's a little after 9.15 now, and I'm probably on the final stretches of my day on the ground here in my hospital.
02:16 I'm working on call overnight, so I'm available to be contacted for emergencies
02:22 and major changes of direction about patients and difficult decisions.
02:25 Some of those difficult decisions are territorial questions about who might be best to look after this patient.
02:31 It is difficult when I talk about my hospital because I imagine if I'm talking to my patients,
02:35 if they were to see me talk about their service, I don't want them to unduly worry.
02:40 That's a difficult thing for me.
02:44 It's the turn of the day now. I've had a little bit of contact with the team in the hospital to make sure they're OK with regards to staff.
02:50 My on-call will finish at 8 o'clock in the morning, but I'll have responsibility for these patients on the ground from 8 o'clock to 4pm tomorrow.
02:58 It's another busy day ahead, so I'm going to try and get some rest now.
03:02 It's not usual that I'm called, and it's very unusual if I'm called into the hospital,
03:08 but it does happen, and that's what I'm available to do if it needs being.
03:11 It's almost as if the days need 25 hours and the weeks need 8 days.
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