Shadowing a junior A&E doctor
LONG hours, anxiety and abuse are just some of the things doctors in the Emergency Department have to go through every day when they turn up for work.
Having only visited the ED at the Great Western hospital once with a minor football injury, I was intrigued to see what happens behind the scenes.
With the complete redesign of the Emergency Department under way, I was given the chance to shadow a junior doctor around the department to see what they deal with on a day to day basis and just how much of an impact the new unit will have not only on patients but also the staff.
I was handed over to junior doctor Lister Metcalfe, who had started at 8am – an hour into his shift and already the bays were starting to fill up with patients.
On first impressions the department felt a lot smaller than I was expecting, but there was a hub of activity taking place in the centre of the room, as new patients were being put on the board and patients who had been discharged were taken off.
I was told that within the first two hours of a patient coming into the department they are seen by two doctors, and within 24 hours they are seen by three, which includes a specialist.
Dr Metcalfe said: “Within an hour and a half of getting in all the bays are pretty much full.
“We then have four hours to decide whether they are going into the hospital or whether they can discharged.
“One of the bigger issues I have noticed is the patients being discharged from the other end which creates that backlog and makes it harder for us to get them out of the department and into the hospital.”
The first patient we saw was Ronald Sutton, 69, of Moredon, who had been brought in with chronic obstructive pulmonary disease.
As a result of his condition he has problems breathing and sometimes that means he needs to be brought into the hospital by ambulance, so has plenty of experience of the department and welcomes the new plans.
He said: “The service we receive here is very good.
“I think the new plans would be a good idea not only for the children but for the adult patients.
“When you are not feeling well and you are in the department you don’t want to hear upset children and I am sure the children don’t want to see the adults.
“I think the new bays will be better as well if you can see the doctors, because when you are tucked away from everyone you don’t know when you are going to be seen and if they have just forgotten about you so it will bring those anxiety levels down.”
In between patients, Dr Metcalfe was sat at the computer making notes on what he had just done and checking that he was prescribing the right drugs.
I was shown an X-ray of Mr Sutton’s chest where Dr Metcalfe was checking to make sure there was no infection.
Despite the years of education and training doctors go through, I was surprised by the number of checks there are in place to ensure that there are no mistakes.To prescribe Mr Sutton with antibiotics, he had to consult with the Clinical Guidelines for the use of Antibiotics, which showed in a table form the various antibiotics and what to do if the patient was allergic to penicillin for example.
As Dr Metcalfe explained, though the checks are there to ensure that they don’t discharge a patient when there could be an underlying problem, even if the patient has been in several times with the same problem, and helps give doctors some peace of mind.
He said: “One of the most difficult things is dealing with anxiety. We usually have to go home thinking did ‘I do the right thing?’ and you have to learn to deal with that otherwise it is difficult to switch off.”
The second patient I was taken to was Pauline Hicks, of Stratton, who was suffering from chronic abdominal pain and had run out of tablets.
She was there with her husband Chris and they have got used to being in and out of the hospital and have had varied lengths of stays three hours to a fortnight.
They also welcomed the new plans, especially if it speeds up their time between coming in and being discharged.
Mr Hicks said: “I think it is a good idea especially having the bays that look on to the doctors.
“I know the doctors have lots of patients and are busy, but we are just left waiting not knowing what is going on.”
The final patient of the day was in the minors section to see a man who had come in after a horse trod on his ankle resulting in a large amount of swelling.
After checking the bones it was decided that there had only been ligament damage and the patient was advised to follow the old acronym of RICE, rest ice compression elevation.
Luckily for me that was the end of my shift having only been on the department for two hours, but it was nowhere near the end for Dr Metcalfe.
I always knew doctors had a tough job but having seen them in action my respect has grown. It is nice to know that anyone who goes through the ED are in safe hands, no matter how long the wait.
DOCTOR METCALFE'S VIEW ON THE REFURBISHMENT
WITH building work now in full swing, Dr Metcalfe is looking forward to the completion day – not only from a work point of view but also because he is a father himself.
He said: “I think one of the most important things when you have a child in the department is for them to trust you and to keep them calm and entertained.
“It is no good having a child getting worked up because they are already ill and that could make things worse.
“I think with the new plans if they do have their own waiting area then it will not only keep the child calmer but also the parents, and the children feed off that. My son is always looking around at what is going on.
“With a new play area and things for them to do then they feel like they are at a nursery or somewhere similar rather than a hospital.
“I also think it will be beneficial going forward as well because the child we not develop a fear of the hospital which a lot of adults do have because of bad experiences.
“I also think the changes to the bays will have a big impact. From a safety point of view it is nice for everyone to be in one area to see each other especially during the busy periods.
“I think it will also benefit the patients to know what is going on and that they are not being forgotten about.
“I think everybody is looking forward to the day it is all completed and it will make a big difference.”
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