Melody Redman: Fine balance of life on A&E frontline

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MY first four months as a doctor have been spent working in A&E at Scunthorpe General Hospital.

I have gained a unique insight into the pressures that emergency departments face which will remain with me throughout my career.

Every day, my colleagues and I try to do the best for our patients, who can present with anything from a minor injury to a fatal illness, but each day, rising demand and recruitment challenges are putting increased strain on emergency care.

At the moment our hospital is at maximum capacity, and despite the frontline staff working as hard as possible to meet the growing demand, the four-hour A&E waiting time target is inevitably being missed.

The difficulty is that emergency departments run on a fine balance; if just one or two people over our limit are admitted needing immediate life-saving treatment, everything else falls behind.

Trying to help people who are seriously ill often takes a lot of time, which is time that may impact another patient as everyone has their own pressures, time demand and priorities.

In A&E we try to manage those as best we can but often something has to give, especially when we’re dealing with life-threatening conditions.

The other day a patient came in just as I was about to finish my shift. Her GP had told her to visit A&E the day before but she had decided, against the advice, to wait for another day.

She was extremely unwell when she arrived and needed immediate treatment. A&E was incredibly busy at this point, and several patients then breached the waiting time target as saving this patient’s life became our priority. That day I went home emotionally and physically exhausted, but confident in our decision to prioritise patient care over hitting targets.

As a doctor I want to do what is best for my patients, but a vicious cycle can develop where we exhaust ourselves trying to provide the best care, which means that we become less efficacious and more prone to error.

We’ve all been reassured by the phrase “everybody makes mistakes” at some 
point in our lives, but for doctors our mistakes can greatly affect a patient’s health or care.

Needless to say, we don’t want to make mistakes, but with such high stakes constantly riding on everything we do, it is vital that we are supported sufficiently in order to maintain our concentration and focus because the truth is that doctors are human too.

We need sleep, rest and food so we can perform at our best. However, somewhat ironically, to provide the best care we can for patients and to meet the needs of the workplace, we often stay late, work through breaks and don’t have time to 
eat or drink.

We all know it’s harder to keep your concentration, your patience, and your motivation when you are tired and hungry. The British Medical Association is lobbying hard to improve the working conditions of doctors; work that my experience in A&E has proved to me is vital, to help doctors like me continue providing the best possible care for patients without reaching exhaustion 
and burn-out.

Despite the difficulties, pressures 
and tensions I have learned about from A&E, I move to my next post with a positive view about emergency care.

As A&E doctors, we can learn so much from our patients and can make a real difference to those around us, although targets and pressures can unfortunately prevent us from providing as good a service as we aspire to.

I am grateful that at my hospital, we have a great team and look after each other as well as our patients. Throughout my placement, I have developed my clinical knowledge and skills, although both my patience and resilience have been put to the test.

This experience has clarified for me that the NHS’s difficulty to recruit doctors to work in emergency and acute care is largely down to the strains imposed on the system, rather than the role itself, which a privilege and one I have greatly enjoyed.

Melody Redman is a junior doctor at Scunthorpe General Hospital.