Melody Redman: Race against time on my first shift in A&E

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AT 8am, I arrive at the emergency department fully armed for my first shift: A&E scrubs donned and ‘NHS’ proudly branded above my left chest pocket.

My fob watch (a hand-me-down from my mum, a former nurse) is clipped on, a selection of pens and a pen-torch are on hand, my name badge is visible and my trusty stethoscope hangs neatly around my neck.

Wide awake with enthusiasm, apprehension and excitement, I pick up the file for my first patient. The department is busy and Mr Smith has been waiting in a cubicle for an hour, which means I only have three hours until he breaches the four-hour national A&E time limit.

The triage nurse summarises that he had a fall. I gather my thoughts about what questions I need to ask him, while trying to keep an open mind. I step into the cubicle and introduce myself. He is such a friendly chap that I immediately feel at ease. I listen to his explanation, ask questions and examine him.

Then another staff member pops her head in, to politely remind me about the time constraints – he must be dealt with within four hours. That only leaves me with around two-and-a-half hours to do appropriate tests, diagnose what is wrong and make sure he has received the treatment he needs.

I ask Mr Smith if he is happy to undergo blood tests and X-rays to find out what is going on, and that I will discuss my plan with a senior doctor. As I step out of the cubicle, my eyes dart around the department, finally resting on a senior doctor who is in the middle of some paperwork. The doctor spots me as I make a bee-line, kindly asks if I am OK, visits Mr Smith and the three of us agree on a plan.

I silently heave a sigh of relief as I can now begin the relevant paperwork for the patient. Before we can send Mr Smith for an X-ray or take any blood samples, we have to order them electronically and print appropriate labels and forms, while also completing paperwork documenting the consultation.

While the paperwork is incredibly important for patient safety and accountability, it takes a lot of time and I am constantly aware, and reminded, that time is of the essence.

It is challenging when you know that you only have a maximum of four hours per patient, but want to provide the best possible care you can for each one. If you’re not free as soon as a patient 
is triaged, or you are taken away for 
an emergency, your time is easily eaten up.

As a result of lobbying by organisations including the British Medical Association, all doctors starting work this week undertook a period of induction and shadowing in their hospitals prior to their first day.

I had a four-day induction, including shadowing the doctor I was to replace, and it made a huge difference. Rather than frantically trying to figure out how site-specific systems and equipment work, I could focus on trying to provide the best care for my patients.

No matter how much medical knowledge you have, adjusting to the wide variation in IT systems, departmental layouts and equipment consumes a lot of time.

While waiting for the X-ray to be performed and uploaded onto the system, I go to see my next patient, who has been waiting. As I pop out to start the paperwork, a senior nurse approaches me and asks: “What is happening with Mr Smith? He is back from X-ray and we need to decide before he ‘breaches’ in 50 minutes.”

Despite knowing the nurse is just doing her job (effectively), I immediately feel a sense of pressure and think, what if my very first patient breaches?

While juggling jobs that need doing for my second patient, I review the X-ray and ask for a senior’s opinion. After we discuss Mr Smith’s case, we agree that he is fit to go home with some advice; he is noticeably very relieved.

With plenty of time to spare, the patient is discharged from the department and does not breach the four-hour limit. Phew!

I continue with the care for my second patient, and as I finish sending the blood samples off, a nurse and a healthcare assistant walk toward me, waving around a mysterious piece of paper. I worry that I have done something wrong, until I notice their wild grins.

They proceed to explain that Mr Smith completed a ‘Friends and Family Test’, a survey where patients are asked if they would recommend the service to family or friends in similar situations, and had thanked me by name on the card.

I am so touched and encouraged to have this palpable representation of my first patient as a junior doctor, and it has really highlighted to me how important feedback is.

Medical care in the NHS is now a very transparent process, in which there are many routes through which complaints and concerns can be raised. We often receive negative feedback, given when things don’t go as well as colleagues or patients would have liked or as they should have done. However, sometimes it’s encouraging to know what we are doing well. A thank you can go a long way.

As a little girl, my mum taught me a song about please and thank you being the magic words.

Now that I’ve grown up, I realise that they are not magical, but are very powerful indeed.

Dr Melody Redman is a junior doctor at Scunthorpe General Hospital. This is the first of a three-part series that will continue on Monday and Tuesday. Names have been changed to protect the identity of patients.

To take part in The Yorkshire Post public debate on the future of hospital care, email jayne.lownsbrough@jpress.co.uk and include a question. The event will be at Cedar Court Hotel, Huddersfield, on September 22.