Melody Redman: I wish we could treat the person, not just the chart

In healthcare, we see and share the most privileged and the most fragile moments of people’s lives. From the earliest moment of life – the intimate joy of a baby’s birth – to the sorrow and pain felt by an elderly lady as she sees her husband pass away in hospital. Patients and their families regularly shed tears; sometimes of joy, sometimes of tragedy. In A&E there are plenty of reminders that I am dealing with real people, often in delicate situations.

Comparison is important throughout, a fact I was most recently reminded of when Mrs Jones presented to A&E with chest pain, which she attributed to stress as a result of the death of a parent.

In our modern, fast-paced world, people can overlook an important symptom as nothing more than ‘stress’. Similarly, patients may find some dodgy internet source which results in a dangerously wrong self-diagnosis. Mrs Jones said this was the first time she’d been to A&E, and what a scary environment it seemed to her. With lots of unfamiliar noises around, magnolia painted walls and doctors and nurses darting around the department, I was not surprised she felt that way!

We exchanged a couple of jokes about how it is not the same as it is on TV. Media portrayal that seeks drama and entertainment is not the place to look for an accurate representation of a hospital. It is unfortunate then that I couldn’t offer Mrs Jones the time I would have liked to spend with her, as resources are limited and there was this constant background thought of ‘two hours left until my other patient breaches their four hour A&E limit’. There was time to perform all the necessary investigations, but I would like to have had more time to make Mrs Jones feel more at ease.

Like Mrs Jones, Mr Brown also arrived in A&E as a result of chest pain. My heart slowly sank as this delightful patient expressed his frustration with his numerous health problems, yet the chest pain was a new problem, and of course, quite a frighteningand painful one. Mr Brown also began to talk about several long-term health issues that were flaring up and bothering him.

Not treating long-term health problems that are not directly related to the cause of admission to A&E is something I am finding difficult to address while working here. I have been trained throughout medical school to see the patient as a whole – considering various aspects that include biological, social, psychological and spiritual issues.

To fully do this, a doctor needs time and resources – the two things that we have limited access to within the A&E department and something the British Medical Association has been highlighting for some time. I wanted to spend time looking at the best options for Mr Brown’s long- term health problems, to try to improve his quality of life. He was such a lovely gentleman (who I’m sure had lots of stories to tell!) and I wanted to reassure him that he was valuable.

However, once the chest pain was dealt with appropriately, Mr Brown had to be discharged from A&E and was advised to visit his GP and seek advice and treatment there for his other health issues. I know I dealt with the cause for admission to A&E, but I would like to have done more for him.

“This is A&E. We deal with current problems. You can’t fix every problem every patient has.” Several times, senior doctors have reminded me that I need to focus on the main reason a patient is admitted to A&E, whether that be chest pain, an overdose, a broken bone, or anything else.

That is the role of the department; an amazing open door through which people can receive free immediate healthcare for accidents and emergencies! While I recognise the role of an A&E doctor, it creates a tension within me as I feel must be contained and squeezed into the time and brief that I have been given.

Some of the challenges are ones that I had expected, others are a surprise, and some are a total shock! Despite this, I am reminded of the Hippocratic Oath: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”

I am determined that despite the tensions I experience, a patient will always be more than a set of symptoms, a condition, or a diagnosis. It is my hope and my ambition that the framework of the NHS will always allow doctors in all departments to live up to this promise and treat the person, not just the chart.

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 [email protected] and include a question. The event will be at Cedar Court Hotel, Huddersfield, on September 22.

Melody Redman is a junior doctor at Scunthorpe General Hospital. Names have been changed to protect the identity of patients. She concludes this three-part mini series tomorrow.