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A&E doctor: I fear the job I love will one day break me

It’s clear that our current workload is unsustainable, and if we don’t act soon, the NHS could crumble.

By Lailah Peel

I’m incredibly lucky to have something that is relatively rare in this world – a job that I love. Perhaps an unpopular opinion, but it’s the truth. Equally, as a junior doctor working in A&E I must be clear that it is far from sunshine and rainbows all the time (and not just because your average emergency department won’t have any windows).

It’s become increasingly difficult recently, and I genuinely fear that the job I love is evolving in ways that make it more and more unsustainable and may, in fact, one day break me. There’s always been good days and bad days, and of course the really awful days that you would rather forget but rarely can. These past two years, the good days are rarer as our A&Es are so often full to the brim. This is not because of increased demand, but due to poor staffing and exit block – no beds on the wards means longer stays in A&E for many of our patients, and often the frail and vulnerable people suffer the most.

This last week or so has been no different, but in some ways that’s what’s made it worse. While the sun is shining, and it feels like everyone else has been making the most of barbecues and beer gardens, we’ve had business as usual. I’ve been on a variety of late shifts, so I’ve at least been able to enjoy a little sunshine before work.

Ominous calm

As I arrived for my first shift of the week on a sunny Friday afternoon there were no ambulances queuing and it all felt like a good omen that things were working for once. I wouldn’t quite describe it as “quiet”, and not just because my colleagues would have all thumped me (that word is recognised as being cursed across the NHS). It was more that everything actually seemed to be working as it should, and you could feel the impact that was having on all of us and the mood in general. This was a good day, or at least it started off like that.

Predictably, it was short-lived, and the queues started growing as the evening went on. People were waiting outside in ambulances, within the department for a bed, and for simple bits of patient care. One of my patients had been incontinent as there simply hadn’t been the staff available to assist them when they’d needed help. They were mortified, as were we; that’s far from the level of care any of us would want for our patients.

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A couple of days later things were even worse – at one point patients were waiting more than two hours just to be triaged, and at least six hours to be seen by a doctor. The emergency buzzer went off a couple of times, with several of us rushing to the waiting room to patients who had deteriorated while we heard more pre-alerted emergency calls being announced over the tannoy. That same evening, I had a couple of patients presenting with pain and complications while enduring long waits for elective procedures. One patient told me they would have to wait more than a year for their operation, another had already been waiting two years. A colleague commented that our NHS has become a collection of waiting lists and queues and we are just working as damage control, which felt all too poignant – and true.

[See also: “I’m feeling gently told off”: Wes Streeting and Dr Phil Whitaker in conversation]

As good as a rest

After a busy weekend I had a couple of days away from A&E midweek to attend a training day as part of the role I have as a peer supporter. A change is as good as a rest they say, so I was looking forward to different scenery, but to some extent it hit all the harder as we discussed our experiences of colleagues struggling, and of a system that is failing to offer doctors support. Burnout is now almost an accepted outcome of being a doctor, with record levels being reported across the profession, especially in emergency medicine. I’m sadly too used to recognising the warning signs in colleagues, in part from having experienced some of them myself in the past.

But it hit differently when, late into a busy weekend shift, I had a patient clearly struggling with a lot of complex situations which culminated badly. It quickly became apparent that they were a doctor, and I could feel my heart break as I heard first-hand about the little support they’d had and how warning signs hadn’t been recognised. Sadly, as doctors we know how to put a brave face on and to say and do the right things to reassure those around us, until it’s too late. I hope it hasn’t been too late for this individual as I was able to signpost them to specific support for doctors, and hopefully offer a plan of action and some cause for optimism in a desperate situation. We so often go above and beyond for our patients, and that can be to our detriment.

[See also: Where is the NHS workforce plan?]

The joy of toast

Despite this, it actually hasn’t been a bad week. It’s the team I work with that has made it so, and perhaps one of the key reasons why, despite all the trials and tribulations, I still love my job. At one point I was on the receiving end of some unpleasantries from a colleague in another team while trying to make a referral for a patient. My consultant was quick to step in, and the situation was resolved. Incivility is too often a recurrent issue across the NHS, and it feels like it’s on the rise with the increasing pressures we’re all under – but working in a team that has your back makes it so much easier to tackle.

Being able to ask for help whenever you need it, or sometimes not even needing to ask at all, makes tough shifts easier. It can be as simple as a giggle over something inane – one particular favourite this week was whether a small cup contained urine or Irn-Bru. Likewise, someone gently checking in because you don’t seem like your usual self, or presenting you with a slice of heavenly NHS toast when you’ve not managed to get away for food – these small moments have big impacts and keep us going.

I don’t know what my next shift in A&E will bring, let alone the long-term future. But I hope that we are able to recover from this, that the NHS once again becomes the pride of our nation. It’s clear that the current workload is unsustainable, and if we don’t act soon, the NHS could crumble. We need to do more to look after our staff so that we can continue to look after our patients, and also each other.

[See also: Fifty days on an NHS ward]

This piece first appeared in a print Spotlight special edition on the NHS’s 75th anniversary. Read it here. It is being repromoted today, 20 July, as a 48-hour strike by senior hospital doctors gets underway.

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