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A&E won’t kiss it better



I’ve spent the last 48 hours being tailed by a TV crew trying to get me to say something outrageous on camera about frequent fliers, appointment non-attenders, heartsinks and other assorted time wasters. In particular, they wanted to know why some patients habitually turn up at casualty departments with problems that any sane person would recognise as trivial.

You’ll not be surprised to learn that my on-screen persona – as opposed to my on computer screen persona – was empathetic, sympathetic and frankly, generally bloody pathetic. I even sank low enough to mention hidden agendas, deep seated health anxieties and all the other mushy crapola I had stashed away in my Fluffy Locker to get me through revalidation. Hopefully most of that interview will end up on the cutting room floor, otherwise my status as the Hard Man of Primary Care will definitely be up for review.

In an effort to put the suffering patient’s point of view the chief inquisitor showed me an information leaflet published by an NHS Trust based somewhere south of the River Thames. The aim of the leaflet, it was clear, was to dissuade patients from showing up at the chronically overstretched A&E department at PFI Crisis University Hospital (Teaching).

‘Could you explain this?’ asked the girl with the microphone. ‘It says here that if you have diarrhoea you should consult a pharmacist. However, it also says that if you are vomiting you should see your GP. Suppose you have both? Where do you go first?’

‘Fair point, well made,’ I thought and then paused for dramatic effect while trying to think of an answer that didn’t imply that a hefty dose of loperamide from Poundshop and a side order of Man the F**k Up pills might be a more sensible option.

‘Tell me, Dr Copperfield, how is a patient in distress supposed to choose where to go based on the advice in this NHS leaflet?’

I wondered whether I could persuade her that pharmacists had particular training in the care of runny tummies and that many GPs had a special clinical interest in up-chucking. Then I remembered a similar leaflet that had been produced by my local NHS Trust. I produced a copy with a flourish: ‘You’ll see from this leaflet that patients suffering from diarrhoea and vomiting – or vice versa – are advised to attend their local 8am-8pm Seven Day NHS Walk-In Centre’.

These centres of excellence, I assured her, were staffed by specialist nurses who had post-graduate qualifications in both of the twin disciplines of poo-ology and barfiatrics.

‘So the take home message for patients is that A&E will not, as this leaflet makes clear, kiss anything better?’ she said.  Especially diarrhoea, I thought to myself. There’s only so much even the most dedicated casualty registrar will do for a patient.

It’s no wonder that people turn up at A&E after being presented with such a bewildering set of options. I’d probably do the same. Paralysed by choice we’d all plump for the most familiar. A&E has always been there, whereas walk-in centres, urgent care centres, NHS111 and minor injury units mean little or nothing to the punter in the street, especially when the world is falling out of his bottom.

Then I noticed the strapline at the foot of the leaflet: ‘A&E – we only deal with real emergencies’. That’s a lie and there’s the rub. They deal with anything and everything, always and everyone. Turn up at A&E with an insect bite or a sticky eye and they’ll sort you out within four hours or send you a bunch of flowers with a card apologising for keeping you waiting. They don’t send people away to get care from a more appropriate agency, even if that would be the most sensible option.

And maybe that’s no bad thing. What with all the GANFYD writing, GPPAQ scoring, dementia screening, QOF pointing, CQC appeasing and counter-terrorism activities I have to squeeze into a ten hour day I simply don’t have a moment to spare to deal with sick people.