The doctor lifted the lid on life working on the front lines of our health system. Photo / Joel Ford
A New Zealand doctor has spoken out about the harsh reality on the front lines of our hospitals, revealing what you need to know before you visit one of our busy emergency departments.
The advice appeared on Reddit, where someone saying there were working as a doctor in an emergency department shared a "rant" that included what they said were some common frustrations among medical professionals.
The list of rules and tips appeared as New Zealand prepares for the inevitable arrival of the Omicron variant of Covid in the community, which is tipped to put extreme pressure on health services across Aotearoa.
• "It's an EMERGENCY department. E.g. You've had this ingrown toenail for the past 6 weeks, why haven't you seen a podiatrist or GP and why did you decide to come in on a Friday night?"
• "Please answer as honestly as possible when we ask you to rate your pain out of 10, 10/10 being the WORST pain ever (I.e. can't talk, writhing around). We use it to see how pain relief is working for you. I'm sick of the classic "I normally have a high pain tolerance and this is a 7/10" - this makes no sense to me. And don't hit me with "12/10" whilst you're still Snapchatting your friends thinking it will get you seen quicker."
• "People seem to misunderstand they're more likely to be referred to specialties if they come to ED as opposed to their GP. Please don't demand to see certain specialties, we'll decide after working you up."
• "Please don't be rude to us because you weren't seen within minutes of arriving. ED is based on a triage system. You should be concerned if you're wheeled straight into a bed space within minutes of you arriving."
• "Saying 'but I've had this for x number of weeks' doesn't get you triaged higher.
• "There are people who know how to get seen quicker e.g. saying they've got chest pain -> straight to a bed -> tells doctor "actually I'm more worried about my knee pain that's been there for past 9 months". Please don't do this…"
• " PLEASE PLEASE PLEASE at least try some Panadol and ibuprofen rather than presenting straight to ED if you have pain or a simple injury. No it won't "mask" your pain and we'll still believe that you're sore!"
• "Please give your feverish child some Pamol before coming. We believe your child is feverish, you don't need to prove this to us."
• "You shouldn't be coming into ED for a "check-up". Some people treat coming in to ED like going to a supermarket."
• "There's literally bare minimum number of staff on overnight so please if your issue can wait till the morning that'd be great. It frees us to see actual unwell patients and resuscitations and traumas."
• "Don't rock up to ED just because you have bit of sore throat and upper respiratory symptoms. I have to take extra 5 mins PPE ing to see you when you in fact just need a Covid swab in the community + paracetamol and rest. Plus you're exposing possible covid to the elderly, the young and the immunocompromised patients (and us). Plus you are just taking up the side room / isolation room that a dying patient / immunocompromised septic patient / gastroenteritis patients need more. Nothing grinds my gears more than taking 5 mins to put on my PPE and seeing this runny nose patient on his/her phone and telling me they haven't tried paracetamol."
• "You coming up to us asking when you'll be seen just took away 5 mins of my time and you'll now have to wait that extra 5 mins to be seen by me."
• "This ain't a hotel. Try to do as much as you e.g. get your own cup of water and blanket, help your family member to walk to toilet. Family members who understand this and don't treat nurses like hotel employees = real MVP"
• "There's a lot going on behind the scene. My work doesn't end after examining you. I need to document everything, chart meds, request scans, talk to specialities etc. Even if you think it'll be a quick stop by at ED to have your rash looked at, there's a lot of admin involved after you leave = I end up leaving late and miss out on family time."
• "I know it might look like I'm sitting down at my computer and not doing anything, but I'm still doing work (as per the point above)."
• "Patients and their families always always make complaints about supposedly us staff 'laughing and joking' at our stations and 'not working'. We are humans. Is it so bad for us to sit down for 2 mins and crack jokes with our colleagues? I would've quit this job a long time ago without these little moments of bonding with my colleagues and laughing at silly things."
• "If you call the ambo, have a rough idea of how you'll get home if you were to be discharged from ED (I know it's hard to do in the moment when you're so unwell). The number of people who want ED to arrange some sort of free transport back home for them is mind boggling. At least bring your phone and wallet with you so you can catch a taxi or call your parents to come pick you up."
Royal New Zealand College of General Practitioners medical director Dr Bryan Betty said the post was a useful look at the pressure that our doctors and nurses are under, but stressed it shouldn't dissuade anyone from seeking treatment when they need it.
"It's across the system, it's real, and we need to be pragmatic about it," he said.
Betty added that workloads were also heavy in general practice as the sector continues to deal with backlogs caused by Covid, as well as swabbing, vaccination and managing active community cases.
"General practice is working at capacity," he said, also agreeing with the doctor's assessment about the need for GPs to continue to deal with the sort of minor complaints highlighted.
Betty said the point made that patients thought a visit to an emergency department might speed the process of being referred to a specialist was based in fact.
"That talks to some of the problems we've got in our system at the moment," Betty said.
"As a general practioner, in many part of the country you can't quickly access either diagnostics or specialist referrals, so there is an issue around that has been murmuring under the surface.
"We would certainly like more access to diagnostics, more access to appropriate specialist opinions when we require them because what we're seeing is that when the hospitals get full a lot of referrals are getting turned down or turned away and, for some patients, they are perceiving that it may be a quicker route to getting to see a specialist".
Betty acknowledged there are pressures across the health service and GPs had noticed a rise in conflict with patients, particularly around vaccine exemptions.
Betty said that Omicron would be a problem for all frontline health services, across general practice and hospitals, saying there was a need for "very clear, consistent national messaging" about the symptoms of Omicron and how to get tested and treated, adding that for most it would be a mild illness.
He said New Zealand could see a situation similar to the one unfolding across the Tasman as far as pressure on the health system, but hoped that our extra time to administer boosters could soften the blow.
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