30 Jun 2018

Why the hospital doctor makes films about working in A&E

By Saleyha Ahsan, Emergency Medicine Doctor and filmmaker, gives her view.

There is nothing more focusing of the mind than caring for a sick patient who arrives in your A&E. For those first few moments, standing by the bedside, you enter the patient zone, where everything outside it becomes a blur, writes Saleyha Ahsan.

A quick initial assessment to see how sick they are, followed by a plan of what needs to be done immediately and then over a period of time. Resuscitate, stabilise, rehabilitate, repeat.

Being an emergency medicine doctor is the principal job you trained hard to do competently and safely, after all the studying and exams. The adrenaline, the piecing together of clinical clues, the action you and your team take to save a life. You can in that moment, for the person in front of you and their loved ones, make a difference, making it the best job in the world. And even in those tragic cases, sadly an integral part of emergency department life, when death comes, you comfort those that look to you for answers as they say goodbye to loved ones. No-one said it was going to be easy. And I was prepared for that, when I made the decision to become an emergency medicine doctor.

It’s when factors beyond your control, outside your patient zone, interrupt and vie for your attention, that it becomes hard. Like lack of bed space in the rest of the hospital, so the A&E department becomes a ward with patients staying long enough to get breakfast, lunch and dinner served. When resus resembles a critical care unit with severely unwell patients who should otherwise be in ITU, if there was space. Or when the A&E department stretches onto the ambulance forecourt and patients stay on ambulances where they are assessed by nurses and doctors, because there is nowhere to offload.

Your job then becomes much more complex as your attention is divided between those newly arriving – our expected patient population and those that have exceeded their four-hour allotted time and become part of the A&E ‘ward’ family.

When this happens, especially as the lead middle grade doctor on a night shift, bandwidth is stretched. That feeling when you are in the centre of it all at its peak trying to think of everything and everyone, including my team, is akin to what it must feel like when your brain is falling out of your ears from the pressures of it all. That’s when you stop, take a breather and turn to your team to re-group. Teamwork is a crucial part of emergency medicine but because of the pressures, recruitment is a challenge. That’s why so many departments in the UK are so heavily dependent on temporary locums to fill the rota gaps. But when you have a majority locum workforce, you have less of a cohesive team and instead a more fluid workforce. Thus a shift with a locum doctor, new to the department, is far from ideal and not to mention costly. But sadly in many departments in the UK, that is the norm.

However in Ysbyty Gwynedd, something revolutionary in recruitment has taken place. Emergency medicine consultant, Dr Linda Dykes, has created posts that attract the rarest of medical species – the middle grade doctor in emergency medicine from far and wide. She uses the concept of flexibility and also offering opportunities to work in other areas aligned with emergency medicine, such as global health and pre-hospital care. These creative approaches, developed through listening to junior doctors, have resulted in fully staffed middle-grade rota without having to rely on locums. It works and saves money.

Had I not decided, at the age of 30, to leave the Army, to retrain as a doctor, I would not have believed how thin the wedge can get. And it is because of this that last week as the Channel 4 News series set in Ysbyty Gwynedd Emergency Department was transmitted, I was staying close to my father who is an inpatient in hospital in London.

It is because I know how stretched things are and all the numerous factors that the healthcare teams have to juggle and think of, that I stay for the entirety of visiting hours. Keeping an eye and yet not interfering. Sometimes knowing too much can be as much of a curse as a blessing.

That’s also why I was determined to bring to Channel 4 News the A&E realities of what many of us know – through either being one of the 1.5 million employees of the NHS or through needing it for ourselves as patients or relatives. Hence the film series from the vantage point of someone who stands in the same shoes as those she has filmed, who knows what caring for multiple sick patients in a department with no capacity is like, looking for a bed and trying to make crucial clinical decisions in amongst the noise, fatigue and pressure.

With the country short of over 3,000 emergency medicine consultants nationwide, a large amount of goodwill from the existing workforce takes up the slack, but is this really sustainable? In this crucial moment marking 70 years of the NHS, it is time for senior health managers and the government at their level to stop, think and regroup like we do at our level when the department is stretched. In the words of Dr Pete Williams, emergency medicine consultant at Ysbyty Gwynedd, the NHS needs to stop being the political football that it currently is so that those who are the dedicated workforce can get on with the job in hand of caring for the nation’s health, especially at the sharp end of life and death.