A day in the life of an A&E junior doctor.

By berrysmotivation - April 05, 2017

Let’s start with a typical day shift which starts at 8.00am. You certainly have to be at work at 8.00am, meet up with colleagues who were on the night shift and take hand-overs if there are any. Which basically means if there are hand-overs you have to continue from where your colleague left off.

Let’s assume there are no hand-overs. You walk into the department, probably greeted by the grumpy night staff waiting for you so they could leave. 

The department is usually divided into majors and minors. Majors for seriously ill patients where you deal with cases like heart attacks, acute abdomen, respiratory failure, overdose etc. In minors you deal with cases like fractures, minor head injuries, and patients with no issues i.e. people coming in with headache, cough, catarrh and just anyone who loves to use up the free health care services.

Getting on to the business of the day. There is a big screen which shows you all the patients in the department, seen or waiting to be seen by a doctor. Your consultant would have obviously told you where to start off either majors or minors. Say for instance you start in majors. You are to pick up the next patient waiting to be seen. On the system, you put your name by the patient as the doctor seeing the patient.

You have 4 hours to sort out that patient. The patient is said to breach after 4 hours and the hospital is supposedly fined for every patient that breaches because the waiting time according to the NHS policy shouldn’t be more than 4 hours. The 4 hours starts to count from when that patient is booked into the department. So you take the ambulance sheet to get a brief summary of the patient. The paramedics are quite good in history taking and preliminaries, so you get a rough idea from their sheet or if the nurse dealing with 
that patient is nice enough to tell you a little before you walk into 
the cubicle to do your bit.
Remember your 4 hours is already counting, even though you may have picked up that patient at 1 hour of waiting. Meaning you have 3 hours left.

In the cubicle, you start off with introducing yourself which is very important, taking your history from the patient and maybe taking blood samples if the nurses were too busy to do it. At this point you must have prescribed medications needed depending on the situation. You send of the sample to the lab, if the patient requires any imaging e.g. XRAY you will have to request that and call for the porters to take the patient to the x-ray department or if the patient is too sick to be moved, you request for a portable x-ray to be done by the patient’s bed side. Now take for instance a CT scan is required, you have to walk to the radiology department or call radiologist to approve your requests, which means you must be able to justify your reason for requesting a CT scan. Trust me, it is usually a battle, and feels like an interview. Sometimes your consultant may have an input to get your request approved.

Remember, your time is ticking, at 2 hours, you hear the voice of the nurse in charge for that day asking for your plan with the patient. Worst case scenario, you have a very ill patient, at this point you are probably sweating and confused. You are by the computer, waiting for the results to be sent back from the lab. If a test needs to be repeated e.g. Troponin levels, you have to go back to this patient to take some more blood. Hopefully you have a patient with good veins. Meanwhile, the list on the big screen is piling up, paramedics are waiting to hand-over patients, patients pouring into the waiting room. The pressure is building up because you need to finish up with this patient and pick up the next. Senior and junior colleagues in and out of cubicles making decisions concerning their patients. The emergency bell for another patient who may have gone into an arrest may start to ring, all nurses, including you and other doctors are racing to the patient having the arrest to probably resuscitate. You still haven't finished with your patient, health care assistants keep flashing different ECG or venous blood gas readings for you to sign off  or detect any acute changes. Chaos! 

Fingers crossed, the results of your patient comes back unremarkable. Clinically the patient is fit for discharge, your works is easy.
In cases where the patient cannot be discharged you have to decide if it is a surgical, medical, gynaecological or paediatrics case for possible referral. This is the most difficult part.

You bleep the medical registrar for a possible referral for example. Just be prepared. Here goes another battle, they may or may not be willing to take the referral if it isn’t clear enough, and they suggest that it could be a surgical case, surgery says oh no it is a medical case too or we can co-manage. The battle is almost never won but remember your time is still counting. The site managers have marched in from their office because they are obviously monitoring the process on their system to ask you for reasons why the patient is about to breach or has already breached. The cycle goes on and on.

The good part about being a junior doctor, is that you run through your decisions with either your registrar or your consultant.
All being said. The A&E is quite an interesting place to work for the vast cases you come across but you need strength to be honest.
I may not have been able to cover all but this is certainly what a typical day in the A&E feels like.
I would break it down in subsequent post. We would be seeing what a day shift is like compared to the night shift.
Have fun reading.

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  1. Hmm... this is really an Eye Opener.. Am I prepared for AnE life.. even if that's what I am most passionate about.

    1. You will be able to. Just have a prepared mindset.

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  3. I love to work in AnE. Gives some sort of satisfaction. When you are on shift you are active ... Off, you can relax.
    Then you don't have to see the same patients over and over for many days especially those with chronic diseases.

    Was this the 1st job you took up when you started working in UK?

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    2. Yes thats a good way of seeing it. It actually makes it easier.

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  5. Nice post. It's always good to have these kind of insights into working in a new environment. Keep up the good work Mute

  6. Nice post. It's always good to have these kind of insights into working in a new environment. Keep up the good work Mute

  7. I love accident and emergency postings,love the rush,the adrenaline pumping.