The Problem With A&E…


A&E.  The emergency department.  ER.  Whatever you call it, it is the same wherever you go – the place for accidents, emergencies and life-threatening situations.  A noisy and frightening department where the value of life is suddenly realised to be incredibly important and the healthcare professionals working in it do everything they can to save it.

However, over the years (particularly with the various problems in the NHS) the A&E departments are fast becoming places where people go to when there is nowhere else to turn.  In my physiotherapy career, I’ve heard horror stories of how elderly people are “dumped” in A&E when their family no longer want to care for them, how people have to wait almost 24 hours to be seen and how patients deemed “not an emergency” are turned away, only for them to come back later seriously ill.  I’ve seen first-hand how the emergency team are forced to deal with drunks and drug addicts rather than the police, and how they are a very abused department – being sworn at, threatened and even spat at whilst trying to treat someone.

The emergency department is seen as a safe haven, a place where you will be looked after and treated.  But unfortunately for a lot of us, it’s only been a place full of negative experiences that has made us too scared to ever present ourselves there again.

My first experience of A&E came when my GP sent me there when a kidney infection was persisting and I was in a lot of pain.  I presented myself to the receptionist, who was rude before they’d even opened their mouth, and despite a letter from my GP I was made to feel like I didn’t need to be there.  This happened probably about 5 times in the space of a few months when my infections were not improving or I was in severe abdominal pain – each time I was confronted by a rude receptionist (is it a requirement that all healthcare receptionists just assume they are more qualified than the doctor or something?), waited a long time to be seen and faced by junior doctors who told me I was fine and not needing to be there.

The single most awful experience I had was with a locum emergency doctor, who shouted at both me and my husband “for wasting his time” and was so rude to me during my examination, and then proceeded to ask my why I thought it was appropriate for me to come to A&E (again, I had a letter from my GP).  We did complain about this experience, and actually got a very nice and long investigation report and apology form the trust director, but that still doesn’t make it any better.  Another close second was the time a junior doctor told me that, as a physio, surely I could identify and treat the back pain I was experiencing? Spoiler alert – I had a kidney infection with a suspected kidney stone.

All but one time of me attending A&E was via my GP.  The one time that wasn’t was when I was taken in via ambulance with sepsis.  I have always wondered if I had come in all those times via ambulance, with a paramedic in my corner, would I have been treated differently?


Well actually, the point is is that we shouldn’t be treated differently at all.  Regardless of even having a GP referral, you are in A&E because you are very unwell and need help.  It seems a bit judgmental in my eyes, and the discrimination us with chronic health conditions face are not needed.

Since being diagnosed with my health conditions, I have only been to A&E a couple of times, again for kidney infections that just won’t shift.  When the consultants or nurses learn about my conditions, they are sympathetic and repeatedly tell me how “I’m so young to have gone through so much”, but I strongly think that if I were there with my Endometriosis pain or bleeding, then they wouldn’t be that sympathetic.

It’s unfortunate but very common among my followers and others in the chronic health community, that we experience a lot of poor standards in A&E.  The most common reasons that this patient population might present to A&E are severe pain and severe bleeding, both things that can be major problems if left untreated or be something serious unrelated to our conditions.  Yet we are frequently dismissed.

The problem is, A&E is an incredibly overstretched and under-funded service. The NHS Mandate set out a “4 Hour Wait Target” across all hospitals, where 95% patients who come to A&E should be admitted, transferred or discharged within 4 hours.  If hospitals do not meet this target, they are fined.  And because of how busy the emergency department is, how understaffed they are, and the inevitability to very serious emergencies cropping up at any moment, these fines are common and cost NHS trusts a fortune.  This means that any patient that can be sent home – usually us – are – even if being admitted had the tiniest chance of helping them.

And because A&E is not a department that manages long-term health conditions, quite often healthcare professionals deem our conditions as “inappropriate” to seek emergency care, even though we come with very acute, debilitating and serious symptoms.  The vast majority of us have sent away with pain relief and that is that – no further investigations and no other point of contact.  If you have a referral or appointment with the desired specialist coming up, then you are even more likely to be treated unfairly – “you’ve got an ultrasound in 4 weeks, we don’t need to do one now” and so on and so on.

Another problem with A&E is that there is a serious lack of education regarding most of our conditions.  I’ve come across healthcare professionals in A&E who haven’t heard of my conditions and it makes you wonder what things are left out of the medical curriculum.  The other thing is that they might know what your disease is, but they are seriously under-educated and don’t understand the disease at all – a bit like when I’ve been told Endometriosis “can’t grow there” or “I can’t feel any, so you don’t have it,”.

For us lot, we have to be persistent and raise our voices in these already distressing situation.  We have to fight for our symptoms and the treatment for them, and to be taken seriously.  We often find ourselves educating those trying to treat us, or being seen to “make a fuss” just to be seen.  And there is a part of me that understands how the stresses and struggles of working in the NHS mean that some staff members might be short-tempered or under so much pressure they are exhausted, but that shouldn’t mean you take it out on your patients.

The only important message I want to put across is that if you feel you need to attend A&E – by ambulance, referral or on foot – because your pain is so severe, or you’re bleeding non-stop, or are experiencing major symptoms that are not right, then go.  Don’t put up with being treated like you are making a fuss or your illness is insignificant.  Sometimes we have to put our foot down to be taken seriously, and whilst that is a sad fact, it is quite often what is needed.


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