ATTENTION PLEASE

To all the admitting teams I refer to:

I would like to being the following to your attention:

1)We are here to work. YOU are here to work. You are getting paid overtime to be here late at night, and while I appreciate that it is crap, you being snotty to me on the phone at 3 am will NOT help matters. I have been there, I have also done the 36 hours without any sleep, and I know it is bad. I am not waking you up/referring another patient to be funny, I am doing so because they are sick and need admission.

2) Just because A and E officers work 8 or 12 hour shifts does not mean we are lazy. While you deal with pretty much the same, day in and out (with the occasional 'pink canary'), we have to deal with everything and anything that gets thrown our way. Because of overcrowding and a lack of beds, we have to deal with uppity, angry people ALL THE TIME, because they have been waiting 8 hours to be seen. We are at the proverbial front line of people's emotions, all the time. We soften them up for you. We explain whats going to happen, we console. We also provide life saving interventions all day, and do resus after resus after resus. Its very emotionally and mentally draining. We work just as hard as you.

3) If you go to theatre for any period of time and you are on call for casualty, you need to get someone to cover for you. Or at least answer your bleep. End of story.

4) Please trust me. Again, I am not referring patients for a 'second opinion', or because I am trying to be mean. I am doing so because I believe that they have a condition which prevents discharge. This opinion is formed from a)the history I have taken from the patient, b) the examination I have performed and c) the investigations I have done. There is always a reason.

5) If I tell you that a patient is unstable, this is not to try and place undue pressure on you or annoy you. I know you have five patients waiting to be seen. But you need to prioritise. I am only telling you the patient is unstable so we can try get them to theatre/CT scan/ICU a little bit quicker. I will do my best to stabilise and manage the patient as I can, but most will need further intervention.

6) We have protocols in place for a lot of conditions: we use them. Please do not argue with me about a referral if I have followed a protocol/guideline and you are the end point.

And while we are at it:

To the doctors I have referred patients telephonically to while sitting at a peripheral hospital, terrified and desperate:

a)Yes, I might be more junior than you, but I am not stupid. Please do not treat me as such. I know you are stressed, so am I! If there is something missing from what I am telling you, or something you want me to do tell me exactly what it is, and let me phone you back. I am phoning for your help. Please give it.

b) It is easy to forget what it is like to work in a hospital that has no CT scan, no after hours blood laboratory, no after hours Xray, insufficient or undertrained staff and no consultant support. That is where I am. Picture it for a minute and then please give appropriate advice. Thank you.

And that said:

To all the doctors in Ireland and South Africa who have been friendly, kind, helpful and supportive, THANK YOU. Know that A and E has got your back.