A disheartened junior doctor working in one of the busiest A&E departments in the country has released harrowing diary extracts of his daily experiences.
The trainee medic, working for a hospital on the south coast of England, has spoken anonymously as the NHS faces one of its worst winters on record.
It comes after US President Donald Trump sparked fury today after tearing into the NHS, branding the UK’s system of universal healthcare ‘broke and not working’.
Health and Social Care Secretary Jeremy Hunt immediately hit back, saying no-one wants to live in a US-style system where millions have no healthcare cover.
The doctor has told his shocking account to MailOnline exclusively and said he expects the same issues to resurface next winter. He has revealed how:
- He avoids eye contact with patients on trolleys who look at him like ‘some sort of Messiah’ because he knows he can’t do anything to help them
- Disgruntled colleagues believe a hotel with three cooked meals would be a safer place for thousands of patients in the current NHS climate
- Doctors bargain, negotiate and cajole for spare beds, describing the constant pressures as being like a trading floor of a stock exchange
- He often sacrifices his lunch breaks to cope with the soaring demand placed on his hospital and dreads going back to work the next day
- The winter crisis will be exactly the same next winter, and that he would guarantee his future mortgage on the same worrying problems occuring
- He can barely afford to buy a hot chocolate or coffee because his rent is a quarter of his salary and he is drowning in debt from six years of medical school
During the week this account was written, waiting times soared to their highest levels this winter, ambulance delays and bed occupancies were also worryingly high.
The crisis, which has forced Prime Minister Theresa May to apologise, is worse than last year which was branded a ‘humanitarian crisis’ by the Red Cross.
Patients have died in the corridors of A&E units this winter because there are not enough beds, concerned chiefs revealed in a scathing letter to Mrs May.
While a lack of space has led to some taking to the floor, including a 22-year-old woman who used her coat as a pillow during a five-hour wait in A&E.
It comes after US President Donald Trump sparked fury today after tearing into the NHS, branding the UK’s system of universal healthcare ‘broke and not working’
Monday, January 15: ‘They look at me like I’m a Messiah’
My day has already started and I’m behind with breakfast. I know that the prospect of eating will be somewhere in the afternoon, if I’m lucky.
During the morning it will be sneaking off with a feeling of guilt to the doctors’ mess, which is in a rancid state to grab whatever measly, meagre food is available or even a drink.
You may be reading this and thinking why don’t you just go to the shop that’s in the hospital and grab a quick hot chocolate or a coffee? My rent is a quarter of my salary and I’m drowning in debt from six years of medical school.
I look at the board and see how many patients are waiting and I see lots of red, which is a bad sign – indicative of the prospect of breaching targets.
This doesn’t really faze me because I don’t have to answer to the board of directors, but I can see my boss who is stressed and furrowing his brow.
All the consultants are stressed, all the registrars are stressed and the juniors don’t look too happy either.
Embarrassingly, I asked one of my colleagues if they have just finished a night shift, and they reply ‘no I’m just unkempt and I’m sorry, I’ve been ill’.
A lack of space in A&E has led to some taking to the floor, including a 22-year-old woman who used her coat as a pillow during a five-hour wait on the ground at Hereford County Hospital
I’m walking in and out of the department seeing patients directly in A&E.
I look down when I see patients playing on trolleys and looking at me like I’m some sort of Messiah. I look down because I know I can’t do anything until they are assigned to me.
Every trolley has a paramedic who also looks at me with puppy eyes. Equally I’m powerless to do anything because of bureaucracy.
We go through the board and one of the patients is being admitted, not because they have anything medically wrong with them – but they are all alone at home and the hospital is a ‘safe place’.
My consultant colleague admonishes the system saying that a hotel with three cooked meals would be a safer place.
We talk about the position by one of the trusts in Essex who tried to introduce this but faced an amazing backlash.
I see several patients and all of them are rather sick. It would be very helpful if the nursing staff could help me by taking small jobs from me, like taking blood.
But I am saddened to hear that they have not received the training for this in this particular hospital, despite the fact that they have done it 10,000 times.
So I put my head down and do those jobs, knowing full well I could see so many other patients. But that is the system isn’t it?
I see a patient who is designated to go home today and I am saddened to hear that transport isn’t available.
And furious campaigners marched on Downing Street at the weekend, calling for the Government to properly fund the over-stretched health service
Thousands of protesters braved the wintry weather to demand an end to the winter NHS crisis as hospitals are overwhelmed with thousands left in corridors waiting hours for treatment
Another patient can’t go back to the nursing home because it’s been closed because of the flu. I bow my head in shame, feeling guilty and responsible.
I managed to slip away for lunch and en route I see colleague I haven’t seen for a while, also looking dishevelled.
Paradoxically, he tells me with a gleaming smile that he is leaving for Australia.
We chat for about five minutes and he tells me how he is going to fast track his way to consultancy in six years. He can’t wait.
I scoff my food nervously, looking at my pager praying that it doesn’t go off. I trot back having had my breakfast.
It’s nearly 2pm and I finish at 5pm. I look at my jobs list and compute how I am going to manage this. I don’t want to hand anything over to evening team or they will berate me.
A consultant gets back with a fake smile on his face looking at the board and seeing who can possibly leave.
There is a glimmer of hope in a gentleman pleading to leave, but his blood sugars are not stable because his insulin wasn’t given on time.
I’ve been asked to certify a death. A lady in the side room has just died after a short battle with ovarian cancer. The family look distraught and I offer my sincerest condolences.
After I finished doing that, I pounce on the packet of Pringles that someone has kindly brought in.
I run around like a headless chicken finishing off what I can do and who I can see. I hand over jobs to my colleague who writes them down furiously whilst her pager goes off.
I leave the department with my head down looking out of the corner of my eye to the six trolleys with patients and accompanying paramedics.
A fleeting thought runs through my head, if they’re all here then who is going and responding to the 999 calls? I can’t wait to come back tomorrow.
Royle Family actor Ralf Little joined the nurses, doctors, and activists today after publicly declaring his support for the protest on Twitter on Tuesday
Patients have died in the corridors of overcrowded A&E units because there are not enough beds, and desperate calls for extra funding have been ignored
Tuesday, January 16: ‘I need the money’
I’m starting the day with a handover meeting.
The room is partially filled with doctors that I am not familiar with. This is because there is a shortage of doctors on the rota, and human resources essentially need to liaise with agencies that will provide doctors for a fee.
I am covering in a different department. The reason being because I am available, and also I need the money.
I do have to say, that this elderly department I’m very much looking forward to working in. The pace of it is different to that of the emergency department.
The patients predominantly are medically fit, however these patients are complex, multi-morbid and require a lot of attention from the multidisciplinary team.
I’ve been asked to write a death certificate for a patient who sadly died this morning and is surrounded by family.
The family express their gratitude for the care, which I have found humbling, however they are in a hurry to get the death certificate so the siblings can execute the will. I am quite taken aback by this demand.
In any case, this leads to me spending approximately an hour-and-a-half liaising with colleagues to establish a cause of death and ensure everything is documented precisely.
This also has a knock-on effect with the patients that I was responsible for on the ward.
I really want to spend more time with my patients, especially elderly patients, as I feel that loneliness is so prevalent.
I find myself with many patients using many of the communication skills that I have developed over years in order to curb and conclude the consultation. It is efficient, however, again I wish I could do more.
I have to do a board round again, going through patients that I am responsible for -despite the fact that I have had limited time with them.
I get collared by the ward sister and some of the other nurses who are keen to discharge patients, however, for me it means lots of paperwork on top of the list of jobs that I need to do. My list builds up by the hour.
I was really looking forward to a talk at lunchtime, which included a free lunch but the future looks bleak for me. I have to sacrifice hours in order to make progress.
During the week this account was written, waiting times soared to their highest levels this winter, ambulance delays and bed occupancies were worryingly high (stock)
PRIME MINISTER THERESA MAY FINALLY APOLOGISES FOR THE 55,000 OPERATIONS CANCELLED… A DAY AFTER REFUSING TO ACCEPT THE NHS WAS IN THE MIDST OF A CRISIS
Mrs May finally apologised to patients who faced a delay on January 4
Prime Minister Theresa May finally apologised to patients who faced a delay on January 4, after it was announced 55,000 operations will be postponed.
The unprecedented move to cancel non-urgent procedures to free up beds and frontline staff was made by NHS bosses.
The decision prompted an apology from Health Secretary Jeremy Hunt yesterday, following pressure from his critics that he was ‘running scared’.
Mrs May apologised during a visit today to Frimley Park Hospital in Surrey, one of many trusts affected by the NHS move to cancel procedures.
After refusing to accept the NHS was in a crisis the day before, she said: ‘I know it’s difficult, I know it’s frustrating, I know it’s disappointing for people, and I apologise.’
Her comments followed official data which showed record numbers of patients are being forced to wait in ambulances for treatment.
Some 16,900 people were forced to wait for more than 30 minutes in ambulances to be seen by staff at A&E over the Christmas week – the highest total this winter.
There are so many worries as junior that they just don’t teach you in medical school.
You have to be seen being hours proficient, efficient, intelligent, possess excellent communication skills, respond to working with colleagues and their demands, respond to working for patients and their demands and also think about furthering your career prospects. All of this has to be included in your daily work.
This is the same for any other profession, but the difference for me is one mistake can cost a life.
An angel was sent from above as a medical student pops up and helps with the more ‘educational’ tasks of finding forms and running requests.
I make it home somehow miraculously by 5:30pm.
Wednesday, January 17: ‘I have sacrificed food for sleep’
Breakfast or sleep? That is the question. I am nearly six months into this job and I have sadly sacrificed food for sleep.
I don’t really know what is the lesser sin; a hungry doctor or a tired doctor.
Colleagues who seek to lose weight are loving this part of the job, I must add. It is, indeed, a very good way to lose weight.
Last night, I looked at my iPhone Health app which measures the distance I walked and it is quite remarkable. I’ve also had to change my shoes twice in six months because the soles have worn away gradually.
I have a very important meeting with my supervisor to ensure progress. One must remember that junior doctors are trainees and so need to be constantly monitored.
I remember reading the sign of an Oxbridge graduate once in an article and one of their characteristics is wanting to squeeze 36 hours in 24 hours. The same goes for doctors.
There just isn’t enough time to treat patients, do extra courses, voluntary work, charity work and teach. And then, on top of that, having your bosses watch you like a hawk is really quite a burden to face.
It is an eerily quiet start to the day. I’ve just been told one of the patients who had abdominal pain from a really bad ulcer had a catastrophic bleed over night and sadly died. There was nothing that could have been done.
Any sense of being tired now has evaporated.
Unfortunately, I have to spend 40 minutes on the phone trying to sort out my IT passwords as the system has gone into meltdown.
I do feel for my IT colleagues as I do see doctors being really demanding and having a sense of expectation but, on the other hand, spending 40 minutes fiddling with passwords is something I could do without.
This is the unglamorous side of being a doctor. It doesn’t matter which grade you are in.
There are co-ordinators in each department and they move around like worried aunties who are always on the edge.
Beds, beds, beds. Moving patients from one bed to another. Bargaining, negotiating, cajoling. It’s very much like a trading floor on the stock exchange.
They harangue the junior doctors to speed up any possible discharges. I see a patient who has come in complaining about shortness of breath.
She talks so fast I wonder whether her shortness of breath has a non-medical cause. I manage to get a few words in between and somehow examine her.
She remarks that she has jumpers older than me. I laugh out loud. Patients sometimes say the funniest things. I move on to the next patient.
The crisis, which has forced Prime Minister Theresa May to apologise, is even worse than last year – which was branded a ‘humanitarian crisis’ by the Red Cross
This one is a publican, a bit like Al Murray but without the shaved head. He definitely has the silver tongue and whilst I’m trying to take blood from him, he asks about his scan.
I finish taking blood and get a chair to sit down with him. I explain that the scan has revealed some abnormalities that require further investigation.
The banter dies down. It all becomes serious. I genuinely hope the next scan doesn’t reveal something sinister.
I see many more patients, hold about six meetings, some formal meetings and some in the corridor.
I think about my friends who are lawyers and bankers, who probably sit in a really nice board room with a jug of water.
All my meetings involve being on my feet. I hope I don’t get varicose veins in the future.
There’s so much more I can write about this day, but I don’t really have time. Sleep overwhelms me.
Thursday, January 18: ‘The crisis will happen again next winter’
My alarm wakes me up at 7am. Blurry-eyed, instead of snoozing for the next 20 minutes or going down for breakfast, I scroll through the news.
There’s a lot in the news about this NHS crisis. There’s a piece about medical students being drafted in to help out.
I read with more interest. I watch a clip of a couple of really enthusiastic students on Sky News who sound like they’re in a clinical exam, mumbling but somehow all the information comes out. The BMA have waged into this debate.
It’s 7.10am. I’m reading about how they express their dismay at students being called to help out. I reminisce about my times as a student where I would gallop onto the wards and constantly ask doctors to see patients, do tasks, procedures, fill out forms, but it was something that needed to be done.
I certainly haven’t seen any medical students being asked to act as the cavalry and dig trenches. They actually come when they want, do what they want, get what they want and go with smiles on their faces.
I have only myself to blame for not going downstairs to get breakfast today. I managed to swill down a protein shake and half a pint of water which isn’t too bad. I will relish the day I get to get hash browns and beans at the canteen.
Most of the area where I am working today has been cordoned off and sectioned off because of flu.
A lot of my time today is being taken up by wearing protective equipment. I want to be a surgeon so it doesn’t really bother me because I will have to gown up in theatres thousands of times.
I have a conversation with the nurse about how many pairs of gloves the hospital actually goes through. We stop and think. Wow. A huge number. No wonder we get paid so little, most of it is being spent on equipment. I get told some inhalers can cost £60. I think about the budget of the NHS – around £120billion. It’s quite a lot of money really.
The bed situation is a lot better now. The pressure seems to be wearing off. There aren’t random flashing pop-ups on my computer screen saying black alert. However, the pace of work is still exactly the same.
Trying to discharge patients who don’t need to be in hospitals. Specialists coming down into A&E to work with the emergency colleagues to give an opinion that will speed up the patient’s duration in hospital.
These shocking pictures show Kyra Dew lying in agony on the floor of A&E for more than five hours – using her coat as a pillow
The trainee medic has spoken of his day-to-day dealings anonymously, as the NHS is being crippled by one of its worst ever winters on record and ambulance delays soar
This will happen again next winter. I will guarantee my future mortgage on it (I don’t have a house yet).
I go to a bleep-free teaching session (meaning I can’t be disturbed) about research literature reviews. It a chance to take a breath and gather my thoughts for the afternoon flurry of work.
I see a patient who wants to discharge herself. She looks well and has steely determination to leave. She’s in her 80s and came in with alcohol withdrawal. She toddles around the bed ordering me about. I plead with her to stay. She agrees reluctantly but only because I spend 35 minutes talking to her.
I manage to get home at 5.30pm but that’s only because in this hospital they are very supportive.
Today was a good day.
Friday, January 19: ‘Work morale is low’
Everyone is talking about this Bawa Garba [barred by the General Medical Council for making fatal errors while caring for six-year-old Jack Adcock, who had sepsis] case in the mess, in the corridors, in theatres.
I do have to admit when I’ve spoken about it, it seems many of the doctors don’t know the detailed facts about the case.
It’s gripping, like the OJ Simpson case (I’m too young to remember but have watched the dramatised version).
Everyone forgets to mention this poor kid that lost his life, focusing more on the legal arguments and medical ethical issues. People need to step back a second and think about this boy.
The doctor, who works in a casualty unit on the south coast, told MailOnline his heartbreaking story, which he expects to face again next winter (a patient reportedly had to sleep on the floor at Pinderfields Hospital in Wakefield this winter)
Work morale is low. Doctors are anxious not only by what’s been going on in the last month but it’s been a steady barrage of issues. Chronic underfunding, doctors practising defensive medicine after constantly being litigated.
I am sorry about this outpouring, I think the weather hasn’t helped with this. It’s probably a case of SAD (seasonal affective disorder) but I have seen doctors visibly stressed and overworked.
I thought this winter pressure was abating. But there is a constant stream of patients, combined with being pulled left, right and centre by nurses, healthcare assistants and senior doctors. For a trainee, it’s more difficult. One has to swim against the tide whilst being constantly tugged from behind.
I do understand why people are leaving this work environment probably because one doesn’t have to put up with this riff-raff elsewhere or if they do they are being remunerated commensurately.
I would love to have a couple of weeks off somewhere sunny and drink some ice cold lemonade. That’s all it would take to reset me.
Despite the absence of this, I haven’t lost that glowing ball inside me full of warm thoughts about how I get satisfaction practising as a doctor. I’m honoured and it’s a privilege.
HOW MUCH PRESSURE WAS THE NHS UNDER DURING THE ‘HUMANITARIAN CRISIS’ OF 2016?
The NHS endured its worst ever winter crisis, with waiting times, cancelled operations and bed-blocking running at, or near, record levels last year.
Official figures illustrated the scale of the scale of the turmoil to engulf the health service in the face of unprecedented pressures.
Bed-blocking due to a lack of social care places was at a record high with more than 2,500 health patients prevented from leaving hospitals each day – specifically because there is nowhere for them to go.
Statistics from NHS England report also revealed nearly 200,000 patients waited at least four hours in A&E between the winter months of December to February – a five-fold increase from just 41,000 five years previously.
Supporters of the NHS reacted in fury after the Red Cross claimed hospitals were facing a ‘humanitarian crisis’ after its worst week in 15 years
Extreme waiting times also reached record levels, as nearly 2,000 patients were forced to wait at least 12 hours in A&E over the same period.
And cancer referral rates in February were at their second lowest level on record.
Supporters of the NHS reacted in fury after the Red Cross claimed hospitals were facing a ‘humanitarian crisis’ after its worst winter in 15 years.
The charity said it stepped in to help the NHS in England to deal with the increased demand during the winter, but have been hit with criticism accusing them of overstating the issue.
It comes as it emerged that two patients died on trolleys in Worcestershire Royal Hospital’s accident and emergency department in January.