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Time-wasters in A&E: time to shake the label

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There is one of those memes doing the rounds on social media; you know, a picture with words to give a message.

This time it is a chart telling the public where to go for their health needs: “pop off to pharmacy if you are having diarrhoea and can get off the toilet” it begins, concluding with “don’t go to A&E unless you are comatose”.

In spite of my cynicism, it is a useful message; but one which is clouded by a statement that has been accompanying it: “Pass it on; if it prevents one time-waster it’s a bonus”.

Time-waster: what exactly does it mean?

“The implication to me is that they are wasting my time as a nurse”

The person is wasting their own time, sitting for five hours waiting to be seen in A& E when they could be home watching TV or playing on their Xbox?

The implication to me is that they are wasting my time as a nurse – the professional who is being paid to be here.

It speaks of a paternalistic attitude of “I know best”, “I am more important than you” and “you are below me”.

It is judgemental and enshrines the patient in front of us as “wrong”. It may mean the meme creator is suggesting that there are patients who waste my time as there are people more poorly than them who need it more; but that elevates one person as more valuable than another and is accompanied by assumptions about what one is deserving of.

The ‘time waster’ sits alongside the ‘bed-blocker’ character and represents a similar attitude in a different part of the NHS.

“This is outside the ethos of the NHS value-based 6Cs of care and compassion”

This is outside the ethos of the NHS value-based 6Cs of care and compassion. The person - the so-called time-waster in front of you is a real person who needs care.

They may have been sat at home on their own for hours. The pharmacy they are meant to go to is shut. The health-line 111 is busy, or their pay-as-you-go phone is out of credit and they do not know who to call for help. The GP is closed and does not do visits and they cannot get an appointment for three days anyway. The out-of-hours service is in the centre of town, and costs to get there on the bus, and they live fairly close to the hospital where they can walk easily.

They are feeling scared that they are going to die as they have never felt this ill before, or they are a parent who has had a child crying for hours who suddenly goes floppy and they have run out of paracetamol. Is that a heat rash or sign of meningitis?

“With services in the community eroding, people don’t always know who to go to”

With services in the community eroding, people don’t always know who to go to, and when scared and unwell don’t have the time or capacity to find out. The hospital, with its doors always open and  bright lights shining in the night give the message that this is where you can get help.

There is no question that things need to change in the way of education to better support people to understand their own health needs.

“Labels such as time waster are unhelpful and inappropriate”

However, labels such as time waster are unhelpful and inappropriate. Instead we have a duty to provide a service that is caring, compassionate and welcoming - no matter the pressures.

You never know, one day you may need the service and would expect people to respect you as a valued member of society and provide optimum care.

Dr Jenny Hall is senior midwifery lecturer, Bournemouth University

  • 1 Comment

Readers' comments (1)

  • As a Nurse Practitioner working in a busy city centre ED I have not heard the term 'time waster' used by my colleagues. 'Inappropriate attendance' is sometimes used.
    We have a duty of care to all patients who attend ED with no matter what condition. Some EDs don't see patients who present with symptoms of more than a week duration but ours doen't have this policy.
    ED staff are under a lot of pressure to have patients turned round within the 4 hour target. The pressure is intence with managers haranguing staff to see more patients and to see them quicker.
    It is frustrating therefore to see a patients who attends with 9 weeks of knee pain, who has already seen their GP and been referred on for specialist treatment. One recognises the patient is suffering but there is little the ED can offer to help. The patient has to be seen, a history taken, the patient examined, the medical notes written and copies sent out to the GP. This takes time.
    The next patient perhaps with a suspected DVT or severe cellulitis who has already waited 2 hours is ready to be seen. This patient has more urgent needs, blood tests may need to be taken, the results of which can take an hour. Referrals to to other specialties have to be made, treatment initiated, perhaps IV antibiotics. Before you know it the patient has been in the department 3 and half hours and the managers are applying pressure to get the patient admitted or discharged asap.
    There are many conditions which the ED is not ideally equipped to deal with, particularly chronic disease managment where the community staff have greater skills and expertise.
    There are moves to have community medical centres working next door to EDs so patients can be triaged more easily and this would be a great idea.

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