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A good deal of thought has gone into the physical design of new emergency departments, and quite right too. Good patient flow, space and a calming environment can do wonders for a unit’s performance and atmosphere. There’s one thing, though, they often haven’t thought of.
At St Elsewhere’s, the staff break room is opposite one of the waiting areas. As you walk past, especially if you’re rash enough to be carrying a coffee cup or a lunchbox, you can feel the hostile gaze of a row of uncomfortable, frustrated patients boring into you. Occasionally, if the wait’s longer or the patients are rowdier than usual, there’s even heckling: ‘Oi, we’ve been waiting hours!’, or ‘That’s right, you enjoy your sandwich while we’re suffering out here!'
Needless to say, it doesn’t contribute much to anyone’s enjoyment of their limited breaktime. The trouble is that, for the patient, attending the emergency department is always a ‘special occasion’ – a time of heightened emotion and anxiety – but for the staff it’s a regular day’s work. And if it’s a day’s work lasting 10 or 12 hours, then that half-hour break away from the coalface is absolutely vital.
In 2014, Leicester hospitals became briefly notorious when they banned staff from drinking tea or coffee anywhere they might be seen by patients. The idea was to cultivate the impression that doctors were hard at work at all times, not slacking off by having breaks or consuming refreshment. Apparently, this wasn’t just the deranged stratagem of an incompetent management consultant: people had actually complained.
Not many departments went far as Leicester – possibly noting the universal mockery they attracted – but I’ve worked in several places where eating or drinking at a desk in A&E was banned for ‘infection control reasons’. Given we provide drinks to patients in the same space, either we don’t mind poisoning them or this is a spurious cover story to avoid the unacceptable spectacle of a doctor drinking coffee in public.
So perhaps the solution is to conceal all evidence of medical staff eating, drinking or performing any other non-work-related function. Meals could be served in windowless cubicles, coffee provided in a secret cubby-hole behind the sluice and the staff loos labelled ‘Biohazard’ to discourage prying eyes.
No, seriously, maybe that is a solution. People who are frightened or in pain can’t be expected to think completely rationally, and it’s naturally galling to see someone going on their lunchbreak when you’re waiting for a cast on your broken arm. Hospital design really could take this into account. But on the other hand, is it unreasonable to ask our patients to pause and remember that the people serving them, even in their urgent need, have needs of their own?
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
I agree. The general public seem to forget that doctors and people who work in the emergency services e.g. police and ambulance are human too. Unfortunately we aren't some super-human species that can exist with food and drink and the occasional sit-down.
If there is a genuine infection control reason, there needs to be research and proof before implementing changes throughout the hospital. Everything we do in medicine should be evidence-based, and I find infection control to be one of the areas with the least evidence and the most hypocrisy, with some staff using it as an excuse to exert some sort of power over others. For example, why, as you say, can we not have a drink in areas where patients are? Why are ties not acceptable in case they dangle on people, but grotty never-cleaned lanyards are fine? Why are rings banned when there is more evidence to say they don't increase infection risk than they do? This is particularly the case when there are exceptions - are there magical properties of a wedding band that repel bacteria more than any other plain ring, or does that just show that it's more of a 'uniform' requirement than one focused around patient safety?
Reminds me of a particularly tough night on call. I was so exhausted that a nurse was kind enough to make me a cup of coffee and one patient saw me drinking coffee and later complained that “ the doctor just sits around and drinks coffee”.
it's a long time ago but a patient did offer me a piece of fruit from her locker top supply because she had seen how long I had been on my ward round. I was too embarrassed to eat it but it did give message to the other patients.
I'm working in ED at the moment as a junior doctor, and its surprising how few of my colleagues know what breaks they're entitled to - 30 minute break for 5 hours work & a second 30 minute break for more than 9 hours (taken individually, or combined as close to the middle of the shift). The number of ED doctors who actually get a whole hour of break time in their 10 hour shifts is tiny.
Our nursing colleagues have a much more protected and respected break system, bothering a nurse on their break is sacrilege. Perhaps we need greater awareness of our rights as employees, and of the processes in place to protect us if our rights are violated.
When I drink or eat in an area where there are patients I always explain to the first that I havent been able to leave my workplace for several hours and need to do this to carry on effectively. It would be great if there was somewhere to sit and indeed food available so I dont have to do this. Our canteen shuts at 2pm. I rely on the kindness of others. Regarding breaks- nursing breaks are unpaid so they should take them. Ours are part of our professional contract.
I think the issue is that emergency departments are such a mess with poor staffing, poor decision making, poor leadership, poor toilet access and hygiene that patients vent their frustration staff. Improve service - complaints will go away.
I recently was reported to the Chief Medical Office or Northern Ireland, Scotland and Wales - for delay in seeing a patient by 15 minutes for which I thought the patient would accept my honesty about this
Such is the level of expectation, from NHS patients , -
Solution: 1. " No Deal Brexit "
2. Pay Higher Tarrifs for Sandwiches from , Indian / China/ Russia/ Brazil
3. Smuggle sandwiches accross Hard North Ireland Southern border
But we as British- but we prefer to die in a queue , complaint about the mismanging complaints and say Thank you for agreeing to a " No Deal "