“In theory, my job as an emergency physician consists of taking care of the patient during the first hours following treatment to avoid any deterioration in his condition. It can be a victim of a road accident or a cardiac arrest, but in fact, it is mainly patients with a more vague health problem, whose seriousness of the cause must be estimated. . Is it just chest pain or a quietly looming myocardial infarction? In this last option, we must act as quickly as possible to maximize the chances of survival. Once stabilized, I direct the patient to the right department of the hospital (cardiology, gastroenterology, geriatrics, etc.).
I love this job because I get up and I don't know what my day will be like. Every morning, I leave for the unknown. When the job is done well, I know that the whole team and myself have been able to make a difference to improve a patient's chances of survival. It's very satisfying. Not to mention that emergencies are the only public services open 24 hours a day. And in addition to care, I like the social dimension, like offering coffee to a homeless person, even if this is not the role of emergencies.
Make a patient wait 48 to 60 hours on a stretcher
Except that since my first internship in the emergency room in 2016, the situation has deteriorated continuously. At the time, I remember that between emergency physicians, we had a challenge called the no-bed challenge. Every morning, we said to ourselves how many patients had had to spend the night with us, for lack of beds in the hospital departments. And it sometimes happened to us to face this situation. Now it's every day. We end up with 3 to 10 patients to monitor because there are no more beds available elsewhere. This is not the role of emergencies.
The consequences of this deficiency are concrete. First, we cannot do our job well. We have to take care of the patients who stagnate with us, which prevents us from taking good care of the newcomers. Fortunately the interns take over but they are still students in the learning phase. An intern does not have the same pace of work as a full-time doctor, especially if he is at the start of his internship. Me, in parallel and as an emergency doctor, I have to dedicate two thirds of my day to the management of files of patients awaiting hospitalization. I repeat it here, it is not my job.
Second, the patient waits longer. However, as I said earlier, extending the deadlines means reducing the chances of survival in the event of a serious problem. In fact, some wait 8 hours in the waiting room! Some weekends, after the diagnosis is made in the emergency room, some patients may wait 48 to 60 hours for an inpatient bed on a stretcher in an emergency room hallway.
Dealing with reproaches from a patient's family is probably the most complicated
The lack of beds sometimes leads us to send home elderly, frail people who are very close to needing oxygen assistance because they live close to the hospital or have family proximity, because there is no longer enough room in our house when we should be keeping them under surveillance. It is not normal.
I am aware that I am not doing my job well. In reality, in the emergency room, we do abuse and it is absolutely not our fault. I see every day that I do the best I can but I have no other solution to offer patients.
This is the number of visits to English emergencies in 2021, i.e. 20% more than in 2012, and +100% compared to 2002.
Facing the reproaches of a patient's family is undoubtedly the most complicated. They ask us if we find the care of their loved one admissible. I know very well that she is not. I tell the families but I tell them that I can't do anything about it. I remain their only outlet…
In the current context, I can still say that there are no deaths due to poor working conditions. We manage to take care of critically ill patients. The problem concerns patients in the gray zone: those whose vital prognosis is not engaged but whose condition could, without supervision, deteriorate rapidly. Today, we still manage to take care of patients in vital emergencies, but this delays the care of other patients.
Change of job within 10 years
Not only do we need more beds available in the hospital to discharge emergencies, but also better health education for the English. If you have a runny nose, yes, you can take a doliprane and wait four days. The Court of Auditors has calculated that in 2016, 10 to 20% of patients could have been cared for by a general practitioner. A not insignificant figure but which in reality is not huge and which we could deal with. Except that in the current context, we can no longer take care of this surplus of patients.
Summer is going to be complicated. In my hospital, a quarter of the posts of emergency physicians for July/August are not filled. There will of course be interim doctors to fill in, but the root of the problem is the lack of attractiveness. Myself, I see myself continuing to be an emergency doctor for another 5 years but not 10. It is not possible to do your job in such poor conditions for so long. »
The government's response to the emergency crisis
On June 8, the Minister of Health announced:
– the doubling of overtime pay for non-medical staff and additional working time for doctors
– the possibility for student nurses and caregivers who completed their initial training in June and July to start practicing immediately, without waiting for the official presentation of their diploma
– that retired caregivers who volunteer to resume work this summer will benefit from facilities for combining with their retirement pension
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