Personalities and Patients

My recent set of night shifts were surprisingly OK. I had a few problems, and as per usual, none of them were clinical. Management and personality issues were the biggest problems completely! One night was horrendous. I arrived and the Consultant basically said be as safe as possible, and don't worry about the target - you'll get there. We worked through and did really well. At handover in the morning, we'd prepared a list of patients who just needed a review by the social team, and would then probably be fit for discharge. It's our hospital policy to refer these patients to the medical team overnight, as they can't stay "under" the ED all night. The medics had accepted the referrals, but not seen the patients yet (as they were low priority). I suggested these patients were just referred by us to the social team - but was told they were no longer our responsibility. Which isn't really fair and isn't really playing the game. One of these patients had been referred to the surgeons for an opinion, she was medically fit for discharge, but over 80 and lives alone, so couldn't be sent home at 2am. The surgeons had referred to medics to wait for social review. I knew this, as I'd kept up to date with what was happening. I got told off for knowing what was happening with the patient, and told I'd explode if I kept up to date with the entire department. Which I agree. But. I do know my whole department because patients ask questions, so you check. And, before the patient gets to that point they've been discussed with me - and you don't forget that quickly. And. It's not necessary to do this in the middle of handover, in front of everyone after a long and very stressful nightshift. Another night we got to a 3 and a half hour wait. The Nurse in Charge wanted me to escalate to my Consultant - after some debate I refused and just cracked on and saw the patients instead. I'd identified that the problem was no Nurse in the waiting area, where most of the patients were. This meant the docs had to do all the repeat obs, urines, walk patients to x-ray, repeat ECGs, wounds etc. Which we don't mind doing - but when the docs are the slowest link in the chain, it's really time to be reallocating Nursing resources. In the time it takes me to walk a patient over to the main area, and back again - I could have seen another patient (depending on the patient!). There was a problem, and a solution, but no-one wanted to fix it. Of course, the whole problem is compounded by patients "wanting it checked before I go on holiday", and not wanting to wait more than an hour etc. to be seen... These are half of the reasons that emergency medicine is one of the most challenging specialties. It's not just the clinical aspect - every aspect is complicated.