People are going to A&E with hiccups – as a doctor I know why

I’m not surprised at the news that millions of people are turning to A&E for minor ailments. 

Those of us working in the NHS have known for a long time the kind of pressure it is under and how A&E is a symptom of general pressures on the NHS.

New analysis of NHS data by PA Media found that more patients were turning to A&E for minor conditions, such as coughing or hiccupping.

It shows a simple reality – our healthcare system is under unprecedented pressure.

And just like last year, when I read how more than 250 needless deaths occur each week because of long A&E wait times, I wasn’t shocked.

A few months later, Lord Darzi’s report was released, which found that the NHS is in a ‘critical condition’ and is falling short of targets for cancer, A&E and hospital treatments, which has contributed to poor survival rates for cancer and heart disease.

As a resident doctor, this is my reality day in, day out.

In some A&E departments, teams are faced with 13-hour wait times as well as a waiting room full of people with heart attacks, brain bleeds and in agonising pain – all of whom are yet to be seen before shifts have even started.

Patients aren’t necessarily to blame for attending A&E for minor conditions – after all, we have seen a minor cough or cold turn out to be something more sinister.

But it can be dangerous.

I’ve seen large numbers in the waiting room, which can mask those patients most at risk of deterioration and who need urgent care because we can’t get to them quickly enough to triage, and some may not declare themselves through the front door.

So if a patient comes in with chest pain, they may get looked yet quickly, as it could lead to something serious.

But if we are seeing a patient with a cough, it might be some time before we spot it and notice they’ve had a heart attack.

These high admissions are now the norm.

No sign of easing

A recent analysis by the BMA showed that the waiting time is at a crisis point, and the number of patients waiting over 12 hours for an emergency admission in July 2024 was 81 times higher than in July 2019 – a statistic the BMA emphasised was an ‘underestimate’.

Sadly, as other doctors tell me, the state of A&E is horrific across the country – with no sign of it easing.

Young women with yet unknown ectopic pregnancies float around waiting rooms for hours before a set of observations alerts clinicians to just how sick they are.

Patients with strokes who have a delayed diagnosis because they weren’t seen quickly enough are put outside the ideal treatment window for removing a clot in their brain and instead receive the next best course of action, which is simply to take medication.

Even one young man’s life-saving treatment was delivered on the floor of an emergency department because of a lack of space.

He was fine afterwards. Healthcare staff weren’t. 

‘I did what I could’

A&E staff know we’re just not getting to our patients quickly enough, and it feels exhausting – especially when we’re fighting just to offer the basic human rights to our patients.

Previously, these excess wait times would have been escalated. Managers would have been in the department; A&Es would have declared a major incident or asked for an ambulance divert. 

Now, there’s nowhere to divert patients to because all other hospitals are in the same position. 

A&E staff have got used to saying: ‘I did what I could’, not: ‘I did what I should’.

We’re losing our patients when their deaths could have been entirely prevented – and it’s soul-destroying.

Hospital wards can shut their doors when there are no more beds, A&E has no such luxury.

Instead, staff try to do what they can. 

A&E, alongside secondary care, has historically always seen the spillover when people can’t access their GP or pharmacists (particularly over the Christmas period), and I think this is a large part of what is being reflected in these figures.

More medical appointments are not going to be the only solution – there have to be effective health education campaigns to show people how to better deal with minor illnesses and that they will run their course, and what to watch out for.

Patients are suffering because of a lack of investment in health. We need investment.

We need to fund our GP services to help keep patients out of A&E whose needs would be better served in the community. We need to provide appropriate and robust primary care for our ageing population that doesn’t cause an annual ‘winter crisis’.

Healthcare staff are incredibly resilient; we’ve worked through enormous uncertainty at great personal risk, but we did not sign up to give our patients substandard ‘cowboy’ treatment.

We’re reaching the limit of what we can tolerate.

The NHS has the potential to be brilliant if the money goes where it’s needed. The system can’t run on the goodwill of healthcare workers alone.

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It needs a government that will protect it, who will rebuild it, and invest in, not just health, but all the essential services too. 

I want the public to stand alongside the people who care for them. For them to speak out about the importance of keeping essential staff in the service, our politicians need to hear loud and clear just how important the service is, and I want them to listen and support us, too, because everything we do is for our patients.

We need the public and politicians on our side more than ever. Without change, we won’t have an NHS.

A version of this article was first published on September 12, 2024.

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