Low-life scum at Kings College Hospital A&E

[poppylucky]

Has anybody been watching the Channel 4 programme '24 hours in A&E'?

It follows the daily life at Kings College A&E department over 24 hours.

I could'nt believe the sort of dregs of the erath people that are treated there, byt that i mean, drug addicts, alcoholics, hooligans.

All of them wasting NHS funds - OUR taxpayers funds.... i really felt sorry for those dedicated Doctors/Nurses/Porters that have to deal with all those low-life scum everyday. There really is a case for all these self-inflicted ailments they come in with (dragged in with, by the Police mostly...)- should be made to pay for the medical treatment given - if its possible!.

The abuse and violent threats the Staff have to put up with there on a daily basis is very sad and unfortunately symptomatic of some parts of our society.

Unfortunately Kings Hospital is the main reception point for certain areas all around East Dulwich/Dulwich Central/Village, which have higher crime figures, especially when it comes to stabbings. It receives the highest stabbing victims of any Hospital in Europe apparently! That was a shocking and sad fact.

Now i know where some of our NHS funds are wasted on..!

[Alan Medic]

Are you suggesting that low life scum aren't treated then, as if they are what you say they are they're not likely to be able to pay?

[Alex K]

Provision of care to the destitute, the marginalised, is left to junior doctors; just another rung that must be climbed on the route up and out to a BUPA consultancy in leafy Surrey.

Or: Don't feel too sorry for the KCH A&E personnel. If you choose that life you're in it for one of two things: Either the money (the fellow who sewed me up the last time I came off my bicycle, one Sunday morning at King's not too long ago, was moonlighting for considerable quantities of dosh; his day job was as a plastic-surgery registrar north of the river) or the adrenaline thrills of move-'em-in, patch-'em-up, move-'em-out, and no tedious outpatient-clinic aftercare / doctor - patient relationships.

[Moos]

What an oddly surly and resentful post.

[DJKillaQueen]

Sigh...why does anyone even dignify the OP with a response.

[srisky]

SOrry DJKQ, I can't resist...

Poppyluck - some of these 'low-life scum' come from terrible backgrounds and have not been able to break out of the vicious cycle. They can be challenging to manage in hospital and in the communituy. However, they should not be confused with those who on the weekend decide they want to go out on a binge drinking mission and start some fights just for kicks and expect everyone else to deal with the mess.

Alex K - a medical degree takes 6 years, which is a lot longer than your average degree. Your starting salary as a junior doc (if you work 9am-5pm, 5 days a weeks) is ?22K. I don't think that's great renumeration for the intesity of the work or the responsibilty it entails. It takes a minimum of 8 years to reach consultant level. During these 8 years or more you have to take several exams, paid for out of your own pocket. You also have to attend numerous courses, often paid for our of your own pocket. These amount to several thousand pounds. YOu have to carry out audits and research in your own time (ie. no study leave). Increasingly, junior doctors have to undertake an MD or PhD, which meanes up to 3 years out of training with a substatial cut in salary. The funding for this is extremely competitive. The consultants you speak of frequently worked over 100h/wk as junior docs and not infrequently for over 24h straight with no rest. They now supervise the junior doctors and also work in the outpatients clinics and perform complex procedures. The unltimate responsibility for the patient falls to them.

It's a vocation and many of them love their job but many have also left the profession or the country because of this. I know many would not want their children to enter the profession. University fees (another topic entirely) will not help matters.

[Moos]

srisky, I don't think you should feel you ought to apologise for your excellent post. Better to counter with facts and a positive attitude than let nonsense and spiteful cynicism sit unchallenged.

[womanofdulwich]

a and e kings on a fri or sat night is not a good place to be. BUT it makes you realise how lucky you are- some of the poeple there that need attention are rather sad cases- who you assume are regulars there and see it as a reception area- or refuge even.

[srisky]

Thanks, Moos!

Just to add...

....given the vacuous, celebrity-centric era we live in, I don't blame people for thinking plastic surgery is just boob jobs, tummy tucks etc. There is clearly an increasing demand for these procedures. However, plastic surgery also entails reconstructive surgery e.g following road traffic accidents, burns etc. Perhaps he is going make loads of money doing cosmetic surgey but this, in the main, is not paid for by the NHS.

....finally (I hope), did you ever wonder why there was a need for the A&E dept to hire someone to 'moonlight' for a shift? There is a shortfall of junior drs of varoius grades in numerous specialities around the country. To make up for the gaps in the rota and staff shortages these dept have to hire docs as locums. Locums usually have full-time jobs elsewhere and locum in their spare time, maybe to pay for an exam or to make up for a pay cut during research or maybeto buy an expensive car - and why not?

[Alex K]

Thanks srisky / moos -- I'm myself a consultant physician, at King's, and I know from the inside that all that you have set out in your posts is true. The young man wielding the suture needle on me (lovely subcuticular technique, by the way) who was still in plastic-surgery training may elect to spend his life restoring presentability to childhood burn victims. If so, good for him. He may elect to spend his life doing follicular-plug hair transplants, and if so, good for him. I'm not here to judge.

Would it cost the nation less to buy every medical student a Jaguar and a starter flat at the beginning of his or her studies, and to cap medics' pay at ?40K / year thereafter, rather than to let them -- yes, including me -- gouge the public for forty years at ?120K+ / year whilst they and their partners cry the blues about at one time having had to eat baked beans from the tin? Discuss. Certainly front-loading the medical compensation package would ensure that our medics are selected solely from among those who feel the Call, the "vocation", as srisky puts it. And what about me, preaching water and drinking wine? I came to the UK from the USA ten years ago to work in a socialist medical system, gladly taking a 50% salary cut, because I believed and believe in health care free at the point of delivery. To my way of thinking, in the USA I was drinking wine, in the UK I'm drinking wine still, although -- financially speaking -- screwcap (UK) rather than A.O.C. (USA).

Now, as to the psychology / motivations of those who elect A&E work, which were the matter of my post and which your comments have not addressed: I hold that trauma / acute-care medicine is medicine without commitment to the patient. (This opinion applies to anaesthesiology and to intensive-care medicine as well.) The commitment extends to the situation; the patient is handed along for follow-up to a different medical team. Those who make it their career, in medicine or in nursing, are not interested in long-term involvement with those whom they treat. Those who do it as locums, in medicine or in nursing, are well-compensated. For these reasons I suggest that the OP's sympathy toward A&E staff is misplaced. Someone working by choice in A&E beyond student or trainee obligations has, I think, buttered his / her bun, and is happy lying in it.

[zeban]

Love this thread- apart from the ridiculous original poster! very interesting points Alex K and srisky. I'd agree with Alex K completely.

And with srisky regarding this:

'some of these 'low-life scum' come from terrible backgrounds and have not been able to break out of the vicious cycle. They can be challenging to manage in hospital and in the communituy. However, they should not be confused with those who on the weekend decide they want to go out on a binge drinking mission and start some fights just for kicks and expect everyone else to deal with the mess. '

[steveo]

How can you butter a bun and lie in it?

[Alex K]

"You've buttered your bun, now lie in it" -- Jiminy Cricket, in PINOCCHIO -- always amused me. Shows how old I am, I reckon. (No, I didn't see it on 1940 first release...)

[steveo]

Wasn't there an idea to have drunk tanks with paramedics rather than having these tossers clutter up A&E's?

[srisky]

Alex K - you speak from a unique perspective.

1. I don't expect you to divulge the details of your salary but how ?120k/y for 40y? A newly qualified Dr starts at ?22k and the NHS consultant salary peaks at ?94k after 7years. Are you including private work? As you know, only consultants do private work and this is optional, so if it feels like the public is being 'fleeced' then don't do any private work. You can always volunteer some of your time in countries that are not as well off as the UK/USA.

2. If people are going into the UK medical profession for money then they are fools. Yes the money is good in the end but the slog is long and you give a lot of your personal time. If it's money they want then they are better off becoming lawyers or accountant, who work very hard too but are renumerated far better and sooner. Also the government (past, present and no doubt future) are not continually messing with them and eroding morale.

3. Interesting suggestion re: starter package and capped salary. However, you may end up with a form of conscription to ensure there are enough people entering and staying within the profession.

4. Agree, various specialities have no long term committment to the patient. However,if every Dr/nurse wanting long continuity of care the no-one would want to become anaesthetists, intensivists, radiologists etc and then where would we be? They care for their patients in the immediacy of the situation. Agree, sympathy is not necessary.

5. Everyone that does something to help others, whether it is professionally or as a volunteer, does it because they get a 'rush' or 'gratification'. If it always felt crap then no-one would do it.

[srisky]

'Alex K - you speak from a unique perspective.'

- in the sense that you have worked in the USA and UK and that you are a consultant physician; not in the sense that your opinion is unique!

[JohnL]

If you got into trouble when drunk when I was young they'd sew you up with no pain killer within about 30 seconds.

[RosieH]

I think the same should go for people who ski, bungee jump or play rugby.

[steveo]

Those that ski, bungee jump or play rugby probably don't tend to vomit on the floor or threaten the staff

[Alex K]

@srisky -- 5), yep; 4), yep, sympathy mis-placed; 3), worth a try, with conscription added if need be, although to relax entry-visa and professional-practice restrictions for medical careworkers from non-European lands would probably take up any slack; 2), agreed, and "eroding morale", oh, my, yes!; 1), the consultant top whack, brutto, that you cite is, I believe, pay before London weighting, on-call premium, and "discretionary points", and, most importantly, is for a ten-session NHS commitment. Many consultants work a twelve-session NHS commitment as well as seeing private patients. After pay for the extra two sessions, before private work is figured in NHS income alone, netto, not brutto!, thus often kisses ?100K / year; from the underside, but even so. Why am I still renting, then? Alimony, child support... Oh, well. **grin**

Private-practice work and keeping one's hands clean: For me to do no private-practice work was not possible, it was explained to me when I moved here, since to refuse it would unduly burden colleagues in a thin rota. Those same colleagues were reluctant to allow fees that I earned for such work to be shared out amongst them; they imagined feeling beholden to me, and disliked the prospect. An accommodation was reached. I turn over all my private-practice fees to King's College London, the academic conjoint twin of King's College Hospital Trust, to support my division's academic work with the purchase of reagents and laboratory kit, books and journal subscriptions, and travel and lodging for visiting students from Third World venues, yadda yadda. Whether any of my consultant colleagues in other divisions does this I can't tell you.

"Details of salary" are an interesting if pornographic topic. At the University of Michigan, an anecdote only but bear with me, please!, every year the student-run campus newspaper printed the salary of every one, EVERY ONE, who worked at the University of Michigan hospitals complex, several tens of thousands of people it was, from surgeon-in-chief through postroom porter. The State of Michigan paid those salaries and they were matters of public record in which the public was expected to take an interest. Why individual NHS workers' salaries and CVs are not also yearly published puzzles me. Transparency of this sort could only be salutary: Jealousies fed on imagination grow fatter than those fed on fact. In addition, market forces work best when information is freely accessible -- otherwise a cartel exploits some advantage against the interests of the public. Is the BMA a cartel, are the Royal Colleges cartels? Are senior NHS management a cartel who justify their own juicy wages more readily by supporting high pay for medics and then saying "But see what THEY'RE paid!"? More questions than answers.

[HonaloochieB]

I ended up there the Tuesday before last and I was so nice they didn't let me go 'til the Thursday evening.

Just goes to show, if you make the effort...

[PeckhamRose]

I had no idea that their salaries was not a matter of public knowledge.

I was considering applying to be a governor but the time is not right for me but in the next round I may, and may if I win election try and get this changed.

I have accounts with Nationwide Building Society and just got sent voting forms, and the non exec directors salaries were published within the literature. That was scary, given four local branches have been closed down.

Anyway, thanks for your time educating us all, Alex K!

[Alex K]

If PUBLISH THEIR SALARIES is a plank in your platform when you DO stand for election as a hospital / trust governor I shall surely vote for you.

[PeckhamRose]

Ha! I am also planning on fighting re the car park. And I don't have a car!

This thread is good for having highlighted the snobbish holier than thou hypocrites than populate the society and needs to be eradicated out via eugenics. Sorry, I mean they need to be "educated".

[ianr]

AlexK> If PUBLISH THEIR SALARIES is a plank in your platform when you DO stand for election as a hospital / trust governor I shall surely vote for you.

Be ready to face litigation (DPA or FoI) if you take that route as a governor. If you want to challenge policy or practice, the safer route, short of rewriting the acts, would imo be to make FoI requests for such information and appeal against any refusals. And I've not checked, but I'd be surprised if there weren't already a fair number of substantive decisions on the topic already, at least at ICO or tribunal level:

"Example: The Commissioner found that the exact salaries of specialist registrars employed by University Hospital Birmingham NHS Trust should not be disclosed. He found that as ?employees who interact with the public? they ?should expect some personal data about them to be released? but that they should expect less scrutiny than senior executives who are ?responsible for policy decisions affecting the public and the expenditure of public funds?. (ICO decision notice FS50092819, February 2007)" [from http://www.ico.gov.uk/upload/documents/library/freedom_of_information/practical_application/salaries_v1.pdf]