Doctor: when you work in the Polish HED, nothing can surprise you anymore

Out of the three days of Christmas, the worst in my opinion is the night from the first to the second day of Christmas. Always – says in an interview with Medonet, the doctor of the hospital emergency department, Bartosz Fiałek. During Christmas and beyond, the doctor makes a warm appeal to everyone.

1. Christmas ER: on Christmas Eve these are mainly problems with foreign bodies – most often bones, abdominal pain and defecation disorders caused by overeating. The first day of Christmas looks similar
2. Bartosz Fiałek: Due to the influx of drunk patients during the three days of Christmas, the worst – in my opinion – is the night from the first to the second day of Christmas. Always
3. Doctor: any symptom that appears suddenly is disturbing and may directly threaten our health and life, it is an indication to go to the HED
4. Due to staff shortages, I happened to break records, I must admit disgraceful. For example, on St. Nicholas’ Day (Sunday) I went on duty at eight in the morning and came back after 14 PM on Monday. So I was at work for 30 hours
5. In my opinion, work in most Polish SORs (not all) is a situation similar to war
6. The doctor’s appeal: if you don’t have to go out, stay at home. Remember about distance, airing and disinfection – this is the basis during this year’s holidays
7. More current information can be found on the Onet homepage.

Monika Mikołajska / Medonet: You have been working at the HED for six years. What does this Christmas ER look like? What problems do Poles come with the most?

Bartosz Fiałek, ED doctor, rheumatologist: Patients come with myocardial infarction, stroke, sometimes resuscitation is undertaken, it happens that people die – just like every day. During holidays, there are also specific ailments, interestingly, characteristic for specific holidays. On Christmas Eve, these are mainly problems with foreign bodies – most often bones – in the throat, esophagus, stuck in the palate, as well as abdominal pain and defecation disorders caused by overeating. This is the result of restricting ourselves to eating all day (some people fast before Christmas Eve dinner), and in the evening we indulge ourselves to the limit. There are also single poisonings, because, for example, a product was stale or badly stored.

The first day of Christmas is similar – we overeat, we improve our Christmas Eve dinner with a hearty breakfast, and then … we continue to eat.

The type of patients begins to change in the evening. People with alcohol poisoning, that is simply drunk, but also with injuries, often to the head and other injuries caused by participating in “disco fights”, begin to appear. This continues until the beginning of the second day of Christmas. Unfortunately, this is the standard in our country. When you drink it is a proverbial death. It happens that people who have four or five per mille are sent to the SOR. These are isolated cases, but still. It is precisely because of the influx of drunk patients during the three days of Christmas that the worst – in my opinion – is the night from the first to the second day of Christmas. Always.

What help is provided to such patients “under the influence”?

There is no effective treatment. If nothing happens, we evaluate basic vital signs and observe. If the patient is, for example, after a head injury, which is the most common condition, or is unconscious, we perform computed tomography of the head. It happens that we give fluids intravenously to eliminate alcohol faster. Then the person remains in the hospital emergency department for observation until sobering up.

Should drunk people who are okay with nothing, stay at the emergency department?

If the absurd idea of ​​liquidating sobering-up stations had not emerged, the patients, after being examined in the emergency department and excluding indications for hospitalization, would not have had to stay in the hospital. There would be no unnecessary burden on the staff who help people with heart attacks or traffic accidents. And yes, we have to deal with people who, in the vast majority of cases, do not need healthcare.

It probably does not apply only to people “under the influence”. For most Poles, a visit to SOR is associated with a nightmare of endless hours of waiting. Later, however, it often turns out that going there was not necessary at all. So let’s clarify once and for all: when do you need to seek help from a hospital emergency department?

Remember, a hospital emergency department is a place where health and life are saved. That is any symptom that appears suddenly, is disturbing and may directly threaten our health and life, is an indication to go to the emergency department. Such a symptom is, for example, drooping of the corner of the mouth, monocular loss of sight, weakness in the limbs, speech disorders, severe dizziness, numbness of the arms or legs. These are all symptoms of a stroke. The indications for seeking help at the Emergency Department are also: dyspnea, chest pain, drug poisoning, injuries, traffic accidents, loss of consciousness.

1. When is breathlessness a serious illness? [WE EXPLAIN]

When is a visit to the SOR not recommended?

If our stomach starts to ache after Christmas breakfast or dinner, we should take an over-the-counter pain reliever, possibly a diastolic medicine, and wait for improvement. If there is no improvement, you should seek medical attention, not necessarily in a hospital emergency department, but, for example, at emergency centers. So, if the standard treatment that we are able to apply at home does not help, we use the help of qualified medical personnel, and the nature of the symptoms determines whether we go to the HED or to another place.

Unfortunately, in Poland there is often a belief that you go to SOR in every case.

Recently I had a patient who came because he had a headache for three days. I asked if he had taken pain medication. It turned out that he did not take it. Of course, a headache can be a life-threatening emergency, but this patient should take a painkiller first and see if the pain subsides. Most often, such a patient receives adequate medication from us, which he could take at home, the symptoms disappear and the patient leaves the hospital. I repeat, this is not an indication to visit the HED. It would be so if the pain appeared suddenly and, for example, “it would be the strongest in life”, as patients often describe. This would give rise to a suspicion of subarachnoid haemorrhage which requires urgent treatment.

We still have night and holiday health care …

This is the emergency place I mentioned earlier. There, medical services are provided in states of indirect health and life threat. So with a three-day headache that the patient has not decided to treat on his own, it is possible to go there, and not immediately to the emergency department of the hospital. It happens that the HED comes to a person who has a sore throat for three hours, has had back pain for three months, or has had two loose stools a day. These are conditions that should be treated at home first, then go to the NPL for help, and only if recognized by a doctor from the so-called evenings, go to the Emergency Room with a referral.

It’s important to remember that. Now the effect is that those who really need help quickly get it later …

In many hospitals, due to extreme staff shortages, it is not possible that there are two doctors in the HED during medical duty. For example, I am alone. We operate in such a poorly organized system that we work for two or even three employees, and yet we manage, although our efficiency also has its limits. Physical and mental. Of course, everyone who comes, even if it is not an emergency, is provided. But it takes our strength, it takes timebecause, for example, in the case of a headache, we have to examine the patient, possibly order laboratory tests or computed tomography of the head. Added to this is bureaucracy – we must describe all the steps taken.

And if they suddenly bring people back from an accident, you drop everything and save.

This is. Meanwhile, more and more people are waiting in the queue, including many who should not go to the SOR. Time passes, they get nervous, they start to complain, while we resuscitate the man … I then ask: “Should I leave the patient we are resuscitating now and come and put your sprained finger on you?” I often hear the answer: “No, yes, no, but how much will I wait?”.

It is not the fault of these people. It is the fault of deficiencies in health education. These patients simply do not know where to seek help, so they go to the HED and thus to some extent – unconsciously – make it difficult for people who really need them to access our services. The second thing – the system does not make it easier for them to get help, because I am alone on duty. And I am not able to take care of an accident victim, sew wounds or order additional tests and medications to a patient with abdominal pain.

How long is your on-call time at the accident and emergency department?

Differently. As a standard, the duty at the SOR during the week lasts 16 hours, from 16 to 8 the next day. On public holidays and non-working days it is 24 hours. Due to staff shortages, I happened to break records, I must admit it is disgraceful, although it is nothing compared to many other colleagues. And so, for example, on St. Nicholas’ Day (Sunday) I went on duty at eight in the morning and returned after 14 PM on Monday. So I was at work for 30 hours. My scheduled duty lasted 24 hours, but because the doctor who was supposed to be on duty fell ill, I had to wait until 14 pm for the substitute. These are dramatic situations. In my opinion, there is no man who, for 30 hours of work, without sleep, would be able to perform his work with due empathy, even paperwork.

When you work in a Polish hospital emergency department, nothing can surprise you anymore. I bet that on duty I can put out the fire, call the prosecutor, because someone will die in the corridor, somewhere five floors below us, that we will resuscitate two patients at once (Until the resuscitation team arrives, I am the head of these two teams fighting for their lives). And here I must say that in the Emergency Department we have a truly phenomenal team of rescuers and nurses.

You compare the work in the Polish health care system to the war, and you wrote about the work of the SOR: I do not know a job worse than a hospital emergency department.

In my opinion, working in most Polish SRDs (not all of them, of course) is a situation similar to war. Some say it’s an exaggeration that I shouldn’t be saying that. But I’m not taking it back. It is extremely difficult work, and you often have to make several critical decisions at the same timebecause there are so many people who need urgent help, and you are the only doctor.

When 25-30 patients with various diseases are sent to the HED during the round-the-clock duty, it is simply impossible to provide them all properly, being the only doctor. That is why I say that working at the HED is like working as a doctor in a war in a field hospital.

This year is absolutely unique – the pandemic and its limitations … Maybe this year’s Christmas ER will be easier for doctors.

I don’t expect holidays to be any different from the point of view of working in a hospital emergency department. It’s just that, anyway, people with COVID-19 will be added to the group of patients going to the HED. In recent days, five or seven patients with SARS-CoV-2 infection reach us every day. So in my opinion, it will not be easier, quite the opposite.

What would you like to tell people as a doctor this pandemic Christmas.

I have a hot appeal. If you don’t have to go out, stay at home. Remember about the distance (minimum 1,5 meters) as well as ventilation and disinfection – this is the basis for this year’s holidays. If you go out, join the above sanitary and epidemiological rules wearing protective masks. It really works.

1. The seven holiday situations where we most risk becoming infected with COVID-19

Let’s skip Christmas in a large group. Let’s wait. There is a good chance that we will spend the next Christmas together under normal conditions. Let us be aware of the risks to ourselves and our loved ones, especially older family members, if we spend this time with them. Let us consider whether it is really worth taking them, or will it not cost us more than the benefits obtained. It’s like with a drug – here we also estimate the risks and benefits, if the former is higher than the latter – we do not give the drug.

We should also remember when we think about using the help at the HED, in the case of an immediate threat to life, in emergency situations or in the event of an exacerbation of existing chronic diseases. ED is for rescue, not treatment or additional tests. In all other health situations, let’s first try to deal with ourselves, and if that doesn’t work, go to night and holiday medical help. We will not refuse any health benefits.

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