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All I Want for Christmas is... a Discharge Summary

A Christmas experience working in the NHS

Your phone alarm jolts you awake—6:30 a.m. blinks accusingly on the screen. Below it, in festive irony, reads December 25th. You can hear the soft, contented breathing of your family still asleep, unaware of the cruel realities of your Christmas on-call. You tiptoe through the house like a burglar, making your morning cappuccino. This year’s nod to festive cheer? A Rudolph pin on your lanyard—cheerful enough to acknowledge the season, subtle enough to keep the infection control nurses, who will most likely not be at work today, from raising their eyebrows.

Outside, your car window has frozen over, of course. Ten minutes of scraping later, you’re driving down deserted streets that feel more ghost town than winter wonderland. The radio DJ harps on about home, roaring fires, and chestnuts, while you clutch your lukewarm coffee and hope the hospital can manage at least a half-decent roast potato for lunch.

Arriving at the entrance, you’re greeted by someone in a Santa suit—a wobbly "Merry Christmas" echoes through the cold air. For a fleeting moment, you smile, before realising it’s definitely Peter from Ward 18, who volunteered to play Santa for the patients today. You make a mental note to thank him later—he probably skipped his own morning traditions to be here.

Inside, Michelle, the head nurse, greets you with an apologetic sigh: the SHO, Michael, has called in sick (likely the same "flu" that always seems to hit on bank holidays), and the beds are full. No room at the inn, you mutter to yourself. The locum finally arrives at the ward, asking if there are any cases of tinsil-itis on the ward today. You sigh- it’s way too early for this.

Yet somehow, the Christmas ward round feels different. Your clipboard gives you Santa-like powers, bestowing the greatest gift a doctor can give: a discharge letter in time for dinner. Few things are more heartwarming than telling a patient they’ll be eating Christmas pudding on their own sofa today. And so, fuelled by caffeine and a tray of Quality Streets, you make it your mission to spread whatever Christmas cheer you can.

Lunch rolls around, and—miracle of miracles—the canteen turkey isn’t entirely cardboard this year. You Facetime home to see your family in full swing. Mum picks up the call, half-laughing, half-shouting, as she tells you Uncle Roger has once again ruined dinner by bringing up politics. You shake your head, smiling, and wonder if all this could’ve been avoided had Roger subscribed to On-Call News and read last week’s newsletter on avoiding controversial Christmas family debates.

But between the jokes, the treats, and the paper hats someone’s left at reception, there’s a bittersweet edge to Christmas in the hospital. A reminder that for some patients, this ward isn’t just where they spend Christmas—it’s where they’ve spent far too many days. A father who won’t hear his kids tear open presents this year. An elderly woman whose only visitor today will be the nurse changing her dressings. You step into a room where the hum of machines fills the silence, and you realise that for these patients, the lights above their beds might be the only Christmas lights they’ll see.

For many staff, there’s a strange kind of togetherness. You watch staff handing out cups of tea like they’re mulled wine, nurses sticking tinsel to mobility aids, and patients chuckling at jokes they’ve heard a hundred times before. It’s not ideal, but it’s something.

So here’s to the Christmas spent On-Call: to discharges and dodgy canteen meals, to (some) laughter on the ward and quiet moments of care, and to the people who make even the bleakest day a little brighter.

The Four Horsemen of the Ward: Holiday Edition

'Tis the season, but in the hospital, it's more doom than delight as the Four Horsemen of the Ward arrive to ruin Christmas. Step in Influenza, COVID, RSV and Norovirus:

1. The Maskless Masses
   Visitors stroll in unmasked, armed with holiday cheer and absolutely zero awareness.

2. The Test-Averse Tribe
   No one’s testing for COVID anymore. Apparently, “I feel fine” is the new diagnostic gold standard.

3. The Ventilation Vacuum
   Still, no upgrades, because nothing says “modern healthcare” like stale air and windows that barely crack open.

4. The "Oops, I Got COVID Here" Phenomenon
   Public health Wales recently released some figures that 72% of current hospital COVID cases were admitted for something else and infected after arrival. What a gift.

To A&E or Not To A&E: That Is the Question

As winter arrives, we all need to play our part in safeguarding our A&E departments.

As frosty mornings descend upon us, so too do the large swathes of patients turning up to Accident and Emergency (A&E) departments across the UK. Waiting times increase, and the annual strain on our already overburdened NHS feels heavier than ever. However, amidst the chaos, one fundamental issue continues to surface: many people—patients and even some NHS staff—still misunderstand the purpose of A&E.

A&E is the department in the hospital most closely in contact with the public as it provides the most informal access.

Let’s clear this up: As devised by Sir Harry Platt in his famous 1962 report, A&E is for medical emergencies or significant accidents (as the name implies). It’s not a backdoor GP service, nor a place to shortcut the routine healthcare process. As doctors, we’ve all encountered the head-scratchers: the patient with chronic toothache who didn’t think to call their dentist, or the individual presenting with a month-long history of rectal bleeding who hasn’t rang their GP. In 2017, it was estimated that 30% of A&E visits were unnecessary—cases that could have been managed elsewhere.

But before we point fingers at the patients, let’s acknowledge that the problem isn’t solely a matter of ignorance or entitlement. Systemic barriers and misdirection often compound it.

Here are some key factors driving inappropriate A&E visits:

1. Algorithm-Driven Advice: NHS 111 staff follow strict protocols to assess risk. Faced with uncertainty, the default recommendation often becomes, “Go to A&E.” While understandable, it contributes significantly to unnecessary visits.

2. GP Access Issues: Struggling to get a same-day GP appointment? Many patients find A&E to be the path of least resistance.

3. Health Inequalities: For some patients, systemic issues like poor health literacy or lack of access to timely care make A&E their only perceived option.

4. Professional Referrals: Allied health professionals, cautious of litigation or clinical uncertainty, sometimes funnel patients to A&E rather than making a definitive decision to manage them elsewhere.

The idea of a "gatekeeper doctor" at A&E—someone empowered to turn away inappropriate cases—sounds tempting. But practically, it’s fraught with risk. Without a full history or exam, sending a patient home prematurely opens clinicians to potential litigation if a serious condition is missed. Instead, the triage system is left to filter cases, leading to hours of waiting for some and frustration for many…

“Remember, if you're working ANY hours that fall on the 25th or 26th OR have a zero-day fall on either of these days, then you are entitled to a day in lieu.”

“Working over the Christmas period is bad enough without having to stir my tea with a wooden (non-reusable I should add) spoon!”

“I will never forget that Christmas Eve nightshift in ICU where a nurse with a reindeer hairband performed CPR whilst “Merry Christmas Everyone” played on the radio.”

“Hi, ED Doc here. I can’t believe I actually have to say this, but please do NOT insert frozen potatoes into your anus in an attempt to cure haemorrhoids.”

Email us to share what’s on your mind in our next issue!

Weekly Poll

The Festive Rota Dilemma:

Last week’s poll:

How often does the state of the NHS come up as a dinner table topic with your family?

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If there’s one thing the festive season excels at it’s draining our wallets at record-breaking speeds. Something about those messages of generosity and giving causes our spending to spiral. We mean well, of course, but who among us hasn’t been the recipient of a less-than-ideal gift?

Opening presents is the one time of year when everyone in the family gets to audition for the Oscars. “Oh, I’ve always wanted a lavender-scented bath bomb set!” 3 in 5 Brits (58%) admit they’ve received an unwanted gift, amounting to a staggering £1.27 billion squandered annually. That’s approximately £41 per person down the drain—quite literally, in the case of all those soaps, moisturisers, and bath bombs.

We work tirelessly for our paychecks so it’s only fair we ensure our money is well spent. Perhaps it’s time we embraced a radical cultural shift: include the receipt! There’s no shame in a tactful exchange. Better a practical swap than another ill-fated candle set destined for the back of a cupboard.