He explains: "I see people who don't need to be here, I see people who need to be here but have come here a bit late, I've seen people who are just concerned, I see people sent by their friends because their friends are concerned, there's a combination of all this.
If Dr Nafousi's comments seem controversial, his A&E colleague Dr Jane Brenchley, also a consultant and clinical lead, has views that make for even more difficult reading.
Because the emergency department waiting room has been full of people who simply do not need to be there, Dr Nafousi says.
Pointing to a line on a graph on his laptop, he explains: "November 2018 you can see it was around 27 or 28 million, and here you can see last month, it's peaking almost at 40 million.".
We always know winter is coming and that hospitals, in this case the Royal Berkshire in Reading, like almost every acute site in England, will struggle.
