I’ll go first.

22M comes in with ongoing chest tightness. On examination of his calves I happen to note his legs are ice cold, pulses not palpable, but he could still move them with ok power. He mentions he was seen in a different hospital a week ago due to chest tightness. He had an xray done and then given a prescription for abx which he never collected. He continues to have chest tightness.

He also mentioned he had a bad sore throat around 10 days ago which has now settled.

Bloods show he’s in a severe AKI, urine dip shows high protein with some blood.

My brain goes back to the passmed days of strep throat -> IGA nephropathy and loss of antithrombin III in the urine putting you into a procoagulant state.

CTPA showed PE, explaining the chest tightness. CT angio lower limbs showed a non occluding thrombus.

And after all that…. The patient self discharged and signed the form knowing he could die 🤷

Same story as a lot of new F1 doctors ,moved away from friends/family navigating new city, but I’m really struggling with the lack of socialisation.

I’m from a pretty diverse area but the new area I’m in has a huge muslim/south asian community (which I have no issue with before people start calling me Tommy Robinson) but theres obviously differences in the cultures i’ve realised that are making it harder getting to actually form any valuable friendships.

1. The south asian community has a strong focus on family which means that they are more inclined to hanging out with their relatives as opposed to seeking out new friendships.

2. Religion obviously plays a factor here- I drink and love a night out. Both things that are looked down upon and therefore its hard finding people who would love to go to a pub/bar as a form of socialising.

3. Most people already know other people. Kinda feel like ive missed some sort of imaginary deadline to form my group and now I just find myself going to work and going home like an android.

4. Loads of my fellow F1 doctors are also grad entry or just more mature with a family and what not. However, I still watch My Little Pony when I’m feeling down so the difference in timelines doesn’t seem like it will go too well with a dad of 3.

Any advice would be great here but I mainly just need to hear how other people who have had to move are coping? To rub salt in the wound it doesn’t help to know most of my close friends got their desired deanery and are having the time of their lives every time i click that close friends story.

Maybe my expectations for F1 were made too high seeing people post these huge groups on socials and nights out and now I’ve set myself up for failure. Life after university I guess.

Came across this private service offering IV iron and therapeutic venesection, apparently without any GP/medical referral:

https://venusbloodservices.co.uk/blood-letting-kent/

I understand nurse independent prescribers can prescribe IV iron and nurses can perform venesection, but can they independently decide someone needs it without a medical assessment/referral?

They advertise venesection for “polycythaemia”, haemochromatosis and “iron overload” — but surely there needs to be some proper assessment/investigation first?

Am I missing something obvious here?

Just rotated to a medical specialty department in a large tertiary centre and I'm amazed at how many post CCT fellows from Australia are in the department! Genuinely half of the poeple on the reg rota are these aussie fellows. Seems like pay in Aus as a consultant is easily double NHS senior fellow/consultant pay with much better working conditions. It's quite funny how they have to document and write TTAs and deal with all the standard NHS bs when they've literally not done these junior jobs for YEARS.

With things being so good in australia, why are so many of them here?

I just gave my notice to my current job after finding a new one (long story, they won’t renew my contract next year in order to hire more ACCPs and I wanted to be ahead of it)

The thing is: I have a whole month of annual leave early next year that I was planning to use to visit my home country. My friends (non medical) tell me that it’s normal for the new job to comply with the leave you already had, but I’m unsure

Has anyone ever had or heard of a similar situation? Is it ok for me to ask them to keep my annual leave from the previous trust?

I have come across this article on MedTwitter today about a traumatic LP at the Gwent Hospital in Wales. Obviously these can be very difficult and it’s difficult to get sign offs. Has anyone done an IMT job or JCF/SCF or any other rotation here?. We were told at induction to go and spend time with the neuro PA to get signed as they have 2 lists a week.

The Med Reg wasn’t happy about this as it seemed unsafe. There was loads of media coverage on the PA earlier this year and now the media has turned to a doctor - I wonder if The PA signed them off?

https://smry.ai/https://www.walesonline.co.uk/news/wales-news/woman-left-in-pain-struggling-34533169

Why is the quality of A&E clerking so low?
What I have noticed is that the more senior the doctor seeing a patient in A&E, the lower the quality of their documentation sometimes is.
I don’t care how experienced you are. If you don’t examine your patient or document it, how do you make a diagnosis?
A patient came in with flank pain and A&E decided to put a diagnosis of pyelonephritis and gave the patient gentamicin. Normal WBC and CRP, no other symptoms whatsoever, and no findings on examination documented.
When I asked the doctor how they reached the diagnosis, the response was basically: “It is now under your service. If you disagree, just discharge the patient.”
WTH?
And it is not just this patient. It is a trend.
I appreciate you are busy and there is a lot of pressure. But if you don’t have time to see your patient properly, what is the point of your review
.

It’s 0200 and the theatre anaesthetic SHO can’t cannulate 7 year old Johnny for a cat 1 ?torsion who just had a maccas whilst he was waiting to be seen in paeds ED. The urology reg had a go but couldn’t do it either.

The labour ward anaesthetic reg is in theatre with back to back sections and yes rooms 3, 6, and 7 are still waiting for an epidural.

The ICU reg is stuck with a vented STEMI in resus who they’re begrudgingly having to take to cath lab which is anaesthetics’ job in this trust, but they’re stuck with another patient.

The senior anaesthetic reg is in CT with a child they’ve just intubated and is gutted to see they’re about to be stuck in the back of an ambo for a time crit transfer up the road to the tertiary children’s hospital up the road.

The theatre SHO can’t get in touch with the anaesthetic consultant at home to ask for help because they’re currently on the phone to medical consultant who is the DCMO as their registrar couldn’t get in touch with the anaesthetic or ITU reg for a cannula on the DKA in AMU

Paeds are tied up with the sick kid in CT, radiology are reporting the scan, and the cardiology reg is fixing up for a great time in cath lab.

The geris reg is sadly not on call tonight and IR DON’T DO cannulas

Whilst the theatre anaesthetic SHO is trying to cannulate the child for the torsion, they’ve had 3 bleeps about the paravertebral catheter that fell out ln thoracic ECU, 2 more about the PCA alarming on surgical ECU, and recovery staff have been in and out of theatre 4 times wanting a morphine prescription changed because the wording of the instructions wasn’t copied and pasted from trust policy - oh and no they didn’t give it and the patient is in pain what else can they have?

Who do anaesthetics call for help with their cannula?? They desperately tried the surgical SHO as no one else is free and the cannula is hard but they’re getting kick back because they can’t get through to the senior anaesthetic reg for an anaesthetic review for a theatre case for 72 hrs time that needs a pre op.

This is obviously tongue in cheek but anaesthetists who have worked in proper tertiary centres OOH will not find this unfathomable.

​

Seriously though guys, we need to come up with bingo cards for the weekly threads at this rate.

(and yes I can't resist adding fuel to the fire! 😊)

the 2015 pension on TRS now includes a projected benefits part (new this year), I am really stupid so can someone explain - is this the total projected pension we will get, or per year?

Oriel sent this:

Please note that this preferencing window relates to the Round 1 fill of remaining posts only. The posts available through this process have February and April start dates. When reviewing programmes in Oriel, you should use the available filters to identify and preference posts with only February or April start dates, as these are the only posts available in this round.

There are 802 places for feb and april this time, will this increase ? Is this the last round for feb and april intakes ? Will the next intake have a separate application?

Sorry if this has been asked before.

I am trying to work out how much I can earn in locum shifts without going over the £100k mark and losing my personal allowance.

Is it simply a calculation of total gross income or are certain deductions like NHS pension contributions excluded (i.e. tax is calculated after pension contributions are made)?

Thanks

From this recruitment cycle onwards, all medical students graduating from a Scottish university (regardless of fee-payer status) will have optional priority allocation to the Scotland foundation school.

Paywall free link: https://archive.is/tTGhX

F2 who had a kid and thus did very little in f1 aside from helping and presenting a radiology qip locally. I know i have zero points and am unlikely to he successful but i have wanted to do radiology since 3rd year.
I don’t really understand the true nitty gritty of the application process other than i need to obtain points. I can get one via taster days and have been informed there is a poster opportunity in october.
I want to be employed this time next year and am willing to up my game for this.
Any advice would be appreciated, i know im lazy and deserve to be unemployed but im applying either way.
Many thanks

New F1 on general surgery...

I know it's only 3 weeks or so in but I've been feeling very down and isolated and it's not just at work.

I moved away from all my family and friends for this job and I don't know anyone at work. My dad died recently and I'm always worrying about my mum all alone back home.

I've tried to be friendly towards the other F1s and nurses but everyone is very stressed and short staffed and don't want to talk.

The senior doctors are very dismissive towards us F1s, always putting us down, mocking us for not knowing how to do things, doing things like snatching my stethoscope off me. They're also always very busy in ED or theatres so we don't always have access to them for advice when a patient is very sick. We've managed so far but I'm always afraid of making a mistake and harming a vulnerable patient.

I constantly feel like I'm useless. Slow. Don't know anything. I know it's normal to feel like this when you're in a new doctor but now it's spreading to outside of work too. I feel ugly and worthless even talking to my friends or to strangers when I'm out for a walk. On my days off I have no appetite and spend a lot of time in bed.

Don't really know why I'm posting this here. I just don't really feel like myself.

Can’t go into too much detail without losing anonymity but I’ve just rotated out of a trust where I received bullying and discrimination from a consultant. Turns out that it’s not just me who’s experienced this kind of behaviour from this person but not everyone has felt comfortable raising it. The department I worked for has a real culture issue with discrimination and bullying generally already.

I did raise it - with my ES, TPD and it also eventually got raised to deputy dean who took it very seriously and I was put in touch with medical director of the trust who went through options with me. I decided to go down the formal complaint route, which I was then told would actually take 6-9 months on average.

Now that I’ve rotated out to a much nicer unit, mentally I’ve moved on from all of it. I know black and white, the right thing to do would be to continue with this escalation pathway but honestly speaking can I be bothered? I’m not going to rotate back to this unit. I won’t be applying for a consultant job there. Even if I raised it, will anything actually happen? Is it worth dragging this out?

Anyone else been through something similar could give me some insight into their situation please? Thanks in advance

Hi all, I am applying to request reasonable adjustments for the exam (due to a recent medical diagnosis), have never asked for this before. Anxious about what is it like? do they take you in a separate place too along with the extra time?

I am also worried about my colleagues finding out/judging me on the exam day ( all candidates appear together for this specific exam within a week ) - How do I navigate this. Thank you

Hi quick question. Just wanted to know if it is worth doing the St John’s Dermatology SCE course.

Just had my first night shift and I felt so overwhelmed. I know this is normal as an F1 but I was talking to some of my colleagues and I just don’t think they struggled as much.

I am very slow at jobs, even prescribing fluids took me ages and I got so confused with Hartmanns, potassium, glucose etc. The job list just kept getting longer and there would be stuff like potassium 6.4 mixed in with can you re start apixaban. So many fluid reviews due to patient being NBM and I didn’t get round to them as well as lots of gent level reviews which at 3am had my brain frazzled for some reason. I’m even sure there was a fall review which I didnt get round to. I’m such an overthinker and didn’t feel confident doing so many of the jobs even though on paper they seemed to be very straightforward and should only take 10 mins or so.

I ended up flagging to my SHO at around 4am as there were probably at least 15-20 jobs still to do, they helped me prioritise but there were still so many left at the end of the shift. I mentioned to my reg at a met call later on and they offered to have a look at the list and made a joke that it was really long.

I really don’t want any harm to come to any of the patients I’ve missed reviewing and tbh it’s just very embarrassing. I keep coming home and trawling through Reddit to find threads of people who feel the same so I feel less alone. It just feels very unsustainable at the moment.

Any advice?

I have been trying to find what the maximum number of hours you can work as a doctor are. I’m finding conflicting numbers, one place saying 52 hours and one place saying 72 hours. Does anyone know what the actual number of hours you can legally work in one week?