Sometimes the worst part of being a dr is that no matter how stressed/close to tears/overworked you feel, you still need to display the happy-to-help joviality of a frankie and benny’s waitress. What an effort
We moan about the NHS but I sent a patient for a CT KUB today and the only positive finding on the scan was (accurately) a fractured right distal radius
@Mybrainisbrian
He had an incredibly fast heart rate due to an underlying arrhythmia and when the nurse did the swab, he converted out of the arrhythmia to a normal heart rate (have a look at valsalva manoeuvres)
“…and we used to have prescribe all their doses for the weekend and chase an INR on the Sunday if we were the F1 on call and write their discharge doses in a little yellow book and we’d never even heard of a NOAC!’
Thinking about the time some jnr drs presented an audit at grand round on successfully improving inhaler use in IPs and at the end a consultant put his hand up to tell them he’d calculated their results weren’t statistically significant
@Beska
See also:
- no thanks for the 99 times I do discuss escalation at 4am
- ‘disappointing’ is such a profoundly shitty verdict
- diagnostic uncertainty in view of frailty syndrome presentation and sensory/cognitive impairment
I could go on 😤
Watching an obstetrician operate during an emergency is insane, their concentration is unmatched. You could walk into theatre on an elephant and they wouldn’t notice
Imagine being given 4 months to complete a complex, mandatory tick box exercise, someone suggests presenting it at GR for an extra point at interview and some professor elects to humiliate you in front of your entire cohort of colleagues. I’d be raging
Lol I did a 13 hour med reg night shift at £60/h as an emergency to help a friend and after tax, NI and student loan I managed to earn £374.70 what a joke
@gfreeman2012
Reverted from a very rapid heart rhythm due to an underlying rhythm disorder, to a ‘normal’ heart rhythm, which is a process that usually requires medications
I’m using MRCP pt 2 questions to revise atm bc the Geriatrics SCE exam contains quite a bit of gen med (and bc why not) and I can’t believe this shit is still flying around
Don’t get me wrong the money is nice but is it really worth the stress of being the senior medic on site, the sleep disturbance, the effects on my health, the lack of sunlight??
Friends and families of my patients.
I know you’re angry
I know you feel let down
I know you’re making sacrifices
But NHS staff can’t be the emotional punching bags for these frustrations.
I have no control over vaccines, lockdowns or restrictions.
And I’m trying my best.
Just to clarify I was in the theatre for less than 30s bang in the middle of a MOH and crash CS. I’m a med reg. Let’s not over complicate this. It was a brief observation of a clinical situation that I’m not used to. We don’t need your feedback
@Faezalamodi
Actually for me, why can’t the vignette be ‘a 42 yo man who was recently diagnosed as HIV +ve…’ bc then a) we’re not making diagnostic assumptions based only on demographics which can reinforce biases and narrow clinical judgement but also b) it’s irrelevant detail
Hard pill- the pandemic has made some drs difficult to work with, because they are absolutely, unequivocally burnt out but we don’t create a culture where this can be a) admitted or b) managed so instead of having time off they soldier on, becoming increasingly irritable and rude
Can we call neuro to see if they want the mri. Ok can we call radiology to vet the mri. Ok can we call the coordinator to book the mri. Ok can we call the radiographers to do the mri. Ok can we call the family to consent for the mri. Ok the mri is broken. Ok can we call neuro to
I see it’s that time of the year where we have to do reams and reams of frustrating paperwork in our own personal time for the next rotating hospital bc HR departments have an inexplicable ability to communicate or create a centralised database
Completely unexplained insomnia last night. Woke up at 00.30 after 1h sleep, then was awake until about 6. Alarm goes off at 6.40. I’ve taken the day off work for obvious reasons but I feel completely fraudulent. I’ll be back tomorrow but insomnia truly is hell
I’m on wk 3 at my new trust and my 1hr 20min commute for an 8.30 start is absolutely killing me. I’m not a morning person anyway but I’m constantly knackered, not what I need for the 9h shifts. Not sure I can do this for 12 months. Genuinely don’t know what to do ☹️
@_B_e_t_h_B_
@darylthedevine
I’ve been a waiter in a high end pub and it was sometimes *worse* than being a dr because it’s as phys/mentally exhausting but has an unfavourable power balance (customer is always right) which is why I reject the ‘unskilled work’ rhetoric re. minimum wages
I really hate the new Geris specialty CiPs. Two of them aren’t even pure Geris (Stroke and Movement Disorders), one isn’t hospital based and one is continence. What happened to frailty? Memory disorders? Palliative care and ACP?
It’s happening all over again.
“Previously f+w…loss of taste with cough…RR 35 and HR 125…bilateral infiltrates with lymphopaenia…pO2 5.2 on NRB…”
I’m tired.
>90 yo patient a/w fits. CT head- 3 metastatic lesions. PMH: Mod-Sev dementia, CFS 6, not suitable for SACT, for BSC. O/e massive, tender hepatomegaly, CXR nil obvious. Qu: do you perform CT CAP before d/c to NH with Comm Pall Care?
I love when the consultants who write exam questions produce a full Enid Blyton style autobiography for their imaginary patients like I need to know where this lady was doing her Xmas shopping. Was it John Lewis? Was it TK Maxx?? We’ll never know
I have a feeling a lot more hospitals are actually in a severe crisis but feel it’s easier to let healthcare professionals continue to struggle than it is to publicly admit it
“Patient is full recovered from the acute illness and is clinically appropriate for discharge home with no further medical or therapy input required”
“OK but we need you to write MO or she can’t go”
I really feel like if an older person falls, but it’s due to acute pathology like heart failure or sepsis we should instead call it ‘collapse’ to avoid tick box medicine. Why are you doing a 24h tape on a 90 year old with Klebsiella bacteraemia???
One of my old consultants shares a name with a historian who writes books about the sex lives of peasants (I’m not joking) and they’ve used my consultant’s photo in an online review of one of her books, instead of the author’s 💀💀💀
People who get mad at healthcare professionals who don’t take food/leftovers to work as a cost saving idea sometimes underestimate both the lack of, and restrictions on, food storage and heating in NHS wards. Also the microwaves are always filthy
Discovering one of the ear pieces on my stethoscope is broken might explain why everyone I’ve examined for the last two weeks has had ‘reduced air entry throughout both lung fields’
Why is there such a reluctance to use Diltiazem or Verapamil for control of AFRVR? Treatment seems to be either BB or Dig, such that we almost seem to become deskilled at using CCBs acutely
I’ve had a tax rebate almost every year of being of a dr and I think it’s because when I was an F3, my new hospital thought I was a locum ophthalmology consultant
@LouiseHogh
@sleepy_doc
Kingston is still at the top of my list for me to come be a consultant at so as long as the pigeons have moved on I’ll be applying!
Broadly speaking a good dr is:
☑️ clinically proficient
☑️ kind and compassionate to patients
☑️ kind and compassionate to (all) colleagues
I will not think highly of you until you’re all three, no matter how many letters follow your name
Is there anything more stressful than receiving a new rota? On call on induction week, working Xmas *and* NY once again, on call during weddings, planned visits home, an hour commute for an 8.30 start/17.30 finish…
@DrHelenOram
It’s from the Pastest MRCP part 2 question bank, I downloaded the app yesterday and was one of the first questions to come up! But I passed part 2 in 2015/6 and I remember similar questions appearing then
Delirium can be so strangely diagnoses. You can have a patient in MOF 2nd to severe sepsis and it’s delirium ?cause but someone else has 1+ of leucs and all of a sudden it’s 2nd to UTI? It’s strange how these (questionable) associations stick
@wparrysmith
Just to clarify I was in the theatre for less than 30s bang in the middle of a MOH and crash CS. I’m a med reg. Let’s not over complicate this. It was a brief observation of a clinical situation that I’m not used to.
I was at a seminar on Thursday and a female Geris Cons asked a qu about frailty and the speaker said ‘perhaps you could tell us what frailty is first?’ and an unknown man in the audience interrupted, told a story about frailty and didn’t even answer the question
Seeing many pts whose NOK report declining cognition coinciding with lockdown starting; perhaps subclinical cognitive impairment now becoming apparent due to loss of social support, exacerbated by loneliness and temporal disorientation?
I finished nights on Friday and yet today bc of sleep patterns I’ve been up since 3.30. Insane how, were it not for annual leave id be back at work today, expected to do my usual clinical duties
Getting apologies from ED drs who believe their referrals for elderly patients are ‘bad’. But any acute condition can exacerbate frailty- it doesn’t have to be overwhelming illness. If it’s safer to admit for therapy and symptom control then surely that’s a very *good* referral?
Naming wards after fun things always sounds like a good idea until you’re ringing the cardiology reg in a medical emergency like ‘Hi, is this Hotdog A? I’m ringing from Jane Austen B about a patient on the Microwave Unit’
At
#Dementias2024
National Conference today, will attempt to tweet some things of interest. Currently hearing about new potential pharmacological therapies in the research pipeline for treatment of Alzheimer’s dementia (thought to be ~28!)