There are two ACPs who I work with and honestly don’t know what they actually do. Both see 1-2 patients takes them all morning then leave for afternoon clinic/audits etc… where as I, the least experienced FY1 see at least 6-8 patients if not more.

Been multiple shifts where I’ll ask them is there anything to be done for your patients and they will say it’s done. Surprise it’s not and I do all their jobs and even add on their plans. I’ve been given TTOs to be done 10 mins before home time when pt was ready for discharge in morning, correcting their mistakes on the wards as their pharmacology trash and for me to say that is crazy because mine is pretty much on the floor.

Honestly soo tiring, the SHOs and registrar told me to just keep my head down and I’ll be rotating soon no point of making waves. Probably just a rant but it’s actually nonsense how excellent doctors can’t get positions and this is what we get instead.

One round of strike action in a 6 month mandate.

This was a clearly AI message sent out to congratulate these "Third Tier" ACCPs for winning "AHP team of the year". Just making "cheaper replacements" sound nicer.

Sounds like a FoI is needed u/Sildenafil_PRN

Credits to medicalmodelbri on Twitter

This is absolutely insane. If any doctor were responsible for what she let happen, we'd be struck off with no second chances.

How does an NHS trust put her in a senior position of leadership after what happened?

This is probably just as bad as all the VSM responsible in the Letby case going on to hold other VSM positions in other trusts after they 'resigned'

At least she lost her CBE.

Hi all,
Ive just been diagnosed with myasthenia gravis and unfortunately I’m an ED reg. I’ve been told I likely can’t do nights because it makes my symptoms so much worse. Has anyone had experience of anything like this?
I’m not sure whether I’ll be able to continue as an ED trainee without doing nights, or whether they’ll just adjust my shifts. I’m going to talk to my TPD but just curious if anyone has any idea. Thanks!

Inspired by a harry potter meme I saw on here couple weeks ago

It has gotten better.

Hello! New FY1 here.

How do you explain to patients the risks of doing extra investigations, like false positives and over treatment?

The last week I've had a lot of "request scan" for patients who seem to have basically no chance of having any pathology. The classic is a patient who's been on antibiotics for 2 days, CRP and WCC are high, cultures are not back. Consultant asks for micro advice, micro advice CT to assess for abscess. Pt is clinically stable.

A lot of these patients then need a repeat scan because something was on the liver. Or a referral to gynae because of an ovarian cyst. They rule out whatever people are worried about, but multiple incidental findings.

I totally get I'm inexperienced, and if they're asking me to request a scan, I'll do it. However we need to explain to patients the risks/benefits of doing so. I have no idea how to explain that the main risk of whatever intervention is that we find something else. Over investigation and over treatment took me months to grasp in medical school. Is there a good way to explain, or is it futile?

I don’t cope very well at all with swapping from nights back to days. Ideally, I would just have a block of nights. I recently swapped so I had all my 7 nights in a row and it worked really well, and I was able to adjust back much more easily. Someone suggested to me that it might be risky in terms of how indemnity stuff to do that, ie if something went wrong would I be in trouble for it? I also always swap my post nights days as I adjust better with only one day of rest. What’s the best way to manage this; should I speak to the trust or to my indemnity? Or is it allowed?

Question related to fluid/volume replacement in severe/borderline major haemorrhage upper GI bleeds.

Obviously patients need volume replacement, and in timely fashion. But come across 2 school of thoughts - some advocate to prioritise replacing with blood as don’t want to dilute clotting factors and most physiological, plus oncotic properties etc.

Others talk about giving crystalloid, and not transfusing until hb <70 (restrictive transfusion), which found a bit confusing using this arbitrary cut off, especially when there is often a lag in Hb, and if Hb has dropped say from 130 to 80, surely they would benefit from transfusion?

Don’t know what approaches people take to this? Or what the evidence base is?

Anyone who have been successful in securing ACF Cardiology posts previously ? I am in need of getting some expert advices.

This is my third time I am applying for ACF posts on this round and I have not even been able to get shortlisted last two years. I have a reasonably good research and academic portfolio and already fullfilling all the eligibility criteria. But never able to secure anything so far.

I was going through my previous oriel applications before I apply this time and Just wanted to ask few questions if anyone would give me a guidance.

1) I see that the oriel application does not open any tabs for you to upload your evidence. But the application instructions specifically says that you need to upload all the evidence with the application . How did you all tackle that ?

2) Would appreciate any other expert advice..

This is my third year doing the same applications unfortunately .

Thank you ever so much !

Hoping for some advice.

My partner and I would like to do an August 2027 wedding.

If all goes well with applications I would hopefully start ST1 training in August for a run through programme. Applying to a new area so won't know rota coordinator team.

We are thinking of doing the wedding towards the end of August so presumably induction will be out of the way by then.

Given I won't be able to ask for leave until April/May time as I won't even know my trust till then, is it safe enough to commit to planning everything for this life changing event, though I obviously can't guarantee induction would definitely have happened and that they will definitely approve the leave?

I know we have rights for life changing events it's just hard to navigate the uncertainty of planning things without knowing there won't be something I can't miss. For all I know they could have a delayed start and induction and then I'm stuck.

Anaesthetic trainee here.

Epidurals are fuckin’ voodoo man! I need some help.

Putting them in, fine. Checking the block, fine. Exam answers for anatomy of epidural space, sure. The theory behind how they actually work… feel like I understand it, then realise I don’t. Trying to change position to make it work better, sometimes works sometimes doesn’t. Missed segments - what’s that about?

Has anyone got a resource, or a video, or something that actually explains what they do, how they do it, and why some positioning techniques work and why some don’t (trendelenberg apparently doesn’t).

Thank you in advance!

Edit: thank you everyone for your comments!! Much appreciated!

Doesn't look as though you can list Scotland as a preference. Assume this means that there are no jobs and no possibility of any jobs coming up.

If a job was to become available down the line would they open preferences back up or just offer to the highest ranked on the list who did not have a post. Would listing preferences elsewhere then make you ineligible for a post that later became available?

Hi, I'm a little confused about zero day entitlements. Lets say I do a weekend then have Tuesday as an allocated Zero Day. If I then take Monday as Annual Leave (and thus break up 7 consecutive days work) do I lose my Zero Day? Thanks

Hi everyone,
Hoping to apply to radiology this cycle
Only have one audit at present
The first cycle showed compliance in 3 out 4 domains, and the 2nd cycle didn’t show any improvement after the intervention was applied

Based on this would this score 3 or a score of 1

Thank you in advance :)

Hospital doctor here. How do you answer questions along the lines of "why do I feel so tired/sleepy/achy all the time" to people with normal blood results and haematinics/vitamins etc? Or to even people with a deficiency/health issue that are on treatment but you don't feel like this will solely fix their issues?

I'm struggling to answer with honesty without seeming somehow dismissive or sounding cliche.

Also is there something I'm missing/any reading I can do regarding lifestyle advice and regarding handling this especially for people that are quite insistent? It's been a while since I've been on GP and some of the basics don't come as naturally to me.

I’m waiting for my rank for HST ahead of first offers on Tuesday, is refreshing oriel over the weekend entirely pointless?

First time being Datixed, patient with a VP shunt required an MRI head, i added details of VP shunt in request but ‘failed’ to mention it was programmable. The department rejected the request and did not contact anyone to let them know. Second day some other doctor requested the MRI and failed to mention VP shunt altogether and scan was rejected again. No patient harm, radiology department is datixing as they had to find out details of the shunt themselves and caused a scan delay.

Hey all, Just planning to start preparing for paces. Found quesmed videos to be very helpful. Has anyone used this instead of the conventional past test ones?

My friend who is a GPST3 on a Skilled Worker visa was on authorised unpaid leave for unforeseen circumstances which didn’t fit any other leave. She became unwell during that period and sent her fit note. Her employer (LET) continued to record her absence as unpaid leave although she made them aware and sent the fit note in time.

For a person on a skilled worker visa, you’re only allowed 28 days of unpaid leave annually, otherwise you’re at risk of losing the visa (home office rules). She only became aware that her fit note was not recorded is when she was contacted by the sponsorship team from the LET that they are withdrawing sponsorship as the system says she is on unpaid leave for more than 28 days.

I’d appreciate some advice on how to approach this?

I mean everyone can say they regret not going earlier about anything but it's kinda a big thing to say yeah I think this person is a murderer.

Regardless of her guilt the truth of which I doubt will ever come out what should have happened without doubt is that the medical director there Harvey should have been taken to task for the way he bullied consultants there but the regulator let him off the hook an insane decision considering the gravity of what he did

Rotated into a trust (IMT). Nights shifts are 4 nights, weekend, x3 normal days and then 3 nights. Just about managed nights previously (x1 set /2months). Feel this is having a real knock on effect on MH and noticing an uptick in symptoms.

Going to discuss this with my ES and ask for OH referral. I want to work some nights, and worried about loss of exposure if taken off nights completely. Also worried about the implications this will have moving forward, I guess it would be unrealistic to work in a group 1 speciality all considered.

Anyone had any experience in having the frequency of nights reduced?

Thanks.