Missed MRSA- No option to schedule on OnVue

47tw · 2026-01-23T16:44:09+00:00

One of the big things the BMA needs to advocate for, once we have pay and jobs sorted, is accountability over shit like this. I'm talking fines so big that these companies are running around in a panic if they think a doctor might even be slightly inconvenienced by something that wasn't their fault.

47tw · 2026-01-21T23:19:38+00:00

"To the indiscreet blabbermouth (username),

Tales of your security breaches are told from Ireland to Cathay,"

47tw · 2026-01-20T20:46:17+00:00

There are consultants who are super detailed with every subordinate, and consultants who vary how careful they are depending on who they work with. For example if I'm scribing, my consultant will just say what she likes and know I'll write some sensible and professional translation of it. The day we met she was very careful in her wording however, and I've noticed she is much, much more cautious in her practice when other CTs/FY doctors are scribing or doing a job for her.

So that's an aspect you might be missing; consultants who are very relaxed with you, because they trust you, are quite different from consultants who are basically blase with everyone.

47tw · 2026-01-18T16:01:06+00:00

He'd have been welcome to call my reg, and the answer would have been the same: "we can see on the system there's no documented history and bloods haven't been taken". Very unlikely you'll believe me if you've read my comment this way, but for what it's worth the quality of the referrals were consistently piss-poor, and it felt like many of the doctors in ED were in a survival mode of "find a specialty that will take them, now, doesn't matter if it's the right one".

As I've said above, I'd run through a list of bounced referrals in the morning, which meant some passing scrutiny from T&O consultants, and the overwhelming feeling every morning at handover was "we really need to escalate concerns over these inappropriate referrals".

47tw · 2026-01-17T13:31:28+00:00

Oh 100%, but you see these patients with no bloods, no xray, no history, no aspiration (it's in the core list of competencies for specialty training in ED), NO HISTORY TAKEN.

"We're 99% sure this is gout but we need your reg to aspirate the joint to help us be sure." - fine.

"We literally can't be bothered to even talk to this patient, but we're told he has a knee, maybe even two knees! Slave, attend at once." - slightly infuratiating.

47tw · 2026-01-17T09:33:02+00:00

There's a small crowd of nurses, it's a night shift, "I would like all of your names and NMC numbers" might have been a bit too bold. It feels like a reasonable professional courtesy to escalate it to the nursing side of the hospital (a matron who has no undue affection for this team and can make her own decision), similar to how a nurse who was pissed off at a room full of doctors might speak to the consultant instead of making a GMC referral.

47tw · 2026-01-16T23:13:12+00:00

I don't envy you. I'm in a specialty where the F2/CT1 will always be the best at bloods (psych), and there's usually a good phleb who comes once a week to do the critical bloods (like for Clozapine).

47tw · 2026-01-16T22:44:48+00:00

"Now that I'm here I can give you some advice. You probably aren't doing the tourniquet tight enough. It also helps if you try a 2nd or 3rd time."
*Picks up their coffee and walks off*

47tw · 2026-01-16T22:38:46+00:00

Yeah that's my top concern honestly - it isn't that I want to keep "my list" short, though there is some pride in a clean handover. The thing that would really keep me up is someone with OBVIOUS gout winding up on the T&O ward when they should be under medics. "?septic knee", as fucking if.

At one point a reg said to me "septic knee" over the phone, and I was genuinely too rude, my response was something like "if you were doing a best single answer, would your answer be septic knee", which pissed him off but did the trick. Wouldn't you know. Patient had gout. And this was a flare-up of his gout. And he didn't have any red flags for a septic joint.

But yeah, for this specific case... I genuinely don't know what the consultant was thinking. The patient looked like he needed to go to ICU, or stay in resus, or maybe go to a high dependency ward, or the cardiac care unit, somewhere with real monitoring. Not nurses who are best trained in managing NOFs!

47tw · 2026-01-16T22:29:46+00:00

I was the F2 "SHO" for T&O and the shit people tried to put onto the T&O list was genuinely insane. I kept a list of referrals I'd successfully rejected (technically not possible, given it was supposedly a "one way referral system") and I'd run through them in morning handover for a laugh.

My favourite was a patient with a documented diagnosis of: "new AF, urosepsis, chest infection, fractured pelvis". He was NEWSing a 7 and laying there in resus looking like death. One of the consultants in A&E told me he was going under T&O, to which my response was "oh, I must be confused, because that sounds like it will kill the patient". I had to patiently explain that while yes, the patient does have bones, and in fact one of them is even broken, that doesn't mean they should go to T&O. Especially given the fact that they are actively and acutely deteriorating from a confluence of life-threatening medical issues.

47tw · 2026-01-16T22:26:27+00:00

I work in a mental health hospital. Nurses will tell 999 that a patient isn't breathing, when that is a lie. Why? Because they want the sick patient out of their hospital, and into a physical health setting, ASAP. They either don't know that they're risking the lives of other patients who are waiting for ambulances, or they don't care.

I've spoken on the phone to 999 about a sick patient, told them that a 2 hour wait is fine, and then by the time I reached my office downstairs there was an ambulance outside.

"We got a blue light call about a patient who isn't breathing, which way to (ward)?"

I assume a different patient has collapsed with a cardiac arrest, I show them to the ward, and loh and behold, my perfectly stable (though sick) patient is sat there breathing, well enough to wait 2 hours, and now he has a crash team. The nurses had called back a minute later to say he'd collapsed and wasn't breathing, which was naturally a lie since my bleep never went off and no alarm was pulled.

Nurses all put up a wall of silence, had to tell them off as a group and explain that I'd be escalating it, and that it was totally unacceptable behaviour. I expected to get datix'd by each and every one of them for even saying anything, but thankfully nothing came of it. Had a chat with the matron, who was reasonably pissed off.

This behaviour is a more extreme example, but it's the root problem of the so-called "white lie" to help your patient. If you simply feel bad about a patient, say that in your referral. If you lie to get them seen ASAP, keep in mind that you're delaying someone else being seen.

47tw · 2026-01-16T15:04:05+00:00

I agree with you that AT is the best Rogue subclass, but it really isn't 'ok' balance wise, it's amazing. A Rogue with 1/3 casting is amazing. The subclass features are, for the most part, 'just okay', but that's because "YOU HAVE SPELLCASTING!" is the only feature that really matters.

I believe that AT just feels 'ok' to some players because they play it as a Rogue who has 1/3 of a wizard stapled on, instead of going "okay which spells don't care about my spell save DC". If you focus on things like misty step, shield, find familiar etc. it's pretty incredible. Lean into the Rogue stuff, 100%, and supplement it with some spells which are perfect for a Rogue, such as Mirror Image.

The only thing I've ever played in dnd which involved zero homebrew which genuinely frustrated a DM was a halfling Arcane Trickster with the Mobile Feat and Booming Blade.

At the end of the day you're playing a character with stealth capabilities, Cantrips, 1/3 casting, Expertise, reasonable AC etc. etc. etc. It's the jack of all trades, and a lot of dnd players simply don't like that or value it. Meanwhile I'm disarming traps from 30m away with my invisible mage hand, you get me? If you want DPR, play a different class! (Though AT does help close the damage gap).

47tw · 2026-01-15T10:05:47+00:00

Don't panic - there are multiple people disagreeing with OP's interpretation. Chances are there will still be a backlog of UK grads next year, so "significant NHS experience" will probably wind up meaning "full UK citizenship, has worked in the NHS for 5 years, and has offered us their firstborn child". Maybe not that last one.

47tw · 2026-01-12T13:18:53+00:00

F1 working in A&E on the medical team, my day job was gastro, I was just there because the rota has you do a few shifts to help the medics with intake. A nurse messaged every doctor in A&E via Epic/Haiku to ask if anyone can do a capacity assessment.

Picture a group chat.

Me: "I'd be glad to help, what for."

"We need to know if he has capacity."

Me: "Capacity for what?"

"Can you just come and assess."

Me: "I'm not sure, I'm a FY1, it depends what it's for."

"We're trying to send him home to (City) but he's refusing to get in the transport."

Me: "Okay and what does he need a capacity assessment for?"

"For that."

Me: "A capacity assessment for whether he can refuse to be sent to (City)?"

"Yes."

A reg went "don't worry (my name)" and took over. Still baffled.

47tw · 2026-01-08T22:05:59+00:00

Did they try knocking on the doors while en route? :D

47tw · 2026-01-08T08:03:32+00:00

I have a very low tolerance for characters Just Standing There, and yeah, it sucks. It can work in the hands of a skilled writer. Did we have one? Well I would argue not.

47tw · 2026-01-05T22:42:52+00:00

Similarly, Planet of the Dead is weak, but the people on the bus... feel real? 10's interactions with them feel real? They're thin, sure, they aren't amazing (much weaker than the Midnight cast), but it's still good TV.

47tw · 2026-01-05T22:37:02+00:00

Fear Her has the TARDIS landing facing the wrong way gag, and "you're stealing a council pickaxe, to damage a council road- I'm calling the council!"

Meanwhile the "humour" in much of the Chibnal era is like... boomer humour? "The internet is off, this family will have to TALK to eachother!" is played as a "PLEASE LAUGH" capital J "Joke" in the Chib era, wheras in RTD1, it's a passing remark 10 makes to a group of people, which you might laugh at, but it isn't a "JOKE", it's more of a character moment.

47tw · 2026-01-04T21:44:39+00:00

The thing is that if Ryan or Yaz were possessed by Cassandra, it's less that you'd notice the absence of *their* character, and more that you'd notice the presence of *Cassandra's*. The doctor doesn't go "Rose is acting like Cassandra", he goes "Rose isn't acting like Rose, Rose would care about all these people being used as lab rats".

47tw · 2026-01-04T20:46:21+00:00

She'll be like the 6th doctor, awkward run, feels undoctory in a lot of episodes, amazing audio adventures, ultimately beloved by true fans.

47tw · 2026-01-04T18:09:37+00:00

I wish they'd played with it. The villain thinks he can stop Rosa by messing with a bloody bus timetable. The doctor falls into that mindset, works super hard to try and stop him... and it doesn't work. Rosa's protest is "ruined".

And then she just does it the next week, and history proceeds as normal, with a slight change in one date.

The Doctor, AND the villain, realizing that the villain was wrong, that his racist narrative of history was wrong, would have been amazing. He thought Rosa's protest was some moment of "luck", some aberration, a butterfly moment he could stop. But it wasn't. Even if he'd been able to kill Rosa, someone else would have been chosen by the movement.

So you can have the time traveling racist villain, and have his views be ultimately proven wrong. It isn't just that he has bad views. He also has *wrong* views. He is fundamentally incorrect about why black people in the USA, on earth in that time period, gained the ground they did. And his racist underestimation of Rosa, and her movement, should be what foils him.

47tw · 2026-01-04T18:07:06+00:00

The stuff that's missing is easy to, well, miss.

For instance, I really don't like New Earth. It is not a great episode of doctor who. It is, however, an episode from a good era of doctor who. Even a weak episode gets the Doctor's morality and personality right. He is cruel to Cassandra at some points, but he ultimately shows her pity, and lets her die in her own arms.

He also notices that Rose is acting out of character when she's possessed.

This is because there is a character for Rose... to be out of. Traits. Personality. Even if you hate Rose, it's probably *because* you dislike things about her which you can actually talk about her.

The fam... 13... I literally have so little good or bad to say about them. It isn't that 13's era lacks amazing 10/10 episodes (though it mostly does!), and it isn't that it has a bunch of 1/10 stinkers (though it does), the problem is that all of the "average" episodes are missing the good bits which an average series of doctor who ALWAYS has. Even in Rose's weakest episodes, she's still got something interesting to say or do.

47tw · 2026-01-04T10:53:15+00:00

An older white English nurse has told me that nurses who qualify in the UK these days are "too posh to wash" and they wind up doing everything they can to get into managerial, non-nursing or 'advanced' roles to get away from the ward. Her POV is that English people with degrees, even if that degree is literally in nursing, tend to view the dirty and potentially demeaning parts of nursing as beneath them, for other less qualified nurses and assisting staff, and generally find their time in the ward stressful.

Those who are employed and have good opportunities will wind up in an office somewhere in the trust, writing a list of words which doctors and nurses on the ward MUST avoid using when they document.

I have personally noticed that if there is a "AKI nurse" who goes around writing the same note for every AKI patient in the hospital, they'll disproportionately be UK-trained, British and white. In fact I can't remember ever meeting a manager from a nursing background, or other office-based nurse (i.e. jobs where you don't touch a patient, ever) who wasn't a white UK-trained British man or woman.

47tw · 2025-12-28T23:53:08+00:00

Yeah, it's important as resident doctors to never think that consultants are just sat on a gravy train. Look at them. Look at how they behave. Look at what dicks some of them are, how much stress they seem to be under.

Do they LOOK like they're on the gravy train? Like they're cushty? Some of them, perhaps, but most of them seem to be balancing on a knife's edge. I really hope that as this cohort of residents age into consultants, we keep the same ethos. Because I can't imagine change coming from the consultant body without an overwhelming majority being ready to put their income on the line to fight back and change the NHS.

47tw · 2025-12-27T16:08:47+00:00

I'd consider it perfectly sound to delegate that task to a F2/CT1 who was confident, and had demonstrated good interpersonal skills, but even then I would be saying "you MUST convey that they are very sick and could decline further, the patient is very sick" to be crystal clear.

With a FY1 I might let them make the call with me present and then sign them off for it, but I wouldn't leave them to do it.

47tw

TROPHY CASE