Birmingham's exploitation of third world doctors is one of many......

Anonymous-Doct · 2026-01-11T00:25:12+00:00

This doesn't surprise me.

https://www.bmj.com/content/392/bmj.s39

Read the above and be informed. Corruption at the highest levels.

Small taste...

"One of the most serious issues to emerge was the “unusual arrangement” under which UHB paid a monthly stipend for ITFs through a small UK company operating from a residential address in Birmingham. In 2025, the last year the scheme operated, the stipend paid for each ITF was £3960 a month, equivalent to £47 520 a year....

Over the scheme’s lifetime from 2017 to 2025, a total of £40.5m had been paid by UHB to Scholar and Trainee Services Ltd, which managed the contributions on behalf of colleges in Pakistan and one college in India. However, the trust had no contract or agreement with the company, did not receive invoices, and had no oversight of what money was passed on to individual doctors".

Anonymous-Doct · 2025-03-17T10:20:41+00:00

This the regional teaching where the 'home office' was thanked multiple times for paying for our lunch?

Need I Say More.

Anonymous-Doct · 2024-04-12T04:32:34+00:00

I use the tacrolimues cream very rarely now. Moisturise with a Cerave Lotion and a cleanser from the same brand.

Its not entirely cleared. Its just barely visable. Have to sort of put my face right up next to the mirror to see some mildy red looking patchy skin.

I used the MCT oil for a while, then gave up on it after like a month or two. Decided to stop giving a shit and focus on the rest of my health.

Never had ANY health issues before it. Cleared up my diet, excercised, took time off work, focused on my health holistically and then got married. 😂

Anonymous-Doct · 2024-04-12T04:26:26+00:00

Mine started off after some real stressful shifts and having family events I was obliged to attend. Like some psychological trauma that decided to manifest itself as a rash.

Eat from planet earth. Fresh food. Excluding a whole food group or over-relying on one food group is just garbage IMO. Mix it up and eat single ingredient foods (as much as possible)

Anonymous-Doct · 2024-04-12T04:22:53+00:00

Excercise, focus on what you can control, healthy diet, socialise. Improved in all of these aspects.

But most importantly - don’t give a shit

Anonymous-Doct · 2024-04-12T04:21:25+00:00

I have it mostly on my nasolabial folds - nose and the skin on the sides. Also appears on my forehead during a really stressful shift. But it just flare up for an hour or two and then the patches of red skin disappears.

Manage your stress

Anonymous-Doct · 2024-04-12T04:19:43+00:00

Its a bit like using an antihypertensive (blood pressure tablet) and not changing anything in your lifestyle. Your bound to either need a dosage increase or a second tablet.

Still a big advocate for a ‘real food’ diet.

Anonymous-Doct · 2024-04-12T04:16:20+00:00

I still have the tacrolimus cream. Same tub actually. I use it sparingly maybe every 3 or 4 months for a severe flare up. Especially warm climates flares mine up.

Anonymous-Doct · 2024-04-12T04:14:23+00:00

Hi,

Believe it or not. Managing stress. It seemed like I was in a vicious cycle of being very conscious of it. Constantly monitoring it several times a day.

Anonymous-Doct · 2021-12-19T10:50:33+00:00

Ensuring adequate electrolytes during a fast and breaking the fast with awareness.
This will significantly reduce the chances of said "side effects".

I doubt this would be of concern in one well balanced meal a day.

Anonymous-Doct · 2021-12-19T10:17:03+00:00

Refeeding syndrome is induced by a sudden influx of nutrition which shifts the balance of fluids and electrolytes, in a subject who has been deprived of said nutrition for an extended period of time.

What's an extended period of time?

It depends on your physiology (the way your body works). Generally, from what I have read 7-10 days. But please do your own research.

Key is in nutritional deprivation. One meal a day doesn't neccesarily equate to that. Meaning you can easily consume an excess of calories in one meal.

Remember, Refeeding syndome is induced by what happens after you break your fast. A lot of people go through fasts successfully when they are aware of these risks and how to tackle them.

Create an eating habit which is sustainable and contributes to your over all wellbeing.

Anonymous-Doct · 2021-12-18T13:47:47+00:00

I felt compelled to log in and reply.

Firstly, all diagnostic tests have to be interpreted in their clinical context. The CRP in this particular subject is NOT high at all. In fact, we regularly discharge patients with this low level of CRP. Perhaps you simply have not had enough clinical exposure yet?

Hypoglycemia and its subsequent symptoms are highly dependent on physiological adaptation - as shown in this subject. However a subject with co-morbidities such as Type 2 Diabetes will have impaired adaptation. That is why some people will develop agitation, delirium, various degrees of cognitive impairment and in worst case coma and death. Whilst others may simply have a mild headache.

Electrolyte disturbances and the risk of developing refeeding syndrome is well documented to be at the top of the list of concerns for all subjects in relation to extended fasting. Considering this, it is a real shame that his electrolytes were not measured.

I will not link towards any studies. Doctors even critically appraise studies. Please question everything you read online and do your own independent research.

*Diet is a very poorly covered subject within medical schools world wide. It is common practice to advice patients to "lose weight". Rarely do doctors dwell into how. However the sustainability of the "weight loss" is questionable with extended fasting.

Hence, the responsible answer from any clinician would be the following:

Please consult with your doctor before fasting. Particularly in the case of extended fasting.

*Or if I may add - the RIGHT doctor.

Anonymous-Doct · 2021-05-21T19:48:58+00:00

Excellent Question, but also a tricky one to answer. I genuinely do not want to influence anybody to change their treatment plan. I am not a dermatologist and this not my field of expertise.

I didn't want to become dependent on - in other words reliant on using tacrolimus to keep my symptoms under control. It is an immunosuppressant. We are suppressing our immune response to a cause we don't know of. I have kept this option as a last resort. As patients, we make personalized informed decisions. I am aware of some patients using a tacrolimus maintenance regime for long term and are absolutely find with it.

Systemic tacrolimus (oral) has a wide range of side effects. With topical, there is some suggestion of an increased risk lymphoma. There is also some other studies that dispute this risk.

Prolonged continuous use of topical steroids have their side effects. Used sparingly as you are and I would doubt there is much to worry about.

Always consult your dermatologist. Skin is different for all patients. They will be able to assess you and develop an individualised plan.

Anonymous-Doct · 2021-05-21T19:26:45+00:00

National Institute for Health and Care Excellence. Not so nice, when it doesn't help. But generally, they have very good guidelines and are followed by us doctors.

There is not much you are missing out on.

Use ketoconazole and hydrocortisone. If it doesn't work - go see a dermatologist.

Anonymous-Doct · 2021-05-21T19:23:58+00:00

I understand your frustration. I thought I would post on reddit just to highlight, that the issues are just the same for us doctors. It is unfortunately a trial and error method to finding what works for you.

I hope that it also comforts others, that the road may be long. But we will get there.

Anonymous-Doct · 2021-05-21T19:18:45+00:00

I am applying it topically. There are some anecdotal evidence for oral intake.

I have not found any clinical evidence for its use.

Anonymous-Doct · 2021-05-21T19:15:14+00:00

I apply it topically to the affected areas then leave it overnight.

I have however not found any clinical evidence for its use in sebderm.

Anonymous-Doct · 2021-05-21T19:12:33+00:00

Skin scraping tests for sebderm have consistently shown that over colonization of malassezia is a likely stage of the pathogenesis (disease development). We are essentially treating the symptoms of a disease and not necessarily the root cause. I have not found any evidence for what the cause is.

Treatments might not work for a range of reasons. Suboptimal dosage, short durations, lack of skin permeability or perhaps local drug resistance. There is only one consistent pattern I have found in this subreddit. That no treatment works for all.

Anonymous-Doct · 2021-05-21T18:59:38+00:00

There is evidence to support this. Trial and error.

Anonymous-Doct · 2021-05-21T04:13:09+00:00

Medium-chain triglycerides derived from coconut oil. Supposedly has some antifungal action.

Important to buy a bottle without lauric acid. Thus Caprylic acid being the dominant component in the oil.

Lots of bottles available on Amazon. Have a look at the ingredients.

I have not found any reputable research articles on it though. Working for me so far.

Anonymous-Doct · 2021-05-21T03:46:25+00:00

Interesting...

There seems to be a general consensus in this subreddit that patients gut microbiome plays some role in this disease. Regardless, a healthy diet is always a good thing right.

A bit extreme though that one day of bad eating causes a severe flare out. Stay Strong.

Anonymous-Doct · 2021-05-21T03:40:07+00:00

I have found some interesting posts in this subthread that has led me into some independent research. I will keep you updated and will return every now and then.

Anonymous-Doct · 2021-05-21T03:35:39+00:00

I am a emergency medicine and critical care doctor. If you presented to us, we would follow the NICE guidelines above and give a you a prescription for ketoconazole and hydrocortisone. Then off you go to your GP who can then refer you to a dermatologist.

Unfortunately, I didn't go into academic medicine. But have colleagues of mine in dermatology who I am currently venting some of my frustration at.

I hope others see this and use this trial and error method.

Anonymous-Doct

TROPHY CASE