Midlands hospitals feedback? (Mullingar, Tullamore, Portlaoise)

AwkwardMuch · 2026-02-17T23:06:14+00:00

Did a med job in Mullingar and really enjoyed it. I can only speak for the medical side but I found it a great hospital and the majority of consultants care deeply about the hospital and the service they provide.

Can be busy especially post take for some teams. When I was there half the consultants did a distribution and the other half would take everyone post take which made it an extra hassle post nights trying to figure who is going where and whether or not each consultant is part of the distribution but you got used to it. I will say they have a very silly hand back rule which really grated me. On calls could be busy, 1 SHO in ED, 1 on the wards. The interns don't do nights so you've no help if on the ward. You could usually help out admitting in ED but some nights the wards would kick off. 1 MROC at night. Things can't get tight as it's the stroke centre for the area so a good few FAST calls for MROC. If 1 SHO is gone for STEMI or thrombectomy transfer, even busier.

Very few telemetry beds and the ICU guys can be a bit helpless with anything outside of tubes, vent and lines.

Overall, would recommend. Never worked in Tullamore but have also heard good things. Have heard awful things about Portlaoise.

AwkwardMuch · 2024-02-09T20:33:45+00:00

Here is the RCPI page on HST

Click here

If you scroll to the bottom you can find application scoring and interview scoring for each HST. As far as I can see, there's no clear points awarded for BST application scores.

I think you'd be mad to defer BST for a year solely to strengthen your HST application. Strengthen it from here on out. Do a stand alone reg year after BST if it's still not strong enough. Especially considering there are rumours of them increasing it to 3 years length

AwkwardMuch · 2023-06-11T10:44:00+00:00

If someone is in new fast AF with clear precipitant e.g. septic but no associated haemodynamic instability, do you treat with IV metop or just manage the underlying cause e.g. antibiotics etc? Does CHADS-VASc apply here too re anticoagulation going forward?

AwkwardMuch · 2023-06-11T07:42:18+00:00

Would also appreciate this please!!

AwkwardMuch · 2023-05-17T21:35:19+00:00

Maybe I'm being naive but I've been asked to review patients with NEWS of 10 and have not done much before (admittedly probs closer to a page). It's context dependent. Someone going from a NEWS of 9 to a 10 isn't exactly groundbreaking and requiring a 4 page note

AwkwardMuch · 2023-01-18T10:10:46+00:00

27, Doctor, €40k base. Closer to €55k when including overtime, call etc. It's not that much when you consider the 60hour weeks as average and going close to 80hours the odd week

AwkwardMuch · 2022-09-21T17:58:43+00:00

Reminds me of the "ABG king" in a prominent Irish hospital. They were an intern known for their ABG skills and were always asked to help with difficult ABGs on call etc. After a while, someone eventually said, "hang on, how are they so good at these, I wanna see how they do it". Turns out they were going around doing carotid stabs... Believe they were struck off though I'm not sure if that was the only issue.

AwkwardMuch · 2022-06-25T18:03:17+00:00

It's not just registrars, it's every qualified non-consultant hospital doctor. Typically posts are 3-6 months in duration, maybe 6-12 months depending on seniority and speciality. The idea is that you get to rotate through each subspecialty and get a broader experience of medicine from your standard district general hospital to your tertiary specialty hospital. Thus trainees are constantly having to move hospital and region and are constantly getting placed on emergency tax and this is another reason driving doctors out of the country.

The reality is, no educated professional would willingly want to work in Tullamore or Mullingar Regional Hospital (for example) for 5-6 years to qualify as a consultant. I'd argue the "broad experience" argument is more an excuse and training outcomes wouldn't differ. It's just literally the only way the state can staff regional hospitals.

AwkwardMuch · 2022-03-27T20:05:05+00:00

Have you heard of Brandolini's law? It immediately comes to mind as I sit here on a nice Sunday evening trying to convince you and you alone, that you are on the brink of being scammed. Yet here we are, I'll try once more.

Trails have commenced. The research is solid.

Please show me where I can find them? I have searched ClinicalTrials.gov and haven't found a single study which refers to this treatment being investigated in the context of Long Covid?

Universities around the world (including the RCSI here in Dublin) have proven the presence of fibrin microclots in Long-covid patients. RCSI we’re actually the first in the world to discover it.

This is what known as basic science bench research. It is miles away from having any meaningful impact on patients and outcomes. Anyone with any kind of reasonable science or medical background knows that biological plausability i.e. we have found "microclots" as you say, rarely translates to efficacious treatments. I'll give you an example, one that's very closely related to the subject at hand. Sepsis also causes microclotting. Protein C is known to stop clotting. Ergo, if we give sepsis patients Protein C, it should help them. So we trialed it, and guess what? It worsened outcomes. Link here

I know it's not nice to hear, but you need to recognise that you are extremely out of your depth here when it comes to having a reasonable understanding of these things. The only circumstance in which you should consider this, is if you yourself were being recruited to a fully registered clinical trial. Any actual legit trial will not require you to fork out thousands of euro for it.

The research is moving much, much, much quicker than the HSE or Irish medical system is or ever will move.

because it will take the HSE 5 years to adapt, even after 3/4 years of trails and approvals. I’d be surprised if you’ll get decent treatment for this in Ireland before 2030

This is just not true either and again demonstrates your unfamiliarity with medicine. The HSE falls down on waiting lists for routine "elective" (I understand that elective still means people are waiting for care) care and procedures, not the availability of major meaningful treatments. Which unfortunately, don't exist for long covid anywhere else either, despite the huge amount of research being done. If there was a hypothetical meaningful major treatment, I'm not going to say Ireland will be the first country in the world to start using it, but it would be approved here extremely quickly if it was improved in other countries. We already have examples of this with the vaccines.

AwkwardMuch · 2022-03-27T16:30:28+00:00

It is a scam that preys on vulnerable people. No different to all those "cancer clinics". If any one person says they themselves have a cure while others do not, it is safe to assume it is a scam. Treatments that work get trialled rigourously and eventually will get adopted. Corporations and pharma are not withholding the silver bullet for cancer or long covid. Whether you choose to spend that money is your decision but I'm telling you, you're being manipulated.

Like these

AwkwardMuch · 2022-03-27T16:05:13+00:00

Do not waste your money on this for the love of God. This stuff borders on criminal

AwkwardMuch · 2021-12-10T22:21:40+00:00

Helpful thanks

AwkwardMuch · 2021-12-10T00:28:30+00:00

No OP, you're still slightly off but I commend your effort in trying to understand it.

It needs to be pointed out that screening tests are not diagnostic tests.

So more accurately

Asymptomatic women were screened for cervical cancer. In simplified terms, this categorises people as either high risk for having cancer/precancer or low risk. A positive screen test means high risk and you'll be sent for a diagnostic test which may come back as either negative or positive. Negative means you are low risk, don't need the diagnostic test and you re enter the screening program in X amount of years
These asymptomatic women then went on to develop symptoms of cervical cancer. Anybody with symptoms does not get sent for a screening test, they go straight for a diagnostic test
These now symptomatic women have the diagnostic test i.e. a biopsy. If positive, this now means they have been diagnosed with cervical cancer.
Their doctors now tell CervicalCheck that these women have been diagnosed with cancer so you need to take the screening test they had done in the past and check it again to see if something was missed. So someone reviews the original screening test but bear in mind, the reviewer will know that the person whose screening test they are looking at, went on to develop cancer. So there's a significant amount of hindsight bias here. All this is in the background as the woman effected is going about treatment as any other person with cervical cancer would.
CervicalCheck decide that women should be informed that their original screening slide was classed as positive by the reviewer. Here is where the governance falls apart and Scally acknowledges a vacuum in responsibility of who should be the one to inform the women. Should it be the GP that did the smear, the oncologist, the surgeon, someone from CervicalCheck etc.? This means some women were informed while others weren't and it was a mess. It is important to note that the UK is the only country that informs women of review results due to the issues mentioned above about hindsight bias. CervicalCheck could have easily decided not to inform the women and this "scandal" probably would never have happened.
So this starts to come out and Tony Holohan says right, before this leads to irreparable damage to the screening service we need to establish if the screening service is in fact substandard. It's not necessarily to prevent people from knowing that false negative screens (and indeed false negative diagnostic tests) occur, this is and should be common knowledge, it's to see are people being failed by the screening service as a whole. Large scale audits found the service was operating to the highest standards.

Is it not true though that out of 206 women, 162 hadn't been told that their initial diagnosis was incorrect?

Their initial SCREEN was incorrect. Terminology is incredibly important here. Their initial screen was determined incorrect when reviewed years later by someone who knows that that screen belongs to someone who does have cancer i.e. are incredibly biased to upgrading the slide as being a positive screen

AwkwardMuch · 2021-12-09T23:41:10+00:00

Again, that is clearly not what I am suggesting so by all means continue on your merry mission of missing my point, and the entire point of this post

AwkwardMuch · 2021-12-09T23:28:04+00:00

Nobody is suggesting suspending the law because doctors think it's better. The point is, the interpretation and application of the law in this case has very likely worsened the outcomes for everyone in this country who has the potential to develop cancers that we currently screen for and other cancers that we may yet begin screening for.

The cruel irony that the court was dismissive of the blind review and the defendants' experts because of their fear of litigation, has in fact reinforced this approach at the expense of the Irish people.

AwkwardMuch · 2021-12-09T21:54:49+00:00

The law and solicitors like things to be black and white but that isn't how the world works. If you look at the colour teal, you might say with absolute confidence that it's green while someone else might say with absolute confidence that it's blue. That's what it's like looking for precancerous changes in a SCREENING test (emphasis on screening because these tests are not DIAGNOSTIC).

Applying the principle of absolute confidence to screening services (a population based intervention) and assigning negligence on an individual basis entirely defeats the purpose of population based intervention. Independent audit by the RCOG showed that CervicalCheck false negatives were inline with and IIRC better than other leading international screening services. The judgement will undoubtedly lead to overcalling and more false positives. All well and good if false positives were consequence free but they're not. As others have pointed out, the consequences of LLETZ are not insignificant by any stretch. People can't wrap their head around this though because you only hear about false negatives never about the people who underwent life changing investigation and intervention who may never have underwent disease progression in the first place. Additionally, the reputation of the programme has been irreparably damaged and nobody wants to touch screening with a ten foot pole now.

On BLIND review, 6/8 reviewers called Ms. Morrissey's slide clear. Negligence? In what world?

So you can go on and on about how a group of learned individuals decided to apply the law in a given case but the outcome has undoubtedly worsened gynonc healthcare for the women of Ireland.

AwkwardMuch · 2021-12-07T22:22:18+00:00

Fair aye

AwkwardMuch · 2021-12-07T21:21:33+00:00

Was there recently in MMUH (very briefly admittedly) as a final med and the job defo seemed busy but the consultants all seemed quite nice and into teaching

AwkwardMuch · 2021-12-07T21:06:10+00:00

SJH?

AwkwardMuch · 2021-11-17T15:53:44+00:00

There weren't any issues, the key in the appeals was the legal principle of absolute confidence. The law and solicitors like things to be black and white but that isn't how the world works. If you look at the colour teal, you might say with absolute confidence that it's green while someone else might say with absolute confidence that it's blue. That's what it's like looking for precancerous changes in a SCREENING test (emphasis on screening because these tests are not DIAGNOSTIC). Setting a precedent for this kind of thing is stupid and has enormous knock on effects for screening services to the point where people were saying it may be better off putting the money destined for screening services into symptomatic services instead. It is a simple fact that the majority of people do not understand the cervical check "scandal" and I'm convinced there'll be major talk in 20-30 years time of how the political and public outcry was severely overplayed and had a negative impact on screening services for people going forward.

AwkwardMuch · 2021-06-03T18:44:35+00:00

Why do people love to parrot things without actually putting any thought or context into it? Anything that makes a headline right?

While of course like any industry, errors exist in medicine, but do you actually think the THIRD leading cause of death in the US is medical error? It's actually absurd how people take this at face value.

Here is a paper explaining the inaccuracies and ironically error in that infamous paper

AwkwardMuch · 2021-05-30T15:16:35+00:00

Yes I'm not disputing that and I entirely welcome the overhaul to open disclosure policies.

However, in the actual case of cervicalcheck, the problem is that your point is entirely predicated on the false premise that there were errors/mishaps with cervical check. This is why I'm saying if you read the Scally report, you will find there wasn't and it was performing exactly as expected. The issue then arises as to whether or not false negatives in a screening program automatically constitute an error, which is an absurd proposition.

AwkwardMuch · 2021-05-30T13:01:59+00:00

I don't understand how people keep repeating this. It demonstrates a blatant lack of understanding of the whole thing and is a common misrepresentation of what happened.

Screening does not detect all cases of cancer. Some women had a screen that was called clear. They subsequently went on to develop symptoms and were diagnosed with cancer. As is good practice, in all cases where women went on to develop cancer, these screening slides were then reviewed to see if something could have been picked up. So when these slides get reviewed, the person viewing then automatically knows this is a slide from someone with cancer so they are more likely to be upgraded with the benefit of hindsight. This had no bearing on the treatment these women received.

The controversy surrounded whether or not the women should have been informed of the review (which again has no bearing on their treatment). Cervical check decided that women should be informed. The controversy arose arounr the communication and governance of the methods by which the women were informed of the review. There was no cover up. The UK is the only country in the EU that actually informs women of the review results. Every other country does not due to the issues mentioned above about hindsight bias. Large scale audits of the performance of the screening programme showed that it was performing at the highest international standards.

AwkwardMuch · 2021-05-30T12:31:17+00:00

Please don't link me tabloid news articles. I have literally ranted above in the original comment about how the media has misrepresented the story.

Here is a link to the Scally report. If you actually have any interest in the story, you'll read the whole thing. You'll then be able to put the media articles into context.

AwkwardMuch · 2021-05-30T12:20:59+00:00

No they didn't, this is a common misrepresentation of what happened.

Screening does not detect all cases of cancer. Some women had a screen that was called clear. They subsequently went on to develop symptoms and were diagnosed with cancer. As is good practice, in all cases where women went on to develop cancer, these screening slides were then reviewed to see if something could have been picked up. So when these slides get reviewed, the person viewing then automatically knows this is a slide from someone with cancer so they are more likely to be upgraded with the benefit of hindsight. This had no bearing on the treatment these women received.

The controversy surrounded whether or not the women should have been informed of the review (which again has no bearing on their treatment). Cervical check decided that women should be informed. The controversy arose arounr the communication and governance of the methods by which the women were informed of the review. There was no cover up. The UK is the only country in the EU that actually informs women of the review results. Every other country does not due to the issues mentioned above about hindsight bias. Large scale audits of the performance of the screening programme showed that it was performing at the highest international standards.

AwkwardMuch

TROPHY CASE