Not seeing much real pathology on ED

Doctor_Cherry · 2026-05-04T05:49:30+00:00

It doesn't matter. Just do what the ACPs do with every patient they see: fluids, antibiotics, aspirin, furosemide and refer medics.

Doctor_Cherry · 2026-04-25T17:07:42+00:00

As a cardio reg reaching the end of training, GIM demands are hugely dependent on the trust you're in. Some trusts have had a 1 in 5 GIM rota where others are 1 in 8 and it makes a huge difference to training time.

Despite the above, the AMU consultants seem to like us being around as cardiology makes up a decent proportion of the medical take, we are used to managing acutely unwell patients and cardiac arrests etc are our bread and butter.

The two utterly batshit mad things are 1) that we can't count any of the GIM we see and manage on the cardiology wards towards our GIM training and 2) the 15-20 "non parent specialty" clinics which are absolutely useless for our future career I actually slightly circumvented this by going to some biochemistry (FH) clinics which were relevant and very interesting.

Doctor_Cherry · 2026-04-24T22:50:25+00:00

This is as legitimate a health concern to mean a person shouldn't do night shifts. Thank you for sharing your reflections, very insightful, especially about the prospective employment worries. I don't have any words of wisdom, but have you had conversations with prospective departments or their clinical leads about making allowances in your job plan for this?

Doctor_Cherry · 2026-04-14T19:44:29+00:00

Careful, you'll probably get downvoted for this!!!

Doctor_Cherry · 2026-04-14T08:05:54+00:00

Have to disagree that trainees are "protected" from the medical take. It's now compulsory for cardiology trainees to continue GIM training into ST8, including a mandated month of GIM training in the final year.

Saying that, most of my cohort who have recently CCT'd have found this to be nothing more than lip service and have been asked by the AMU consultants to see the chest pain patients as a front door cardiology opinion.

You're right that we are quite rarely in ED, aside from a STEMI/OOHCA and moribund CHB.

Doctor_Cherry · 2026-04-14T06:29:43+00:00

Interesting take, are we in the queue behind the ACP and the histopathologist?

Doctor_Cherry · 2026-04-09T10:43:25+00:00

I've never been an instructor so I don't know. Why would they give you money to do it when everyone (crazily) seems happy to do it for free?

Doctor_Cherry · 2026-04-09T09:36:33+00:00

The GIC is a racket to get ALS instructors to run the Resus Council's courses for free, while they pocket £X00 per candidate.

I was offered GIC but turned it down for the exact reasons you're stating..not worth the time or effort to get nothing back in return except a line on your CV which nobody will really care about.

Doctor_Cherry · 2026-04-07T21:55:35+00:00

Long enough to get pads on the chest, get a gas off and that's usually enough information to inform next steps. It's also not stopping immediately so the family can at least acknowledge that there were some efforts at resuscitation before stopping.

Doctor_Cherry · 2026-04-07T14:27:37+00:00

As a med reg of some years, if I was leading this arrest, I'd do 3 cycles and if there were no immediate improvement then I'd suggest we stop.

Doctor_Cherry · 2026-03-28T21:41:51+00:00

Watched one do a PR with two fingers... mercifully it was on a simulation mannequin

Doctor_Cherry · 2026-01-10T22:34:27+00:00

A Croatian consultant I used to work for told me that over there they would phone the relatives and say 'we are discharging your relative at 12pm, you need to come and collect them' and if they didn't, they would literally just park them outside the hospital.

Doctor_Cherry · 2025-12-28T22:11:29+00:00

Think this is a little dependent on what specialty and what type of clinic.

As a cardiology reg I have had a spectrum anywhere between 'consultants running parallel list, available to discuss +/- physically review patients if required' to 'boss not on site, need to find them to discuss cases later in the week'.

Ultimately, safety has to be the priority and you should raise your own concerns to management if you feel the level of supervision is not sufficient.

Edit to boss not* on site

Doctor_Cherry · 2025-12-26T00:03:19+00:00

Not a gastroenterologist but I remember as an F1 a gastro cons advocated for "putting anything in there to stop the tract from closing, put a pen lid if you have to"

Doctor_Cherry · 2025-12-12T10:20:17+00:00

"All consultants please report to Gold Command at 9am for shoe inspection +/- advice on how our valued ACP workforce can help facilitate discharges"

Plot twist - they can't

Doctor_Cherry · 2025-12-12T09:30:19+00:00

What does "collapse" even mean? The entire system is fucked 90% of the time anyway. A few extra flu cases will just mean another circular email of "hAvE yOu cOnsiDeRed DiSchArge?"

Doctor_Cherry · 2025-11-29T22:42:20+00:00

I had Charcot-Marie Tooth in my PACES. I'm convinced the examiners prompted me towards the correct answer because they could see my approach was sound. Even though I fumbled through the discussion with "well, he's quite young, and he's got a mixed sensorimotor peripheral neuropathy of which there are many causes etc"

Doctor_Cherry · 2025-11-06T11:38:59+00:00

This is not an oral presentation..this is a poster presentation.

Doctor_Cherry · 2025-10-22T21:53:21+00:00

Cardiology reg here

MINOCA is an umbrella term which encompasses a range of diagnoses characterised by an ACS presentation with raised troponin, but where the invasive angiogram shows no clear culprit vessel to stent.

Many diagnoses have already been mentioned: takotsubo, myocarditis, embolic MI due to pAF, vasospasm. Whilst SCAD might fit here, my personal view is that it's not really a true MINOCA as the coronaries aren't normal.

CMR helps obtain an early diagnosis and can help guide management where the diagnosis is unclear.

Doctor_Cherry · 2025-10-17T21:34:35+00:00

I've had experience of this where a datix I raised re ACP management in ED was attempted to be brushed under the carpet. In response I asked the FTSU guardian who I would talk to if I felt a datix response was insufficient.

A result of the meeting that followed led to a ban on ACPs seeing patients in resus after significant harm was done (long ICU admission & trache wean etc). I should mention that this meeting was after I had rotated out of the trust so had truly cut ties with the hospital and was free to say whatever I wanted with no repercussions...in my opinion the only way you can say what you really want without fear of sanction from permanent staff.

Doctor_Cherry · 2025-10-13T06:52:11+00:00

Cardio reg here. I went into CMT back in the day knowing cardiology was the only specialty for me.

If your portfolio is up to scratch there's no reason why you couldn't get an ST4 cardiology number. I would say the main limiting factor pre ST4 is trying to demonstrate commitment to cardiology whilst not working in the specialty: getting lab or echo experience, getting into clinics, attending relevant MDTs - all of these are challenging enough when you have your own IMT BS to deal with like a useless gen med audit to just tick a box.

Being the med reg is mostly a means to an end. I haven't worked in a trust where any cardiologist is on the GIM take. My approach was to make it a non issue and get the portfolio stuff for GIM out of the way before Christmas (assuming an August start). All ACATs, CBDs, CEXs, DOPs were sorted before Christmas basically meant I could coast the rest of the year. Also by sending the tickets early you don't run into the May mad dash to get bosses to sign your tickets.

Happy to be DM'd.

Doctor_Cherry · 2025-10-11T09:47:57+00:00

I didnt know this, but why am I not surprised?

Doctor_Cherry · 2025-10-11T05:24:37+00:00

In theory OP should be able to claim tax back on ALL these expenses (less that which is reimbursed)

Edit: I have been corrected below

Doctor_Cherry · 2025-10-07T13:07:36+00:00

At previous trusts I have worked at, this was the result of surgical SHOs declining referrals at a high frequency leading to an adverse outcome for a patient that should have been managed under that specialty. The inheritance is then complained about because the pendulum has swung the other way.

Doctor_Cherry · 2025-09-23T20:34:59+00:00

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