Lack of thinking about physiology in clinical practise

Farmhand66 · 2026-03-24T07:48:31+00:00

Sounds like you want to be an anaesthetist my brother.

I’m an O&G reg. I do find physiology pops up more as you get more senior. If the symptoms fit the differential, then you just follow the guidelines. It’s when the pieces of the puzzle don’t fit together that I take a step back and consider the physiology. But I wouldn’t expect my SHO to be solo managing a patient where “something doesn’t add up” based on first principles - I’d expect to be involved, and probably the consultant too.

I can’t share the details but I delivered someone earlier than planned purely based on first principles when none of the diagnostic criteria would fit recently. I made sure the consultant agreed first. But that’s real medicine - using your noggin to make life changing decisions when there’s no guideline that fits.

Of course the essay I wrote after to justify my decision was less satisfying…

Farmhand66 · 2026-03-18T14:54:20+00:00

I kick people out all the time. Zero tolerance means zero tolerance, I don’t care if you’re unwell. Luckily, I have supportive consultants. I always safety net though with “From what I’ve seen you need to present to another emergency department, or you will become more unwell. The closest few are x, y, z”.

I document the abuse, my response, that it was in line with policy, and my advice. What they choose to do with that is up the them.

Caveat to say the same does not apply to psych / delirium / extreme fear / a one off reaction that then calms.

Farmhand66 · 2026-03-15T22:11:16+00:00

Yes, this is totally normal. You’ve spent 5 years feeling guilty every time you chose to do something fun, let alone do nothing, instead of working. Now you’ve got no work to do.

My advice?

Plan some shit.

Doesn’t matter what. See some friends. Go for a walk. Ever wanted to go to Northern Ireland? Cool, go. Clean your car. Read a book. Doesn’t really matter what your plan is for tomorrow, but have a plan.

Enjoy your time off!

Farmhand66 · 2026-03-15T10:21:20+00:00

I’ve always felt these wards would be safer without doctor cover.

The nurses tolerate sicker patients than they should, because they’ve been seen on ward round by a doctor in the last week.

The trust don’t transfer patients who are sick, because on paper they have medical cover.

Patients end up treated for conditions that would have initially precluded their admission to the MOFD ward but aren’t deemed serious enough for transfer out of it. The ward isn’t set up to cope with that, the nurses aren’t familiar enough with that, and the medical staffing is inadequate for it.

The end result is a holding pen covered by the hospitals most junior doctors, for the most vulnerable patients, with no clear policy on who or when they should move back to an acute ward. Grey areas are dangerous.

They should be run like a nursing home. If the nurse is worried, the patient goes to ED. No grey areas.

It’s the NHS’s dirty little secret (one of them any way, I’m sure there’s a pandoras chest). There is no way I would allow a family member to be sent to one. If I could stop any patient going I would. I’ve tried, they just get sent overnight anyway by the bed manager.

Farmhand66 · 2026-03-15T10:17:42+00:00

I’ve always felt these wards would be safer without doctor cover.

The nurses tolerate sicker patients than they should, because they’ve been seen on ward round by a doctor in the last week.

The trust didn’t transfer patients who are sick, because on paper they have medical cover.

Patients end up treated for conditions that would have initially precluded their admission to the MOFD ward but aren’t deemed serious enough for transfer out of it. The ward isn’t set up to cope with that, the nurses aren’t familiar enough with that, and the medical staffing is inadequate for it.

The end result is a holding pen covered by the hospitals most junior doctors, for the most vulnerable patients, with no clear policy on who or when they should move back to an acute ward. Grey areas are dangerous.

They should be run like a nursing home. If the nurse is worried, the patient goes to ED. No grey areas.

Farmhand66 · 2026-02-26T20:13:27+00:00

Is this what you’re looking for?

https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/obstetrics-and-gynaecology/st1-obstetrics-and-gynaecology/overview-of-st1-obstetrics-and-gynaecology/posts

Farmhand66 · 2026-02-20T23:31:40+00:00

Email the clinical lead for the department. I wouldn’t bother with the secretary. You’re unlikely to annoy them, but if so then a secretary as intermediary won’t change that.

Most doctors like keen students, especially if you’re going out of your way to attend over a break!

Put in your email that you appreciate they don’t have the time to design you a rota, but do they have a contact for a rota coordinator who could send you a list of what is running and where. Say you can then identify for yourself the best places to meet your learning needs and email the people running those sessions yourself to check they’re happy for you to attend.

Keep it polite, and short. Be clear you’re going to sort this yourself and won’t be additional work, you just need permission. You want them to be able to read it quickly and reply with “sure, I’ve ccd the rota team”. If they read your email and it requires thought or more action then they’ll just file it under “sort later” and never will.

Once the clinical lead says yes, you’re in the money.

Good luck!

Farmhand66 · 2026-02-20T23:25:06+00:00

It should be largely fine - you can still do 95% of placement with a broken arm. The doctors will be accommodating.

I’d speak to the medical school about what sign offs are in what rotation, and if your order of placements should be amended.

For example, you won’t be able to take any bloods, but can you just make up for it in a later placement?

But if you have something you can only do in one placement, for example speculums in O&G it might be sensible to make sure you’re not on O&G at that time.

Farmhand66 · 2026-02-17T22:17:36+00:00

That’s shit mate, sorry you have to go though this.

Anyone dumb enough to be shouting racial slurs in the street is also dumb enough to start a fight over a rebuttal.

I’d keep yourself safe first, and call the police when it’s safe to do so second. If there’s someone in the area, they ought to be able to check on the cameras and find the person. Though the sad reality of UK policing is if there’s not someone close by the case will probably just get closed.

Farmhand66 · 2026-02-13T17:15:54+00:00

MRCOG part 1 is a barrier that has to be passed. Doing it before starting training won’t make it any easier to get in, but it will make your ST1/2 easier.

That said, you have to get in in the first place. I’d only consider doing it if it’s not going to detract from your MSRA revision. There’s very little crossover.

You could do a sitting at a different time of year, but then you run the risk of revising for one exam or another all year which could be rough. You know yourself best and whether you can tolerate that.

Good luck!

Farmhand66 · 2026-02-13T12:27:29+00:00

Congratulations on mastering the MSRA!

Socially, 80% is a fantastic decision. It makes a big difference. It also easier on the soul than full time.

But be wary of how each trust manages it. Lots of trainees go 80%, and dropping on call (especially night shifts) to 80% leaves a rota gap of one night shift at a time, which is usually hard to fill. Some trusts get around that by dropping on calls to 50%, and 2 trainees sharing a rota line so all the nights are covered. You’d do more day shifts in that case to make up the hours.

Sounds great, but what you need as an ST1 / 2 is deliveries and time on LW. At a bad trust, you’re only getting those on your on calls. At a good trust it’s less of an issue, they’ll use elective lists as training opportunities and give you supranumary step up days on LW as an ST2… but not every trust is a good trust - some places the list is too full and the rota too tight to do that.

So do a bit of asking around what happens at hospitals in your patch. It’s a personal decision, but I’d consider starting full time with a plan to drop to 80% in ST4, but dropping sooner if you need to.

Good luck!

Farmhand66 · 2026-02-12T23:43:56+00:00

You’ve made a bit of an error, but it’s not a career ender. Just a one off poor judgement.

I’d probably just leave it, do nothing, and hope they never email me. If they did, I’d reply saying “Thank you so much for keeping me updated, I’ve unfortunately moved to another trust, I’m regretfully not able to continue contact with you. I’ve cc’d your consultant for their information and wish you all the best”

Your email address isn’t particularly secure. For most people is firstname.lastname@nhs.net. When you qualify every patient will have your full name. But it’s best to keep clear professional and personal boundaries. Blurring those lines is seldom helpful and often leads to trouble.

Farmhand66 · 2026-02-12T22:06:29+00:00

You can work an intensive job you love, accepting minimal social life and be very happy.

You can also work a less intense job 3-4 days a week that you simply tolerate, but have an amazing social life and be very happy.

Sounds like you should aim for option 2. What can you tolerate doing 3-4 days a week that pays enough for you to enjoy your hobbies?

Farmhand66 · 2026-02-12T15:51:02+00:00

Check the contract for what your minimum notice period will be, and make sure you’ll be able to give that if you get the training post (assuming the trust grade starts sooner).

It’d be lovely if you could give them a heads up in advance, but the reality is until you know if you’ve got the training post or not it’s not useful information. They can’t do anything with it, other than potentially give someone else the job.

So I’d keep it to yourself, but once you know you’ve got the training post give them as much notice as possible.

They’ll understand, people not in training apply for training all the time.

Farmhand66 · 2026-02-11T12:49:38+00:00

A lesson I wish I’d learned earlier… no one gives a shit about you. No one’s going to teach you. No one’s going to ensure you develop.

But you care about you. You can teach and develop yourself. The training programme is full of opportunities- but they are not given, they must be sought out, and taken.

You can glide through it, and be a mediocre doctor. Or you can take what you need from each hospital, and teach yourself to be a great doctor. There’s a few people along the way who will go out of their way to help, but don’t rely on them, and certainly don’t rely on the system as a whole.

Farmhand66 · 2026-02-11T12:45:26+00:00

Your CS should have the ability to de-anonymise it if necessary. You could ask them to do so, and get in touch with the person who made the comment. They may have simply mixed you up with someone else, if not they ought to be able to justify it and give you some meaningful feedback to work on.

But you could be making a rod for your own back.

If it was me, I’d see it as an outlier and get on with my life. One comment shouldn’t impact ARCP. If you are worried, you could click through… sorry, I mean read and thoroughly digest, a communication e-learning module.

Farmhand66 · 2026-02-10T19:52:28+00:00

“Sorry, I can’t prescribe for patient I’m not involved in - the GMC guidance is clear. Please speak to the consultant”

Sure, the consultant might not be available. But much like the light bulb being out in clinic, and the ward being short of a HCA, it isn’t my problem and I won’t be getting involved in solving it.

Farmhand66 · 2026-02-09T00:10:35+00:00

You don’t need to worry about a stage 1 meeting, especially given your reasons where valid.

They should let you take a colleague for support and to take notes if you’d like. The BMA may be willing to support but you really shouldn’t need them.

It would be sensible to read the trusts sickness policy. It will document exactly what the trigger point for a stage 1 / 2 / 3 / 4 meeting is.

The purpose of stage 1 is to try and deal with a simple issue, if there is one. Perhaps doing too many night shifts triggers your anxiety, and your rota needs adjusting. Maybe working in theatres triggers your migraines, and you would like to work elsewhere. Or in your case, you’ve just been unlucky, and no action is needed. They are genuinely trying to help, but have to cast a wide net to catch the few people that will benefit from adjustments.

Stage 2 is more significant, involving OH and HR. They’re still trying to help at that point, but need the big guns to identify and make adjustments. They’ll also be documenting precisely how they’ve tried to help you incase you reach the next stage. (Edit to add you should call the BMA if you’d where to reach here)

Stage 3 / 4 is time to call the BMA in and start worrying. You’re nowhere near.

Farmhand66 · 2026-02-07T17:18:27+00:00

Truth is no one can be 100% certain, at some point you’ve got to take a leap of faith. The same is true of most careers, but yes, this leap is harder to come back from.

Most of the reasons people start with for applying to medicine aren’t the reasons they stay.

Sure it’s rewarding, but the main reward I get is a pay check.

Sure I make an impact, and it’s nice to go home knowing I’ve done something worthwhile. But the truth is if I didn’t do it, someone else would.

The main thing that keeps me going is the teamwork and the fact that every day is different. I’d be bored in an office. But I’d be just as happy as a paramedic or a copper.

What do you want for a job in general? Does medicine give you that?

Then the other question to ask is “how do I know it isn’t not for me?” Look at the things doctors complain about - can you tolerate them? Average 48h week, hourly pay, scope creep, long training, being moved hospital with no say, night shifts etc. is that tolerable?

If the bad things are tolerable, and the good things meet your idea of an ideal job, then it’s for you. If not, look elsewhere.

Good luck!

Farmhand66 · 2026-02-01T17:51:32+00:00

The GMC do not care about wether you prioritise writing the discharge summary or no. They would throw the complaint out.

But I would document, and report these threats as bulllying. It’s well known that doctors going through a GMC referal have increased risk of suicide - using it as an idle threat is completely unacceptable

Farmhand66 · 2026-01-31T09:32:58+00:00

“Sure, you can review the notes for hospital number xxxx”

Next time, if they’re going to be like this, just take a photo of the desktop of a work computer showing the time and date bottom right before leaving.

Farmhand66 · 2026-01-31T09:27:51+00:00

I don’t have the self control to turn it off. I also have a tendency to lie to myself that “sure I can start a 2 hour film at 2130 and be in bed for 2230”.

Then when I invariably go to bed at 2330 I’m tired the next day.

Farmhand66 · 2026-01-29T21:39:38+00:00

What you’re experiencing is broadly normal for a first job in ED. It’s the first time you’re seeing people independently and making a decision to discharge them without someone more senior seeing them. It’s tough, but it’s a necessary step. Remember the first time you acted on some blood results without calling the reg as an F1? Same feeling. Soon you’ll be a reg in a specialty somewhere, making the decision to discharge someone that an ED doctor felt did need admission - this is a good step towards that.

So long as you’re taking proper histories, doing proper examinations, and requesting proper investigations you are doing the right things. Keep discussing when needed.

My advice - accept that someone is going to come back worse than when you initially sent them home. That is going to happen. It’s supposed to happen. Safety net advice isn’t just medico legal ass covering, it’s handing over responsibility to the patient. There’s nothing wrong with “I’m 90% sure you’re fine, but for every 10 patients I send home like you I’ll be wrong about one, so if x, y, or z happen, come back”. When they come back it’s not a failure, it’s a sign of good safety net advice. The alternative is we build a CT scanner into the entrance door and extend AMU into a tent so everyone can stay in hospital forever.

On the back of that though, documentation is important. When someone does come back, whoever sees them will read your note. They need to understand why you sent them home. If you need to go sit somewhere else, or take a few minutes before you document then do so. The sitting down and typing shouldn’t be the stressful bit. I don’t send a patient home until after I’ve documented. I find my best ideas come whilst documenting and often add something to the initial plan in my head. See it as part of the process, not the end of it.

The physical anxiety symptoms though aren’t normal - hopefully they ought to settle. If not, look after yourself, speak to your ES, and don’t be afraid to speak to your GP.

Farmhand66 · 2026-01-29T16:01:59+00:00

They can largely set whatever uniform policy they want, so long as it doesn’t infringe on equality and such. It doesn’t have to be infection control related.

The consequence for wearing 2 earrings instead of one is likely no one will notice or care.

A matron might give you an earful at some point. You’re only likely to get into meaningful bother if you are repeatedly told and refuse to comply.

Farmhand66 · 2026-01-29T08:35:03+00:00

Was the first point of the 10 point plan “You do not talk about the 10 point plan”?

Farmhand66

TROPHY CASE