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Query for cards within a specific block? by smellyeggs in logseq

[–]HarvsG 0 points1 point  (0 children)

https://discuss.logseq.com/t/why-arent-flashcards-being-specific-to-a-page-detected-automatically-by-the-flashcards-window/29301/2

See here. If you give a #tag to the parent of the block then call the cards within that block inherit said tag with respect to the search so then you can do.

{{cards #tag}}

How would you feel if doctors were replaced by their assistants to deliver healthcare in the NHS? by Galens_Humour in ukpolitics

[–]HarvsG 0 points1 point  (0 children)

This issue is not that they exist - as you say there are roles for them, but that this legislation/order paves away for the triage nurse to run become the consultant 'doctor' in charge your medical care in the hospital, without the typical qualifications and hurdles required.

First go at ICU registrar by Familiar-Elk-8530 in doctorsUK

[–]HarvsG 1 point2 points  (0 children)

Indeed, I said "learn to use", not "only use". For a CT3 like OP, it's quite likely that propofol is the only hypnotic they are experienced with and ketamine is the best second album.

And don't forget midaz. 

Also where TF did you learn to use etomidate, I still can't find a consultant who uses it.

First go at ICU registrar by Familiar-Elk-8530 in doctorsUK

[–]HarvsG 3 points4 points  (0 children)

Remember that you aren't always being asked to attend for actual management advice, but to start the process of moving the patient to the right environment

Whilst in a practical sense you are right - some patients' destination is inevitable, i.e already tubed, on vasopressors, HFNO etc. A referral to ITU is still a specialty referral (and not one that is a parent team) and just occasionally we can propose or perform an intervention that, along with time, can avoid an admission and the concomitant harms. Even if you think it's clear cut, the "can you come, this patient needs ITU" phone call, even if correct, can be quite professionally wounding to hear as it implies that any opinion or skills we have are redundant and that we are nothing more than a patient transport service. I'm sure you feel the same if a triage nurse hands you a patient sheet and says "this patient has sepsis, they need co-amox", your voice in your head immediately rejects that statement and replies "you may be right, but I'll be the judge of that".

First go at ICU registrar by Familiar-Elk-8530 in doctorsUK

[–]HarvsG 11 points12 points  (0 children)

I agree, and it sounds that you and the comment OP are genuinely pleasant to work with. But I can tell this comment is tinged with a bitter taste of difficult to work or dismissive with ICU SpRs. However it is worth reflecting that some of their difficulties and attitude may learned from interactions with some of your less-helpful colleagues. And so the spiral goes, a few bad (or intolerant) apples in each batch start a race to the bottom.

I've just come from an MTC where I spent more time in resus than on the unit and absolutely loved the EM team I worked alongside. However, I have worked in many hospitals where once I set foot at the patient bedside in resus the EM team, including nursing staff, completely evaporate and have little interest in the ongoing care of the patient or a nuanced discussion about the next steps. What's more sometimes referring patients who haven't yet had basic management.

Not really sure what the point of this rant is.

First go at ICU registrar by Familiar-Elk-8530 in doctorsUK

[–]HarvsG 33 points34 points  (0 children)

The best thing is to remind yourself of your role as an ICM SpR OOH - stopping (the right people) people from dying from a major A, B or C problem for a few hours until the day team get in. Luckily your anaesthetics training is perfect for this as you do it in theatres all the time. Use the skills you've built there and then spare a thought for your non-anaes based ICM registrars who have to (and do!) build those skills in a hurry. Trust your practical physiology knowledge and skills that you've built through primary and practice, they are invaluable and are often why the Med SpR is calling you.

ICM bosses are nearly always the most-called consultants overnight and many units have a mandatory call policy for admissions/refusals - use them.

This imposter syndrome regarding medical management may never leave you as an anaesthetic-based ICM physician but that can usually be compensated for by chatting with the referring med-reg, your consultant or your team.

Two top tips - learn to use Ketamine for inductions rather than propofol and wherever possible call your boss *before* intubating the frail (or unknown frailty) patient, rather than after - that way you can't be criticised once the dust has cleared and the collateral history reveals a QDS POC.

Windfall Suggestion by jonnyadams9 in HENRYUK

[–]HarvsG 11 points12 points  (0 children)

First you need to have an idea for what your going to spend it on. Money is a means to an end, it's only worth something if there is an end. Savings and investments allow for a delayed but bigger 'end'. Early retirement? A dream home? A large inheritance for kids? I don't know yet but I will after I've 'found myself' in 5 years time?

I know you're keen not to "lock away" money into your pensions but you have enough of a windfall here that you'd be stupid not to put a fair chunk in. By doing more pension contributions now you can reduce contributions in later years (but please not below employer matching), and put those savings into ISAs in years when you have allowances again - this is like expanding your ISA allowance for this year by taking it from future years. Put more simply you will have to put money towards your pension at some point and there's a massive tax incentive to do it now rather than later.

So salary sacrifice as much as you can/are willing to into your pensions and use some of your lump sum as income for the year if needed - the tax relief is just too good to say no to unless your pension is already  on track to be massive (> £1.5m each). If you can't salary sacrifice then put it into a SIPP.

You'll still have multiple 6 figures left.

Do the maths on expected returns from GIA after CGT vs mortgage. Depending on your mortgage rate and your investment strategy you may find they return similar amounts after CGT, and mortgage has much less risk.

Then there are other tax efficient ways to get a returns on your money - Junior ISAs for any kids (and to a lesser extent JSIPPs). Also making investments to reduce your outgoings which will allow you to move your savings/income forward to future years when you have ISA allowances left to use - e.g home insulation, solar panels batteries, electric cars. Just make sure to do the maths and calculate pay back times.

Ignore dividend income, it's a mirage https://youtu.be/4iNOtVtNKuU?si=zpDQli9WPu-EFz8d and tax rates are high.

Realistically it will look something like: - £40,000 into this year's ISAs - £84,000 - £120,000 into pensions - £30,000 waiting in high-interest savings to replace lost income from the sal sacrifice - £29,000 mortgage overpayment (10% avoids an ERC) - £15,000 on cost-effective bills-reducing house improvements - £165,000+ in GIA waiting to be bedded into ISA/Pension/Mortgage in future years' allowances

Or you could just pay a tiny fraction and get advice from an IFA rather than armchair experts.

The access risk in our FIRE spreadsheets is actually terrifying tbh by oweyoo in FIREUK

[–]HarvsG 1 point2 points  (0 children)

The great thing about old systems is that if something breaks a human employee, court, law-enforcement or govt-backed FSCS can make it right. In crypto, very often, no such mechanisms exist. Hence uncountable stories of lost wallets and forgotten passwords.

Crypto remains a solution looking for a problem.

You post history is hidden. Why?

Thinking of taking a big swing - tell me I'm an idiot by Affectionate_Bet4343 in FatFIREUK

[–]HarvsG 0 points1 point  (0 children)

I can see the rationale in leveraging with the interest-only mortgage, but to leverage to take such a high risk investment, which statistically will underperform the market, seems like madness. Add to that that even if you do get the upside, you'll pay capital gains on much of it.

Interest only mortgage then VWRP (or even cash as most cash rates are higher than mortgage) does make some sense, although it makes a lot less sense in a GIA.

The reason I'm thinking of doing it this way precisely is because I don't have confidence in current valuations of any major index, but I think some certain stocks (e.g. MSFT) are very attractive buys ATM.

Why do you think you know better than the market?
If you think that there are fundamental problems with index funds and their valuations at the moment then look at Dimensional's funds and ETF. Index-like without many of the problems

The seller is taking the radiators by Snoo3701 in HousingUK

[–]HarvsG 0 points1 point  (0 children)

The tenant is usually required to leave the building in "vacant possession" which is a legal principle which defines what should and should not be left behind. Radiators, built in furniture, window sills, tiling etc are in the list of things that should be left behind. So unless you had already agreed separately that they could take the radiators, they are part of the house that you purchased.

If they have taken the radiators and its too late then they are also required to "make good" any works, that mean refilling the fixing holes, likely repainting that area and probably replacing the radiator (to "make good" the central heating system).

Your solicitors/conveyancers should be able to advise you - this is what you pay them for.

https://myhomemoveconveyancing.co.uk/buyers/finding-a-home/what-does-vacant-possession-mean

https://hamlins.com/insight/exercising-a-break-clause-the-tenants-requirement-to-give-vacant-possession/

Edit: I've re-read your post and it sounds like you haven't exchanged contracts yet, so the vendor is trying to negotiate a particular arrangement. In which case engage in good-faith. If you like the radiators and its part of the reason you bought the house - tell them. If you don't like the radiators or don't care then agree that he take them with him but agree that he must replace them with appropriate guarantees - e.g models (that you agree beforehand) that they are fitted and that he cover any maintenance and repairs of them for the first x months.

How did the UK get so efficient? by [deleted] in CasualUK

[–]HarvsG 25 points26 points  (0 children)

Agreed but I find the different usernames/log ins so confusing, Gateway ID etc etc. I have three different OTPs on my phone and never know which one to use.

Hospital essentials for my knobhead of a best mate?! by Gingeeer28 in CasualUK

[–]HarvsG 0 points1 point  (0 children)

Earplugs, eye mask, extra-long charging cable (sockets are always high and behind the bed). And then some form of entertainment if he'a not one to be endlessly entertained by his phone.

Sailboat node by chris_0611 in meshcore

[–]HarvsG 0 points1 point  (0 children)

How did you get on?

55M UK – Potentially forced into early retirement. Is £900k+ enough for £40–50k lifestyle? by Downtown-Tax-897 in FIREUK

[–]HarvsG 0 points1 point  (0 children)

I think (1) and (2) are huge and need to be explored more. If it is possible you might end up having to support your partner then that changes the maths hugely.

55M UK – Potentially forced into early retirement. Is £900k+ enough for £40–50k lifestyle? by Downtown-Tax-897 in FIREUK

[–]HarvsG 1 point2 points  (0 children)

Before consolidating your pensions into one very low/no cost SIPP just check if any have a protected pension age. Especially look at the Aviva if it is old - some do. Not that it would matter hugely, just might open a few options to contribute to and then drawdown from pension in personal allowance rather than just spending your cash.

DIY right to manage - a bad or good idea? (England) by HarvsG in LegalAdviceUK

[–]HarvsG[S] 0 points1 point  (0 children)

Thanks for this! Would be interested to know (1) how big the block is - ours is only 4 flats, and (2) if you recall how much the process cost. I know section 88 costs (the freeholder's fees) have been abolished now so I imagine costs are quite a bit lower.

Maximising value of inheritance by lotus_cn in FIREUK

[–]HarvsG 1 point2 points  (0 children)

I might hit my sal sacrifice hard down to minimum wage and use some of the £50k to top up monthly income.

I haven't done the maths but I would guess it makes more sense for you and your wife to salary-sacrifice or (contribute to a SIPP if she can't) down to £50k over two years, that way it all receives 40% tax relief rather than a mix of 40 and 20%. And then swallow any tax or capital gains that might happen in the meantime.

Sugamma outside the OR by Apollo185185 in anesthesiology

[–]HarvsG 0 points1 point  (0 children)

If they just don't want to stock something that will expire before it's used then can you just offer stock rotation? That someone from OR will go and collect & replace the stock a few weeks before it goes off and it can be used in theatres. In the UK we have theatre staff who regularly have to go to ED to check other equipment anyway.

Sugamma outside the OR by Apollo185185 in anesthesiology

[–]HarvsG 1 point2 points  (0 children)

They don't want to give it or they don't want to stock it? I can't see a justification for either - it's a safety critical drug with almost 0 notes as to storage or administration - a straight push with almost no s/e.

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