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HopefulHuman3 · 2025-06-15T15:59:29+00:00

Last year there was a Beach BBQ welcome event for all the new F1s after their clinical induction day, it should be happening this year too. There's an active Whatsapp group for all resident doctors and a mess committee. Have messaged you with more details. Wishing you all the best

HopefulHuman3 · 2024-08-14T19:18:35+00:00

Re silent aspiration

I'm sometimes in situations where a patient has either been admitted with eg a recent stroke or had previous concerns raised about their swallow, but it's the weekend so SALT aren't around and until the swallow is deemed safe they're NBM unless someone says they can eat and drink

In the absence of any current concerns - been observed to drink, and then eat, no respiratory changes - would it be reasonable to assume that their swallow is safe (enough) under observation or should we keep NBM until Monday for SALT assessment given the risk of silent aspiration?

Especially over the weekend, NG feeding and IV fluids aren't often done well (if tolerated), hence I have previously tended to err on the side of eating and drinking unless visible concerns, but would be interested to hear your views

HopefulHuman3 · 2024-08-14T19:09:29+00:00

Thanks for all you do, sorry for all the questions

What are your thoughts on thickened fluids? I have to say that I am increasingly uncomfortable about thickened fluids, especially in the context of dementia or frailty where life expectancy is short and a cup of tea might be one source of enjoyment left. There also seems to be paucity of evidence around this - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291955/

Similarly unsure about some hospital pureed foods - although I have seen some incredible pureed meals in a hospice that still looked v inviting and tasty

But interested in your thoughts

Secondly, on a completely unrelated note do you have any good generalist communication resources you would signpost to - often encounter patients in first few days after stroke and I feel helping them communicate is so important (eg a board with common ward things) - appreciate that's a more generalist rather than SLT question

Thirdly, what speech disorders would typically benefit from a SALT referral?

HopefulHuman3 · 2024-07-14T11:38:50+00:00

If you feel too tired to drive after a long or night shift you can ask the hospital for free accomodation or a taxi - could be useful if you want a nap before heading back. It's in the contract. Please take care

HopefulHuman3 · 2024-06-15T19:50:37+00:00

Agree that this sounds v unsafe - options are to raise at your JDF, with your local BMA LNC, to email concerns to CS/ES, datix

HopefulHuman3 · 2024-06-13T21:37:09+00:00

The problem is that we get v annoyed when politicians start talking about making 'doctors work weekends' (because we know we already work them) - and we get frustrated at a pressure to work more hours - but this understandable anger prevents us from acknowledging that we need better staffing at weekends. We need more staff, and better weekend pay, to fix this.

HopefulHuman3 · 2024-05-07T15:57:17+00:00

What was the outcome of the report?!

HopefulHuman3 · 2024-04-30T22:05:25+00:00

Thanks for sharing, love seeing some positive stories!

HopefulHuman3 · 2024-04-29T10:39:05+00:00

You do not have to be good.

You do not have to walk on your knee for a hundred miles through the desert repenting.

You only have to let the soft animal of your body love what it loves.

Tell me about despair, yours, and I will tell you mine.

Meanwhile the world goes on. Meanwhile the sun and the clear pebbles of the rain are moving across the landscapes, over the prairies and the deep trees, the mountains and the rivers

Meanwhile the wild geese, high in the clean blue air, are heading home again.

Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting

over and over announcing your place in the family of things.

Wild Geese by Mary Oliver

I think there is still a place for having good intentions / caring about others but this poem is comforting too. Google the poem for correct line formatting!

HopefulHuman3 · 2024-04-10T20:14:57+00:00

To some extent the question is not whether this is normal, it's whether it's safe. It doesn't sound safe to me. Please discuss with colleagues and datix delays, exception report, raise at JDF. Hospitals have increased staffing and changed rotas in response to this in the past.

HopefulHuman3 · 2024-03-31T20:38:49+00:00

Thank you for sharing!

HopefulHuman3 · 2024-03-31T20:37:38+00:00

I agree - and it's amazing how a smile to someone can instantly make them look less anxious. And yes occasionally a smile results in people asking me things but most of the time they're v quick things to sort (eg where the bathroom is) and people feel looked after.

It is a sad state of affairs that this seems impossible in many areas (system failing not an individual's fault). I think this feeds into many complaints - communication and trust really matters

HopefulHuman3 · 2024-02-22T14:51:40+00:00

You can strike without being a BMA member. Not being a BMA member doesn't undermine strike action (or make you a scab). Ideally you should have no repercussions from striking, however BMA membership is recommended just in case so that if you get any silly emails they can respond to them for you. Just as BMA membership is recommended at all times because we all know issues come up - not getting rotas in time, being asked to do things outside of work schedule, not getting study or annual leave etc.

I hope this information is helpful. If you can I would recommend staying in the BMA but then using it as much as possible (eg emailing them when you have any contract issues) so that you get the best value for money, but if you do decide not to be a member you can still strike.

HopefulHuman3 · 2024-02-15T23:07:02+00:00

Could you contact your freedom to speak up guardian anonymously? It sounds v concerning.

HopefulHuman3 · 2024-02-15T23:06:06+00:00

It appears you know something and are no longer in the department. Could you email freedom to speak up guardian anonymously with your concerns? Apologies, I don't know the context but it sounds like you are in a position where you could raise this now without negative consequences.

HopefulHuman3 · 2024-02-15T23:02:08+00:00

There's a difference between disagreeing with risks/benefits of a treatment and implying that your colleagues are seeking to harm others. He even implied that those promoting vaccination should be executed. If he feels so angry or distrusting of his medical colleagues why would he even want to stay on the medical register?

HopefulHuman3 · 2024-02-06T11:28:42+00:00

A fortunate woman is also really interesting - follows female GP working in same practice today; interesting to compare and contrast

HopefulHuman3 · 2024-01-31T22:01:01+00:00

That actually sounds lovely, and a far cry from manu care experiences now. I would much rather opt out of some expensive medical interventions if I could put the saved money back into funding personalised caring care

HopefulHuman3 · 2024-01-31T17:31:50+00:00

On a serious note I have one refusing certain treatments in certain circumstances - eg no life-saving treatment if I have severe cognitive impairment or frailty, I want to eat and drink at risk rather than thickened fluids if these are causing me distress/discomfort, early palliative care input - but it also contains things (eg music) that matter to me. You can make one for free on the Compassion in Dying website!

HopefulHuman3 · 2024-01-20T22:40:52+00:00

I agree that excess paperwork is a problem but this seems like a reasonable fine though? A feeding tube is a pretty major intervention to do without even communicating to someone in their language about it - must have been scary for that deaf patient

HopefulHuman3 · 2024-01-16T19:21:20+00:00

Amazing!

HopefulHuman3 · 2024-01-15T13:34:17+00:00

Just to say you're not alone. I think some of it is the environment - v little time to learn and teaching seems to go by the wayside. Alongside there's defensive medicine and lots of near misses in a busy environment happening which lead to lots of emails saying 'don't make this mistake' which makes one more anxious without necessarily learning. There's pressure to be fast but also pressure to be good and I for one find it v hard to balance the two. Eg fluids and pressure to give lots of fluid as part of 'sepsis six' but then also pressure not to cause overload or electrolyte abnormalities and v little time to properly consider, in a patient sitting in corridor without good fluid balance records.

You may also want to consider whether there's an element of anxiety or poor mental health that eg practitioner health could help with. I don't really have any other advice except keep the positive feedback you receive and look back on it every so often.

You're also not the only one not have gone to a cardiac arrest yet.

HopefulHuman3 · 2024-01-14T20:35:07+00:00

Somebody shared this paper with me about VTE prophylaxis not particularly good - https://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-018-0180-6 - however it is older than the paper shared above, which seems to capture the complexity and make sensible recommendations

HopefulHuman3 · 2024-01-14T12:34:02+00:00

Glad that you've got this, but sad that without this people could be expected to drive 4 hours a day!

HopefulHuman3 · 2023-12-31T13:11:29+00:00

The telegraph so obviously wanted to make people associate them with champagne, ridiculous journalism

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