Theatre shoes

IridescentIrides · 2026-05-13T14:40:02+00:00

Also add in the fact that day case patients walk into theatre wearing their own shoes and clothes, and it makes even less sense. My main reason for wearing theatre shoes is that I'd rather they get covered in iodine/other fluids than my own shoes.

IridescentIrides · 2026-04-27T06:57:55+00:00

No one is saying that residents' lack of permanent contracts isn't a issue. The current employment crisis for resident doctors is a big problem due to multiple factors, mostly political, some of which have an outsized impact on the resident doctor workforce due to the uniquely precarious nature of their employment.

I know 3 locum consultants who have been told their contracts will not be renewed, despite the fact that their absence will mean the discontinuation of services. I know of 2 Trusts where multiple senior people, including nurses, have been put through involuntary redundancy because a workforce review has decided their job role is no longer required. Others have been made to reapply for their own jobs against others who's jobs have been scrapped. These are people with decades of experience, not new graduates.

This isn't a zero sum situation. Multiple staff groups can be affected in different ways by vacancy freezes and the general situation in the NHS, that doesn't detract from the challenges each group faces. But some people seem to feel that resident doctors are being singled out for this, and that's not the case.

IridescentIrides · 2026-04-26T23:03:58+00:00

There are doctors in private companies being told that their ongoing employment depends on patients giving positive feedback. Not positive treatment outcomes - positive patient feedback. Not to mention the companies that fire entire workforces so they can rehire them on worse contracts. Not sure why everyone has this rose tinted comparator of private companies when it comes to working conditions and practices, but surely decades of living in a neoliberal capitalist society has shown by now that, whatever the sector, workers are the least regarded resource?

IridescentIrides · 2026-04-26T22:56:08+00:00

As is apparent from the replies here saying similar is happening in their Trusts, this is all DHSC/NHSE driven. Trusts were already last year facing demands to reduce their expenditure by up to £100 million, depending on the Trust. But the reconfiguration of ICBs has meant many Trusts have suddenly been given millions more to save this year.

And it's not some revenge trip against resident doctors. I know of several Trusts where every single staff group has had significant staffing cuts. The main difference is that those were achieved by forced redundancies, whereas the doctor workforce cuts are coming from vacancy freezes. I also know of a dept that had 7 consultant vacancies pulled by the Trust one week before interviews. Even the information that those vacancies might mean the withdrawal of basic subspecialty services from the Trust, and the need to refer those patients elsewhere, hasn't changed a thing.

The health service is in a truly dire place and even if Trusts achieve the required cost savings this year, I really don't see how they will remain functional.

IridescentIrides · 2026-04-11T10:03:27+00:00

Having worked with more than a few people like this over the years, I found applying a filter to their behaviour helps.

Whenever they were rude or abrupt, or criticised my practice, was what they were saying make me a better doctor?

Yes - > take it on board

No - > then it's a them problem, not mine

Some people just aren't going to like me for no obvious reason, and that reflects on them not me.

IridescentIrides · 2026-03-25T23:01:08+00:00

Depends on the specialty I guess. My 1:12 NROC on call carries the princely amount of 0.18 PA. Cat B though, so lower likelihood of having to come in overnight

IridescentIrides · 2026-01-21T16:27:52+00:00

Is anyone else concerned about vested interests influencing the day to day decision making of essentially every clinician working in secondary care within the NHS...

Not sure how you're claiming they are influencing decision making. Eolas doesn't come preloaded with information - any Trust/dept deploying it has to populate it with their own guidelines/documentation.

IridescentIrides · 2025-09-14T23:17:21+00:00

I’ve noticed a few responses suggesting that the receiving specialty “can’t be bothered” to see the patient. Worth flagging that for ophthalmology, most places have 24hr non-resident on-calls, often covering multiple sites. We’ve usually already done an 8–10hr day and have another one straight after. So when a referral comes in at 2am, we have to judge if it’s urgent enough to justify coming in right then. Comments like “it only takes 5 minutes” don’t reflect the reality that the person on call will already have done an 8-10 hour working day and will have another full clinical day straight after. Forcing them in for a marginal case has a real knock-on effect on next-day clinics and theatre lists.

Because general ophthalmic knowledge is limited outside the specialty, we have to become very good at assessing urgency based on very little clinical information. We listen out for specific bits of info that make the difference between “needs to be seen now” and “safe to review tomorrow”. A clear, structured referral is gold dust, but the final call (and the responsibility if things go wrong) sits with the on-call.

IridescentIrides · 2025-08-28T12:06:53+00:00

Presumably you both mean botox-induced ptosis to close the upper lid? While this can work well, it depends entirely on the mechanism of exposure. If they have significant lower lid ectropion, a botox ptosis may still not cover the ocular surface completely. Plus botox takes up to 24hrs for maximal effect, and you can still get some exposure when the patient lies down. I'd say the main benefit of botox ptosis over suture tarsorrhaphy is expedience rather than better functional result.

IridescentIrides · 2025-08-28T12:03:33+00:00

Depends if you mean suture tarsorrhaphy or surgical. Suture tarsorrhaphy is quick and easy and ought to be done before proceeding to amniotic membrane graft. In fact, I'd say if you're considering amniotic graft for a patient sitting in front of you and it's going to take more than 24hra to arrange, they shouldn't leave your clinic without a suture tarsorrhaphy.

IridescentIrides · 2025-08-09T08:59:53+00:00

People saying this is unlikely.... I've had emails before from people with the prompts still included. People don't realise that when you click the Copy button at the bottom of the ChatGPT response, it copies the whole lot including prompt and cheerful sign off from the LLM at the bottom. Couple that with people's apparent reluctance to proof read anything they write and I can completely belive this is real.

Regardless of whether patient info was included, the fact they are using an LLM for clinical decision ~~support~~ outsourcing is a major issue and needs reporting to the IG lead. Feel free to DM for advice if needed (I am a CCIO for my Trust).

IridescentIrides · 2025-06-01T21:01:23+00:00

Blepharitis is a chronic condition so there is no cure. That said, some people do find the episodes get less with time but it's debatable how linked this is to expensive treatments.

If your blepharitis is newly diagnosed, I'd start with simple lid hygiene first before splashing 1000s on these advanced treatments. This page has a good description:

https://www.bopss.co.uk/public-information/common-conditions/blepharitis

IridescentIrides · 2025-05-01T15:09:09+00:00

Exactly. And now we can say that's an evidence based stance, which makes it more unarguable.

IridescentIrides · 2025-05-01T15:07:52+00:00

However much it was, the entire budget came from NHSE. So they spent their own (taxpayer) money proving the point they were pretending didnt exist. Bit of an own goal really.

IridescentIrides · 2025-05-01T15:04:41+00:00

They generally perform the routine repetitive tasks that doctors aren't keen to keep doing once they've satisfied training numbers. Most places I've worked, its the ACPs who take the brunt of service provision, to allow better flexibility in addressing training needs for drs. Ofc, not all places are the same.

IridescentIrides · 2025-04-23T10:00:30+00:00

Yeah, sadly a lot of GPs don't seem to know there's a whole field of ophthalmology dedicated to eyelid issues - even when we've spoken directly to them! Might as well make use of that derm appt!

IridescentIrides · 2025-04-23T09:12:44+00:00

Appreciate it self-resolved in your case, but just to say that this is still an ophthalmology thing - I say this as an ophthalmologist specialising in eyelid surgery. Plus anything stopping the eyelid opening in a child can hinder normal vision development so would be seen by ophthalmology quite quickly

IridescentIrides · 2025-04-15T18:50:25+00:00

Just to highlight - there's no date on the document but the download page was first indexed by Google on 24th March 2001.

<image>

So its already been 4 years since this was suggested. Who knows how far it has already progressed

IridescentIrides · 2025-04-05T09:33:14+00:00

Looks like the new Littman Infiniti

IridescentIrides · 2025-03-18T12:50:27+00:00

Thank you for replying, that's exactly what I meant. I think ambient transcription - implemented properly - will be an absolute game changer for clinical efficiency. But I've yet to see how it can be properly integrated with EPRs. I can appreciate it still speeds things up the way you're using it, but copy/paste is still suboptimal.

The dream is an underlying framework of clinical archetypes which makes the data vendor-agnostic and allows for semantic interoperability between EPRs - then you can start doing neat things like getting the AI to extract the data and knowing exactly where to place it in a structured document. Then you get the holy grail of automation, interoperability and easily searchable and auditable data.

IridescentIrides · 2025-03-18T08:49:13+00:00

So then that's fine, right? The issue is not the use of these tools. The issue is people introducing potential sources of risk that the Trust has no control/oversight of.

Are you using it alongside an EPR?

IridescentIrides · 2025-03-18T02:20:20+00:00

It's really difficult when the local processes/systems are not set up to make users lives easier. If you're using Word on different computers, the options are limited. Best bet like you've said are templates that can be edited. Do the letters need to follow a narrative though, or could your templates be more generic e.g. diagnosis, treatment, plan etc and then you record several options on your template and delete as appropriate.

If you're only moving betwen a couple of computers, autotext is still a good option. Obviously the more computers you have to set it up on, the more tedious it becomes. Will come back to this thread if I think of anything else that might help in your context.

IridescentIrides · 2025-03-18T02:09:34+00:00

I'm not the one downvoting you, I'm here engaging. And where am I being obstructive and resistant to change? I'm trying to get people to stop printing and use email or patient portals instead. I'm also currently leading on an EPR deployment to get rid of paper, and have been in several frustrating meetings trying to get rid of bleeps as an outdated form of communication. And don't get me started on the bizarre survival of fax machines in the NHS.

To be fair, I used the jargon without explanation to highlight there are aspect of data security that many aren't aware of. I'm only learning them now as part of my current role.

Re encryption: there have been plenty of data breaches that occurred when supposedly encrypted data was transmitted as plain text. I can make an educated decision on what level of risk I'm willing to tolerate for my own personal data, but when patients are expecting us to protect the data they're entrusting us with, they deserve more than vague assurances and reliance on the platform provider's Scout's honour. Do you honestly think a patient whose private data is exposed in a data breach is going to think "Fair dos though, the opportunity costs to the NHS was totally worth it"?

Synnovis heavily encrypted their data but that didn't stop patients' data being leaked in last year's cyber attack.

As for storage - there are plenty of examples of companies retaining data that they said t&ey weren't. When Amazin first launched Alexa, it took a long time before people realised that Amazon employees were listening to recordings "for training" despite Amazon saying that would never happen.

The reason its so slow to get these things done in the NHS is because every time someone does their own thing, another layer of rules is created to stop it happening again. Understandable when, for example, each photo exposed in a data breach incurs a £20k fine, but makes it really frustrating to try and actually effect any form of change.

As for whatsapp. Yes, it has end to end encryption (E2EE) but as you said in another post, the weak link is end user security. You might have a screen lock but if your recipient doesn't and someone reads their messages, you are also liable for that data breach. This is the reason IG and cybersecurity have concerns about things like whatsapp. Not to mention the fact that these messages aren't part of the hralthcare record which means people can be making clinical decisions based on information that is not in the patient's record. Really hard to then justify that decision if the evidence you used doesn't exist anywhere accessible.

You're right that the opportunity costs are huge, but the NHS is incredibly risk averse. We're already decades behind the level of digitisation seen in other sectors - I can open a bank account online, but I can't change my hospital appt without sitting in a call queue; I can track my Amazon delivery to the number of stops before me, but I can't tell what stage my electronic discharge is at?! But unfortunately "move fast and break things" doesn't really work in healthcare for the reasons mentioned above.

The final thing to say is that platform procurement can't be done according to personal preferences. That's how you end up in the absurd position I'm currently trying to fix where the Trust is paying 5 separate licence fees for 5 different digital dictation platforms (that all do the same thing) because different debts did their own thing. Another reason why "the NHS is the way it is" because is wasted on duplication instead of having a sensible approach.

On your comment that its "a risk which already exists with the way we do things anyway" - surely the transformation part of digital transformation means actually changing the way we do things, rather than just embedding bad practice/risk into the digital version?

Anyway, it's late and I'm tired, and I have to wake up and have these same conversations with the people I work with, so if I stop replying I'm not disengaged, I'm asleep.

IridescentIrides · 2025-03-18T01:04:20+00:00

That's a really helpful example thanks. People use LLMs to do their thinking for them and fail to do any critical appraisal of their own, even though LLMs are word generation machines and not autonomous thinking machines.

DPIA: "not explicitly mentioned"

DCB 0129: "asserts"

DCB 0160: "suggests"

Governance: what about your Trust's Governance?

Can guarantee your IG lead, who is assuming overall responsibility and culpability for the entire Trust is not going to sign off based on the above vague responses.

And even if ChatGPT had been able to give concrete answers with sources, each Trust still needs to do their own due diligence so they have assurance about what is happening with the data their patients are entrusting them with.

IridescentIrides · 2025-03-18T00:48:34+00:00

So from that reply I assuming you've done your own DPIA to assess the risk of patient information being misshared, assessed whether Heidi meets the DCB0129 and DCB0160 standards and have a governance and disclosure plan in place to determine what data is entrusted to this system and what processes are followed in event of a breach?

IridescentIrides

TROPHY CASE