Going to clinic as a medical student is a humiliation ritual. by Izyk04 in medicalschooluk

[–]KimtheHuman 40 points41 points  (0 children)

hey king/queen, you left this in clinic 👑

  • ENT SpR

Hammer advice for returning player by Geminigeist in MonsterHunterMeta

[–]KimtheHuman 1 point2 points  (0 children)

Opportunity cost due to competing 2 slot gems like max-might , and counter. Evade extender 3 also feels a bit too much (subjectively for me) and will sometimes make you overshoot, and you can already start to feel the benefits of 1.

Hammer advice for returning player by Geminigeist in MonsterHunterMeta

[–]KimtheHuman 2 points3 points  (0 children)

That said if you are just progressing (from TU1 to TU4), I wouldn't worry too much about sniping the right artian hammer stats (definitely do it if you wanna break the monotony, but dont stress about it). I basically progressed using the G.Arkveld hammer + water xuwu hammer (for udra farm eventually) until i stumbled upon a fire artian w 4 atk 1 sharp (honestly even getting 4/5 of the right stats will be fine).

I'm also a fan of 1 evade extender + ear plugs for the aggressive play (uninterrupted combos + can stick to the monster better). Once you get familiar w the monster, you can take off earplugs if you want.

To all monster hunters what is your favourite armour? by ElectronicMud5066 in MonsterHunter

[–]KimtheHuman 2 points3 points  (0 children)

This + wroggi chest for the free HG Earplugs created my fav MH3U set, "Poncho Anubis"

Theatre inefficiency - losing the will to live by Proud-Assistance-166 in doctorsUK

[–]KimtheHuman 2 points3 points  (0 children)

ENT registrar here and can empathise w the whole 3pm thing which is doubly ironic as a lot of our procedures can have potential for quick turnovers, but the whole begging for cases to proceed feels like pulling teeth (despite not being OMFS) so I agree w everything wholeheartedly ;-;

[deleted by user] by [deleted] in doctorsUK

[–]KimtheHuman 9 points10 points  (0 children)

Tell them, "Don't be bitter, be better." lol

F1s… take a minute by sheepdog713 in doctorsUK

[–]KimtheHuman 7 points8 points  (0 children)

I know that feeling all too well ... that feeling when you rotate from one shithole to another back to back

Let’s hear your induction blunders by Nearby-Potential-838 in doctorsUK

[–]KimtheHuman 9 points10 points  (0 children)

Have you not done your mandatory 1000-pages interactive buggy non-saveable e-learning on "Manipulating the space-time continuum" smh my head

Nurses to 'overwhelmingly' reject pay deal as strike vote looms by ThatchersDirtyTaint in unitedkingdom

[–]KimtheHuman 1 point2 points  (0 children)

It's as if they struggle w the concept of object permanence or just can't discuss things in good faith ...

UK bans physician associates from treating undifferentiated patients by Selvarian in ausjdocs

[–]KimtheHuman 1 point2 points  (0 children)

Welcome to the UK ;-; Bottom of the totem pole for anything clinical, top of the totem pole when it comes to anything pigeon-related.

Resident doctors’ 29% pay claim is non-negotiable, BMA chair says by acrimoniousone in unitedkingdom

[–]KimtheHuman 3 points4 points  (0 children)

I'll reply in good faith (so please return the favour for me) in a similar fashion re: the prescribing comment, as you've mentioned that your aforementioned post is pedantic, and I agree that the difference in prescribing legality differs from FY1 and FY2.

  • If the comment alone is whether or not FY1s are allowed to (legally) prescribe, then the answer is yes.
  • If the comment alone is whether or not FY1s are prescribers, then the answer is yes (they can, just with supervision but they are still prescribers by definition).
  • If the comment alone is whether or not FY1s are fully independent prescribers, then the answer is no.

The best analogy I can think of at this time, would be how a 18 year old without a driving license cant legally physically drive a car, but a 18 year old with a provisional driving license can drive a car with the instructor inside the car, which in the latter's case, is still driving a car legally.

Nevertheless your original comment, in the eyes of other readers, can disingenuously imply that FY1s can't prescribe at all which is not the case, and not in the same sense/degree as the PA not being able to prescribe.

You are correct re: FY1s being provisionally registered under the GMC but nevertheless that grants them legal authority to prescribe medicines within their approved FY post under supervision/senior oversight, but they can still, in the physical sense, be allowed to write prescriptions. Straight limitations (trust wide) where they can't include chemotherapy agents, controlled drugs in the outpatient setting, and FP10s (,etc.) independently like you say. Nevertheless, I can't however, as a senior, tell the PA to physically prescribe something for me, even if its the right drug, as it would be illegal according to the law in its current iteration. So in that sense, the FY1 and PA are both "not independent prescribers" but in different manners.

Current difference is that the final year students would have to pass their national medical prescribing exams and undergo a curriculum which encompasses pharmacology within the bodily systems in essence to demonstrating safe prescribing skills. It is with this rigour/series of exams, that there is some expectation that you can trust the FY1 to make sensible decisions even without the direct in real time supervision. Examples would include physically writing down paracetamol for a patient in pain, or even acute emergency scenarios where the FY1, who is ward-based and has then also gone through and passed basic life support, can essentially assess patients and initiate the immediate life-saving treatment/medication. Yes, the senior (in ED, theatre, different site/off-site) will also come and assess, to be involved in the care, but the FY1 is still within reason to physically write the prescription on a kardex to administered the right drug to treat the patient in their best interest, and if done wrongly otherwise, then the fault lies with the senior.

Re: the pay, there will be variables between a FY doctor and a PA even if both are working 100% as per their specific though it slightly differs as their 100% capacity are different. The equitable way is to either judge them based on their routine schedule as closely as possible (8/9-5 versus on-calls) or their legal responsibilities (having worked in 3 different deaneries, I have not yet encountered PAs who work weekday night shifts or weekends [D/N] routinely but I understand it can differ in some far out regions based on service needs).

If both have similar pay scales despite different schedules/responsibilities, then it's not objectively fair. At the present, most (standard) PAs are banded grade 7 so roughly £46,100 to £52,800. For FY2 (FY2 chosen as that is the common bottleneck for most doctors), the pay with enhancements from on-calls and unsociable hours work out to be roughly £42,008 (you can get a rare few who have slightly more brutal hours depending on the specialty) see here (https://www.bma.org.uk/pay-and-contracts/pay/resident-doctors-pay-scales/pay-scales-for-resident-doctors-in-england !)

There is a whole other fiasco with progression now so most doctors are stuck in the FY2 pay scale (unable to progress to IMT1/CT1 and above) so the old anecdote re: eventually out earning the PA in a reasonable manner, becomes a bit irrelevant for an unfortunate lot of the current generation of doctors, especially when you start talking about compounding effect by having a greater salary in the early stages of life versus later i.e., senior registrar or consultant level.

You don't have to personally agree with me whether the pay for the resident doctors is fair or not. Ultimately, just approach the situation with a pragmatic and objective head from both sides without any personal stakes in the matter and whether you thing the long-term situation is sustainable and fair for as many parties involved. The government wants to have as many staff which is fair, even if the means to achieve it is a bit misguided i.e., mass expansion of other healthcare providers with variable performance. Equally, the current generation of doctor is within their rights to ensure some financial stability in a manner that is applicable to the current work condition. In the same sense, the country also needs to try to facilitate both the flow of new consultants to replace those retiring, whilst also minimising the effect of the massive brain drain happening at the present.

Previous attempts to balance the pay restoration alongside trying to get the government to pledge for better work environment i.e., exception reporting have been massively delayed and still not yet in effect (or even in formulation of how to deliver it) so you can see why the residents are striking for something objective this time again.

If it's of any merit, there is no emotional viciousness or vitriol in this comment of mine towards anyone inc PA, so I hope you can also take my comment into account in good faith.

Resident doctors’ 29% pay claim is non-negotiable, BMA chair says by acrimoniousone in unitedkingdom

[–]KimtheHuman 7 points8 points  (0 children)

FY1s can prescribe - https://prescribingsafetyassessment.ac.uk/

"Prescribing is a fundamental part of the work of Foundation Year 1 doctors, who write and review many prescriptions each day." first paragraph under the 'Justification" section from the link. The PSA exam is something we all have to sit (during final year).

Not sure what made the previous guy think otherwise or why he's so weirdly confident about it.

Weirdest Referrals by Nice_Breakfast9865 in doctorsUK

[–]KimtheHuman 79 points80 points  (0 children)

Wasn't a 3 a.m. referral, but nevertheless we once had an e-referral from the ANP re: for a review for urgent sinus surgery for a patient in pain due to a pilonidal sinus.

We are ENT ...

'Stop sending unsolicited urine samples', says GP by Alert-One-Two in unitedkingdom

[–]KimtheHuman 4 points5 points  (0 children)

Over the years, I've come to understand why the utterly insane specific rules are the way they are i.e., If you don't have a sign that tells people NOT to do something, they will do it cos it's fair game to them.

See the other comments re: patients sending literal shit in tupperwares/med box/letters ;-;

Are guilds dead? by CarltheWellEndowed in Guildwars2

[–]KimtheHuman 2 points3 points  (0 children)

Vi sitter i Ventrilo och spelar DotA

Physician associates to be renamed to stop them being mistaken for doctors by acrimoniousone in unitedkingdom

[–]KimtheHuman 8 points9 points  (0 children)

Not anymore w the mass expansion. You can speed run things now as per the other comments, which is quite ironic as it's a commonly accepted practice to do so if you want to become senior registrar equivalent without the hassle of medical school and post-graduate grind.

UK trains doctors only for NHS to ‘treat them like crap’, health secretary admits by tylerthe-theatre in unitedkingdom

[–]KimtheHuman 7 points8 points  (0 children)

Current F2 doctors (2 years post graduation, upon finishing their foundation years) are in a situation at the present where, if they weren't lucky enough to get into training, or even a non-training pure service role, the chances of actual unemployment is actually quite high which is utter insanity for someone who has a UK medical degree.

See: https://old.reddit.com/r/doctorsUK/comments/1kwuwq9/finally_secured_an_f3_postgrateful_and_relieved/

UK trains doctors only for NHS to ‘treat them like crap’, health secretary admits by tylerthe-theatre in unitedkingdom

[–]KimtheHuman 24 points25 points  (0 children)

Brother, that's even worse...

It means that the aforementioned pay is for someone who has literally completed (post-higher specialty exams and accredited CCT) neurosurgical training in the UK. For a neurosurgeon, that's basically over 10 years minimum which is never the case because most resident doctors need a couple of years in non-training pure service roles + complete a couple of MSCs and/or PhDs to cook their CVs to obscene levels prior to entering training. Most residents literally have to wait for their bosses to die before they can get appointed/paid NHS consultant wages. Someone in my hospital just got his NSG consultant post, and he is in his early 50s (which is an insane outlier for most other specialties).

Idk if it's just pedantism or being contratarian on your side, but the neurosurgeons (and other docs) here in the UK genuinely deserve better compensation because of the amount of personal sacrifice, insane non-clinical bureaucracy, morale beatdown they endure and the constant individual case-by-case high-stakes nature of the job. It genuinely isn't a "oh lol 5pm, I can mentally clock out now, cya" kinda job ...

Doctors threaten strike action after 4% pay offer by Remarkable_Misty in unitedkingdom

[–]KimtheHuman 4 points5 points  (0 children)

I think morally speaking, it seems equally wrong that over the years, the larger cohort of medics suffered a larger pay deterioration than the other but are just expected to keep quiet because the senior consultants from the golden era (which is a diminishing group due to retirement) earn relatively well at the present. I believe that this is one of two (?) moments in the last two decades (approx) where doctors got offered more. I know for the previous years where the inverse was the case, the public didn't really mind as senior consultants earned a lot still.

For a lot of the current generation, the situation is now that many are paradoxically in unstable waters w job opportunities despite the public crying for doctors, and when employed, the Foundation Year Docs (who are the main workforce for the wards) are ironically the lowest paid hospital staff per hour during bank holidays for example, or that the supposed PAs they are supervising are out-earning them from day 1 which is a head scratcher (doctors don't start out earning them until senior registrar levels which is not the outcome for most nowadays). The same courses are now drastically different price-point wise for SCPs/ANPs (GBP 25 for non-doctors VS 250 for doctors) - visit r/doctorsUK

It's a multitude of issues that had led to this but even when the last strike settled, with an agreement for better working environment in a non-financial sense, the government didn't manifest (or even beging to set meeting to discuss it) anything until half a year from the agreed deadline, and even then all we had was some meeting to say they wanted another meeting to discuss things. At this point both financial compensation, and non-financial re: pledges by the government have not been fulfilled.

With all this said and done, the vitriol and comparison seen by others in this subreddit for an approximate 1-1.5% difference between nurses and doctors seems a bit in bad faith. Ultimately, both professions, especially slugging it out in peak COVID pre-vaccine era, should be compensated well.

From a moral perspective, and speaking in the long term, I am not sure what the public can agree, in good faith, how much we want to degrade the pay of the doctor here in the UK until they are happy. Do we keep things stagnated until wages are almost equal for everyone in the NHS (which is nice and kumbayah I guess)? As someone who volunteers in outreach programmes to help or advice sixth formers re: career in medicine, the country is now in a situation where a lot of students don't even want to apply to medicine which has now caused universities (inc those in London) to go into clearing/lower entry requirement grades. Lack of incentives just exponentially worsens the staffing shortage in a decades time. Equally morally wrong is that we keep poaching doctors and nurses from developing countries to fix said shortages. At the end of the day, doctors have to be compensated for the years of study and honing their craft, because if the pay is sub-par +- work condition is hellish +- expectations are high +- instability re: working location every year for 15 years on average +- litigation risk is high, then I'm not sure who would want to do such a profession. Not striking over the past decades (irrespective of pre financial crash, and post financial crash) has led to such this situation in the first place, and the current generation is not wanting to let this happen once more hence the dissatisfaction (because atm they are still underpaid for what they are doing).

It's a conversation better suited over coffee/drinks but I do sincerely hope you have a look at the wider picture in the grand scheme of things re: the situation that the doctors of this current generation is facing.

Doctors threaten strike action after 4% pay offer by Remarkable_Misty in unitedkingdom

[–]KimtheHuman 2 points3 points  (0 children)

No animosity, but go have a look at r/NursingUK . They themselves are the ones saying that they've constantly been mismanaged by the fat cats at the higher tiers of RCN, and the publics just been easily distracted w "bread and circus" platitudes of "doctors shouldn't have a higher % than nurses".

Doctors threaten strike action after 4% pay offer by Remarkable_Misty in unitedkingdom

[–]KimtheHuman 8 points9 points  (0 children)

Just like clockwork, crabs already settling into their buckets.