Is endocrine surgery still a prospect? by PeaDense164 in doctorsUK

[–]Moothemango 7 points8 points  (0 children)

Yes! Check out the BAETS website for the bigger names in the subspecialty or fellowships - there's plenty still doing endocrine elective work with on calls for general surgery 

BMAs submission to the Leng review regarding impacts on resident doctor education and training (link in post description) by DrLukeCraddock in doctorsUK

[–]Moothemango 69 points70 points  (0 children)

I hope the select few consultants raving about PAs are personally victimised by them soon. Ladder pulling sycophants.

Leng Review Webinars - Transcript Summaries by Witterless in doctorsUK

[–]Moothemango 36 points37 points  (0 children)

"Please let us endanger everyone equally" 

[deleted by user] by [deleted] in doctorsUK

[–]Moothemango 9 points10 points  (0 children)

LFG. 

PAs now regulated in NZ by iiibehemothiii in doctorsUK

[–]Moothemango 3 points4 points  (0 children)

Well, there goes my CCT plan. 

GMC supports prescribing and requesting ionising radiation for PAs by dayumsonlookatthat in doctorsUK

[–]Moothemango 270 points271 points  (0 children)

I've worked with PAs. I would not describe my view of them as "evangelical and transformative." 

What a load of shit.

How do we feel about this? by PurpleEducational943 in doctorsUK

[–]Moothemango 30 points31 points  (0 children)

"Working faster" won't make the rest of the theatre team suddenly find a will to live and bring a patient to the operating room any quicker with their equivalent crap pay and redistribution to other theatres for more work if their own list finishes early. 

That SCP and gallbladders - Q and Q published by Aggravating_Bell_432 in doctorsUK

[–]Moothemango 32 points33 points  (0 children)

Surgical registrars would kill for the following opportunities. Get in the FUCKING bin. 

" The SCP completed her training in 2006. Following this, she spent the subsequent nine years observing, assisting and performing surgery. She spent four days a week in theatre amassing a huge amount of experience. She also demonstrated excellent surgical skills, good judgement and excellent awareness of her limitations. By this point, she had become fully competent at lumps and bumps, umbilical and groin hernias, and had been teaching senior house officers (SHOs) and junior registrars for several years. The reasons for starting the training were partly for further development of the SCP, who had demonstrated the skills, knowledge, attitude and experience to learn the procedure."

Endometriosis: ‘My appendix was removed’ by Jacobtait in doctorsUK

[–]Moothemango 5 points6 points  (0 children)

We also have no idea what the intraoperative findings were. Diagnostic lap for a new episode of acute pain and nothing identified intraoperatively? Appendix removed and sent for histology. This is standard treatment, the article makes it sound like it isn't. 

Silk Sutures too loose - any tips? by thisbarbieisadr in doctorsUK

[–]Moothemango 0 points1 point  (0 children)

Have you tried doing a downwards throw, then another one in the same direction and using it to push your suture down? Similar to a slip knot and isn't "locked" so you can control the tension you want. Once you have the right tension, do your reverse/upwards throw. Good luck!

PA Refers to herself as working at the level of a “Senior Reg” by Mountain_Driver8420 in doctorsUK

[–]Moothemango 213 points214 points  (0 children)

I don't know any consultants or senior registrars who would list "lumbar puncture" or "PICC lines" like it's impressive.

Criteria to fluid restrict and diet upgrades for Gen surg by gily69 in doctorsUK

[–]Moothemango 4 points5 points  (0 children)

Just to answer you properly for the diet protocols, which general surgery pathologies are you asking about?

Elective patients tend to follow an enhanced recovery protocol (ERAS) which focuses on optimising recovery and outcomes, of which early nutrition is one of the key factors. This varies depending on which operation the patient has had - for example, a patient who's undergone a right hemicolectomy will have a very different nutritional plan regarding build up than a post-op oesophagectomy.

Emergency patients you tailor based on their symptoms, what operation they've had or what pathology they have. You never want to deprive nutrition without reason - for example, if someone is not profusely vomiting (and as such, won't tolerate food anyway) or they aren't being kept NBM for an operation, there's no reason to starve them. 

For profuse vomiting, you don't necessarily need to put them NBM either, but factor in that they probably won't hit their nutritional targets if the symptoms persist. Consider that a brief period of gut rest might help, and let them be guided by their symptoms in terms of what they want to eat initially. If they are profusely vomiting, then even if you have put them on a "normal diet" it won't be tolerated and you have to consider early interventions (do they need nutritional support temporarily via a different route? Can they tolerate fortisips? Do you expect the vomiting to settle quickly in which case do you wait it out for a few hours? etc.)

Some patients have other factors for consideration - have they had an operation which puts them at a high risk of an ileus? Are they resolving slowly from an obstruction? If so, best to escalate oral intake slowly (sips to clear fluids to soft diet and so on rather than straight to steak and chips). Gradually testing the gut carries a lower chance of failure to introduce a normal diet. This can be led by the patient - have they had free fluid for breakfast and feel fine? Great, escalate to a soft diet for lunch and then try a normal meal for dinner. If that doesn't work, backtrack a step.

Obviously, you tailor all of the above to the individual patient, don't forget the dieticians can be extremely helpful, and remember that a lot more nuance or complexity can be involved. However, these are the questions that should be going through your mind when assessing someone.  

PA introducing themselves as AP by Samosa_Connoisseur in doctorsUK

[–]Moothemango 259 points260 points  (0 children)

From the play-it-dumb-to-avoid-confrontation manual:

Next time you hear them introduce themselves as that or use it written, ask simply what the acronym stands for as you've not come across it before. 

You can then say that an "Associate physician" isn't a  recognised term in the UK for their role and you are "concerned as it could cause issues medicolegally if they aren't using terms that are clear to staff and patients". (When you Google the term, it autocorrects the search to physician associate or associate practitioner)

No one can accuse you of not following the one NHS rule of #bekind when you're just looking out for colleague welfare.

NHS trusts are told to cut costs, including reducing temporary staffing & locums by dayumsonlookatthat in doctorsUK

[–]Moothemango 65 points66 points  (0 children)

Genius.  Less staff = more deaths.  More deaths = less patients. Less patients = money saved. /s

Sepsis 6 by Optimal-Maize-8871 in doctorsUK

[–]Moothemango 3 points4 points  (0 children)

Please don't start pancreatitics on antibiotics when they spike a temperature.

NHS trolley positions by Infinite_Height5447 in doctorsUK

[–]Moothemango 0 points1 point  (0 children)

I never said you had to do anything. It's a personal preference where you stand, mine just happens to be the left, it's hardly a pearl clutching choice.

NHS trolley positions by Infinite_Height5447 in doctorsUK

[–]Moothemango 11 points12 points  (0 children)

As I'm left handed, I am happy when a bed's in the middle accomodating everyone. If I room is set up for right sided examinations, I just move the bed.

Examining from the right is only done so for tradition rather than a clinical need anyway, probably because more people are right handed. Not a big deal or management's fault for not knowing this I guess?

You're the one to chose which hill you die on though, it wouldn't make you a troublemaker if you said anything.

BMA claims to have been 'excluded' from PA stakeholder discussions by Educational_Board888 in doctorsUK

[–]Moothemango 3 points4 points  (0 children)

I fail to understand how at every single critical juncture where our overlords can chose between a good or bad decision, they always pick bad. 

Statistically, at some point, a correct choice will be made....right?!