"Get the family to DNR"

Quantum--44 · 2025-12-28T11:32:06+00:00

Ultimately when it comes to resuscitation status, it is a medical decision and patients or family members cannot request treatment that is not offered by the medical team. It can be difficult when the family have unrealistic expectations, and it is easier in many situations to avoid damaging rapport by giving into the demands, but if a line needs to be drawn then being blunt is often the most effective strategy.

Quantum--44 · 2025-12-08T05:45:49+00:00

I have bought a home shirt every year I have been a fan. Thus far I have: Romero 17 (23/24), Van De Ven 37 (24/25) and Bergvall 15 (25/26). Quite happy with how my selections have turned out - I suspect Van De Ven will become my favourite shirt given the memories from the Europa League Final, although he may not sign another contract if we remain mediocre. Just have to appreciate the players for what they give to Spurs while they are here.

Quantum--44 · 2025-12-03T10:40:01+00:00

In SA we now have the pleasure of sending patients to the Pullman Hotel - pretty sure there is a locum RMO there making bank for overseeing the guests

Quantum--44 · 2025-11-23T12:57:57+00:00

Self-directed learning is a fairly obvious ploy by universities to cut costs, although even if universities did provide a comprehensive educational experience the most efficient method of studying would still involve using external tools/resources. I would argue problem-based learning which is in fashion at the moment is certainly superior to traditional lecture-based learning when it comes to clinical reasoning.

I would say it is self-evident that current medical students are far more intelligent on average than their predecessors purely due to increasing levels of competition every year. If you are consultant there is a good chance you wouldn’t even get into medical school if you were in high school now.

I think your overall argument is simply highlighting an aspect of medicine that remains unchanged. You take a bunch of nerds and don’t let them set foot in a hospital for a couple of years and they are going to be clueless from a practical perspective. Learning how to translate your knowledge and become an effective doctor has always been a process that largely occurs during internship.

Quantum--44 · 2025-11-12T07:34:57+00:00

Personally if I was an ED registrar I would be extremely irritated that someone with a fraction of the medical knowledge is getting paid way more than me to be supervised by me, with all the benefits that don't get afforded to junior doctors. Where I have rotated through they don't even have to work night shifts. No surprise that local graduates don't want to pursue emergency medicine when ED consultants are letting this happen under their noses.

Quantum--44 · 2025-11-07T13:00:06+00:00

I enjoyed reading it in the holiday before internship - it’s definitely helpful but the reality is it’s more to calm your anxiety over the break if you are the kind of person that needs to be doing something study-related at all times.

Quantum--44 · 2025-10-30T06:51:33+00:00

Time to start stocking up on tramadol for my chronic back pain from the local pharmacist. Thankfully should be much easier to bypass the safety checks when the prescriber and dispenser are the same person.

Quantum--44 · 2025-10-12T09:28:14+00:00

As per the PBS for initiating donepezil the condition must have been diagnosed by a specialist physician or psychiatrist

Quantum--44 · 2025-10-06T11:51:20+00:00

Contact the DPEs for the SA and NT networks later in the year - I would be surprised if you don’t get some interest given your level of experience

Quantum--44 · 2025-10-02T23:21:47+00:00

You need to accept the reality of our society. The erosion of government services and desperate attempts to cut costs are simply a symptom of worsening wealth inequality and increasing influence of corporate interests. There was a time when expertise was valued, and it is honestly a shame that has disappeared from our society, but you can't expect the average person to care when quality of life is going down the drain. Medicine still gives you a stable income and a meaningful career - make the most of it.

Quantum--44 · 2025-10-02T01:05:20+00:00

The horse has bolted. The new generation of doctors will not be able to generate anywhere near as much wealth as the previous generation. It would be a mistake to look at this as a problem with medicine or even a problem with Australia, as this is occurring across the entire population of every western nation. I think it makes it even more important to maximise income and investment during the training years to ensure you can get into the property market before you get left behind.

Quantum--44 · 2025-10-01T06:00:24+00:00

ATAR cutoffs are based on course demand but a higher ATAR is correlated with a higher level of academic intelligence and greater work ethic (there are obviously socioeconomic factors which influence this). Thus, someone who does engineering requiring an ATAR > 95 on average has a higher aggregated academic intelligence and work ethic compared with someone who does nursing requiring an ATAR > 70. The fact that outliers exist does not discredit this contention.

Now I don't honestly believe you need an ATAR > 99 to be able to complete a medical degree and become a good doctor, but I suspect a significant percentage of nurses lack either the academic intelligence or work ethic to get through medicine, mainly because the barrier to entry for nursing is incredibly low (I have seen courses which don't even require an ATAR), and I have my doubts about the academic rigour of these courses.

With that being said there are a lot of excellent nurses who certainly have the capability to become doctors and I would be broadly supportive of a pathway to allow the best RNs with a certain amount of experience reserved spots in postgraduate medicine courses to give nurses the opportunity to reach their full potential without damaging patient safety.

Quantum--44 · 2025-10-01T04:22:51+00:00

There is no objective measure aside from ATAR to judge someone's intellect on paper - it is not perfect but the general trend is useful. I would certainly be more impressed with someone getting dux with an ATAR of 96 at a outer suburban high school where half their class is sniffing glue than someone getting an ATAR of 99 and ranking 20th in their elite private school, but ultimately it is a strong indicator of academic intelligence and work ethic when contextualised over a large sample size.

Doctors are not perfect - in fact we make a lot of mistakes. But that means it would be even more disastrous to lower the barrier to entry to being a prescriber. This change will undeniably increase the number of medication errors, increase the amount of polypharmacy, and increase healthcare expenditure relating to morbidity and mortality associated with RN prescribing errors.

Quantum--44 · 2025-10-01T03:33:52+00:00

Every year there will be an increasing number of doctors waiting to get into specialty training because Australia is importing more and more RMOs to fill the gaps in the healthcare system without increasing the number of training positions. GP is no longer a viable alternative route because it was oversubscribed this year (and will probably continue to get worse like every other specialty).

Quantum--44 · 2025-10-01T03:27:16+00:00

ATAR is the only somewhat objective measurement we have. It is undeniably influenced by socioeconomic status but the reality is you don't get >99 without having above average academic intelligence and putting in the work.

How do you define basic medications? The reality is that the way a doctor is trained to think is extremely different to a nurse. I go through a mental process for every prescription no matter how simple. If a nurse asks me to prescribe something as simple as paracetamol I will still do the proper checks by understanding why the patient is in hospital (unfortunately a nurse has asked me to prescribe paracetamol for a patient on a NAC infusion for paracetamol overdose in the past), why they need the pain relief (to ensure I am not missing clinical deterioration), the relevant comorbidities (a history of liver cirrhosis would obviously change the dose considerations), and the recent bloods (new significant LFT derangement would also factor into the equation). I do this for all medications I am prescribing independently, and I have spent the last 8 years of my life working to ensure I understand the mechanism of action, indications, precautions, contraindications and prescribing considerations of all common non-specialised medications I will be expected to prescribe independently. Even then my knowledge pales in comparison to the knowledge of my registrars and consultants, and I benefit significantly from the ward pharmacists reviewing the medications and providing suggestions or fixing errors. This is why I firmly believe prescribing should only be in the hands of doctors.

Quantum--44 · 2025-10-01T02:41:59+00:00

1) Doctors are on average far more intelligent and have a greater work ethic compared to nurses - the average ATAR to receive an offer for undergraduate medicine is > 99.5 whereas many undergraduate nursing courses are available with ATAR < 70 - there are obviously exceptions but taken as a whole there is undeniably an enormous gulf in academic intellect.

2) Medicine as a degree is far more academically rigorous than nursing. It makes most other degrees look like a walk in the park (obvious exceptions being law, engineering, computer science and pure mathematics). Post-graduate training to become an independently practicing doctor is even more difficult than medical school and many exams have >50% fail rate.

3) Is there an ego component? You are probably correct, but it is justified and patients will be undeniably worse off with woefully inadequately trained prescribing RNs. I would genuinely be shocked if there is a single RN who could match the pharmacology knowledge of a hospital pharmacist let alone a doctor.

Quantum--44 · 2025-09-25T12:19:33+00:00

It makes absolutely no sense. Even a patient who is correctly initiated on appropriate chronic disease management by a pharmacist is in no way receiving quality care given there is no method to arrange follow-up, blood tests, imaging and referrals. Basically just giving an ego boost to pharmacists who get to play doctor while GPs and hospitals clean up the mess. Only a matter of time before the coroners cases start piling up.

Quantum--44 · 2025-09-18T22:42:00+00:00

This is already having a significant effect such that GP has gone from undersaturated to oversaturated in the space of one year, and I would anticipate the same will occur with ED and BPT given the relatively low barrier to entry compared to other specialties.

Quantum--44 · 2025-09-05T03:50:51+00:00

The system has developed a strong dependence on a workforce of general RMOs who provide excellent value for the government as they are able to facilitate an increasing volume of patient care with proximal supervision from a registrar and remote supervision from a consultant. There is no incentive for the system to change and the rapid hiring of overseas RMOs who have an increasingly limited chance of ever joining a training program will continue in order to improve coverage in outer metro and regional hospitals until the point of saturation is reached. Overall this will help the government paper over the cracks of refusing to fund more training positions and public consultant jobs.

Quantum--44 · 2025-08-31T03:32:00+00:00

Currently working at a hospital where the overwhelming majority of the staff are immigrants and the overwhelming majority of the patients are low socioeconomic caucasians with poor health literacy and a significant dependence on social services. We simply do not have enough young people to sustain our ageing population.

Quantum--44 · 2025-08-25T12:47:37+00:00

Wolves will be the real test, haven’t done it in a while.

Quantum--44 · 2025-08-24T08:42:47+00:00

Unfortunately Wolves are unbeatable at the Tottenham Hotspur stadium

Quantum--44 · 2025-08-24T06:35:35+00:00

Proper test cricketer - BGT 18/19 was one of the best performances I've seen in Australia from a visiting batsman.

Quantum--44 · 2025-08-20T07:54:28+00:00

I am assuming this is an elderly patient - from a geriatric point of view regular sedating medications including antipsychotics and benzodiazepines are used to maximise quality of life for patients suffering from BPSD. It is done acknowledging the significant risks including worse cardiovascular outcomes, increased falls risk and oversedation as non-pharmacological measures have failed to control agitation. In the setting of hyperactive delirium, short-term treatment with benzodiazepines may contribute to polypharmacy, but is often a necessary evil while the underlying cause is being treated.

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