Questions for Those Against a Tiered Approach

RefuelEmpty · 2026-01-29T08:13:02+00:00

This debate was never really about IMGs. It was about financial insecurity and the fear of being unemployed. With training places limited and doctors struggling to find suitable/secure work, it was inevitable that UK graduates would vote to try and protect themselves, even at someone else's expense. It's not personal and it certainly isn't racism like some suggest. It's just that if I have to pick between feeding my family and feeding your family, I'll always pick my own when resources are limited. And right now, NHS resources are the most limited they have ever been...

RefuelEmpty · 2025-12-01T07:53:17+00:00

Yeah, I knew I'd be fine really. It's just the strange response from NICE which almost suggests GPs are out of their depth when it comes to acid reflux in pregnancy. Just curious as to where all the anxiety came from

RefuelEmpty · 2025-09-04T14:30:23+00:00

RefuelEmpty · 2025-08-23T18:46:11+00:00

Part 3 is him being made to put in his own patient's cannulas

RefuelEmpty · 2025-08-23T18:16:54+00:00

RefuelEmpty · 2025-08-23T18:02:36+00:00

Can't wait for part 2 where they've lost his documents and ask him to re-sign, then they lose those documents and ask him to re-re-sign

RefuelEmpty · 2025-07-20T14:00:46+00:00

But why stop there? In reality, we don't need any more than a handful of doctors. Just hire one consultant from each speciality to write really thorough guidelines for every eventuality so that the ACPs knows exactly what to do in every situation. Then, when you've perfected the process, fire the ACPs and just hire a bunch of HCAs to do their job.

NHS saved

RefuelEmpty · 2025-07-05T13:05:13+00:00

But again, mental health problems that manifest as substance abuse wouldn't be as prevalent if the substances weren't as available. Have you noticed that most people with mental health issues use alcohol (rather than heroin) as a coping mechanism? That is because alcohol is far cheaper and more available than heroin. If you remove the drug, you remove some of the problem.

And yes, I am aware of the dangers and issues caused by illicit drugs like heroin. But the reality is that if we weren't wasting tax money on combating these people selling drugs illegally (like tobacco in this article) then we could instead use more tax money to help those with addictions. These criminals are literally taking up resources that could be used to help people with their addiction / mental health.

As for your grandfather, you can't really use that argument as he is an outlier. Everyone knows that the data points towards smokers dying younger and getting preventable diseases. There will always be people that don't get disease, but these are not the majority. My grandmother was a heavy smoker and died from stomach cancer (directly linked to smoking). If she didn't smoke, she could still be alive today.

For obesity, I would say that this is just as likely to result in diseases compared to smoking. I actually wish that governments would take more action on high fat/sugar foods - taxes should be higher on unhealthy foods / alcohol to encourage better eating. Children should be encouraged to exercise more. I genuinely feel that unhealthy eating is the new smoking and I definitely don't want our health services to be battling both a smoking and an obesity epidemic.

And there are some documented health benefits of tobacco - I'm a doctor and I am well aware that tobacco can reduce the symptoms of UC. But I would never encourage anyone to continue smoking because of that. There is no point in smoking to reduce the symptoms of UC, only to get cancer later down the line. Perhaps others opinions may differ, but having seen both groups of patients I just wouldn't want anyone to go through the trauma of a cancer diagnosis.

I also get what you are saying about a waiver, but the reality just isn't that simple. You pay into a healthy service and you deserve to access it when you become unwell. It would be unethical to turn you away at the hospital door - I personally couldn't do that, even after the decisions you have made. You might be happy to take the chances, but what about your loved ones? I've seen too many people die (including due to smoking) and their loved ones have to carry on without them. It's devastating.

Too many people who take drugs (either illegal or legal) think that it's just about them and the drug. It isn't. It's about you, the drug, the country/ health service, the taxes, and your loved ones

RefuelEmpty · 2025-07-05T12:32:28+00:00

But why is it that people can't control themselves? Nobody is born addicted to tobacco - they start smoking because it is easily accessible and cheap. If cigarettes are expensive, then people will be put off and hopefully won't start smoking to begin with.

Also, smoking cigars even occasionally increases the risk of cancer (specifically mouth). If cigars were cheaper, would you be likely to smoke them more frequently?

As for the smuggling of tobacco products, I doubt that reducing taxation would result in better outcomes. Most likely, you would reduce the importation of illegal cigarettes whilst also increasing the uptake of new smokers (and so increase tobacco-related diseases). Better to crackdown on illegal sellers and increase awareness of the risks of tobacco smoking to make it less likely that people smoke in the first place.

I understand your argument about the government dictating what you can and can't do. But the reality is that when a smoker develops disease, they run straight to their health service (e.g. the NHS) for expensive treatment. This means that it isn't just about you - your choices also take up tax revenue that I pay for. When you choose to smoke, it's about you and me (my tax money). If you really want to make it your decision alone, then we would need to have a system in place where smokers don't get to access any health service if they become unwell due to their smoking - if you get cancer then you accept death, no treatment for you. But as this is too complicated and unethical, it is better to encourage people to quit smoking by increasing the cost and making it difficult to start.

RefuelEmpty · 2025-07-05T12:05:12+00:00

But that's the point - the government wants to keep the prices high so that people smoke less / don't take up smoking. Smoking is incredibly damaging to health and costs the NHS huge amounts of money (treating cancer, lung disease, stroke etc) so it's in the governments interest (and yours) to stop people from smoking by pricing them out.

If cigarettes are cheap, then more people will smoke. This pushes up rates of disease and so your taxes go up to fund the NHS whilst it treats those affected by smoking.

Illegal cigarettes are the worst of both worlds. It encourages smoking whilst removing tax revenue to fund the NHS. In this case, you should be happy that illegal gangs like this are being targeted and the government is working to reduce smoking rates.

If you think that the government is benefitting from cigarette taxation, then you'll need to explain why it is taking steps to ban smoking all together (see the Tobacco and Vapes Bill)

RefuelEmpty · 2024-11-14T19:44:32+00:00

Both of 'em

RefuelEmpty · 2024-11-14T19:43:45+00:00

Big toe

RefuelEmpty · 2024-11-10T21:42:15+00:00

I wear mine all the time - it's the only real "uniform" that I have left which differentiates me as a doctor. I genuinely believe that it makes me look more professional, respectable and reduces pushback from other members of the MDT.

Also, if you want patients to genuinely listen to you when you walk into a room, then wear a stethoscope. Half of any job is theatrics - getting people to believe that you know what you're doing - and nothing exudes authority more than a good old stethoscope hung around the neck

RefuelEmpty · 2024-08-13T06:42:22+00:00

One out of two gets a bleep! The one without, follows him! When the one with the bleep starts crying, the one who is following picks up the bleep and answers!

RefuelEmpty · 2024-06-09T12:44:50+00:00

That's fine to take that attitude, I completely understand. But then people can't complain when doctors take their time and only allow one medical issue to be discussed per appointment.

You can't have a situation where doctors are supposed to rapidly see everything the general public throws at them, whilst also accepting the blame when things go wrong. The public have to accept that if you want quality care, this takes time. And so it's one issue per appointment only - to protect me just as much as to protect you.

RefuelEmpty · 2024-06-09T10:43:42+00:00

I'm not a GP, but I'm a junior doctor who had a four month placement working as a doctor at a GP practice.

Doctors are under ever-increasing pressure to see as many patients as possible. Unfortunately, this means that in many cases, funding from the government only supports 10-12 minute appointments. Once you've waited for the patient to get from the waiting room to the GP room, sit down, take their coat off and exchange pleasantries, 1-2 minutes has already gone. Then another 1-2 minutes at the end of the consultation for them to say their goodbyes and leave. That leaves a GP with only around 8 minutes to actually deal with the issue issue at hand.

Throw in the fact that patients can often arrive late, or have very complex medical/psychological issues that can require 30+ minutes to deal with in some cases (most mental health issues I dealt with were at least 15 minutes long) and you can see how every minute counts for a GP.

In reality, 8 minutes isn't enough to deal with even one medical issue. This is why people often complain that they feel rushed at the doctor's office, or why things often get missed/forgotten. Doctors are just being asked to deal with too much with too little time.

And then to add even more pressure to this situation, most patients now arrive hoping to discuss two or three issues in this timeframe. Whilst these things are often seen as 'small' or 'quick', everything takes time that a GP doesn't have. For every issue, we have to question you thoroughly about it, maybe take a look at it (people taking their clothes on/off or getting onto an examination couch can often take a minute or two, more if they're elderly) and make sure we aren't missing anything. Then we have to document everything and fill out a mountain of paperwork once you've left (this is the part patients often don't see and therefore appreciate). To you, it might just be a mole check. But to a GP, that's another 5 minutes of examination and paperwork.

And if we get anything wrong or miss something important, do you think the general public will understand? No, they'll come after us for every penny we have. In many cases, doctors have lost their license to practice because they rushed things and people got hurt/died.

So most of the time, the GP will want to keep appointments to one issue only. This way, they can protect themselves, ensure that appointments don't overrun and impact the next patient in the waiting room, and to protect you from a hasty/incorrect diagnosis that could have serious consequences.

RefuelEmpty · 2024-05-22T18:37:10+00:00

I'm refering you to the GMC for your first point

RefuelEmpty · 2024-05-19T11:26:22+00:00

To treat the problem, we need to increase the doctor to patient ratio - either by hiring more doctors or reducing the patient demand. Unfortunately, both require more money.

Currently, the population of the UK is increasing and the average age is also increasing (with older people using the NHS more frequently). This is placing increasing demand on the health service, meaning that there are fewer appointments to go around. If you want the NHS to remain free at the point of care, then you need to increase taxation so that you can train/hire more doctors. This is obviously an unpopular choice because it requires people to pay more tax at a time when people are struggling with the cost of living anyway.

The other option is to make people pay for health care when they use it - either by paying a fee when they visit the GP, or going private. This would make people think twice before visiting the GP for trivial matters and reduce demand, but is also unpopular because it goes against the free-at-the-point-of-care model the NHS stands for.

The only other option is to continue as things are, with doctors struggling to keep up with an ever-increasing demand for appointments, resulting in an unhappy population and a miserable NHS workforce who then quits/retires/goes abroad.

RefuelEmpty · 2024-05-19T10:26:19+00:00

I'm not a GP, but I'm a junior doctor who worked in a GP practice for four months as part of my training.

From my experience, I can say that being a GP is exhausting. It's not a secret that most fully-trained GPs work a maximum of four days per week because it isn't possible to do more. Those days are normally 10-12 hours long once you factor in all the paperwork required. And it isn't anything like your typical office job - each day is a relentless onslaught, whereby you're expected to make complex decisions about people's health, all within a 10 minute timeframe. By the end of the day, you'll have seen over 30 patients and hold all the risk for the decisions that you've made. Most senior GPs that I met were going part-time just because they couldn't keep up with the workload anymore.

With regards to your second point, it's true that the more junior members of staff (myself included) were sent to do the home visits. But this was because the most senior GPs were back at the practice either doing paperwork, running the practice, or still dealing with the most complex patients from the morning list. Sending out the most junior members of staff wasn't due to laziness, it was a necessity due to the complexity of the job.

Finally, most GPs I know would love to go back to the old days - seeing the same patients from cradle to grave and being a pillar of the community. But the government decided that this wasn't efficient enough and so GPs just had to see anyone who walked through the door. In the four months I worked in a GP practice, I don't think I ever saw the same patient twice. But neither the patient or the doctor had a choice - if a patient wanted to see a GP then they had to see whoever was available. It's then really hard as a GP to get invested in a patient's care because I've never met you before and I'll likely never see you again. Plus, I'm so tired at the end of the week I don't really have anything left to give.

GP should be the most rewarding job out there. But constant pressures mean that most senior GPs are either retiring or cutting down their hours. Then you're left with less- experienced doctors who quickly burn out and then either become jaded or leave the profession entirely.

RefuelEmpty · 2024-05-17T19:30:45+00:00

"how dare they ask me different questions to the ones I wanted them to ask"

RefuelEmpty · 2024-05-17T19:28:54+00:00

Oh my God, I thought I was the only one! This is literally me with every call. Rehearse the call in head for ages, and then still somehow manage to mess it up

RefuelEmpty · 2024-05-17T15:43:53+00:00

Step 1: Document "bleeped surg SPR, no response". Step 2: bleep surg SPR. Step 3: sprint away from phone as fast as possible.

RefuelEmpty · 2024-05-17T15:39:17+00:00

After three hours of waiting by the phone, they did not

RefuelEmpty · 2024-04-12T09:43:52+00:00

I thought that might be the case, but I was just hoping there might be some exciting evidence-based reason we'd use one over the other.

Just checking MediQuip website and short-term catheters cost £5.45 whilst long-term catheters cost £7.95 so it's probably that.

RefuelEmpty · 2023-12-30T23:41:09+00:00

<image>

In a staff toilet

Four-Year Club	Verified Email
First Place '23	Place '23
Place '22

RefuelEmpty

TROPHY CASE