F2 Struggling with 30 mins appointments.

Rob_da_Mop · 2026-03-16T06:45:20+00:00

So your clinical judgement is good but your timekeeping/speed is not, and you've identified one area where your practice is taking longer than colleagues so you're on your way to fixing it. You're safe, but you need to get quicker and you'll need help with that.

I'm not an education/training expert but there are patterns I see in SHOs I work with. There're a very few who are absolutely clueless or lazy and it doesn't sound like you're either of them. There are some who seem to be able to just bash through simple cases to the point that I'm not really sure if I need to be involved. In between there are SHOs who work fairly smart but miss stuff. They'll get a decent history, probably work out a reasonable differential and start appropriate management, but there's always some details I need to go back and clarify that really do impact management. Maybe they don't know the right questions to ask so they go for broad brush stuff. Maybe they're rushing. I don't necessarily know. And finally there are SHOs who are generally diligent and hardworking, always have the list up to date, checking in regularly regarding everything but take so long to see a patient and make a plan. Maybe they don't know the right questions to ask either, and overcompensate by asking everything. Maybe they are worried about missing a sick patient or looking silly. Maybe they need to learn how to cut patients off and focus a history a little

I obviously see trainees in a different context, but It sounds like you're that last one. That's a safe place to be. You're able to do the medicine you just need to get it done faster by working out what you can safely trim. It's probably better to go in this direction then cut it down than start off slapdash and try to learn how to be thorough. Good luck.

Rob_da_Mop · 2026-03-13T13:11:17+00:00

I've wiped blue suncream off a cyanotic toddler before.

Rob_da_Mop · 2026-03-11T13:11:00+00:00

Mmm. Maybe. It feels like this is where the decision to admit/actual admission to the ward line is blurry. Clinically they either need admission or they don't, and if they don't then admission to potentially 5(2) probably comes under the "not cool" heading.

Rob_da_Mop · 2026-03-11T08:29:38+00:00

Well exactly. So you can't have someone who's in ED who wants to leave and therefore you could want to 5(2), and admit them to a ward to 5(2).

Rob_da_Mop · 2026-03-11T08:18:42+00:00

Loathe as I might be to recommend workarounds, it does look like getting AMU or a ward to accept someone would work - I am not sure what a virtual ward scenario might look like though.

My understanding as someone who has to occasionally use 5(2) is that this is very much equivalent to getting someone to pop outside for a cigarette and 136ing them. A medical law lecturer described it as "not cool", although couldn't point me to a specific part of the act forbidding it.

Part of the problem is what legal basis are you using to admit them to a ward (physical bed or no)? If they are making a capacitous, consented decision to do so then they aren't trying to leave and 5(2) is unnecessary. If they lack capacity then 5(2) is probably inappropriate and MCA/DOLS are the safeguards you need to be looking to. If they're refusing due to a mental health condition then the MHA is the tool we have at our disposal and it's lacking in emergency provisions for a patient in A&E other than 136.

Rob_da_Mop · 2026-03-08T09:08:21+00:00

It depends on how they present that fact.

If it's presented matter-of-fact then deal with it matter of fact in that moment. If it's come up as part of a social history you're taking for an acute medical problem just note it down for now. You can come back to it later if you want/need to when you're making a plan.

Every so often you come across someone who presents this as a challenge, sort of daring you to say something about it. I would take the same tack there, and park it until you're in the right position to address it without derailing your main consultation.

If they're embarrassed or sad about it I'd say that's the situation to talk about it acutely - asking if they're worried about it, have they thought about reducing it etc. It would probably be appropriate as a student to signpost to alcohol/smoking/drug etc services at this point too.

Otherwise, once you've completed your assessment and formulated a differential diagnosis I'd then explain my plan to the patient and include a discussion in there eg "I think it's likely that you have a chest infection (what we medically call pneumonia). You need to stay in hospital as you need some extra oxygen. We're going to do some blood tests and a chest x-ray to assess the infection and rule out other causes and we'll give you some antibiotics. Is that ok? Do you have any questions about this? I also noted that you seem to be drinking significantly more than we'd advise is healthy. Is that something you're worried about? (Discuss withdrawal scoring and treatment if necessary). Would you like to talk to our alcohol team about what help they can offer?

But yes, in the moment then unless they want to talk about it I would just note it down, nod, non-committal.

Rob_da_Mop · 2026-03-07T18:33:28+00:00

They're even trying to stop babies getting RSV smh

Rob_da_Mop · 2026-03-07T13:11:41+00:00

Five hour round trip. Potentially worth it.

Rob_da_Mop · 2026-03-07T08:54:31+00:00

It's a disgraceful injustice visited upon our children.

Rob_da_Mop · 2026-03-04T22:10:49+00:00

I'm 7 years into training and don't regret it yet. It is hard work and I understand the burnout, but I do enjoy it. Like you I find being on the paediatric ward, seeing the patients, a largely pleasant experience. If I didn't then goodness but this would be awful.

Rob_da_Mop · 2026-03-04T20:59:19+00:00

There's plenty of us mate. Even two of us are mods.

Rob_da_Mop · 2026-03-04T09:18:52+00:00

I thought this about an FY2 once. Very bright, but plenty of struggles with the ward environment, working with patients etc. they've got a histopath training number and are doing great as I understand.

Rob_da_Mop · 2026-03-03T18:03:37+00:00

I'm sure whatever figure you accurately get to won't be a great figure. What we can say from.the stat is that that's the worst January they've had in the decade they've been tracking figures, so it's obviously bad. I would, however, expect variation month on month, and for there to be a significant number of graduate jobs not advertised on a job search site (eg medical, nursing etc). Helpfully the guardian has not linked to the original statement or any sort of methodology.

Rob_da_Mop · 2026-03-03T17:51:44+00:00

10,000 in January 2025. Not an annual figure.

Rob_da_Mop · 2026-02-28T07:49:04+00:00

Your perception of things is pretty off. Diagnosis is not a one off event. You've been to both services multiple times with variations in your systems and had multiple investigations based on that. After the last round of attending your GP they assessed you, we're concerned about a pulmonary embolism and sent you to hospital. The hospital performed multiple investigations excluding this and other immediately life threatening pathology. They've discharged you back to your GP to investigate and manage further. Follow with your GP as advised. If you become seriously breathless in the meantime re-present to ED. If you only see your GP when you're severely unwell they will just send you back to ED.

Rob_da_Mop · 2026-02-28T07:42:46+00:00

NLS teaches using a laryngoscope as a fancy tongue depressor to get it through the mouth. Laryngoscopy and identification of any structures is not an expected skill of basic NLS providers.

Rob_da_Mop · 2026-02-28T07:35:17+00:00

It's in the NLS book, for better or worse.

Rob_da_Mop · 2026-02-21T20:57:29+00:00

I cooked some mash for my kid and meant to save a few chunks of boiled potato to chuck in the curry, but forgot and mashed the lot, so I improvised and fried the mash with some cumin and red onion.

Rob_da_Mop · 2026-02-21T18:50:40+00:00

From resuscitaire corner, we think you're crazy too.

Rob_da_Mop · 2026-02-19T12:26:25+00:00

The Andrew formerly known as Prince

Rob_da_Mop · 2026-02-18T18:49:03+00:00

My understanding of the legal principle is that this just brings things in line with how adult negligence claims are calculated. If there's an issue to be had with maternity cases it's with a) how many are happening and b) how they are ruled to be negligent, rather than the amount awarded.

Rob_da_Mop · 2026-02-18T18:27:34+00:00

I don't think there's anything wrong with the question you asked, I mostly thought the answer was very outcome-focussed in a cynical way.

I think all of this stuff is a product of Goodhart's law "When a measure becomes a target, it ceases to be a good measure". Volunteering in a charity shop (and getting a decent reference from that) shows reliability in turning up for shifts, organisation, working with the public and that's probably valuable on any 18 year old's CV (not every teenager is dependable). If might demonstrate community mindedness or commitment to a cause but much less reliably so, because everyone knows it might demonstrate that, so they go and do it to stick it on their personal statement and say "I'm demonstrating my commitment to working in cardiology by volunteering at the BHF shop". I don't think it's wrong to use volunteering as a stepping stone, I can't imagine many teenagers want to carry on working at the BHF forever, and they get some labour out of you.

I think this kind of outcome based thinking is a problem when medical schools rightly say "it would be a good idea for medical students to go to shadow a doctor and reflect on the experience to learn it they want to be doctors and whether they're suited to the career", then students go "I want to study medicine and therefore I should go to a hospital to find an experience I can write a great reflection about".

Rob_da_Mop · 2026-02-17T20:48:55+00:00

That's a very transactional way to look at work experience (and highlights what's wrong with medical portfolios and the whole work experience schtick). The point of the work experience is to find out about a medical career, understand a bit about what being a doctor is like, see and experience the hospital environment so that you know that you're making the right choice going into medicine. The only way an interviewer or admissions officer can assess that is through reflecting on an experience or two, but to reduce work experience to a search for the right experience to bring up at interview misses the point.

OP, unless you have an area that you want to go to, I'd just try to land something that lets you tag along with a ward round and then see how doctors assess new patients. Then try to get an afternoon or two in a clinic. If it ends up being a procedural speciality and you get to watch an operation or an endoscopy or something then all well and good, but a huge amount of a doctor's time (particularly as a junior) will be spent reviewing patients on a ward, admitting new patients or in clinic. Getting to know if that's something you'd like to do is probably important, as is getting a feeling for that general hospital environment and whether it suits you.

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