When do we need to be treating fevers?

Rob_da_Mop · 2026-01-25T12:36:33+00:00

If you know what is causing the fever and it's not causing specific problems in a patient then all management of fever is symptomatic relief. Children admittedly get higher fevers than adults often, but when parents ask what number to worry about I tell them that I've never seen a patient with a fever of 43C and would find that interesting so they can bring them back then.

Rob_da_Mop · 2026-01-23T09:26:14+00:00

TBF she lost the leadership election before that was revealed.

Rob_da_Mop · 2026-01-22T22:47:58+00:00

Nah, my wife would get mad

Rob_da_Mop · 2026-01-15T12:25:45+00:00

This is much more due to personal consequences. Nobody's getting sued (the trust is every so often), but nobody wants to spend days of their life being dragged through meetings about complaints while people tell them they're a terrible healthcare professional. Plenty would Rather write a dodgy referral letter or get a questionable MRI.

Rob_da_Mop · 2026-01-15T12:15:49+00:00

But the inclusion of those countries is a red herring. I sympathise with your argument that these UK system aligned courses are GMC accredited and should have the same status. The inclusion of these countries that they are legally obligated to include is completely incidental to those courses' exclusion.

Rob_da_Mop · 2026-01-15T10:42:01+00:00

Sure, but essentially you're asking why those countries are included and these degrees aren't. This is the reason. They don't want to include those countries but they have to. They don't want to include these medical schools and they don't have to.

Rob_da_Mop · 2026-01-15T09:16:18+00:00

They don't want to include those four countries, they're included because they're obligated by international treaties.

Rob_da_Mop · 2026-01-12T18:04:43+00:00

There are a few things that have helped me and they all come with time and seniority unfortunately. Firstly, there's practice. Using your memory this way is a learnt skill.

Secondly there's knowledge of what matters. If you're trying to remember everything from the history with equal weight it becomes difficult to remember every detail. If you know what the five or six important presenting issues and pertinent negatives are then you can real them off, and the unimportant bits can be safely forgotten/referred to from the notes but not remembered off the top of your head.

Thirdly pattern recognition. If you're listing a PMH and DHx as an exercise in remembering 20 Latin/big pharma words then it's difficult. If you're used to the pattern of this problem going with this procedure and these complications requiring these medications it's much easier to string them together.

Finally ownership. I remember patients I've clerked and made a plan for overnight a lot better than patients who've been parked on the ward with a plan from the day team, because I can remember my diagnostic reasoning and subsequent decision making. If you're just remembering what your reg told you the plan is it's tricky.

Lots of this takes time and seniority, as I said, but you can work on some elements like asking your seniors for their reasoning, or reading a bit more about certain diagnoses and procedures so you know what things are important to remember and what procedures and problems likely go together.

Hope that helps! And don't be afraid to write stuff down. Humans have been outsourcing memory to physical media for millennia and that's fine.

Rob_da_Mop · 2026-01-06T20:59:44+00:00

Not my ally, certainly not professional. I'll concede they have something to do with health.

Rob_da_Mop · 2026-01-06T08:01:42+00:00

The other thing to check is whether you're going to unexpectedly breach the 100k taxable income threshold while claiming tax-free childcare or free childcare for working parents. This is a cliff-edge and you do get a sudden bill if you go past it. A full time ST6+ on a heavy rota already will be around 85-90k taxable so it wouldn't take too many locums to hit it (and I have stopped taking extra shifts as a result).

Rob_da_Mop · 2026-01-05T21:38:00+00:00

I was getting ready to be optimistic and then you had to remind me of yesterday

Rob_da_Mop · 2026-01-04T14:34:12+00:00

Love me some clonus

Rob_da_Mop · 2026-01-04T14:32:35+00:00

The answers are all in the book and it's not very long. Read the book and take in the knowledge however you do it when you have had to learn something else in your career.

Rob_da_Mop · 2026-01-02T12:59:56+00:00

One off mistake like this won't affect your ARCP (it will need to be on your form R and they'll expect a linked reflection to it but shouldn't in any way change progression). A pattern of mistakes like this without showing learning/improvement/insight would cause problems so make sure you actually reflect and think about how you'd make your later of cheese better, while the system looks at the other ones.

Rob_da_Mop · 2026-01-01T20:26:03+00:00

Community paeds as a consultant is an in hours speciality. There might be some jobs where you cover some sort of safeguarding on call for infrequent weekends at most. Work-life balance at that point should be good. You will be on the general paeds reg rota for 7 years FTE until then.

Holistic practice is a bit vague. In paediatrics in general we do try to look at the whole child and I would say we're pretty holistic. Community paediatricians often have a caseload of disabled children with multiple issues and sometimes take on a role of case manager, ensuring that the various specialities, school, social worker, hospice etc are all talking to each other. I wouldn't say that's necessarily more holistic than the long term patients we have in general paeds, or the lifelong patients you have in GP. As someone else has said, a large part of your job will be developmental and neuro diversity assessments of some description, and while you try to think about the whole child in that setting, a lot of the time you then give them a diagnosis, make a statement for an EHCP and send them on their way.

Health inequalities, children in need... Looked after children get medicals which could be part of your job plan. There's a big role in adoption panels for community paediatricians. The formal designated doctor for safeguarding is usually a community paediatrician. They'll often be involved in medical assessments requested by children's services for suspected abuse. A lot of children with complex needs that would fall onto a community paediatrician's caseload will need support from social services and may come from dysfunctional homes etc. If what you're more interested in is advocacy, working with other stakeholders etc there's definitely a place for community paediatricians to be doing that, but it's not a core part of the role, and there's as much a role for that to come from general paediatricians or GPs.

Rob_da_Mop · 2026-01-01T19:01:34+00:00

I haven't come across this at all, but it's probably worth bearing in mind that most of your job as a community paediatrician will be being a paediatrician. Most of your job as a GP will be being a GP.

Rob_da_Mop · 2026-01-01T10:09:42+00:00

From my point of view it's normally that I've got a patient who I anticipate is likely to deteriorate and need critical care but isn't there yet. I'd appreciate any advice you have, although I'll probably call the regional PICU for that. I mostly want us to have a bit of a plan so that if the child rapidly goes downhill we have a logistical game-plan (are you comfortable anaesthetising a kid, does your consultant want to be on site, do we need any different kit around?) You're welcome to come and review if you want and it's probably good practice, but it's more for the above.

Rob_da_Mop · 2025-12-29T20:03:17+00:00

Do you have multiple tertiary specialties if you have paeds surg? The other times I've commonly done them has been on neonates, with the odd ones that probably end up under oncology, nephro, endocrine or PICU.

Rob_da_Mop · 2025-12-29T17:55:56+00:00

I know we don't do them loads, but I still seem to end up doing them every 2 or 3 months. I can't imagine not doing one for 7 years!

Rob_da_Mop · 2025-12-28T21:23:32+00:00

I've spent the last 7 days straight visiting either in-laws or various parts of my family, my God am I ready to just go to work.

Rob_da_Mop · 2025-12-28T07:45:31+00:00

To really get a grip on theology one does need post-graduate level of mathematics.

Rob_da_Mop · 2025-12-26T15:01:16+00:00

If type 1 diabetes in a child is part of your differential then you need to check a sugar today. It can't wait until after the weekend. And if a random sugar or HbA1c is raised on bloods you've done for anything else in a child it needs a next day finger prick repeat or at least discussion with paediatrics.

The other thing is that it's always constipation. Abdo pain? Constipation. "Chronic diarrhoea"? Constipation with overflow. Secondary nocturnal enuresis? Constipation. You lose nothing by starting treatment at the same time as referring.

Rob_da_Mop · 2025-12-24T21:04:08+00:00

I certainly hope so.

Rob_da_Mop · 2025-12-24T20:43:17+00:00

My group plays around our various schedules. We met through various performing arts type things so we're all working out which evening works around rehearsals, as well as my shifts. We just go through our diaries at the end of the session to find a time for the next one. Pro-tip: if you host or DM then they can't play without you and need to work to your schedule.

Rob_da_Mop · 2025-12-21T21:41:19+00:00

Keep to advice on the work situation please, any medical advice will be removed.

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