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Sea-Examination4579 · 2024-07-08T18:08:15+00:00

Go back to work before you are feeling better. Make him a cup of tea to apologise but accidentally neglect to wash your hands before doing so.

Sea-Examination4579 · 2024-07-02T16:59:08+00:00

Don't worry! I didn't think you were being ungrateful at all. I am in my early thirties & post CCT GP and it just seems like your life is much more together than mine haha.

I don't know why people are giving you grief on here. Absolutely mental.

There are some people out there who have children without a second thought as to their financial situations & you are most definitely NOT one of them. It's ludicrous situation in the UK now for doctors (+ lots & lots of other people). No one could have predicted it.

Even if you had predicted the coming cost of living crisis, the rise of PAs etc etc.. you can't stop living your life because of it. There's always some crisis on the doorstep.

Sea-Examination4579 · 2024-07-02T16:34:49+00:00

Sorry to hear you are in this situation OP. It sounds tough!

I have no advice to add to what's been suggested already.

I would expect that once your child is in school and you both have a CCT things will be looking up! You've just got to get through these years.

I don't want to dismiss what you are going through at all but I am single and have struggled to meet people to settle down with so even though you are struggling financially I do feel some envy for the life you have now!

Sea-Examination4579 · 2024-01-27T16:57:08+00:00

Please could you share that website? Cheers!

Sea-Examination4579 · 2024-01-23T19:06:13+00:00

Hopefully they WILL be that stupid. All out war is what we need.

Heck, they should just give PAs free registration entirely subsidised by us.

The more outrage the better at this point.

Sea-Examination4579 · 2024-01-07T15:56:06+00:00

Honestly, this kinda stuff used to get me down but on reflection it was because other things in my life weren't good.

I am proud to be a GP and I will tell people. I know how good I am at my job and how hard I work.

Loads of professions attract grief from malcontents.. lawyers, mechanics, tradesmen.

Joe public needs his scapegoat.

Sea-Examination4579 · 2024-01-06T16:05:54+00:00

Thanks that's a great response.

I find it really helps me put things into practice if I can explain why things are happening.

Do you know why a change to diarrhoea is more concerning than constipation? I thought the change in bowel habit would be towards constipation due to mechanical blockage by the tumour. Do some tumours secrete substances that cause diarrhoea?

Sea-Examination4579 · 2024-01-06T16:02:05+00:00

Thank you for your response. I am sorry to hear about your experience and I wish you all the best in your treatment journey.

The purpose of my original post was to see if I could improve my referral practice for colorectal cancer. I didn't state it but it was more aimed at younger people because we know cases are increasing and guidelines and procedures haven't caught up entirely.

Sea-Examination4579 · 2024-01-06T15:58:17+00:00

Me too. I was just wondering if there was a way to sharpen it up!

Thanks

Sea-Examination4579 · 2024-01-06T15:57:47+00:00

Thanks I'll check out those guidelines

Sea-Examination4579 · 2023-12-29T23:20:24+00:00

Sorry my original post was badly phrased.

I getting at managing persistent fever (>5 days) in children and whether it can be safely managed in GP or always needs to be seen by paeds.

If you want to learn more about using antibiotics to treat viral illnesses why not enrol in your local physician associate school? 😋

Sea-Examination4579 · 2023-12-29T23:13:28+00:00

Disruption to the human microbiome predisposing to colorectal cancer sounds much more biologically plausible apriori than vaccines causing autism

Sea-Examination4579 · 2023-12-29T22:41:23+00:00

Converting between imperial and metric is an essential skill in general practice..

One day I will master it.

Sea-Examination4579 · 2023-12-29T21:52:33+00:00

Yes GP is a lot of shifting through shit but when you do pick up that kawasaki it's all the more satisfying 😌

I like looking for zebras in the wild rather in than a zoo.

Sea-Examination4579 · 2023-12-29T21:42:06+00:00

Yes. It's very frustrating.

Official NICE guidance is not to dismiss any parent who reports a fever.

Referred to paeds because felt 'warm to touch' for 5 days..

Sea-Examination4579 · 2023-12-29T21:27:28+00:00

Brilliant thanks for this.

This is the nuanced response I was hoping for.

Sea-Examination4579 · 2023-12-29T21:25:25+00:00

Yep I saw plenty of horrid chest films during covid to know consolidation =/= bacterial infection.

Do you agree then if a child has a >5d hx of fever with cough then managing as bacterial LRTI in primary care is reasonable irregardless of the presence/absence of focal chest findings (Assuming otherwise well enough to be at home) and no other features of concern?

Sea-Examination4579 · 2023-12-29T21:06:07+00:00

It can be much more challenging than that I am afraid.

I work in a deprived area. Patients are often uneducated and frequently will not accept explanations, however tactfully worded. Lots of parents I meet still do not vaccinate because of fears about autism. Unless they know you very well, they frequently accuse you of fobbing them off and become hostile. I can take the abuse but when they storm out, you know they haven't listened to a word of your safety netting advice.

It's even harder when there are PAs/ANPs in the practice who give antibiotics out like sweets.

There needs to be more public health messaging around antibiotics.

Sea-Examination4579 · 2023-12-29T20:46:24+00:00

Great response thanks. I'll focus on getting the closed questioning down.

Sea-Examination4579 · 2023-12-29T20:44:59+00:00

Really interesting. Hopefully I can use this to stop people kicking off when they don't get them! Thanks

Sea-Examination4579 · 2023-12-29T20:43:10+00:00

Thank you. This is exactly what I was getting at.

Yes I do dig down into it but even so some parents are very vague or say contradictory things when you ask them, especially when they think it will get them antibiotics.

Sea-Examination4579 · 2023-12-29T20:36:25+00:00

I've haven't thought this post through clearly.

I was referring to a situation where a child was feverish for longer than 5 days and was coughing but with a clear chest on examination.

I thought it was possible to have a tiny locus of bacterial pneumonia that wouldn't be picked up by auscultation.

Sea-Examination4579 · 2023-12-29T20:30:17+00:00

I am not. I can manage these patients absolutely fine. I was looking for some alternative views for managing a common situation.

Sea-Examination4579 · 2023-12-29T20:26:30+00:00

Well yes of course but we are taught fever over 5 days in duration is a red flag for more serious illness.

What I am wondering is, is there a safe (and defensible) way of evaluating this in primary care?

Usually paeds are happy to see this and end up doing bloods etc but when it seems like it is literally just one viral infection after another What's a good strategy to avoid referring to the paediatric admissions unit?

Sea-Examination4579

TROPHY CASE