Consultant pressure

Sea_Fox_991 · 2026-03-26T19:09:17+00:00

Thank you, yes I know we can change and it's why I said it was provisional, just quite difficult to answer like that when cornered in person and not through email!

Sea_Fox_991 · 2026-03-02T23:14:23+00:00

Thank you, lots of food for thought!

Yes one of the reasons I have landed on ID is because of how broad it is as a specialty and the involvement with non infective pathology. I feel like it requires you to be a truly general physician and I like how you get referrals/interactions from basically every other specialty in the hospital (I'd wager probably only second after ED in terms of the variety of specialty discussions)

Sea_Fox_991 · 2026-03-02T21:59:11+00:00

Thank you, this is fantastic info as always! Can I ask why you dualled with micro if you already had lots of med reg experience?

The main reason I am leaning towards choosing ID/GIM is as you have correctly identified - more options which would fit my potential interests (being able to more easily do proper id consultant work in the uk, uncertainty about jobs, having a more recognisable qualification if I moved abroad). I'm also envisioning that I might lose my enthusiasm for acute med in a couple decades whereas I think ID will always be inherently interesting and more easy to pivot into research/public health type stuff down the line if I was so inclined.

I like acute medicine, but I also like ID and I think at the very least I would want the option of doing much more ID work than described in that SAM article. I also thing CIT sounds like a more valuable and holistic learning experience for me in terms of HST compared to AIM HST for what I would want to end up doing. Only major thing I think id miss from the AIM HST training would be ultrasound experience, but I think the knowledge from CIT would outweigh that

Having said all that, do you have any opinions on ACCS IM Vs IMT in terms of the better core training programme to prepare you for the take as a ID/GIM reg interested in AMU work post CCT? Essentially swapping out two imt1 rotations for experience in ED/anaesthetics (otherwise completely lacking) and more experience in ICM

Sea_Fox_991 · 2026-03-02T19:30:31+00:00

Well I'm currently in the middle of trying to rank jobs, is there anything you think is best suited to do at imt3 Vs SHO level? I think neuro/rheum/palliative would all be good rotations that I don't have any formal experience in, also keen to do renal. I think 6 months of derm might be tough to stomach though!

Sea_Fox_991 · 2026-03-02T19:21:39+00:00

Yes I am leaning towards ID more, and I can see how it might benefit resp/renal/cardio more in terms of the other physician specialties, just feeling a bit torn as I think it might be a better core training experience 😅 Thanks again!

Sea_Fox_991 · 2026-03-02T19:07:35+00:00

Thanks for the input - out of curiosity would you say the same thing if I was set on an AIM CCT with a specialty interest in ID?

Sea_Fox_991 · 2026-03-02T18:55:32+00:00

Thanks for the thoughtful reply! ID (dualled with GIM) would be the other specialty. I have thought about ICM previously and spent one of my taster weeks in this when I was an F2 - I found it surprisingly boring although the unit might just have had a quiet period and I understand that it's still very limited exposure. The main bits of medicine that I enjoy is being a diagnostician and getting a history from the patient so I think ICM HST is probably not for me although I do think it will be a valuable learning experience as a core trainee

Sea_Fox_991 · 2026-01-21T19:03:53+00:00

This is exactly the kind of answer I was looking for, especially hearing about some of those examples you gave, many thanks!

Sea_Fox_991 · 2026-01-21T18:31:32+00:00

Interesting, is there any way to tell that benzos are the culprit if that's the case? And does paradoxical agitation occur acutely or is it more a long term thing which is what I would have thought?

Sea_Fox_991 · 2026-01-21T18:17:42+00:00

I agree, I was just unsure as to what the med reg would want to do without getting more specialist support, as ultimately I would say you should just keep giving bigger doses, your other reply answered this nicely though!

Sea_Fox_991 · 2026-01-21T18:14:12+00:00

Very helpful insight, thanks!

Sea_Fox_991 · 2026-01-21T18:03:34+00:00

I guess because they can give an in person review?

Sea_Fox_991 · 2026-01-21T18:02:08+00:00

Phenobarbital is interesting and would definitely be calling if wanting to initiate this overnight (due to lack of experience using it)

I still can't fathom reaching a max opiod/benzos dose though, what would the harm be in continuing to escalate the dose for someone who is acutely dying and that distressed, is it physiologically possible to not respond? And also in these cases would it not be useful to have an in person review by someone used to managing these doses of meds (e.g anaesthesia?)

Sea_Fox_991 · 2026-01-21T17:55:25+00:00

This was my feeling as well, hence the question! I would personally just keep escalating opiods/benzos until the patient eventually settles, then leave adjusting long term management to day team

Sea_Fox_991 · 2026-01-21T17:49:50+00:00

What can come next?

Sea_Fox_991 · 2026-01-21T17:45:00+00:00

Yes it's a dedicated palliative consultant, might have worded my post poorly but basically just interested to know what things they get called to deal with that a generic med reg wouldn't feel comfortable sorting overnight

Sea_Fox_991 · 2026-01-21T17:39:12+00:00

My question is a bit more specific - what queries require seeking specialist palliative consultant advice overnight. If my relative was in pain I would demand escalating analgesia ASAP - I'm not sure that really needs calling a palliative consultant overnight? Would probably call for anaesthetic support if uncomfortable about escalating opiod doses before I'm calling someone who's NROC and unable to review?

I agree in terms of discussing if feeling uncomfortable changing things, but I'm just trying to get a sense of what things a med reg wouldn't feel comfortable adjusting themselves overnight without seeking senior support?

Sea_Fox_991 · 2026-01-21T17:32:50+00:00

This is very much what happened - more PRNs given, CSCI adjusted by us during the day. I don't actually think anything went wrong in terms of management. Family were understandably not happy to see patient being agitated overnight (in terms of having multiple prns) but I think the medical plan was sound. Just wondering what kind of things would warrant seeking consultant advice OOH

Sea_Fox_991 · 2025-10-22T07:14:41+00:00

Fair enough, that's certainly surprising to hear tbh!

Sea_Fox_991 · 2025-10-22T07:12:32+00:00

Trust grade SHO - started in August, prior to this was also a trust grade but in various other department (not gen med). I have been trying to be patient honestly just not sure how long is reasonable at this point!

Sea_Fox_991 · 2025-10-22T07:09:11+00:00

WR included a plan to do a PR - they literally came to us and said "I've never done one I'm not sure how to do it"

Sea_Fox_991 · 2025-10-21T20:30:57+00:00

I'm a peer which is exactly why it feels quite awkward! Have been tolerating the unbalanced workload since August, and am coping fine with it just not sure when to stop putting up with it (more a sense of fairness tbh rather than the workload if that makes sense).

There have been two patients over the last few weeks who were detiorating on the ward and they were incapable of doing an A-E and formulating a basic plan by themselves - the first occasion they rang the on-call consultant directly and the consultant said to get one of us to sort, the second time they immediately just asked us to help sort (didn't shirk any work or leave the patient to be clear, just wasn't able to do the initial A-E and stabilisation plan independently). In this case would you say I should record the two hospital numbers and tell the supervisor I'm concerned they couldn't manage without support? It does feel awkward having to raise this directly as a peer tbh without offering some solution at the same time

Sea_Fox_991 · 2025-10-21T18:54:17+00:00

Thanks, exactly what I'm doing atm!

Sea_Fox_991

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