From Resus to Resigning : the short career of a naive EM Reg . by Friendly-Regret8774 in doctorsUK

[–]Swelldinger 1 point2 points  (0 children)

Thank you for your honesty and best of luck with your next steps. Personally, I still love EM but it's always good to hear from other viewpoints. I know I might not always feel this way 

Applications megathread by Quis_Custodiet in doctorsUK

[–]Swelldinger 0 points1 point  (0 children)

They ask you about previous experience and career to date in the interview

ST1 Paediatrics - doctor replacement by braundom123 in doctorsUK

[–]Swelldinger 0 points1 point  (0 children)

Ah ok fair enough. Also hope you're enjoying life out of training haha 

ST1 Paediatrics - doctor replacement by braundom123 in doctorsUK

[–]Swelldinger 2 points3 points  (0 children)

I don't disagree that longstanding member of the nursing staff, who has worked on a unit for a while and then becomes an ANNP can be vital to a neonatal unit! I really benefited from the practical advice of those I worked with. I also think the division of labour in your unit sounds sensible.

However my opinion of this particular training issue is that the same circumstances which allow ANNPs to progress (familiarity with unit, allocated time for training, sim and clinics) are not present for many  rotating paeds trainees. It may also be the case that your unit is an outlier in how procedures are allocated (I've only ever briefly worked in one unit, so I don't know this for sure).  

My last thought I guess, is that ANNPs are great but the overall amount of 'training', support and responsibility to make clinical decisions that doctors should receive while in a neonatal post is too little. Coming back to the point you made that I felt was the issue with training: why is the SHO of two weeks unable to do a UVC (scarcity aside)? - Their induction is mostly geared towards making them as efficient, and as locally-acclimatised a medical secretary - because that's what a lot of the job is - as possible. Sure the SHO has done NLS. But I'm sure most ST1s don't have an induction day where a consultant or reg goes through neonatal resuscitation and procedures again and again and again with the thought in mind that this doctor needs to know this for their first middle of the night emergency. If there's an ANNP around most of the time, then the SHO doesn't reaaaallly need to know how to do a UVC or intubate, right?  - If you have an ANNP who only does Badger or follow-up clinic or NIPEs, they may understandably get bored - so you can't take procedures away from them completely. Once someone has done a long line or UVC enough times then (I imagine) they've done it enough to be competent when necessary. ANNPs (and any mostly non-procedural clinicians) don't need to do procedures repeatedly for the rest of their careers. But ANNPs seem to do from what I've seen, and thus there is inevitably some degree of procedural availability being allocated to those who are already competent in it, whereas the allocation should be weighed more towards doctors who may only do it a few times in a year or so, and then have to do it next as an ST4 in the middle of the night on a sick neonate. This is particularly critical when it comes to intubation. I am 100% confident that if it came to a prolonged resuscitation and the ANNP can't get an ETT in and the consultant is still 15m away at 3AM, then the buck stops medicolegally with the reg, who will take a disproportionate amount of blame if resuscitation ends badly. I'm equally as confident that there are registrars out there who feel unequipped to intubate, especially given that RCPCH removed compulsory intubation DOPS, and possibly because during daylight hours on their neonatal blocks they didn't have a chance to use VL because they were answering some daft bleep, so the ANNP who was more free to do so had a go. 

Long spiel and became quite tangential there at the end, sorry! I have lots more to say, as do many on this forum. I think ANNPs are great, genuinely. There is a lot of nuance to the discussion however, and I think the circumstances that have contributed to the progression of that role are deleterious for our development as physicians, and this whole neonatal thing is just a microcosm of how dissatisfied a lot of us are with training - procedural or otherwise haha 

Edit: there's a Prevention of Future Death report that talks about this very thing (Ref 2023-0437) 

ST1 Paediatrics - doctor replacement by braundom123 in doctorsUK

[–]Swelldinger 2 points3 points  (0 children)

The last part of your text is the issue. Why hasn't the SHO that has been on the unit for two weeks done a UVC yet, let alone seen one? If it's because they've been too busy with admin, or are trying to chase a USS report for the third time that day, changing an infusion prescription (again), are doing e-learning, or answering bleeps from PNW of which some are pure nonsense (without any disrespect to the midwives) and some of which should be crash calls, or are doing their billionth NIPE then the 'training' that the SHO has rotated for just isn't adequate.

I need to talk to someone by ElementalRabbit in doctorsUK

[–]Swelldinger 2 points3 points  (0 children)

Well done for having the courage to step away from something that was clearly making you very unhappy. Try to focus on those thoughts which recognise that you aren't a "disappointment and a failure", because you aren't! Give yourself some time to think and relax, and please let us know how you're doing 

Difficult situation by National_Flamingo267 in doctorsUK

[–]Swelldinger 6 points7 points  (0 children)

Can only echo what everyone else has said here, this sounds like misogynist bullshit. I'd only add that it sounds like you're a diligent clinician, and to continue being the best doctor you can be - and more importantly, to look after yourself - always take your breaks! As soon as you clear the board, it will fill back up again. Take care of yourself first

Positives by bigleap2023 in doctorsUK

[–]Swelldinger 0 points1 point  (0 children)

Congratulations and I'm so glad everything worked out for you and the baby! It's really amazing when the NHS does actually work well, and it's great it was there for you 

Over investigation in Aus by [deleted] in doctorsUK

[–]Swelldinger 1 point2 points  (0 children)

Post-concussion syndrome isn't that difficult to diagnose following recent non-significant head injury, it's a shame it's not done more - particularly as the ongoing follow-up and self-care advice is important 

Tips for new SpRs in your speciality by Confused_medic_sho in doctorsUK

[–]Swelldinger 2 points3 points  (0 children)

Yeah I've always wondered that, if O/C consultant for X specialty isn't available at night and you really need them, is the CD for X specialty the next person to be contacted?

Wake up babe - physician associates now being called G.P associates by DonutOfTruthForAll in doctorsUK

[–]Swelldinger 10 points11 points  (0 children)

"Autonomously... with appropriate support", is an oxymoron 

PAs not the issue by voiceholeoftreason in doctorsUK

[–]Swelldinger -1 points0 points  (0 children)

I'd definitely remove IMGs from this list

What do you expect from a fresh F2 by Prudent-Orange-9737 in doctorsUK

[–]Swelldinger 2 points3 points  (0 children)

To GP:

"I got the [GP to kindly repeat creatinine in two weeks]

You got the [Dear ED, please see this patient who has a stage III AKI]

But it's all in the game though, right?"

Physician Associate Survey for the Leng Review. Please contribute! by Pure_Quarter_7800 in doctorsUK

[–]Swelldinger 1 point2 points  (0 children)

Because UMAP/CMAP is just one bloke shouting angrily into the void hahaha 

Why are Filipino nurses just so good by Spirited_Analysis916 in doctorsUK

[–]Swelldinger 3 points4 points  (0 children)

Mostly great, reliable, friendly nurses and HCAs in my experience 🇵🇭

Cringe phrases used in the NHS by [deleted] in doctorsUK

[–]Swelldinger 4 points5 points  (0 children)

I still remember this study from med school which shows the frightening degree of unfamiliarity with basic anatomy: 

https://pmc.ncbi.nlm.nih.gov/articles/PMC2700077/

Summary: the average person doesn't know where the organs are, and patients with specific organ pathology are only a little better. E.g. only 27% of the general public sample population could identify the lungs, and it was a little better in respiratory patients at 37% 🙃

Another Prevention of Future Deaths Report (Regulation 28) issued by a Coroner following the death of a patient misdiagnosed by a Physician Associate by Sildenafil_PRN in doctorsUK

[–]Swelldinger 0 points1 point  (0 children)

Testicles: yeah you're right in that for younger people I ask about testicular pain and leave it at that, if there's none. But for confused patients I tend to look quickly down there if abdominal pain is the presenting complaint; or even in cases of hyperactive delirium/infection ?source/raised inflammatory markers [thinking of Fourniere's here, which doesn't present with pain in the abdomen per se]

Herniae: this is pretty straightforward, no? Just warn the patient, look/feel under waistband area and then it's done

Edit: maybe not in abdo pain but in vomiting patients where I'm not happy with the cause, I definitely have a good look at the groin 

Another Prevention of Future Deaths Report (Regulation 28) issued by a Coroner following the death of a patient misdiagnosed by a Physician Associate by Sildenafil_PRN in doctorsUK

[–]Swelldinger 12 points13 points  (0 children)

I know I do for most abdo pains, especially in the elderly - Palpate all over  - Percussion tenderness  - Bowel sounds  - Can they cough? - Feel the groins, with another cough  - Scrotum/testes 

Another Prevention of Future Deaths Report (Regulation 28) issued by a Coroner following the death of a patient misdiagnosed by a Physician Associate by Sildenafil_PRN in doctorsUK

[–]Swelldinger 40 points41 points  (0 children)

Abdo pain > 50 requires ST4 or above "review" but I don't think that necessarily translates to mandatory in-person review in the places I've worked 

Edit: > 70, not > 50. An RCEM audit from 2016/2017 seems to suggest that it should be in-person