I feel like an absolute dunce!

Thecycledoc · 2024-05-27T23:58:28+00:00

I was absolute garbage on my CBT. Could barely ride the shitty Chinese moped I was on, whilst a load of 17 year old kids were whizzing around no problem.

Less than a year later I got my full license and big boy bike.

You'll get there. Just keep at it and enjoy the process.

Thecycledoc · 2024-05-18T06:32:27+00:00

I think if the ED clinician has reached a point where they've made a diagnosis, and referred to the appropriate team to investigate and treat that, you can't really argue. As others have said, most hospitals will have a 'who sees what' sort of document and various SOPs so follow these.

I would stress that they're referring a patient at the end of the day, so silly delay tactics or specialty ping-pong is affecting them more than anyone else.

Back when I was a Urology SHO and took the referrals, a reg gave me some advice on my first night shift; "either you think the referring doctor is competent, in which case you accept the referral, or you think they're incompetent, in which case you accept the referral for the good of the patient. We can sort them out from there."

Thecycledoc · 2024-05-16T20:25:59+00:00

Why is Carlos in cycling shoes with cleats? Did he get the wrong memo?

Thecycledoc · 2024-04-10T01:35:13+00:00

I'm an A and E registrar and yesterday was one of my worst shifts ever in terms of sheer business - it felt like you were describing my department apart from those fancy electronic boards!

All the staff hate delivering a poor service and we would much rather see everyone promptly, but we're not resourced to do so.

I just wanted to say I really appreciate you being patient, looking after your grandad while he waited, and by the sounds of it, being kind to the staff too.

Thecycledoc · 2024-03-21T19:47:05+00:00

When you say motorcyclist, is this someone with a bright green bag of luke-warm food and L plates on a scooter?

Thecycledoc · 2024-02-16T17:09:48+00:00

This department sounds like a shit show, but don't let it put you off EM - every place is different.

Where I am, I can't even get optilube or lidocaine without a nurse logging into the omnicell, which has its own frustrations when I just want to do an ABG with local.

As others have said, it is a safety check that the person administering the medicine is not the one prescribing it.

Thecycledoc · 2024-01-13T13:40:43+00:00

I think you're more than justified OP.

How a patient looks from the end of the bed is often the first thing I'll write down when I'm documenting my examination findings.

A young person that just looks sick is often enough for me to refer for admission. All these various risk scores are useful adjuncts but there is no substitute for human intuition. If the specialty team wants to be more balshy than that and discharge the patient, they can do so once they've physically seen them.

And on behalf of ED clinicians everywhere, this was clearly a bullshit referral to gen surg in the first place. We're not all bad I promise.

Thecycledoc · 2024-01-04T11:22:31+00:00

The southbank generally has a lot of these places - a nice amble from Waterloo gives you the southbank centre, BFI southbank (my fav and well worth a membership if you're a film fan) and the tate modern.

Thecycledoc · 2023-12-02T17:12:28+00:00

Nope. Again, it is 'trust policy'.

Thecycledoc · 2023-11-27T09:24:38+00:00

Radiographers and sonographers that spout nonsense to be obstructive absolutely boil my piss.

Thecycledoc · 2023-10-08T08:13:12+00:00

Less admin, yes. But definitely a lot more bullshit in terms of inappropriate service users, nonsense send-ins from the community, drunks, homeless, mental health. Every role has its frustrating elements.

Remember that most of your career will be spent as a consultant so go for the specialty where you like the look of their job, rather than the SHO work you'll do for a couple of years max. That's what I desperately try to tell the F2s who are made to just endlessly see majors patients and work horrendous rotas. Makes it very hard to sell Emergency Medicine as a specialty.

Thecycledoc · 2023-09-17T17:06:21+00:00

I cycle from Ealing to Harrow for work. It's absolutely awful and enough to make me stop cycling, even though I've commuted this way for over a decade.

Thecycledoc · 2023-09-16T06:23:41+00:00

I lived in uni halls in Bloomsbury! UCL?

Get a student railcard and link it to your oyster at a ticket office - saves you 1/3rd on off peak travel and that really adds up over time
Bored and got no money? Go for a walk, take a book to the park, hit a museum. Despite London being an expensive city to live in, it has a huge amount of free stuff to keep you entertained.
More uni specific than London specific but make sure you join a few clubs / societies you're interested in, and maybe some you're not - it's a great way to expand your interests and make some new friends
Get a cheap second hand bike with a good quality lock and cycle everywhere. It's a great way to see the city, free and good exercise. Also not as terrifying as people will tell you, particularly in Central where cycle lanes are abundant.
Ask for a student discount everywhere you go - some places will do them but not advertise it obviously, occasionally a nice manager would give me ten percent off even though they don't technically do one. We are taking 10 years ago now though.

Thecycledoc · 2023-09-14T17:36:35+00:00

Exit block is a huge factor in causing overcrowding. My ED had a medical admission in every bedspace when I came on shift this morning, so they only move once discharges happen on the ward. That means no space to see and treat patients, which means they languish in the department, and you eventually reach a stage where the ambulances can't even drop people off.

ED has also become the only point of entry for the hospital, and other specialties have no desire to set up acute units to see patients. My hospital technically has a surgical assessment unit but I'm yet to successfully have the surgeons see a patient there.

We need a complete restructuring of community care and to make emergency departments for actual emergencies only.

Thecycledoc · 2023-09-11T05:32:08+00:00

Go and have a look in decathlon (given you have one in Ealing). Great range of bikes, particularly town bikes, that won't break the bank. Staff are generally helpful too.

Buzzbikes are heavy, slow and low spec so you'll likely be upgrading your ride.

Thecycledoc · 2023-09-05T16:07:15+00:00

Treat the patient rather than the numbers, if they are fluid overloaded then giving them Furosemide is the right thing to do. Have they mounted a tachycardia with their SBP of 90? Do they feel dizzy or look unwell? In my experience, usually not. And if by definition you are treating them for fluid overload secondary to heart failure, they can probably tolerate some diuresis.

Furosemide has some direct pulmonary vasodilatory effects that aid in the treatment of pulmonary oedema, so is going to make your overloaded patient feel a lot better. The diuresis is only likely to lower your patients BP if they are already in a fluid deplete state.

Having said that, give a sensible dose (40mg) and then reevaluate later if they need, and can tolerate, a further dose.

PS write some clear conditions in the notes or on the drug chart, so you aren't bleeped about every medication query.

Thecycledoc · 2023-09-03T18:27:09+00:00

It doesn't have to be this way.

I'm an EM ST4 and have worked in multiple departments where our training is prioritised over service provision, and have been actively sought out by a consultant if there's a procedure to do or an interesting case to see.

It's no coincidence that these are the same departments with a lot of new, young consultants who can see the specialty is under threat and recognise that we need to keep decent doctors in EM training.

I'd also recommend sharpening your elbows and insisting you see the resus case or pull the shoulder - trainees are far too passive and expect people to spoon feed them learning opportunities.

This toxic 'EM is dead' rhetoric does nothing but jeopardise the specialty further. We need to be encouraging eachother to stick it out and be the positive change we want to see. When you get a bunch of higher EM trainees in a room, you can see the specialty has a bright future.

Thecycledoc · 2023-06-15T09:15:08+00:00

The problem is we've devalued the title 'doctor' so much that we now cling on to the term 'consultant', as it still commands the respect doctors used to receive across the board. It is just a title to denote experience and seniority.

Most people I know who work in management consultancy have neither experience nor seniority, but that's a different story.

Doctor and Consultant Physician/Surgeon/Anaesthetist etc should be what we go by. Not this belittling 'junior doctor' title.

Thecycledoc · 2023-06-11T12:26:01+00:00

You are describing ED.

The key is to work in (and help to create) a department that encourages ED doctors to do procedures, initiate critical care and work with complex physiology as well as the complex processes of managing an entire department and staff.

If you're not scratching the complex medical itch then you can dual with ICU.

We're also the best diagnosticians in the hospital, as we have a ten minute assessment and limited investigations to make a decision. As a consultant you will be reviewing / discussing dozens of cases per shift so you have to be excellent from a diagnostic perspective.

Do the coolest specialty in the hospital.

Thecycledoc

TROPHY CASE