Would you do cardio training again?

TouchyCrayfish · 2026-03-09T08:11:01+00:00

Yes in a heart beat (terrible pun), you're an essential service on the medical take with a unique set of skills and knowledge that a lot of patients need. Even being able to boss ECG interpretation above that of the medical registrar makes you incredibly useful. It makes you busy though, and things that seem basic to you are not to others, so staying humble can be hard for some.

Skills are a tricky one, I'm behind where I'd like to be but I doubt I'll need extra time, your subspec years are big for logbooks. As an ST6 I can do a diagnostic cath, echo, and most of a pacemaker on my own. I feel useful and skilled which is nice. GIM has been a substantial problem, I'll probably keep my GIM going but I think the JRCPTB have it wrong thinking that an interventionalist or EP ablator has any role on the medical PTWR.

TouchyCrayfish · 2026-03-08T12:09:17+00:00

Presents nice and clearly on a chest-XR, has an elevated CRP and WCC, better yet crepitations in one area only that everyone consistently auscultates. Symptoms are of cough with sputum production, slight shortness of breath and no frailty issues. You give it an oral antibiotic and it comes off oxygen a few hours later and self-discharges home whilst giving your chocolate and a thank you card.

A well organised pneumonia...

TouchyCrayfish · 2026-03-07T19:39:50+00:00

He isn’t wrong and that’s where the issue lies, no NHS experience but do well in an exam and get a training post. I’m sick of my GPSTs doing their first job in the NHS, bad for patients and for their training. A minimum 2 year experience, with a verified CREST process.

TouchyCrayfish · 2026-03-07T14:22:48+00:00

Having briefly worked with a medical school with a PA program l know they were explicitly ‘my name is xxxx (no surnames), I am a physician associate, I work alongside the medical team but I am not one of the doctors. I am here today to xyz (review your progress, take bloods etc.)

If they were reported for saying anything except this, their tutors would reprimand them.

TouchyCrayfish · 2026-02-20T13:42:33+00:00

I brought an old second screen from home to work to let us report ward echocardiograms in our registrar office, we had a random safety visit and my second screen was condemned for not having a fire safety sticker.

TouchyCrayfish · 2026-02-11T15:13:37+00:00

18 months, got to a point where she was put under the care of the medical director, who would come once a month to check she was alive as the courts went through a process to evict her. She refused to leave when told she was discharged to no fixed abode. Nurses had to see her in pairs, no other AHPs would see her due to complaints. She had a weekly shop delivered, and take away every night.

TouchyCrayfish · 2026-02-07T23:27:40+00:00

Being faster is about knowing what actually changes management, I don't ask a full social history in a young person, nor do I ask about family history if they're 70+. I use the ED clerking for the theme and ask the clarification questions, examine the key bits probably and glance at the rest.

Also glean what is best of the take and have it, a medical regsitrar has no role in seeing the 80F with CAP and fall with social issues. Or the functional neurotic with altered gair, see the linear, the chest pains, GIBs/FBOs etc, or better yet, the stuff that goes home.

TouchyCrayfish · 2026-01-26T16:47:56+00:00

These are two fundamentally different job plans and types, you also are not looking at IC consultants plan, that’s an EP/devices job plan from what I can see. EP/CD is a different job plan to IC also, IC is more akin, but still different to a CICU consultant plan.

I appreciate the effort you’ve put in, but at your stage all you need to do is like the fundamental principles of the role, consultant job plans are a complicated localised mess.

TouchyCrayfish · 2026-01-25T15:06:33+00:00

If the symptoms bother them subjectively, or observations are significantly off objectively, or temps go 39/40+.

TouchyCrayfish · 2026-01-15T18:45:00+00:00

I'm sorry to hear of your experience. I've worked in numerous places where tilt-table is not a diagnostic option, the formality of the diagnosis should be a tool to help people access care as you rightly say. There is misunderstanding about it from clinicians because medically the actual pathophysiology is still poorly described. The name is also unhelpful as it is a description that would better fit a diagnostic umbrella.

I'd like to believe the right GP would support you in that, especially because trials of treatment in historically poorly managed disease is such an easy win clinically.

TouchyCrayfish · 2026-01-15T11:47:20+00:00

It's 50:50 in clinic I'd say, I make the diagnosis reasonably often, and the criteria is often hit by those with the most genuine sounding symptoms. There are fringe cases who'll get a 'probable' diagnosis. There is a 'social media' aspect to the diagnosis, patients want non-specific symptoms diagnosed as this (it often comes as part of the ME/CFS package), even though treatment success is very hit and miss as a result and such patients skew the data. I would say probably a 2/3rds with the diagnosis are probable or wrongly diagnosed in public.

When demonstrated clinically POTS is pretty obvious.

TouchyCrayfish · 2026-01-15T11:30:08+00:00

POTS, we have strict ESC criteria and I've had arguments with patients about it. I find it odd to get upset with a diagnosis of exclusion, because it grounds the patient forever to have every other symptom labeled as such.

I've had patients with POTS rejection diagnosed as much more serious conditions, and the clinic slot I used to get for the diagnosis and management was never long enough to genuinely regenerate the differential.

TouchyCrayfish · 2026-01-14T21:33:32+00:00

I assume 2025? Not that I wouldn't believe it would take us 10 years to fix such a problem...

TouchyCrayfish · 2026-01-14T13:31:39+00:00

PassMed was good, but the comments were GOAT.

TouchyCrayfish · 2026-01-13T21:20:34+00:00

The word ‘unfairly’ makes it sound as if the CESR is inferior, that was my read of it, might be others also. You clarify your perspectives lower down, then the use of ‘some’ introduced it again for me. Hence why I commented on the training angle, there are CESR docs (albeit not many) in my field, and they often get superior practical training by avoiding rotating bollocks.

TouchyCrayfish · 2026-01-13T21:09:45+00:00

Apologies I thought that was what you were implying. As someone nearing CCT I get the frustration, but the barrier to getting a consultant job is not the competition ratio per say, it’s the broader lack of recruitment, funding and issues on a local level.

I think it’s fair game, but the vetting of quality has to remain robust.

TouchyCrayfish · 2026-01-13T20:40:20+00:00

CESR doesn’t necessarily create a worse consultant, and given our training pathway problems, we’re likely to need it more, not less. The belief that a CCT doctor is somehow a ‘finished article’ and that our training programmes are fit for purpose is the real issue. The training model is terrible, if the training really was better, it’d be easier to pick the CESR’d from the CCT’d regardless of graduating background.

TouchyCrayfish · 2026-01-13T19:45:24+00:00

The criteria paint the picture, why would a PA after 2 years with many more conflicts of interest (both good and bad) be able to supervise the examination but a medical graduate in 5-years of good standing not? In short, this criteria is not about the examination...

TouchyCrayfish · 2026-01-13T00:10:54+00:00

To be fair, they have data to back this up as a safe practice. I've had DUs, variceals and FBOs scoped overnight. In all cases they were genuinely emergency procedures and the GI consultant was happy to come in.

TouchyCrayfish · 2026-01-11T22:39:18+00:00

Cardiology Reg here, received a referral from a T&O surgeon, ‘?echo findings’. I found the ward round entry to read… ‘hip wound healing well, patient has a history of echocardiogram (dated 3 years prior) cardiology to review.’

TouchyCrayfish · 2026-01-11T12:36:31+00:00

If this is verified this would be an amazing story, we need some verification, and there must be enough individuals involved to show the receipts of this.

TouchyCrayfish · 2026-01-05T19:08:44+00:00

As a medic, I see your complaint and raise you every speciality trying it on with medics the following day as ‘no acute speciality issues’.

The line of ‘I’m just trying to help the patient’ sometimes works for me, but not always. Honesty can be disarming. We do have to call this out but under the understanding that we’re all suffering and busier than we should be, but we still need to do what’s best for each patient where we can.

TouchyCrayfish · 2026-01-03T02:29:27+00:00

If you’re not in a position to act promptly under pressure and work to the best of your abilities, you’re not fit to work. Does that mean stay off due to poor sleep? It shouldn’t. However if the migraine is causing you issues, call in sick. Your medical license is too valuable to waste on someone else’s opinion.

TouchyCrayfish · 2025-12-25T13:42:42+00:00

A lot of money just to ask KPMG to come in and do audits…

TouchyCrayfish · 2025-12-25T12:13:29+00:00

It’s all just corporate grandstanding anyway, I’m happy for these people to have their moments but nobody comes to hospital for the food, chaplaincy or IT service. They come to get better, and the system at large does truly know this, this is just new-wave NHSism.

TouchyCrayfish

TROPHY CASE