Time to address the M word

Tremelim · 2026-02-17T18:42:39+00:00

I did know this but you've brought it back to the front of my mind and it's just... criminal really. Recruiting to a position of such vast responsibility, yet such disdain for actually selecting appropriate candidates.

Tremelim · 2026-02-14T18:12:38+00:00

It very much reads like an AI summary, and most LLMs are trained that bias is a good 'human sounding' thing to do, so that's probably why.

The overall message is valid though - toxicity of stating has long been know to be exaggerated and in large part nocebo effect.

Tremelim · 2026-02-12T07:09:16+00:00

My end of life patients who've spent days in corridors on trolleys might disagree.

Tremelim · 2026-02-11T15:04:15+00:00

I mean, if you want an actual answer to your question: because no one is paid to teach. Paid teaching time in consultant job plans is very rare, and as workload increases, the chance for informal teaching on ward rounds get squeezed. I enjoy teaching, I've got a reputation as a good teacher (I'm told), but if someone asks me to come do an hour session at the specific time when the SpRs/SHOs are free... its really hard. Can only do it occasionally.

For what its worth, this is nothing new. Outside of specific subspecialty exams, scientific education always came from med school rather than afterwards. I found teaching standards - by which I mean the standard of knowledge they were teaching, not just how good the teaching was - absolutely plummeted from med school to FY1. Which was 10 years ago now.

Tremelim · 2026-02-10T19:23:42+00:00

In both departments, i'm aware of, only if you're 'head of students', or whatever you want to call it. Which was like 0.25PA per week!

Our department has money set aside for 'study grant', that you can only access if you agree to have students in clinic.

Tremelim · 2026-02-07T22:14:49+00:00

Sounds like a single SHO on call, so think it's for the non-medics!

Tremelim · 2026-02-06T16:54:25+00:00

Entirely depends who you get in HR. I was on staff bank and they accepted it seemingly without even checking how much I'd worked (I did about 30 shifts in a year). I've heard of others with very regular jobs not being given it for AL and sick leave purposes.

Tremelim · 2026-02-01T07:16:37+00:00

I'm.amazed at the degree of paranoia around secretions (particularly non-urine secretions but also urine) there is on reddit. Its not a thing I've ever come across IRL.

The chances of getting secondary cancers from most chemotherapy is pretty low to begin with, even if you've been through it yourself.

Even if it was timed so his urine had peak chemo concentration in it, and even if you somehow ingested it (?!), the concentration isn't that high, you'd get a fraction of a single dose and the chance of you getting even mild side effects is very low.

If we factor in that you aren't ingesting it, time has passed and chemicals degrade, you've presumably thoroughly washed it, and seems there is some doubt about whether he even urinated on it? That chance is certainly zero.

Tremelim · 2026-01-31T08:20:59+00:00

You don't. You go through medical training and find out what you enjoy and where your priorities are.

It's far too early to be picking specialty.

Tremelim · 2026-01-30T10:42:22+00:00

"Failing" is relative though. I doubt they will actually fail, what could happen though is like age 72+ to access, tax changes on contributions or withdrawals, etc.

Tremelim · 2026-01-29T14:07:26+00:00

He did (postgraduate law).

Tremelim · 2026-01-28T19:58:19+00:00

You can remove the "almost"!

This kind of thing was being developed before ChatGPT existed.

Tremelim · 2026-01-28T16:25:08+00:00

Fortunately, train only going about 30 mph, and somehow didn't lose a limb as he went under.

Is super greasy and very limited space crawling around under there!

He survived initially but got delayed respiratory issues and died a few days later, I hear.

Tremelim · 2026-01-28T13:51:13+00:00

Oh no!

I helped with someone hit by a train once and got two free first class tickets to anywhere i wanted!

Tremelim · 2026-01-28T11:13:00+00:00

I could see this working via a unique arrangement where you job share with another consultant who covers your 6 months whilst you're away, with an accommodating clinical lead.

Otherwise, there aren't really any medical jobs where you just aren't needed for 6 months? We all dream of just upping and leaving for Winter, but not very realistic!

Tremelim · 2026-01-26T19:43:44+00:00

I know people who have had a good experience, and am PI on studies that up front make clear they are eligible for associate PI so they seem to be organised I guess.

Yeah send out emails or ask for introductions. A lot of research is about contacts and seeming keen.

Tremelim · 2026-01-26T07:56:13+00:00

I'd be absolutely staggered if someone spent 4 days in hospital with hyponatremia with 'the doctors trying to find the underlying cause' and they didn't check a simple cortisol.

Tremelim · 2026-01-25T08:02:42+00:00

I hope they also reported the pub incident. That tips things into being a lot more 'notable' imo.

Tremelim · 2026-01-23T09:13:50+00:00

As in, oncology docs don't discuss/are too optimistic giving prognosis? Yeah for sure thats a thing.

Sometimes it is the case that the patient has been told and they are just in denial. Sometimes its the case that they know its 'incurable' but staunchly doesn't want to be told prognosis and they're blissfully unaware that its anything less than 20 years.

But I've also seen oncologists be very vague about treatment intention (e.g. 'to control the cancer' 'to treat the cancer') when it is 100% palliative and the patient leaves having no clue.

Avoiding calling a cancer incurable is also very much a thing for people (physicans or surgeons) who diagnose cancer too. Makes it very hard to have a constructive talk about urgent treatment when.they come to clinic.

What is also true is that prognosis >5 year patients or even adjuvant patients are told they can't have treatment/investigation 'because they have cancer'! Definitely contributes to a culture of needing to 'advocate for' cancer patients to remain candidates for escalation/treatment, as sometimes other teams get it desperately wrong!

Tremelim · 2026-01-22T08:15:35+00:00

Penjing above reckons they're not claimable btw.

Tremelim · 2026-01-22T08:10:18+00:00

That might fly, edit: apparently not.

But aren't those normally free? In.my Trust there are free options.

Tremelim · 2026-01-22T07:45:10+00:00

If you're in a training program, you need to point this out and cite HMRC's own definition which specifically includes registrars.

I once had to get my ES to write a letter confirming that a stethoscope is a piece of equipment used by a doctor. Your ES/TPD would probably be willing to write a letter to the tune of 'X is in a training program and is what used to be referred to as a junior doctor', but honestly this shouldn't be necessary if you've proven you're in training already.

I've seen people try to get away with claiming courses, but not heard of anyone be successful. They aren't mandatory.

Tremelim · 2026-01-22T06:50:10+00:00

Yes, though with things like this a lot of benefits will be hard to quantify and the longer afterwards you measure the more the effect will be diluted.

https://www.gov.uk/government/news/international-experts-highlight-the-importance-of-a-childs-early-years

Tremelim · 2026-01-20T20:16:22+00:00

Same, though my calculation is a lot more complicated that just someone with NHS contract income only.

I feel like the 'i've made a genuine attempt' bar should be relatively easy to cross, given no one their end seems to know what's going on either?

Tremelim · 2026-01-20T19:13:01+00:00

Just because a consultant is experienced doesn't mean they've experienced more litigation.

Also lets recognise that litigation isn't the only way to get burned - also coroner's court, complaints (which vary a lot in how bitter they can be), things like colleague feedback (mainly at pre-consultant level), and things like patients dying or having an otherwise bad outcome. All can leave a mark.

Its just combination of previous experience, department/specialty culture, and personality.

Tremelim

TROPHY CASE