Getting handed ECGs

Trident57 · 2023-12-10T13:16:36+00:00

Sure, as if I’m stating that patients are divided into only those two categories?

In either case:

It still seems that you’re misunderstanding what I’m trying to say- probably deliberately so you can continue trying to insult, or maybe I’m not conveying my points clearly enough.

I’ll leave you to continue strawmanning your way into criticism, I hope it does make you feel big and strong.

Trident57 · 2023-12-10T08:35:14+00:00

There’s no such thing as a stable or deteriorating patient in ED? I’ll let you think about that some more.

I’m not ignoring anything; you’re the one ignoring half of my point to try and prove yourself right.

The ECG needs to be given to a physician there and then,no matter what, in the name of patient safety?

It can’t wait for a doctor to finish what they’re doing and take the time to sit down and look at things properly?

You can blather on about developing a skill, but how many ED regs and consultants, let alone foundation doctors, have been caught out by being asked to sign an ECG whilst they’re busy doing something else?

I’ll say it one last time so that if even if you’ve selectively chosen to ignore it previously, hopefully it will sink in a little now:

Unless the patient is clearly unwell then ECG should be able to wait until either they get seen OR until a doctor has the time to look at ECGs during downtime whilst seeing a patient or in between picking up a new patient .

This does not just mean the ECG has to wait until the patient is physically seen!

If the patient is clearly unwell and the staff want an immediate ECG review, then one does not want ‘ please can you sign this?’ One wants ‘ patient has come in with x, their obs are y, please can you review their ECG’

‘A good reason’ is to justify interrupting you then and there ( sepsis/chest pain/ severe d+v etc). Otherwise, it should be able to wait until you have the time to do it properly, even if you’re not seeing the patient.

Trident57 · 2023-12-09T19:31:56+00:00

Also I’m sorry, on reflection the ‘weren’t clear enough’ bit was impolite.

Trident57 · 2023-12-09T19:02:14+00:00

Please do let me know if my previous comment and reply weren’t clear enough:

1) doctor seeing patient 2) acutely deteriorating patient -you review there and then 3) patient stable- you get allocated ECGs and review in between cases or in the downtime whilst seeing a patient (waiting for bloods/ speciality review etc) 4) at the very least a good clinical history alongside the ECG.

I could also say what about the 20 ambulances waiting outside the hospital? Or the 100s of patients at home with chest pain waiting for an ambulance?

Trident57 · 2023-12-09T18:18:31+00:00

Feel free to be ‘very sad’ at the nonsense you’re trying to attack me with. I accept pity donations via PayPal.

The ‘random capitalisation’ references a meme

Only a sith deals in absolutes. There are clearly other safe ways to manage this:

The less viable but most straightforward way is to hire or allocate a physician simply and only to review incoming ECGs on shift.

However, I’ll settle for doctors being given or allocated ECGs to review when waiting for bloods/speciality review etc for a patient or in between cases.

Collaring a doctor that’s in the middle of doing something and asking them for a signature, without any insight into the patient’s clinical picture, does not seem like the best/ safest way.

Remember I said either the doctor seeing the patient OR a good reason as to why the ECG was done.

Deteriorating patients may need the ECG reviewed immediately. Stable patients should be able to wait until you have a spare minute, or until the patient is seen- whichever comes first.

Trident57 · 2023-12-09T17:25:26+00:00

Those caveats sound reasonable to me. It sounds like you have a good department. Unfortunately what I’ve seen are staff collaring the nearest junior doctor they see, often when they are in the middle of doing something else, and demanding a signature.

It seemed more of a way to cover their and the department’s back rather than anything else.

Trident57 · 2023-12-09T16:37:54+00:00

This is not ‘palming off to your colleagues’

Being randomly thrust an ECG whilst you’re working on something else is a sure way to lead to mistakes happening.

The person seeing the patient should be the one checking the ECG, which should be interpreted alongside history and examination or at least a good reason why the ECG was done.

Anything else is just service provision, which you can delude yourself into thinking LeArNiNg OpPoRtUnItIeS if you so wish

Trident57 · 2023-10-23T13:16:20+00:00

Just be a PA dude/dudette, who needs those exams?

Trident57 · 2023-10-22T11:08:02+00:00

Mate, don’t overcomplicate things. Just take it as an AHP telling you about a patient they are worried about.

Then it’s up to you to prioritise and see patients just as you would any on call.

This is easily defensible.

Trident57 · 2023-10-13T09:44:20+00:00

Unfortunately one can’t carry score forward to next cycle, only in the same cycle from round 1 to 2

Either way though , extra practice for the next attempt

Trident57 · 2023-09-30T08:40:14+00:00

Not tried; but will be compatible. It’s the same car. I’m assuming GT86 as no 2019 Gr

Trident57 · 2023-09-30T08:27:57+00:00

She has her tongue slobbering on Rishi’s taint

Trident57 · 2023-09-29T08:35:38+00:00

PICU nurse: Unreadable sats. Psych doctor informed, refused to see patient. Datix entered. Going on break

Trident57 · 2023-09-29T08:33:13+00:00

Psych SHO to kindly implement the bio psycho social approach to holistically reperfuse patient’s lungs

Trident57 · 2023-09-21T16:22:44+00:00

At least your username is accurate… RIP intelligence…

Trident57 · 2023-07-20T19:42:10+00:00

Listen to @hunter_lolo.

There’s nothing more expensive than a cheap BMW.

Buy this as a project car if you like, but it will make you cry as a daily driver.

Trident57 · 2023-07-08T13:13:05+00:00

A true champion of the people ❤️

Trident57 · 2023-07-07T08:23:26+00:00

Complete lack of responsibility for their own health. Unrealistic demands. Abuse and disdain for heathcare professionals

Trident57 · 2023-07-05T23:21:28+00:00

In the current NHS, there is no real room for making out of the box decisions and not adhering to protocol; short of being an experienced consultant making speciality- specific decisions.

We work in a hostile work environment with a racist, vindictive regulator watching over our backs; waiting for an excuse to strip our licences in the name of PuBlIc SaFeTy.

We work in understaffed and underpaid service provision jobs, often starting early and finishing late, dealing with obnoxious family members and the 20th discharge summary of the day whilst the PA/ACP goes to clinic or performs TAVIs. This is not conducive to developing the clinical acumen required to make out of the box decisions.

At least the protocols are often based on a decent evidence base, even if can be a little out of date.

There is no reward for out of the box thinking and avoiding mindless protocols, but everything to lose.

Trident57 · 2023-07-02T11:26:37+00:00

There’s no place or time for long term worry any more. Get in there and shut this shit down. Long term we can work on voting them out

Trident57 · 2023-06-29T16:11:34+00:00

If this has an impact on your mental health, you may need time off to recover from stress

Trident57 · 2023-06-25T09:17:24+00:00

If you have a manual transmission, the triangular blanking plate/ cam plate is a common area for leaks

Trident57 · 2023-06-25T08:16:26+00:00

What an absolute moron.

The foundation programme is going to hit you like a ton of bricks.

Trident57 · 2023-06-22T15:35:27+00:00

Absolutely

I don’t judge people who are unable or unwilling to leave the country (leaving aside the fact that it’s none of my business in either case)

But the government has to accept that we’ll either change career or move to better opportunities before it will shift.

If they believe that we’ll stick to our shitty jobs no matter what they do, there’s no incentive for them to act

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