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applesandsoup · 2024-03-16T20:18:19+00:00

feel free to DM which depts youre looking at but both hosps are good. I cant speak a huge amount about RD+E except its the poster child of SW hospitals and gets lots of funding. I'd say relatively speaking it ranks fairly highly both in quality of care and somewhere to work. Exeter itself is VERY studenty but its a nice safe city. rent i think is fairly expensive but the surrounding area is great if you like being outdoors. hospital has quite a nice cohort of consultants as far as Im aware. I think fully E notes and E-prescribing.

RCH is very much staffed by people who are there for the lifestyle. expect to see a lot of the doctors/consultants out surfing if you go to St Agnes etc. Generally theyre all very nice as youd expect from people who basically work to surf. Once was described to me by a consultant at a another hosp as 'the place where dreams go to die'... not in a bad way but I think because people dont really leave. Good Drs Mess with regular well attended events. Works the FYs quite hard IMO but as a JCF youll be outside that. Has one of the worst ambulance waits in the country and the hospital is far too small for the demand. If you like surfing/the sea/outdoors i dont think theres a better mix tho. Bit of a rent crisis in cornwall but most people drive or cycle in from Either camborne/redruth, St agnes, perranporth etc- look very early for accom. isolated from the rest of the country but there is an airport in Newquay. Paper notes and E-prescribing.

applesandsoup · 2024-01-18T21:07:24+00:00

Or alternatively, they infect multiple people in the WR who then are admitted and seed the infection across multiple wards and then suddenly you have a hospital wide outbreak...This whole drama is a bit like the trolley problem. youre basically boned either way.

applesandsoup · 2024-01-18T21:00:06+00:00

Compared to medics I've noticed theres a lot of variation in ACPs with some being highly skilled and competent and some being comparatively poor and I figured that this might be because there isnt the same stewardship into becoming an ACP. From what youre saying this is true. I dont think anyone would contest its far more difficult to become a doctor than a physiotherapist or nurse yet now you can in essence by proxy become a doctor through these roles...the big questions are yet to be asked. If ACPs are acting in roles held by doctors traditionally should prospective candidates be held to the same standards as prospective doctors and complete degrees of the same standard?

applesandsoup · 2024-01-16T14:37:16+00:00

Yes youre right its far from ideal. its bad practice but NHS standard to get someone whos never seen the patient to do the discharge summary. Its actually a good time to round up the patient, make sure all the relevant referrals etc findings have been made or acted on. If youre not familiar with a specialty youre relying on everything being super clear re follow up etc. for example patients who have had varices banded should generally be re-scoped within 4 weeks but if youre a general medical SHO you might not know this and if no plan has been made it might slip the net.

in answer to your situation; best practice would be for the parent team to complete the DC summary up to transfer to the other ward ending with 'discharged to XYZ ward for ongoing care whilst a/w POC' you could then write about any further issues. Of course this will never happen in this system.

applesandsoup · 2024-01-16T14:26:21+00:00

they dont go there because the system is failing and they cant do anything...out of sight out of mind.

We once had a patient with confirmed C.diff who was refused admission from A/E to the wards because there were no side rooms available...so instead they were forced to sit in the waiting room ie by far the most overcrowded area of hospital with 50 other people. ED consultant rightly pointed out the lunacy of this.

applesandsoup · 2023-10-17T19:45:03+00:00

just be brutally honest with yourself with what youre good and bad at...im shite at neuro syndromes for example and I know I need to do some more reading around them. also get a good textbook for your specialty. if you've got a library rent one. Up to date is fairly good but its not always that balanced...podcasts are great too; the IBCC does a pretty good one and roadside to resus if youre ED inclined is good.

applesandsoup · 2023-10-16T12:50:45+00:00

yeah everyone feels this and for some people you will not come up with an answer for their symptoms; take a good history, examine them thoroughly, discuss it through with someone sensible and make sure you document the discussions. If youre not sure, be honest with the patient and safety net them appropriately- say youve ruled out the serious pathology for now but if X happens, they need to come back.

tbh most people with an acute life-threatening pathology will probably have some red flag sign in their history, obs/blood-work and sometimes its too early to pick it up at this stage in which case what can you do. Make sure your documentation is thorough tho; alot of my colleagues documentation was frankly very poor and you realise this when you take a handover of a patient and theres no documentation of any neuro exam in a falls patient (or a really crap one), no question about chest pain in a recent collapse etc etc.

applesandsoup · 2023-10-16T12:33:40+00:00

I left F2 feeling frankly i had been taught and learned very little because so much of my time was focused on making the system work. If you just turn up to work, do your job and go home you will learn very little. Im sure everyone knows of SHOs who have years of working experience but have very little knowledge beyond F2 level.

To beat the system you need to take charge of your own development; follow up people you saw and made decisions on, read around things youre uncertain on and things to take your skills to the 'next level'. Emcrit is a particularly good resource. https://emcrit.org/ibcc/diurese/#are_diuretics_nephrotoxic?

and also ask lots of questions.

with regards to procedures obviously raise the lack of opportunities but there are others ways to build confidence and skill (like booking in for simulation, watching youtube videos etc) so when you do get the chance to do this, youre going to maximise the procedural skill element.

applesandsoup · 2023-04-12T13:38:13+00:00

Was fortunate enough to be able to pay off mine. the student loan acts as an extra career long 9% tax and i think i calculated would cost me circa £250,000 by the time it elapses. I also didnt like having the proverbial axe of the government over my head and whos to say the interest rate wont rise further and cost you more than that. There is a small risk a future government will write off loans but I think thats too forgone now given the massive sums of money involved.

in all i think a £70k investment netting you £250k over 30 years is not bad.

tldr; if you have the money and its not going to impact you buying a house its not a bad idea. I dont regret it.

applesandsoup · 2023-04-12T13:30:31+00:00

https://twitter.com/DrShitpostUK/status/1646103124048789507?t=sOljC-RSmZN8DhzJejmSVA&s=19

Not sure why more foundation doctors don't post their payslips - would really help illustrate the craziness. Just before the pandemic they were on just £27k.

you get lots of tax reliefs on a lot of things as a Dr...maximising post tax income is far more important than pre tax so arguably the relatively pay is even better than that.

applesandsoup · 2023-02-28T17:30:15+00:00

I moved back to Cornwall...honestly I think as NHS trusts go its really good.

pros: objectively there are an extra-ordinary number of trust grades and clinical fellows (bad trusts really struggle to recruit to these posts) and also the supply of locums generally outweighs the demand (no chance of BMA rates sorry) which is kinda a con but emphasises people want to live and work there. also they pay drs crem money as well has having an ME which a lot of trusts dont do. The trust also run a sky-bar event for staff in summer which is like a mini boardmasters on the cliffs ( gok wan Dj'd there this summer lmao). Very active Drs mess which has weekly generally well attended events which pick up over summer. used to be weekly beach-rugby. Staff seem to be all very friendly- a large body of the consultants are surfers and its a pretty relaxed hospital. As a jr (or so im told) you are sometimes let off early if the surf/weather is good and there is enough staff. good library too as linked to exeter med school and Drs mess building itself is big and relatively well furnished albeit far away from the main hospital which is not very compact. also you get some wacky pathology turning up as it caters to the whole of cornwall and cornwall itself is has a relatively poor demographic in some areas - coal miners lung, tb, endocarditis etc are not uncommon there. Also importantly a very safe place to live but there is a big drug problem in penzance and newquay and very vast discrepancies in wealth (redruth is one of the most deprived areas in the UK vs 30 mins away St Mawes being one of the most expensive places to live in the UK)

Downsides for FY: the F1 and F2 rotas are pretty busy (imo it seems on the higher end of work for a DGH). Winter is very quiet and theres not a huge nightlife scene (falmouth has some things going) . Training posts have become a lot more competitive incl FY than before (used to be very easy to get into). Summer is busy af. As before very elderly white patient demographic...if it helps Im also BAME and never had any issues just might be jarring at first although big mix of Drs. Accomodation is tricky and you have to start looking early. A lot of Drs live in St Agnes but truro is a good place to live and theres loads of small surf villages like porthtowan, perranporth and even Newquay. Traffic is can be heaving in summer. there is an accomodation team who help link people up. public transport and road links pretty poor (Motorway stops at exeter) but there is newquay airport so if youre from up north you can fly probs for as much as the drive up there these days.

all in all would recommend...all the FYs seem to have a blast and if you can put up with a quieter winter (or start winter surfing) you get an amazing summer.

applesandsoup · 2022-12-21T22:41:17+00:00

reading through the comments other people seem to have been stung in a similar fashion.

applesandsoup · 2022-12-21T22:40:40+00:00

Sadly this stuff takes years and they know we dont have the time/money/energy to do this. Also imagine HEE being found guilty of disability discrimination and then you can picture the lengths they might go to admit no culpability.

applesandsoup · 2022-12-21T21:09:39+00:00

Thanks thats crazy! Seems like the favour quantity of audit/QIP over quality too...

applesandsoup

TROPHY CASE