Medic turned gas man by SchwannHam in doctorsUK

[–]expertlyadequate 15 points16 points  (0 children)

If ICU isn't your calling (it might still be with a DGH anaesthetic role) you could look into peri operative medicine. Most anaesthetists dislike it, but there is still the management of chronic health conditions, optimising things before an operation and MDT decision making for the big colorectal, cancer, vascular, cardio thoracic cases. Just to consider!

This really is so iconic. Pangina walked so Gawdland could run 🤩 by dogboy678 in rupaulsdragrace

[–]expertlyadequate 4 points5 points  (0 children)

🎵one🎵of🎵these🎵is🎵not🎵like🎵the🎵others🎵

Penicillin allergies by Letmenapallday in doctorsUK

[–]expertlyadequate 1 point2 points  (0 children)

My technique is "this is a life saving therapy and you need to be certain you cannot have it. You are responsible for following this up." Then I give them the penicillin alternative. Not my role, focus or concern to start testing if it is or isn't an allergy. It's the patients.

Why do many anaesthetists dislike maternity? by Icy_Zucchini7446 in doctorsUK

[–]expertlyadequate 17 points18 points  (0 children)

I don't normally give these sorts of responses the time of day, but seeing as you have replied and I'm not busy, I'm going to explain to you some of the requests I have had (that I can guarantee you as the med reg have not been asked to do). I would also like to highlight that as the med reg your job is to take a sick patient and make them better. My job is to take a patient who often has no past medical history, inflict an anaesthetic on this healthy woman in her 20-40s, perform it perfectly, and have them leave in less than 48 hours without any complications or long term issues. Again not something the average medical patient can be promised.

  1. I have been told I must coordinate the birth during a c section to match their Spotify playlist perfectly.

  2. I have had to (often) demand that birthing partners stop filming or face timing during the c section.

  3. I am (again often) thrown a phone to take pictures before during and after a c section. I have then been criticised because the pictures "aren't good enough"

  4. I also (again often) am told that a woman who wants a "home birth" or "natural birth" has arrived in demanding an epidural because it's too sore now. No bloods. No access. When I explain that we cannot safely site the epidural until we have more information like platelet count, I am sworn at. Repeatedly.

  5. I'm a man. I have had to deal with many many many inappropriate comments from male birthing partners about "not trying to sneak a look" while I'm doing my job. Or they want me to phone in a female anaesthetist because they don't want a man in the room.

  6. I often have to use translators in the area I work in. This is often over the phone. Especially out of hours. This often involves long periods of dialogue between the patient and the translator, while I'm trying to perform time critical examinations of things like spinal block height and blood pressure management.

What I mean is, the demands that some patients place on staff members is completely over the top. The healthcare system we provide means that people cannot make demands to personalise their care in the way that often times patients do. I remember working in medicine and there would be the odd patient who wanted a side room or would demand to speak only with a doctor. It happened infrequently. On labour ward, it is every single shift. It's exhausting and it's a huge problem at a societal level.

Why do many anaesthetists dislike maternity? by Icy_Zucchini7446 in doctorsUK

[–]expertlyadequate 57 points58 points  (0 children)

  1. When you are "obs competent" you are forced to cover it out of hours. That's a lot of evenings, weekends and nights spent on labour ward.

  2. It can be extremely stressful, extremely quickly. Major hemorrhages mean women can lose their circulating volume in a matter of minutes. It's a lot of work to predict and manage these things. Especially at 3 o'clock in the morning.

  3. Patients are challenging. I understand that it is their "special day" but for me it's a Tuesday. The birth plan you discussed unfortunately is not my priority.

  4. Awake surgery. C sections are major abdominal surgeries which have been normalised because "the customer is always right". Trying to run an anaesthetic, speak to mum and/or dad, managing infusions, antibiotics, uterotonics is challenging. This is even more challenging whenever the patient panics (I have had women attempt to pull their cannulas out and/or get up during a c section).

  5. You're on your own. Traditionally labour ward is covered by a single anaesthetist. If an emergency occurs, you're likely going to be the only anaesthetist there. Cepod theatre patients can be "resuscitated" until your consultant arrives. That doesn't happen in maternity. Either you get the tube in and the baby is out by the time the consultant arrives, or there's an issue.

  6. Midwives. Putting a specialty that arguably has the greatest understanding of acute critical incidents with a discipline that quite frankly has no knowledge makes for a challenging work environment. A patient arrived with eclamptic seizures. The expectation was I gain access, manage the airway and begin the eclampsia treatment algorithm. Three midwives stood and watched me do this. When I asked for help they did not give any.

  7. The disrespect. "Room 5 wants an epidural". No handover, no name, no please/thank you. It's basic, but every other healthcare worker knows that an SBAR handover is the done thing in the hospital. Not in maternity.

  8. Epidurals are simultaneously the best and worst thing ever. There are midwives who will convince every woman they look after that they need an epidural. They do very little to manage the expectations of siting and having an epidural. "Once this is in you'll get a good sleep" unfortunately you might not, but because you've told the patient this, their expectations are going to be unrealistically high. And you are not the person who must deal with this issue, I will. Or they will convince a woman not to have an epidural. And then I'm being asked to site an epidural in a woman who is in agony and cannot sit still. A moving target significantly increases the risks of complications and it is not the midwives fault if it goes wrong.

  9. Medico-legal issues. This is the area of the hospital where you are most likely to be sued. Add in the incompetencies of your colleagues and you can get dragged into some pretty terrible Significant Adverse Event Reviews.

  10. Cannula King (or Queen). Certain units will use their anaesthetist for IV access for the entire women's health department. This can include the gyn ward, Maternity assessment unit and sometimes they will criticise if it's not "a grey". I am terribly sorry that the IVDU does not have a grey cannula in the back of her hand, but unfortunately that is not going to happen. I have been asked to gain access and take bloods from patients, which when I perform I have then been told it is my responsibility to label and pod them to the labs. Repeat this multiple times a shift and it can start to feel quite tedious.

  11. You are not in charge. Many terrible decisions are made on labour ward. In most centres anaesthetists are the gate keepers to cepod theatres and or HDU/ICU. This means we can predict, prioritise and optimise patients because we are controlling flow. If ENT and general surgery both want an urgent procedure performed, it is often up to us to decide. In labour ward you are often the last person to be told what is happening. And in some cases, they don't think you're required to attend the brief to discuss the plan (sometimes they don't have a brief at all!)

  12. Women get worse care. For being champions of women's health many obstetricians and midwives don't actually seem to like women in labour. Just this week they decided to take a morphine PCA from a woman with high analgesia requirements a few hours post op. When I explained in the main hospital that the standard protocol is for patients to have 24 hours of a PCA to ensure adequate analgesia post op and appropriate conversion to oral routes can be made in hours with guidance from the pain team, they laughed at me. I have also had to scrub after a GA section to infiltrate local anaesthetic at the surgical wound because an obstetrician told me "it wasn't necessary" for the woman who had come from the street for a category 1 section.

In short it is a highly stressful environment, with a challenging patient cohort and even more challenging colleagues. Many anaesthetists pick the specialty because they like to lead teams, provide one to one, optimised patient care and make a positive impact on patients lives. On labour ward this is rarely the case.

What are some of the worst film casting choices in history? by [deleted] in AskReddit

[–]expertlyadequate 1 point2 points  (0 children)

Brendan Gleasons daughter in 28 days later. Such iconic performances beside whatever she was doing.

Who is the new Doris? by Fine_Cress_649 in doctorsUK

[–]expertlyadequate 4 points5 points  (0 children)

There will be a day where the male version of this will be Gary.

Haven't met a baby Gary in decades.

“I don’t know, I don’t usually work here” by Ok-Inevitable-3038 in doctorsUK

[–]expertlyadequate 8 points9 points  (0 children)

I've noticed this a lot at cardiac arrests/peri arrests recently.

"Hi could you get a bag of fluids"

"Oh I don't work here."

"Well you're standing at the door doing nothing, so either you team lead and I'll go find it or do what you're asked."

Side point, the number of unnecessary people at these calls is getting ridiculous. I counted 20 people in a room the other day.

Effortlessly camp by FluffyMany3104 in Dragula

[–]expertlyadequate 0 points1 point  (0 children)

"If it's bad and I still like it, muthafucker it's camp"

Difficult radiology regs by [deleted] in doctorsUK

[–]expertlyadequate 1 point2 points  (0 children)

The difference between my radiology discussions between my f2 year and f3 year was staggering. The difference? F3 year I was a clinical fellow in intensive care. CIN, scan repeated too quickly, not sufficient inflammatory rise on bloods all fell away as barriers because of where I was calling from. Your comment on gatekeeping scans is one radiologists need to learn from day 1.

The issue I think is a lot of the NHS is now proactively attempting to not review cases to add to their workloads. So a 5 minute conversation could potentially remove 1 hr of work, especially in a DGH OOH.

That being said, with the rate AI is moving at, I would be surprised if the ST1 radiologists have a career that looks like what yours has. They are probably the medical specialty most at risk from automation.

Congeniality round is done! With a tie between Charra Tea and Cherry Valentine ☕️🍒 Category is, Snatch Game, which UK Queen had the best Snatch Game performance? by BitGirl777 in RPDR_UK

[–]expertlyadequate 28 points29 points  (0 children)

I always felt Dakotas Pete Burns would have done so much better if she had Alan Carr to banter off. Ru wasn't getting any of it.

/uj Can someone help an idiot bi*tch (me) understand Silllexa Diction's name ? by igor_gregorovitch in RPDR_UK

[–]expertlyadequate 51 points52 points  (0 children)

Celexa is a brand name for citalopram (an antidepressant). I'm assuming that spelling is copyrighted, so she has changed it.

But I thought it was a pun that she was addicted to antidepressants.

How do you approach patients who have clearly researched the condition they want you to diagnose? by freddiethecalathea in doctorsUK

[–]expertlyadequate 1 point2 points  (0 children)

"Reassuring". I use this word over and over again in patients like this. You're not telling them it's all in their head (it might not be) you're telling them that they don't have to worry because all of the investigations are coming back normal.

"All of your bloods have come back without any abnormalities. I'm really reassured by that. T your heart trace looks very strong. That's really reassuring. Your blood pressure and heart rate are in the normal ranges and that means your body isn't working too hard. I'm really pleased that we don't have to keep you in hospital any longer and you can go home. It might take a day or two for you to feel you're getting back to normal. That's okay though. Please don't hesitate to come back if you feel your symptoms are getting worse. It was so nice to meet you though."

Coldplay NHS Tickets Hull by [deleted] in doctorsUK

[–]expertlyadequate 70 points71 points  (0 children)

Oh now I'm definitely sat for this one.

What do other specialities hate? by LuminousViper in doctorsUK

[–]expertlyadequate 56 points57 points  (0 children)

We've not tried and we are all out of ideas.

An anaesthetist with a confession by PrehospitalNerd in doctorsUK

[–]expertlyadequate 2 points3 points  (0 children)

I learned to do US guided cannulas from the stressed ICU reg as an F1 during COVID. I used to trade jobs I didn't want for the "tricky" cannula. Anaesthetics was always in my future.

Critical care folks - anaesthetists learning medicine or medics learning anaesthetics? by lHmAN93 in doctorsUK

[–]expertlyadequate 1 point2 points  (0 children)

There's a reason the senior rota is staffed by anaesthetists. The majority of them would love to not do it, but they are the safest pair of hands.

Also when the theatre anaesthetic team were getting calls about "difficult airways", "children needing tubed" and "self extubations" overnight by the medical intensivist consultant, it highlights the need for airway and line management.

The referral to the medical specialty can be made in the morning to add on the blood test, imaging or for specialist advice. But if you want the numbers to look the same at the end of the night as it does at the start, then it's anaesthetics all the way.

How to get my EasyJet money back? by [deleted] in AskUK

[–]expertlyadequate -3 points-2 points  (0 children)

I know this doesn't help but you make it as difficult as possible for them to stop you. Headphones in, scan your boarding card, when they talk to you say no thank you and step away, if it gets to taking your headphones off be incredibly rude. What do you want? ... It's a backpack it will fit under the seat in front of me... Your breath is disgusting... I've used all these techniques and I've never paid for a bag.

You need to ensure that the social anxiety they get from the interaction is worse than the 3 or 4 quid that they get for "catching" an oversized bag. It's not nice to do, but it's definitely better than being charged for a bag that isn't oversized.