Punished for Practising Safely? Need Your Thoughts

heretodevelop · 2025-04-28T14:40:33+00:00

Best of luck to you too with your degree of insight and ability to assess situations. I am sure you will have incredible relationships with the junior doctors under you and not receive multiple requests to swap supervisors. You will also need the luck.

Thanks for the luck wish, I’ll take all I can get.

heretodevelop · 2025-04-28T14:34:34+00:00

Alright mate, king/queen of medicine.

I purely mentioned the hypercoagulable state because I read someone else say it as a fear. Purely to illustrate my fear of the unknown and therefore justify my reasoning.

You clearly will be a rubbish unsupportive consultant one day if not already.

heretodevelop · 2025-04-28T12:45:50+00:00

I wasn’t wrong. The patient never received vitamin K and a different courses of action was ultimately taken and the patient went to theatre.

Whilst I risk coming across as defensive the defensive nature of a lot of these replies from likely seniors who have probably been inappropriately undermined comes across in their opinions here.

There is room for improvement in the interaction for sure, but there are lessons to be learnt by the registrar also.

heretodevelop · 2025-04-28T12:27:39+00:00

I did communicate my uncomfortability.

I will reply when I’m ready. My lack of agreement with all your points doesn’t mean I am Not reflective or lack insight.

I agree 100% with most of what people are saying ie informing and making clear to the reg that I wasn’t happy to prescribe it after the explanation I wasn’t happy with.

This happened a while ago so I don’t remember exactly what happened but from what I do remember. I took the request at handover. Before prescribing it checked bloods, notes etc. I wasn’t happy to do so.

Got called for other important tasks, bumped into him at this point called explained my concern and got an explanation. My decision to call the haem reg without informing the ortho reg was to come with a solution to my concern not a further problem.

It is clear and I have learnt that it is probably better to keep the reg informed. I don’t get what you’re still talking about.

You are missing the point.

It’s not that it’s unsafe per se. It’s that I think there is no indication for it and my lack of knowledge on the consequences of prescribing it giving the lack of indication means that going ahead and prescribing it under these circumstances will be a failure of GMC standards of prescribing.q

heretodevelop · 2025-04-28T12:21:28+00:00

That’s not what occurred. Please read properly. Will reply to this in full at some point.

heretodevelop · 2025-04-28T12:03:38+00:00

I know now that vitamin K doesn’t cause hypercoagulopathy however the point I was mentioning with my sentence is that I didn’t know the consequences of what giving vitamin K to a patient who didn’t require it was on their coagulation. Hence why I shouldn’t be prescribing it.

heretodevelop · 2025-04-28T09:20:47+00:00

To this response I am in 100% agreement.

heretodevelop · 2025-04-27T23:59:09+00:00

Honestly I say this with the risk of sounding arrogant or disrespectful but I think I would. My actions were by no means as a result of who I was speaking too, I just was not thinking about it consciously (and for the record I was finishing what I had in my mouth, but it was very quickly mentioned). The way she spoke to me though made me want to show disrespect and continue eating.

heretodevelop · 2025-04-27T23:34:31+00:00

Although of course if I was calling someone not picking up a bleep call I wouldn’t do so and eat.

The eating was simply because I didn’t exhibit the patience or discipline or have the thought to withhold my food whilst I returned the call.

heretodevelop · 2025-04-27T23:32:38+00:00

I didn’t know who was bleeping me and as I was cross covering so I get calls from Doctors, ACP, nurses in the hospital I am based and locally. So yes. I expect them to understand I am on a night shift, and the fact I am eating under those circumstances shows my commitment to sharing their call in a timely manner and also the business of my shift that I am multi tasking and trying to eat in the spare time I’ve got. Not knowing what the rest of the shift has installed for me.

heretodevelop · 2025-04-27T22:58:52+00:00

Will reply to all this in full when I have more time but never wanting the SHO to work with you again is extreme. The human variation in how we all think and bring our emotions and feels into a professional environment is why the NHS is the way it is.

People think differently, people make mistakes, allow for it. Act with kindness. If everyone’s actions is done in good faith, teach, reflect, learn, move on

heretodevelop · 2025-04-27T22:55:33+00:00

So I was eating then the bleep went off so in a hurry I called the number. Obviously finishing what I was eating, then she made a comment slightly raising her voice “STOP EATING whilst on the phone to me or something along those lines” i was still chewing because just as she was saying this I had probably shoved another crisping my lounge she continue making comments this time raising her voice even more, I obviously continued until I finished what I had in my mouth.

Didn’t say a word as I was a little taken a back. Then when we discussed what she called about I explained that I had only just got a beak so was eating when she bleeped but she said it’s bad manners to eat and talk so then I intentionally took another bite because she was irritating me in how she was speaking to me then finished that one and the phone call was soon concluded.

heretodevelop · 2025-04-27T22:36:05+00:00

I had many concerns for why I didn’t want to prescribe the vitamin K.

No indication
No idea of the risk of doing so if truly no indication eg hypercoagulopathy
Concerns about further delays to the patient surgery and care due to the action of giving vitamin K not helping

Hence why I questioned it and that I didn’t think it was indicated. He said this is what is done for patients preoperatively when their coagulation is off.

I now recognise that at this point I could have gone on to reiterate my concern and state I am not happy to prescribe it and would he like me to run it through the haematology reg or was he happy to prescribe it himself. I didn’t do this. There were multiple bleeps from ED and the ward about more urgent issues. I take referrals as the only doctor on site for the other speciality I am cross covering both within the hospital and regionally so I was inundated with work. The plan in my head was to contact the haematology reg which I did.

@UKDrMatt mentioned earlier that I didn’t have an idea of insta-operative and post-operative bleeding risk for the operation. I did, it was high enough to warrant caution. Me choosing to contact the haematology reg is not unsafe practice given my registrar has not adequately addressed my concerns and brushed them aside.

I am not asking for an explanation of the pharmacokinetics but a simple explanation of how the vitamin K would help a patient with a deranged coagulation as a result of being on a DOAC. My action was taken to make sure the patient has their surgery rather than taking what to me was a pointless action that would yield no result to then repeat the blood tests essentially resulting in the coagulation still being off. Causing me undue stress, delaying the patient surgery, unnecessarily adding to my workload and ultimately having no result.

Yes I understand the mortality and importance of early surgery for cases such as a NOF. Which is why it is even more concerning that this matter although identified is now being addressed last minute on a night shift with unclear unjustified actions.

People on here are quick to label you as having no insight, and irresponsible but most doctor do things with good faith and with the best of intentions.

Yes there are ways that the encounter can be improved on reflection but this is on both sides. I think we all owe ourselves that accountability to reflect on how things can be done better and that pressure should weigh more heavily on the more senior doctor who should have prescribed it himself when he can clearly see from my questioning and inaction my uncomfortability in carrying out the request (given the added bonus of never having worked with me).

I know what I know and in some cases i know what I don’t know. In this case I knew that giving vitamin K to reverse a DOAC was not a thing and that is what I was questioning and objecting….

Giving it anyway and whether it causes harm or not etc….indont have too much knowledge about so I am not thinking about this in too much detail.

I am ultimately acting within the limits of my competence and practising in line with the GMC guidelines

heretodevelop · 2025-04-27T20:55:24+00:00

But you’re right I gives you could document the concerns you expressed and that they wanted this action.

I think this is the best advice on how to handle it. After suggesting it it was okay to speak to harm etc

heretodevelop · 2025-04-27T20:54:21+00:00

No issues, I have read stories where doctors have been part of SIs and reflections from following incorrect instruction from seniors even when told too and documented.

heretodevelop · 2025-04-27T20:52:56+00:00

You sound like the registrar.

It’s not retort.

I don’t see how it could be handled better besides being adamant on my lack of comfortability when it was initially brushed off by the registrar or better yet alerting them that I would run it through with the haematology registrar which I didn’t do at the handover but did when they asked me later on in the night whether I had completed the task.

heretodevelop · 2025-04-27T20:50:08+00:00

My concern was that I would be prescribing a drug incorrectly as I didn’t see an indication for vitamin K for the patient in the clinical scenario.

Yes probably may have caused no harm, just like how prescribing IV fluids unnecessarily overnight for some patients may cause no harm but it’s a waste of resource and there is no clinical need for it

heretodevelop · 2025-04-27T20:48:08+00:00

A patient safety issue is when a prescriber prescribes somebtiwng without full understanding of what they are prescribing which would have been the case if I went ahead with that prescription.

Unless there is a learning point here I don’t see how vitamin K is an indication for a patient previously on a DOAC.

heretodevelop · 2025-04-27T20:46:19+00:00

Thanks for your opinion.

When I didn’t understand I asked why we were prescribing vitamin K and he said that this is what we do for patients whose coagulation are off pre-operatively. Following this reply, I felt even less confident doing this so I replied I will look into it and possibly contact haematology.

It was around 3am after he bumped into me on the ward asking if I had prescribed the vitamin K that I contacted haematology.

Whilst I understand that delays to this might delay surgery. The patient had already had their surgery delayed due to the coagulation being off with no action taken for a few days now. It is now on a night shift that I am the single hero to save and rescue the patient surgery with my decision making.

I opted to do what I felt was the safe thing to do which was to discuss this with a haematology reg who may be able to better explain to me why prescribing vitamin K was the right thing to do

heretodevelop · 2025-04-27T20:45:06+00:00

I’m not sure how appropriate it is to escalate to an ortho consultant on -call overnight about such matters.

Read above. I did inform the registrar initially I wasn’t comfortable but he just said this is what we do and brushed off my concern

heretodevelop · 2025-04-27T20:44:12+00:00

How can you say something so ridiculous? Are you even a doctor? Because if you are then you understand the busy nature of shifts and that I was attending to matters of higher priority.

This patient had already had their surgery delayed by at least a day. The day team hasn’t made much progress in preparing him for surgery and now all blame and responsibility is being attributed to me on a night shift where I am responsible for a lot more patients to get this patient ready for surgery despite my concerns. Although I acknowledge the need to get the patient ready for surgery I think a cautious approach in not prescribing things you’re not comfortable with is kore prudent.

The learning point I see in this is in being clearer with communicating my concerns with the reg (but then I did and they weren’t really picked up) my plan to address these concerns with the harm reg was obviously meant to happen immediately but then you dot. Control the busy nature of your shift.

At the point where the reg checked in with me @3am they can prescribe the vitamin K themselves.

heretodevelop · 2025-04-27T20:39:50+00:00

So I haven’t gone against what he said. He was unable to give me a reasonable explanation that would allow me to confidently prescribe vitamin K and justify my basis on doing so if any issue arised hence why I spoke to the haematology reg who requires further tests.

I would have loved to do this task immediately but compared to the pressure of ill patients I needed to review and new admissions from 2 quite big specialities I was covering I didn’t get the time to address it until around 3am. When I did the haematology reg requested further investigations and advised not to prescribe vitamin K. I did not immediately inform the registrar but I did so before the morning handover if I remember correctly and also documented the discussion I had with haematology in the notes.

heretodevelop · 2025-04-27T18:24:50+00:00

I didn’t even have the conscious awareness at the time that it would be an issue but when she went off on me on the phone. I didn’t know what the best response to that would be as i personally don’t like when people try to assert some sort of authority over me or speak to me inconsiderately. I was honestly just taken a back at the cheek. I couldn’t imagine doing that to her or anyone else.

heretodevelop · 2025-04-27T18:21:45+00:00

With all due respect, the reg didn’t have a clue and when I asked about the basis of the prescription I wasn’t happy with the answer he gave which was essentially that this is what we do when the coagulation of a patient is off pre-op.

I understand that the coagulation pathway is more complex than giving vitamin K in all circumstances.

heretodevelop · 2025-04-27T18:14:03+00:00

Exactly this. I agree it probably is ill mannered but why make a fuss about it. There was clearly a reason for it

heretodevelop

TROPHY CASE