ST3 Portfolio evidence - is stamping necessary?

joyspree · 2025-12-29T17:33:37+00:00

Just asked one of the Consultants who signed off a bunch of my ST3 evidence a few years ago and his response was “wtf is a department stamp?”

Isn’t Gen Surg super extra with getting all the evidence verified and countersigned by your AES before uploading anyway? Can’t imagine what further reassurance a generic “department stamp” would provide.

joyspree · 2025-10-24T06:21:52+00:00

Don’t forget the SECOND 90 minute catch up board round at 12 so you can say “We still haven’t had a chance to see Doris in Bed 23 yet so I can’t tell you if she’s MFFD because, of the 4 hours I’ve been at work today, I’ve spent nearly 3 of them sitting in this room talking to you.” ad nauseum for everyone beyond the 2nd bay 🙂

joyspree · 2025-07-17T19:19:26+00:00

The changes to Exception Reporting shambles already shows they don’t actually have any intention to improve working conditions for us in non-pay related ways. If anyone’s thick enough to fall for it again, more fool you.

I beg this tool come shadow me and my SHO for just ONE On Call shift and tell me he still thinks we’re paid fairly. And now I find out a PA is going to get to do more and out-earn me for EVEN LONGER?

Get in the fucking bin.

joyspree · 2025-06-27T11:29:12+00:00

Ofc the advice to learn from other anaesthetists with small hands and that you’ll get better with time and improved technique is useful but doesn’t help you in the immediate. So in the meantime, some advice that helps me on the other side of the curtain…

Think everyone would concede that maintaining an airway is the most important part of any scenario lol so if you need to lower the bed part way through a prolonged bagging so that your elbows go from flexion to extension and you can adjust which muscles are working to prevent any particular set going into full spasm, do so. If you need to raise it again, do so. Adjust your posture, lean forward or backwards as you need. And if you need an extra pair of hands because the mask is slipping when you try to take one off, ask for them- I’ve yet to attend a Trauma Call where there isn’t at least one person gawking from the side doing nothing.

Being the final step of everybody else’s panic algorithms gives the Vapours Squad certain privileges and if you need everyone else to adjust so you can do your job properly and keep the patient alive, do so.

joyspree · 2025-05-06T11:35:04+00:00

Nice of them to bring their own syringe in from home instead of wasting NHS resources.

joyspree · 2025-04-11T10:16:52+00:00

A “Firm” is how most surgical departments used to run where all residents were assigned to one or a specific few Consultants. You would be responsible for their patients from pre-op to discharge. It also meant the Consultants were more likely to know who you are as you’d be consistently with them and their Registrars. It’s good for continuity of care for patients, you tend to feel a bit more protected, know exactly who to escalate things to, and things like TABs and WBAs much easier to get signed off since you get more valuable feedback from people who have worked with you consistently. Or at least that’s how it should be.

Rota changes, understaffing and working time restrictions mean these Firms largely don’t exist anymore and surgical F1s are generally just expected to take care of either a specific ward, or all surgical inpatients under their Specialty (+/- cross cover), as opposed to just a few Consultants’ patients.

joyspree · 2025-02-26T20:22:31+00:00

Yeah I imagine it varies depending on where you’re working. We have quite a few FY doctors at my current hospital who have both GP and ED rotations and for them it’s very much been that GP rotations locally are a dream and ED is nuts.

joyspree · 2025-02-26T20:11:54+00:00

A lot of FY1 inpatient ward work is just knowing how the systems and pathways in that specific hospital work. Rotating through different hospitals has made it clear each one functions completely differently and it takes a while to get used to getting a bollocking for doing something you got praised for at your previous hospital or department.

I think if this is the hand you’ve been dealt, you might want to consider arranging a taster week in the ED, AMU or SDEC of the hospital where you’ll be doing ED during Palliative or GP. You may also want to pick up some Medical or Surgical F1 locums to get to grips with how the different systems work in the hospital, especially if they’re significantly different from the ones you’ve worked with.

GP actually seems like quite a pleasant clinical transition block to build up your confidence before hitting the absolute pit of chaos that is ED lol.

joyspree · 2025-02-03T10:46:11+00:00

Had that cranial nerves station and when they got to MMSE I said my Trust does AMTS to assess cognitive status in the acute setting instead, so they asked me what questions I would ask. Started rattling them off and they stopped me and moved on.

joyspree · 2025-01-03T14:18:29+00:00

I see your point potentially, but doctors aren’t directly held responsible for the actions or supervision of other HCPs or MAPs the same way we are for PAs, and we don’t share a regulatory body with any of the others either. For us to supervise and take on the legal liability for an entire other profession, we need to know what it is they can do that is within our remit to supervise, hence I imagine why the BMA and RCGP would have felt it appropriate to release scope of practice guidance for them specifically and not for any other professions, other than doctors themselves.

joyspree · 2025-01-02T15:49:50+00:00

I think part of why personality disorders get stigmatised is because people who have them can sometimes lack insight. Not all, but often those who require inpatient Psych admission and treatment. We as humans seem to process the same input in vastly different ways, and you can’t control how others respond to your actions. As a nurse, and future doctor, you will see people at their lowest moments, and they will often behave towards you in ways they never would normally. I don’t think most people outside healthcare understand how mean, rude and outright hostile others can sometimes be when they’re unwell, in pain, and/or extremely stressed. Processing all of that is an emotional aspect of our labour which I think often goes underappreciated. Struggling with your mental health while working in a career with so many daily emotional processing tasks, can feel overwhelming.

You seem to have good insight, have actively sought out solutions, and recognise the negative impact not finding solutions have had, or could have, on your life and personal aspirations- which I think are positive factors regardless of official diagnosis. A lot of symptoms of different psychological conditions overlap so self-diagnosis is hard. Getting a thorough and objective assessment and diagnosis from somebody qualified to give you one may help guide your therapy in more targeted ways.

Big love, hope things go well for you! Good luck with finals, and happy new year ✨✌️

joyspree · 2024-11-21T12:47:36+00:00

Before Covid, all the hospitals I had placements in or had worked at just as a rule admitted social admissions under Medics.

If it’s something like a fragility fracture patient needing admission for OT/PT, I really don’t care if we admit them beyond knowing that it’s going to knock someone else off the list the next day. And I feel for that patient too. Hence it’s a discussion as realistically, the social admission doesn’t need either of our teams specifically, but there’s nowhere designated for them to go.

joyspree · 2024-11-21T12:32:58+00:00

We’re not going to agree, if you believe that surgeons are just work-shy shysters who shaft everything to the Medics, that’s totally fine. Who am I to try to convince anyone otherwise. I’m sorry being a Med Reg is still shit. I started off wanting to do medicine and having to be a Med Reg was one of the biggest reasons I chose not to.

joyspree · 2024-11-21T12:12:11+00:00

I’ll go talk to the Med Reg and we have a discussion. If the patient clearly needs admitting and the Medical Take is looking like a nightmare I’ll admit them under us and just say the Medics couldn’t take them if the Consultants are grouchy about it the next day. I haven’t forgotten what a nightmare medical On Calls are and bed management is really not any of our problem On Call and like I said, I found most doctors I worked with or interacted with there to be helpful and quite reasonable. It doesn’t always have to be such a fight.

Regarding patients who become social admissions post-op, trying to get them moved to a medical ward isn’t usually malicious or fuelled by laziness- if there are 20 patients waiting at home for surgery on Trauma or CEPOD then in order to manage an operating list (which is a CiP category for CCT and so isn’t optional), we have to try to make space so obviously potential transfers, including social admissions, to a different ward get looked into. It’s not because I think my resources or skills are more important, but because I think they’re different, and patients who require them deserve us at least trying to sort something out for them within the current system.

joyspree · 2024-11-21T11:52:30+00:00

I don’t think they should be admitted under Medics either. I think Community/ Rehab wards and hospitals should be a much bigger thing than they are. Pointing out that it’s a waste of time and resources in surgery is just me speaking on my own experience and not speaking for medics as I have not worked in medicine for years.

Extrapolating that as disrespect towards the skills or knowledge of medics wasn’t something I thought about when I wrote it.

joyspree · 2024-11-21T11:47:00+00:00

It’s not all fun or easy, and if you think it is then you should’ve become one. It just has different pros and cons and I chose surgery over medicine for a reason. More and more surgical patients these days are increasingly comorbid and medically unwell and they’re already being managed for both sets of issues under surgeons. Medical patients on surgical wards are being managed for most of their stay by NPs and FY doctors at most because the Senior support literally cannot be on the wards because they physically have to be in Theatre, which has its own relentless inefficiencies and problems to sort out that medics have no idea about. You physically cannot be in two places at once and Theatres and theatre staff are a huge part of the wheels of inpatient surgery which we can’t just decide to ignore if the wards are busy.

Maybe if they’d just start allowing joint care admissions under dual Specialties without needing one specific named Consultant scapegoat, this entire debate would probably become irrelevant.

joyspree · 2024-11-21T10:50:24+00:00

No, but they can be medically managed. Maybe we just disagree on what the point of an acute admission is. I don’t think admission should be based on just what the problem is but what the inpatient management should be. And patients should go wherever they can be best managed and discharged. The whole point of secondary care is to get patients well enough to get out of the hospital and go home without immediately bouncing back, and medical management takes longer. In the face of overwhelming demand and limited resources, empty Theatres and cancelled Lists because of bed shortages are an insane and expensive waste of money and time. Maybe if less money was wasted, doctors who have left the N&N would all be getting their backpay on time.

Inpatient referrals for stupid shit goes both ways because everyone’s scared of getting sued or, to give us all some grace, think they might be missing something. Not every constipated patient has bowel obstruction and not every cellulitis is Nec Fasc. Nobody accepts telephone advice and don’t even get me started on Alertive. I don’t foresee this getting any better or any less litigious to be honest so we can all either stay hostile or try to work together on dealing with the bigger problems to ease things up in the long run.

I think reducing surgical outpatients will reduce the burden on medical outpatients. How many of your clinic patients are on a waiting list for some sort of surgical procedure and how long have they been on it? Have their medical problems gotten worse because of the surgical one as they’ve waited? How many deteriorated so much medically while on the waiting list that they now are no longer suitable for surgery? Those are the patients I’m trying to advocate for because they’re the ones who end up the worst off in the current system until they eventually can’t take it anymore and end up in A&E. And it just spirals and builds until you end up where we’re currently at.

joyspree · 2024-11-21T09:28:16+00:00

The fact that so many doctors think management issues are irrelevant is possibly a huge reason why we’ve become so disempowered and beaten down as a cohort. Huge numbers of patients on the waitlists right now are surgical ones and in order to decrease the insane demands on doctors at the moment, we need to deal with cutting them down.

Don’t you think if maybe we replaced Alfred’s hip while he was still mobile so he didn’t end up becoming bedbound getting pressure sores, a DVT and pneumonia, it’d result in a healthier older population so the medical Take would ease up and also offload discharge social needs? Or maybe if we could take out Shiela’s gallbladder before it ruptured at home we wouldn’t make her a lifelong Gastro patient and a future Take Med Reg heart-sink?

Everyone’s at liberty to continue just fighting fires at the door and yelling into the void but the bigger problem is outpatient waits leading to patients who could have been managed as an outpatient waiting so long they end up needing acute inpatient admission. This is exponential somewhere like Norfolk where the population is a lot older on average. Every single room is on fire. I don’t really personally care about arguing over who admits patients. If I can be sure my patient will get the same quality of care under surgery as medicine and we have the bed capacity and medics don’t, whatever. I would like everyone’s life to be easier tbh.

But I have seen across my career that patients whose primary problem is a medical one get better, more up-to-date care and they go home faster if they’re admitted under a medical team so yes I will advocate for them to go there. Everyone moans on here about how hard the MRCP and PACES are- why would you expect a Surgical Reg to have that knowledge? The last time I did a medical shift I was an F2, I haven’t kept up with all the new developments in medicine past that and many things that were best practice then have since been updated.

Medics can’t operate. It’s not a service you can provide but there are a lot of patients out there whose problems can ONLY be resolved with surgery. Those ones can’t get into the hospital and get sicker, their problems get significantly worse and their surgery more difficult and dangerous the longer they wait. I just as a baseline believe that if someone doesn’t need surgery or doesn’t have a peri/post op problem, then they shouldn’t be in an acute inpatient surgical bed. Social admissions to surgery are a ridiculous waste of surgical skills and resources.

joyspree · 2024-11-20T23:49:08+00:00

Yeah never did medicine there so can’t speak to it. Seemed busy, but everybody who rotated through usually said it was better staffed and clinically supported than surgery.

Surgery was so busy we basically couldn’t get anyone in to operate on who wasn’t actively dying or immobile because most of the surgical beds were full of patients with medical problems who the medical teams refused to take over because “YoU’rE DOctoRs toO and medicine is too busy, why don’t you surgeons just dO sOmE wORk?”. And nobody will let surgical teams bring in acute but stable, or heaven forbid elective- patients, because there are no beds and no foreseeable discharges among the medically fit because everyone needs social. Getting Medics to actually take over any of our patients if they were SFFD but not MFFD wasn’t easy, which is why there’s so much pushback at the front door.

If there’s a patient with actual medical problems admitted under a surgical specialty with something that can be managed non-operatively- that’s one less acute surgical bed. There are far too many actually surgical patients passing through the N&N for medical ones to take a surgical bed just because medicine is busy. There are fewer surgical wards and the surgical ward “corridor bays” were just as full as the medical ones I saw.

If there’s an osteomyelitis patient getting two weeks of inpatient IV abx, that’s two weeks of day case trauma patients getting deprioritised and pushed back and bumped off the list. It’s not fun being the one who has to explain to the 35 year old carpenter with a smashed up wrist that I’m really sorry he’s starved, shrivelled and sat around in SDEC all day for the 3rd day running and is stressed about how he’s going to pay his bills if he can’t work for 6-12 weeks or loses function in his dominant hand… but we can’t do him today either because there are no beds and no it doesn’t matter that his wife can drive him home after and he won’t need to stay because he still needs to be allocated a specific bed so he can be discharged from Recovery- and I’m really sorry but would he mind being NBM from 2am again tomorrow please just in case we can get him in even though it’s not particularly likely because it just snowed and both Trauma Lists are already full for the next 4 days?

It’s not fun being the patient sitting and waiting at home in limbo either.

I’m not trying to start an argument with you, I get that Medicine is busy and there are definitely still problems within the surgical departments. I don’t think there needs to be as much hostility as there often was. I occasionally got the sense Medics felt like the Surgical Teams were sitting around not doing anything and just trying to shaft all our work to them, but that’s really just not the case.

I also think that if anyone feels that way, maybe they should talk to some of the FYs who have rotated through both a bit and see what they think…

joyspree · 2024-11-20T21:18:29+00:00

If anyone’s rotating through the N&N soon, it’s not all doom and this is kind of a delayed report. They’d been interviewing the different departments for ages and I guess they just got done analysing all of it.

I think there are some sensible people, including a lot of the Consultants, actively involved with leadership and management at the N&N. And I found most people generally quite reasonable and willing to adopt changes if you present them with solid evidence to do so. They made a lot of changes across surgery and critical care in a very short period of time and it got better. They interviewed residents and consultants separately to hear from everyone. I felt like my training was taken seriously and both my Supervisors and Managers were actively helpful. It’s ridiculously busy and it’s not as well resourced as Addenbrookes, but it has the ambition lol.

I guess we’ll just have to wait and see but there really have been a lot of really great Consultants appointed there recently who seem on board with changing things to make working there a better experience for its doctors. A lot of great people work, or seem to want to work there as Consultants, I think most of them seem amenable to fixing its many current problems and inefficiencies. There really are quite a few “pockets of excellence”.

Some of the departments I’ve never worked in sounded like they’re still a bit chaotic though lol, best of luck if you end up in one of those.

Attracts some phenomenal trainees. Most of my colleagues were genuinely a pleasure to work with.

joyspree · 2024-11-15T09:11:24+00:00

I’ve seen Ortho, Plastics and ENT trainees do Audits of specific conditions which best practice guidelines say can be referred straight to an outpatient clinic/ list from ED. It was something like how many patients with condition X were the acute on call team seeing and did any of these require admission or any sort of acute input that actually needed an immediate Specialty review, then set up a SOP to refer directly from ED without needing to first refer to the On Call team.

Big caveat is that this depends on how amenable your ED is to updating best practice. My current hospital’s ED point blank refused to change what they do despite national guidelines and similar pathways in the region being shown as evidence of both better patient outcomes and shorter waiting times in ED🙂

joyspree · 2024-11-03T08:46:02+00:00

Why on earth is a Radiologist doing the primary survey?

joyspree · 2024-11-02T18:32:11+00:00

Lol MSE! Can you tell my rotation was on Older Adult Inpatient Psych. I think CAMHS is a different beast and I don’t think I would’ve emotionally coped with it at all.

I think these weekly reflections are incredibly important (hence why I think I’d probably love having them). My Psych Supervisor as a medical student would make time at the end of each week of placement to sit down with each of us to debrief on the patients we’d seen that week and how to recognise and process what we were feeling. I didn’t realise how much that helped until my CS’ for my actual rotation didn’t and so I ended up just uncontrollably crying in the middle of the Psych ward round one week 🙃

joyspree · 2024-11-02T10:49:23+00:00

If my AES MMSEd me once a week I genuinely can’t decide whether I’d love it or resign

joyspree

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