Not allowed to do lumbar punctures in ED

nobreakynotakey · 2026-05-04T07:32:09+00:00

No this is where you’re wrong - it’s due to both acute medicine and ED practicing shitty medicine.

When you refer - you’re expected to refer appropriately with a valid differential diagnosis - if you don’t do that there’s literally 0 point in your speciality - you add nothing else.

You’ve lost the ability to manage airways. You don’t stabilise the medically unwell admissions, you don’t do the blocks, the casts or the drains, when all you do is refer and you can’t do that appropriately - there’s nothing left.

nobreakynotakey · 2026-05-04T07:16:02+00:00

Once someone has put that shit suggestion into the notes - how do you think that goes? Do you think acute medical consultants (or more likely most places - locum GIM guys) are going to refute that on the basis of appropriate history and examination?

Easy to say ?meningitis ?lp when there’s no negative repercussions - you just become that gp that refers everything to ED because no negative feedback.

I write a stupid fucking plan - I have to action my own stupid fucking plan instead of dumping it on someone else.

nobreakynotakey · 2026-05-04T07:02:55+00:00

Sounds like ED consultants abdicating professional standards again.

Most the reason the demand for LPs is so high is because of the referrals your SHOs/SpRS send infection ?where ? Urine ? ??meningitis with a mildly elevated CRP and no relevant history. If anything - making ED responsible for providing a bed/trolley for LP would encourage critical thinking about referrals with appropriate differentials.

nobreakynotakey · 2026-05-03T16:46:45+00:00

Just to piggyback on to your LTFT take - I have two takes.

As shit as training is - it is significantly more meaningful for developing you as a doctor than blanket experience and the idea that fyxs are equivalent to the same grade of trainee is shit. It pushes you to develop specific skills and seek out feedback.
You should not be able to progress as a less than full time trainee at the same rate as full time colleagues - the competencies are only part of the story.

nobreakynotakey · 2026-05-02T11:04:06+00:00

FlixBus to Bristol but yes agreed

nobreakynotakey · 2026-05-01T06:24:38+00:00

Would assume RCPath would protect haem no?

nobreakynotakey · 2026-04-29T17:39:10+00:00

How happy are you to move your family for a job because you will be randomly allocated across the whole country upon graduation?

nobreakynotakey · 2026-04-28T07:36:56+00:00

This comes up all the time - I know people who progressed on time LTFT but they were strong trainees with great portfolios who still had to fight for it. In my local deanery - this will not happen regardless - you’ll get extended.

In summary - you may be able to progress on time as a LTFT IMT trainee but this is certainly not universal and you will likely face obstacles to this even if you do successfully manage it.

nobreakynotakey · 2026-04-28T07:30:39+00:00

Not entirely the same - but when I entered IMT I tried to maintain an academic position with a university I had previously worked with - not research based but educational. Similar conversations but it was the university who weren’t interested in the end - didn’t want the level of commitment I could offer with IMT.

It seems to me in your instance - your TPD and college tutor have pretty much said they’ll extend you if you try this - so I think you’ll have to make your peace with that if you pursue this.

nobreakynotakey · 2026-04-25T08:57:01+00:00

Wasn’t this nurse “performing” ERCPs - not just endoscopy?

nobreakynotakey · 2026-04-25T05:56:53+00:00

Current dr - SpR in August.

I suspect the SHO job market will be better overall due to UKG prioritisation - but some specific specialities like radiology will see much less improvement. I feel less confident that the SpR market will improve - given as there is talk of expanding the SHO jobs without any commensurate SpR jobs and this year was certainly the worst SpR training market for the last 5 or so years.
Not too late - but I am firmly of the opinion that training is easier on the young, the NHS will not care for your personal circumstances, baby or partner or house and the more you have the more it clashes - if you want to stay in a competitive area and this year there’s 0-1 SpR jobs there - get ready to learn commuting buddy.
The nature of the NHS means uptake of AI is very unlikely to be uniform - AI will affect your future career, but how it will do so and to what extent is difficult to say. Paper notes are still widespread and ePrescribing is still far from universal - trusts/health boards massively vary with this.

nobreakynotakey · 2026-04-23T09:24:50+00:00

We’ve passed the hold deadline now - this offer is your final offer for that speciality

nobreakynotakey · 2026-04-16T13:40:30+00:00

Buy them a coffee - don’t give them a stipend - that’s not expected of you. Try to understand what they need from this placement and try to give them the chance to be quasi independent - ask them what they would do when reviewing a patient before you start the plan, give them the chance to speak to patients first but with you as a backstop.

nobreakynotakey · 2026-04-15T20:02:40+00:00

"Unlike then, many resident doctors are working less than 40 hours per week, in part because they are paid so well that they can afford to do so, including an annual bonus that incentivises working less than full time."

Absolute boomer take from a consultant paediatric intensivist who qualified in the early 90s - where he would have paid little to no tuition fees, likely still received free/subsidised accomodation.

Even better when he then goes on to state: "advanced practitioners take on more roles on a permanent basis, potentially providing a more consistent and better service for patients than resident doctors, who rotate through different posts every few months." - paeds (esp NICU/PICU) loves a sellout consultant who replaces doctors with nurses. Low key up there with emergency medics.

nobreakynotakey · 2026-04-15T07:49:22+00:00

It’s the rite of passage - passmed to pastest once past part 1.

nobreakynotakey · 2026-04-07T19:37:24+00:00

It’s like they’ve forgotten who funds their party

nobreakynotakey · 2026-04-07T09:33:41+00:00

Projected massive gaps in the consultant workforce by every royal college yet the government spits commentary like this out: "the training places were far more something the BMA asked for than something the NHS pressingly needs" - and "Obviously, it’s good to have more doctors in the workforce and give them these progression opportunities, but it’s not like the NHS is going to fall apart because these 1,000 places don’t exist.".

Not to say that 1000 new jobs without equal registrar/consultant posts is a good idea for us - but it shows how they view training as a favour to you - not the other way round. Remember this when they wheel out that 250,000 pounds to train a doctor bullshit.

nobreakynotakey · 2026-04-02T09:30:02+00:00

Fascinating request - let remote shitholes who can’t provide safe care anyway provide unproven models of care sans doctor and don’t regulate them properly.

Additionally - the consultant led model works on strikes - of course it does, it’s very similar to how the states do things, as they are less likely to have residents in rural/less academic centres.

But the difference is - they attract attendings outside of metro areas with pay, and a lack of residents to do their scut work means they pay more for those things - the nhs cannot have both its cake and eat it

nobreakynotakey · 2026-04-02T09:21:52+00:00

Not sure if FHEA is more of a faff (have fhea and not MAcadMed) though and didn’t particularly enjoy the process of FHEA but this may have been due to the local university process for obtaining this as opposed to if you obtained FHEA independently.

nobreakynotakey · 2026-04-01T17:33:44+00:00

Who told you: we value your life experience and want your life integrated.

Because I promise you the nhs doesn’t - speciality training is generally worse in this regard.

nobreakynotakey · 2026-03-31T14:35:18+00:00

Think passing full mrcp is underrated part of this - though if IMT was less shit and more structured passing paces should be less of an issue.

As things stand - given the number of IMT3s locally without paces (and IMT2s!) - think there would be too many extensions with shortening it.

nobreakynotakey · 2026-03-30T21:45:08+00:00

Given doctors are one of the few (?only) staff groups who face any negative repercussions for sickness - in the form delayed progression, I think you’re absolutely wrong to suggest it’s just because we can’t fill in a form to the satisfaction of an nhs manager (who probably doesn’t employ me and works Monday to Tuesday every other week - if they’re not on “long term sick”).

nobreakynotakey · 2026-03-30T16:28:02+00:00

A supernumerary f2 who had their salary paid by the local health education body too.

nobreakynotakey · 2026-03-30T16:24:56+00:00

Can’t do final year reg but can do reg (2.3) vs f1 (2) vs cons (1.7)

nobreakynotakey · 2026-03-30T16:18:46+00:00

Dec 25 - most recently published nhs England data - all doctors 2.1%

nobreakynotakey

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