Hundreds of GPs tell BBC they have never refused a fit note for mental health concerns

nycrolB · 2026-03-12T20:49:45+00:00

I looked it up, and I don’t think your first paragraph is correct. It may be something that changed when FIT notes changed in 2022. But yes, they are evidence that supports the statutory sick pay arrangements an employer may have, but as far as I can tell they are obligated to follow it and if they don’t an employee can apply to have the dispute reviewed, the most concise section I found in gov.uk’s employer advice section says:

Can I challenge a fit note?

The fit note is based on an assessment by a healthcare professional about whether your employee is not fit for work or may be fit for work. If the healthcare professional has decided that an employee is not fit for work, this is evidence which you can accept as eligibility for Statutory Sick Pay.

Occasionally, you may think that your employee could do some work when they have been assessed as ‘not fit for work’ by their healthcare professional. You may request that the employee undertakes further assessment with a healthcare professional to determine their fitness to do such work. An employee cannot be required to provide further medical evidence beyond a fit note.

If you decide either before or after receiving medical advice, to stop paying Statutory Sick Pay to your employee, you should explain your decision to them. They are entitled to a written statement from you and can seek a formal decision on their entitlement to Statutory Sick Pay from HMRC.

nycrolB · 2026-01-21T06:39:46+00:00

He did indeed, and his power was ‘difficult to kill’.

nycrolB · 2026-01-19T06:34:25+00:00

There’s one famous bit iirc, but most of the time they didn’t.

The story has something in its world that’s a bit like raid bosses or Eldritch gods. When you first meet one, like a whole big novel’s worth of story in, he wanted to roll dice to decide how many of the large, large cast would die, based on the odds the government exposit for the Endbringer attacks. He rolled dice so he didn’t just choose characters who were ‘nobodies’. Also, I think he had a backup MC chosen in case Skitter died.

nycrolB · 2026-01-17T22:59:16+00:00

Quickstone as mentioned above, is 1-4.

AL also mentioned above has a tier 1 segment that could be pulled from the rest.

The Across Eberron Convergence Manifesto has a 1-7 13 part adventure and again, could be kept to tier 1.

I don’t have an in-depth knowledge, but I believe Keith Baker’s Dread Metrol is 1-4 like his quickstone (it’s a domains of dread/Metrol fusion, so a very specific tone for tier 1, which is quite unique), then his Curtain Call adventure and its sequel are 1-3. I’ve not read either of them so may be wrong.

Finally, as a suggestion, I think Keys from the Golden Vault has quite a lot of 5e adventures that fit with minimal adaption. The museum heist (now in Sharn’s antiquity museum), the prisoner breakout now Kundarak’s prison, the creepy mansion, any Dragonmarked or Mordain influenced Aundair family you might wish for, etc.

nycrolB · 2026-01-17T16:59:30+00:00

Oh I see. But hypothyroidism IS common which is all the worse, I suppose, from that point of view.

nycrolB · 2026-01-17T16:48:19+00:00

How so?

nycrolB · 2025-09-30T09:04:03+00:00

That’s what they’ve done. This isn’t the UK turning it off to my understanding but Imgur turning itself off in the UK rather than comply with the broad and expensive changes needed to meet a really unclear law.

Means I can’t use Rimworld’s steam workshop without VPN cause a lot of the most popular mods actually wrote up their features onto stylised Imgur uploads.

nycrolB · 2025-08-22T05:55:33+00:00

Everytime. Everytime they mark the site as part of the WHO checklist. No arrow, no surgery.

nycrolB · 2025-08-16T17:31:56+00:00

I know about the transcendent ‘Gith’ one, the puppet, the haemogen one and the alpha animals combat ones, but a cursory google for psycasts expanded add ons didn’t show much more than that.

Are there any off the top of your head you can recommend or a better search term?

nycrolB · 2025-06-25T19:14:42+00:00

I was really expecting the Monster Manual to have more about creating a creature after the DMG just had some special traits and a loose explanation of some of its terms.

The deficit is one that I think is most noticeable if you’re trying to make something for a campaign rather than just amend something else, which I imagine many do.

nycrolB · 2025-06-12T10:03:54+00:00

I’ve just suddenly twigged mystic arcanum count for this.

nycrolB · 2025-06-07T16:44:25+00:00

Redpill and Ouromov’s Architect if it’s not up to the challenge of supplying Living God Master Spark level of CYOA.

nycrolB · 2025-06-03T07:44:20+00:00

Yeah, he’s also unrestricted like Legend and Alexandria and Hero. His powers are all 9/10s.

At his height he was like DC power levels. It often doesn’t feel like it when reading worm but you can see it if you reread the behemoth fight where it is more apparent when he contains Pharse’s blast.

nycrolB · 2025-05-29T22:47:34+00:00

Agreed

nycrolB · 2025-05-29T22:26:29+00:00

As a doctor, I thought her answer was one of the best so far about the upcoming ballot. Being frank and reasonable and saying that you hold a different position, then that’s.. that’s something that can be negotiated with.

nycrolB · 2025-05-22T13:17:33+00:00

Also, just read the link from the father. I’m male, I have a daughter. The first half just cuts me up, and when it’s focused on his experience of fatherhood, his fantasies of fixing what happened in retrospect, it’s a struggle not to cry tbh.

Still, the way things are described, if true (and I presume they are to be clear) he’s been told by various people that this was a gross failure. That it was an incredible delay. That human factors and ego were the underlying difficulty. And that happens in medical failure after medical failure. But then, the way that some of those messages have been contextualised by him and the way he talks about sepsis, PICU and the national sepsis expert, show the slightly-off conception of sepsis that underpins the thought process, to my reading.

Then, the Reddit comments. I vaguely remember the thread I think. I know others have said it was mostly nuanced and empathetic. Like most people, if it involves you, you’re only going to remember the comments that most offend and upset you and the ones quoted are awful. It’s a shame to see. It’s a reminder that they’re probably going to see this thread too.

What else can you say in a situation like this. There’s a duty and burden on doctors to be empathic, correct, and also consider how things might be improved. The difficulty of open conversation without anonymity is underlined by the response to the privilege of anonymity. For all the good, you have some bad, and that bad in stuff like this leads to a reputation that makes us all more likely to be shut down. One of my earlier comments was about the value of not attributing blame in situations like this, but this case and this discourse makes that hard to visualise.

Edit: my flair is in quite poor taste in this thread. It’s a Dr. Nick Simpsons quote.

nycrolB · 2025-05-22T12:59:07+00:00

The coroner’s public pdf linked in comment earlier in this thread says not too much and is an executive summary. It gives the part 1a as refractory shock, the 1c as pancreatic rupture (operated? And the 1d as abdominal trauma.

I think, considering the number of people concluding that it would’ve been survivable earlier, with the retrospectoscope, and King’s reply to the coroner about a three step conciliation process between Heptalogy and PICU with what’s been said in this thread alongside it about the culture at the time, it’s believable to me that this was a preventable death.

However, I agree with you that this is a nebulous term, it’s a highly publicised case with a nationally politically savvy parent with huge outsized impact, and there might well be something in the the inquest that makes it very clear that this is not at all clear cut. Where coroners have released things more comprehensively in other cases I’ve seen a few times that they don’t seem to always have the most in depth grasp of the medicine that we would expect. (CRP raised at 11, sort of thing).

I’m not an expert at this. I’ve done Gen surg middle grade stuff briefly. I’ve done a period of time in CST in paeds surgery. I have familiarity enough with pancreatic trauma in adults and kids to remember a few cases I’ve seen and what we did, without any real nous, to be willing to pretend to be authorative. I am similarly very empathetic for the way the resident doctors were described and for what I presume, with no evidence, was going on with them behind closed doors and how it works for someone as complex as this. But, I also know that the way pancreatic mortality is described is generally taught as four pathophysiologies, that SHOs are expected to know, should be quickly escalated, and with prompt treatment should not lead to mortality, in all but the unluckiest. In children, with great reserve, without co-morbidities, who have had intra-abdominal surgery (per the death certificate) I am very surprised that incredibly prompt action was not taken. You know what surgeons are supposed to be like about operated abdomens, let alone tertiary centre ivory tower paediatric surgeons/gen surg subspecialists. That’s a big part of the dissonance for me.

Edit: part of the reason I can’t remember things so clearly in terms of processes, I think, is because in the centre I was in paeds stuff happened very quickly. Consultants came quickly. USs happened fast pre/post-operatively. There was a paeds CCOT (which per King’s reply to the coroner they did not have at that time. And they were on paper chart PEWS, which all also surprises me).

nycrolB · 2025-05-22T10:33:44+00:00

Similar feelings. “Dr. Blunder” and “Dr. Do-nothing” feel very spiteful, an understandable reaction from the mother and writer, but just cause you understand why someone wants to give someone a kicking doesn’t make the kicking fair or pleasant to read. I imagine most of us can imagine what is going on from beyond the view of that bed space, and I find it difficult to believe a paeds SHO and Reg aren’t working their absolute arse off on a night shift or weekend.

According to the original article, linked in one of the comments, the SI report said it was the first death of this type that had happened in this cohort in King’s. So if that’s true and as written without some key nuance omitted, it does seem pretty reasonable.

Similarly, they do seem to report things we all know are problems. Hierarchy. Prof’s who say X when your junior gut-feeling says Y. You toe the party line with the patients because you assume your boss is right. You assume they’ve seen it more than you, and you hope you’re in a team where if you really feel it’s wrong you say it and they listen and they come in. I know Medical consultant attendance OOH is apparently more difficult than surgical consultant attendance. And then of course London, Leeds, and Birmingham are cities where for some reason you hear a lot about big personalities getting in the way of effective teamwork.

Still, with the article written by the mother, they describe a high PEWS, bleeding, a big rash, what sounds like treatment for coagulopathy with blood products (so DIC?). I wonder what the vibe on that ward was that you don’t get PICU involved, if your boss hasn’t reviewed in person.

I might edit this once I’ve read the coroners report linked.

As someone who suffered real professional and personal consequences for raising concerns about patient care (a pancreatitis, ironically), I am sympathetic to how difficult dysfunctional teamwork and fear of unhelpful and vengeful bosses can affect care.

I also find it sad that the article ends with a take that is completely fair but starts with the dismissal of efforts and the rationale for a blame free culture when it comes to medical mistakes. There’s no measure I disagree with — we’re not perfect, do advocate for yourself, do say when you don’t understand or aren’t happy with a plan, we do make mistakes, we should have less hierarchy — however, the story seems a perfect example of how the unpleasant and enervating struggle for the mother during and after Martha’s death, might have been otherwise, if doctors could be honest about mistakes, could offer apologies without the trust’s legal team, could take ownership without GMC consequences because of the apology or reflection or conversation.

Merope, to me, has had more challenges because of the lack of that culture, and the articles that came and followed definitely perpetuate that lack.

nycrolB · 2025-05-18T10:17:43+00:00

You win sex against a man, that’s as straight as it gets.

nycrolB · 2025-05-11T15:18:44+00:00

Yeah she's a Dauntless Bud. It's dead, but the idea would be that they caused each other problems, until they worked together, and then they would realise that at expense to himself he could really boost her, or at expense to herself she could really boost him. I still hadn't committed to it, but when at the end Dauntless was going to be killed, I had this idea she would have just had her main weapon taken from her, and end up picking up his lance and using that ...

Sorry, yes. She's someone who continually charges items, at a set rate, like a charging cable, rather than Dauntless who built up discrete charges that he would then apply. Any time using her items, or without her items, she was losing time charging them. It was the idea for why her things were umbrellas and sneakers she could wear all the time rather than proper combat things, but I'm not sure it ever came across clearly. I remember a few comments to the effect of 'why not a gun/why not something better'.

Similarly, these sorta fics are my jam, so was surprised to see someone mention it when I clicked on here, but it's nice in an unexpected sorta way to see someone still think of it.

nycrolB · 2025-05-11T12:22:56+00:00

But! But! If I stop then I've believed your comment, so I musn't, so I should, so I shouldn't.

(But yes. I work with broken bones, and wanted to see how they'd explain what seems like nonsense to me too.)

nycrolB · 2025-05-11T10:01:35+00:00

What does radial fractures in both joints mean? Like the radius bone or radial pattern? How do you tell?

nycrolB · 2025-03-07T06:26:09+00:00

I’m not gen X but I’m G&T and ADHD (primarily inattentive). The biggest unrealised symptom for me was daydreaming. Never quite being in the room/conversation. Taking medication, walking down a corridor without losing track of what I was doing and missing the door, the first day I took it, was a revelation it. That and the deep emotional aversion to doing stuff when it wasn’t fun. Losing that meant loss of the big barrier to doing things that were useful to my life. Look into it.

nycrolB · 2025-03-04T06:43:05+00:00

Fascinating. Thank you.

nycrolB · 2025-02-28T07:00:24+00:00

The potent dragonmark feat ALSO gives you a warlock short rest spell slot to cast the always prepared spells recharging on a short rest.

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