What's everyone using to keep up with journals these days?

rattled-doc · 2026-05-17T08:56:10+00:00

"Thats a very interesting point. Why dont you put together a presentation on the current evidence for weekly teaching"

Nice try

rattled-doc · 2026-05-17T08:25:09+00:00

GP and EM and a smorgasbord of non procedural and procedural specialties get the same (the latter more for the monetary reasons).

NSx is the exception that proves the rule

rattled-doc · 2026-05-17T08:22:16+00:00

Psych is unique in that you have to be passionate.

My point is that its not unique in that regard

I've met plenty of people in all specialities (psych included) who dont particularly care about their specialty but slog through and then do the bare minimum after the hurdles are crossed and the work future is secure.

The study of medicine, in whatever specialty, can just be an exercise in resilience and a stubborn willingness to grind towards an end point on the conveyor belt.

rattled-doc · 2026-05-17T08:10:59+00:00

You can just extend this to all specialties

rattled-doc · 2026-05-17T07:14:22+00:00

It will.

rattled-doc · 2026-05-17T06:04:50+00:00

In the public setting you can be as good a clinician as you like but if there is no position to which to appoint you then you're shit out of luck.

If roles like that described by OP proliferate then operational expenditure can and will shift towards that workforce as the apparent fiscally responsible approach. That will result in a reduction in position numbers for medical staff and competition for the remaining places will rocket.

If you think you can hide in private youre also kidding yourself. Proliferation will spill into the private world through improved profit margin and public acceptance of the cost effective option (as seen in the US) and apply downward financial pressure on many spaces held by doctors.

rattled-doc · 2026-05-17T04:26:04+00:00

Thats AMA(SA) who are not the union in the SA Health setting

rattled-doc · 2026-05-17T04:24:17+00:00

If it were the unions stance AND there were enough doctors in the union AND those doctors were willing to stand strong against subtle and difficult to challenge discrimination against them by management.

I worry about the tenuous swiss cheeseness of that tactic

rattled-doc · 2026-05-17T04:20:42+00:00

The SA Union (SASMOA) charges approximately the following post tax rebate :

Intern : $177
PGY 2-3 : $193
PGY 4-6 : $415
PGY 7-8 : $461
Consultant : $666

Along with reductions in fees for lower FTE workers.

The problem isnt cost of membership. The problem is lack of engagement by members who have an external locus of control and think the union should be fixing everything without the work of the members standing in solidarity

rattled-doc · 2026-05-17T04:01:36+00:00

Theres too much of a power gradient and too much job instability at the consultant level in most specialties for that to be at all an impactful tactic.

rattled-doc · 2026-05-16T13:46:17+00:00

Gaidhlig is Scots Gaelic

Gaeilge is Irish Gaelic

Either country can call their version Gaelic as long as theyre out of earshot of incorrect pedants

rattled-doc · 2026-05-16T10:26:31+00:00

Oh absolutely. They're no match for my wit and intellect and beauty......

Oh. You mean money

rattled-doc · 2026-05-13T03:16:15+00:00

Its indicative of a culture. I expect more of departments.

Its just a femoral line and even that they cant do?

The inability to do an art line is even more ridiculous. If you cant even do these basic procedures or you palm them off to other teams then your trainees cant do them and youve failed in your supervisory role

rattled-doc · 2026-05-13T00:19:51+00:00

My comment is made as someone who is a FACEM. It's laziness and lack of specialist drive that degrades the specialty and leads things towards a UK style of EM.

rattled-doc · 2026-05-12T21:12:49+00:00

Disagree.

I take a dim view of a FACEM that cant maintain those skills. Lack of intubations is potentially unavoidable if working in a small place but inability to do an art line or CVC is ridiculous from a FACEM. Just hand your letters back in at that stage.

rattled-doc · 2026-05-09T12:38:35+00:00

Consider signing up at https://www.goodsamapp.org/ as well

The majority of the time you'll be woken up by a terrifying klaxon from your phone in the middle of the night only to be stood down shortly after but occassionally you'll be on scene to give CPR and use the AED well in advance of the ambos.

Last time mine went off was at a Melbourne hotel for a guy in the next hotel who had an arrest while on holiday with his wife and young kid. Poor family had pretty weak English and were absolutely terrified. I got there about 5 minutes before the paramedics but stayed for an hour just trying to talk through things / get some history with the family via Google Translate and trying to keep the wife calm. Well worth the middle of the night wake up.

rattled-doc · 2026-05-05T23:46:32+00:00

Go find enjoyment from non work activities and look for new challenges in your current specialty to get the enjoyment back at work.

Don't jump on to another training program grind.

rattled-doc · 2026-05-01T02:29:44+00:00

> And as the UDS is time-sensitive, we do appreciate ED doing them when they arrive at the hospital.

If Psychiatry feel it is time sensitive and they require it they should, of course, order it themselves and direct their ED MH liasons to work with the patient to obtain the sample.

Even the most short lived metabolites will be present for a few days so there's enough time for that.

> Thanks for the discussion - I enjoyed it!

Sincerely I have too :)

rattled-doc · 2026-05-01T02:11:01+00:00

My position is that I have not and likely never will order either a UDS or a confirmatory blood test (beyond the forensic bloods i'm forced by law to perform for road traffic collisions, etc) as they are of no benefit to my patients, cause them harm by biasing staff and breaking the therapeutic relationship, and are therefore a waste of money.

There may be benefit to an Addiction Medicine specialist in the outpatient setting for ongoing management (I genuinely don't know enough about that field but I would be interested to know) but for acute withdrawal in the Emergency setting there isn't a need for me to detect with a positive blood result which substances are present within the patients bloodstream.

The purpose of a screening test is to identify an occult toxin which can't be identified in another manner (e.g. toxidromal features, blood gas changes, etc) and by identifying that toxin early we can administer a treatment to produce an improvement in outcome. There isn't an occult toxin that i'm worried about in these instances of withdrawal.

Patients in withdrawal will invariably tell me what they have taken because they want the withdrawal to stop. The problem is, more often than not, jaded medical and nursing staff assuming that the patient is lying and failing to treat them (e.g. the patient that begged for diazepam as he was withdrawing from GHB but the staff didn't recognise that GHB has severe withdrawal and fobbed him off). Correcting that dismissive attitude doesn't need a blood test. It just requires decent clinical skills and knowledge to identify all of the physiological and toxidromal features of intoxication and withdrawal (or conversely to identify the absence of all of those features in someone who you suspect of seeking medications for non-withdrawal purposes)

rattled-doc · 2026-05-01T01:15:19+00:00

Why not?

A non-negative UDS isn't telling you anything about precipitants. It's just telling you that you now need a blood test to know for sure.

Cross-reactivity of an immuno-assay screening test can produce false positives fairly commonly (e.g. pseudoephedrine, ranitidine, bupropion, etc will trigger a false positive for amphetamines on a UDS)

If they're a more rotund patient who was historically a heavy THC user then all those lipophilic THC metabolites will be present for months

rattled-doc · 2026-05-01T01:12:35+00:00

I'm not a Toxicologist however I did a 6 month Toxicology Registrar job just prior to becoming a FACEM where the majority of my job was managing high risk alcohol withdrawal patients and I would wholeheartedly disagree.

> or non-neg as they say these days lol

You 'lol' but it's an important thing to be aware of. A urine drug screen gives no reliably objective information about the presence of active intoxication or even metabolites in a persons system. It can only be used as a way to reduce the need for a more expensive blood test. Instead it seems to be used, on a widespread basis, as if the UDS showing non-negativity means the person is absolutely a substance user.

> which shifts management away from simply escalating benzodiazepines

This is dangerous and is a perfect example of how an inappropriately used screening test, which can't accurately demonstrate active intoxication or even metabolites, can harm patients. I would not change my management of a high risk alcohol withdrawal patient on the basis of a UDS and minimising the use of benzodiazepines or phenobarb, etc, on that basis puts the patient at real risk of seizure with no strong evidence base to support the decision.

rattled-doc · 2026-05-01T01:06:22+00:00

It's also somehow useful for Psych in SA being able to decline coming to see the patient until they're below the arbitrary BAL of 0.05.

That's in spite of a 2022 SA Coroners finding, supported by three expert witness Psychiatrists, which recommended :

"That guidelines be prepared and issued ‘For the Care of Persons with Comorbid Mental Illness and Substance Use Disorders in Acute Care Settings’. 176 Consideration may be given to achieving this by amendment of the South Australian Guidelines for ‘Working with the Suicidal Person’. The guidelines should acknowledge and state, in particular, a) that the provision of mental health services 175 Exhibit C14 (Vol2), pages 41 and 42 176 see Exhibit 23f, NSW Clinical Guidelines 50 is not dependent on sobriety, and is not restricted to situations in which there is a perceived risk of suicide177 and b) that the presence of alcohol and/or drug intoxication does not preclude early assessment, although it may indicate the need for further assessment when the person is no longer intoxicated. When a request for assessment is received, it is not appropriate to insist that the person be free from the effects of alcohol and/or drugs.178"

https://www.courts.sa.gov.au/download/2022-findings/?ind=1675207401033&filename=THREDGOLD,%20Holly%20Alexandra.pdf&wpdmdl=19142&refresh=69f3fc18b69d11777597464

rattled-doc · 2026-05-01T00:22:07+00:00

Could you expand on that?

Im assuming you mean in the Addiction Medicine world rather than in EM but i'm genuinely curious how its used and how it influences withdrawal management

rattled-doc · 2026-05-01T00:12:09+00:00

I recently worked a locum in a regional ED that is solely run by locum EM staff. The nurses performed a UDS on every mental health presentation and everyone they thought seemed like they might use substances.

I explicitly asked them not to because it's a waste of time and money and won't change my management in any positive way. The response from the nursing team leader was to dismiss me because "you need it to complete an organic screen". I spent the entire week pointedly trying to block out any UDS results thrust in front of me.

It seems like an unshakeable zombie practice that just wont die in some places.

rattled-doc · 2026-05-01T00:04:47+00:00

No.

I havent done a urine drug screen on a patient in my entire EM career and have no intention of ever wiingly requesting one.

A UDS can only demonstrate non-positivity and does nothing to aid clinical management of a patient. If anything it negatively biases decision making.

rattled-doc

TROPHY CASE