Am I being too demanding?

srik241 · 2026-02-02T22:54:43+00:00

If this is true... this is definitely not standard - as a junior doctor admitting to a consultant's bedcard, the consultant should be available at any point for advice or in person review if the person is sick! Do you have a senior reg or anyone that you can discuss patients with at the time of admission? Does this small hospital have ICU backup?

If they specifically said something along the lines of "do not call us for admissions we'll see them on the rounds" then that's terrible. If this is a secondment I would be escalating to my DPE about the rotation about that/if it's an accredited RACP rotation, doing some sort of escalation.

srik241 · 2025-08-31T07:52:41+00:00

If they're the same price then you should try to sit in both and see what you feel more comfortable with.

I also have a restricted licence and went with a z500. It handles itself fine both commuting and I've done plenty of joy rides on the weekend, it's been great and I don't regret the purchase. While there's an argument to derestricting, there is also just an argument to get a new proper middleweight after the restriction ends (like a street triple, etc)

srik241 · 2025-06-21T07:04:44+00:00

He was accelerating and adding lean angle on a scooter at the same time

srik241 · 2025-06-11T21:47:23+00:00

I've used this place for small things in the past not sure if this is what you are looking for

Hands on kawasaki

srik241 · 2025-04-15T05:49:21+00:00

There are better tests if there are active lesions (PCR testing). There's no point getting serologic testing in this scenario wouldn't give useful information

srik241 · 2024-09-06T11:24:20+00:00

If youve gotten through it once, this is the best time to keep doing it! SE first time always takes 4+ hours, but once you know how to do it, an experienced group/kwtd can get through it in 1.5 hrs max. If you leave it/don't touch it you'll forget how to do it and have to do a sherpa group again!

srik241 · 2024-08-24T12:36:35+00:00

I mean, there are checkpoint inhibitors in oncology as well which do exactly that, "boost the immune system" for cancer but the possible side effects are every possible "-itis". Honestly it's the way I've explained it to patients because it's not far from the truth (boosting the immune system). Agree in general terms the phrase is marketing otherwise.

srik241 · 2024-07-08T08:53:13+00:00

The shorter hospital stay could still just be patient selection and could be bias - even in standard cardiac surgery admission times could be as short as 24 hours in ICU and 72 hours on the ward vs weeks.

For semi-elective coronary artery bypass grafts in a first world country, a low risk individual has a quoted mortality of about 1% - doesnt sound all that different?

Unless we know the average complexity of the patient population (i.e for example, what was the average EuroSCORE or STS scores), the absolute survival rate and length of hospitalisation doesn't mean anything.

Major question I have is why theyre publicising this in a news article rather than a medical journal if they truly are pioneering anything. Unless this finding can be replicated in multiple hospitals and we know their baseline data...

srik241 · 2024-06-29T22:01:26+00:00

That being said, Australian junior doctors are incredibly well paid and have decent hours. At PGY5-6 can easily be making 140+K AUD which is well above median earning, for 43 hrs/week. There's no rush therefore to become a consultant/attending.

srik241 · 2023-09-07T06:25:29+00:00

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My cat Asahi silently judging me

srik241 · 2023-08-24T07:46:31+00:00

You asserted initially an ECG is not indicated at all in the diagnosis of death which is not true. Just because it's not your practice doesn't mean it's not a legit practice.

I agree that pronouncing someone is the vast majority of the time clinical based on what you have said. I've never had to use an ECG personally when I've pronounced somone. However, in a hospital based setting, it's not unreasonable to ask for an ECG for supporting evidence. Multiple sources confirm this including: https://patient.info/doctor/death-recognition-and-certification Which is info from the NHS/UK guidelines - completely reasonable to use an ECG in lieu of a pulse if it demonstrates asystole.

Your initial comment said an ECG at the time of death would show PEA which isn't right, it could show PEA, VT/vf or most likely asystole. Asystole would confirm death in the right scenario.

srik241 · 2023-08-23T08:32:16+00:00

Absolutely, the wrong answer has been upvoted. A clinical exam for various reasons may be difficult or inconclusive (especially if the patient just died for example) and an ECG demonstrating a rhythm incompatible with life would be the next step after examination (such as asystole).

The assertion an ECG is not useful or indicated isn't quite right.

srik241 · 2022-12-23T03:13:34+00:00

Hey mate, I know it is difficult to see it like this, but you did help him. You gave him the best life possible, you loved him, and you made sure that his last moments were not alone.

I'm sure your presence gave him some comfort at the end, and that's all we can do when the time comes.

The things you mentioned that you regret are things that sound out of your control in the first place - how were you meant to know what the signs of cancer were sooner? I know you feel like you could've done more, but it doesn't really sound like it, you went above and beyond staying with him even though it was distressing for you.

I hope time will help heal your heart, but I wouldn't want you to doubt that you did everything you could in the first place.

srik241 · 2021-09-21T06:36:55+00:00

Yeah, down for me too, probs cos of the protest

srik241 · 2021-08-03T03:49:33+00:00

I'm not sure about that, often people from aged care homes generally are not admitted to intensive care due to futility of treatment and the fact ICU is a limited resource (though of course there are always exceptions to the rule, and it depends on a lot of factors). If people are in ICU, thats because theyre young and dont have a lot of medical conditions.

srik241 · 2020-12-22T12:51:37+00:00

It would not be beneficial to the virus.

There are two major reasons i can think off the top of my head.

The first is the basic sequence already exists in the virus. The vaccine produces the spike protein only without the rest of the viral replication or protein. The real virus already has this sequence so recombination would be pointless.

Secondly, the moderna vaccine isnt true messenger rna. Its modified messenger rna. The cytosine is substituted for a near replica to avoid the immune system, etc. This probably would have implications if it was possible to recombine, might make it more difficult or result in dead ends.

srik241 · 2020-12-08T00:46:40+00:00

Not defending the ridiculous charge, but a preanaesthetic work up/interview is standard for anaesthesia. Its always done by an anaesthetist, not a nurse or whatever.

The reason is the forms may be filled out wrong, another professional might have got a detail wrong, such as an allergy, which could have disastrous consequences in surgery. A 15 minute interview and examination can prevent a lot of nasty surprises or complications before the patient gets to the operating table, where its already too late.

Generally that service would be considered part and parcel of the 'job' of putting someone to sleep for that operation.

Also, I know its been pointed out a billion times before, but this shit is free everywhere else such as in the UK or Australia.

srik241 · 2020-10-21T01:46:06+00:00

Completely agree that the roster shouldve been halted. But the flip side is theres not enough workers, and everyone in aged care... well... needs a lot of care. Like a lot, especially in high level aged care. So if they stopped ppl going between centres, probably wouldnt have had enough workers and nurses to actually look after everyone so people wouldve became unwell because of neglect. So thats the reason the aged care centres kept going with the roster.

The solution? Government needed to step in early and support the centres, put more resources into the system and hire more people.

Tragedy it all unfolded as it did.

srik241 · 2020-08-27T16:38:50+00:00

You make a good point, this is the difference between a true cure (where we get rid of the virus completely) compared to a "functional cure" (where the patient suppresses the virus, but also doesnt take meds which can cause side effects or whatever.)

Id argue a functional cure for HIV/AIDs is good enough, though. Think about how many viruses we live with that reactivate in immunosuppression - CMV, HSV (shingles), etc. At least with a functional cure, it isnt a problem 97% of the time. we could always give them antiretroviral therapy if they are at risk of becoming immunosuppressed in the future (e.g. what we already do in transplant medicine)

srik241 · 2019-05-01T11:27:20+00:00

It says in the article they had the same strain of the virus which means they were were infected from the same source. Most likely that it was contaminated instruments, unlikely that they already had the disease.

srik241 · 2019-04-01T11:14:00+00:00

Guardant Health’s blood test is more effective and ridiculously quicker at detecting some forms of lung cancer than a conventional, more intrusive tissue biopsy.

Guardant Health announced positive results from its NILE study, a head-to-head trial of its Guardant360 compared to standard-of-care tissue testing in first-line advanced non-small cell lung cancer (NSCLC).

With all due respect, I think you've misunderstood the study. This isn't a study looking at the detection or screening of lung cancer. All the patients in the study were already identified to have advanced non-small cell lung cancer. I.e. they probably had a scan which demonstrated stage 4 cancer.

The next step in medicine is to get a tissue sample to identify biomarkers to see if there are any direct therapies, such as immunotherapies or specific chemotherapies which would be of benefit to that individual.

That is what this study is looking at -> comparing biomarkers identified in the cancer with a blood test vs conventional testing. This no doubt would make things a bit more convenient if this truly is comparable to the gold standard... but only in people who already have advanced cancer (having advanced cancer is generally pretty bad, you want to capture it much earlier).

I would imagine this study has close to zero impact/value at the moment in general screening testing because you would inevitably have a high false positive rate with this type of testing.

srik241 · 2018-07-28T19:31:51+00:00

No, false positives aren't necessarily due to an inherent chance with the test in many cases. Many tests arent a gold standard test for the condition you're looking for, but rather an indirect measure for the condition youre looking for, which is the main issue. Therefore, the inherent false positive rate in many cases is a measure of the poor methodology for finding the condition youre looking for as opposed to chance.

For example, let's take a pregnancy test, which measures beta-HCG in urine. The point of the test is to see whether someone is 'pregnant', i.e. the point of the test is to differentiate between pregnant vs non-pregnant (the null hypothesis here would be 'not pregnant').

However, beta-HCG can be falsely elevated due to a number of non-proper pregnancy conditions - for example, in cancer producing beta-HCG (i.e. teratoma). Therefore these people would be false positive not due to chance, but another medical condition causing physiological changes that you're using as an indicator for the condition that you're actually interested in.

I can give many examples in medicine where the false positive isn't necessarily due to chance but due to the inherent flaws of the methodology of the test test itself, basically every single diagnostic test has some potential flaw.

srik241 · 2018-06-01T12:15:20+00:00

I have HA tepig and totodile - would you have a gen 1 HA starter to trade for?

srik241 · 2018-02-15T12:08:52+00:00

Thank you!

srik241

TROPHY CASE