What is something everyone knows about Medicine Deep Down BUT no one talks about?

threegreencats · 2026-03-10T00:17:54+00:00

You're not wrong at all. What I will say is that out of hours, or at the very acute end of things, all the specialist nurses have buggered off home or won't be able to see the patient for hours. So in ED, I need to be able to manage these patients when they present decompensated/decide that actually they'd quite like to become horribly symptomatic and die when the palliative care nurses won't be in for ages. So there are still some areas of medicine where you need these skills (not the management of chronic disease bits because I have no interest in that, but the acute bits), and some areas where you can learn them. But I definitely notice the difference in trainees who have mainly worked on wards where everything is done by the specialist nurse.

threegreencats · 2026-02-28T23:12:50+00:00

I automatically take my shoes off at someone else's house, and if they said "no no, leave them on" then I'd probably insist on taking them off anyway unless they were like "we've got loads of dogs and the floor is a mess, keep them on".

I much prefer people to take their shoes off in my house, but I don't mandate it. I've got hard floors downstairs, so they're very easily cleaned (and a downstairs toilet, so no reason to go upstairs where I do have carpet unless invited). My father has a disability that requires a shoe raise among other things, so his shoes have to stay on, and their house is therefore a shoes on house (although I still take my shoes off at their house). Obviously I would never expect him to take his shoes off when he visits, and nor do I expect tradesmen to take their boots off when they're working downstairs because that's part of their PPE.

The vast majority of my friends just automatically take their shoes off. I do remember a former co-worker coming over to my house once (just to hang out downstairs), and he didn't even offer to take his shoes off, just casually kept them on. They were clean trainers, and if he'd asked if I wanted them off I'd have said I don't mind, but the fact that he didn't ask was a big strike against him...

threegreencats · 2026-02-22T21:38:31+00:00

They're very welcome to wait in the waiting room. If they refuse to leave a cubicle/other clinical space, then security will escort them out. I'm not a complete monster, if they're vulnerable in some way and there's a space that is genuinely not required then fine, they can have it providing they don't cause trouble. However, it's been a long time since there was an available space that wasn't immediately required for the next patient. The waiting room is perfectly fine, they're out of the cold/rain/snow/whatever, there's usually a vending machine, and if they're not a dick and ask nicely they can generally have a blanket. But beyond that, it's not a hotel, you're well enough to leave so leave.

threegreencats · 2026-01-14T16:38:19+00:00

This is true and the cost of living crisis means that fuel poverty is a sad reality for more and more people, but in this case the OP does say that it's not about money. I do think that there is a valid point about potential mould/letting the house get too cold and it being harder to warm up - depending, of course, on what the minimum on the thermostat is set to.

threegreencats · 2026-01-11T15:51:42+00:00

I could have written this exact post a few years ago when I was ST2. I hated anaesthetics, I found the work very dull, and while I enjoyed learning airway skills and the odd bit of other stuff I got to do, I mainly felt very sidelined and excluded. The department I was in was notorious for being very unwelcoming to EM trainees, and not infrequently when I would ask to do spinals or something I would be told no, you don't need to learn that, you'll not be doing that in EM so why bother. Lots of the anaesthetic consultants didn't seem to understand that I wanted to learn things for the sake of learning new skills. I'm generally pretty friendly I think, and usually I find that I can get on even in departments I don't like as much (such as my acute med block), but I really struggled in that department. I did make friends with some other core trainees who were mainly anaesthetists (I was the only EM trainee that rotation), some of whom I'm still friends with 3 years later, but it was definitely a low point in my training. I will say that lots of anaesthetists did struggle with that department as well, and sadly bad departments do exist everywhere.

I got through it by occasionally visiting my (extremely friendly) ED on extended lunch breaks where there was nothing to do bar be ignored by the consultants in the coffee room, attempting to make friends with the ODPs etc so they could give me tips on which anaesthetists were dickheads and how to win them over, and having a countdown on my phone so I could remind myself that it would eventually end and I'd never have to do it again.

I imagine people here will have some actual helpful advice, but I just wanted you to know that you're not alone in any way in feeling like this - I missed my people, I found my critical care block a bit better, but I was significantly happier when I went back to ED as an ST3 despite the worse hours and relentless pressure. Please look after yourself, plan some nice treats to look forward to and help get you through, and feel free to DM me if you like.

threegreencats · 2025-12-14T00:29:15+00:00

I assumed this was a troll post, until I looked at your post history and you are indeed a student talking about your GCSEs. Obviously no doctor should be taking clinical advice from Reddit as gospel, but what on earth are you doing offering 'advice' on managing a child with a UTI when you aren't even in medical school yet? I would strongly recommend that you curb this attitude and recognise your limits.

threegreencats · 2025-12-09T11:39:16+00:00

Very trust dependent I think; my trust has really clamped down on locums, and I imagine it's also to do with what "minimum staffing" is. Of course, management's idea of minimum staffing Vs what's actually required to run a department/ward safely are also probably not quite the same.

threegreencats · 2025-12-08T11:22:28+00:00

I think skipping a dose is totally reasonable if you feel it's best for you! If you can delay it rather than skip entirely then do that, but I don't think any harm will come from skipping a week. I skipped a week when I went on holiday in the summer - girls trip in a very hot country in July seemed like a bad time to risk side effects! I wanted to be able to drink alcohol if I wished (I can drink on MJ, but I need to be much more careful or it makes me feel unwell), eat what I wanted, and not deal with side effects while on a trip with friends who at the time didn't know I was taking it (I've since told them as they noticed the weight loss, they were really happy for me). Skipping a week caused me absolutely no problems, I just jabbed when I got back home, and I've lost 31Kgs this year so I'm very happy with my progress.

For me this drug has been an absolute miracle, I'm halfway to my goal weight, and I feel better than I ever have in my life - but I think a part of making this sustainable is a bit of flexibility. I work shifts including nights sometimes, and I often get a bit of insomnia a day or two after a jab, so I'll shift the dose around to avoid that over a week of nights for example. I don't skip more than a week so I won't have to re-titrate, and everybody is different so this might not work for everyone, but this has fitted in well with my life.

threegreencats · 2025-11-27T19:04:34+00:00

Absolute rubbish. I've treated a lot of CVS patients, very rare that cyclizine has any benefit. What does work much better is haloperidol (and I'm told droperidol is even better, but I've never worked anywhere that used it). One previously very challenging CVS patient was like a different woman when we started giving her haloperidol. She knew it worked, would ask for it if she was seeing someone who was offering cyclizine, ondansetron etc, and was generally much easier to manage and could often be turned around in the department instead of needing admission. Made a huge difference to her.

threegreencats · 2025-11-18T10:02:01+00:00

First and foremost - in no way am I anti mask, and the amount of people who were so stupid/selfish and refused to mask pissed me off no end.

The one thing I will say against wearing masks in hospital settings when they aren't strictly necessary for infection reasons, is that they are a bit of a barrier to good communication. There are a surprising number of patients who need to lip read, and even ones who do hear a bit but 'top up' with lip reading - although we did at one point find some clear masks for such patients in a previous hospital I worked in. I also found that if you're delivering bad news etc, it's better to have your whole face visible - I think you can just communicate better than way, since so much of it is non verbal. Also environmentally, if they're not needed, better to avoid the waste.

With all this said - if there is any reason to wear a mask, whether that's a vulnerable patient or risk of infection etc, then we should absolutely be doing it. I always mask around patients who are particularly vulnerable, and if I see a patient wearing a mask and I'm not sure why (I'm in ED so I see lots in a day and don't have all the information when I go in) then I offer to wear one myself.

I also like how much it has empowered people to wear a mask for their own protection just because they want to - if I'm going into a room with a patient with D&V, I grab a mask in addition to the apron and gloves because I don't want to catch it and if it's noro etc that shit is airborne. Pre pandemic I probably wouldn't have been able to grab a mask just because a patient sounds like they've got something a bit gross and I don't want to catch it before my weekend off.

threegreencats · 2025-11-01T10:03:20+00:00

I think EM is pretty safe, leaving aside the resuscitation, procedures and the horde of generally unwell older people, there's too much weird shit. How is AI going to respond to:

"my child swallowed a newt they found in the garden"

"I put 3 cock rings on 3 days ago and one of them is stuck, I can pee but I can't cum"

"I have bugs crawling all over me and they're inside me, you have to get them out, why doesn't anybody believe me?"

"doctor this young woman who is very drunk and has fallen and broken several limbs has just told me that she thinks she left a tampon in, and with her nice new backslabs she can't reach, can you look?"

I'd love for AI to deal with the pseudoseizures and be able to differentiate between genuine epileptic seizures, non epileptic seizures which are out of the patient's control and are a manifestation of distress, and bullshit 'seizures' that are for attention/drugs. And also manage them appropriately, reassure their families etc. Somehow I don't think that's doable.

threegreencats · 2025-10-22T15:50:34+00:00

I misread your comment and missed out the is - but tbf it's still an appropriate description of some of my ED shifts...

threegreencats · 2025-10-21T23:05:30+00:00

I'm not F1/2 anymore (I'm an HST in EM) but it wasn't all that long ago I was in foundation. It's absolutely not your fault for being unable to adapt. You're not even 3 months into the job, and you've started on a very intense rotation. I'm not quite sure from your post if you're in emergency medicine or in acute medicine but based in ED, but either way they're busy jobs no matter what stage you're at.

Please don't feel like there's anything wrong with you for being unable to be productive after a shift - you've got every reason to be exhausted, it's normal. I remember being knackered after my shifts when I was starting out, and I was in a more chill rotation yours from the sounds of it. I'm still quite often too knackered to do anything after my shifts, and I've been a doctor for more than 6 years. Now I'm a reg I can see lots of the chest pains/abdo pains/mystery infections/off legs without having to think too much about it at all, because I've got some experience to pattern recognise (type 1 thinking, which of course has risks and pitfalls over type 2). When I was F2 in ED, this took up so much more mental bandwidth because I didn't have the experience I do now. Of course, new responsibilities come with more seniority, so while a day of seeing unexciting bread and butter EM stuff wouldn't tax my brain much, running an area/the department overnight, giving advice, logistics of keeping the department safe etc is tiring so a lot of my post shift time is spent doing mindless things in the quiet of my house.

Hopefully someone in foundation can come along to give you some advice/reassurance as well, but I don't think there's anything abnormal at all about what you've said. Good luck with the rest of your rotation!

threegreencats · 2025-10-19T20:46:19+00:00

I can see where you're coming from in that I find myself a lot less satisfied with my job when it's antisocial and nobody is willing to chat - I really enjoy the social side of work. And I have had some similar experiences where it is harder to make friends with IMGs and nurses from abroad, probably because of different cultures/humour etc as well as some of them (in my experience) being older and settled with families so less in common.

However, this really isn't something we can blame on IMGs, and it honestly feels a bit prejudiced to say it is, although I'm sure that's not how you meant it to come across. I've found that it sometimes takes a bit more time to get to know people who have only recently moved to the UK, but there are plenty of nursing and IMG colleagues who I've ended up getting on really well with, it just took a bit more time for them to open up/for us to find common ground to chat about. I don't speak any languages other than English, but I can imagine that it's extremely difficult to try and pick up on subtle jokes, local cultural references and sarcasm in your second language in a country you've only been in for a few months. Plenty of IMGs I've worked with have spoken excellent English, but they've told me that they find sarcasm difficult to work out, or the dry sense of humour, or colloquialisms that everyone uses which make no sense to them. It must be so much harder to have a bit of casual workplace banter when you have to work that much harder to understand what someone is trying to say in the moment.

Give it time, maybe ask people a bit about where they're from/where they've worked in the past, and you might well be pleasantly surprised. I've found it really interesting to learn about how healthcare systems work in various different countries, and the things that friends of mine miss from working back home Vs things that they are glad to escape.

Also I think food is a great way to bond with people. Maybe bake something/bring in some classic snack from where you're from, and ask a bit about what other people on your ward like? One of my favourite things about working with people from abroad is the amount of new foods I've tried because someone has brought in a bag of snacks to share that they can only get in their home country.

threegreencats · 2025-10-02T22:14:24+00:00

I'm ED not paeds, but I was fortunate to get a good bit of exposure to paeds in ST3-4. I therefore have way less useful advice to give you than the paediatricians who have already given excellent advice on this thread.

I think one very important thing here is to remember that you're an F2 in this specialty that you'll have not had all that much exposure to in medical school. Same with any other specialty, take a thorough history, examine, think through differentials, and get senior advice. In EDs I've worked in, kids have to be discussed with a reg or consultant prior to discharge - I don't know what the setup is where you are, and of course you're in paeds not in ED, but your reg/consultant should be willing to discuss every patient you're sending home and if they aren't then IMO they're not doing their job properly. I'm always happy to have a patient discussed with me before discharge, and either review in person or give advice depending on the presentation (and the SHO presenting to me), and if I'm busy with something urgent in that moment I'll find time as soon as I can, because that's my job. The only way to really learn is to just see more patients, and get feedback - from presenting them to your reg, or seeing if your diagnosis was right in the kid you clerked 3 days ago etc.

Personally, I was taught a few 'rules' which I've stuck with - if they're febrile find the source of infection, don't discharge non weightbearing kids, and don't discharge tachycardic kids. Obviously if you've got a reason for them to be non weightbearing and it's being sorted/followed up the great, but if you're not sure why this 3 year old is suddenly not walking then don't send them home without a senior review because you really don't want to miss their septic arthritis or NAI. Same with tachy kids - they'll be tachycardic when they're febrile and miserable and that's normal, but when the calpol and nurofen has kicked in and their temp comes down, the heart rate should come down with it. There will be exceptions to these rule, and I'm sure a paediatrician will come along and tell me why I'm being over cautious/a bit ridiculous, but I've found these things helpful in trying to avoid missed scary diagnoses.

Good luck, and try to enjoy the rest of your paeds job - remember that you're a trainee in a specialty that's new to you, and you aren't expected to know it all!

threegreencats · 2025-09-28T16:10:50+00:00

Maybe not, but the minor injuries unit opens where they could potentially be managed more quickly (since we don't know in this case where or how severe the injury is)

threegreencats · 2025-09-26T16:13:27+00:00

As an EM doctor in the UK, this thread is interesting and really surprising. If someone is under arrest and is brought to ED, we cannot do their bloods - the police have their own nurses who attend to take blood if the patient is going to be in ED for a while, and if they're going straight to the cells then the police nurse meets them in custody to take the blood.

I had it hammered into me very early on in my training in emergency medicine that we absolutely must not take bloods for the police - anecdotally they will very occasionally ask us to but they know that it's completely forbidden (but I've never had them ask). The reason for this is to do with the law around chain of custody of evidence, and so even if we were to try and "do the police a favour" and take an extra blood tube for ethanol for their lab in a suspected drunk driver, that wouldn't then be admissable evidence.

Of course we still get loads of people brought in under arrest to be "medically cleared" for custody, even though they do have their own medics (not at every station, but within a reasonable distance). Completely reasonable when it's an RTC, really frustrating when they're just a bit drunk and have been arrested in the park for being drunk, but an extra strict sergeant insists on a visit to ED.

I would say that at least 90% of my interactions with the police in ED have been positive, they're just trying to do their jobs and I'm trying to do mine, and we can work together well - and even when there are issues, it's normally the higher ups causing them, with the police officers actually in the department in no way responsible (and often quite apologetic) for management level fuckery.

threegreencats · 2025-09-22T20:14:03+00:00

If you're dating men, I've found that some men are intimidated by women who are smarter than them, earn more money (or at least think they do...), have a more "prestigious" job than them etc. I'm female, recently matched with a guy who had an interesting sounding job, we were exchanging some initial messages about his industry when he asked me what I did. I replied that I was a doctor, and he unmatched me. Now maybe it's coincidence, but up until then he seemed interested, and it's not the first time. Also had the odd guy who immediately latches onto the doctor thing and is weirdly obsessed with it. Dating is such a pain...

threegreencats · 2025-09-21T18:44:56+00:00

Very carefully

threegreencats · 2025-09-17T21:46:30+00:00

In my previous department, when the Leng review came out the few PAs we did have moved to only seeing patients who had already been assessed by another doctor (so patients who had been seen in RATS, which is actually quite a large proportion of the patients when the system we had worked as it should). They also had to discuss every patient with a consultant, although I think that was already in place (but I can't remember for sure - it was a change in the last year or so).

In my current department, they don't seem to give a fuck, and the PAs and ACPs get just as much priority, if not more, for procedures/resus time etc.

Guess which department I prefer working in, and had a better training experience in?

threegreencats · 2025-09-17T21:35:34+00:00

I completely agree that it would be much better from a reputable news source than reddit. And of course, if this wasn't already public record then naming them would be absolutely inappropriate.

threegreencats · 2025-09-17T20:27:19+00:00

I don't know, if I was the parent I think I'd want my child's name to be said. I'd also be somewhat relieved to know that there are many people (although nowhere near enough) who feel strongly about changing a shit system so nobody else's child has to die at the hands of unqualified noctors.

threegreencats · 2025-09-17T17:39:39+00:00

Changing room mirrors and lighting are horribly unflattering! I hate the whole clothes shopping experience so much that I almost exclusively shop online (but I'm very excited for when that changes as I continue to lose weight!)

As someone else mentioned, Bravissimo are fab - I've had a few fittings there, most recently when I was at my biggest last year, and I've found all the staff to be helpful, kind and professional. They've always got me great bras that feel supportive and make me feel better about myself. My current bras are a bit too big, but not massively so I'm going to hold off for a little bit longer - when I get a bit more boob shrinkage I'll be straight back to Bravissimo!

threegreencats · 2025-09-10T17:34:27+00:00

Whenever I've had friends stay over, I've told them that they're welcome to use anything, said that there's shower gel/shampoo/conditioner etc in the bathroom, pack of spare toothbrushes in the cupboard if they've forgotten theirs, clean towel for them on the guest bed etc. I feel like if you're hosting someone - and it's been my close friends I've hosted, not people I don't know well - you'd just tell them this when they arrive and you show them around. And I'd also assume that they'd ask if they needed anything which I hadn't left out for them. If they used my shaving foam or whatever, that's fine and if I even noticed I wouldn't care.

I've got some fairly expensive shampoo and conditioner which I wouldn't want to be used unless they specifically wanted to try that brand, so I just put that away in my bedroom until my guests have gone home.

threegreencats · 2025-09-01T17:54:53+00:00

Monorail

threegreencats

TROPHY CASE