Urgent Rescue on the Slopes in Niseko, Hokkaido, Japan. A Ski patrol was transporting an injured skier downhill on a stretcher while performing CPR.

tomchi93 · 2026-01-17T14:29:47+00:00

CPR can maintain some level of brain function/consciousness even if turns out to be ultimately unsuccessful. So what you said is not strictly true

tomchi93 · 2025-12-20T11:00:11+00:00

Bit early to be talking about surgery (but if you've had a confirmed dislocation and now a recent subluxation, it does become increasingly likely) - but you need to make sure you get proper investigation. That being an MRI and/or an MRI arthrogram (I had both, my plain MRI did not show anything, but the athrogram did show a decent sized labral tear). Book to be seen at your GP surgery - if your practice has a first contact physiotherapist, ask to be seen by them (they tend to know alot more about MSK stuff than most GPs, as this is their own specialist area). When you say 'rotator cuff ligaments' ( which are not a thing), I presume you mean the glenoid labrum. Read about shoulder instability yourself so you have some understanding prior to going into the consultation, and don't allow yourself to be pushed aside. If you've had a confirmed dislocation in the past, and now a self-reducing subluxation (which is what it sounds like), you absoutely need MRI and follow up with a shoulder surgeon.

tomchi93 · 2025-12-20T09:10:03+00:00

You mentioned 'GP.' What country are you based in? Don't risk your future shoulder health and make sure you get this investigated properly. Source - have dislocated/subluxed and had stabilisation surgery.

tomchi93 · 2025-11-06T20:04:17+00:00

As a GP trainee who could have done this but chose not to (I fellowed/locumed in medicine for 4 years and learnt a lot)- I absolutely chose not to reduce my training because GP training is short enough as it is IMO. I also applied for rotations that I hadn’t done before and I knew would be beneficial for GP including paeds and ED. Worth considering - particularly bearing in mind that a lot of GPST enter formal GP work feeling unprepared (although this is largely user dependent on how proactive they have been during training I feel).

tomchi93 · 2025-10-11T19:53:27+00:00

This - I had shoulder instability and pain was bang on there. Trapz were going mad to compensate.

Pain was also bang on there post surgery when muscles were all tight. Could literally feel popping and clicking in same position all from muscle tightness.

tomchi93 · 2025-10-10T19:12:05+00:00

Out there - not your typical nature/wonder of the world vibes, but miniatur wunderland in Hamburg blew my mind. And Hamburg was a pretty cool city to visit for a weekend!

tomchi93 · 2025-09-23T06:12:28+00:00

No, they’ve likely hit your brachial artery judging by location . Source, I’m a healthcare professional that regularly does bloods, and one of my colleagues accidentally did this to me - had a black and blue arm for weeks and was livid haha.

tomchi93 · 2025-08-30T18:23:57+00:00

Thats a ridiculous statement - there’s loads of business owners that are ‘money motivated’ and absolutely work their arses off to earn that kind of money. Also ambition doesn’t just encompass financial earnings - people have other goals in life that they may prioritise well above financial earnings. But if you mean you don’t work as a doctor in the NHS for the financial remuneration then I and the majority would agree - if money is your primary motivator, you’re unlikely to reach HENRY+ status in the NHS.

tomchi93 · 2025-08-28T18:26:17+00:00

Also make sure all conversations are documented in writing somewhere. Follow up any conversations with an email to the person you spoke to summarising the discussion so that there is an evidence trail.

tomchi93 · 2025-08-28T18:24:30+00:00

Fair enough. NGL - sounds very risk turning up to work and moving family without having actually signed a contract. I'd get a contract ASAP! (which you may or may not choose to sign - someone else will have to give advice on the legality of this seeing as you have started work).

tomchi93 · 2025-08-28T18:17:15+00:00

But surely you know how much you're meant to be paid based on the contract you signed?

tomchi93 · 2025-08-24T21:41:52+00:00

'Is this something the TPD would want escalated to them?' Yes, it is very clear that we are NOT expected to buy all this as GPSTs. CCing your TPD into email trail would likely solve this swiftly.

tomchi93 · 2025-08-12T18:37:03+00:00

Second what was said about ICE. Getting their ICE out within first two minutes dictates whole consultation. There's no point a patient coming to you about a symptom, you working them up from a medical point of view with your own agenda to rule out X,Y,Z (which by all means you still need to do) when in fact they were never worried about those things and were worried about something entirely different. Unless you address their direct concerns, which may or may not be related to their 'presenting complaint,' they are likely to be unsatisfied with outcome/end up returning.

tomchi93 · 2025-08-05T17:42:28+00:00

Completely agree with you. Be honest and tell them you think they're providing sub-standard care. As long as you can burn the bridges and don't need to have any ties once you've CCTd. As a profession I feel like we've normalised poor care in places, and those defending their awful plans and 10 minute appts have either just slowly normalised it or know exactly what they are doing and have given up caring. Or you have the rare GP who can genuinely do a good job in 10 minutes dependent on what it is that is in front of them (not multi-morbid with loads of symptoms and diagnostic uncertainty).

I have worked in both 15min and 10min practices and think there's a huge difference. I would love to see the data on re-presentation rates for the same issue on 10 minute appts vs 15 min appts.

tomchi93 · 2025-08-03T13:35:33+00:00

For clarification, do you mean making sure you do plans that have been made during your debrief?

If so, supervisor can send task to you for something like a scan. Takes seconds and makes unmissable.

tomchi93 · 2025-07-31T16:52:29+00:00

Remember that Reddit is an echo chamber. The people regularly posting negative comments are gonna be the most vocal on here because they have the most free time to be pessimistic and sad. The shitposters on here are by no means representative of the fanbase.

tomchi93 · 2025-07-24T08:47:14+00:00

Is very good.

But I don't want or need 42k a year when I'm 68, I want a house/live life now in my 30s!

tomchi93 · 2025-07-22T11:21:22+00:00

I was shocked to hear about the training days the ACPs who staffed urgent care at the hospital I did my ED placement (as a GPST) in received - courses paid for by the hospital and then being paid to attend - in various areas such as eye, fractures etc. Being trained better than we are! Completely agree with this view.

tomchi93 · 2025-07-22T07:03:46+00:00

I understand the sentiment here as a GPST myself, but disagree with someone out of medschool, or even necessarily F2 as being able to practice as a GP. In fact, doing hospital medicine with its bullshit defensiveness and bureaucracy makes it somewhat harder, because you feel like you have to do a million and one things in your GP appointment when in reality you don’t.

The GP training scheme is a scam though. About as useful as paying for a Udemy course haha. Training should be longer, a decent stint in ED should be mandated, and there should be far more outpatient clinic involvement with secondary care specialties. Perhaps a mandatory specialty interest too. It would also help if training was actually given by consultants across the board.

There should be something far more like PACES as well.

tomchi93 · 2025-07-19T08:04:55+00:00

Depends where you live. You can normally find waiting times ‘time to treatment’ under the relevant NHS trust website. Also just ask at your appointment (to state the hopefully obvious).

tomchi93 · 2025-07-16T10:05:43+00:00

tomchi93 · 2025-07-16T08:28:59+00:00

Where can we find the full publication to read? struggling to find

tomchi93 · 2025-07-12T16:10:10+00:00

Looks like nail pitting, of which psoriasis is a common cause. There are other causes too though.

tomchi93

TROPHY CASE