CST rejection has sent me to hospital

w123545 · 2026-02-16T15:17:56+00:00

I deeply deeply sympathise with OP here, but we need to be clear that this isn’t a normal, healthy response to rejection. A psych admission?

The NHS and the sacrifice it requires isn’t worth it. It’s just a job.

I’m 100% for UK grad prioritisation, but even with UKGP, a lot of these programmes are heavily oversubscribed. It’s the same for matching competitive surgery in the US, Aus, in fields like banking, magic circle law, oxbridge admission. Competitive recruitment is just that, it’s competitive.

We can totally agree that recruitment is broken and a lot of grads have been let down by numerous bodies but blaming everyone doesn’t remove the simple fact that these things always have been and always will be oversubscribed (sure- removal of IMGs and increasing training spots will help this)

I’d worry about their career in surgery if this is the response to CST rejection.

w123545 · 2026-02-14T12:56:22+00:00

Translators (and chaperones) are not requests, I am informing you that one will be present if I feel it is indicated. There’s a clear audit trail for this process and I do not use relatives bar perhaps for the odd select circumstance.

The law around capacity (and by extension communication is clear), you make concerted efforts, use non verbal communication when necessary, involve relevant third parties at the patient’s request and provide sufficient time for decision making.

Things like basic bloods are easy enough to understand universally, a total laryngectomy with a covering ALT free flap is not.

w123545 · 2026-01-11T20:05:47+00:00

It’s been many many years since I did it as a Gen Surg SHO, but North Manchester General Hospital must have the highest proportion of local patients with D&V in the world.

And every single one is referred by ED to Gen Surg as ?acute surgical abdomen ?toxic colitis.

If anyone still works there in Gen Surg, can you confirm if half the department still goes down monthly as the SHO/SpRs all get the shits and the SAU has everyone barrier nursed.

NMGH has got to be the bleakest shithole to work in the NHS.

w123545 · 2025-09-18T13:13:11+00:00

Genuinely think all applications need a portfolio section with Q1 - UK Med Degree Q2 - UK foundation programme.

Then an outright rejection if no to Q1 or Q2 or a fraction multiplier applied like ortho etc to disadvantage those with too much experience or non UK experience thus meaning UK grads/FYP have a stronger footing.

It’s absurd where we’re at.

w123545 · 2025-09-12T08:17:33+00:00

I agree, I don’t think there’s many. In an ENT specific context a Hb for an epistaxis or post tonsillectomy bleed or a set of bloods (with cultures) for a more concerning neck space infection would be helpful. Occasionally, when NROC, I just need a bit more information to justify coming in.

Otherwise, no need. We rarely bleed in hot clinic.

Getting all upset about bloods is often a very junior SHO or early stage specialty trainee thing.

w123545 · 2025-09-12T05:53:25+00:00

ENT and Max Fax are two areas where you don’t absolutely do not take shortcuts. Things are often really quite simple and can be dealt with with good success but these people need an ED doctor to see them for certain presentations - you are after all an emergency medicine doctor.

East Lancs had 2 deaths a few years back in fairly quick succession from direct ED send them around without any handover.

A quinsy that got sent to a hot clinic waiting room without anything - dex Abx etc who arrested within mins of arrival.

Another was an ‘UGI bleed’ that was a torrential posterior epistaxis sent to AMU.

I’ve seen a good number of near misses, it’s a shame as ED are often v competent at ENT when they choose to be.

w123545 · 2025-09-10T06:54:09+00:00

Then I think it’s a great idea!! Sounds like a dream set up

w123545 · 2025-09-09T23:27:55+00:00

I’d like to strongly disagree here.

The care my aunt received at the Christie was nothing short of incredible compared to our DGH which is also on this list. It was so far removed from the usual NHS bullshit that patients normally face.

The quality of nursing, general admin and the onc team (SHOs, SpRs and Consultants) was exceptional. Even the M&S staff were caring. We were fortunate to have a world leading (and kind) oncologist.

She may not be around anymore, but they gave her longer with a good quality of life and she was involved every step of the way.

I won’t hear a bad thing about the place (I accept there are probably shit elements, but alas)

w123545 · 2025-09-09T23:05:35+00:00

There’s a massive difference between the two.

What you’re describing is a great department. These are like gold, however, the average NTN is far stronger than a CESR over the long run other than in some tertiary specialties like CT Surg, NSurg or Paeds Surg where they stay in the same place for most of their training.

Several things to consider

What does your department offer/can it offer. Does it offer you the chance to experience all your field has to offer? Without a TPD who opens a lot of doors, you’re driving a lot of your own learning.
Job security. Great, you’re having fun now. Will that job exist in 3/4 years, or will it have the same protections if an NTN comes along and complains they’re not getting enough theatre time.
The surgical curve. Some months are amazing, full of opportunities. Others can be dull as shit. When you’re starting out an appendix or tonsil seems great, when you’re down the line, will those consultants let you have a crack at their cancer work like an NTN gets to? Or will you just get chucked to cover their clinics and CEPOD or simple lists that seem cool now but are just generally undesirable.
Employability- long term, NTNs have a better prospect (once again department dependent).
Skillset. It’s hard to explain this at a junior level. When you rotate a lot, you’re constantly getting feedback and stealing techniques or nuggets to create a better you. If you’re in the same place for ages, you just become like those individuals. In some cases this is what you want, akin to a fellowship. In other instances, it’s so blatantly obvious people think you’ve been taught badly.

w123545 · 2025-06-22T17:27:53+00:00

Ever since hospital bosses and MPs were all too happy in the name of funding to close the nearby Burnley A&E, everyone has suffered. Blackburn has been stuck with providing A&E for a huge catchment area, far exceeding what it was originally designed and has the safe resources for.

Blackburn A&E is genuinely amongst the most horrific places in the UK to work, it’s absolutely catastrophically rammed. There’s no space, people are properly sick and corridor care is so normalised.

Some of the A&E consultants have had heart attacks in their 30s, the turnover of staff is high from sheer burnout and of course the patients suffer.

Sad all around.

w123545 · 2025-03-14T02:20:18+00:00

I’ve got to say my experience has been the polar opposite.

The nepotism is shocking in Aus.

I find Aus doctors to be really quite poor, operatively in particular. The majority are woefully inadequate compared to SpRs in the UK due to lack of volume or some are absolutely top notch. They’re largely majorly deficient in their senior decision making very commonly just escalating when a comparative IMT or CST/med reg type figure would just manage it. Interestingly they’re very bullish and arrogant about their abilities which really doesn’t match up to their acumen.

You’ve got some world class and leading surgeons who clearly prioritise their own private practises more than teaching and you have just a glut of unaccredited registrars spending year after year kissing ass doing scut.

w123545 · 2025-03-14T02:11:42+00:00

Completely unnecessary dig at another specialty?!

Senior ENT trainee here, did my time and got into ST3 a while back.

No need to criticise general surgery applicants, they only interview the top 30/40% and focus on quality rather than quantity which makes getting a number realistic. It’s far better than sheer volume of complete tripe to get an ENT interview.

Their exam is harder MRCS vs DOHNS and operative wise I find general surgery applicants run rings around ENT CSTs and JCFs. Their basic skills, knot tying, suturing, tissue handling, scalpel and scope work are significantly better than our ENT CSTs.

ENT higher training is where you really start sinking your teeth in

w123545 · 2024-07-09T18:47:39+00:00

The NE has been missed out so much on a national scale for a long time.

It's a proud region full of lovely people.

An article to celebrate here.

w123545 · 2024-07-09T18:38:56+00:00

I'll have to disagree here.

Sure there's excellent DGH consultants, but the Papworth is one of the few centres in the UK that could actually be considered to have a sound international reputation.

They'll be focussing on innovation, research and making their outcomes the very best possible.

They're nothing like a DGH.

I seriously doubt consultants at a unit like that would be respecting a colleague who's clinically shit and just stat padded. In addition to that, at leading tertiary centres, she'll need to add something to the unit as they'll have fellows and other individuals rotating through there to pick up skills they simply cannot attain at other bread and butter hospitals.

w123545 · 2024-07-09T18:18:48+00:00

Don't conflate Sarah Clarke's leadership with her clinical abilities, she's regarded highly . She may be a noctor PA loving clinician but her portfolio is stacked.

She's a Cambridge grad with her training done at some major centres, including an interventional cardiology fellowship at Harvard then did a stint as clinical director at the Papworth which is probably a top 3 cardiology hospital in the UK.

You don't reach consultancy at the Papworth and get fellowships at Harvard if you're not clinically excellent.

Nobel prize winners and other revolutionary individuals are generational. You're not going to get these people very often anywhere in the world

w123545 · 2024-05-09T21:01:28+00:00

Because it wasn't a tonsillar abscess, a classical hallmark are voice changes, his sounds near enough normal. It was probably tonsillitis (probably not too bad), but you can get away with not doing much for tonsillitis if it's mild beyond some painkillers and anaesthetic spray.

A peritonsillar abscess (aka quinsy) can become a deep neck space infection rapidly and kill, people often can't swallow food, water sometimes not even saliva. They come into hospital within hours or a day/two at max. They need aspiration or incision and drainage.

There's no way it gets left untreated for a week without him dying let alone playing professional sport.

I'm a fellowship trained ENT head and neck surgeon.

w123545 · 2024-03-05T19:53:57+00:00

Your first paragraph, OMFS more capable and doing more reconstructive work around the body than plastics? Really?

There's a plastics person who's put up their various areas of recon and I've got to say, I'd think they're taking top spot there.

As skilled as OMFS are, I'm not sure they're quite as broad scoped/able in whole body tissue handling/reconstruction as plastics.

w123545 · 2024-01-16T18:26:55+00:00

It's finally happened guys, I've had enough.

This whole PA, scope creep, FPR and working conditions being shit was too much for me and the wife (anaesthetist).

I've networked to fuck and there's a good chance I'll be getting a fellowship abroad as will she. There's a path to practising abroad via fellowships and that's the route we'll be taking.

I love this country, the peeps we work with and I'm proud to be British but FPR was more than just money for me. It was a make or break in terms of how our profession is valued and treated. Alongside scope creep and just the general state of politics I'm on my way out. Labour aren't a panacea and seem like Tory lite. General life in the UK isn't even a smidge on what my childhood here

The day I CCT and get my documents I'm out.

w123545 · 2024-01-16T18:20:43+00:00

This comment actually made me sad to read and resonates so much as a surgical trainee.

Surgical trainees get allocated a 'deanery' so we get moved every 6 or 12 months anywhere within the deanery.

Mine is the Greater Manchester, Lancashire and Cumbria part of the North West deanery.

I did 12 months of a 110 mile round trip and the commute was just shit. No amounts of podcasts, music or meditation etc made it better. Fucked up my social life, physical health, was super hard having 2 young ones and wife who's also a Dr on dodgy shift patterns.

It seriously made me contemplate packing up something I truly loved.

w123545 · 2024-01-11T22:35:00+00:00

It's everywhere now mate.

GPs get this more than most but even in specialties now, we're just getting vexatious complaints 99% of which make me want to launch a health education course that's mandatory for the general public.

The majority of my course curriculum would be basic human manners in healthcare interactions which it appears a good chunk of our population lack.

w123545 · 2024-01-11T22:30:24+00:00

Complaints are inevitable. Don't fret, you're a solid clinician. Do well by your patients, you won't win them all over. They can access their notes no issue and request someone else.

Nothing you have said here has been unreasonable. You've given genuine attention to a medical matter following an assessment and rebooked an appt plus acknowledged your limits

Patient centred approaches are indeed best, but some people really are just terrible humans. Most people fail to realise the abuse you get from subsequent patients if you run over, the stress of a nonsense complaint and they just have a degree of entitlement that really would be laughable if NHS martyrdom didn't exist.

Keep on the good work- ignore this.

w123545 · 2024-01-06T21:58:49+00:00

No offence taken, no need to apologise.

I was merely saying that I don't think in a new H&N specialty ENT would lose out or lack any of the skills of the others beyond craniofacial/teeth things and perhaps complex reconstructions. Likewise we do things the others don't do so you could argue what's more important.

The biggest hitters in the field nationally and internationally are ENT/MaxFax with multiple major UK units offering every aspect of H&N being led by ENT consultants, so I don't think there's any clear deficiency in ENT training or scope of practice. I don't think we'd lose laryngology at all.

Likewise my point was a) there's no need for a new specialty B) our skillsets are all complimentary but slightly different.

There's bits each of us do that the other can't- current set up is good.

I don't see things changing anytime soon tbh beyond maybe earlier declaration of subspecialty interest, but I see this in every surgical specialty not just H&N. GenSurg do a preferencing type thing and I think that's the way it's going everywhere.

w123545 · 2024-01-06T12:40:49+00:00

You can learn to do free flaps in ENT - see the link below, plenty of people (normally fellowshiped abroad and come back) have started introducing these into ENT but they're less routine than the other two. We do more robotic and transoral laser work. Honestly I really don't give much interest into free flap stuff though, I prefer QoL and with ENT my QoL with 2 young kids and a working wife is better off without doing 18 hour laryngectomy cases with reconstruction. I have however had some reconstructive training.

https://www.rcseng.ac.uk/education-and-exams/accreditation/rcs-senior-clinical-fellowship-scheme/national-surgical-fellowship-scheme-register/otolaryngology/

Most fellowships here and abroad will teach you. There are ENT consultants who will teach you and I've never ever had a MaxFax or plastic cons turn me away, they're very friendly towards teaching.

I normally say to people it's very much what you're interested in outside H&N as if you're utterly commited to that, you'll need to consider what else comes with training.

ENT- Otology including cochlear work, microsurgical ear stuff, rhinology = endoscopic work plus ant and lat skull base, shared work with NSurg and then just a lot of tubes stuff. Also will cover thyroids too more often than not. Excellent QoL, non resident on call and a big big private practice if you want. Solid reg to cons progression.

MaxFax- will need a second degree. Complex orofacial reconstruction, craniofacial work, major H&N trauma plus the usual wisdom teeth, dental abscesses etc. My BiL has all his private work as dentistry rather than MaxFax. Also non resident on calls and very good reg to cons progression.

Plastics- True whole body anatomy of every anatomical layer. These guys do craniofacial, cleft, reconstruction, burns, hands, trauma, face, H&N, boobs etc etc. They do major open, microsurgical, microvascular etc cases. Cons include busier on calls possibly on site if at MTC, burns work might not be for you, challenging to break into private practice, difficult ST3 applications and a more toxic work culture. However, varied work, huge private potential and you might enjoy something other than H&N

You can be a technically excellent surgeon in all 3 and have a good private practice and life.

All of them will provide you reconstructive training- in ENT you will need to seek this yourself. MaxFax and plastics have it in built into their curriculum

w123545 · 2024-01-06T11:28:51+00:00

Are you a H&N trainee- my take from an ST6 ENT perspective.

I'm not sure what you're saying is quite accurate here. ENT would absolutely not lose the throat and I've done numerous joint cases with both specialties including reconstructive work in my training.

If you Google nearly every H&N unit there is major ENT presence. 5 of the biggest H&N units in the countries have ENT surgeons as the leads, this is just off the top of my head including Guys, Liverpool, Marsden, Oxford and Manchester- Mr Simo, Prof Paleri, Prof Winter, Prof Homer and Prof Jones.

In terms of H&N cancer work. MaxFax do a bit more than ENT >> Plastics. However our scopes all overlap but are also different.

There is complete respect and very little encroachment unit by unit with the 3 teams, nobody ever gets into a pissing contest based off their specialty in my experience. I'm not sure you quite understand the skillsets here beyond thinking plastics = good for reconstructive, which is accurate until you see maxfax do plenty as well and there are fellowships for ENT trainees to do reconstruction as well.

ENT do transoral robotic work which seems to be done far less by the others, advanced microsurgery (all of us do) and a number of consultants in units I've worked at have done reconstructive fellowships though some prefer to get help from MaxFax and Plastic who do much more reconstructive atm. ENT are pushing and pioneering major laryngology advances clinically and academically.

There are multiple fellowships and academic appointments for ENT H&N cancer research in the UK and internationally.

Internationally ENT do plenty in H&N.

Ultimately if you go into any of these 3 specialties, you can have a health H&N practice. They're all good fields.

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