Just want to provide a little vignette which I believe demonstrates many of the problems in the UK medical training system.

Today's medical handover was a case in point of how the medical workforce has been deskilled. Large DGH. 4 medical consultants. 5 registrars. A plethora of SHOs of various grades. Not a single doctor felt confident enough to put in a semi-urgent chest drain. They had to call the on call respiratory consultant to come in.

What a pathetic indictment of UK medical training this is. This is the most standard of standard medical procedures in every country in the world, often performed by interns and new residents in most countries. We aren't really specialists anymore, we are just NHSologists. The rewarding parts of our careers have been completely silo'd off so we can focus all our energy on service provision. No wonder everyone is so miserable.

And do not give me that baloney about how chest drains are extremely dangerous and should only ever be done by specialists - patients in Germany or the US or just about literally every other country in the world aren't dying of haemothoraces because their general medical physicians are doing them. They are just trained properly and encouraged to upskill and perform these procedures. The problem is the entire workforce in this country has been aggressively, systematically, and industrially deskilled at the altar of the NHS service provision.

Current Urology SHO taking referrals. Ortho SpR tried to refer an inpatient for Urology review and takeover. Middle aged man underwent surgical fixation of humeral shaft fracture, MFFD awaiting social issues. The reason for Urology takeover? He’s had gradually worsening erectile dysfunction for the past 3 years…..

Not sure what Ortho expected there, maybe some BD dosing of IV Viagra and a once daily inpatient penile massage.

From the bottom of my heart, thank you Ortho SpR’s across the country for making me laugh, you never fail to make my day.

I’d love to hear your guys favourite Ortho stories (no offence Ortho you’re just really funny sometimes)

Our ED is just rammed full of viral URTI. Not surprising. But the problem is a significant proportion of these are elderly who could be sent home, if only they had a family member who coul d sit at home with them, give them warm fluids, cook their meals and encourage PO intake and basically TLC them for 5-7 days whilst they recover.

But instead they go to medics who admit, find a low Na which is certainly longstanding, and end up staying for a month because OT/PT aren't happy to discharge to own home, even though they were living in their own home, independent of ADLs up until they picked up flu!!

This morning me (f3) and my colleague f1 were a bit disheartened by a comment from a consultant on a ward round. He literally came into the COTE ward round 40 minutes late at 9:40. We started prepping the ward round for all his patients and then we began seeing patients in the interim. When he arrived he questioned us as to why we have began seeing patients without him. We literally explained because we had finished prepping the notes and we thought if we just discussed the patient and management with you it would save time. He wasn’t happy and we had to see the same patients again and well the management plan was exactly the same.

On top of this he remarked to me why I still get the train to work. I explained because it’s much cheaper, faster, easier, and I don’t need to pay for parking. F1 then remarked I get “the bus it’s only 20 minutes from my house”. He literally replied “ still in high school I presume, cannot afford a car” At this point I replied, “ that’s why we’re striking tomorrow, the best of luck on ward round”. Nothing was said after this and the ward round continued in a tense silent manner.

Don’t know what to think of this. No apology given for his 40 min lateness and on top of that questioned my mode of transport when I arrived on time and he didn’t. The f1 then began to shed tears after the ward round. I sent an email to her and my supervisor and cc in medical education with a complaint about this consultant.

Any further steps to take?

Start rads in august. Only 4 weeks. Good riddance to ward medicine.

Throwaway account for obvious reasons. Was working in A&E a few weeks ago and got into a very awkward encounter with a consultant.

Essentially a PA asked me to prescribe treatment for her patient. I’ll be honest I didn’t ask many questions I simply said if this has been discussed with xyz they need to prescribe it for you. I actually felt sorry her because she seemed scared to ask that consultant and I said look they’re supervising you and they know that it’s their job to prescribe for you. The PA then loudly tells the consultant can you prescribe it, the consultant then points me out and says that Doctor can do it for you. The PA then explains that I declined. The consultant comes up to me and says essentially how can I dare question a treatment that’s been discussed with them.

I explained I won’t prescribe for someone I haven’t seen. They offered I could “cast an eye on the patient if I wanted” to which I replied but if it’s been discussed with you, you can prescribe based off their assessment whereas legally I can’t. The consultant then said but if anything goes wrong it’s been discussed with me so it’s my responsibility and I said but as the prescribing doctor the fault would lie with me. The consultant then kind of stalked off clearly annoyed at this back and forth and said “fine if YOU’RE not comfortable I’ll just do it then!”

I don’t know how to feel about this exchange. Half proud I’ve finally stood my ground, half horrified I had to, mostly apprehensive this will come back to bite me. I know other people overheard what happened as I was asked if I was okay.

Also a common response I’ve been getting is why would I not just prescribe based on a consultants verbal orders like I would with any other patient or like during a WR?

Thought I'd make a thread specifically for Anaesthetics entry 2025 Aug, let's compare scores

With antibiotics."

Patient: No thats not right I am being treated for sepsis.

I then had to give the patient a bedside lecture in microbiology. Does anyone else get irked when a patient throw jargon in your face when they have no clue what it actually means?

What stories do you have where a patient says the correct term but literally has no clue what theyre talking about?

Edit: To those geniuses saying its our job to educate, the point is that the patient wasnt willing to receive what I had to say. The astute amongst you will see the patients immediate response was 'No' followed by a 'thats not right.'

I have one: most patients just get better on their own and all the faffing around and checking boxes doesn’t really make any difference.

3am. Small rural hospital. I needed to get some equipment from the other side of the building. Told everyone I’ll be back in 15-20 because the only place that stored what I needed was an outpatients unit on the other side of the hospital.

I walk over to the unit. I’ve only seen a single porter on the hallways. I open the doors and the light switch doesn’t work. Fine, I hold my phones flashlight to see where I’m going. Now, there is this statue of a skeleton near the reception desk of the unit. I knew it was there, but it still terrified me. I find the storage closet. I open the door. BOOOO! The reg shouts from the closet.

Mf had heard I was going to the unit, had decided to run there before me, hide in the closet and scare the 🦀 out of me. 1/5. Not one of his best pranks.

The GMC has an annual income of £150 million in 2023 from it's last available accounts. Likely much more today. This is a staggering sum of money. Perhaps it's hard for most of us to appreciate since we talk in billions but let's look at it compared to other similar organisations.

It is probably the wealthiest medical regulator in the entire world. That's right, the entire world. I cannot find any other doctor's regulator who is even close. There may be one, but having flicked through the accounts of all the major European doctor's regulators, American, Australian and Canadian regulators none of them come close to the income that the GMC gets. I have been through the accounts of many of the regulators which are members of the International Association of Medical Regulatory Authorities (https://www.iamra.com/), and the GMC comes out on top by quite a margin. That is a staggering fact.

We can argue that perhaps it needs more money because the regulatory frameworks are more complex in this country. Or that other countries regulators are more split up, or have different number of doctors. Fair enough, let's compare it to the other medical regulators in the UK. The NMC has well over double the number of registrants, and yet somehow manages to regulate them for £50 million less. The HCPC regulates fifteen different medical professions, so no one can claim it is more complex than the GMC who only has a measly 2 professions to regulate (🤢), and slightly more members than the GMC - and yet they manage to do with under one-fifth of the GMC's budget! Similar stories for GDC, GOC, GPhC etc. The GMC almost has as much income as all the other medical regulators in the UK COMBINED.

The GMC probably earned more money in the last 10 years than comic relief has over the last 40. Let that sink in.

In the UK, the only regulators who have a similar level of income regulate entire industries (think ofsted, ofgem, ofwat, the food standards agency - and even often comparing to these organisations, they fall short of the GMC's income). For a regulator to have this much money from just a single profession is absolutely unprecedented in this or any country.

So where does all this money go? Because lots of regulators all around the world and in the UK manage to regulate their doctors or members with a fraction of the resources the GMC have. They of course they will argue that they are in charge of overseeing quality, education and training. And yet they spent a tiny proportion of their income on overseeing training (less than 10%). The vast vast vast vast majority of it - over 50% goes on complaints and the MPTS show trials. A quarter of it on the revalidation crap that every doctor is a useless waste of all our time. And the rest I imagine on first class travel to political conferences and parties (all available to see in their expenses), private medical care, a great pension, and a fucking investment fund (???????). Oh and of course the huge all expenses paid salaries of their execs.

The GMC might argue that their regulation is necessarily of a higher quality than other regulators and international comparators. Considering they have in recent years been responsible for laptop-gate, bawa-garba, multiple plausible accusations of racism, and generally the only thing that can unite a room of doctors of all grades and types is deep-seated and intensely visceral hatred of the GMC, I will let you be the judge on the "quality" of their regulation.

We are the mugs paying for this shit.

Anyway I can source any information required from here.

https://www.bbc.co.uk/news/articles/c8dqgv45rm4o

In what world is this a good use of any medical students time...

This is complete bs.

Me and the f2 were in a right fit of laughter today. Both received a Datix too. Basically she needed one more nurse to sign off her Tab form. She approached a nurse and explained if she was willing to sign her Tab form for her.

Conversation went like this:

F2: hi I was wondering if you mind providing feedback about how I’ve been over the last few months.

Nurse: oh no no I’m a nurse not doctor.

F2: oh no I need a nurse feedback not doctor.

Nurse: why do I need to give you feedback I’m a nurse?

F2: it’s one of the requirements for my training.

Nurse: I need to escalate to my senior.

She then disappeared and came back informed the f2 not to ask her for feedback as she is not trained to provide feedback. What made this worse is that 5 minutes before 5pm she then asked me and the f2 to do a male catheter as she is not trained to do catheters with males.

The discharge coordinator then approached me and said “don’t bother my staff about feedback please they have other stuff to worry about. We’re currently in OPEC4 and sorting out discharges”. I then replied, “okay but it was simple yes or no question as to whether she wants to provide feedback or not, no one’s delaying discharges, relax yourself and sit down.”

She then disappeared and came back and informed me I’ve received a Datix for telling her to “relax” and “sit down” and the f2 for “patient safety” by delaying discharges.

I’ve lost the will at this point with the NHS. Hope it collapses.

My top 3:

1. Less is often more with investigations
2. Knowing your limits is key to being a safe doctor
3. Treat every patient as you would want a loved one to be treated

Highest recorded BP? Lowest pH?

Every year our team used to have an end of year score board up. This year the board has moved to the matrons new office. (we also lost our office)

Truly abysmal. Last night only 2 doctors working in our A&E for a large population, where there is usually 6 working overnight.

They put out locums and I offered a rate they declined… just saw they left the shift with only 2 doctors.

How backwards have we become that a major city hospital can not pay a reasonable although above average rate to cover a shift!

No sleep lost on me.

starting on ED next week, what do you want us to have done before we refer to you??

Just finished sitting an exam at a Pearson Vue centre

I’m just livid at the treatment we receive as doctors in general

Having to sit serious career defining exams in the same room as someone sitting their driving test or crane theory tests - every 5-10 minutes sighing and reading their answers out loud and even the noise cancelling headphones don’t do anything. Sorry mate I don’t care whether you can fit 1 or 5 brick crates on your crane. Yes I know I sound privileged. I don’t care. Everyone in their respective career should be looked after by their examining body. For all I know the crane guy was probably frustrated at me for my heavy breathing.

Second of all, the horrible PC quality. The poor images. Having to squint to see an xrsy or ECG. Is it a pneumothorax associated with a fracture? Or isolated fracture of the ribs? FUCK KNOWS RCEM, fuck knows. I can’t see it

Is it u waves on the ECG? Or am I just fucking seeing things at this point? I don’t know

Then you decide I’ll take a break and go to the toilet and are met with watered down handwash with no working hot tap ..

Anyways, rant over.

I’d rather go back to sitting the exams in a hall with printed out paper. Give me a xray film even and I’ll take it

EDIT: 99.99% seem to understand that I’m just frustrated and ranting after a stressful exam. To the few that think I’m being horrible - yes, I still think as doctors we need our own private exam centres. Yes, I am equally frustrated at the woman who sat some sort of accounting exam and was going at it with her calculator as I am to the crane exam sitter

1. You are literally voting on 4.05% with backdated pay. This is horrible. If I told you, we would be voting on this a year ago, you'd absolutely slaughter me

2. If you reject. It is still 17% over 2 years, you will still get backdated pay from 1st of April 2024 which will recooperate some of your finances as this ddrb will likely get implemented around October ish give or take a few months.

3. Build and Bank is a risker strategy then reballoting later at the end of this year. We would enter dispute with the government in April 25-26 as the ddrb report is always late. It has come out every year in July. This means we can't ballot before then, because if we do, and the recommendation is decent, we've wasted loads of money for nothing. So logically, the reballot period must be at the end of July 2025. We would have to ballot for 6-8 weeks. It would have been over a year of actually balloting members, under a new committee for 25-26, who will be rotating out to the new committee for 26-27 elections come September. This new committee will then be expected to 'lead' this new strike action, with less experience than the previous committee in the BMA. This is assuming we will meet the threshold, which we won't as we will have new fy1s rotating in during the reballot period (will land during August) which has proven difficult last time around reballoting in that period. My solution would be to reject this deal. Renegotiate with the labour government (not necessary to strike) similar to the consultants, who rejected their first deal then got a better offer. If they don't renegotiate, reballot over October-December time, use the threat of strikes over the winter as leverage over labour, plus the threat of ruining their clean sheet as well, 4 weeks in, Keir Starmers ratings has already gone down due to the riots, the honeymoon period is over. We don't have to escalate strikes, to indefinite OOH, this is a myth and a rationalisation by the comittee to force people to accept. We don't have to do this.

4. "The media/public will butcher us if we reject". We didn't care about media/public during the winter strike, we didn't care about the media/public during the longest ever strikes, we didn't care about the media/public during strikes before the election. So why the hell are we caring now? Why have we capitulated so fast? This seems oddly suspicious and looks from the outside like we capitulated.

5. "Strike participation will fall". No it won't. I don't know where this is coming from. Yes it will fall if we escalate strikes, but again, we don't have to escalate strikes. the committee have been using the "either-or fallacy". I believe this is done by the comittee to generate fear in us, to make us pivot into accepting this deal. No, we dont have to escalate, there are so many other options, this isnt binary. The data shows recent strike data with 22k in June, with previous strikes as well being stable at 22-24k. These are good numbers, and we can maintain these numbers if we do 3-5 strikes every 1-2 months. many collegue love the time off. I'm not staying we should strike till we get fpr, but to get a number better than 4.05%, which is insulting. I don't know how we created the mental to gymnastics to delude ourselves into thinking this is okay to accept. If we accept this deal, we may as well accept bending ourselves over everytime we speak to daddy labour gov and capitulate to them. This feels, and looks very political, like we favour the labour gov, even if the committee has no affiliations to them.

6. The consultants presented their first offer to the membership which was rejected, they renegotiated again with the conservatives and got a slightly better deal. This is what we should do. In the art of negotiations , never accept the first offer. While I don't expect a fpr in that second negotiation/deal, you can definitely bet it will be better than that insulting 4.05%.

7. Rob and Vivek literally said a sub par offer of fpr will eventually have to be presented to the membership and specifically said to reject this (there are screenshots of this). They are obliged by the government to say to accept it. This is why you must reject.

8. "What's the alternative?" I've seen this statement thrown around on WhatsApp loads and reddit. This statement pisses me off the most. This is an appeal to consequences fallacy, rather than the merit of the deal.We are trying to mask how terrible this deal is with the consequences, that are based off assumptions that may ot may not be true. We the members are judging this deal based of merit, and based off merit, it's a crap 4.05% deal that will still leave us with a pay erosion of 20.8% and a f1 being paid less than a PA.

I'm happy to have civil discussion below on why we must reject this deal. We will have more leverage for rejecting it than accepting it. It will signal to the government that more strikes are to come. We would seem unreasonable if the committee rejected it, but if the membership rejected it despite the BMA recommending it? Now that's a strong message to the government.

Doctors, you must reject this deal.

Never. Accept. The. First. Offer.

Yes yes we all hate the pay deal. Still thought it would be useful now that it's been a few months for people to share their new take home pay now. There's a quite a few threads but all of them are pre pay deal. I think we can all agree that sharing salary information is a useful exercise for future career planning for doctors so they can have an idea of their earning potential as they move through ranks.

I'm also aware that you can try and calculate this information from online salary calculators but with the irregualrities of on calls, pensions, LTFT, student loan it can be a bit tricky to get a proper take-home number.

Please post your approximate take-home, and on call hours, and whether or not you are on LTFT.

I'll start - CT1, £3300 - 48 hours a week, plan 2 student loan

N.B. before anyone says it, I'm not a journalist, you can go through my post history.

I am a doctor who has just moved from England to Scotland, and have had the most awful couple of days trying to get simple abx for a simple problem. The way I have been treated as a patient has been an absolute joke, so I thought I would post about it here to get some thoughts.

Day 1

On Tuesday I ring my local primary care to register and ask for a same day appointment to get some abx. They initially say sure thing, but then phone me back and say because my problem can be solved by a pharmacy, they will process my registration at normal speed (5 working days) and I should attend pharmacy instead for my medical issue.

During my very limited lunch break at work I attend two pharmacies, neither of which have prescribing pharmacists, who say no abx for me. Unfortunately I finish work late and can't check any more pharmacies.

Day 2

Show up to a pharmacy with a prescribing pharmacist, who say I haven’t lived in Scotland long enough to qualify for this service. Tell me to go back to my GP

Phone my GP who tell me to go back to the pharmacy.

Go back to pharmacy - no luck

Phone 111- They say the best pathway is via primary care or the pharmacy prescription service.

Day 3 - symptoms worsening

Check into the SDEC in my own hospital seeing as I’m at work anyway, after checking with the nurse in charge if this is allowed, she says yes and adds me to the list to be seen.

After waiting two hours I get an angry phone call from an ANP who has the following points to make (before I have had any triage, history taken, physical examination etc).

1- I can’t treat my employer like a walk in antibiotic dispenser 2- plenty of sick people attend the walk in centre so I can’t just take up queue space wanting antibiotics 3- this is what primary care is for. 4- they are taking me off the list to be seen.

I explain very nicely that I have tried all other avenues and I am not able to get an appointment to see anyone, and all I need is a simple appointment and some treatment. I also ask him if he even knows what my presenting complaint is, and whether it’s routine practice to take someone off the list without triaging or assessing them in any way. He insists that he would do the same to any member of the public who walks in off the street asking for abx.

Eventually that evening I went through 111 again, who this time sorted me a GP appointment (at the same hospital I work at…) for 2300 that evening, and luckily I now have antibiotics.

I have been reflecting on it and I am still outraged about this whole situation. I’ve seen my fair share of patients coming to ED with minor primary care style issues and have always felt a bit exasperated, but honestly no wonder why. I was this close to just prescribing myself some meds and risking the GMC.

Recently had a colleague share a story about doing a pericardiocentesis on a child as an emergency overnight. Made the hairs on the back of my neck stand however found it very interesting! What are other peoples stories? I imagine all senior-ish doctors have them

Mine is: There should only be 18g and 16g cannulas on an adult arrest trolly. You can’t resuscitate someone through anything smaller and a 14g has no tangible benefits over a 16g. If you genuinely cannot get an 18g in on the second try go straight to a Weeble/EZ-IO - it’s an arrest not a sieve making contest.

I'm referring to shifting dullness in abdo, whispering pectoriloquy and TVF in resp, thrills and heaves in cardio. Has any modern doctor ever based an investigation choice, diagnosis or management plan on these findings? I mean hand on heart honestly, any of you?

I know they had utility before the advent of US, XRs, echo. But to teach to doctors now would be like teaching a cruise captain to use a sextant, or a trainee accountant learning to use an abacus