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TSR Doctors society

The bill proposing doctors be made exempt from European Working Time Directive is in parliament soon. Just in case anyone had forgotten!

http://www.publications.parliament.uk/pa/bills/cbill/2015-2016/0046/16046.pdf

Reply 4041

AnonymousPenguin

16

Original post by nexttime

The bill proposing doctors be made exempt from European Working Time Directive is in parliament soon. Just in case anyone had forgotten!

http://www.publications.parliament.uk/pa/bills/cbill/2015-2016/0046/16046.pdf

That's a private members bill though, right?

I don't recall it being allocated sufficient time during the sessions, so it's unlikely to be ever implemented. Peter Bone is one of the sponsors, ha.

Reply 4042

Becca-Sarah

19

Original post by nexttime

The bill proposing doctors be made exempt from European Working Time Directive is in parliament soon. Just in case anyone had forgotten!

http://www.publications.parliament.uk/pa/bills/cbill/2015-2016/0046/16046.pdf

Let's not get distracted from the main issues of the contract. It's the parliamentary equiv of trolling to put in a bill like that.

Reply 4043

Anonymous #1

Anybody else ever had problems with post-work anxiety? I've spent a few sleepless hours every night the past few weeks, worrying about lots of 'little' decisions I've made at work, catastrophising things out of all proportion and beating myself up for it. In the light of day they are perfectly normal & reasonable decisions again. Never been a worrier type person before, but it's affecting me quite a bit as I'm not sleeping so well, and the self-inflicted vote of no confidence is making me doubt myself more of the time!

Any suggestions for trying to tackle this, or will it just go away with time? I feel like I'm stuck in some kind of rut of low confidence. It's strange because I've been an F1 since August and it's only the past 2 or 3 weeks where I have felt like this pretty much every day, yet nothing has really changed about me or what I'm doing. I have some annual leave coming up and I'm just hoping that time away from work will help.

Reply 4044

Becca-Sarah

19

Original post by Anonymous

Anybody else ever had problems with post-work anxiety? I've spent a few sleepless hours every night the past few weeks, worrying about lots of 'little' decisions I've made at work, catastrophising things out of all proportion and beating myself up for it. In the light of day they are perfectly normal & reasonable decisions again. Never been a worrier type person before, but it's affecting me quite a bit as I'm not sleeping so well, and the self-inflicted vote of no confidence is making me doubt myself more of the time!

Any suggestions for trying to tackle this, or will it just go away with time? I feel like I'm stuck in some kind of rut of low confidence. It's strange because I've been an F1 since August and it's only the past 2 or 3 weeks where I have felt like this pretty much every day, yet nothing has really changed about me or what I'm doing. I have some annual leave coming up and I'm just hoping that time away from work will help.

You could ask to meet with your clinical supervisor (there is an option on e-portfolio for mid-placement review etc) and talk through some recent cases that made you worry. Having someone who has seen you work, and knows the cases in question, might be enough to put your mind at rest that you are doing ok.
However, if it's affecting your sleep, it might also be worth seeing your GP. Being more sleep deprived than usual isn't going to help with making good decisions at work or thinking rationally about your decisions afterwards, and it sounds like something like CBT may be useful for working on not catastrophising things and learning how to stop your overthinking causing anxiety.

Reply 4045

Etomidate

15

More strike dates announced, and 48hrs this time. Things are ramping up.

Reply 4046

Becca-Sarah

19

Original post by Etomidate

More strike dates announced, and 48hrs this time. Things are ramping up.

Plus the judicial review, which I think will be more effective in the long run.

Bit concerned that I've just booked a place on a course during the first strike dates, but hadn't formally applied for study leave yet. Hope I still get to go!

Reply 4047

Etomidate

15

http://jama.jamanetwork.com/article.aspx?articleid=2492881

Thoughts?

Reply 4048

username974975

11

Anyone suggest any good MRCP part 1 books? I'm using the "Pastest Essential Revision Notes for MRCP fourth edition."

(edited 8 years ago)

Reply 4049

Helenia

20

Original post by KenGosgrove

Anyone suggest any good MRCP part 1 books? I'm using the "Pastest Essential Revision Notes for MRCP fourth edition."

Question banks. Lots and lots of questions. Most of part 1 is pattern recognition.

Reply 4050

RetiredAccount89

18

Original post by Etomidate

http://jama.jamanetwork.com/article.aspx?articleid=2492881

Thoughts?

When you are a hammer everything is a nail.

Reply 4051

Captain Crash

9

Original post by Etomidate

http://jama.jamanetwork.com/article.aspx?articleid=2492881

Thoughts?

I'm not sure of the benefits of the SOFA definition of sepsis over the old one. The old one was rejected because it wasn't sensitive or specific enough. This may be more sensitive... but bloody hell - a definition based on a composite score of PaO2, creatinine, bilirubin and platelets (amongst other things)? I'm not sure how that's any more specific (or useful in initial clinical assessment of the patient) than the old one.

Reply 4052

TheRabbit

17

Original post by Etomidate

http://jama.jamanetwork.com/article.aspx?articleid=2492881

Thoughts?

I've only briefly scanned though, so maybe not picking stuff up right but a change in SOFA score seems a lot less sensitive than the current SIRS and I am not sure what proportion of patients who currently score for sepsis on SIRS would have a change in SOFA score of 2 - though perhaps SIRS is oversensitive. Given sepsis needs to be treated quickly including lab tests such as bilirubin, creatinine and platelets seems silly too - it makes sepsis a post-treatment diagnosis.

Reply 4053

RetiredAccount89

18

Original post by Captain Crash

I'm not sure of the benefits of the SOFA definition of sepsis over the old one. The old one was rejected because it wasn't sensitive or specific enough. This may be more sensitive... but bloody hell - a definition based on a composite score of PaO2, creatinine, bilirubin and platelets (amongst other things)? I'm not sure how that's any more specific (or useful in initial clinical assessment of the patient) than the old one.

Exactly my point. When all you are focused on is sepsis then everything is sepsis...

especially with these criteria.

An alcoholic with a cold will easily qualify.

Reply 4054

Friar Chris

19

Even with (our trust's) existing sepsis criteria, everyone who looks at the obs machine the wrong way or happens to sneeze seems to qualify. It's actually pretty bad, to the extent I think I've only ever seen the sepsis proforma used once outside of A&E in my trust, because people just don't respect it. Not without unfair cause; we'd have half of our average wards on them at any given time if they were used by the book. Most of the COPD patients on my ward qualify (by a large margin) for our sepsis criteria when they're totally well and at home, simply on the basis of their RR and HR.

All it takes is a random lady to have a slightly elevated heart-rate and mildly worsened confusion and boom, according to policy she'd be on taz and fluids and oxygen with a catheter and ABGs being taken, when really her problem was actually that she had no sleep the last night because of another troublesome patient causing mischief on the ward all night, and maybe needs a small one-off dose of zopiclone tonight if the ward environment is upsetting her sleep. Or a 2-hour post-surgical patient who is otherwise with a bit of post-anaesthetic sweating and dehydration who just needs some paracetamol and a bit of fluid. Unfortunately, I have seen people come to harm from the old 'sepsis six' when it wasn't actually needed; it's not like high-dose broad-spectrum IV antibiotics, fast fluids, catheters, ABGs and oxygen are all risk and side-effect free treatments :erm:

Tl;dr the guidelines are there for a reason; so that septicaemia isn't missed... but when you make them so non-specific and all-encompassing, you go the other way and discourage people from using them at all, and really that means that they're actually counter-productive in that regard.

Reply 4055

nexttime

22

Original post by Friar Chris

Even with (our trust's) existing sepsis criteria, everyone who looks at the obs machine the wrong way or happens to sneeze seems to qualify. It's actually pretty bad, to the extent I think I've only ever seen the sepsis proforma used once outside of A&E in my trust, because people just don't respect it. Not without unfair cause; we'd have half of our average wards on them at any given time if they were used by the book. Most of the COPD patients on my ward qualify (by a large margin) for our sepsis criteria when they're totally well and at home, simply on the basis of their RR and HR.

All it takes is a random lady to have a slightly elevated heart-rate and mildly worsened confusion and boom, according to policy she'd be on taz and fluids and oxygen with a catheter and ABGs being taken, when really her problem was actually that she had no sleep the last night because of another troublesome patient causing mischief on the ward all night, and maybe needs a small one-off dose of zopiclone tonight if the ward environment is upsetting her sleep. Or a 2-hour post-surgical patient who is otherwise with a bit of post-anaesthetic sweating and dehydration who just needs some paracetamol and a bit of fluid. Unfortunately, I have seen people come to harm from the old 'sepsis six' when it wasn't actually needed; it's not like high-dose broad-spectrum IV antibiotics, fast fluids, catheters, ABGs and oxygen are all risk and side-effect free treatments :erm:

Tl;dr the guidelines are there for a reason; so that septicaemia isn't missed... but when you make them so non-specific and all-encompassing, you go the other way and discourage people from using them at all, and really that means that they're actually counter-productive in that regard.

Well to be fair, the sepsis-3 people do agree with you:

"The current use of 2 or more SIRS criteria (Box 1) to identify sepsis was unanimously considered by the task force to be unhelpful."

Also surely you need suspicion of infection to instigate a sepsis protocol, not just bad obs? No?

Reply 4056

TheRabbit

17

Sepsis was SIRS plus infection and like any diagnosis needs some application of sense, e.g. they may meet the criteria for sepsis however the most likely diagnosis is they have a cold and alcohol withdrawals in which case you would not treat as sepsis.

Reply 4057

Becca-Sarah

19

Original post by nexttime

Well to be fair, the sepsis-3 people do agree with you:

"The current use of 2 or more SIRS criteria (Box 1) to identify sepsis was unanimously considered by the task force to be unhelpful."

Also surely you need suspicion of infection to instigate a sepsis protocol, not just bad obs? No?

The temperature of 37.5 (on a boiling ward, under ten blankets) is usually enough to call it ?infection therefore ?sepsis, IME.

Reply 4058

Smile88egc

15

Changeover for me tomorrow, should probably be doing some portfolio or a PDP or something....
Not looking forward to being "new" again!

Have found writing to my MP about contract imposition to be good procrastination though :smile:

Reply 4059

Tech

12

Does anyone know about ACF funding? I'm wondering if it makes a difference whether you go for one that's locally funded versus one that's NIHR funded?

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