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Original post by Anonymous
I would appreciate a bit of advice on this scenario please.
On an evening medical shift, I was handed over to chase a CT abdo report and to discuss results with patient. Elderly patient, having CT to investigate RUQ pain and jaundice, was thought to most likely have cholangiocarcinoma but day team wanted to exclude cholecystitis. Very well clinically, initial plan was to await abdo USS the next morning but consultant insisted on urgent CT. I was told that the patient had been told it may not be good news and was happy to discuss results without any family present. This was out of hours and I had never looked after the patient before.
CT showed the patient had cholecystitis. It also showed she had probable lymphoma in the abdominal lymph nodes.
I'm just wondering what other people think would have been appropriate to tell the patient at that point? Just deal with the cholecystitis and leave the day team to talk about lymphoma, or tell the the patient about both? Is at appropriate for OOH/HAN team to break bad news to patients?
Would much appreciate people's opinions.
On an evening medical shift, I was handed over to chase a CT abdo report and to discuss results with patient. Elderly patient, having CT to investigate RUQ pain and jaundice, was thought to most likely have cholangiocarcinoma but day team wanted to exclude cholecystitis. Very well clinically, initial plan was to await abdo USS the next morning but consultant insisted on urgent CT. I was told that the patient had been told it may not be good news and was happy to discuss results without any family present. This was out of hours and I had never looked after the patient before.
CT showed the patient had cholecystitis. It also showed she had probable lymphoma in the abdominal lymph nodes.
I'm just wondering what other people think would have been appropriate to tell the patient at that point? Just deal with the cholecystitis and leave the day team to talk about lymphoma, or tell the the patient about both? Is at appropriate for OOH/HAN team to break bad news to patients?
Would much appreciate people's opinions.
I would not be giving any scan results to anyone OOH tbh. 1) Even if they say they are happy, you won't exactly be available for questions afterwards, or able to spend any time with them anyway, so its just not fair on them 2) Its not going to make any difference overnight. Your work OOH should be limited to things that will make a difference overnight. Anything on top of that is a favour for the day team and at your own discretion.
If it does make a difference and you need to be doing things for them overnight, then clearly you may need to keep the patient informed.
Original post by Anonymous
I'm going to be starting a (very) quiet supernumerary job in the middle of January. Have been advised by the 2 incumbent SHOs on the job to either use the time for things like QI work, exam prep or other future-planning fodder. I've decided to very slowly begin prep for Parts I/II of the MRCPCH.
Can any body here who has done the exam recommend any useful resources to study from?
I'm in no rush to sit the exam so am not following any schedule or aiming for a particular exam sitting - just seeing how much of the groundwork I can lay down and accrue knowledge of bits that I evaded at medical school (embryology, metabolic disorders, syndromes etc.) I've tried doing some googling, but the same (seemingly outdated) sites keep coming up.
I know lots of people like to hammer out question banks, but I definitely want to do some theoretical learning first before trying to assess knowledge and learn from the questions. Though any advice for question banks that reflect the exams would also be appreciated.
Can any body here who has done the exam recommend any useful resources to study from?
I'm in no rush to sit the exam so am not following any schedule or aiming for a particular exam sitting - just seeing how much of the groundwork I can lay down and accrue knowledge of bits that I evaded at medical school (embryology, metabolic disorders, syndromes etc.) I've tried doing some googling, but the same (seemingly outdated) sites keep coming up.
I know lots of people like to hammer out question banks, but I definitely want to do some theoretical learning first before trying to assess knowledge and learn from the questions. Though any advice for question banks that reflect the exams would also be appreciated.
When i did it there was an official book from the MRCPCH. I remember the questions they provided as being pretty... bipolar (some insanely hard, some blindingly easy), but i always prefer official sources to question banks, which in my experience focus far too much on minutiae and rote memorisation vs the real exams.
Would like some advice on a situation
In the afternoon a nurse came to me about a patient. He wasn't someone I had been before, but apparently he was a complicated medical patient who had previously disappeared from the medical ward, was found unconscious, and subsequently developed a surgical problem. She then described how a prescription error had been made and this man had been receiving two doses of humulin a day when he was meant to only get one. This had been corrected and datix'd by the diabetes team in the morning, but he had now gone into a profound hypo, with an initial BM of I think 1.3. She said she had been with him for the last half hour giving him a total of 6 glucoboosts with his BMs going up and down and had just managed to get his BM steadyish, and on the last BM was 3.3. She came to me because she said she needed a cannula.
I clarified that he was conscious, and told her that if he was conscious he can continue getting glucose orally, and that I could come and see him in a moment. The nurse left with a bit of an 'on your head be it'. After she had left the ward sister came to me and said I should really put a cannula in in case something else happened and he did become unconscious. She was very nice about it and I respect her, and explaining it that way made more sense, so I went and put it in. When I saw the patient he was pretty drowsy but easily rousable. I confess I actually have no idea what his baseline was, and if a level of drowsiness was normal for him or not. I sort of presumed it was, but recognise now that I should definitely have at least clarified that.
From my point of view, although I didn't verbalise it, it rather sounded like the nurse had come to me AFTER she had successfully managed the acute hypo, and toast rather than a cannula was more in order. Although I see the ward sister's point with regards to safety, I also think that beyond him getting another erroneous dose of humulin there was no reason for him to fall unconscious.
I admit I haven't had to manage many hypos. Am I failing to take them seriously? Any advice would be gladly received.
Separate to this, I have some concerns about this particular nurse. She is quite young. Although generally she is pleasant, she has a bit of an attitude of telling me what to do rather than asking me. With this situation part of the problem was that she came in basically telling me that she needed me to put in a cannula right now, rather than explaining the situation and saying something like "Can you please see this patient, and I think he needs a cannula too". I was already the only doctor on the ward for 40 patients and it was 3pm and I hadn't eaten yet, so I didn't take it well. She has also once asked me to prescribe an enema that she had already given without it being prescribed because 'she knows what to do'. I did it without thinking initially, but the more I think about it that sounds kind of serious.
Sorry for the long drawn out story. Just didn't feel like I handled things too well and it's been playing on my mind
In the afternoon a nurse came to me about a patient. He wasn't someone I had been before, but apparently he was a complicated medical patient who had previously disappeared from the medical ward, was found unconscious, and subsequently developed a surgical problem. She then described how a prescription error had been made and this man had been receiving two doses of humulin a day when he was meant to only get one. This had been corrected and datix'd by the diabetes team in the morning, but he had now gone into a profound hypo, with an initial BM of I think 1.3. She said she had been with him for the last half hour giving him a total of 6 glucoboosts with his BMs going up and down and had just managed to get his BM steadyish, and on the last BM was 3.3. She came to me because she said she needed a cannula.
I clarified that he was conscious, and told her that if he was conscious he can continue getting glucose orally, and that I could come and see him in a moment. The nurse left with a bit of an 'on your head be it'. After she had left the ward sister came to me and said I should really put a cannula in in case something else happened and he did become unconscious. She was very nice about it and I respect her, and explaining it that way made more sense, so I went and put it in. When I saw the patient he was pretty drowsy but easily rousable. I confess I actually have no idea what his baseline was, and if a level of drowsiness was normal for him or not. I sort of presumed it was, but recognise now that I should definitely have at least clarified that.
From my point of view, although I didn't verbalise it, it rather sounded like the nurse had come to me AFTER she had successfully managed the acute hypo, and toast rather than a cannula was more in order. Although I see the ward sister's point with regards to safety, I also think that beyond him getting another erroneous dose of humulin there was no reason for him to fall unconscious.
I admit I haven't had to manage many hypos. Am I failing to take them seriously? Any advice would be gladly received.
Separate to this, I have some concerns about this particular nurse. She is quite young. Although generally she is pleasant, she has a bit of an attitude of telling me what to do rather than asking me. With this situation part of the problem was that she came in basically telling me that she needed me to put in a cannula right now, rather than explaining the situation and saying something like "Can you please see this patient, and I think he needs a cannula too". I was already the only doctor on the ward for 40 patients and it was 3pm and I hadn't eaten yet, so I didn't take it well. She has also once asked me to prescribe an enema that she had already given without it being prescribed because 'she knows what to do'. I did it without thinking initially, but the more I think about it that sounds kind of serious.
Sorry for the long drawn out story. Just didn't feel like I handled things too well and it's been playing on my mind
Original post by Anonymous
Would like some advice on a situation
I think with managing that hypo, there are probably a few more things to consider. Firstly anyone who needs more than three hypostops to maintain their capillary blood glucose, you need to be considering prescribing a bag of IV dextrose, usually 10%. Have a look at your trusts hypoglycaemia algorithm (can also be found inside the hypobox).
Secondly depending on what kind of humulin it was, the period of action can be up to 24 hours (eg Humulin U), plus the patient is presumably unwell so has more than enough reason to become hypo again.
With regards to the nurse, in the first instance I would approach her or the ward sister about her giving prescription medications without a prescription. It’s probably also something that should be datixed as ultimately it’s a safety concern. It’s a bad habit for a nurse to get in to and can easily slip into less innocuous medications. Also in this instance, I would have refused to prescribe it just to make her sweat, and document in the notes what had occurred so that she didn’t inadvertently receive another.
Finally, the whole business with cannulas used to piss me off to no end too, especially when you’re being told who needs a cannula, rather than asked. More often than not, it’s a reasonable request, but a decent proportion of the time it’s utterly stupid. So my suggestion would be to politely ask why and triage the urgency accordingly.
I would also suggest finding out which nurses on the ward can cannulate, because for some reason they do the training then keep it a secret.
im just sorting out my portfolio for ct1 anaeathetics interview, is there a way to get stuff off my online eportfolio to print off in a nice way without just printing the page and it coming out in a terrible format and looking ugly, like are we able to save the entry as a pdf and then print that, i cant find a way, im using the turas portfolio for fy2
Original post by Anonymous
I would appreciate a bit of advice on this scenario please.
On an evening medical shift, I was handed over to chase a CT abdo report and to discuss results with patient. Elderly patient, having CT to investigate RUQ pain and jaundice, was thought to most likely have cholangiocarcinoma but day team wanted to exclude cholecystitis. Very well clinically, initial plan was to await abdo USS the next morning but consultant insisted on urgent CT. I was told that the patient had been told it may not be good news and was happy to discuss results without any family present. This was out of hours and I had never looked after the patient before.
CT showed the patient had cholecystitis. It also showed she had probable lymphoma in the abdominal lymph nodes.
I'm just wondering what other people think would have been appropriate to tell the patient at that point? Just deal with the cholecystitis and leave the day team to talk about lymphoma, or tell the the patient about both? Is at appropriate for OOH/HAN team to break bad news to patients?
Would much appreciate people's opinions.
On an evening medical shift, I was handed over to chase a CT abdo report and to discuss results with patient. Elderly patient, having CT to investigate RUQ pain and jaundice, was thought to most likely have cholangiocarcinoma but day team wanted to exclude cholecystitis. Very well clinically, initial plan was to await abdo USS the next morning but consultant insisted on urgent CT. I was told that the patient had been told it may not be good news and was happy to discuss results without any family present. This was out of hours and I had never looked after the patient before.
CT showed the patient had cholecystitis. It also showed she had probable lymphoma in the abdominal lymph nodes.
I'm just wondering what other people think would have been appropriate to tell the patient at that point? Just deal with the cholecystitis and leave the day team to talk about lymphoma, or tell the the patient about both? Is at appropriate for OOH/HAN team to break bad news to patients?
Would much appreciate people's opinions.
There's a few things that spring to my mind. I don't think asking a cover doctor to discuss scan findings that require non-emergency intervention with a patient they've never met, is good practice. If you've had some interaction with the patient and do a shift that's not expected to be busy because you cover a small group of patients - yes ok - but not if it's routine medical ward cover for numerous wards.
Putting that to one side though is about your own level of experience. A diagnosis of cancer can't be made radiologically, certainly not just with enlarged lymph nodes and if you are comfortable in expressing your certainty as well as uncertainty regarding the scan findings then that's ok. But a lot of that is dependent on your relationship with the patient - if you've never met them and come along at 7pn and talk about swollen glands that may or may not be malicious - this may not be wholly appropriate.
I told a young 25yo patient and husband of a diagnosis of metastatic Ca on a friday evening (6pm). In hindsight I wish I hadn't because it was pretty horrific. But the family and patient were literally camped outside the room everytime we were on the ward asking if the biopsy results came back. Eventually the biopsy results did come bcak So I felt it would be wrong to withold the information they wanted. But my interaction with them turned out to be so traumatic I wish I hadn't done it. The reaction would've probably been the same on the Monday though. Sorry to digress - it's a different situation to yours but there is probably an ethical argument to be had if delaying giving the results of investigations (by 12 hours maybe) is right or wrong
You guys are my role model. I hope I become a doctor once
Sorry come for a rant...
The CMT clinic requirement is an absolute goddamn nightmare. They expect us to get 3.5 clinic days per 4 month rotation... and its just impossible. On my last rotation we weren't scheduled for any clinic time so just had to try to sneak off on a quiet afternoon... literally never happened. This rotation we were very generously scheduled for 3 clinic days. Below the minimum, but very generous, they are very keen to emphasise to us. Then today i got pulled off of a said clinic day because the ward was drowning and needed help, even though due to a quirk of the rota and how admission work there were 3 ward doctors from 5-9pm perfectly capable of clearing up jobs (normal staffing 9-5 is 4 ward doctors).
Others are just being not at all stressed about it, seeming to think that it will be overlooked at the end of the year or that they will magically get 5 or 6 days in the third rotation. Only I seem reluctant to miss clinic time and its making me look like a moaner/not a 'team player'!
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
I have a plan of how to tackle it. Just wanted to rant.
The CMT clinic requirement is an absolute goddamn nightmare. They expect us to get 3.5 clinic days per 4 month rotation... and its just impossible. On my last rotation we weren't scheduled for any clinic time so just had to try to sneak off on a quiet afternoon... literally never happened. This rotation we were very generously scheduled for 3 clinic days. Below the minimum, but very generous, they are very keen to emphasise to us. Then today i got pulled off of a said clinic day because the ward was drowning and needed help, even though due to a quirk of the rota and how admission work there were 3 ward doctors from 5-9pm perfectly capable of clearing up jobs (normal staffing 9-5 is 4 ward doctors).
Others are just being not at all stressed about it, seeming to think that it will be overlooked at the end of the year or that they will magically get 5 or 6 days in the third rotation. Only I seem reluctant to miss clinic time and its making me look like a moaner/not a 'team player'!
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
I have a plan of how to tackle it. Just wanted to rant.
(edited 6 years ago)
Interim ARCP next week, and just hoping being exam positive will make up for a dearth of WBAs. Anyone got any experience of face-to-face surgical ARCP? Am I going to get eaten alive?
You mean this isn't a standard expectation everywhere? I've made it to one clinic day so far since August, and it was during leave.
Original post by nexttime
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
You mean this isn't a standard expectation everywhere? I've made it to one clinic day so far since August, and it was during leave.
Original post by nexttime
Sorry come for a rant...
The CMT clinic requirement is an absolute goddamn nightmare. They expect us to get 3.5 clinic days per 4 month rotation... and its just impossible. On my last rotation we weren't scheduled for any clinic time so just had to try to sneak off on a quiet afternoon... literally never happened. This rotation we were very generously scheduled for 3 clinic days. Below the minimum, but very generous, they are very keen to emphasise to us. Then today i got pulled off of a said clinic day because the ward was drowning and needed help, even though due to a quirk of the rota and how admission work there were 3 ward doctors from 5-9pm perfectly capable of clearing up jobs (normal staffing 9-5 is 4 ward doctors).
Others are just being not at all stressed about it, seeming to think that it will be overlooked at the end of the year or that they will magically get 5 or 6 days in the third rotation. Only I seem reluctant to miss clinic time and its making me look like a moaner/not a 'team player'!
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
I have a plan of how to tackle it. Just wanted to rant.
The CMT clinic requirement is an absolute goddamn nightmare. They expect us to get 3.5 clinic days per 4 month rotation... and its just impossible. On my last rotation we weren't scheduled for any clinic time so just had to try to sneak off on a quiet afternoon... literally never happened. This rotation we were very generously scheduled for 3 clinic days. Below the minimum, but very generous, they are very keen to emphasise to us. Then today i got pulled off of a said clinic day because the ward was drowning and needed help, even though due to a quirk of the rota and how admission work there were 3 ward doctors from 5-9pm perfectly capable of clearing up jobs (normal staffing 9-5 is 4 ward doctors).
Others are just being not at all stressed about it, seeming to think that it will be overlooked at the end of the year or that they will magically get 5 or 6 days in the third rotation. Only I seem reluctant to miss clinic time and its making me look like a moaner/not a 'team player'!
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
I have a plan of how to tackle it. Just wanted to rant.
Yeah I know some colleagues who've come in pre-night shift to go to clinics - I honestly refuse to come in during my spare time unless it becomes a dire situation at the end, and consider them barking mad to be doing it. I have no idea how the Powers What Be thought doubling the clinic requirements in exactly the same rotas where people previously struggled to get to clinic was a good idea. So. Many. Clinics! I've been popping down to them for 1-2 hours max and counting them anyway, as after that I need to go back to the ward to try and tackle the mountain of jobs. To be fair to them the consultants on my job are very encouraging that we should go to clinic, but practically it's a challenge as it's often very busy. I've wondered about taking some days of study leave to go to clinic, actually. Don't see why it shouldn't work.
Original post by seaholme
Yeah I know some colleagues who've come in pre-night shift to go to clinics - I honestly refuse to come in during my spare time unless it becomes a dire situation at the end, and consider them barking mad to be doing it. I have no idea how the Powers What Be thought doubling the clinic requirements in exactly the same rotas where people previously struggled to get to clinic was a good idea. So. Many. Clinics! I've been popping down to them for 1-2 hours max and counting them anyway, as after that I need to go back to the ward to try and tackle the mountain of jobs. To be fair to them the consultants on my job are very encouraging that we should go to clinic, but practically it's a challenge as it's often very busy. I've wondered about taking some days of study leave to go to clinic, actually. Don't see why it shouldn't work.
Yeah our consultants are very encouraging too. To the point of kind of being annoyed that we don't go to clinics. In fact, we keep getting e-mails asking why we aren't going to the big departmental teaching/meeting on Friday afternoons 2-5pm. Almost tempted to reply saying 'when you schedule your busiest clinic of the week for Friday afternoon then still manage to attend, is the day I too will also be there'. They just seem to have no clue...
We don't routinely have consultants or regs on the ward as they are always in clinic, so there's a bit of an 'us and them' thing going with not much understanding in between
(edited 6 years ago)
I've taken study leave before to make sure I can get to at least some clinics during work time and it worked really well. Get your requests in early, even a couple of days in a 6 month block can make preparing for ARCP so much easier. You can use the afternoon/morning for eportfolio/audit too if you can't bear double clinic.
Original post by nexttime
Sorry come for a rant...
The CMT clinic requirement is an absolute goddamn nightmare. They expect us to get 3.5 clinic days per 4 month rotation... and its just impossible. On my last rotation we weren't scheduled for any clinic time so just had to try to sneak off on a quiet afternoon... literally never happened. This rotation we were very generously scheduled for 3 clinic days. Below the minimum, but very generous, they are very keen to emphasise to us. Then today i got pulled off of a said clinic day because the ward was drowning and needed help, even though due to a quirk of the rota and how admission work there were 3 ward doctors from 5-9pm perfectly capable of clearing up jobs (normal staffing 9-5 is 4 ward doctors).
Others are just being not at all stressed about it, seeming to think that it will be overlooked at the end of the year or that they will magically get 5 or 6 days in the third rotation. Only I seem reluctant to miss clinic time and its making me look like a moaner/not a 'team player'!
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
I have a plan of how to tackle it. Just wanted to rant.
The CMT clinic requirement is an absolute goddamn nightmare. They expect us to get 3.5 clinic days per 4 month rotation... and its just impossible. On my last rotation we weren't scheduled for any clinic time so just had to try to sneak off on a quiet afternoon... literally never happened. This rotation we were very generously scheduled for 3 clinic days. Below the minimum, but very generous, they are very keen to emphasise to us. Then today i got pulled off of a said clinic day because the ward was drowning and needed help, even though due to a quirk of the rota and how admission work there were 3 ward doctors from 5-9pm perfectly capable of clearing up jobs (normal staffing 9-5 is 4 ward doctors).
Others are just being not at all stressed about it, seeming to think that it will be overlooked at the end of the year or that they will magically get 5 or 6 days in the third rotation. Only I seem reluctant to miss clinic time and its making me look like a moaner/not a 'team player'!
Apparently people in a neighbouring trust have resorted to using their annual leave to come to clinics because the wards can literally never spare them for any actual, y'know, training. Its not just us.
I have a plan of how to tackle it. Just wanted to rant.
Yup I don't know any CMT that has been happy with clinic provision and hasn't had to use at least study leave to hit it.
I am currently a Trust grade in a department that gives a crap. So in 4 months almost got that much clinic time without doing any asking and have been allowed 5 days of study leave to do something I find interesting (could have been clinics if I wanted).
It doesn't get better unless you stomp about it. Just don't do what I have had done to me where the CMT SHO buggers off to clinic without prior warning leaving you in the lurch on the ward...
That's not the problem though - the consultants are actively annoyed with us that we don't attend clinics and teaching. The problem is getting off the ward at all! The theoretical minimum staffing - 1 doctor (of any grade) to 18 patients - is just so hard that when there's an extra person its very hard to justify abandoning the others (i'm actually relatively pro just doing it anyway, but the group (some of whom don't require clinics) isn't). Long term there are also very few days where we are above minimum anyway, and its looking like we might be losing someone else and so having yet another rota gap.
As i say, i have a plan. It involves going to educational opportunities anyway and exception reporting everything. Just need to convince the others.
Random: Neurologists here are indeed very enthusiastic. Some here are very keen to talk over the phone about GABA receptors and saturating them with consistent benzo use?
As i say, i have a plan. It involves going to educational opportunities anyway and exception reporting everything. Just need to convince the others.
Random: Neurologists here are indeed very enthusiastic. Some here are very keen to talk over the phone about GABA receptors and saturating them with consistent benzo use?
I think I got to about 50 clinics in cmt but I did 3 jobs I had my own list and another where I was encouraged to go and had a gpst2 and f1/f2 also on the ward who weren't really keen.
The only way is to have rostered clinics and an f1 or f2 who can hold the ward when you're away. If that doesn't happen it's hard to get to clinics adhoc. When I did resp Occasionally my reg and I used to come and round from 730 to 9 on clinic mornings to ease pressure from the f1. If he joined us (left it to him) we'd try and find a day he left early. I didn't mind coming in early as it meant leaving the house only 45mins early and it's easier to be efficient (purely from seeing pts point of view) at 730 than 930. It was a very busy DGH job but we managed. That was 4-5 years ago though, I hate to think how busy it is now
The only way is to have rostered clinics and an f1 or f2 who can hold the ward when you're away. If that doesn't happen it's hard to get to clinics adhoc. When I did resp Occasionally my reg and I used to come and round from 730 to 9 on clinic mornings to ease pressure from the f1. If he joined us (left it to him) we'd try and find a day he left early. I didn't mind coming in early as it meant leaving the house only 45mins early and it's easier to be efficient (purely from seeing pts point of view) at 730 than 930. It was a very busy DGH job but we managed. That was 4-5 years ago though, I hate to think how busy it is now
st1 accs em interview next week, any advice is appreciated x
Missed the flu vaccination sessions at work, so I figured after clerking my n'th flu patient I should probably go to get it done at the GP, and apparently occupational exposure doesn't actually qualify you for one 
Not complaining (plus my fault for missing hospital sessions) but I do find it kind of curious how the system works!
Not complaining (plus my fault for missing hospital sessions) but I do find it kind of curious how the system works!
Original post by seaholme
Missed the flu vaccination sessions at work, so I figured after clerking my n'th flu patient I should probably go to get it done at the GP, and apparently occupational exposure doesn't actually qualify you for one
Not complaining (plus my fault for missing hospital sessions) but I do find it kind of curious how the system works!
Not complaining (plus my fault for missing hospital sessions) but I do find it kind of curious how the system works!
You can get it done at some pharmacies for ~£15 if you can't find anywhere to do it for free. Though how effective it is this season is questionable...
Original post by seaholme
Missed the flu vaccination sessions at work, so I figured after clerking my n'th flu patient I should probably go to get it done at the GP, and apparently occupational exposure doesn't actually qualify you for one
Not complaining (plus my fault for missing hospital sessions) but I do find it kind of curious how the system works!
Not complaining (plus my fault for missing hospital sessions) but I do find it kind of curious how the system works!
It does qualify you, but your employer has to provide it, not your GP.
Does your hospital occy health not have some spare? After flu clinics officially finished, our OH was still offering drop-in jabs.
The cost of attending post-grad conferences (even with student rates) is simply ridiculous..
Original post by Anonymous
I would appreciate a bit of advice on this scenario please.
On an evening medical shift, I was handed over to chase a CT abdo report and to discuss results with patient. Elderly patient, having CT to investigate RUQ pain and jaundice, was thought to most likely have cholangiocarcinoma but day team wanted to exclude cholecystitis. Very well clinically, initial plan was to await abdo USS the next morning but consultant insisted on urgent CT. I was told that the patient had been told it may not be good news and was happy to discuss results without any family present. This was out of hours and I had never looked after the patient before.
CT showed the patient had cholecystitis. It also showed she had probable lymphoma in the abdominal lymph nodes.
I'm just wondering what other people think would have been appropriate to tell the patient at that point? Just deal with the cholecystitis and leave the day team to talk about lymphoma, or tell the the patient about both? Is at appropriate for OOH/HAN team to break bad news to patients?
Would much appreciate people's opinions.
On an evening medical shift, I was handed over to chase a CT abdo report and to discuss results with patient. Elderly patient, having CT to investigate RUQ pain and jaundice, was thought to most likely have cholangiocarcinoma but day team wanted to exclude cholecystitis. Very well clinically, initial plan was to await abdo USS the next morning but consultant insisted on urgent CT. I was told that the patient had been told it may not be good news and was happy to discuss results without any family present. This was out of hours and I had never looked after the patient before.
CT showed the patient had cholecystitis. It also showed she had probable lymphoma in the abdominal lymph nodes.
I'm just wondering what other people think would have been appropriate to tell the patient at that point? Just deal with the cholecystitis and leave the day team to talk about lymphoma, or tell the the patient about both? Is at appropriate for OOH/HAN team to break bad news to patients?
Would much appreciate people's opinions.
Not appropriate to discuss at that time.
Simply tell the patient that the scan needs reporting by a specialist senior radiologist and leave it like that.
I am extremely transparent with my patients and am loathe to keep them in the dark. But getting this sort of non-urgent news out of hours from a doctor you have never met before and without being able to tell thema plan moving forwards is poor practice.
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