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    So I was partially right, hopefully can perfect the rest of it over the next 3 years
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    *Subscribes*.. This is an excellent thread
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    (Original post by electricjon)
    I'd also stick to dentistry.
    Yeah, pretty true
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    (Original post by electricjon)
    So I must say I'm pretty confused. When I first started this thread I wanted to put forward interesting and unusual cases with wide ethicolegal considerations and controversial subject matter, based on my own individual experiences and lessons learnt.
    So then I am criticized for being patronizing and posting cases that are "unrealistic" and outside the levels of responsibilities expected by a junior doctor and that it is merely a front for showing off my arrogance.
    Nevertheless, even though they were all real cases that I experienced when I was a junior doctor, I open up the floor for others to offer cases, and now we are talking about patients with post-operative neurosurgical wound sepsis in whom we are considering lumbar puncture, inotropes and arterial lines and central venous pressure monitoring?!
    Sounds like contradictory bulls**t to me. What was an open non-technical debate meant to be accessible to all has now turned into a classroom exercise. And a bad one at that. I mean, who specifically asks for creatinine and neutrophils, as opposed to urea & electrolytes, and a full blood count, before blindly giving them a unit of blood without even knowing their haemoglobin? Treating patients with temperatures of 38.7
    by exposing them, opening a window, placing a fan near them and administering... ice
    packs? It's laughable really
    And you Subcutaneous, who first laid into me, are now presenting this case. I gather you're a 21 year old newly qualified nurse working on a neurosurgical ITU. So you're not even a doctor? Yet you're going to teach dodgy medicine to a bunch of enthusiastic medical students that don't know right from wrong yet? I find that the very definition of arrogance: an offensive display of superiority or self-importance. I was just trying to facilitate a debate. You have hijacked it.
    It didn't really seem an open debate...it seemed more of an educational, shared learning and peer support structure around cases which could potentially arise, one of the best ways to learn and develop sometimes as a practitioner. Instead it was rather warped not because it was a bad idea, but you came across slightly patronizing..instead of acknowledging those with little clinical exposure were along the right lines, maybe had the right idea, or getting them to question or think what's happening in simpler terms, or getting them to think about WHY they're suggesting things and how it may affect the patient.

    You told me to post something realistic, I did that but tried to initiate a bit more thinking around the bigger picture and learning. There were some odd suggestions, could be considered wrong but they're learning, we all are and they were on the right lines, it's not nice to put them down and say it's 'laughable' that someone with less experience may be wrong...ofcourse they'll make mistakes!

    I think it's really sad you've made the above post, and ruined what could have been a potentially educational and shared learning experience for many.


    PS..it doesn't take a medical degree to know it's probably a bad idea to leave a patient who's pyrexial, sweating in blankets, dressing gown, hot stuffy room. The poster who suggested it was right on track, it just helps the patient feel that little more confortabe. Yes it's not how you'd treat it medically, but it's just common sense. The poster showed they were thinking of the patient as a whole..not just a machine.
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    I give up.
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    (Original post by electricjon)
    I give up.
    Most people have.
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    (Original post by electricjon)
    So I must say I'm pretty confused. When I first started this thread I wanted to put forward interesting and unusual cases with wide ethicolegal considerations and controversial subject matter, based on my own individual experiences and lessons learnt.

    So then I am criticized for being patronizing and posting cases that are "unrealistic" and outside the levels of responsibilities expected by a junior doctor and that it is merely a front for showing off my arrogance.

    Nevertheless, even though they were all real cases that I experienced when I was a junior doctor, I open up the floor for others to offer cases, and now we are talking about patients with post-operative neurosurgical wound sepsis in whom we are considering lumbar puncture, inotropes and arterial lines and central venous pressure monitoring?!?

    Sounds like contradictory bulls**t to me. What was an open non-technical debate meant to be accessible to all has now turned into a classroom exercise. And a bad one at that. I mean, who specifically asks for creatinine and neutrophils, as opposed to urea & electrolytes, and a full blood count, before blindly giving them a unit of blood without even knowing their haemoglobin? Treating patients with temperatures of 38.7 by exposing them, opening a window, placing a fan near them and administering... ice packs? It's laughable really.

    And you Subcutaneous, who first laid into me, are now presenting this case. I gather you're a 21 year old newly qualified nurse working on a neurosurgical ITU. So you're not even a doctor? Yet you're going to teach dodgy medicine to a bunch of enthusiastic medical students that don't know right from wrong yet? I find that the very definition of arrogance: an offensive display of superiority or self-importance. I was just trying to facilitate a debate. You have hijacked it.
    I think the people criticising were in the minority compared with those who were quite enjoying it. And don't forget people are far more willing to criticise on here than in real life - don't take it personally.
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    (Original post by electricjon)
    So I must say I'm pretty confused. When I first started this thread I wanted to put forward interesting and unusual cases with wide ethicolegal considerations and controversial subject matter, based on my own individual experiences and lessons learnt.

    So then I am criticized for being patronizing and posting cases that are "unrealistic" and outside the levels of responsibilities expected by a junior doctor and that it is merely a front for showing off my arrogance.

    Nevertheless, even though they were all real cases that I experienced when I was a junior doctor, I open up the floor for others to offer cases, and now we are talking about patients with post-operative neurosurgical wound sepsis in whom we are considering lumbar puncture, inotropes and arterial lines and central venous pressure monitoring?!?

    Sounds like contradictory bulls**t to me. What was an open non-technical debate meant to be accessible to all has now turned into a classroom exercise. And a bad one at that. I mean, who specifically asks for creatinine and neutrophils, as opposed to urea & electrolytes, and a full blood count, before blindly giving them a unit of blood without even knowing their haemoglobin? Treating patients with temperatures of 38.7 by exposing them, opening a window, placing a fan near them and administering... ice packs? It's laughable really.

    And you Subcutaneous, who first laid into me, are now presenting this case. I gather you're a 21 year old newly qualified nurse working on a neurosurgical ITU. So you're not even a doctor? Yet you're going to teach dodgy medicine to a bunch of enthusiastic medical students that don't know right from wrong yet? I find that the very definition of arrogance: an offensive display of superiority or self-importance. I was just trying to facilitate a debate. You have hijacked it.
    As has been raised several times on this thread, the majority of people reading are applicants, for whom a lot of examples of BP, heart rate etc mean very little at this stage. We've got years ahead of us to learn this stuff, so the only thing we can currently really identify with is the ethical dilemma scenarios. Bring them on, I say. I'm really enjoying your 'case studies', although it is making me panic a bit that I wouldn't really know how to approach them if I were in your shoes... Hopefully medical school will instill it in me
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    (Original post by electricjon)
    I give up.
    Understandable, but thanks for doing the earlier cases anyhow. I found them interesting and appreciate you making the effort
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    (Original post by junior.doctor)
    I think you're starting to get a little TOO devil's advocate here! This situation wouldn't have happened OOH without a senior around as it's an elective extubation - that decision simply wouldn't have been made at 4am unless there was a boss in from home already. If we're talking more general CPR decisions at 4am, you should start CPR and call the 2222 and then make a decision together as a team. You can only hope that most people who need one might have had a form done before the point of arresting, but if we're still going with the fact that the doctor here is an FY1, then an FY1 certainly shouldn't be making CPR decisions.
    Do you work in a Leeds hospital?

    Just because I know the crash team number is 2222 in Leeds hospitals.

    Or is it that everywhere?
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    (Original post by fletchdd02)
    Do you work in a Leeds hospital?

    Just because I know the crash team number is 2222 in Leeds hospitals.

    Or is it that everywhere?
    Its standard.
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    (Original post by Alex D)
    I'll be honest mate, I don't see where some people are getting this 'arrogance' thing from. These cases are absolutely fascinating and have certainly given me a massive amount of food for thought. I think it's less your arrogance than certain inexperienced members who don't like realising how much they've still got to learn.
    Agree, I think being challenged and questioned is a great way to learn.

    And yeah as Subcutaneous said, I did think of the answer, but having the scenario play out and being questioned I found very useful as well as reading what other people suggest and seeing why they're right/wrong.

    It was also interesting to read what a nurse/student nurse would do.
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    (Original post by Subcutaneous)
    I think it's really sad you've made the above post, and ruined what could have been a potentially educational and shared learning experience for many.

    .
    I think electricjon did a great thing and I was so pleased he started the thread. I found style of being questioned useful.

    I disagree that he's ruined anything. I really appreciate the time and effort he has spent with us.

    I'm not sure why you're so critical?

    I think being questioned and criticized is a great way to learn and I didn't take being told I was wrong too seriously. It's just a way to learn and we're on a forum, not dealing with real patients. It's a learning exercise. Hell, better to be told we're wrong in a practise scenario than with a real patient.
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    (Original post by electricjon)
    I give up.
    Please don't.

    I think the majority of people really value and appreciate your contribution.

    There are a small minority of vocal critics, but I think the majority really enjoy participating. I suspect a lot of people are just reading the posts if they're not sure how to contribute and they also find it really useful.

    A lot of med students (and med students to be) love this thread!

    I have to say, this thread was one of the best things to happen on this forum for years.
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    (Original post by electricjon)
    So I must say I'm pretty confused. When I first started this thread I wanted to put forward interesting and unusual cases with wide ethicolegal considerations and controversial subject matter, based on my own individual experiences and lessons learnt.

    So then I am criticized for being patronizing and posting cases that are "unrealistic" and outside the levels of responsibilities expected by a junior doctor and that it is merely a front for showing off my arrogance.

    Nevertheless, even though they were all real cases that I experienced when I was a junior doctor, I open up the floor for others to offer cases, and now we are talking about patients with post-operative neurosurgical wound sepsis in whom we are considering lumbar puncture, inotropes and arterial lines and central venous pressure monitoring?!?

    Sounds like contradictory bulls**t to me. What was an open non-technical debate meant to be accessible to all has now turned into a classroom exercise. And a bad one at that. I mean, who specifically asks for creatinine and neutrophils, as opposed to urea & electrolytes, and a full blood count, before blindly giving them a unit of blood without even knowing their haemoglobin? Treating patients with temperatures of 38.7 by exposing them, opening a window, placing a fan near them and administering... ice packs? It's laughable really.

    And you Subcutaneous, who first laid into me, are now presenting this case. I gather you're a 21 year old newly qualified nurse working on a neurosurgical ITU. So you're not even a doctor? Yet you're going to teach dodgy medicine to a bunch of enthusiastic medical students that don't know right from wrong yet? I find that the very definition of arrogance: an offensive display of superiority or self-importance. I was just trying to facilitate a debate. You have hijacked it.
    (Original post by Subcutaneous)
    XX
    Yup.

    Subcutaneous, why don't you go start a similar thread in the nursing forum if this offends you so?

    I actually found reading your contributions to the scenarios useful and interesting, in fact it was the first time I found your posts in this forum worthwhile and it was a pleasant surprise that you could actually say something useful rather than just attack medics.

    It comes across from the majority of your other posts in this forum that you simply want to criticize doctors and start a doctors vs nurses conflict all the time and start some useless "nurses know better" thang.

    I am really disappointed that you have dissuaded electricjon from continuing this thread. You have ruined a great thread for a lot of medics (and medics to be) and there are many disappointed people who have enjoyed taking part or just reading the cases and contributions.

    As I said before, I think this thread is the best thing that has happened to the Medicine forum for years. Most of the other stuff on here is a load of rubbish.

    To be perfectly honest, if people are so offended by being mildly criticized (rather jokingly) on an internet forum, how are they going to handle being laid into by their senior medics in real life?
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    Okay okay you've talked me round. I shall persevere. Thank you to all those who have left supportive messages.
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    (Original post by electricjon)
    You are a newly qualified doctor. Well, sort of. You passed your finals last month, and got distinction, and are just waiting for the graduation ceremony next week. To celebrate, you have been on a cruise ship for the past couple of weeks. You're not entirely rusty though - you were getting work experience with the medical teams on board and asking a lot of questions, as it something you want to consider doing in the future, but nevertheless, your holiday has come to an end and it is time to go home.

    You are on the flight back from New York, when the tannoy says "Ladies and gentleman, would any medically trained personnel please make their way to the rear of the plane."

    What would you do?
    Hope that the doctor who operated on a flight with a coat hanger and some whiskey is also flying back from NYC?

    Head to the back of the plane? As a medic, are you obliged to do so? If the patient is an American, can he sue the **** out of you? If you're on a plane between US and UK, which laws/medical codes of conduct take effect? Is you're a British doctor, do the US laws/code of medical practice apply to you? (provided that you're not working in the US?)
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    You make your way to the back of the cabin and introduce yourself to the staff. Looking relieved, they rush you over to where a man is sitting. He is Japanese, in his 50's and dressed in a sharp suit. He is clutching his chest and complaining of crushing pain. He looks terrible - pale, sweaty, clammy, breathless.

    Now what?
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    (Original post by No Future)
    Head to the back of the plane? As a medic, are you obliged to do so? If the patient is an American, can he sue the **** out of you? If you're on a plane between US and UK, which laws/medical codes of conduct take effect? Is you're a British doctor, do the US laws/code of medical practice apply to you? (provided that you're not working in the US?)
    Well, technically, you aren't obligated to do anything. They make you swear the Hippocratic Oath at your graduation day, so until then you can't be reprimanded for ignoring the call.

    Also, you're not a doctor yet, you're a medical student still, even though practically you're a doctor.

    And US/UK laws don't apply here - you are in international airspace. I imagine you could still be sued though if you caused serious harm, though through neglectfully ignoring the tannoy? I think you'd get away with it - no-one would know anyway... you'd just get back to watching the in-flight movie.
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    First things first, I get that this is a very pressing emergency, but I'd make it very clear to everyone present (including Japanese man, but fortunately I can speak some Japanese!) that I'm not a licenced doctor yet.

    I would carry out basic first aid tasks such as supporting him against a wall with his knees drawn up to his chest (iirc) and then do as many observations such as resp rate, pulse rate that I could without any equipment while I wait for the real doctors to arrive and take over.
 
 
 
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