#universityoflondon #foundationday (at Senate House)
#universityoflondon #foundationday (at Senate House)
Wow. 4.5 years since I last did this one as well. Got ATLS next week, just three days after APLS! #trauma #lifesupport (at UCH Education Centre)
Hard to believe I last did this course in 2007! Need to keep up to date anyways, so here we go again… See you in 3 days!! #apls #paediatric #lifesupport #manual (at UCH Education Centre)
#dontfeedthepigeons (at Gordon Square)
I bear the stigmata of starting a new post in the NHS: yet another blood test for HBsAg, HCV, HIV, VZV, measles & rubella. Once it’s done, that’s meant to be it; but the records can’t ever seem to be transferred properly between NHS organisations, so it’s easier for them to stab you again and repeat everything than try chasing occupational health records from other organisations. It’s amazing, isn’t it, in the age of space travel, “the cloud”, robots, and iPhones? (at St. Mary’s Hospital)
*delete as applicable
Dear [medical / surgical / orthopaedic / gynaecology / neurology / cardiology / urology / renal / gastroenterology / respiratory / dermatology / paediatrics / psychiatry / oncology / haematology / ENT / plastics / maxillofacial / cardiothoracic / neurosurgical / infectious diseases / ophthalmology]* [consultant / ST / CT / FY]*
I do appreciate that sometimes we send you patients from the emergency department who are not completely “sorted”: we may not have ordered all the tests you would like, or provided all the treatment that might be required in the first 24 hours; sometimes, we might even have made the wrong initial diagnosis or asked you to see a case that you later need to refer to the [medical / surgical / orthopaedic / gynaecology / neurology / cardiology / urology / renal / gastroenterology / respiratory / dermatology / paediatrics / psychiatry / oncology / haematology / ENT / plastics / maxillofacial / cardiothoracic / neurosurgical / infectious diseases / ophthalmology]* [consultant / ST / CT / FY]*.
I also appreciate that, when you are on call, we in the emergency department are your main source of work. Perhaps it sometimes feels like we refer pretty much every patient we see to you. That must be frustrating.
You and I both have to acknowledge that I do not know as much about your specialty as you do. If I did, you wouldn’t have a job. It would probably help both our mental states if you could be a fly on the wall in the emergency department and see firsthand that we actually only refer about 1 in 6 patients to another specialty (excluding outpatient referrals like fracture clinic). We send all the rest home following diagnosis and treatment in the emergency department.
Although I don’t know as much about your area of practice as you, we A&E registrars & consultants are the only doctors in the hospital who can provide initial care for any and all of:
I might well have dealt with all these problems during my last few days on duty. Perhaps you would be comfortable managing one or two - maybe even three or four, possibly five - of these emergencies. But I’d be very surprised if you could manage more than half of them. In the emergency department, we can and do - so please credit us with a little bit of respect for that.
The four-hour target is annoying for you, I know, when we have to refer people who only need a few more hours in hospital, maybe just waiting for the results of a scan or blood test, or even just a little more time to see if their symptoms change or get worse; but it is good for patients, who get to spend their time in a more comfortable, less stressful environment on the ward instead of staying in A&E for hours on end. And it frees up cubicles in A&E so I can see more of those people who I’m going to send home.
In A&E, we do have to make decisions with limited time and often without access to a patient’s full hospital notes, while the patient is still frightened and in pain, before we have all the test results back, and (especially out of hours) without any background history from their GP. Sometimes everything becomes a lot clearer a few hours later, when the test results come back, the GP surgery opens, the notes arrive, and the pain relief we gave in A&E has worked. That makes your job easy. But “stupid A&E” you think: “it’s obvious this patient [could have gone home / should have been referred to another specialty / ought to have had different treatment or tests]*.”
I respect your expertise in the field of medicine in which you practise; please respect my expertise in what I do, too. And please always remember the key to clinical medicine is in your history and examination findings: when I phone you with a referral, I have seen and examined the patient; it is disrespectful to me, the patient, and medical professionalism when you “refuse” the referral without seeing the patient.
Pre-excited AF (an irregular broad-complex tachycardia) in patient with Wolff-Parkinson-White syndrome. #bad #notgood #ecg #ekg #heart #tachycardia #wpw #wolffparkinsonwhite #atrialfibrillation #af #preexcited #broadcomplex
#cockpit #pilot #captain #copilot #airplane #aeroplane (at Aeropuerto de Tenerife Sur-Reina Sofía (TFS))
There’s just no contest between sitting back with a cup of coffee and my iPad versus driving 120 miles each way on the M1 to visit mum & dad! #travel #train #gobyrail #eastmidlands #london #loughborough
#cold #feet #water #pool #swimmingpool #wet #legs #green #night #nightswimming (at Vincci Seleccion La Plantacion Del Sur Hotel Tenerife)