US PGY2s are 2 years out of med school, learning to do complex surgery under supervision. Meanwhile here, our FY2s are doing...ward cover, paperwork and are lucky if they get to see the inside of an operating theatre. How have we ended up this way...?
🧵1/ With patient permission. This is one of our I6 PGY2s (right) doing a mitral repair, a superb PA (left) is assist and an attending is 2nd assist. A resident anesthesiologist is at bedside.
Many patients wonder how residents participate in their care.
One asked this week:
I would be concerned if I was calling another hospital for tertiary specialist advice and I get advice from someone who does not even hold a medical degree... If you can't man a tertiary service, don't have one.
Ah, to be able to just go into the specialty you wanted without rotating all over the country and facing steep competition ratios, portfolio and interviews. And going home at 5. Must be nice...
It is a curious phenomenon when doctors asking for a room to do their mandatory mountain of paperwork in a modicum of peace is 'elitist' while...other HCPs already have one. I didn't know it was elitist to ask for the same as others but okay.
Respectfully, how is having a work area for doctors elite?
Other HCPs have theirs too. I'm not doing the race to the bottom of taking away anything. I'm asking the question why doctors often don't have offices/place to do work?
Watching a BBC series on surgery, and all the orthopaedic surgeons are like “actually it’s a very sophisticated specialism, of profound delicacy and complexity”
and then there’s this guy:
Just so I get this right... If you are a reg locuming to cover for gaps during industrial action, you will be paid less than a PA. Yes, that definitely makes sense.
Statement from the Trust ⬇️
In response to concerns and questions raised on X following the publication of a screenshot from our booking system, circulated on Wednesday, the Trust would like to make clear that the original screenshot shared was incorrect.
The rate card…
@Xeon4f145d96s1
@BMA_JuniorDocs
Where was this published? Quite disheartening to read. I had PAs going off to theatre while I as a CT2 was assigned to ward jobs with the CT1. They'd very happily come back to tell us about the fascinating cases they'd seen in theatres with the consultant.
'As if I wasn't here...' Well they're not there are they. They're swanning off doing the doctor's jobs while the actual doctors are being trapped on the ward. The seniors facilitating this behaviour have a lot to answer for.
Oh here is also the list of jobs I was given by the reg level PAs when I was busy on call holding the bleep. So they can go to theatre/clinics ASAP.
I had seen none of these patients. And I had to prescribe all these. Not from a consultant or a doctor but a PA.
@jessicawsw
I thought the next line after asking what he was doing for Xmas was going to be 'so he asked him if he could cover the on call that day instead of the currently rotaed SHO.' 😂
In November, we are launching a one-year pilot of physician associates within ophthalmology, to explore expanding the healthcare workforce while increasing non-medical eyecare professionals within hospital service.
Read more 🔗
The one-upmanship currently on
#orthotwitter
about the fastest hemiarthroplasty is getting close to having someone claim they had the implant in before they heard the sonic boom, such was their speed.
I think I'd rather still be watching CPR video on the awake guy in a chair
We need to do away with this misleading term of 'junior doctor'. I spent 6 years in Med school. I've been a doctor for 8 years. If all stays on track I will still be a 'junior doctor' for another 4 years until CCT. This bank holiday I will be fixing everyone who comes in today.
.
@SkyNews
Junior doctors can train for up to TEN years, not 8 as you’ve just reported.
Like this:
Medical school. 5-6 years.
Then:
FY1 - 1st year
FY2 - 2nd
CT1/ST1 - 3rd
ST2/ST2 - 4th
ST3 - 5th
ST4 - 6th
ST5 - 7th
ST6 - 8th
ST7 - 9th
ST8 - 10th
'The junior doctor earns their base salary...and then more for additional hours.' Yeah it's funny how when you work many more hours than someone else you earn more money. But why is the base salary higher for the assistant to the physician?
'They are there to work alongside doctors not instead of doctors.'
Health Secretary Victoria Atkins reiterates 'regulations' on physician associates after the death of 30-year-old Emily Chesterton.
@gmcuk
@DrLKVaughan
@DrGrumble
I was offered a PA in Worthing and was told they would 'See and treat acute patients so my Junior Doctors could get on with Discharge Summaries'! I did not take up the offer. I asked for a 2nd Ward Clerk & was told there was no £.
A senior trainee being sent to get the coffee by the consultant while the AA does the blocks... Feeling bad for my colleagues on the other side of the curtain.
So this is real. What is more shocking; that a consultant demanded a doctor's shoes as punishment, that the doctor handed over their shoes...or that it was a care of the elderly consultant? They're meant to be the nice ones!
⚠️ WHAT is going on in the NHS?
Doctors - you have the right so say ‘F*** Off’ in these scenarios
Whist these Consultants exist, medicine will be further degraded
In any other workplace this would be an investigated for harassment/subhuman working conditions
@ImperialNHS
@DrNeilStone
Yes we should. They look like the Royal London Rotation are proud of their incoming trainees. This is a major milestone in their career and this is a nice way of celebrating their achievement.
A lot of sense being made here. Patients need to know yes you are the doctor looking after them, not the 'junior', the 'trainee' or by first name. There ain't nothing junior about the work being done by those under consultant/SAS level and gives a false impression of our level.
From last week’s
@bmj_latest
.
@scarlettmcnally
would like us to call doctors “doctors”, and drop the term “junior” and “trainee”.
She’s got a point! Read more here.
Link if preferred:
When seeing patients, I now always introduce my FY/SHO juniors to the patients as Dr [name]. They're professionals who earned their title and do a difficult job day in, day out. There's nothing 'junior' about it. My boss also introduces me as Mr Ho, which I do also appreciate.
please use “doctor” w/ us
When speaking about a consultant, say “consultant”. SAS, say SAS
When speaking to patients,I use “doctor” or “surgeon”, & then clarify my role in the team
When speaking to colleagues, i may use some “jargon” - SpR etc
#JuniorDoctorsStrike
#medtwitter
Receiving the 8th referral from ED for minimally displaced distal radius fractures that just needs a cast and fracture clinic while scrubbed in theatre struggling to put a smashed ankle back together.
Honoured to be nominated for this award and very pleased I was able to have such a positive impact on this patient during their time in hospital. I will endeavour to maintain this level of care throughout the rest of my future practice going forward.
Congratulations, Sebastian Ho, for your Living Our Values nomination!
A patient nominated Sebastian for the fantastic care and attention they received following a broken ankle.
Well done, Sebastian!
It was a long 3 hours drive back but what a fascinating couple of days. Worked through the Stoppa, KL and Ilioinguinal approaches on cadavers, PW and APC fracture plating, pelvic ex fixes, passing SI screw guidewires and built on my previous P&A trauma knowledge. So awesome!
@timricketts_
UK docs seem in a constant need to put themselves down and honestly it's truly baffling. Saving lives is kind of a big part of what we do. It's a big part of why we went in to this profession.
@daphnetchia
You are exactly right. Junior surgical trainees should be doing these rather than service provision. Some 'senior people' will say 'but these are simple cases' but nothing is simple until you've done dozens of them and then progressed on to more complicated operations.
'Selecting the future surgeons who will be operating on patients is very resource intensive. So we will instead shortlist them using the GP exam...' Why not add some other unrelated assessment to cut down candidate numbers. Determined applicants will do it regardless...
This was only 7 ringgit, which is about £1.20. In UK, this would be about £11.00, no roast chicken option, chicken less taste. Ahh... do I have to go back?
@walsh_joe
Will never understand this mindset. Many people work hard but ours is highly technically demanding, requires many years of training, and have extremely high consequences if things go wrong. Why keep comparing to 'the average'. It undervalued what we do.
@mrthomasjacques
...you spent hours performing it? It's a skill that should be second nature. I'm an Orthopod but chips down in trauma call, I will bleed, cannulate, fem stab or stick a chest drain in a patient because it's within my skill set. As doctors we should be able to do it all.
The devastating human cost inflicted upon doctors of tomorrow. Before launching into a job with long hours and high stress, they'll have family and friend support networks stripped away and sent wherever the UKFPO decides. Now with no influence over where this is. Terrible...
Finals started today and we had to do our OSCE whilst people were trying not to cry after getting sent to foundation deaneries at the bottom of their list. As grads, some have spouses, houses and babies that UKFPO don’t count as a reason to consider for mitigation. An awful day
...yeah that's definitely what it is.
If you keep telling a group of people they're so special they can complete med school in less than half the time, no wonder they come out thinking they're the best.
The N&N taught me to be a surgeon through my CST years. Returning years later as a Reg in Spine, Pelvis and Limb Recon has been an absolutely wild ride. It's been the toughest year ever but I'm grateful to all my trainers who have pushed me be the best I can be.
@eoeortho
Taking a stand at Addies today for our profession. This is not a decision taken lightly but FPR is required or we will continue to haemorrhage doctors to greener pastures abroad.
@lorraine_hickey
I thought it would be a challenging career path but we'd put in the work and be renumerated well for it. Man, we were all naive children...
Falling down the Pubmed rabbit hole of DHS/SHS vs IM Nail for intertrochanteric fractures again after being denied the use of a short TFNA last week...
@veggieequallife
Ahh the old passive aggressive 'so you're not coming to see this referral. I'm going to datix you.'
I wonder which type of HCP and specialty that could be... 🤔
@DrMaxxC
It's very difficult for them these days. Less focus on learning the job and specialties, and more on hunting the elusive sign offs to allow them to pass the year, which I get. And doctors stretched too thin to sit down and teach them and facilitate training.
Attention Medical Students & Foundation Year Doctors! Book now for Medical Student Day at 2023 BOA Annual Congress on 21st September at Liverpool. The theme for the day is ‘Grand Theft Ortho’ - an immersive day of interaction between all players of T&O!
@ollieburtonmed
Fortunately PAs and SCPs can take over roles previously done by doctors...like the procedural work and clinics while the doctors get dumped with the paperwork and wards...
@AkbaniUmair
Amazing. There is a certain dedication to nonsense like that that doesn't even pause while striking. No doubt they would also tell you off for having hot drinks in direct view of patients.
@passing_gas
After being hyperfocused, scrubbed and standing for 12 hours, I need to eat, take a leak, work the stiffness out of my knees, and literally just step out of that environment for a moment. It's not quite the same being on the other side of the curtain.
@drdamoeyes
The MSN messenger generation has no need to be taught this in med school 😂 The only ones who need to be taught to type are our old school consultants when we're having supervisor meetings and watching them tap out a sentence with two index fingers.
@ShivaniM_KC
It wasn't even that. It was 'don't say anything or we'll sanction you. And write an apology to this alleged murderer.' It's even worse than just turning a blind eye.
Been asked to do a teaching session for 4th year med students on 'soft tissue injuries' for an hour. Bit of a broad topic in that time. What should I definitely cover
#orthotwitter
? Each condition could be their own talk!
I mean, while UK doctor morale is at an all time low, why wouldn't you want to get your kicks in there.
I like how they added Google at the back too, really just hammer in how much contempt they have for the profession.
Teaching Cambridge medical students how to repair the tendons of injured pigs with Plastics (but really Orthopaedics) fellow
@daphnetchia
!
Now they can walk again!
@MedleyMelanin
The problem is these people talking down their own profession weaken our position. If we don't respect ourselves as professionals who do a very difficult job, why should anyone else?
So it's been 15 years since I last painted any minutures but it has been surprisingly therapeutic post call getting back in to it.
Decided to keep it retro with Heresy legionnaires; Dark Angels in MkIII armour and Blood Angels in MKVI armour. Turned out alright I think!
Must be nice for a surgical junior to have a structured rota that includes plenty of theatre and clinic time. Could you even begin to dream of such a thing...
I’ve had it.
We need to shut this down.
Surgical trainees, what do you think of this nonsense?
Why are you giving up your lives whilst this is happening?
@fatima_medic
I mean... I have a cons who says 'well done' when people do things even if they're wrong which I thought was funny. And it was funnier when I was assisting him in theatre and he was saying it while he was operating himself. 😂
Teaching keen medical students from my old med school today together with one of my old colleagues! Hoping to get the next gen of Orthopaedic surgeons ready for the road ahead!
#MedEd
#medicaleducation
#ortho
#orthopaedics
So, my journey back to Malaysia and SG has come to an end. So much has changed since I was last back and I wish I'd returned sooner.
Until next time...
So this is interesting. Having a mentor in Med school, prior to being a higher surgical trainee is an absolutely wild concept for me but it shouldn't be.
Did many UK doctors have mentors to inspire us down a specialty path that early on and if not, why don't we?
#medtwitter
Thrilled to have matched in Orthopaedic Surgery at Houston Methodist Hospital! Thank you to all my family, friends, and mentors who have supported and challenged me throughout this process. So excited for this next chapter! 🦴🛠️
@MethodistHosp
#orthotwitter
#MedTwitter
#Match2023
Meeting and chatting with many other ATLS instructors and course directors from across the country at the College, and hearing some fascinating talks from doctors from both UK and across the pond.
Pardon? CT and MRI reporting? CT Ablation?
Just so I get this clear, the reports we're now potentially going to make clinical decisions off will be reported by someone without a med degree or Radiology specialty training.
Well, I don't foresee any potential problems there...
4 hours up and another 4 back down between Harrogate and Norwich but I've successfully completed my ATLS Instructor course! Looking forward to helping others gear up to manage trauma patients in future!
#orthotwitter
@Davemademedoit
@techpriest
One day your boss complained to anaesthetics that they were taking too long and anaesthetics told them 'if it's so easy, you do it yourself.' And so they did. 😂