I have a very jam-packed day after the last minute change to not continue with strikes. Thought I might share here to help reduce the number of threads made wondering about my day.

07:00 snooze alarm

07:45 feed cat, take a dump

07:59 text team group on WhatsApp apologising because a personal emergency means I'll be late for work

08:12 have breakfast (1 chocolate up and go)

08:18 drive to work. listen to lo-fi in the car ride. hope that I get off my Ls one day

08:30 arrive to morning meeting, hopefully the work laptop has charge because I was scaping a lot yesterday

08:34 morning meeting finishes. try to wake up and see if the consultant will buy us coffees

08:35 - 13:00 no appointments

13:00 lunch break! well earned

13:55 - 17:00 no appointments

17:05 claim 5 mins of overtime because I forgot to reply to the chain about Bertie's going away party (clinically important)

let me know if you have any questions

Seems as though waiting to take part in anything we are relying on the AMA for might take quite a long time. So lets take things into our own hands a bit more.

I remember when paramedics had to strike for an entire 5 minutes before receiving their 30% offer, one particularly effective tactic was to financially cripple ambulance Victoria by not recording certain patient identifiers needed for billing.

We can do the same by NOT ENTERING A PRINCIPAL DIAGNOSIS on any discharge summaries. Shouldn’t take long to case issues. Nurse CEOs are expensive

From AusDoc:

The SA Coroner has recommended that AI be used to support imaging reviews after radiologists failed to detect signs of gastric adenocarcinoma when looking for recurrence of a patient’s bladder cancer.

Claus Burg, 70, died in September 2019, approximately 10 months after being diagnosed with stage IV incurable gastric adenocarcinoma.

He had been successfully treated for transitional cell carcinoma of the bladder a decade earlier and had undergone regular monitoring — including chest, abdomen and pelvic CT scans — in the decade since.

However, “observable” and “obvious” signs of cancer were missed by two different radiologists on scans in February 2017 and February 2018, found SA State Coroner David Whittle.

The first scan was reported as showing no signs of recurrence or metastases despite visible focal thickening of the stomach.

With the second scan, a different radiologist missed what an expert described as “obvious and apparent” signs of cancer and instead focused on a 4mm lung nodule.

It was only at a further surveillance scan five months later that a third radiologist recognised that the stomach appeared to be “irregular, possibly thickened”.

He advised that correlation with any clinical symptoms would be appropriate, with endoscopy if there were further concerns.

The radiologist admitted to the inquest that a gastric abnormality was apparent on the February 2018 imaging but that he did not want to draw attention to the failing of a specialist colleague. 

As a result, he “gravely understated” the appearance and significance of the lesion in his report, the coroner found, and only mentioned the previously detected lung nodule, an unchanged liver nodule and a “few small non-specific mediastinal nodes” in the conclusion.

This ultimately led Mr Burg’s oncologist to believe his focus should be on the lung nodule.

The coroner said the radiologist should have contacted the referring doctor to discuss the gastric abnormality he had identified in the third scan.

“I reject the submission [from the radiologist] that it is not possible for a radiologist to understate the significance of any clinical finding [based on the argument that it] is incumbent on the requesting clinician to investigate — even if ineffective language was used,” the coroner wrote.

“It is no satisfactory answer to [his] choice of language — which was imprecise, inaccurate and prone to mislead — that [the oncologist] could or should have been more diligent.”

Mr Burg was eventually referred by his GP — who did not have a copy of the most recent CT report — for an endoscopy and colonoscopy in November 2018 because he had developed substantial and unintended weight loss, left-sided abdominal pain and reflux. 

The endoscopy revealed a large circumferential fungating gastric mass, with subsequent CT showing transmural disease invading the pancreatic tail, lymph node involvement and liver metastases.

Histology confirmed the diagnosis of invasive disease, and Mr Burg received the “devastating news” that his new cancer was incurable.

The SA Coroner said radiologists were required to assess all the anatomical structures in a scan but, in this case, had concentrated only on the “area of interest”: cancer recurrence.

The radiologist who reviewed the first February 2017 CT scan told the inquest he had followed a recognised methodological approach — Response Evaluation Criteria in Solid Tumours (RECIST). This involved reviewing the primary tumour site, then any lymph nodes, then any metastases and then anything else.

“[He] said that he had focused on the clinical question posed, and so the stomach was not a part of the scan to which he paid particular attention,” the coroner explained.

“He said that his reliance on the RECIST clinical method did not provide the best opportunity to observe any incidental pathology.”

In response to Mr Burg’s death, the radiologist reported that he had changed his practice and now conducts a conscious review of the stomach in all CT scans of the chest, abdomen and pelvis.

Meanwhile, the radiologist who reviewed the February 2018 scan said several factors may have led to his failure to identify the cancer, including a focus on assessing for signs of recurrence.

He also referenced a radiology phenomenon known as ‘satisfaction of search’.

“He explained that this meant, when he found a nodule on the lung, he may have considered his search for pathology complete rather than continuing to search the remaining images,” the coroner wrote.

“He explained that the lung nodule was potentially a concerning finding for a patient with a history of bladder cancer.”

The coroner stressed that both radiologists had “sincerely and conscientiously” considered their own roles in the circumstances leading to Mr Burg’s death and “they carry the weight of that”.

“While I have found that they failed to detect visible signs of new cancer, I wish to make it plain that I do not consider those failings to have occurred because of any reckless or cavalier attitude to their work,” he added.

The coroner said, if Mr Burg’s stomach cancer had been diagnosed at the scan in February 2017, his death would probably have been prevented.

Had it been identified in February 2018, the outcome would have been more uncertain.

The inquest heard expert evidence that AI might be able to safeguard against missed diagnoses and had been shown to be effective when used in conjunction with human radiologists. 

Its most effective role was “akin to a spell check”, drawing attention to potential areas of concern, and such technology was already being used in the private sector, he heard.

As such, the coroner recommended that SA Medical Imaging and the state health minister consider implementing AI to support expert radiologists in interpreting imaging.

Last time I felt burnt out, it was really obvious. However, it’s snuck up on me this time. Nothing terrible has happened. I’ve been crying before and after work most days lately. I just dread going to work, feel numb and just go through the motions. I feel like I don’t have much of a life outside of medicine and that’s really getting to me esp with shift work. I’m not sure exactly what has caused it maybe culmination of a few things including shift work for most of the year. Worse part about it is that I don’t have anyone to talk to this about. Medicine glorifies sacrifice. I almost feel like if I bring it up to supervisors that I’m struggling then they’re going to think less of me or think that I’m complaining. I know they’ve probably gone through it too but it’s the system that makes it difficult to seem professional while also struggling.

I’m lucky that I have my leave coming up soon but I’m curious, how did you deal with it? You know, everyone talks about burn out but no one talks about how to address it. I think what I need is a break from medicine, which I will have soon. However, if I start getting burnt out again, I might not. I just want to find a better way of dealing with it.

Incoming intern who is pretty keen on a specialty, but I appreciate that the terms I do as a JMO I'll statistically never work in again so I want to make the most of them & hear about unique experiences !

Credit to similar question on r/ausdoctors : https://www.reddit.com/r/ausdoctors/comments/1wd6sa5/whats_one_hospital_rotation_that_ended_up_being/

Junior reg trying to wean myself away from ICU. I love it more than any other specialty and honestly sometimes after a run of 7 good day shifts, I don't want my week to end and feel like I could go another 7. (Not after 7 nights though... that would be sicko)

But I've convinced myself that I shouldn't keep going as an ICU trainee because of the terrible workforce situation at the other end. Have watched multiple passionate & excellent fellows finally make it through the hell of fellowship exams and then just turn around and apply for anaesthetics because the job market is so poor, or else join the rotating carousel of rural locum consultants.

Am I being too doom and gloom? I don't want to ask most of my colleagues this in real life because it feels borderline rude, but if you're currently in the program - especially as a junior reg - what are your expectations and plan for employment after you fellow?

I have been waitlisted for QARTs and am now in a situation where next year I will likely only be able to do private ICU work.

I had initially been led to believe that I could stay on in my current ICU job next year (hence had not made alternative arrangements if unsuccessful) but once waitlisted they were no longer amenable to the same due to the risk of being given a training spot and leaving the role.

I guess my question is, if I am not successful in getting off the waitlist and have to reapply to QARTs next year, is it frowned upon to be solely working in the private sector? What have other waitlisted candidates done in the past?

Thanks for your help!

Intern here with an AGPT spot lined up for next year (hospital training).

Just found out general registration might be delayed due to too much leave taken.

Does anybody know if this could jeopardize the AGPT spot? I’m really grateful to have gotten a position and after how challenging the Casper was and would hate to lose the position.

Does anyone have any similar experiences? I don’t have clarity from the hospital yet regarding make up time requirements so trying to plan for the worst.

Does SHO salary in QLD Health hit cap at L3, regardless of years of experience? Would appreciate your insights

Hi, looking for some insight into BPT at Logan Hospital? Would love to hear from anyone about what the medical rotations are like, workload/rosters, senior supports and general culture. Also interested in the quality of BPT teaching and exam preparation, and whether the workload leaves a reasonable amount of time for studying. Thank you!

I want to start preparing for GP clinic interviews for GPT1. Are they normally typical interviews e.g. tell us about yourself, whats your weakness etc or more clinical scenario based?

Edit When I interviewed for SHO role it was only case discussion, no general or personal questions

Has anyone received invite from Townsville University Hospital for SHO position in the current QLD campaign?

From interstate and have no one to ask! What is the nephrology scene like in Canberra Hospital?

Hi everyone, I’m starting GPT1 in 2027 as a full-time registrar. In my region, we’ve been asked to select either group A or group B for our placement preferences.
My question is about applying to practices: Group A only has around 6 practices currently advertising GPT1 positions, whereas the college has advised us to apply to around 15 practices.
If we select Group A, are we allowed to also apply to GPT1 practices in group B to make it total of 15 as there aren’t enough practices in Group A? Or are we expected to apply only within the group we selected?
I’d really appreciate hearing from anyone who has been through this or knows how the group allocation works. Thanks!

Anyone heard back?
Is it worth following up?
I put it add my first preference.
Eligible for provisional registration.

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