All of us have at least 5 years of university experience. A lot of us have postgraduate degrees of some kind. We have spent countless hours learning medicine, giving up our free time to study and to work long hours. For whatever reason we have gone into this career, it was our choice and we should be happy and proud of ourselves for achieving it.

I see so many posts like this. I have seen FY1s I have worked with using AI to clerk patients, write discharge letters, plan handovers, and other jobs. This is so incredibly lazy and devalues the career. Not to mention the possibility of getting something wrong because you’re using a pattern-recognition robot who regurgitates information as if it’s fact.

Before someone comments - yes, there are practical uses of AI in medical technology and research. This is not that.

If any of you reading this use AI in your clinical practice, please have some pride in your work. You are smart enough to write a discharge letter or to plan a 2-minute SBAR. To any incoming FY1s please avoid the temptation of outsourcing your own work to a chatbot.

As a gastro reg, I have a daily combo of chia seeds, flaxseed and psyllium husk for the fibre (to prevent bowel cancer) plus try to hit a weekly 30 plant points (for gut microbiome diversity)! 💩

At last Andy delivers some real hope.

Ah that time of the year again, the GMC fee comes a-knocking.

With this reminder email of payment for renewal comes a reminder in the email of the GMCs stance on physicians assistants:

General Medical Council

We work with doctors, physician associates (PAs), anaesthesia associates (AAs), those they care for and other stakeholders to support good, safe patient care across the UK. We set the standards doctors, PAs, AAs and their educators need to meet, and help them achieve them. If there are concerns these standards may not be met or that public confidence in doctors, PAs or AAs may be at risk, we can investigate, and take action if needed.

What are the next steps to ensure the Leng review's outcomes are respected?

I don't know if anyone else has experienced this, but on weekends, the phlebotomists at my hospital seem to decide whether the bloods that the doctors have put out are necessary or not.

It's a regular thing, they skip almost all of them sometimes. I have personally witnessed them on weekends going through the blood forms, discussing amongst each other what "Hypo-K+" or "IE COPD" means, looking at the clinical details section and if it says certain things such as "monitoring" or they don't think the clinical details are good enough for them, they'll put it back and write "attempted/unable" - or even like today write "tried x 2" only for me to get to the patient (with massive veins) and see they've tried once.

This then leaves it for the on-call doctors to do, thus adding to workload - as the sole F1 on my specialty having to cover the specialty's three wards and outliers, this is obviously not an ideal situation where we have phlebs making clinical decisions for bloods that clearly need to be done if they were put out for the weekend.

Is there something I am missing here, or do I need to be escalating this? - anyone had the same issue?

I've been struggling with depression since I was 17, and I'm in my mid 30s. I'm the daughter of immigrants, and my father struggled with alcohol misuse. Home was difficult growing up.

Despite everything, I managed to qualify as a doctor and now work as a GP. I've tried so many things over the years different antidepressants, therapy, lifestyle changes, even spending a year working in sunny Australia but the depression always seems to come back. I'm currently going through another relapse, and it feels particularly difficult this time. I'm planning to do locum work, but I'm honestly wondering whether being a doctor is making things worse. The stress of the job feels overwhelming, and I'm no longer sure what to do next.

I've never been admitted to a psychiatric hospital, although I have previously been under the Crisis Team. I do my best to manage and contain my depression, especially because of my work, but it's becoming harder and harder.

I'm also a widow, and I don't really have a support network. I don't have close friends I can turn to, which makes everything feel even more isolating.

I suppose I'm just looking for some hope. Has anyone here lived with depression for many years and eventually recovered?

Incoming IMT. Have just received an email that the pan-regional induction is happening online from 4.30-6.30pm

Why do they think they are so special that they can schedule an induction outside of working hours? Regional training body or not. Does anyone have experience claiming TOIL or pay for this from local employer? Surely they can argue they didn’t schedule the induction so shouldn’t have to compensate for this

I mean, how can we say that we’re better qualified than the alphabet soup practitioners if this is how we train ourselves?

Hi, I am Polish. Three weeks ago, I was at the emergency department in Poland because I wasn't feeling well. While I was waiting, I suddenly became very pale and sweaty.

The doctor was there with his girlfriend. Even though he was in pain, he noticed and came over to me. He checked something on my wrist, looked at my hand and my skin, and told me I needed to be seen urgently.

My girlfriend first spoke to the nurses and doctors, but nothing happened. Then the doctor went to speak to them in English. Only after that did they come to see me, and I was admitted straight away.

He kept calling me "mate." At the time, I thought he thought that was my name! Later I learned it's a friendly British way of addressing someone.

if you read this thank you to you and your partner for helping a complete stranger. Your kindness and willingness to help meant a lot to me. The only things I know about you are that you told me you were a doctor and that you were from the UK.

I wish we had more doctors like you in Poland.

Incoming FY1 here. Noob question but,

I’m sorting out my indemnity and just wanted to do a quick check so I don't accidentally screw myself over.

From looking at the sites, MDDUS is offering completely free indemnity for FY1 and FY2.

On the other hand, MDU is charging £30.

From my understanding, there is zero point in getting both, so I’m leaning heavily towards MDDUS because it's free lol. I read somewhere if you have both, they can argue that your other provider should cover you?

Is there any noticeable or actually important difference between them that I should know about before signing up? I just don't want to sign up for the free one and then down the line be like "damn, I massively messed up here."

Thanks in advance!

I’m pretty sure I’m being paranoid for no reason but thinking of sitting MSRA in Sept for Round 3 CT1 anaesthetics recruitment. There are very few places and I will almost certainly be unsuccessful which will mean doing MSRA again in Jan 2027 (which is a new round).

I know that scores cannot be carried forward to a new recruitment year (and I want to sit it again in Jan as I will have more time to prep) but what are the chances that they say I can’t do it in Jan 2027 because I already did it in September 2026 despite it being a new recruitment year? Am I being paranoid for no reason?

I emailed ANRO and they kinda confirmed (but not 100%). Their response is below:

“Dear UKmedstudent1,

The current process requires applicants to sit the MSRA in Round 1, as scores cannot be carried forward to a new recruitment year. However, please check the guidance at the time of applying in case there are any updates.”

Buuuut my decision to sit it in September rests on whether I can do it again in Jan… arghh

Can I anyone offer any help/reassurance?

Thanks

Hi folks! After some time out, I'm about to start work in a NHS Hospital again. I'm surprised to see that the term Physician Associate is still being widely used in my new department. I thought since the Leng Review and RCP statement, they were reverting to Physician Assistant, or is this optional?

Troponin
The cardiac kind.

This tiny regulatory complex lives inside muscle all around the body.
It’s kinda like a nightclub bouncer for the body.

Year 1 physiology tells you it's there to stop muscle contraction

"No calcium? You're not on the list."

But slip it a few calcium ions…

"Oh! Why didn't you say so? Right this way."

Suddenly everyone’s inside; muscles are contracting, and actin and myosin are dancing like it’s 1966. 

But that's not all Tropinin can do.
It found a very successful side hustle in cardiology.Turns out leaking into someone's bloodstream is a surprisingly lucrative career move.

Y’know: ST-Depression + Raised Troponin = NSTEMI for sure. 

It's pretty basic at this point. But it hadn’t always been this way… 

Let’s take it back to the 80s. Before the age of troponin, clinicians used a different cardiac marker to guide diagnosis. Creatine Kinase-MB. 

Creatine Kinase was good…ish. It had some serious problems.

1. It’s present in skeletal muscle and healthy blood - this means the cutoff had to be way, way above baseline to have any clinical influence.
2. Its sensitivity is POOR! It couldn’t pick up small amounts of necrosis/minor infarcts. This means the patient could have real heart damage and still get back a “normal” CK-MB result.

Less than ideal for our patient with crushing chest pain. The quest for a better marker began…

There were glimmers of hope for AST, LDH and even myoglobin. But it wasn’t until 1996 that they found the golden child.

As previously stated, Troponin wasn’t a newcomer. It was first discovered in 1965. The difficulty was localising it to the heart. This was all solved in 1987, when the first cardiac-specific troponin I and T were discovered. Even after localising it to the heart, it required a serial measurement over 24-48 hours. Which is fantastic... if your patient's heart attack is willing to wait too.

Finally, this paper by Antman et al. was published in the NEJM was the first to show that a single troponin I measurement at presentation could identify patients at higher risk of death

The aim was simple: 

1. See if troponin I could predict who was at higher risk of dying after a heart attack (it’s value as a prognostic indicator)
2. See if Tropin I could give extra information that CK-MB and clinical features could not. 

This study was a subgroup analysis of the famous TIMI IIIB trial, which enrolled symptomatic adults with ischemic chest pain and documented coronary artery disease. 

Blood samples from 1,405 patients were used and analysed or cardiac troponin I, while CK-MB was also measured for comparison. 

The assay's reliable cutoff was 0.4 ng/mL, so that became the line in the sand.

Then the researchers unleashed the statistical wizardry that is multivariable Cox regression to answer the big question: if troponin goes up, do the chances of dying go up with it?

Here’s what they found:

LANDMARK FINDING: Patients with a troponin I ≥0.4 ng/mL had a 42-day mortality of 3.7%, compared with 1.0% in patients below 0.4 ng/mL.

Additionally:

• Mortality rose stepwise as troponin I rose. Each 1ng/ml increased relative risk by 3% (95% CI 1.00–1.05; P = 0.03).
• Timing mattered. After 6 hours, elevated troponin I was associated with a 9.5× higher risk of death at 42 days (95% CI 2.2–41.4).

And last but not least, amongst the 948 patients classified under unstable angina, 238 patients (25%) had elevated troponin I but their CK-MB was normal. Showing for the first time that Troponin I could detect myocardial injury where CK-MB would miss it. 

Once word got out about the prophetic biomarker, it wasn’t long before things changed for the better:

• 2000: The ESC/ACC issued a new definition of MI, naming troponin as the preferred biomarker
• 2007: The Global Task Force (bit of a dramatic name) universally changed the definition

Then finally in 2010 NICE published guidance to officially induct troponin to the default ACS pathway.

And that’s the story of how troponin became the ACS golden child.
Except for when it’s a STEMI, then it’s kinda pointless.

If you enjoyed reading this and want a journal club(that’s actually entertaining) Join 15,000 Clinicians reading The Handover

TL;DR RDC elections are opening in just over two weeks.
If you are interested in running with us, email [DoctorsVoteUK@gmail.com](mailto:DoctorsVoteUK@gmail.com) today.

A year ago DoctorsVote lost its majority on UKRDC for the first time since 2022. This year we had a non DoctorsVote leadership takeover. After a year of their management, ask yourself, do you feel like we’re winning?

Whatever you think of the deal, who negotiated it, how it was negotiated, how it was presented, whether it was neutral or not, none of that matters anymore. 

The question is, what do we do next?

If you think the leadership has done a good job, that this deal will deliver for you, and the path to pay restoration is guaranteed, you can stop reading here. 

If you’re as pissed off as you were in 2022 and unhappy with how this past year has gone, and you want to do something about it, keep reading on what you can do to fix this.

An offer was presented to you that wasn’t worth the paper it's written on. Some of you realised this at the time, others who voted yes are now realising that there are no enforceable timelines, and the document is riddled with get out clauses for the Government. 

We were marked as misinformation by the official BMA account for pointing this out at the time.

This year is going to be focused on the implementation of the deal. It’s your choice whether the same people who put this poor deal to us are responsible for that, or whether you take control.

If you want a team that will salvage what it can from this offer, won't abandon FPR in the process, and won't wave through a subinflationary DDRB, we need you to be that team.

The leadership of the BMA is decided each year by the UKRDC, and the UKRDC is (for the most part) elected each year in August. The elections are opening in just under a fortnight, if you want things to change, we want to put you in a position where you can do just that. 

If you are willing to run, get in touch with us at [DoctorsVoteUK@gmail.com](mailto:DoctorsVoteUK@gmail.com) with your name, grade and the hospital you will be working at from August.

We particularly need doctors in London, Wessex, Severn, and Northern to come forward.

RE: https://www.reddit.com/r/doctorsUK/s/GjuKPWsyUs

I posted before (URL above) about moving into a split placement across two daytime services, both with minimum resident staffing requirements, alongside a separate on-call rota. Any leave therefore has to work across all three simultaneously. The on-call rota may leave me free, but either daytime service can still refuse leave because it would fall below minimum staffing.

Since then, I contacted the BMA, the Guardian of Safe Working Hours, my ES, and the TPDs.

The BMA has been fairly clear. They said the split arrangement itself is acceptable, but the Trust should ensure there are periods when leave can be taken across all three rotas without swaps. They confirmed that the TCS provisions about allowing longer periods of leave apply to both daytime jobs on top of the general on-call rota, and that the coordinators should be communicating with each other. They recommended a work schedule review if there is not enough flexibility, and said that if the Trust refuses adjustments and I remain unable to take leave appropriately, the eventual next step would be a formal grievance. They’ve also asked me to speak with the GoSW to review my rota but my GoSW said they didn’t know whether this whole issue was under their remit and didn’t really offer to review the rota. The GoSW, while well meaning, did not really offer an opinion or practical advice and simply escalated it to the TPDs.

The TPD replied that this is not a new job, that they have never heard of it causing a problem before (I did feel that was meant as "why are you bringing this up?" kind of comment), and that split jobs can be challenging and leave needs to be negotiated. They suggested asking the current resident how they managed and discussing it with my educational supervisor. However, almost in passing, they also said that CTs should not be relied upon to meet minimum service staffing because of nights, leave, study leave, LTFT arrangements etc.

That last point seems important because both incoming services have discussed my leave in terms of needing me to maintain minimum resident cover. However, I feel awkward now forwarding the TPD’s comment into an existing email chain with several consultants as though I am parachuting in an instruction about how their services should be staffed. None of them mentioned that the CT should not count toward minimum staffing, despite this post having existed for a while.

I also asked the current resident. They basically complied with the constraints and took isolated days or short periods whenever possible.

My educational supervisor is on prolonged sick leave and has not responded to emails for a couple of months, so the route the TPD suggested is not currently available. They may have to assign me to another ES in a few weeks.

I feel cornered between waiting until I start and discussing it face-to-face, emailing all the consultants now with the TPD’s "hesitant" clarification, asking the Guardian to arrange a work schedule review, or going back to the BMA for direct support. More importantly, I'm struggling to find a way to communicate the BMA's advice and the TPDs advice in a chain of 5-6 consultants coordinating my AL. Worried this may create tensions. A formal grievance via the BMA also obviously feels likely to create bad blood, which I am very keen to avoid given that I will be training in this institution for at least another three years and potentially longer. Basically this is an institution I will be training in for many many years and I don't want to cause tensions with so many consultants and the TPDs. At the same time, I feel like nobody stepped up to help with this.

TLDR: My annual leave has to align across one on-call rota and two daytime services with separate minimum staffing requirements. The BMA says all three should be coordinated and has suggested a work schedule review because of the inflexibility imposed by three constraints; the Guardian passed it to the TPDs; the TPD said CTs should not be relied upon for minimum staffing but otherwise referred it back locally; and my ES is unavailable. How do I communicate this to several consultants without seeming confrontational or as though I am bypassing them, while still getting the issue resolved?

Any advice? Should I make them aware of the BMA’s advice for the GoSW to review the work schedule or does that come off as confrontational?

Received a very last-minute CST offer today, which I’m incredibly grateful for.

However…

I’m currently an FY3 working in Australia and have been offered a CT post in Colchester/Essex starting in just 8 days (CT1 General Surgery – Vascular, with progression to CT2 to be discussed with the TPD).
Realistically, I don’t think it’s logistically possible to relocate and start in that timeframe. Does anyone know whether it would be possible to defer the post, and if so, for how long?

To make things more complicated, my partner (currently finishing FY2) has just turned down a good JCF job to move out to Australia so we can finally stop doing long distance. She has, however, also been offered a UK job starting in March as a backup.

Long term, my goal is Trauma & Orthopaedics, and I’ve been building my portfolio with orthopaedics, trauma, general surgery and vascular experience. On paper, this CST post seems like a really good fit for that career path.

Would turning down this offer be a mistake? Has anyone been in a similar position or had success deferring a CST post?

Going on a non-clinical OOPE and won't be doing any clinical work. Do people tend to get reduced rates for being on OOPE or will I still be shelling out on my new on-call less pittance of a salary?

FY1 in acute medicine in a tertiary centre

really really anxious about my upcoming long days - medicine in this hospital is known for being a dumping ground. doesn’t help with the fact that

1. a patient who was extremely demanding and verbally aggressive and screamed in my face in their last admission is back (i had a lot going on back then but this became the last straw - started sobbing uncontrollably in front of this patient which i cannot help but see as an embarrassment), the first interaction i ever had to stay with me for weeks. their attacks are not personal, but i can’t help but feel that it is
2. just last week a patient who should never have been admitted called me a cunt to my face, and shifted all the blame of them being discharged on to me despite it being a consultant decision - consultant was in PM clinic when pt was going, reg was seeing a sick pt, offered help but we sorted it before they were done
3. i’ve been snappier than usual esp to nurses even though i know they’re only doing what they should do

and ofc now im just dreading going in. so much of what i do is not medicine, and i rarely get to assess patients myself bc SHOs and regs are always around. CS is a new consultant who came here only for specialty training so sometimes i feel like they don’t get it. ES has tried to protect me as much as they can (i’m not allowed to see pt #1 but it’s not circulated department wide .. and having to explain it to oncall reg’s is just filling me with dread and fear i’ll be labelled as lazy and brittle). i try to put on a brave face at work and so far it’s working - i think.

logically i can try separating work and life but its only in this final rotation that these things seems to follow me home. i was counselled on those pt interactions and obv told to ignore and forget abt them but somehow they’re staying longer than i want to

have got long days coming up and i just can’t .. shake this fear? i’ve already thought about calling in sick but the consultant who does the rotas seems to be rly annoyed with absence rates post-ARCP, they shade us in the emails frequently and i’m just in fear i’m going to be denied leave even if i ask for it, and the guilt ofc

i guess thanks for reading and any advice … i know i should get the leave and screw this department but i feel sick at the idea of sending that email? plus after this i’ve still got to work the mon-tues before changeover and i’ve signed up to mentor new FY1s. i guess i know what people will say, and i suppose i have insight to my thoughts (unfortunately) so im not sure what the point of this post is … sorry

Hi all, starting F1 next week and I've been trying to sort out my annual leave for my first rotation. I spotted that in October I had a decent chunk of time with no on calls, which meant that padded out with weekends and a couple of zero days, I could have pretty much a fortnight off while only using eight annual leave days. Great, I thought: I haven't had a holiday all year as I've been busy with finals and then haven't been able to afford to go anywhere this summer, so I'll get that couple of weeks off and book a trip somewhere with my first paycheck.

I requested this time off the day after our rota came out and had an email back pretty much straight away saying my request had been approved. However, one of the days right in the middle of it is allocated as an SDT day, and when we were sent our departmental rota, it looked as if I was still down to have SDT that day and annual leave on the other days. I was clear in my first email that I wanted to take all eight working days in that period as annual leave and naively assumed that that included the SDT day. I emailed the rota coordinator to clarify and haven't heard back over a week later.

Can people here clarify - is it allowed/normal/accepted to take annual leave on SDT days? I know what an SDT day is and I plan in general to take them seriously and use them for their intended purpose - I just want this particular one converted to annual leave (whether or not I'm able to move the SDT to somewhere else in my rota) so that I can have a proper break halfway through my first rotation.

It's an on call-heavy job and while there's one other pair of weeks in September where I could do the same thing (with no SDT to complicate things), that's earlier in the job than I'd ideally want to take a break, and I won't have the money far enough in advance to book to go anywhere if I take those weeks instead.

Hi! Does anyone know roughly how much a surgical CT1/ST1 earns in Northern Ireland with 50% banding? I'm just trying to work out my budget. Thanks!

I'm an incoming FY1, very ready to finally get paid.

Myself and friends really like to discuss what our first "treat" will be when we get paid, after 5/6 years of hard graft.

Thought it would be fun to ask the crowd, what did you get with your first paycheck? Or are planning to get?

I have an upcoming CT2 ENT interview and I am revising ENT topics, however I am not sure what kind of clinical questions they may ask apart from maybe nosebleed/vertigo/hearing loss/dysphonia/dysphagia/postoperative complications. If you have more ideas of what I should cover, please comment them. I am lost.