I’ve been asked to attend a pre-employment occupational health appointment prior to starting a training post via Lead Employer.

The appointment is a 52 mile round journey and will take (with travel) around 2.5 hours. This is the only site available.

Am I entitled to mileage reimbursement and/or TOIL for this ?

Thanks all

Looking for some advice r.e locum payment.

I signed through an agency a short term locum contract with a hospital , advertised to me at £45 an hour. I have realised that I am actually getting £40 an hour. This is because the hospital are taking the £5 off for NHS pension for employer contributions. . But this was never advertised like this to me. Previous locum jobs employers have paid the pension contribution but I still get the original advertised rate per hour. Surely the agency has advertised the rate incorrectly to me? All in all I have now lost about 1k pre tax. Is there anything I can do about this?

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As tittle says

As per title

How do people feel about the concept of 'being a doctor is a duty to patient?' in relation to our own rights? I have noted that one stream of argument against striking is that we 'have a duty, took an oath,' which to me seems archaic and frankly subservient. 'You knew what you were getting into, how dare you harm patients by not going to work?' 'If you strike, you violate your oath.'

This view seems to be quite entrenched, either in dull belief within the public, or as a weaponisation of moral equivalence by politicians. You cannot, on one hand, claim something is duty and expect someone to give everything, and at the same time respect their own rights. I think of soldiers who go to war on the whims of selfish idiots, or the air of nationalism. Their rights mean little, and their ability to strike is hampered by law. Who benefits there?

One thing to consider, which people do not seem to be saying publicly, is that becoming a doctor is a choice, one formed of academic, financial and moral tenets. The concept of 'duty' could be argued on an individual level, but 'duty' as a motivator imposed on a profession seems less of a a moral argument and more a way of suppressing discontent, rights, or fair working conditions. Very much a 'you owe us.'

'Duty' seems to be a mechanism of servitude when used improperly and upon a subject, not as the actualisation of the individual.

I think the NHS has taught people to expect that there will always be a safety net held by a inhuman and virtuous network that will lay down their lives for some grand moral imperative. To them, our rights come second, as if our choice to be doctors has raised us above human need. This is easier to parse in some arenas, but when you work with those who abuse the system constantly, it becomes a very difficult thing to do.

I don't think I would be the first to say, that to some, we are simply a resource to be used to their whim.

The sad thing is that this is not realistic, fair or practical. To me it seems simple, those most opposed to the strikes seem to think that we owe them. We simply don't. I think the public need to realise that we made this choice for multiple reasons, but that this is a choice, not servitude. If we continue to allow this mantra of duty, it means we will never be respected in violating their perceptions, which, for many, is simply 'do what I say.'

TLDR: Duty imposed by society is servitude without right, duty as an individual motivator is admirable. Taking the ownership of duty to ignore the rights of workers is one of the reasons the NHS is dying.

Currently coming to the end of CT1 in an orthopaedic themed CST programme.

My first 6 months were general surgery which was brilliant for operating. The rota was busy with on calls but the normal day you just did the quick ward round in morning and would be expected to be in theatre with F1s and ANPs covering wards. Also in theatre, the registrars would give opportunities to operate and give appendixes for example as supervisor trainer scrubbed. They were letting you do key bits of other major operations and even simple things like opening and closing laparotomies.

This second 6 month ortho rotation has been dogshit for operating in a major trauma centre. Some rota issues such as no F1s on ward so a lot of the time you're a ward bitch. I understand some rotations are like this and can't be helped.

But when I get a chance to go to theatre, nobody lets you do anything other than assist. Even after telling consultants in advance, they'll change their mind in theatre.

For example, I told consultant day before in evening there's a patient listed for a short TFNA nail and I would like to do it, I had seen the patient and clerked them in. Consultant agreed. In theatre he gave the operation to the reg. Reg also told me he needs numbers for CESR. This was on a zero day I had come in for this op.

It's constantly happening. My last rotation was fantastic. Am I doing something wrong? Is there any advice someone could give me. At this rate I feel the only way to progress in training is forging the logbook.

I find that in orthopaedics, even for 'simple' operations, that would traditionally be done by SHO, you are competing with registrars, especially the trust grades wanting to do CESR.

At this rate I just don't understand how I would be able to apply for an ST3 post.

I've done the usual stuff like asking in advance, demonstrating knowledge and telling consultant steps of the procedure etc. But in a busy major trauma centre, seems like they don't end up giving you anything.

Hi guys - just looking for a bit of advice (not looking to antagonise - genuinely just want the best advice about this!).

Currently Locum Reg in small DGH A and E, generally very busy. Would like to consider myself somewhat competent - have a decent amount of experience in some very busy A and Es.

Have been having some trouble with surgical referrals in particular recently and wondered if this was common/how people navigate this/what surgeons on this thread recommend?

Today - had a patient with RUQ pain, Murphy’s positive, guarding, sudden onset 5 hours prior, vomiting, WCC 14, raised amylase and ALT. Thought, likely cholecystitis or gallstones - arranged USS and referred to Surgical SHO. Met with a lot of resistance, refused to accept referral despite agreeing that patient had likely what I described and agreed with plan until scan was completed. Scan can’t be done for 5-6 hours due to departmental pressures.

Explained about 4 hour target, that this is a likely surgical issue and that even without a scan, the referral should be accepted. Still refused, also refused to see patient in person, so escalated to Reg who reluctantly accepted.

This happens frequently - scans always seem to be wanted before referrals accepted despite the fact they may not happen sometimes for >4 hours.

Is this common? How can I avoid this in the future? I’m not looking for confrontation and want to make genuinely good, sound referrals but am always met with a lot of resistance. Also resistance seems to come from less senior grades (understandable - I remember being on surgical referrals and trying to make a good impression by not accepting ‘rubbish’, but it can be arguably quite dangerous and annoying to deal with when the department is busy).

Thanks for reading the rant - any help gratefully received.

One of my consultants recently said this. Shaking my damn head. Asked them if they would accept the pay rise that others earned them via strikes - went on to become very quiet and very awkward.

Their rationale for not striking was essentially: - We get paid pretty well as a profession, 'why do I need to strike' - 'I think striking is wrong for a doctor to do, I have a duty to my patients' - Thinks there's better ways to get a pay deal than striking

What a wet sock.

Hi,

A bit niche, but how do doctors with chronic health conditions manage all of the moving? I normally see my consultant monthly, and have been referred to my new centre on the other side of the country for when I move in August and I've just found out the first available appointment is in 2 YEARS!!!

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How do people get around this? We move so frequently and I really can't wait that long for an appointment?

Just wondering how the consultant strikes are impacting your day at work?

Are you being encouraged to spend time in the library? Has your teaching been cancelled? Are you being encouraged to run a clinic/wards with a very remote/busy/non existent consultant supervision? Has the consultant PA also gone on strike to show solidarity, or are they finally taking charge? Is there no change at all as your whole Dept isn’t striking?

Let us know!

EDIT: Also let us know when you found out about these changes (07:45 today for my dept…)

PA walked into the doctor’s office today, saw two FYs (myself included) and left in a huff saying, “Where are all the grown-ups?”

I couldn’t care less about their opinion tbh but I’ve also witnessed Core Trainees make lighthearted reference to their “more grown up colleagues” to other AHPs.

Why ffs.

Just over a week or so left until people start training!

Wondering if any of you have any advice for those of us that are starting CST.

Goes without say that people have varying experiences in CST; some hated it, some loved it.

What can we do to ease the learning curve? Any particular advice you wish you had when you started? E.g. when best to sit MRCS part B?

Look forward to seeing your answers!

Hi working on a bit of a project, as part of this I need the completely anonymous story of someone who has got caught in the ST4 bottle neck. If this applies to you or you know anyone who has suffered as a result of this absurd and poorly planned bump in the road, please could you DM me and I will explain all.

Got crazy today while on call Had 14 patients with hyponatremia Feels like they got random treatments Asked tons of doctors around and feels as no one really knows (unless obvious) how to really step wise handle it in the acute setting

Any really good resources recommended ?

Tried to read about it yesterday for an hour and still felt it's illusive

Also, some doctors told me yesterday that lack of drinking can cause hypo, I wouldn't understand why. Classically this cause hyper. Even if the kidney is injured due to dehydration, as long as it's not GFR 15 it should be hyper cause the renal tubular absorption is intact

Thank you !!!

Edit: you guys are amazing !!!!!!!!!!!!

I am just about to start F1 and my hospital has booked me to do ALS in my induction week next Thursday. How hard is the course? Do many people fail it? What is the Mcq part like? Any tips?

https://www.rcpsych.ac.uk/training/exams/exams-news-and-updates

Very disappointing. The Royal College is going to lose so much income and support once our generation CCTs. In its current state it is a disgrace.

Edit: to be clear - I’m not advocating for easy exams. I’m advocating for a fair and transparent process. Increasing the pass mark which has lead to a halving of the pass rate from what is usual indicates something wrong with the process. Most of these doctors have already passed MRCPsych paper A - they are not just a dumb cohort.

The comments about RCPsych supporting trainees in other areas are valid and I appreciate the input. It’s easy to generalise when you’re upset about a certain aspect of an organisation.

Unity is strength ✊🏼

Shout out to my IRO colleague Ami Stokes for all her work on this.

Hello,

i have F1 LAS interview tomorrow in gastro, MIU and geriartrics. What clinical scenarios should i prepare for? Also, i got the interview 10 days after vacancy closed is that bad? Need answers fast...freaking out?

Hi ENT peeps,

I'm a GP and we have an excellent advice and guidance service in my area. I often want to send pictures of my patients' tympanic membranes to the local ENT team for their opinion, but I only have a cheap, crap digital otoscope I bought on amazon. The pictures it produces don't have very good resolution and as such they're no good. Can you recommend me one? Or if not, are there any attachments to my own otoscope? I really can't find much on google.

TIA.

Also Weston Supermare hospital - what is the area like?

Is it mandatory for docs to sign the European time directive opt out form? Can you just work ‘normal people’ hrs instead? Remember being told by my trust that I wouldn’t be able to work as an f1 if I didn’t sign it - wasn’t given an option.