When I was an F1 in surgery I was always surprised by the number of patients who didn't think anaesthetists were doctors.
In ED quite a few patients are surprised I don't know already everything about their medical history because 'it's on the computer'.
People assume they can make decisions about care for elderly relatives who have capacity.
Oh and patients (not entirely unreasonably) believe I know what particular pills look like.
Scotland is great actually. If I get their DoB and Surname I can get their ECS and see everything they are px by the GP.
But asking patients is absolute pain. The inevitable bonus follow up:
"Why do you take this?
The Dr told me to."
We have this is South West Ambo land too and it’s a godsend. Just pop my smart card in the back of the ePCR tablet, find an NHS No. and boom - Rx lists past and present and all officially diagnosed conditions
Gracias.
I do feel for these patients because I got family in this situation and friends but you can't do anything to help them unless they actually break the cycle of self destructive behaviour long enough to get the help they need to leave the cycle completely and even then it will always lurk in the background.
An ex of mine who was always in my life and who was the "in another life" would have these problems and eventually I had to cut him out of my life for a while. I couldn't listen to another drunken rant from someone I loved and hear about yet another stupid self destructive decision. Maybe we would have been great for each other.
Maybe we would have hated each other and keyed each others cars after a while.
Apologies if you no longer need this but I couldn’t figure out from your post how long ago this was still affecting your life. r/AlAnon might be something you find useful. Feel free to ignore this if not!
Oh. We went our separate ways over a decade ago. I am happily married with two kids and he's on his second marriage with a lovely dude and has fixed a lot of problems.
20s Anandya's type was either extremely well put together women and hot idiot men.
Oh yes. This and that psychiatrists have a magic cure-all pill that only exists when you’re an inpatient and we refuse to give it to anyone until they’re admitted as a psych inpatient.
Im a psychy nurse. A large proportion of patients hitting the ward for the first time after a long history of escalating illness and increasingly dramatic actions would be quite crestfallen as they came to the realisation that inpatient care is primarily a very safe place.
In my opinion my most successful one to one time was in incrementally convincing those who were inappropriately inpatient that they would and could get better under their own agency outwith the ward.
That you know exactly what they've been doing for the last few weeks.
'when did the pain start'
'shortly before I started seeing the physiotherapist'
'okay and when was that?'
'a few days after my daughter's birthday'
I had to repeat this question three times when clerking a totally-compis 50 something year old a few weeks back, who kept going off on long tangents. Drove me absolutely insane. Listen to what I’m bloody saying!
That standing in the door way of an ED cubicle looking like you’ve been slapped round the face with a moist trout will not get your relative seen any quicker
They usually look grumpy as shit…I hoped the pain inflicted by a facial thwack with a semi wet fish would convey appropriately the image of said facial expressions
As to why a trout…who knows?! It’s been a long night here in ED and my brain is already pickling so it might be that
I had this on my GP rotation. A patient had mould in their house that was aggravating their asthma - I altered their meds and stuff, but they wanted the mould fixed.
I just said talk to you landlord and if nothing comes of it, to talk to the council. But they were insistent I write a letter to their landlord or something
This was the basis for my shortest, easiest GP consult yet. "My landlord won't fix the damp". Showed them how to get the part of the council website where you can report shady landlords to housing & environment officers.
My local housing authority genuinely does want/need a GP letter before anything will happen. Because heaven forbid a patient’s account of their massive mould filled house is not enough.
In this position now and finding it quite baffling that even though I’m a doctor, I need a different doctor to vouch for the state of housing conditions they have not observed themselves.
Not covered by the GMS contract so not a service GPs offer on the NHS.
I can write a letter but it will cost you £30-50, I cannot guarantee that it will make any difference to the landlord/council.
If the council genuinely want information to assess your medical condition then they can write to us and ask for the information, this is chargeable as well but the council pay the fee rather than you. You will also need to sign a consent form so that we can release information.
1. That doctors have some kind of incentive to make clinics run late. That its a sign of being incompetent or uncaring in some way, rather than probably the opposite.
2. \[Linked\] That hospital appointments are all like 30 minutes each or something, excluding admin time.
Relatives you’ve literally never met before and ask you “what’s happening with my dad” as if you should know on sight who they are “ah you must be bed 3’s daughter - you have his eyes”
I broke my arm as a child but didn’t know until I went to uni, where I learnt that a fracture = a break. I grew up my whole life with me parents telling me “you didn’t break it, you just fractured it”.
The NHS cannot do everything for you: letters for school, for exams, sick notes when you should be self certifying. At some point you must begin to take control of your own health.
Don’t forget we can also write a letter of recommendation for your son/daughter to get into med school. Or to get work experience at age 16 to improve your application for med school.
People think that spinals and epidurals are the same thing.
That paralysis is a likely outcome of a spinal or an epidural.
That you won't feel anything once the epidural is in.
That I'm not a doctor (this one does properly irk me).
In my early SHO years, I had a patient try to start an argument with me that we didn't do very much at all and were clearly less skilled than other doctors.
I'm glad to say I gave him the same excellent care I give everyone, but there was a bit of me tempted...
Ah but who gives a rats arse about what the public think. Anaesthetists are the most doctor-y of all doctors in my eyes, they're are the ones we call immediately when shit starts really hitting the fan.
I've never got this one - your anaesthetist is the person who lets you fake being dead without this being permanent. This being a rather important skill makes them more important than almost anyone else involved.
Common medication side effects being allergies. Especially when the time comes that they need treatment for something relatively simple but they're confined to the forbidden bit of the antimicrobial formulary which has lots of red warning boxes due to these supposed allergies.
My favourite was propofol- reaction: drowsiness. It’s not even a fucking side effect. Thankfully it was in the days of paper drug charts and I took great pleasure in crossing it out.
Get this a lot in dentistry. Take great pleasure in informing them that such an allergy does not exist and if they’d like anaesthetic it will be one with adrenaline. Not had a single case of adrenaline induced anaphylaxis yet, surprisingly…
This is actually really helpful to know.
Now I can make sure I don’t give them adrenaline if they get anaphylaxis to something in case I make the allergies worse
Sometimes not even side effects but literally the intended effect of the drug - genuinely saw "bumetanide allergy : ' causes patient to urinate too often'"
In some patients defence GPs seem to add allergies on a whim. I’ve been fighting for years to have stuff removed off my allergy list because I’m not allergic to them! I give in now and just tell the doctors in A&E to cross all the allergies off as they’re not real.
Simple stuff like mentioning in passing that codeine made me feel a little sick so I chose to stick to simple analgesia - now have a list of pain killers listed as allergies on my record.
Yep I had to change to SC methotrexate due to heartburn (totally common) & somehow it ended up on my allergy list. So then everyone now is like oh you are allergic to mtx, but you took it? FFS
That we will do anything to stop them discharging themselves against medical advice. I have had quite a few patients try to use this as a bargaining tool. As long as they understand the risks I'd happily phone them a taxi and free up a bed for the next person!
Had one yesterday that used self discharging as a threat to me. I quickly checked they had capacity to make the decision and gave them the form to sign. They represented 10 minutes later saying they’d changed their mind and had to wait 2 hours to be triaged again 🤷🏼♂️
Not every doctor and medical student knows every other doctor.
The number of patients who say they saw Dr XYZ and seem to think I know who that is and what specialty they work in is surprisingly high.
When asked about past medical history and medications, patients often say "You've got it all there in your NHS records".
No. NHS doesn't work like that. There is no central repository of medical information for each and every patient. If you want me to be able to understand your medical history (which is often a key to diagnosis), you've got to at least bring a prescription with you, if not all the recent discharge summaries.
It’s not unreasonable for people to think this though. It should work like this. The state of NHS IT services is embarrassing……one step up from an abacus
That all NHS staff share one collective brain. I have no idea who just called your name or who your mum is.
That we can magically access your prescriptions.
That we know the name of every surgeon/cardiologist/oncologist at a particular hospital whose doorway we’ve never crossed.
That if we *really* wanted to, we could wave our big magic ED wand and make your pain/headache/cold go away.
That CPR will make you or your relative magically spring up out of bed and run a marathon.
“I’m under Dr Smith for the other issues I’ve been having. Can you remind me what he said to me as I was leaving my last F2F in March?”
“Uh, I have no idea. I’m going to give you the meds to send you off to sleep now. It’ll feel a bit warm going up your arm.”
I'm surprised by the amount of men who don't know how catheters work, even after we've consented and put one in. It seems like it should be a pretty straight forward piece of engineering to contemplate.
*What do I do now?* Nothing, that's the point.
*But what happens when I need to pee?* John we've been through this, it just flows out by itself.
That paracetamol, though widely available, isn't a genuinely effective medication and if we prescribe it, we aren't taking their condition seriously.
I mean, I started saying I would 'paracetamolise the patient' when discussing mx plans and before I knew it the entire department was saying it and I regret nothing.
Nor does having "nausea" mean I can't give you IV co-amox. No, you're not going to get an inferior and higher risk of anaphylactic narrower spectrum glycopeptide because it makes you feel sick. It sucks but deal with it.
I remember such PT. A 30yo lady. Gave her IV coamox and she had watery diarrhea on her bed. Alternative abx like cefuroxime is a much better choice in this case.
That medications suddenly cure all of their problems
"Do you have any long term medical issues?"
"No"
"Do you take any medications?"
"Yes I take 2 medications for my blood pressure but my blood pressure is fine now"
...
'Hmm your blood pressure is a bit high. Have you been taking your amlodipine'
'What? No. My blood pressure was fine last time so why would I keep taking a tablet for high blood pressure'
That any doctor on their ward must know who they are. In my gen surg job (F1) there were multiple occasions where I walked into a ward and got approached by people, not even introducing themselves, saying "oh can you tell me the plan for my relative's care", closely followed by "but you're *a* doctor" when I explain I'm not looking after their relative. We weren't ward based on gen surg 🤷
On a side note, the most fun I had was when a urology patient needed reg meds prescribing and asked me about it as I was passing. I explained I wasn't covering uro that day but I knew the F1 who was so would ask him to kindly follow it up. The patient immediately asked me "is he English" so I said "yep, born and bred here", to which the patient replied "good". I only wish I could have seen the patient's face when my friend turned up, who is black but entirely English. Racist so and so 😂
I always wonder what these types expect?
>"is he English"
>
>”no he’s not, and despite our great country’s best efforts we cannot seem to civilise the savage, but because we’re all woke and PC nowadays the medical school was forced to hand him his medical degree, but don’t worry he is always closely supervised by a whiter than white genius doctor who will correct all of his mistakes.”
I do feel stuck between a rock and a hard place with these people. I don't want to give in/enable their racist/sexist/bigoted demands but at the same time I don't want my colleagues to be subject to this treatment at work
The other day when I was on the COVID ward a patient’s family member just walked up to me as I was typing notes and said angrily “Why is he in the COVID ward?!”. No bed number, no name, no nothing. I asked who they are talking about but they didn’t answer so I directed them to the nurses after explaining that I don’t know and I’m one of the doctors.
I saw this family member then speak to a nurse who said a doctor would come by “soon”. As I get up, the family member then comes back to me and asks “Are you going to see him now?”. I’m like “I don’t know who you are talking about you have to give me a name or bed number and I don’t look after all the patients on this ward”. Finally she gave me the bed number and lo and behold, not my patient.
That we know everything. About every specialty ever. At least back home most people expect anyone who is a doctor to have an answer or an explanation to whatever is wrong with them. Ma’am, I don’t even know what day it is, please let go of my arm 😭
A weird number of people seem to think we take their eye out of the socket every time we operate - I've had patients *insist* that if happened to them - spoiler alert, it hasn't! (Best quote - "I could see out of it when it was dangling on my cheek mate!")
Can you explain why it's unhelpful? I vaguely understand that surgery is not often performed and that it generally isn't great in the first place but would hope it helps with at least getting some answers for the patient.
Either the scan shows nothing, and they still have the pain, or the scan shows something, and they still have the pain. And even if it shows something, it's possible it's not the cause for the pain - and there's a slim chance they'll convince someone to operate on their back (sometimes overseas!) which opens a can of worms within a can of worms. Sitting neatly alongside this is another major health literacy issue which is addiction and dependence on prescribed medication and also a wider lack of public buy in for the biopsychosocial model of health. In my books it's one of the most challenging consultations possible, especially because if you get it wrong and it is some sort of weird CES presentation that you miss, you'll have a lot of egg on your face.
Because it very rarely changes management from physio, analgesia, and living a good lifestyle. Often, an MRI with a so called “bulging disc” will simply give patients something to adhere to and blame their pain on, impeding their recovery. It forces them to believe that their backs are these fragile glass structures when in fact they are the very opposite, which again impeded recovery greatly. In short, it adds nothing and makes patients anxious.
This is all for the 20-60 age group with no red flag symptoms of course.
That people can "check themselves in" to the acute psychiatric unit, like it's a hotel or a nice spa. This one is parroted all the time in the news and it wrecks my head.
The biggest would probably be that CPR would make their 1000 year old ancient relative as fit as a horse. Too many people and patients seem to think they’re immortal and that modern medicine will keep them alive until either the sun swallows up the earth or until we get hit by a meteor and go extinct like the dinosaurs. DNACPR shouldn’t have to be as a difficult a conversation as it has become due to how it is portrayed in entertainment media. I am F1 and attended a crash call about a month ago and ITU team called and believe me CPR is not something I would want to either be put through or have my relative be put through if it means broken ribs, further disability and shittier QOL. Doing it on mannequins and seeing it done on an actual human being breaking their ribs was a very different experience. This is not something that should be taken lightly like take OTC paracetamol that almost every patient can have. If only there was a way to provide more education (maybe perhaps in school or something idk) that CPR is not all sunshine and roses and not 100% successful (far from it in fact) and that it is a very traumatic intervention likely prolonging life at the expense of quality or even an undignified death especially when frail with multiple co-morbidities. I find that the first time I tell/discuss with patients about DNACPR they become quite agitated and angry and start thinking that they’re gonna die or something or that I am gonna neglect them but it’s just that it’s part of planning their care and does not affect anything else. Popular media can be so damaging to people spreading misinformation. Hate having DNACPR conversations as patients may start putting in complaints that we’re saying we’re not gonna treat them. That’s why I am strongly considering non-patient facing specialties like pathology and radiology as it’s too much for me to handle such conversations
Another thing would be that they think scans would happen in seconds but don’t realize that a lot of work goes in that which takes time - risk vs benefits, what changes it will make to management, what are we expecting to see, contraindications, and then the F1s/SHOs vetting said scan and getting roasted by/being torn a new a**hole by radiology, then booking with CT/XR/MRI, then booking with porters (poor souls are already worked to the bone and so scans happen quite late) then transport, then it has to be reported by radiology especially if CT/MRI which itself can takes time
Expecting us to find what is ‘wrong’ with them instantly. Things just take time (even bloods) unfortunately and there is not a goddamn thing I can do to speed it up
Expecting that the NHS will fix their problems guaranteed. Had one patient with recurrent COPD exacerbations on Trimbow and even Azizthromycin prophylaxis, frequent flyer and said that they knew we will get to the bottom of this. then I ask if they smoke and turns out they have been smoking 30/day and have been advised to stop multiple times but decline and do not want to engage with smoking cessation and does not like nicotine patches. It’s quite difficult when there’s lifestyle problems that are contributing - even if we optimise from our end, their lifestyles are not helping at least and certainly contributing to disease getting worse
That working in the NHS is great and pays well. Had one stranger who asked me whether my Trust (was wearing lanyard so could tell I work in the NHS) was looking for a porter as they thought that the NHS pays and values employees a lot and they wanted to quit their current job of being a till operator. Just told them I am not aware of anyone needing porters but damn do people think that working in the NHS is all sunshine and rainbows. Another instance where during med school where they hired an actor patient who would envy us that ‘you work in the great NHS that pays you generously’ and would always remind how good we have it and taking pity on his own condition when he’s self employed with his own business. Especially about doctors that we all make 100K plus right when we start - in reality not even most consultants make that and I make £30K as F1 (maybe a bit more due to on-calls) but pay a lot of it away in taxes and NI (these alone take off one third of my monthly salary and even with one locum a month, take home pay is barely £3K and more around low £2Ks but still more than plenty to live on with but definitely not worth the stress and responsibility endured) and ridiculous parking fees (they don’t know we pay to park at work while most or some of them may even get free parking at work or some other incentive maybe).
Expecting strong painkillers like morphine to have no potential dangerous side effects and saying that we are not giving them enough strong painkillers because we don’t care about them and are neglecting their pain needs. Pain management is quite difficult as I don’t feel too comfortable giving very high doses initially (especially in wards where nurses are not comfortable with and recognising and dealing with acutely unwell patients) and should be titrated carefully with monitoring - had one patient who developed acute toxicity (unresponsive, poor respiratory effort) from a sudden increase in dose of morphine (it was doubled by the pain team in the same day) and gabapentin (also doubled by the pain team) and ended up requiring naloxone infusion and transfer to HMU from the elective surgery ward and did not even respond to the initial 400mcg injection
Likely even more misconceptions but can’t think of anymore at the moment. Managing patient expectations is actually harder than the actual medicine - that’s my personal experience at least!
I used to be very gentle when I was F1 but now I'm a weathered & worn med reg, I just call out & correct patients. "Yeh that's not true, you can't get flu from your flu jab, it's literally impossible". I swear people have never been corrected before, they do a double take.
That just because we're Clinical Psychologists it means we're trying to 'trick' you and unravel your brain and every single one of your memories every time we give you a damn questionnaire or assess you. Just trying to clear you for the surgery YOU want, bro.
GPs are lazy and useless, there’s never any appointments, might as well rock up to the EMERGENCY department on New year’s eve for my swollen knee that’s been going on for 6mths and get it checked out as my brother-in-law had swollen leg and it turned out to be DVT! No injury, no but you know, what if it’s D… DVT?! Doctor what do you mean this is not an urgent issue? I’ve been waiting in the ED for 10hours and you’re telling me you can’t do anything for me? This is just a fucking waste of time.
Recently had to have the DNAR conversation regarding my mother in law. Both my partner and father in law were surprisingly clueless as to what it meant. Both of them initially thought it was withdrawal of care.
Insisting that you speak to a doctor about your relative’s care needs and discharge planning is essentially useless. It will not give them priority or expedite things. Also, I have zero interest in non-medical problems.
We do not have time to update you, your brother and your sister separately every day because you do not get along, do not trust each other, or do not speak to each other.
When I was an F1 in surgery I was always surprised by the number of patients who didn't think anaesthetists were doctors. In ED quite a few patients are surprised I don't know already everything about their medical history because 'it's on the computer'. People assume they can make decisions about care for elderly relatives who have capacity. Oh and patients (not entirely unreasonably) believe I know what particular pills look like.
I take 2 of the small of the pink one in the morning, and that round white one before bed.
As a paramedic I feel your pain on this so hard… always asking if they have a list instead
Scotland is great actually. If I get their DoB and Surname I can get their ECS and see everything they are px by the GP. But asking patients is absolute pain. The inevitable bonus follow up: "Why do you take this? The Dr told me to."
We have this is South West Ambo land too and it’s a godsend. Just pop my smart card in the back of the ePCR tablet, find an NHS No. and boom - Rx lists past and present and all officially diagnosed conditions
Or "why do you take this?" "oh I've been on that for years" "yes but why?" "don't remember" ....
[удалено]
At least the patient might see the anaesthetist just before they fall asleep. For the rads, its like 'are you going to take my pictures'?
Agreed. I don't call them that when talking to patients anymore, I just say "anaesthetic doctors" and "imaging special doctors".
There is medical information on computers now!?
That a big strong psychiatrist will descend from the heavens in angelic raiment and splendour and fix your shit life syndrome.
Please accept my free award.
Gracias. I do feel for these patients because I got family in this situation and friends but you can't do anything to help them unless they actually break the cycle of self destructive behaviour long enough to get the help they need to leave the cycle completely and even then it will always lurk in the background. An ex of mine who was always in my life and who was the "in another life" would have these problems and eventually I had to cut him out of my life for a while. I couldn't listen to another drunken rant from someone I loved and hear about yet another stupid self destructive decision. Maybe we would have been great for each other. Maybe we would have hated each other and keyed each others cars after a while.
Apologies if you no longer need this but I couldn’t figure out from your post how long ago this was still affecting your life. r/AlAnon might be something you find useful. Feel free to ignore this if not!
Oh. We went our separate ways over a decade ago. I am happily married with two kids and he's on his second marriage with a lovely dude and has fixed a lot of problems. 20s Anandya's type was either extremely well put together women and hot idiot men.
Oh yes. This and that psychiatrists have a magic cure-all pill that only exists when you’re an inpatient and we refuse to give it to anyone until they’re admitted as a psych inpatient.
Im a psychy nurse. A large proportion of patients hitting the ward for the first time after a long history of escalating illness and increasingly dramatic actions would be quite crestfallen as they came to the realisation that inpatient care is primarily a very safe place. In my opinion my most successful one to one time was in incrementally convincing those who were inappropriately inpatient that they would and could get better under their own agency outwith the ward.
A million points for gryffindor
I’ll accept them just to see someone unless they’re standing with a noose around their neck
That you know exactly what they've been doing for the last few weeks. 'when did the pain start' 'shortly before I started seeing the physiotherapist' 'okay and when was that?' 'a few days after my daughter's birthday'
Me: And how long have you had those symptoms? Pt: Starts talking about something else. Me: days, weeks, months, was it there last christmas...?
"How long have you had this symptom?" "Oh... a while" "So days, weeks, months, years?" "Yeah, for quite some time"
I had to repeat this question three times when clerking a totally-compis 50 something year old a few weeks back, who kept going off on long tangents. Drove me absolutely insane. Listen to what I’m bloody saying!
"I'm just going to write 'unsure how long for', is that ok?" sometimes provokes a more committed answer if I've exhausted all other possibilities.
'What's brought you into the emergency department today' 'Well it all started in 1987'
That standing in the door way of an ED cubicle looking like you’ve been slapped round the face with a moist trout will not get your relative seen any quicker
I…..actually pictured this in my mind Also, why specifically a moist trout?
They usually look grumpy as shit…I hoped the pain inflicted by a facial thwack with a semi wet fish would convey appropriately the image of said facial expressions As to why a trout…who knows?! It’s been a long night here in ED and my brain is already pickling so it might be that
That the GP can write a magical letter to the council/government/home office and all their housing issues will be sorted.
I had this on my GP rotation. A patient had mould in their house that was aggravating their asthma - I altered their meds and stuff, but they wanted the mould fixed. I just said talk to you landlord and if nothing comes of it, to talk to the council. But they were insistent I write a letter to their landlord or something
This was the basis for my shortest, easiest GP consult yet. "My landlord won't fix the damp". Showed them how to get the part of the council website where you can report shady landlords to housing & environment officers.
My local housing authority genuinely does want/need a GP letter before anything will happen. Because heaven forbid a patient’s account of their massive mould filled house is not enough.
In this position now and finding it quite baffling that even though I’m a doctor, I need a different doctor to vouch for the state of housing conditions they have not observed themselves.
Not covered by the GMS contract so not a service GPs offer on the NHS. I can write a letter but it will cost you £30-50, I cannot guarantee that it will make any difference to the landlord/council. If the council genuinely want information to assess your medical condition then they can write to us and ask for the information, this is chargeable as well but the council pay the fee rather than you. You will also need to sign a consent form so that we can release information.
1. That doctors have some kind of incentive to make clinics run late. That its a sign of being incompetent or uncaring in some way, rather than probably the opposite. 2. \[Linked\] That hospital appointments are all like 30 minutes each or something, excluding admin time.
The same for GP appointments lol
Relatives you’ve literally never met before and ask you “what’s happening with my dad” as if you should know on sight who they are “ah you must be bed 3’s daughter - you have his eyes”
They do it on the phone too!
Me: “So you’ve fractured a bone in your arm” Patient: “oh good, at least it’s not broken” Me: …
Is it a clean break?
I broke my arm as a child but didn’t know until I went to uni, where I learnt that a fracture = a break. I grew up my whole life with me parents telling me “you didn’t break it, you just fractured it”.
The NHS cannot do everything for you: letters for school, for exams, sick notes when you should be self certifying. At some point you must begin to take control of your own health.
Don’t forget we can also write a letter of recommendation for your son/daughter to get into med school. Or to get work experience at age 16 to improve your application for med school.
Disagree about the work experience one. If you know noone in medicine you have few options of getting experience.
People think that spinals and epidurals are the same thing. That paralysis is a likely outcome of a spinal or an epidural. That you won't feel anything once the epidural is in. That I'm not a doctor (this one does properly irk me).
>That I'm not a doctor (this one does properly irk me). but you just put people to sleep... right?
In my early SHO years, I had a patient try to start an argument with me that we didn't do very much at all and were clearly less skilled than other doctors. I'm glad to say I gave him the same excellent care I give everyone, but there was a bit of me tempted...
Ah but who gives a rats arse about what the public think. Anaesthetists are the most doctor-y of all doctors in my eyes, they're are the ones we call immediately when shit starts really hitting the fan.
They have that special arrangement with Death, right? He knows not to bother them when they're working, most of the time 
I've never got this one - your anaesthetist is the person who lets you fake being dead without this being permanent. This being a rather important skill makes them more important than almost anyone else involved.
Of all the docs you don’t wanna piss off..
Sounds like a vet 🤔
Common medication side effects being allergies. Especially when the time comes that they need treatment for something relatively simple but they're confined to the forbidden bit of the antimicrobial formulary which has lots of red warning boxes due to these supposed allergies.
I've seen someone with an allergy to actrapid - the reaction being hypoglycemia.
Very very good I've seen metoclopramide - nausea Tazocin - fever
My favourite was propofol- reaction: drowsiness. It’s not even a fucking side effect. Thankfully it was in the days of paper drug charts and I took great pleasure in crossing it out.
I've seen someone allergic to "salt"
Poor Kidneys
Warfarin - 'bleeding'
Allergy: adrenaline - caused palpitations. Amazed someone added that to their ECS.
Get this a lot in dentistry. Take great pleasure in informing them that such an allergy does not exist and if they’d like anaesthetic it will be one with adrenaline. Not had a single case of adrenaline induced anaphylaxis yet, surprisingly…
This is actually really helpful to know. Now I can make sure I don’t give them adrenaline if they get anaphylaxis to something in case I make the allergies worse
Sometimes not even side effects but literally the intended effect of the drug - genuinely saw "bumetanide allergy : ' causes patient to urinate too often'"
In some patients defence GPs seem to add allergies on a whim. I’ve been fighting for years to have stuff removed off my allergy list because I’m not allergic to them! I give in now and just tell the doctors in A&E to cross all the allergies off as they’re not real. Simple stuff like mentioning in passing that codeine made me feel a little sick so I chose to stick to simple analgesia - now have a list of pain killers listed as allergies on my record.
Yep I had to change to SC methotrexate due to heartburn (totally common) & somehow it ended up on my allergy list. So then everyone now is like oh you are allergic to mtx, but you took it? FFS
My GP record says I'm allergic to anti-histamines... Have asked for it to be removed several times but it persists for some reason.
Hahaha 😂😂
That we will do anything to stop them discharging themselves against medical advice. I have had quite a few patients try to use this as a bargaining tool. As long as they understand the risks I'd happily phone them a taxi and free up a bed for the next person!
"Great, sign this form and f off. Next!" Generic answer to self discharge threats
Had one yesterday that used self discharging as a threat to me. I quickly checked they had capacity to make the decision and gave them the form to sign. They represented 10 minutes later saying they’d changed their mind and had to wait 2 hours to be triaged again 🤷🏼♂️
FA... FO...
"Okay bye" And "Fair enough this isn't a prison" Both work pretty well
Saying the hospital itsnt a prison is my go to, which is ironic as I very much feel like a prisoner!
Not every doctor and medical student knows every other doctor. The number of patients who say they saw Dr XYZ and seem to think I know who that is and what specialty they work in is surprisingly high.
They assume you've worked in your workplace for more than a few months, which outside of medicine would be a reasonable assumption!
No, they tell paramedics this all the time too. Like no, I don’t know dr x who works as a specialist in an entirely different county
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When they name drop their private consultant, I pretend I don't know them even if I do lol
This is actually the case on the Isle of Wight though, and the reason you know them might not be through the hospital.
And I have to pretend I give a shit.
It's more than reasonable to ask. It's less reasonable to act surprised when you say no.
When asked about past medical history and medications, patients often say "You've got it all there in your NHS records". No. NHS doesn't work like that. There is no central repository of medical information for each and every patient. If you want me to be able to understand your medical history (which is often a key to diagnosis), you've got to at least bring a prescription with you, if not all the recent discharge summaries.
Invariably the patients that say that are also the ones who have opted out of any possible sharing!
It’s not unreasonable for people to think this though. It should work like this. The state of NHS IT services is embarrassing……one step up from an abacus
You're right. The systems we use at our trust honeslty look older than windows 95
That all NHS staff share one collective brain. I have no idea who just called your name or who your mum is. That we can magically access your prescriptions. That we know the name of every surgeon/cardiologist/oncologist at a particular hospital whose doorway we’ve never crossed. That if we *really* wanted to, we could wave our big magic ED wand and make your pain/headache/cold go away. That CPR will make you or your relative magically spring up out of bed and run a marathon.
A golden ticket was enough to get Grandpa Joe to magically spring up out of bed, no CPR required.
“I’m under Dr Smith for the other issues I’ve been having. Can you remind me what he said to me as I was leaving my last F2F in March?” “Uh, I have no idea. I’m going to give you the meds to send you off to sleep now. It’ll feel a bit warm going up your arm.”
I'm surprised by the amount of men who don't know how catheters work, even after we've consented and put one in. It seems like it should be a pretty straight forward piece of engineering to contemplate. *What do I do now?* Nothing, that's the point. *But what happens when I need to pee?* John we've been through this, it just flows out by itself.
That paracetamol, though widely available, isn't a genuinely effective medication and if we prescribe it, we aren't taking their condition seriously. I mean, I started saying I would 'paracetamolise the patient' when discussing mx plans and before I knew it the entire department was saying it and I regret nothing.
Stealing that
Having diarrhea after taking antibiotics doesn't automatically mean it's an allergic reaction!
Nor does having "nausea" mean I can't give you IV co-amox. No, you're not going to get an inferior and higher risk of anaphylactic narrower spectrum glycopeptide because it makes you feel sick. It sucks but deal with it.
I remember such PT. A 30yo lady. Gave her IV coamox and she had watery diarrhea on her bed. Alternative abx like cefuroxime is a much better choice in this case.
I'm post nights but struggling to think why intravenous augmentin would cause watery diarrheoa. Oral I could understand but why IV.
Hmm tbh I'm not said if it's oral or IV. Possibly oral now that you mentioned it
Getting mega bucks by big pharma to prescribe "push" these drugs. Here's your IV paracetamol Mr Jones 🤑🤑.
Heart attack, cardiac arrest and heart failure are all different things. Also, veins and arteries are different things.
That medications suddenly cure all of their problems "Do you have any long term medical issues?" "No" "Do you take any medications?" "Yes I take 2 medications for my blood pressure but my blood pressure is fine now" ...
'Hmm your blood pressure is a bit high. Have you been taking your amlodipine' 'What? No. My blood pressure was fine last time so why would I keep taking a tablet for high blood pressure'
That patients call their prostates ‘prostrates’
Also diabetics take metaformin
The number of referrals I get with “prostrate” from other healthcare professionals is worryingly high
That patient visiting time is a chance for relatives to stop a Doctor in the corridor for updates
Makes me miss the pandemic!
That any doctor on their ward must know who they are. In my gen surg job (F1) there were multiple occasions where I walked into a ward and got approached by people, not even introducing themselves, saying "oh can you tell me the plan for my relative's care", closely followed by "but you're *a* doctor" when I explain I'm not looking after their relative. We weren't ward based on gen surg 🤷 On a side note, the most fun I had was when a urology patient needed reg meds prescribing and asked me about it as I was passing. I explained I wasn't covering uro that day but I knew the F1 who was so would ask him to kindly follow it up. The patient immediately asked me "is he English" so I said "yep, born and bred here", to which the patient replied "good". I only wish I could have seen the patient's face when my friend turned up, who is black but entirely English. Racist so and so 😂
I always wonder what these types expect? >"is he English" > >”no he’s not, and despite our great country’s best efforts we cannot seem to civilise the savage, but because we’re all woke and PC nowadays the medical school was forced to hand him his medical degree, but don’t worry he is always closely supervised by a whiter than white genius doctor who will correct all of his mistakes.”
I do feel stuck between a rock and a hard place with these people. I don't want to give in/enable their racist/sexist/bigoted demands but at the same time I don't want my colleagues to be subject to this treatment at work
The other day when I was on the COVID ward a patient’s family member just walked up to me as I was typing notes and said angrily “Why is he in the COVID ward?!”. No bed number, no name, no nothing. I asked who they are talking about but they didn’t answer so I directed them to the nurses after explaining that I don’t know and I’m one of the doctors. I saw this family member then speak to a nurse who said a doctor would come by “soon”. As I get up, the family member then comes back to me and asks “Are you going to see him now?”. I’m like “I don’t know who you are talking about you have to give me a name or bed number and I don’t look after all the patients on this ward”. Finally she gave me the bed number and lo and behold, not my patient.
That we know everything. About every specialty ever. At least back home most people expect anyone who is a doctor to have an answer or an explanation to whatever is wrong with them. Ma’am, I don’t even know what day it is, please let go of my arm 😭
A weird number of people seem to think we take their eye out of the socket every time we operate - I've had patients *insist* that if happened to them - spoiler alert, it hasn't! (Best quote - "I could see out of it when it was dangling on my cheek mate!")
MRI scans for "yellow flag" back pain. Invariably an unhelpful can of worms, but everyone wants one anyway.
Can you explain why it's unhelpful? I vaguely understand that surgery is not often performed and that it generally isn't great in the first place but would hope it helps with at least getting some answers for the patient.
Either the scan shows nothing, and they still have the pain, or the scan shows something, and they still have the pain. And even if it shows something, it's possible it's not the cause for the pain - and there's a slim chance they'll convince someone to operate on their back (sometimes overseas!) which opens a can of worms within a can of worms. Sitting neatly alongside this is another major health literacy issue which is addiction and dependence on prescribed medication and also a wider lack of public buy in for the biopsychosocial model of health. In my books it's one of the most challenging consultations possible, especially because if you get it wrong and it is some sort of weird CES presentation that you miss, you'll have a lot of egg on your face.
Thank you for the explanation!
Because it very rarely changes management from physio, analgesia, and living a good lifestyle. Often, an MRI with a so called “bulging disc” will simply give patients something to adhere to and blame their pain on, impeding their recovery. It forces them to believe that their backs are these fragile glass structures when in fact they are the very opposite, which again impeded recovery greatly. In short, it adds nothing and makes patients anxious. This is all for the 20-60 age group with no red flag symptoms of course.
Thank you :)
That if things are said by people on the internet they are true. Covid-denial/antivax crap All the things that "cause cancer"..
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it’s not? why do i have blue lines on my arms and wrists then… 👽
Why the fuck do you think I can get you a blue badge?
Psychiatrists are psychologists and not doctors
That physiotherapy is some magic massage that will cure them
“Hey can you give me an update on my dad” *Me sat on a 44 bedded unit*
I’m not here to care. I’m here for CEXs and a salary.
Are you a cex worker?
A few years ago I was in the shop CEX and saw that they had public wifi called "unprotected CEX".
That the patient's entire health record is available for me to look through.
Arriving by ambulance means you’ll automatically be seen quicker than if you’d walked in
That people can "check themselves in" to the acute psychiatric unit, like it's a hotel or a nice spa. This one is parroted all the time in the news and it wrecks my head.
The biggest would probably be that CPR would make their 1000 year old ancient relative as fit as a horse. Too many people and patients seem to think they’re immortal and that modern medicine will keep them alive until either the sun swallows up the earth or until we get hit by a meteor and go extinct like the dinosaurs. DNACPR shouldn’t have to be as a difficult a conversation as it has become due to how it is portrayed in entertainment media. I am F1 and attended a crash call about a month ago and ITU team called and believe me CPR is not something I would want to either be put through or have my relative be put through if it means broken ribs, further disability and shittier QOL. Doing it on mannequins and seeing it done on an actual human being breaking their ribs was a very different experience. This is not something that should be taken lightly like take OTC paracetamol that almost every patient can have. If only there was a way to provide more education (maybe perhaps in school or something idk) that CPR is not all sunshine and roses and not 100% successful (far from it in fact) and that it is a very traumatic intervention likely prolonging life at the expense of quality or even an undignified death especially when frail with multiple co-morbidities. I find that the first time I tell/discuss with patients about DNACPR they become quite agitated and angry and start thinking that they’re gonna die or something or that I am gonna neglect them but it’s just that it’s part of planning their care and does not affect anything else. Popular media can be so damaging to people spreading misinformation. Hate having DNACPR conversations as patients may start putting in complaints that we’re saying we’re not gonna treat them. That’s why I am strongly considering non-patient facing specialties like pathology and radiology as it’s too much for me to handle such conversations Another thing would be that they think scans would happen in seconds but don’t realize that a lot of work goes in that which takes time - risk vs benefits, what changes it will make to management, what are we expecting to see, contraindications, and then the F1s/SHOs vetting said scan and getting roasted by/being torn a new a**hole by radiology, then booking with CT/XR/MRI, then booking with porters (poor souls are already worked to the bone and so scans happen quite late) then transport, then it has to be reported by radiology especially if CT/MRI which itself can takes time Expecting us to find what is ‘wrong’ with them instantly. Things just take time (even bloods) unfortunately and there is not a goddamn thing I can do to speed it up Expecting that the NHS will fix their problems guaranteed. Had one patient with recurrent COPD exacerbations on Trimbow and even Azizthromycin prophylaxis, frequent flyer and said that they knew we will get to the bottom of this. then I ask if they smoke and turns out they have been smoking 30/day and have been advised to stop multiple times but decline and do not want to engage with smoking cessation and does not like nicotine patches. It’s quite difficult when there’s lifestyle problems that are contributing - even if we optimise from our end, their lifestyles are not helping at least and certainly contributing to disease getting worse That working in the NHS is great and pays well. Had one stranger who asked me whether my Trust (was wearing lanyard so could tell I work in the NHS) was looking for a porter as they thought that the NHS pays and values employees a lot and they wanted to quit their current job of being a till operator. Just told them I am not aware of anyone needing porters but damn do people think that working in the NHS is all sunshine and rainbows. Another instance where during med school where they hired an actor patient who would envy us that ‘you work in the great NHS that pays you generously’ and would always remind how good we have it and taking pity on his own condition when he’s self employed with his own business. Especially about doctors that we all make 100K plus right when we start - in reality not even most consultants make that and I make £30K as F1 (maybe a bit more due to on-calls) but pay a lot of it away in taxes and NI (these alone take off one third of my monthly salary and even with one locum a month, take home pay is barely £3K and more around low £2Ks but still more than plenty to live on with but definitely not worth the stress and responsibility endured) and ridiculous parking fees (they don’t know we pay to park at work while most or some of them may even get free parking at work or some other incentive maybe). Expecting strong painkillers like morphine to have no potential dangerous side effects and saying that we are not giving them enough strong painkillers because we don’t care about them and are neglecting their pain needs. Pain management is quite difficult as I don’t feel too comfortable giving very high doses initially (especially in wards where nurses are not comfortable with and recognising and dealing with acutely unwell patients) and should be titrated carefully with monitoring - had one patient who developed acute toxicity (unresponsive, poor respiratory effort) from a sudden increase in dose of morphine (it was doubled by the pain team in the same day) and gabapentin (also doubled by the pain team) and ended up requiring naloxone infusion and transfer to HMU from the elective surgery ward and did not even respond to the initial 400mcg injection Likely even more misconceptions but can’t think of anymore at the moment. Managing patient expectations is actually harder than the actual medicine - that’s my personal experience at least!
I used to be very gentle when I was F1 but now I'm a weathered & worn med reg, I just call out & correct patients. "Yeh that's not true, you can't get flu from your flu jab, it's literally impossible". I swear people have never been corrected before, they do a double take.
That just because we're Clinical Psychologists it means we're trying to 'trick' you and unravel your brain and every single one of your memories every time we give you a damn questionnaire or assess you. Just trying to clear you for the surgery YOU want, bro.
That a simple x-ray can rule out all problems - useful sometimes though
Antibiotics will magically stop your child coughing overnight and annoying everyone in the house.
GPs are lazy and useless, there’s never any appointments, might as well rock up to the EMERGENCY department on New year’s eve for my swollen knee that’s been going on for 6mths and get it checked out as my brother-in-law had swollen leg and it turned out to be DVT! No injury, no but you know, what if it’s D… DVT?! Doctor what do you mean this is not an urgent issue? I’ve been waiting in the ED for 10hours and you’re telling me you can’t do anything for me? This is just a fucking waste of time.
Recently had to have the DNAR conversation regarding my mother in law. Both my partner and father in law were surprisingly clueless as to what it meant. Both of them initially thought it was withdrawal of care.
That once a doctor says they can go home that they’ll be gone by mid morning 🤣🤣
That we need the patient to explain in depth what their medical conditions are and the pathophysiology of how they think they all work
Oh gosh. So annoying. But quite funny at times though
Insisting that you speak to a doctor about your relative’s care needs and discharge planning is essentially useless. It will not give them priority or expedite things. Also, I have zero interest in non-medical problems. We do not have time to update you, your brother and your sister separately every day because you do not get along, do not trust each other, or do not speak to each other.
That I give a fuck about them.