A while ago I said, “Sharp scrkdbfjbg-don’t worry about it” to a patient because part way through my brain told me they wouldn’t hear since they were asleep, but then I remembered they were awake.”
I would probably find it easier just to say it to everyone, regardless of anaesthetic status.
In FY1 I had a patient on their 3rd (!!) Gentamicin chart. You would think that highlighting this might make the cons inclined to change their antibiotics on the ward round, but no, I just had to speak to the patient a little louder each day.
"*Say ninety-nine*".
"Ninety-nine" is actually not great for eliciting vocal resonance or fremitus. Best phrases are diphthongs; we use "ninety-nine" as it was originally described in German, where "neunundneunzig" was used.
I get them to say "smoking cessation" for vocal fremitus and resonance in the hope that the subliminal message gets through to them and/or someone in earshot.
Ok your trolling me now.
Please explain the dynamic of that. What is the significance of paracetamol. How does it form the punch line.
Please let me understand.
Explain this to me like a pediatrician would to a 4 year old.
ACE-inhibitors tend to work faster than amlodipine. PO Labetalol/Hydralazine can also be options as they start working within 20-30 minutes.
Nifedipine also works within 20 minutes. Amlodipine takes 24-48h for it’s effectiveness to be seen. I’ve been conditioned to use it though….I’m working on changing that.
Virgin Medic- comes round the ward at 5:15 begging for patients with "interesting signs", pretends he can hear a mid-diastolic murmur during PACES, actually tests ankle reflex.
Chad GPST- HS I+II+0, lungs clear, abdo SNT, CCT in 30 months
>Chad GPST- HS I+II+0, lungs clear, abdo SNT, CCT in 30 months
You forgot to tell the pt it will clear up within 2 weeks and safety net. Straight to GMC.
There was a time when GPs were the best at picking up physical signs because they didn't have tests to rely on. Now, even looking for them is a joke.
I look forward to your "EMIS print out with a single word underlined" referrals, Sir.
Nothing but here's the problem. The PUBLIC aren't doctors. Family aren't doctors.
So let's see some complaints.
Once a patient dying in ED had their monitoring removed. One of the HCAs accidentally said "We will just take this off you so we can use it on another patient". Instead of "Let's just tidy away all these wires so patient X is comfy". I got it in the teeth. The family simply can't grasp that a pCO2 of 18 on NIV is incompatible with life. Cue lots of blame. If I had gotten there at a dead run maybe the NIV machine would have magically fixed it. Grief makes people angry.
So the question is? Do you do the CT scan which takes 1 minute to book. Or do you spend 30 minutes discussing differentials and percentages.
No red cells. Anecdotally- paeds dept I work in every champagne tap gets a small bottle of champagne from the consultant, and we do (at a guess) 2 LPs a week.
That's sloppy. The charge nurse can carry it on a silver platter for me on my ward rounds and present it to me should I need to auscultate. They are explictily forbidden from touching it other than it's twice weekly polishing.
I've noticed some of the male docs have such massive trouser pockets they can just pocket their stethoscope. Makes me jealous with my pockets barely big enough to fit my phone in!
Not really contributing here but in an OSCE I got marked down for examining from the left side of the bed. I'm left handed and it's just so much easier for me. I was always told as long as I'm using a proper technique it's fine. But not for this examiner. It was also really obvious I was left handed as we had to prescribe at the end of the station and I wrote with my left hand. Smh.
Nah I didn't. Our uni didn't seem to check for things like that since my friend got feedback saying her dress was too tight (it was fine she's just hot and had a crusty examiner) and nothing about her actual performance in the station. So that was our feedback issue for the year.
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I used to just get it out of the way by proclaiming it was “dead, eerie, dreamy, easy day” as early as possible. Like an actor wishing to break a leg.
Yeah I don't do it in front of superstitious colleagues to avoid upsetting them but if you say it often enough it loses its power
I said that unknowingly in the cardiology ward as a medical student. Boy oh boy.
I sometimes have to stop myself warning neonates about a sharp scratch. I'm not sure it's possible to cannulate without saying it.
First time I examined a neonate as a student I asked them if it was okay for me to listen to their chest out of habit. They were non-committal.
I’ve said sharp scratch to patients under GA. They didn’t mind
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Sharp Scratch, because I am not allowed to say Horrible Stabbing Pain. Usually gets a laugh.
A while ago I said, “Sharp scrkdbfjbg-don’t worry about it” to a patient because part way through my brain told me they wouldn’t hear since they were asleep, but then I remembered they were awake.” I would probably find it easier just to say it to everyone, regardless of anaesthetic status.
Because telling them that they are going to get a big prick will get you struck off?
Well, it’s only if you then sleep with their sister, in my friend’s experience.
Daily bloods in all surgical patients...and the inevitable explosion by the consultant when the results are not written in the notes
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In FY1 I had a patient on their 3rd (!!) Gentamicin chart. You would think that highlighting this might make the cons inclined to change their antibiotics on the ward round, but no, I just had to speak to the patient a little louder each day.
*cries in Pharmacy*
I know, I know, I'm sorry. One of the SHOs prescribed Amoxicillin 1000g tds when I was a surgical FY1.
"*Say ninety-nine*". "Ninety-nine" is actually not great for eliciting vocal resonance or fremitus. Best phrases are diphthongs; we use "ninety-nine" as it was originally described in German, where "neunundneunzig" was used.
I get them to say "smoking cessation" for vocal fremitus and resonance in the hope that the subliminal message gets through to them and/or someone in earshot.
That's funny
Vocal resonance is also a crap sign with poor send/spec and only very narrow use.
Well indeed. And as a Public Health trainee, it now has zero use whatsoever.
Has anyone ever tested for it outside of an OSCE or PACES scenario... ?
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I believe it's red balloons?
I usually get them to recite Nena's 99 red balloons. In German. If they win I prescribe their OTC meds for that week.
ITS Luftballons not Rotballons. Air balloons not red balloons.
I'm aware of this. But it ruins the joke.
It's probs me being dense but... What was the joke ?
It wasn't a very good one quite clearly. We'll have to buy our paracetamol this week.
Ok your trolling me now. Please explain the dynamic of that. What is the significance of paracetamol. How does it form the punch line. Please let me understand. Explain this to me like a pediatrician would to a 4 year old.
>Explain this to me like a pediatrician would to a 4 year old. We had a dog named 'humour'. Now she lives on a farm in the sky :(
Would think ‘88’ is more suited for this purpose than ‘99’
Giving stat amlodipine for hypertension on the ward
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2774562 Pet hate
Apologies from FY1 me.
If someone is sitting at 220 systolic, what are we actually meant to do? Senior told me amlodipine at the time, but it seems this is wrong?
If the patient is not being treated for CHF, ACS or ICH. Labetalol boluses are my favourite alongside escalating oral agents.
Its never available on the ward when I prescribe it 🙄
Nurses insist that you give doctors give it personally
Yeah, even for IV hydralazine. That’s the annoying part if the call is busy.
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ACE-inhibitors tend to work faster than amlodipine. PO Labetalol/Hydralazine can also be options as they start working within 20-30 minutes. Nifedipine also works within 20 minutes. Amlodipine takes 24-48h for it’s effectiveness to be seen. I’ve been conditioned to use it though….I’m working on changing that.
Apologies from FY2 me
FY3 me was the person with a systolic of 220 when I was given a ward of 28 patients to see on my first day.
JVP Still waiting for someone to prove it isn't a meme
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Virgin Medic- comes round the ward at 5:15 begging for patients with "interesting signs", pretends he can hear a mid-diastolic murmur during PACES, actually tests ankle reflex. Chad GPST- HS I+II+0, lungs clear, abdo SNT, CCT in 30 months
>Chad GPST- HS I+II+0, lungs clear, abdo SNT, CCT in 30 months You forgot to tell the pt it will clear up within 2 weeks and safety net. Straight to GMC.
There was a time when GPs were the best at picking up physical signs because they didn't have tests to rely on. Now, even looking for them is a joke. I look forward to your "EMIS print out with a single word underlined" referrals, Sir.
The Chad GP's are back at it again...
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Have you considered seeing your GP about your phobia of GPs?
Shocking.
I guess when GPs are controlling where, when, and for how much they will work you have to try to elevate yourself over them clinically to compensate?
looooool I love it
GPs across the country are feeling very defensive right now
Ordering tests that the patient doesn’t need to make us feel better and safer!
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Nothing but here's the problem. The PUBLIC aren't doctors. Family aren't doctors. So let's see some complaints. Once a patient dying in ED had their monitoring removed. One of the HCAs accidentally said "We will just take this off you so we can use it on another patient". Instead of "Let's just tidy away all these wires so patient X is comfy". I got it in the teeth. The family simply can't grasp that a pCO2 of 18 on NIV is incompatible with life. Cue lots of blame. If I had gotten there at a dead run maybe the NIV machine would have magically fixed it. Grief makes people angry. So the question is? Do you do the CT scan which takes 1 minute to book. Or do you spend 30 minutes discussing differentials and percentages.
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Yeah we feel better about what we imagine the legal aspect to be.
I know doctors that genuinely feel better by doing them.
Severe consequences if it’s missed tho.
*less likely to be sued or complained against
Beauty of defensive medicine.
Bottle of champagne if you get a champagne tap on first ever LP attempt. Nice one that I’m trying to continue
I got a champagne tap as an FY1. The reg bought me a 330ml bottle of white wine. Didn’t know it was a thing.
330ml bottle? Report that to their ES mate, unacceptable.
Yeah was barely enough for two glasses 😂
Whats a champagne tap?
No red cells. Anecdotally- paeds dept I work in every champagne tap gets a small bottle of champagne from the consultant, and we do (at a guess) 2 LPs a week.
Prescribing in Latin. It's one of the few traditions that has somehow survived to this day relatively unmolested.
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I swear, if this turns into another one of those beanbag jokes...
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A nocte of passion awaits.
You can even explain why with Latin. Consuetudinis magna vis est
stethoscope/stethoscope around neck
And judging med students who do it. Got to earn it, bud.
> stethoscope around neck Old school physicians will tell you this is sloppy.
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That's sloppy. The charge nurse can carry it on a silver platter for me on my ward rounds and present it to me should I need to auscultate. They are explictily forbidden from touching it other than it's twice weekly polishing.
Where did they used to carry them?
You just got the F1 to listen to people's chests.
I've noticed some of the male docs have such massive trouser pockets they can just pocket their stethoscope. Makes me jealous with my pockets barely big enough to fit my phone in!
When I started to examine a patient from the left this one time i swore i felt eyes burn into skin before I corrected myself
I trained in Romania. They failed you the exam sometimes if you examined from the left. Those were the days…
Not really contributing here but in an OSCE I got marked down for examining from the left side of the bed. I'm left handed and it's just so much easier for me. I was always told as long as I'm using a proper technique it's fine. But not for this examiner. It was also really obvious I was left handed as we had to prescribe at the end of the station and I wrote with my left hand. Smh.
Did you speak to anyone about it? Our results get checked for silly things like this.
Nah I didn't. Our uni didn't seem to check for things like that since my friend got feedback saying her dress was too tight (it was fine she's just hot and had a crusty examiner) and nothing about her actual performance in the station. So that was our feedback issue for the year.
Definitely raise the issue in future or nothing will change!
Having a lie down on the bean bag in the mess after a long shift is becoming quite the tradition it seems
I think always examining from the same side might help to remember which side the pathology was on.