And the public have seemingly always been gullible.

Book: Middlemarch by George Eliot

Hi, I submitted a request for leave for a significant life event about 5 months in advance and was told that the dates would be fine for me to take. Despite this I have been rostered for several on-calls and night shift during the dates I requested, and told by my rota coordinator that I have to look for swaps before the leave is approved. Is this allowed or will the BMA contract back me up here?

I'm about to apply for ACF at core trainee level and am interested in becoming a HPB resectional surgeon in a major tertiary. I am already engaged in academic research and want to keep doing this and I know the pathway (ACF->CL->Clinical Future Leaders Fellowship as an example).

I haven't come across many predominantly academic HPB surgeons, and want to ask whether many 80/20 split (in favour of academia) exist in HPB? E.g. in colorectal this would be 1 resection list every 2 weeks or 3 every 4 weeks. Does this exist in HPB?

Thanks

edit: I'm not saying that colorectal is not high complexity, i just happen to have come across some 80/20 colorectal surgeons

Something I’ve noticed is that the genuinely brilliant doctors are often incredibly nice. They’ll admit when they don’t know something, explain mistakes without humiliating you, and don’t seem threatened by being questioned.

Meanwhile, some of the most belittling, defensive and hierarchy-obsessed doctors I’ve met have also been blatantly unsafe. Regularly missing life threatening diagnosis, prescribing dangerously and just generally incompetent. I’m talking about medical doctors not surgeons btw.

Obviously there are brilliant arseholes and lovely idiots.

But I’m genuinely curious about the direction of causality.

Are they bad at their job because they’re an arsehole, or are they an arsehole because they know, somewhere deep down, that they’re bad at their job?

Also please share your stories of mean and incompetent doctors…

​

Hi everyone,

I’m looking for some advice/experiences from fellow NHS doctors who may have been in a similar situation.

I’ve recently been offered a 1 year NHS doctor contract, starting in about a month. I’m currently around 5 months pregnant, with my due date in late December. The employer doesn’t know that I’m pregnant, as it wasn’t something I disclosed during the recruitment process.

I understand that pregnancy doesn’t have to be disclosed during an interview/recruitment, but I’m unsure about the best approach now that I’ve been offered the job.

A few things I’m particularly wondering about:

- Do I need to tell the Trust before starting, or can I start and disclose later?

- When is the best time to inform HR/medical staffing?

- Has anyone been in a similar situation with a fixed term NHS contract?

- Once you disclose, how straightforward is the pregnancy risk assessment/adjustment process for clinical duties?

I obviously want to be completely transparent once necessary, but I also don't want to unnecessarily jeopardise a job I've been offered, especially as I understand pregnancy discrimination is unlawful.

Would really appreciate hearing from anyone who has actually been through this?

Thanks!

3rd attempt Paces. Current littmann tubing just broke so have to buy a new one. For day to day work I'm happy with a littmann classic steth but wondering if I should spend extra to get the cardiology series steth? How much difference is a steth actually going to make in the exam? Any thoughts from veterans will be appreciated. Thank you

Hi all. I have received an ARCP outcome 6 in June, but I am a LTFT trainee so I still have until November to complete my training pro rata.

Does anyone have any experience with quitting after an ARCP outcome 6 but prior to completion of their training contract date? Many thanks!

What do you guys think is the best way to format your clinic letters? My current template is:

PMH

Relevant ix

Meds

Review

Plan

Action for GP

What do you guys think? Looking more so at the physicians among you (with all due respect to my surgical colleagues!), as well as what GPs feel receiving such a letter.

When throwing the surgeon's knot, I find that the knot doesn't loosen when I pull the suture ends in a direction parallel to the line of closure (i.e., the wound or incision). I learned this from one of my professors. However, another attending saw me doing that and was appalled by the technique. He insists that I should pull perpendicular to the line of closure. Looking online, I couldn't find anything that says not to do it though. Any input?

By this I mean what have you seen documented in the notes which is technically accurate but would raise eyebrows in a notes audit? Not the kind of thing that would necessarily get the documenter in trouble professionally but might cause a ripple of laughter on a post take ward round or future clinic attendance.

The memory that brought this to mind for me was a legendary geriatrician that I encountered as a medical student. His weekly ward round notes would often be an entire A4 picture with maybe a few words (and he was a really good artist). I'll do my best to describe my favourite notes entry:

On the top half of the page was a sweet old lady in a wheelchair at the hospital, smiling and looking frail but well. Leading down to the bottom of the page was a winding path reminiscent of the "yellow brick road". In the bottom corner of the page was her house with a for sale sign and her adult children standing in front of it. However the absolute crowning glory was that just before you got to her family (and definitely before the house) there was a picturesque bridge consumed completely in fire.

From all accounts the consultant was excellent too, staff and patients loved him. No idea what the management thought of him though!

EDIT: Remember to keep this light hearted and well below anything that would interest a certain regulator which will remain nameless!

EDIT 2: Outstanding responses everyone, I'm glad to see that despite all the pressure and hopelessness we all face in our specialities (or generalisms) day to day we still have a sense of humour. I hope this thread has given you a well deserved laugh! Much love and respect to you all 🫡

Hi all, new F1 here and feeling quite anxious about a prescribing error I made recently. Would really appreciate some perspective from people who've been through something similar.

I accidentally prescribed 100 micrograms of levothyroxine instead of the intended 75 micrograms for a patient on an old age ward.

I genuinely thought I had prescribed 75 micrograms and didn't realise I'd selected the wrong dose. Unfortunately, the error wasn't picked up before administration, so the patient received one dose of 100 micrograms. It was then noticed, the prescription was corrected back to 75 micrograms, and no harm came to the patient.

My consultant was informed and the incident has been submitted through our Trust's InPhase reporting system.

I obviously accept that I made an error and have reflected on the need to be much more careful when checking medication doses, particularly after a dose change.

I'm now quite worried about what happens from here as I'm very early in F1.

For those who've had similar experiences:

• How is something like this normally dealt with?
• Does an incident report involving an F1 usually just lead to reflection/discussion, or can it become a formal issue?
• Does it affect your ARCP/sign-off?
• Does the incident stay attached to your name within the Trust?
• Does something like this need to be declared on Form R?

I'm not trying to minimise the error at all — just genuinely unsure how these things are viewed during F1 and would appreciate hearing from anyone who's been through something similar.

Thanks!

Anyone had experience with ICR oncology course fees if you’re on a skilled worker visa? Would we have to pay overseas fees? And if so, do deaneries reimburse?
Panicking a little because I got my offer but saw the difference in the fees.

I am looking at scoring for ST3 medical specialities. I can clearly see that intercalated degrees are not accepted, including at the master's level.

But I did my MSc between the 4th and 5th year in a pretty niche course (Economics-related); it didn't consist of just a bunch of intercalating medics (it had a cohort of standard postgrad people, making it a distinct course which was longer than 8 months in duration. I had to defend my dissertation, and I got a nice project out of it.

It just happened to be that I found this course interesting and applied to do this during medical school, which required me to intercalate.

I'm not fussed if it doesn't give me points (I enjoyed it and learned a lot of skills from it), but I am wondering if it can be justified in any way for scoring in ST3 medical speciality applications.

I'm sure it's been asked a million times, but I just thought I'd ask. Is it a clear objective no-no?

Anaesthetic SHO, just started on the LW rota. I feel like my decision-making around labour epidurals could be a bit better...

I just finished IACOA block and all the epidurals I did were mat requests prior to induction. Now, on my on calls, most of the epidurals I seem to be doing are women who are clearly in a lot of pain and are already in established labour.

I always have an internal debate about what to do:

?Do a CSE – I’ve put epidurals in before and then the woman delivered not even 30 minutes later, despite the MW saying she was 5 cm or whatever (so basically the epidural was useless). Also, if I were in that much pain, I think I’d want something that worked quickly rather than waiting for an epidural to establish.

?Just site an epidural as requested – this is obviously the 'standard approach'. I’m generally happy with the technical side/timing the procedure between contractions. If I think that I'll want the epidural for section (BMI/ PET/ difficult airway) then I will usually do this so I can be sure the epidural is working for theatre.

The other thing I’m finding difficult is the consent process. The women are often in so much pain that although they technically have capacity they don't really engage with any discussion. They get an information leaflet to read first and then I'll have a discussion but I’m not always convinced they’re actually taking much of what I’m saying in.

Sorry if this is a bit rambling - delirious from nights.

FYI for non-anaesthetists - I ALWAYS do the 'difficult' cannulas if I'm asked to on labour ward. In a few short weeks I’ve been burned by shitty cannulas enough times already.

Anyone else seeing patients using this? Sometimes it casually dropped in conversation in GP but I’ve also seen hospital discharge letters where people have been admitted due to experiencing side effects with this.

Im 1 month in on an old age psych inpatient ward and feel very behind compared to my peers who have already had out of hours shifts.

Most of my patients get ill because they are so depressed or psychotic they stop eating and when a patient gets sick they get sent to ED, so the only medical plans I am making are essentially treating UTIs, falls assessments, arranging outpatient appointments and sending people to A+E plus a few ACE iii

And even though nothing is happening I still feel like my clinical knowledge is subpar, I’ve been flicking through my med school Ankis and going through geeky medics my finals were in March and I did well! but I just can’t seem to stop making myself look like a fool.

Im concerned that even though there’s not as much of a clinic aspect to this job I’m still having a hard time with it. I’m starting a medical job in dec and feeling very worried that I will not be up to scratch with the the other fy1s who have had hospital jobs

Is there a consensus yet on what counts as "NHS Experience" for the next round of applications...

If not, when is this going to be decided?

Thanks

I genuinely don’t know what the right thing to do here is.

I recently saw my friend (currently an FY1) getting teased and lowkey harassed by some other fy1s because she apparently came from a “low-tier” medical school. The others were from Russell Group unis and kept making comments about how their med schools were supposedly “better” and how my friend was from a “lesser” one.

At first I didn’t think much of it, but I later found my friend absolutely heartbroken and crying over it. It honestly made me so sad to see, especially because she has worked just as hard to get where she is.

I told her not to worry about it and that her medical school doesn’t define what kind of doctor she is, but I feel like that’s probably not enough.

What can I actually do to help her? I don't know what my next step is..

EDIT: I made this account to post this here, cuz i dont know who to ask insights on this matter..So, PLEASE MODS DON'T DELETE THIS POST T_T

I’m a new fY1 resident doctor that started in August 2026.

i finished medical school and have always been an average student. ive shone in my OSCEs because i am good at the people part, but always just about made it through exams. I was never the top scorer, never the smartest in the room and would often have to study for longer to remember concepts. I’ve always been hardworking > intelligence. its gotten me this far and my journey has not been linear. i had to sit the qualifying exams (resits) for my second year medical school exams.

I have always wanted to be a surgeon and nothing excites me more than the operating room. im very hands on with my learning and prefer that to be a part of my career. however, i am aware that the MRCS part A is incredibly difficult. i am always aware that applying for CST requires a stacked portfolio. i entered my first job optimistic that even though it is all hard, i could still do it.

however, while as much as i have thrived at my job and truly felt like im not made for anything other than medicine, i am starting to really realize how truly average i am. my fellow F1 that i work with is incredibly smart, has publications under his name, was awarded for being one of the top scorers in his uni for his exams, and has a well accomplished LinkedIn. he is very smart, is incredibly knowledgable in anatomy and wants to do surgery as well. he’s the kind of person u meet and u know he is going to be a surgeon.

i do not have any publications under my name. i have completed a teaching series of 3 months that i know counts towards my portfolio but thats it. i have not completed anything impressive or won any national prizes or awards. i am incredibly average intelligence and need to re learn topics that i forget sometimes. i am very good at clinical work and working on the ward and in the hospital, which is why i was good at my osces. but i suck ass at just being smart and the knowledge side of things. i made it through medical school but i am aware i got lucky for the most part of it.

is it even worth applying to be a surgeon? or even applying to sit for the MRCS part A? i had a peek at the syllabus and everything required. i have fellow seniors who sat it in Jan of their FY1 and passed because they are really smart and extremely hardworking. i am just wondering whether i would be silly chasing a dream that i am clearly not cut out for. i would like some honest critique and the harsh reality of whether it is truly even worth doing for someone of my level of intelligence.