I need to find a way to leave this dump.
You'll never leave TTH.
Where you gonna go?Originally Posted by Spikey M
Do not question my quarter baked plans, m8.
@randomlegend - is this what you were talking about before?
Nice to have a doctor on staff in a restaurant, tbh. Bars should get some as well.
Why do they restrict training positions? Is it cheaper to import?
The people most seething about this are generally the same sort of people who claim that foreigners built the National Health Service, who think that foreign medical staff are done for malpractice more often because of racism, and who think that a government health monopoly is good because it can use its purchasing power to lower costs. It's hard to see how they could have painted themselves into more of a corner really. Oh well.
Because manufactured shortages are the government's specialty.
Last edited by Pepe; 24-03-2025 at 02:48 PM.
No they aren't.
Yes. You should see the training competition graphs.
They are restricting training places because consultants are expensive.
They want the NHS to be an army of Noctors (nurse practitioners, PAs, paramedics practitioners, etc) "supervised" by a small number of consultants who basically act as liability sponges.
Last edited by randomlegend; 24-03-2025 at 04:12 PM.
So what is the agenda at work here? I mean when it was the Conservative Party doing it it was obviously all a scheme to run it into the ground so that their rich mates could benefit at our expense, which is why you were right to say that their voters are immoral; but why are the people that you voted for doing the same things?
Tbf to RL the people that he voted for in this instance are also doing the same things on everything else hence why everyone thinks they're shit.
I mean, if it saves money and the outcomes don't degrade too much, then it could be a good thing for everyone but medicine students, but I am sure that RL will tell us that it is actually more expensive and will cause millions of deaths, so either they are stupid or they are evil.
Why not both?
I suspect what will ultimately happen if this path is allowed to be continued upon is you'll end up with a truly two tier health system, where the poors have to get by seeing the Noctor brigade whilst those that can afford it pay to see an actual doctor.
GP surgeries have already started to backtrack on the PA experiment though, and some hospital trusts are following suit. Lewisham have just removed PAs from their A and E entirely because they were unsafe, to give an example.
It's almost like medicine is actually hard and can't be learned in two years by people with humanities degrees from mickey mouse universities.
The breadth and depth of what you need to know and be able to do is enormous to be able to practice medicine safely. I am an actual doctor with about 7 years of post-graduate experience - most of that in a very good paediatric department - and I remain extremely aware of the fact that a kid could walk in tomorrow with something I have literally never heard of and wouldn't know how to manage. What I am confident I could do is recognise that fact and go to the right place for help. That takes a lot of training.
Meanwhile you've got PAs with two years of medical training or experience of any sort seeing undifferentiated patients in A and Es and GPs up and down the land, and they simply have no idea what they don't know and are completely unable to do this, even for relatively common things which fall outside their extremely narrow "knowledge" base. They have a huge amount of unwarranted confidence, almost universally in my experience. It is a scandal in the making, I'm telling you.
Last edited by randomlegend; 24-03-2025 at 11:33 PM.
In my experience at the GP, Noctors >>>>> Doctors.
I have no idea how the hierarchy of doctoring works, and I think it has changed since it was explained to me once upon a time in the 2000s [SHO what?], but is it not possible to have an army of doctors, not an army of consultants? If there's a training based conveyor belt that gives the latter, is that not a problem? In a field I'm more familiar with most trainee solicitors, for example, don't end up as partners, I don't think [most barristers don't become KCs etc] and most of the mundane legwork, which is almost all the work, is done by the lower down the pecking order folk. Is it possible to have a system where you have x % trainee doctors, y % normal doctors and z % senior doctors/consulatnts whilst maintaining a balanced amount of overall doctors? Or does the senior group grow over time leaving you with only the choice to stifle the lower groups if you want to maintain an affordable system?
Obviously there are other issues more broadly, for example the trainee solicitor probably gets paid more in year 1 than the however many years qualified medical consultant.
Last edited by niko_cee; 25-03-2025 at 09:22 AM.
Yeah, patients often think this because they don't actually understand what they need (and more importantly don't need) and what good medicine is.
That's not to say there aren't crap doctors, but patients often get a lot of satisfaction from interactions with the noctor brigade because they simply give the patient what they want.
Extremely common examples would be antibiotics for patently viral infections or referrals to specialists or for scans that are not warranted.
This is why they often actually end up costing the service a lot more money overall even if they are paid less, and that's before you even start getting to the mistakes they make which GPs/doctors then have to spend time mopping up.
Last edited by randomlegend; 25-03-2025 at 10:12 AM.
Yeah like my knee that was lacking cartilage and ligaments. Doctor just waved me off, at least the noctor rolled up my trousers and looked at the fucking thing.
Also, noctors say things like "hello, how are you?" and "goodbye" which seems to be lacking amongst your lot.
Essentially acute care kind of does work like that already, but the majority of those non-consultant doctors doing the legwork of the acute care will be on training programmes to become consultants.
The numbers for that wouldn't seem to add up; how can the system need all those non-consultant doctors to become consultants when day to day you probably have a ratio of 5+ non-consultants per consultant in order to deliver your acute care?
The reason for that is elective care is almost entirely consultant delivered, because that's where most of the more complex diagnostic medicine and long-term decision making on management is done, and that requires a consultant.
I think your analogy pertaining to solicitors doesn't really fit. The majority of solicitors won't become partners, but they will (to my understanding) become essentially autonomous practitioner's with their own case loads etc. I would say that makes them similar to consultant doctors. The partners are more akin to GPs who are practice partners (i.e. have a stake in the business of the GP practice) rather than salaries GPs. Hospital medicine probably has a less obvious comparator but I guess it would be people like the service directors for the various specialities.
What's been the actual outcome with your knee? Have you been offered any intervention which is going to make any significant difference? It's a very long time since I did orthopaedics, but I'm guessing probably not?
I agree the analogies to other fields are problematic.
I don't really understand this though.
Is what you are saying that, essentially, we need trainee doctors and non-consultant doctors to largely run 'acute care' [is that A&E?] and we then need that system to feed out the qualified older hands to prop up the rest of the health system in consultant roles? Again with the x, y and zs, if you are a trainee for x years, a qualified doctor for y years and then a consultant for z years is it not necessary for the z number to be no more than, and really probably a lot less than x and y? Is that the case or are you a consultant for much longer than either of the other roles? What percentage of the system is elective care? It just feels from the outside, with no real knowledge, that this is a system doomed to become disastrously top heavy.
Professional diagnosis: fucked.
Had one surgery which has restored pain-free day-to-day stuff. I will need a second (bigger) operation if I want to play sports again. Next booked in with the consultant in May and I think we will probably decide on going ahead with it.
I had a Chinese consultant type as a neighbour who worked at the local hospital. We called him the Chocter.
Ok, so simplified structure of medical training.
Go to medical school for 5 years, then you are a doctor.
Every doctor who qualifies in the UK then has to do 2 years in what's called the "foundation programme", where you rotate through a range of specialities every 4 months. You may have heard these doctors referred to as F1/2s or FY1/2s.
Traditionally, after this everyone would apply for speciality training, whether this be GP or a hospital speciality (there's a bit more complexity to this but it's not that relevant). This lasts between 3 years for GP up to 7-8+ years for some hospital specialities. For roughly half of this time you'll be a Core Trainee and the other half a Speciality Trainee.
The term SHO is officially gone but very much still in use and would refer to any doctor above F1 but not yet a registrar. A registrar would be anyone who is in a training programme and has reached Speciality Trainee level but is not yet a Consultant.
Once you complete those years and fulfill all the requirements of your training programme, you are a consultant in your speciality (or a GP if you did GP training).
In recent years, more people have not gone directly into training programmes but have either taken fixed contract jobs in a specific speciality or just done locums. In these roles you don't progress up the training ladder. Initially people were starting to do this as it was possible to make a lot of money, but the market no longer exists for this.
Now large numbers are simply not getting into training so are forced into these fixed contract jobs. This is due to explosion of competition ratios from the enormous number of international medical graduates coming in.
So yes, career wise you will be a Foundation Doctor for 2 years, a core/speciality trainee for 3-8ish years, then a consultant for the rest of your career (ignoring any gaps in training).
Acute care is essentially all the stuff that happens when someone presents to hospital unwell. So that's A and E, but it's also all the care of people then admitted to the hospital for ongoing treatment and investigation under a speciality.
So if you present with bowel obstruction, you'll be admitted under general surgery and have an emergency operation. Then you'll be cared for on the ward post-op until you're well enough to go home. This is all acute care.
The on the ground work here is predominantly done by non-consultant doctors. All the initial assessment of the patients, the institution of initial management (IV fluids, antibiotics, etc), the organising of initial investigations, etc. Senior registars are able to act as the senior decision makers for much of this care and deliver much of the more complex stuff, like doing the actual operation for our bowel obstruction patient. Consultants are there as the senior decision makers for things beyond the registrar, and will also do ward rounds at varying intervals (may be every day, may not, depends on speciality) where they see all their patients and make decisions about their ongoing care.
Elective care is all the planned care, and this is predominantly consultant delivered. So that's all the outpatient clinics. All the planned operations in surgical specialties. Multidisciplinary case discussions around the management of patients with complex or serious problems like cancer. Diagnostic procedures like endoscopies. Complex radiological investigations and reporting. Morbidity and mortality reviews. Etc etc etc.
Then there's all the adjacent stuff like management and teaching.
I can understand from the outside why it might seem like you've got all these doctors, how can you possibly need them all to be consultants, but there is more than enough consultant level work to go around. Most places are short of consultants.
Last edited by randomlegend; 25-03-2025 at 11:11 AM.
Good, I'm glad. Maybe the GP you saw was indeed just crap. Not examining a joint when someone has come with a joint problem would certainly not be my practice.
GPs are incredibly hamstrung by the fact they often only have 5 minutes appointments though, whilst the noctor brigade often get 10 plus. GP is an unbelievably hard job. As a med student I've sat in with duty doctors (like the on-call GP for the day in a surgery) where they've had 100 patients on their list for the day. A hundred.
Last edited by randomlegend; 25-03-2025 at 11:16 AM.
My solution:
- Let everyone who wants to take the tests/courses/whatever take them. Have them every month, hell every week. Allow retakes.
- Flood the system with doctors
- Since there are so many, you can pay them less
- The people of Britain can be treated by full-fledged doctors as opposed to 'noctors' for less money
- Everybody wins
My suggestion. Don't be so fat and unhealthy.
Huh? You want to run 10 years of medical training weekly?
I agree. Let's form a coalition.
Taking about those tests that done people were mistakenly told that they failed and it ruined their lives. Let them retake them asap, no need to wait six months or a year or whatever. Also, those ten years could probably be eight or even five. Make people specialize earlier if needed.
Are you telling me that people have to wait months for an appointment and then they only get to see a doctor for five minutes? Because if so, lol at that. Also, what kind of totalitarian system does not let doctors choose how many appointments they want to take?
No, these appointments are handed out daily, you just call first thing and try and get an appt.
I see. So these are just the gatekeepers to the real care?
Yeah, like triage. Mostly useless. And they are further gatekept by the dangerous Karens on reception (Koctors) who know miles more.
Not really. They're who you see for non-energencies. Obviously some times they'll refer you for "real care", but more often than not they're chucking antibiotics at a cough that's lasted more than 10 days.
Those are things doctors would love.
The exams being run more often will never happen though. They are barely able to cope with the administration as is (hence examgate). They also cost a lot of money and we have to pay for them.
Exams are also a very small part of how we are assessed. I have a portfolio with a huge number of requirements I have to fulfill each year to progress. Having someone pass the exams definitely does not equate to them being a capable consultant.
Last edited by randomlegend; 25-03-2025 at 01:36 PM.
Yes. Hospital speciality appointments are longer but in GP that's the reality.
The duty doctor is like the on-call doctor for the surgery for the "urgent" appointments people call up for on the day. Things that need to be seen but probably don't warrant A and E.Also, what kind of totalitarian system does not let doctors choose how many appointments they want to take?
A GP's normally list will not have that many patients, but they are still packed in back to back 5 minute appointments.
I would not be a GP for all the money in the world.
Last edited by randomlegend; 25-03-2025 at 01:34 PM.
They are the gatekeepers to specialist care, but they are also an extremely important speciality in their own right. They manage a lot in the community.
Being a generalist is a very, very hard job. You can get literally anything walk through your door and in five minutes be expected to work out what to do with it. That's fine if it's someone with an obvious viral infection or whatever, but you will get the unicorns occasionally and picking them out so you're not the GP in the daily mail who "MISSED MY DIAGNOSIS that ten people in the whole world have" is tough.
And with that, I never vote Labour - or, most likely, for anyone - ever again. I wish Mr Farage the best of luck in finishing off whatever is left of the country in 4 years time.
What, not even if they promised policies you agreed with at some point in the future, presumably under new leadership?
Not sure what anyone was really expecting of the more of the same but just more competent ticket.
The best bit is the diehard tories who defended the same policies under a blue rosette will be rabid about this cos it's the red team.
And it turns out they aren't even 'more competent'. You cannot help but to lol.
In fairness I'm just kind of settling for no obscene corruption at the moment. That'll do me.
I'm just after a government that can outlast supermarket vegetables.
Corbyn was right again...
Maybe we're looking at this the wrong way round. Maybe we should aim for vegetables that outlast governments. Food waste solved overnight.
How does one game the outcome of this and the US stuff ala the chap in the Big Short?
It feels like I should be taking the tax hit and putting what's left into that rather than a pension.
He was right about everything. I hope it was worth it for these cunts that stabbed him in the back. It's funny that they've turned out to completely fucking shit at being in power but I'm sure the cushy directorships they get from their donors afterwards will make it worth it. They won't even have the shame to be embarrassed.
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