r/doctorsUK

Oncology SpR in large tertiary centre. I have been working there for approximately two years.

Every rotation we have multiple SHOs going off sick with burnout/ find them crying in cupboards. This rotation seems particularly difficult with lots of long term sickness and tears.

From a senior point of view, the workload does not seem exceptionally high. they are usually asked to manage 6-10 patients each (10 would be unusual) and I think there is quite robust senior support (2 cons ward rounds per week and on average 2 SpR rounds per week). if someone gets sick I will see them on the day, sometimes within minutes of being bleeped. I try and teach on my rounds and do portfolio bits and I think most of my SpR colleagues are equally helpful. Yet they are falling like flies. We had a few difficult deaths and I am aware that inpatient oncology is a pretty miserable sample of oncology life, but nothing particularly challenging recently.

When asked how things are I usually don‘t get anything particularly useful, but then they will rip into us in the placement survey.

If anyone has done/is doing oncology as an SHO, what’s so bad about it and what would you change?

Edit

Interesting stuff. I think some points are spot on I Can understand the frustration as the SpRs often share it:

1. we do have a firm system and whilst the consultant and SpR are fixed, the SHOs move between firms often which is probably quite unsettling. This is due to how variable our numbers are (1 weeks breast cancer have 2 patients and the following week 12) so it is difficult to justify assigning an SHO to one or more subtypes for the whole week. We also have ACPs which Are assigned to a given firm. they do some follow up clinics in their tumour types and have been around for donkey. Quite experienced in their niche, quite junior outside of it so if at all possible we keep them on their turf.

2. Emotional burden is high and maybe we are so used to it that we underestimate how sad it can be to start a syringe driver in someone your age

3. Non-oncology issues are left to juniors to sort. This is probably true, my gen med knowledge is not as sharp as when I was an IMT and I am sure I send more referrals than medical SpR doing regular medical on calls would. consultants are obviously even worse at this and rely heavily on the SpR.

4. Escalation plans are a bug-bear of mine. Some consultants just don‘t do them. when they do them, sometimes it’s worse as they make an explicit plan to escalate people who should never be escalated. I make an escalation plan for every patient I admit on call.
   Af the same time, I would be involved in any discussions with ITU/HDU and I hardly ever refer to them.

I think the best suggestion so far is to have an SHO rep feeding back to the SpRs. at the moment it’s all through consultants via the end of placement survey and the feedback we get it’s all a bit garbled and non specific.

Extracts from the article below:

Two Essex doctors have been banned from practicing following allegations that they helped medical students cheat on their exams. Dr Elmira Yaghmaei and Dr Hamed Salehi both worked at Common Stations PLAB Academy in Romford, which offered students Professional and Linguistic Assessments Board (PLAB) 2 exam courses.

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The initial concerns in the case of Dr Yaghmaei, a tutor at Common Stations, arose following a PLAB 2 exam day in February 2019 when a General Medical Council (GMC) member of staff found a folder left at the Clinical Assessment Centre. The folder contained a large volume of information about the PLAB exam and wording within the pages claimed copyright on behalf of Common Stations, which suggested ownership by Dr Yaghmaei.

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One note from a Seema Khan said: "All the stations were exactly word by word the same as we were taught and I already knew the diagnosis/differentials/what questions to ask etc before going into the cubicle… it was like magic!!!"

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It was claimed that Dr Salehi created and distributed teaching materials containing exam information to students being tutored by Common Stations, assisting them to obtain an "unfair advantage". The GMC also said that Dr Salehi made posts on social media and distributed leaflets stating that Common Stations had achieved a 100 per cent pass rate in PLAB 2.

Honestly - being falsely accused of inappropriate behaviour with patients is my biggest irrational fear.

In 10 years of being a doctor, i’ve only had a couple of complaints from patients (mostly excellent feedback), so i don’t dwell on this, but sometimes the thought does creep in that it only takes ONE big’un and your career is in jeopardy. The complaints I had were mainly for me being stern with patients who were rude to team members, and once for refusing a home visit and instead insisting the family take their mum to hospital, whose speech was slurring, swallow was affected and was drooling… ?stroke.

But a false accusation of sexual assault in an intimate exam basically, that’s my fear. In GP, it’s not as easy to always grab a chaperone without making your list run late. Don’t get me wrong, as a male, with female patients I ALWAYS get a chaperone for intimate exams, but not for abdominal exams unless i get the vibe from the woman that she’s nervous or insecure. For males I offer a chaperone, but they’re usually like “nah you go ahead doc, I don’t want an audience” 😂

But there are bad people out there who are trying to make a buck off of you, and I worry about this happening one day.

Anyone else feel the same, or got any advice around worrying about this?

I have recently had a patient that disclosed recreational drug use in their days off. They worked in a high stakes industry (eg where drug use while working would be very dangerous). It wasn’t a drug that causes extreme dependance and the patient said they only used it when off.

I didn’t see a reason to raise it/report it because of the nature of their profession…. I am curious, where do you guys draw the line between reporting this kind of stuff?

One jab for GLP-1, back when it all began;
A second with GIP added on, big pharma’s grander plan.
A third now with glucagon, to burn through the fat stores;
Exhaustion for readers, who can’t take one paper more.

One drug to beat them all, three receptors to target;
One drug to shrink them all, and tear up the drug market.

In the land of Indianapolis, in the labs of Eli Lilly, scientists forged in secret a master drug, to rule over all.
Into this molecule, they poured their capital, their clinical trials, and their will to dominate all of metabolic medicine.
Their new elixir binds tightly not only to GLP-1 and GIP receptors, but invokes the ancient fires of glucagon, for a threefold conquest of obesity. 

Soon it will surely claim a more catchy name, but for now, it is known only as Retatrutide

One by one, the complications of obesity fell to the power of the triple agonist 💪

So confident were they in the power of their creation that the scientists presumptuously named their key study TRIUMPH-1.

Published in the sacred scrolls of The New England Journal of Medicine, this phase 3 trial gathered a great host of 2,339 adults with obesity, but without diabetes.

Over 80 weeks, the subjects were randomly assigned to once-weekly injections of retatrutide (at doses of 4 mg, 9 mg, or 12 mg) OR a phantom placebo 👻

And the final reckoning? 

Retatrutide resulted in a mean weight reduction of 17.6% (4mg), 23.7% (9mg), and 25.0% (12mg) under intention-to-treat analysis, compared to just 3.9% with placebo (P < 0.001).

• At 104 weeks, a subset of patients achieved a 29.9% reduction at a 12mg dose.
• In fact, one-fifth of those on the maximum dose achieved over 35% weight loss!🤸

More weight loss than Gollum after finding the ring

Not content with mere weight reduction, the trial also took aim at other obesity related issues.

• 574 weary travellers with knee OA saw their pain scores improve by up to 3.6 points, vs. 1.9 with placebo (P < 0.001).
• 243 patients suffering from obstructive sleep apnoea had a reduction of 31.7 apnoeic events per hour vs. 9.9 on placebo (P < 0.001).
• For people who entered the trial with prediabetes, a massive 90% achieved complete normoglycemia vs. 54.2% on placebo.
• And across all arms, there were drops in blood pressure, triglycerides, and non-HDL cholesterol.

 

But all quests have their setbacks, with TRIUMPH-1 being no exception:

• GI upset was the most common side effect: patients reported nausea (up to 42.4%), diarrhoea (up to 34.1%), vomiting (up to 25.3%), and constipation (up to 26.1%)
• Thus, the drug discontinuation rates were high, peaking at 11.2% at the maximum dose of 12 mg.
• A high proportion of the placebo group understandably weren’t too pleased with their tic tac and ditched the trial to quest elsewhere.

Notably, the drug was pitted only against a silent placebo, avoiding a clash of arms with the great titans of semaglutide and tirzepatide.

But despite this, we may now truly have found a weight loss drug that bows to no one. 👑

One drug to beat them all, three receptors to target;
One drug to shrink them all, and tear up the drug market.

If you enjoyed reading this and want to get smarter on the latest medical research Join 16,000 Clinicians reading The Handover here 👉 Read The Handover

hi, im an fy1 and i feel like im just horrible at it- i know i'm still new to it, but I feel like I'm struggling so much more than everyone else is. I really struggle to keep up with all the jobs and I'm so uncertain with everything that I'm double checking basically everything with my sho which i can tell really winds them up. every time i'm on call i just feel like im trying really hard but that I'm completely useless and give everyone else way more work. i did fine at medical school and i dont think im lazy but i worry everyone else thinks im lazy and im being bad on purpose, but i really want to be better- i just dont know where im going wrong compared to everyone else, or how to be better. I'm really struggling with adjusting to being an f1 more than most people and im just left feeling horrible about myself most of the time. I see so much on here about how the new f1s are feckless and so acopic and this isnt usually me. Any advice on just being less dead weight?

2 months into FY1 and I’ll be honest I haven’t got a single QIP or audit throughout med school no research or poster presentation. Med school was hard enough for me to get through exams without these additional things but now I want to apply for IMT after fy2. I want to specialise in dermatology or stroke medicine (unsure yet) but I honestly have no clue how to build a portfolio. I’ve looked at the IMT requirements but where do I even orally present these presentations and how do i even go about doing these projects it seems so overwhelming. Also doesn’t help that I have crippling anxiety so can’t even orally present these things and IMT is already so hard to get into i’m terrified i’m so behind and i have no idea where to start! any advice would be greatly appreciated

As a doctor currently on a night shift, I am very jealous of all the nurses going for protected rest breaks.

I fully understand that those are unpaid, however BMA documentation states as doctors we should have 3x 30 min breaks on shifts over 30 hours.

I do not know anyone who has ever managed this consistently over any shifts (long day or nights).

Is this just an accepted part of our profession or is there an actual solution to having proper breaks

My mum has stage IV cancer and I’m a trainee working in a closely related field. She had a really good response to chemo and has subsequently been referred to surgeons to consider whether there is a role for surgery.

While waiting for the surgical process/MDT and appointments, some of her original symptoms have started to return, particularly pain. Her team are aware of various ongoing issues, but I’m finding the waiting incredibly difficult because I understand enough medically to worry about progression happening while we wait.

I’m struggling to work out where the reasonable boundary is between being her daughter and using my knowledge of how the NHS works to advocate for her. Should I leave the pathway to run its course once the treating teams have the relevant information?

I’m very conscious that I don’t want to use being a doctor to seek preferential treatment, and I also know anxiety can make every delay feel intolerable. At the same time, I don’t want to look back and feel I could reasonably have advocated for her and didn’t.

I’d particularly appreciate hearing from doctors who have had a parent/partner with serious cancer/illness. How did you decide when to chase/escalate and when to step back and just be their family member?

I will be upfront and say that I voted against the deal that was offered to us. I was highly - and I believe rightly - sceptical of Jack Fletcher as chair given his links to the labour party. Overall, I was disappointed by the last iteration of the RDC, feeling it was a step backwards and a diversion from the goal of FPR. The diluted messaging and kneecapping of our momentum felt deliberate. And, to be honest, the council's priorities felt quite self-serving, as a group of mostly LEDs/early-stage trainees pushing for exam fees being covered and improvements in LED contracts, etc., rather than improving pay and conditions for all and addressing bottlenecking at all levels. Not to mention the censure and all the dodginess which ensued in its wake.

With all that being said, we are facing many issues as a profession and as the new council, this is your opportunity to advocate for us and try to turn things around. Ultimately, I believe we all hate the schoolyard politics and want to see our situation improve. We need to do away with the division and take urgent action on the following:

• Doctor substitution (arguably our biggest fight yet) - ACPs, "consultant" AHPs, reporting radiographers; noctors as responsible clinicians for psych patients
• Bottlenecking at consultant level
• Working conditions (yes, including pay - FPR has still not been achieved in England)
• Bringing back the BMA rate card
• Excessive growth of medical schools without capacity for training

I’m a senior registrar and have recently completed the Edward Jenner Programme (Levels 1 and 2). I’m considering whether to do either the Mary Seacole or Rosalind Franklin leadership programme next.

Has anyone here completed either of these programmes? Did you find them worthwhile, particularly at senior registrar/consultant level and did they add much to your CV or leadership development after Edward Jenner?

I’d also be interested to know about the workload and time commitment as I’m currently progressing towards a PGDip alongside clinical work.

Thanks

I have a Clinical Oncology ST3 interview coming up and I'm working out how to preference regions. I have no geographical preference. I'd really appreciate honest views from current registrars:

1. Resident nights: Which regions or hospitals have resident on-site nights, and which are non-resident on-call from home? How often are you on?
2. Training quality: How are radiotherapy planning time, clinic numbers, supervision and study leave?
3. Rotations: Are the sites within commuting distance of each other?
4. Culture: Do you feel supported, and are rota gaps or burnout a problem?
5. Recommendations: If you were starting again, which 3 to 5 English regions would you rank highest, and which would you avoid? A short reason would be great.

Happy to take DMs if thats what you prefer. Thank you!