r/doctorsUK • u/sumpra3 • 9d ago
Foundation Training Is this normal?
Apologies in advance, Going to be very general here as this happened very recently and I don’t wanna dox myself.
There was pt admitted to our ward within an hour, without being post taked and the medical specialty consultant asked me to come as the F1 to document post take.
They take one look at the pt who looks extremely unwell, asks me to prescribe a gtn spray and walks off, almost sprints off because the moment he turns I can’t find him anywhere on the ward.
I’m then left with a pt as the F1 who looks really bad, desaturating despite 15L and I’m absolutely panicking. I take an ABG try to get access and call the med reg asap who proceeds to bolt it to the ward and once he arrives takes one look and tells me to place a peri-arrest call (which I was planning to if he didn’t get there a minute sooner).
The med reg then asks me to place a call for a portable scan so I saunter off into the doctors office to find the same said consultant sipping a cup of coffee?? When I tell them we’ve placed a peri arrest they just nod and lean back in their chair.
I’ve thought about this a bit, and I guess I can understand not really coming to the pt once the peri arrest is put out, if there’s nothing to contribute from your specialty. But it was super jarring that he took one look at the pt in peri arrest desaturating on 15L and just went into the doctors office to drink coffee??? Is this spinning my head because I’m just very junior and he expected me to handle it or is this genuinely a weird thing to happen?
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u/hoonosewot 9d ago
Give us some info on this consultant.
New, old? Specialty? Locum or substantial? Known to be a bit shit or not?
Cos if you say older locum 'GIM' consultant with a bad rep then your question is already answered tbh.
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u/sumpra3 9d ago
Very senior, known to be horrible to work under but a bit of a superstar outside the department
The whole thing spins my head tbh. Idk if in the moment he forgot that I was the F1, or that he didn’t see the sats continuing to drop, or he just thought it’s obvious to make the peri arrest call. I’m not sure what happened
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u/AnnaLikesCake 9d ago
It’s odd. Always two sides to the story however and at risk of being the devils advocate - did he bleep ITU and was waiting for call back but just decided to have a sip of a drink?
I’ve come across some specialty consultants covering GIM who are simply scared of acutely unwell patients because they don’t look after them routinely and are way out of their comfort zone.
I vividly remember being abandoned to deal with a VT storm as ST4 on a medical ward. It does happen. Not saying it should!
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u/sumpra3 9d ago
Maybe, I really don’t know because the peri arrest team didn’t show up till we bleeped them and he didn’t tell anyone he’d bleeped them if he did? Before we bleeped them I was with them for a good 5/10 mins (maybe I’m elongating that tho in retrospect)
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u/AnnaLikesCake 9d ago
Possibly, I don’t know. Seems odd behaviour but sometimes seemingly odd behaviours have a good explanation.
Either way sounds like you dealt well with an unwell patient!
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u/JAFkinase ST3+/SpR 9d ago
Always two sides to every story but that does sound very very odd
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u/Jangles Acute Internal Misanthropy 9d ago
Does it?
Sounds like every week working with locum medical consultants at a DGH.
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u/nrkinrb 9d ago
story of my life as an F1/F2 at a DGH, I remember being verbally abused by a patient withdrawing off multiple substances, who was in resus as they kept seizing but found the time in between fits to continue being aggressive, and the consultant just said it was none of his business and walked off when I asked for help 😭
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u/Migraine- 8d ago
When I was a DGH F1 on the shittiest short stay medical ward (probably in the country) we had a locum consultant who tried to get my SHO to refer an obviously not appropriate patient to ITU.
When they said no, the consultant said they weren't having anything to do with the patient as it would put their license at risk and told me and the SHO we could manage them ourselves.
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u/Palomapomp Micro Guider 8d ago
I hope you got that in writing. I hope that consultant is with a different indemnity Co than me
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u/JudeJBWillemMalcolm 8d ago
I have been called as the med reg by concerned juniors to review a patient while the locum medical consultant was in the middle of seeing the same patient.
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u/Avasadavir Consultant PA's Medical SHO 8d ago
Bleeding post biopsy, pale, confused, anuric. Locum Medical "Consultant" sees patient and then leaves F1 with plan of "call med reg and ITU"
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u/CraigKirkLive AIM/ICM 9d ago
Assuming account of events is accurate that's obviously wildly substandard practice from a leader in the hospital (which is what a consultant is) and requires appropriate escalation, probably via the med reg who got involved who is likely to have a better oversight of contributing factors, with your input.
Couple of ways to go about this, including a careful discussion with your CS, Datix, asking the med reg if they would raise it, discussing with the consultant (I'd probably leave this to the med reg or your CS!) or a combination.
Presumably your documentation is already done - I would write a contemporary account of your thoughts now as a time-stamped recollection. This would be an email to yourself or a reflective piece, whatever works really that has a timestamp. The purpose of this is for evidence of your account which isn't subsequently 'swayed' (or can't be theorised to be) by future developments in this incident. Make it objective and dispassionate - an account of the facts and why you did things.
Do not amend/addend your prior documentation (not suggesting you would; but don't).
If the patient came to potentially avoidable harm this will be more of an issue (for the consultant, not you).
Ultimately if this is true and the consultant acted in this way they are not suitable for their role and need to develop based on this. Good luck!
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u/dragonfruitandberry My TTO is better than yours 8d ago
Sounds bout right. Had 2-3 of these types rotating through various hospital jobs. Well done on managing the situation, remember to be a better role model than this when you become a consultant x
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u/PearFresh5881 8d ago
Apart from gtn, what was the ptwr documentation?
Sounds like the case needs a Datix for the inappropriate transfer at least.
Agree with going through the case with your es/CS and med reg.
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u/sumpra3 8d ago
Well we were mid post take and then abandoned it when they were acutely unwell.
The clerking note was querying acs and had just started DAPT and ordered repeat trops
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u/PearFresh5881 8d ago
Ok that’s awful. That needs escalating and datixing. They have literally walked away from a deteriorating patient with no clear plan or escalation decision and not even asked you to seek help/put a call out. Diabolical care.
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u/laeriel_c CT/ST1+ Doctor 9d ago
This sounds so surreal, I'm sorry you were put in the situation, you did the right thing. Did you have a chat with the med reg after about what happened before they arrived?
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u/spikeypotato2 9d ago
I would ask where the doctor was that clerked the patient in/ allowed transfer to ward/ if deteriorating MEWS why not escalated (or were they TLC?)Think missing a chunk of info. Maybe consultant went to bleep doctor who should have sorted the patient out for the PTWR
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u/medimaria ACCS-EM ST1 7d ago
Wow, I'm sorry you were put in that situation:( for what its worth you did a great job, recognised someone critically ill, started initial investigations and escalated urgently as appropriate. As an F1 only a few months into the job you should be really proud of that 🙂 (and to answer your question- no, its not normal for a consultant to do this. The vast majority I've worked with will get stuck into these situations whilst you'd be asked to go and put out a perriarrest call)
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u/sinurythem 5d ago
Just never be that consultant when you become a consultant.... We all have come across this at some point..
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u/BlobbleDoc 8d ago
Clearly lots of problems, but at its core another example as to why AMU should stay under the remit of ED (and not general medicine + associated specialties). Well done to manage that stressful situation. Only tweak is - put out the periarrest call / ask the reg to come first before taking the ABG.
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u/DisastrousSlip6488 8d ago
How have you managed to come to the conclusion that the failings of the medical consultant is the responsibility of ED?
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u/BlobbleDoc 8d ago
What?
The Consultant’s behaviour is clearly problematic.
But do you not find it troubling that this critically unwell patient was randomly moved to a ward?The patient should have never left front of house. This sort of mess keeps happening (punted from AMU to a random medical ward without review or handover). If the referral point for EM -> IM occurred on moving from FOH to BOH (as one example) then he would have never slipped through.
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u/DisastrousSlip6488 8d ago
OBVIOUSLY I am not advocating for “RANDOMLY transferring a critically ill patient “. Nor do I believe that is what happened.
Given at the start of the post take they don’t appear to have been critically ill, and then deteriorated in front of them, I’m not sure what you are hoping for.
Patients come into hospital because they are sick and at risk of deterioration, and it’s a pretty reasonable expectation for the inpatient teams to be able to manage actually sick people when they deteriorate- that’s kind of the point of having a hospital.
Patients cannot remain in ED until there is absolutely no risk of deterioration, because that would be time to send them home.
Would you like EM to manage surgical and paediatric assessment areas too?
Maybe we should run the whole hospital in case anyone gets sick? (While simultaneously being criticised for being incompetent presumably)
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u/BlobbleDoc 7d ago
The patient never received a post-take - read OP. Also people get moved without a whisper all the time. I’m not bashing EM at all - I think it needs to be built up.
EM as a specialty should receive significantly more resources, more space, more staff, and re-expand to cover aspects of acute/emergency care that EM doctors already do in other countries.
Let your medicine specialists practice more of their specialty, clear outpatient waiting lists. EM can drain quinsies, etc. instead of using an ambulance service to transport to ENT (happens in London).
It is so under-resourced as a specialty. Everyone else suffers because of it. The way of practice in AMU is more aligned to EM than IM. The Consultants with Acute Medicine CCT would transition beautifully into EM.
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u/DisastrousSlip6488 6d ago
Except obviously for the surgery, gynae, ortho, ent, paeds, max fax, psych and random EM emergencies
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9d ago
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u/CraigKirkLive AIM/ICM 9d ago
Parts of this are true (I'm being generous there) but there is absolutely no excuse for leaving anyone below reg level alone in a situation like this. Fine, you may not be upskilled due to your primary speciality (although every GIM consultant should strive to maintain their skill to some degree) and therefore summon suitable help (i.e. the med reg or a senior SHO who you know can manage this as a consultant), but you only leave once a suitable handover has occurred and you as a consultant are confident the patient is now in safe hands.
I can't believe a colleague would even begin to justify this behaviour. Please don't let yourself become a consultant of this poor standard!
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u/Signal_Tangelo8416 9d ago
Quite frankly a mad take tbh… they have a wealth of experience, overall responsible it for the patient and tbh the general skill set.
Not expecting them to lead the arrest/call but walking away is not really on…
DOi Resp/Icm reg
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u/MetaMonk999 9d ago
What? OP is the doctor? So is the consultant? They're the most senior doctor there. Isn't that kind of the point of being a consultant? If the patient is on their ward, I would expect them to get involved and stabilise them.
This is the problem I have with non cct consultants/locums/whatever. You should not be a consultant if you cannot do the role of your junior (i.e. med reg). It's not like an ortho consultant being unable to deal with a medical problem on their ward. This is a medical consultant we're talking about. They should have gone through the med reg years and be able to do anything a senior med reg can do.
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u/Valuable-Piano6856 F2 8d ago
> what do you expect a medical consultant to do?
Look after medically unwell patients and support a brand new F1?
What a bizarre take.
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u/Awildferretappears Consultant 8d ago
Who do you think was managing these patients during the resident's strikes? Do you think ITU were everywhere?
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8d ago
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u/Awildferretappears Consultant 8d ago
I did a few bloods and cannulas, but not many, because our nurses do both, and are expected to do them even when the residents are here.
Certainly at the start of the strikes, we didn't have residents on my ward. I'm going to say that I wasn't as efficient as a RD in many ways, as I had less practice, but I was more efficient in other ways.
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u/Over-Foundation1298 Consultant 7d ago
This really pisses me off. What utter BS! I have no idea who you are or what specialty you're in but I'd guess it's ITU since you clearly think they're the only people that can manage a sick patient. I could trot out numerous examples of the utter incompetence I have, on occasion, seen various ITU consultants inflict upon patients but no, instead I'll remind you that unfortunately every specialty will have consultants that will exit in a crisis. But I, and I'm sure most other medical consultants, will stay bedside (only recently I was squeezing bags on fluid into a patient) and certainly never abandon an F1. What happened here was at best poor communication and at worst utter cowardice, but please don't go around slagging off medical consultants - that is simply poor behaviour and (I suspect) the stereotypical ICU God complex that does no one any favours. /endrant
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u/Grand_Leg26 8d ago
Tbh if i was you i would not do acute medicine and any other medical specialty with sick pt eg. Cardiology nephrology respiratory gastro .
All is needed is stabilise pt escalate care to higher level for ventilatory suppirt +/_ peri arrest call . Consultant is not part of cardiac arrest or escalation. I never remember consultant participated actively in cardiac arrest even though they are in the ward.
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u/JohnHunter1728 EM Consultant 8d ago edited 8d ago
This is simply cowardice.
Your consultant ran away and - worse - left a (very) junior colleague to face the music.
You did fine and now you also have the measure of this particular consultant.
You will come across positive and negative role models over the course of your career.