r/ausjdocs

https://www.instagram.com/reel/DViKoEwlIKS/?igsh=MWF2NzRlNmhzeWkwNA==

Curious to know what your thoughts are on my mini syncope rant. Since there's so many that come through ED and then spend a couple days on the ward. (PREFACE: I'm not even a reg - so these are just some musings. Not me thinking I know better necessarily)

1. Loss of consciousness is immediately labelled syncope. Passing out does NOT instantly mean syncope.

2. LOC on the realm of ~5 minutes .... is that even still syncope?? Thought the definition of syncope necessitates rapid onset and relief.

3. The insane differential and pointless investigations. Seriously, without any neurological changes why am I ordering an MRI - Brain for EVERY syncope to rule out stroke !? I get an initial non-contrast CT brain. But Stroke/TIA tends to be part of the differential a lot. Also (more of an academic pet peeve) but you can't say someone has syncope and then include hypoglycaemia on the differential bc if the patient lost consciousness due to hypoglycaemia it's not a matter of transient global cerebral hypoperfusion is it? It's an issue with glucose availability and metabolic cause of LOC. I hate how they get immediately labelled as syncope.

Re: MRI-B and ruling out stroke

Fair enough if they had some sort of lateralising/focal neurology on history or on examination when in the ED. But for EVERYONE (in reailty - more than 50%) (??) cmon... Also thought reduced consciousness in cases of stroke is rare (brainstem stroke or herniation). what is the yield in these MRIs?

4. Polypharmacy.... I usually see a trend of antihypertensives discontinued, only to eventually be restarted in a majority of cases once we fluid resus them if they had some orthostatic hypotension. That's fine but what's the benefit in continuing on an ACE for example in an elderly very comorbid patient. So many more medication classes could genuinely be contributing especially in a frail patient, and it's just sad to see these nursing home residents come in for the same thing. I'm sure it's hard for that 1-2 GP looking after hundreds of residents.

5. On the fence about repeated blood tests once they hit the ward. I have seen many ... maybe the K is like 3.2. Sure, but no ECG changes. Or some long standing iron deficiency anaemia. Seriously, no zebras here - chronic, stable disease. They hit the wards and then we give them some very small amount of fluid, some oral electrolytes (which they will continue taking on discharge btw for a few days), maybe an iron infusion sometimes. Point is, treatment that is very fit for an outpatient setting. WHY am I wasting money on daily blood tests while I sort out their disposition? A daily FBC and UEC?

Curious to know all your thoughts, and to see if this trend is true across the country.

Eight months ago I posted here asking whether a centralised coroner’s findings database was feasible and worthwhile. The response was encouraging. Life and other projects got in the way, but I finally got around to build it.

https://coronial.com.au

What it is

A searchable database of publicly available Australian coronial findings across all 8 states and territories, from 1979 to present. Currently 8,565 cases.

Every case has been AI-processed to extract structured tags: clinical specialty and setting, type of error (diagnostic, medication, procedural, communication, system, delay), drugs involved, coroner’s recommendations, preventability (as per coroner), escalation failures, AHPRA referrals, rural/remote flags, MHA involvement, and custody/care deaths. Each case has a short AI-generated summary and links to the original court document.

Why

Aviation has the NTSB and ATSB. Every significant accident is investigated, publicly reported, and disseminated so the entire industry can learn. Medicine has no equivalent at scale. M&M meetings are internal and invisible. Coronial findings are public but buried — no tagging, no cross-jurisdictional search, no easy way to ask “show me all airway-related deaths in Australian hospitals in the last five years.”

I’ve wanted this resource for years. So I built it.

Features

- Search - what was that case again where someone unfortunately died from a cataract surgery? When you search for the keyword cataract, you find not just one but two tragic cases directly related to cataract surgery, though there was also another accident case thought to be unrelated to recent cataract surgery, and a drowning case at Cataract Gorge.

- Discover - if you are an anaesthetist / psychiatrist / ED physician etc, you could specifically ask for randomly generated chosen cases. Or even “surprise me”.

- Filter - if you want to find last five years sepsis paediatric deaths in WA, you can find it by filter

- Read just the summary or the full report - you can read just the 30-second AI summary and extracted recommendations, or click into the original PDF.

Caveats

AI-generated tagging and summary makes the scale possible but introduces inevitable inaccuracies. Classifications may be wrong, summaries may miss nuance. Treat it as a discovery tool only — always read the original finding before drawing any conclusions. There’s a Report an inaccuracy link on every case page.

Free. No signup.

Feedback very welcome, especially errors, missing cases, or suggestions for additional tags that would add clinical value.

I have a friend who studied post grad medicine. He is PGY3 this year and got into radiology this year at a metro hospital in Melbourne. (Relevant because it’s a “desirable” location so should be “harder”) He’s not the only one - all other new program members are PGY3. I do acknowledge that they’re a small percentage of their graduating cohort so that’s not the case for everyone.

On the other hand at this same hospital a year 5 reg Ortho surgeon did 5 years unaccredited before getting on the program but that is surgery and she is a woman (if that means anything!) and she did undergrad so was only 35!

Every post on here says in the last 2-5 years (range varies) speciality training has become increasingly difficult to get into and they’re greatly they’re not in medical school now. Essentially being a consultant shouldn’t be an end goal and unaccredited positions will be forevermore etc.

I won’t even start on people saying the money is not what it used to be.

Is it oversupply of grads? Or the fact consultants are rarely 1.0 FTE and most leave the job by dying not retiring?

Is this sub just bias to hating med (because they’re in the thick of struggling to get training, doing the long hours, working away from home) or is it just not good at all?

EDIT: edited for grammar as I was getting roasted in the comments

hello i’m just a medical student, and i’m not surgically inclined but very open to it. the one problem i have is that i just get so freezing in theatre. it may be a problem with bad circulation but it gets to the point where i can barely control my hands because of how frozen they are! i’m honestly so scared of dropping things because of this. i’ve tried rubbing them, moving them and everything but it doesn’t help much.

this is fine when i’m watching, but even when scrubbing in and maybe for the future as well if i want to do things in theatre i feel like it’s impossible. the theatre isn’t even that cold overall, maybe around 10-20 degrees depending on what they set it at. i don’t even feel that cold but my hands decide to lose all blood flow for some reason. they also get a bit blue sometimes even at 20 degrees

does anyone have any tips or ideas on what i can do to help with this?? no one else i know really has this problem

Nothing like hiring "Trauma ED Nurse Practitioners" because you struggle to attract ED Registrars/can get government funding to implement an NHS-esque model of care as part of the de-prioritisation of doctors in Australian healthcare.

https://austinhealthrecruiting.blob.core.windows.net/pds/Emergency%20Nurse%20Practitioner%20%E2%80%93%20Trauma%20-%20Dec%202025.pdf

Especially love the reference to "[s]upport junior medical staff with clinical decision-making and escalation processes".

I am sure Phase 1, 2 and 3 ACEM Registrars are very excited to be called "junior" by and have their decision-making supported by nurses with less knowledge, capability and scope of practice than them.

Not to mention by the end of 2027, the NPs will earn a higher hourly rate than ED fellows with a full scope of practice, while no doubt also not being rostered to work night shift.

Doctors are honestly not angry enough about what is happening to our health system.

I moved to Australia after high school. Finished grad med school here and now im an RMO and wanting to stay in Australia for the rest of my life

I cant help but compare to my school mates who are halfway through their specialist years, while Im still trying to get my pre-training requisites done. I just see those pgy 5+ who are still service reging and I feel worse

Why is it such a struggle here compared to the rest of the world?? I know that we get to have wider experience, but they seem to be making it too complicated to actually get into training. Let alone existing the training.

https://www.coronial.com.au

I have been absolutely humbled by the overwhelmingly positive reception for this project since the previous post.

It turns out that an interest in access to coronial report was more universal than I thought, and this project fulfilled a need with a good use of LLM.

Since 7 days ago, I have continued to work on shipping improvements. Here are some updates.

New: Card carousel view

If you have narrowed your search result to 100 cases or less (say: search term "sepsis", with additional filter of state:wa and specialty: general surgery, the results can now be toggled from a list to card carousels. Swipe through on mobile, or use arrow keys on desktop. Good for browsing your shortlisted cases from a search result.

Smarter search and filtering

Dynamic Filter counts: when you search or apply a filter, the filter item counts update to reflect only what's actually in your current result set. Zero-count options disappear automatically.

"Has coroner recommendations" filter: 5,226 findings to date include specific recommendations from the coroner; you can now narrow to just those cases.

Better data quality

Specialty tagging: previously the LLM was given freedom to assign specialty name, this has resulted in some nonsense e.g. intensive care is given variants of intensive care, intensive_care, critical care, ICU etc. This is now appropriately constrained to a controlled list of 76 specialties.

Hospital name detection: similar issue to above, previously there were variants and nonsense e.g. "Emergency Department of Royal Adelaide Hospital" being considered a separate hospital, as well as one hospital having multiple variants e.g. "The Alfred", "Alfred Hospital" etc. These were cleaned up painstakingly (and follow AIHW hospital name as much as possible), and going forward all detected hospital names will snap to a known list to prevent similar duplications.

Discover page: As requested, added a few specialties e.g. radiology, oncology, respiratory, neurology.

Bug fixes:

- Scraping issues

- Fixed some states' broken PDF link.

Content:

- 14 new cases added from various jurisdictions.

Infrastructure:

- I have moved the hosting of the web app from Vercel to Cloudflare pages as we are easily exceeding the 10GB per month limit for the former.

- I will consider moving the API infrastructure from fly.io to Cloudflare D1.

Feedback welcome. The project is only as good as your suggestions and proposals.

I've been locuming around a smorgasbord of regional EDs around NSW and Vic and there have been some absolutely shocking ED 'seniors' on the rosters. Mostly locums but occasionally a local GP dipping their toe in to the slightly bigger EDs nearby (im talking the 10 bed size range). They just seem to rotate around without ever getting properly called out on it.

Recently had the 'senior' call in a GP anaesthetist because they didnt know how to put in an art line and start vasopressors to keep a patient safe while waiting for retrieval. They also didnt know how to stick in an US guided cannula in an IVDU patient who was stable so suggested a junior stick in an IO to take basic bloods with. Luckily the junior ignored that and just went and did the cannula themselves with the US

Another I had the senior book it out of the department when a resus came in leaving me and another junior doing our best to salvage it.

In another the GP Anaesthetist decided they were bored staying with the ventilated patient in resus waiting for retrieval so just walked out and left them without anyone airway trained on site.

The nurses have generally been amazing though and I guess its a survival trait and acting as the last line of defense between some horrific doctors and the patients.

Am I just having terrible luck or is this everyones locum experience?

For anyone who grew up working class with no family inheritance to rely on for house deposits, finances are important in career planning.

This is all anonymous so I am hoping this provides juniors a realistic guide. For FRACP physicians across specialties, what's the rough income range for an early <5 years of fracp vs later year FRACP in metro areas and the work mix e.g. 100% private, mix or 100% public?

Specialty:

Hours/week:

On call:

YOE post letters:

Income range:

<200k

200-400k

400-600k

600k-1m

1m+

Random seasonal depression shower thought:
With the amount of litigations for the dumbest stuff and life being too much, is it an option to just remain a clinical marshmellow forever?

Hey everyone, not sure if this is just me noticing this but there has been an influx in the number of times I’m called to update a patient’s family.

Just a disclaimer: it’s a no-brainer why families want updates, of course they would, it’s their loved one. I have 0 problem speaking to families.

What has been frustrating is the amount of calls at like 9am while I’m still rounding or doing urgent jobs saying “oh so and so’s mum/sister/niece wants an update you need to call them or come back now they’re stressed.” And an emphasis- it’s not about what is said but more about HOW it’s said. Have gotten a lot of demanding and entitled families/other staff expect I abandon what I’m doing to go tell Mr Smith’s wife that we’ve halved his frusemide.

A couple things I don’t get:

1. Why the nurse who is calling me (who I JUST handed over to) can’t update the family when they are right there and I’m on a different ward (have had some say they’re demanding a doctor- fine in those cases)
2. Why the family can’t ask their very cognitively aware loved one what the plan (that I just told them) is
3. Why am I getting demands by other staff to drop everything and update the family about a stable patient.

It’s just frustrating especially that I’m dealing with really busy lists. If we have 35ish patients I cannot reasonably give an update to every single family who all come in at different times.

I’ve literally had a nurse call me over saying she urgently needs me (me thinking a patient is unwell) only to walk in the room and say “the doctor is here!” to a crowd of family members after I’d just gotten off a met call.

Anyways wondering if I’m being over sensitive but I’m getting very frustrated with this all lately. Being in a term where we have patients on quite a few wards, it feels like ward staff think that once we’ve left their ward we’re just fucking around, as if we don’t have other patients.

Given the developments of AI, it seems only inevitable that neurosurgery is next in the firing line. I mean think about it, AI wouldn't ever need to sleep, so even unaccredited registrars who have autoamputated their reticular nucleus wouldn't be able to compete. And they won't ever lose their temper against the medical student who doesn't know the difference between the superior and inferior colliculi, nor at the scrub nurse for not having spare size 10 gloves when the basilar artery is severed for the 8th time.

I think neurosurgeons should just accept their fate and move to something much less vulnerable to AI, like medical administration.

Hi there, does anyone have any advice as to how to create traction on this?

I'm a Victorian DiT and the AMA aren't getting any additional parental leave in the current EBA negotiations. It is remaining at 14 weeks for primary carer, 2 weeks for secondary carer.

There is some increased flexibility (?you don't have to take it contemporaneously with the birth) but that's it.

I have tried contacting the union to express disappointment over not fighting for any increase at all, but haven't heard back. We attended the bargaining meetings last year and remember this was a top priority for members.

Any advice? We still have time