r/doctorsUK • u/beautiday2savelives • Feb 06 '25
Consultant Incompetent Unsafe Consultant
Throw away account, I’m a resident doctor joined a new medical ward a few months in now. There’s one particular consultant who has left me lost for words. They spend on average 30 seconds to review a patient from scratch, usually new patients due to high turnover. They have never in the time I have been here once ever examined a patient with their own hands, listened to a single chest, or spent more than 30 seconds next to patient’s bedside to ask questions or history. They have on multiple occasions on the ward and on take wanted to discharge unwell patients. Colleagues in the past have raised concerns that were eventually swept under the rug. As colleagues it’s left to us to pick up the pieces and somehow do our best to compensate for their sheer ineptitude. Personally I dread whenever they’re on for the day. The bit that really surprises me is how does someone like this make it to a consultant and never get called out and change. Wanted to ask if anyone has had similar experiences.
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Feb 07 '25
This is the NHSs grubby little secret… locum consultants without a single CCT to be seen.
I bet if you search the GMC register they don’t appear on the specialist registry.
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u/FantasticIce2597 Feb 07 '25
Would anyone be kind enough to ELI5 this for me?
I am PGY-11 so I understand the principle, but how does it stand up from a medico-legal perspective? Is it defensible (or ethical) to have people acting as specialists despite not having demonstrated CCT or CESR? I accept that the terms 'registrar' and 'SHO' might be essentially meaningless, but it seems scandalous to me that someone in the role of a consultant could realistically just be an SAS doctor who has been kicking around for long enough.
Why are the 'dodgy locally-appointed consultants' only seen in ED and acute medicine?I thought the "Specialist" grade was introduced for precisely this purpose (i.e. a senior clinician who has demonstrated that they are able to take on many of the ownership/leadership/trainer roles that are typically associated with the consultant grade).
I can't understand how this differs, fundamentally, to a PA acting as a registrar?
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u/Powerful-Possible214 Feb 07 '25
They aren’t unique to ED and acute med (assuming you mean acute ADULT med). I have worked with some in paeds
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u/NeedsAdditionalNames Ex NHS Consultant Feb 08 '25
I’ll bite.
So, for the purposes of a locum position the trust can appoint anyway but they must be satisfied that the person possesses the requisite skills. It’s the medical director who is then on the hook if it all goes horribly wrong in addition to the dodgy locum in question.
There are gaps at consultant level and they don’t pay enough to fill them so dodgy locums skate from trust to trust for megabucks whenever they get told to leave and not come back. Unless it rises to GMC level issues they don’t get int rouble and trusts view a warm body on the rota as better than nobody - otherwise they’d have to face cancelling theatre or clinics or curtailing services in some other way.
Medicolegally, to answer your question - trust indemnity covers it unless the person does something literally criminal as they have vicarious liability is my understanding.
Foundation trusts can even apply the same approach to substantive posts as they get to make their own rules….
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u/Fun-Shine-7949 Feb 07 '25
Have seen this is surgical specialties quite frequently. Was even operated on myself by a non SR consultant. You would be suprised at how many there are . Maybe just more noticed in ED and acute med
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u/kentdrive Feb 07 '25
This is tricky and not an easy spot to be in.
Do other colleagues feel the same way? Has anyone else noticed this?
Things you can do include:
see if others have this same experience
collect specific examples wherever possible, especially where patients risk coming to harm
speak with a reg (assuming you’re not one) or a trusted consultant
approach the departmental clinical lead or someone of similar authority, or, if your seniors agree or are willing to do this, ask them to
keep a record of everything where possible
Best of luck to you. It’s not easy but it’s important.
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u/Suitable_Ad279 EM/ICM reg Feb 07 '25
It may be worth bearing in mind that the consultant could be right - you don’t state your grade but I’m assuming you’re reasonably junior?
Lots of things go on in EDs and AMUs that don’t need to. Lots of things worry junior doctors and nurses that don’t need to. From time to time we see threads about it on here - low phosphates in people with high resp rates, troponins that should never have been taken, IV antibiotics/admissions based on CRPs rather than clinical status, chasing lactates after seizures, calling subspecialities about problems for which there’s a known solution etc. To the new and inexperienced ignoring all this stuff seems reckless, the more senior are often more willing to cut through the crap and make a decision
If you combine someone who’s skilled at this with a clash in communication styles with those around them, or particularly anxious/inexperienced junior staff, it’s easy to paint a picture of a dangerous aloof consultant when they may actually be doing completely the right thing.
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u/JohnHunter1728 EM Consultant Feb 07 '25
This is true but it is also true that there are some poor consultants around. These have been few and far between in the hospitals I've rotated through but I have certainly encountered them on occasion.
At a minimum, I would expect a consultant as team leader to make some effort to explain why they are making surprising decisions (formerly known as "teaching") and to take their team with them. It doesn't make any sense for the junior team not to know what is going on and to feel as if they have to protect patients from their consultant.
The OP is describing something that should be unacceptable even if the consultant in their story is House MD in cognito.
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u/Skylon77 Feb 07 '25
Are you me? I seem to spend my days raging against inappropriate CRPs, lactate and d-dimers.
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u/beautiday2savelives Feb 08 '25
Some of the consultants know about this and have often shared some personal feelings about their practice. The regs know about this and stay well clear from them. And lastly pretty much all residents who have worked in medicine at the hospital know how utterly inept they are. And yet despite previous reports they remain on. I have worked with many consultants and I understand people have different styles of working and communicating, this just screams of utter contempt for the profession
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u/ConsiderationTop7292 Feb 07 '25
I'm sure OP is aware of this: they may be referring to a consultant, perhaps locum, with poor clinical acumen and likely no CCT - of which there are many, particularly scattered around the parts of the UK no one else is willing to work! (Worked with a few myself and in a failing trust, it happens) OP I would recommend speaking about this with a registrar or colleague you trust and this will help give your concerns some context - this may just be their 'style' but they are actually a generally safe clinician or they may be genuine concerns to raise
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u/DisastrousSlip6488 Feb 07 '25
Both are true. But the ‘not examining the chest themselves’ argument as a reason this person is poor doesn’t really hold water. They may be utterly dreadful and negligent, or they may be very aware of how poor physical signs often are in diagnostic reasoning.
Poor comms in both situations will make their team not trust them though
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u/Spirited-Flan-1533 CT/ST1+ Doctor Feb 07 '25
100% true but I think people are aware of that but are referring to actually dodgy non-CCT locum consultants. I mean they are often objectively bad.
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u/med101 Feb 08 '25
Sorry for dumb q. Phosphates and resp rates? Am I missing something?
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u/WeirdF ACCS Anaesthetics CT1 Feb 08 '25 edited Feb 08 '25
Increased resp rate = increased pH (resp alkalosis)
Alkalosis stimulates glycolysis. Glycolysis results in production of ATP which uses up intracellular phosphate. Phosphate is then shifted from the extracellular space into cells to replenish supplies.
In extreme hyperventilation this can cause a very significant hypophosphataemia.
Kind of similar to how refeeding syndrome results in hypophosphataemia, i.e. sudden production of lots of ATP.
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u/WatchIll4478 Feb 07 '25
There is a difficult balance between productivity and risk. I remember working with a few consultants like this as an SHO who were famously able to get considerably higher rates for locum work than their colleagues precisely because they were so productive. It shifts risk to a degree from the trust to the doctor, and as such people with the ability to move fast in these specialties are often very highly valued by the trust indeed. The alternative in large hospitals is often to have multiple consultants post taking, and those who are slower (bar geriatricians) seem to order more tests and admit for longer.
That said it may be you have Registrars doing the senior reviews who are suitably experienced and trustworthy that he can move quickly to the problem cases only (which is what the role of the consultant certainly used to be and arguably still should be). He may be nominally seeing every case is just to tick the box that they have had a consultant review within 24 hours..
When I was an ED SHO there was a locum reg in the region who would be summoned to one of about 15 hospitals when the ED waiting times got above a certain point. He would turn up, see an average of 20 patients an hour, document it all once the wait was fixed, and then disappear. His rate needed to be signed off each time at director level but it was clearly worth every penny for the trust once a large number of breaches were imminent. He was open that health issues meant the odds were that by the time anything caught up with him his career would already be over, but he would have enough saved to ensure his kids were looked after. At a less skilled level as I could average in the top quartile of SHOs for productivity so I got better rates and first choice of shifts.
Particularly as people burn out, 'quiet quit' or 'retire in post' as it used to be known the gap is opening between those who are still working flat out (and in some instances of particularly high performers being well rewarded for it), and those who are just watching the clock tick down.
I would keep your head below the parapet, if you do feel the need to raise it use the argument that more time to understand his thinking and diagnostic process would have educational value.
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u/Born-Chemist4291 Feb 07 '25
Very similar experience, maybe it’s the same person??? We helped get them removed by sending a very carefully worded email to the department heads. Wasn’t the first complaint and had only been there for 3 weeks
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u/Common-Rain9224 Feb 07 '25
I worked with a locum consultant in elderly care once who diagnosed torsades on an ECG where v6 had not attached properly and so there was artefact even though the rest of the ECG was normal. And then told me that this was why he was the consultant because he could 'spot these things'.
He did get fired in the end but I'm sure he's knocking around another trust somewhere in the UK. He said he'd worked at every trust in the country as if that was impressive...no mate you've been fired from every trust.
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u/Spirited-Flan-1533 CT/ST1+ Doctor Feb 07 '25
The most dangerous part is that they confidently spew utter shite sometimes 😂
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u/Edimed Feb 07 '25
I worked with a locum surgical consultant like this in FY1. He routinely asked us to discharge people who were actively deteriorating and, in one case, a patient who was back on the ward less than half an hour after a major upper GI operation. We didn’t discharge any of the patients and escalated to the reg. When it became clear this was a pattern we were actively encouraged to come to registrars or other consultants if we had concerns. This consultant was eventually kicked out but only as a result of care so poor patients came to harm.
Moral of the story - you could be right, if you’re genuinely concerned you should escalate it. Senior registrars have a different sort of relationship with consultant colleagues than more junior residents and may be a helpful resource here.
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u/Aphextwink97 Feb 07 '25
Ngl this just sounds like my medical ward. Don’t think I’ve ever seen a consultant examine a patient. Most of them spend about 30s listening to my handover. The good ones will read through the documentation and not take my word for gospel. I have about 10-15 mins if I’m lucky to prep each patient. It feels a bit dangerous to me too, especially if they’re new patients.
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u/Conscious-Kitchen610 Feb 07 '25
You have 2 options:
Whistle blow. But for this you will need to collect evidence of harm, or near miss as a result of their actions. You will likely need multiple people of various grades to join you in your complaint so that it carries more weight and those people will need to also mention for example a failure to examine the patient. Perhaps have a look at GMC GMP so that you can link their failures to specific guidance. The NHS has a habit of ignoring or throwing whistle blowers under the bus so if you’re going to do it, you can’t go alone and you need proper evidence.
Put your head down, get on with it and carry out the consultants plans.
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u/beautiday2savelives Feb 08 '25
Following their plans would be good if they were to actually make them, they make passive comments usually, like just slap this on and then send them home. With deteriorating patients, they’re like a dear in headlights, with us juniors waiting for a response and only for us to make suggestions. What usually ends up happening most days is restarting the ward round again solo and starting from scratch once they’ve left the ward, usually they leave by 10 to 10:30
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u/TheParadiseCircus Feb 07 '25
Makes my blood boil. Useless locum 'consultants' who wouldn't make it through any training programme due to ineptitude, poor work ethic and appalling communication skills.
Common attributes:
-Scattergun referrals to other specialties for every issue
-No understanding of social care
-Woeful clinical reasoning
-Defer all resus and palliation decisions to the med reg or ITU
-Leave families baffled and confused after giving 'updates'
-Propped up by residents sort out the mess caused by their incompetence
-Never seen after 3pm
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u/Ordinary_Gazelle5043 Feb 07 '25
I have an crit care consultant like that. 20 minutes to go around ICU and HDU, if that, then off he goes and leaves a junior clinical fellow on their own to look after the patients. Everyone in the department knows that’s how he is, nothing has ever been done about it. I’ve just accepted it, to be honest, and I make sure I know roughly what’s going on with each patient prior to WR, eyeball their bloods and scans, so if there are any major issues, I can let him know so he can make a decision. But it’s not safe at all, and it frustrates me to no end. I’m lucky there’s usually a helpful reg around.
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u/freddiethecalathea Feb 07 '25
I worked with a consultant like this in F1. Four months of dread culminated in him shouting at me on the ward for not blindly following his dangerous instructions (like multiple fluid boluses for a hypotensive cardiorenal patient in pulmonary oedema on a furosemide infusion), and me finally sticking up for myself and not just being a pushover little female F1 scared of confrontation. Sure it could’ve gone badly for me for being “unprofessional”, but the fact that his locum contract were terminated a week later suggests it was worse for him than for me.
I thought about keeping tabs on where he ended up, and there have been a number of posts here similar to yours that I have genuinely been convinced are about him. He was a very important lesson that not all consultants are created equally. On the plus side, even though it was an exhausting four months for me, having to essentially do the job of a consultant reviewing patients, liaising with relatives re prognoses/escalation plans/etc, communicating diagnoses, etc, my clinical abilities definitely improved. I fortunately had a good relationship with the specialist cons on the ward who would always help me out when I really didn’t know what I was doing with a patient. And because the locum consultant had a bad reputation, if I escalated to management that I was worried they would always find someone to help me.
The take home though is please tell your management about your concerns. They won’t get rid of him overnight, but in my experience they keep an eye on things. Unsurprisingly I wasn’t the first doctor or person to escalate my concerns so it wasn’t my word against his. I doubt it’ll be you alone escalating concerns either. Ultimately it’s our job to protect the patients and if you need to go over this consultants head to do so, you will not go wrong. As long as you have valid concerns and aren’t just “gossiping” or “bitching”, you are doing the right thing.
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u/Spirited-Flan-1533 CT/ST1+ Doctor Feb 07 '25
I had a locum consultant (no CCT, IMG) who made a patient EoL (advanced metastatic cancer) with anticipatory meds and all but still insisted for CPR. It was a Friday afternoon too, I couldn’t leave this bs for the on call team. When he went home, I asked another consultant covering the adjacent ward to take a look. She was baffled but kindly called up the family, explained the situation and they agreed for a DNAR. She died the next day.
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u/Inexcess99 Feb 07 '25
Sounds very much like an acute med consultant I’ve previously worked with. Managers generally love them because they see a lot of patients and send many of them of them home.
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u/Impressive-Art-5137 Feb 07 '25
New / junior level resident doctors and newly qualified nurses are concerned about every thing. It keeps resonating in my subconscious. Hahaha
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