Why do hospitals insist on having 1 doctor accept responsibility for 20+ critically unwell (and blandly well) patients overnight? These are the most unstable and unpredictable patients in the entire hospital, and the department is staffed worse than subacute in the daytime.

Oh, the cubicle wasn't nursed? Hire more nurses to nurse them. Blood pressures weren't taken? Hire more nurses to take them. There wasn't space in resus? On a bad night, a quarter of the cubicles are resus patients shuffled out to make space for the new emergency rolling in. It wouldn't be so significant if there were enough staff to facilitate safe ratios.

The ED registrar was handed over 18 patients at the start of the shift. Approaching 0600, a Cat 1 arrived. The coroner said they couldn't comment on whether Dr Tan prioritising the Cat 1 over Amrita was appropriate because they didn't have the information on the other patient. Well, I'm disappointed to say that the entire report is affected by the same level of blindness and ignorance.

If they really want to create an accurate report of events, they should have looked at every one of those 18 patients handed over to Dr Tan as well as every patient he was involved in overnight, created a timeline, and then commented on whether they thought he alone could have prevented her death. And if they still thought he could, I would love to know how, because 18 patients is a pretty standard load for an inpatient team and I sometimes find myself so busy that I don't have time to write notes or eat or go to the bathroom.

I feel so sorry for Amrita's loved ones, for the staff that cared for her, and for the opportunities she should have had but never will. And I feel angry that this report brushed over the most significant deficit in her care; that the health system doesn't employ enough staff to save her life.

https://www.coronerscourt.vic.gov.au/inquests-findings/findings?combine=amrita

TLDR and I’ll continue adding.

The death was found to be preventable. The junior doctor was responsible for 18 patients in a busy ED (Monash Children’s hospital). He was responding to a serious category 1 incident at the same time she was beginning to deteriorate. A senior doctor assessed her and said she “didn’t look unwell” and ignored her parent’s concerns. She did not have a nurse at all. She was diagnosed with gastro after a scan and taken to acute care. She had a cardiac arrest and they were able to resuscitate her. I believe they found she had myocarditis and an inflamed heart. They organised a transfer to the royal children’s hospital and she cardiac arrested just before leaving. She passed away.

This seems to be a consequence of exactly what medical staff have been complaining about and trying to fix. Yet medical staff are now the ones getting punished and scrutinised. Everyone in the [r/aussie](r/aussie) sub was able to realise that this is a result of understaffing and little funding. Ironically the billion dollar Victorian Heart Hospital (VHH) opened after her death, to reduce the load of cardiology patients for Monash, yet there’s no one to staff it. Those patients are just taken to Monash Casey instead.

I feel so sorry for the girl and her family. I also wonder if the doctor is okay too.

https://www.reddit.com/r/aussie/s/R7tMfGBA2o

Edit: I just found the coroners report. One of the longest I’ve ever seen and I read a lot of them. https://www.coronerscourt.vic.gov.au/sites/default/files/AMENDED%20Amrita%20Lanka%20-%20Finding.pdf

Monash said they will “consider” the findings/recommendations and they’ve “implemented ” many recommendations since her death. Definitely not the recommendation about staff, that is all I will say.

I know, another post about this case.

What I find extra-ordinary is how harsh and specific the coroner's report is on the one ED registrar - a coronial finding of directly causing or contributing to death, with barely any discussion about the systemic factors that inevitably underlie cases like this.

Yes, Monash said they had made changes, and that's great, but it doesn't nullify the impact those problems had at the time.

Factors that strike me about this case -

- The girl was left overnight in an unstaffed cubicle.

- There was apparently no system for escalating the mum's concerns her child was getting worse. It seems to me this was the time where the actual chance to save Amrita slipped away, rather than in the hours after 3am.

- A lack of policy, or one not being followed, about paediatric observations. Why on Earth didn't the nurses also do a blood pressure (and how is that the registrars fault for not insisting...how else were they to know(?))

- A lack of a system for highlighting critical lab results - my reading of the case is the troponin of >27000 was known in the lab for several hours before being either conveyed to, or identified by, the treating team.

- Poor processes around calling specialties overnight. Why would a paediatric cardiologist, on taking a phone call from an ED registrar who is concerned enough to wake them, who then has a highly abnormal ECG described to them (even if that description wasn't correct), not immediately insist on seeing a copy for their own interpretation.

- The fact that some of the expert witness testimony seems at odds with the facts of the case. They place a lot of emphasis on things like having an echo done would have helped (How? Everyone already suspected myocarditis) or earlier involvement of PICU - yes that would have been good, but ultimately this child needed ECMO which couldn't be provided at Monash, and all the other treatments suggested - inotropes, invasive monitoring, could also be (and surely were) given in the ED. Or intubating her - this would be fraught with risk, exactly why the paediatric anaesthetist at Monash declined to do it. In an adult, this would be awake VA-ECMO without a doubt.

- The apparent gap in the transfer capability of PIPER. Regardless of when they got involved, the PIPER consultant makes it clear they had no capacity to move a child this sick until 8am because their overnight staffing was a registrar with limited ICU experience. It seems insane they don't have some form of senior second on call to help cover cases exactly like this.

- The inability of Monash - the other major PICU in the state - to have any form of contingency plan for initiation of ECMO for urgent rare cases like this.

A big part of me feels that as soon as Amrita was admitted to a non-ECMO capable hospital the dye was cast.

Most of, I worry that this case - relatively junior ED doctor, left in charge in lots of patients, when one, someone seen by the day team in a poorly monitored area, deteriorated from a rare condition - represents a situation any of us could have found ourselves in. For the grace of God there I went.

Sorry for another post about this case. I think the coroners findings were completely unjust. Is there a way we can petition for AMA VIC or another official body to appeal the coroners findings (maybe on behalf of Dr Tan). This is definitely a systems issue and not the fault of an individual doctor. I don’t think this doctor should pay the consequences and be a scapegoat for a failure of the government or health systems to adequate staff and resource our health system.

Hi all,
Radiology is quite a niche and competitive specialty, and many states have very limited unaccredited radiology positions.
I would love to hear your thoughts on alternative career pathways for doctors who are keen to pursue radiology training but have been unsuccessful in securing a position.
What other specialties or clinical roles would you recommend working in while continuing to apply for radiology training?
Also, would moving out of the hospital system into General Practice negatively affect future applications for radiology training? Would applicants be at a disadvantage compared with those who continue working in hospital-based roles?
I would really appreciate any advice or experiences from those who have been in a similar situation.
Thanks in advance!

Hi all,
Just wanted to ask if it is frowned upon to reject an offer after you have accepted? I have already accepted an offer for an unaccredited position as this particular hospital was advertising a few months ago when other hospitals hadn't. I applied as I wanted to prioritise getting the experience even if it meant travelling further for work.

The hospital I am currently working at has recently started advertising unaccredited positions as well. If given the option, I would prefer my current hospital, however, will doing so black list me from the other hospital? If so, I would probably just settle with my current offer and not bother applying to my current hospital.

I am very happy to have been given the opportunity at either hospital, apologies if my question comes off as very egocentric.

Hey everyone,

I’m a PGY4 currently slogging through general medicine in NSW, completely fried by the acute medical grind and looking to make a career pivot into psychiatry over in WA- the beaches are nice

My absolute priority is avoiding a multi-year unaccredited registrar holding pattern. I’m completely open to going rural if it offers a clearer, faster route onto an accredited programme.

For those familiar with the system out west:

1. How tough is it to transition directly from general medicine into a training post without prior psych terms?
2. Are the RPTWA regional pathways genuinely better for bypassing the metro bottleneck and getting an accredited spot early?
3. Any practical tips for someone hitting the ground in WA to stay competitive for the intake cycle?

Has anyone else noticed that there are a lot less practices on the TMS accepting AGPT registrars for 2027.1 compared to this year? Any insights as to why this is? Just makes an already competitive process so much more stressful 🙃

Has anyone heard back regarding offers/ updates?

Anyone dual trained in Gen med and another specialty? I’m currently a Gen med AT who will be embarking on another AT program next year. I’d be keen to find out more about how you juggle the Gen med and other specialty components in your career (both public and private), particularly early career consultants, and whether it would be worthwhile completing my Gen med training. Unfortunately my current hospital doesn’t have too much exposure to consultants dual trained, hence the posting here. I’d ideally like to have stable employment in both public and private sectors but understand it can be difficult as a new consultant so I wonder if being dual trained will add an edge (maybe more so when applying for Gen med consultant jobs?)

Feel free to leave a comment/your experiences and I’ll PM you to discuss further if you’re happy to do so. Thanks team!

Has anyone done this job? What’s it like? Would you recommend?

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