Locum Casualty Doctor @CasualtySurgeon Twitter profile

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Locum Casualty Doctor

@CasualtySurgeon

10 months

In case #MedTwitter was worried about GPs being overwhelmed, help is at hand from an "experienced practitioner in general practice medicine" who has set up a private practice in Colchester.

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Locum Casualty Doctor

@CasualtySurgeon

9 months

@muddy_gas_doc "The list in theatre 16 is delayed because the consultant cardiac surgeon is on laundry duty today".

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@ICCNurseTeam @DrSandyThomson I took from the tweet that this shows "what ageing can look like when all the social determinants are aligned".

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@NHS_HealthEdEng My overriding memory of HEE is of rota coordinators trying desperately to work out by email and WhatsApp who will be rotating to them next as trainees had been told where they were going but the deanery insisted that they couldn't provide this information to trusts...

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@Xeon4f145d96s1 I'm pretty sure they are freed up to take calls about suspected cauda equina syndrome from FY2s in peripheral hospitals that have chosen not to provide adequate out-of-hours MRI capability.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@NHS_HealthEdEng Oh and the time I was rotated on paper (and for pay purposes) to trust X but told I actually needed to work for trust Y. Needless to say this simple tit-for-tat failed miserably and the tax/pension/student loan repercussions were still being felt 8 years later.

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Locum Casualty Doctor

@CasualtySurgeon

10 months

PS. Much love to my paramedic colleagues but this is not what it is all about...

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Locum Casualty Doctor

@CasualtySurgeon

10 months

In case it wasn't obvious, this is a paramedic that has not yet completed her MSc in Advanced Clinical Practice but can "screen for certain cancers, STDs, and genetic testing", treat "IBD / IBS flares" (they are pretty similar after all) and offer "d-dimer testing for DVT".

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@tsharp1093 I can see the comedy/tragedy but think we should be careful about criticising these initiatives. They are often initiated by someone that means well and trying to change whatever they can personally influence for the better.

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Locum Casualty Doctor

@CasualtySurgeon

9 months

@Dr_BellaR I think it was @CMO_England who recently said "the best bit of advice I was given early in my career was never to worry about criticism from people you wouldn't take advice from".

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Locum Casualty Doctor

@CasualtySurgeon

10 months

This is all apparently reviewed and approved by the @CQCProf who appear to have registered this practice as an "independent doctor" or "Doctor/GP".

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@MHA_92_ @TheBMA The reasons for their sickness problem lie within this email. God save me from ever ending up as a consultant in an ED like this one.

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@jamesupnorth @CQCProf @The_HCPC She might not have intended it but I think "practitioner in general practice medicine" crosses the line.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@adamgordon1978 When I am all grown up, I am going to install a teleconferencing facility in the ED so that 2-3 specialties can be bleeped at the same time. They can then argue about a patient none of them has seen...

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@RCollEM @EMTAcommittee @EMSAS_RCEM @RCEMACPForum @RCEMpresident @RCEMdean @RCEMPolicyVP @RCEMmembersVP @dsdarbyshire @RCEMACPChair @RCEM_VP @6bd20de2260e4ea The penultimate paragraph is a poor take, @RCollEM . If the college can't articulate the point of an emergency physician then it's hardly a surprise that the specialty is haemorrhaging doctors.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@Dr_Abi_W My working class parents (and comprehensive school teachers) drilled it into me from an early age that all I needed was GCSE maths and English at grade C to open up an abundance of exciting careers. Those certificates still sit in an "important docs" folder with MBBS, PhD, etc.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@MrTimLane The senior nurses are conspicuously absent from the discussion so far. It seems unusual for all consultants in a department to be hounding the executive team with concerns about a junior nurse. Where was the nursing hierarchy in all of this?

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Locum Casualty Doctor

@CasualtySurgeon

8 months

@PatLynch93 You're not making his pulse race but that doesn't matter much as he isn't hot anyway.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@thegradmedic The @gmcuk also need to consider their role in augmenting interpersonal and organisational bullying.

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Locum Casualty Doctor

@CasualtySurgeon

8 months

@AnnetteAll23832 Many clinical areas were empty. Unless you were on the general medical wards and/or in ICU, you didn't see what I saw which was death on a scale that I haven't seen before or since.

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@theRCN This is such an odd response. You shouldn't have accepted the deal you were offered - everyone could see that - but having done so your best strategy would be to start campaigning *after* consultants have negotiated the best deal they can achieve.

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Locum Casualty Doctor

@CasualtySurgeon

10 months

Once the results are back, patients can be referred to a private consultant or their "own NHS GP for ongoing management".

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@dr_irfan_malik Surprised anyone is posting under their own names, to be honest. If you aren't burned at the stake by a baying mob then the Inquisition will eventually carry you off in the middle of the night...

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@clairezagorski "We do not treat asymptomatic hypertension in the ED under any circumstances". 😬😬😬

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@EBMgoneWILD The last EM consultant I saw working with HR 130 and sats in the 80s ended up admitted with a large PE. Does RSV typically cause hypoxia in otherwise healthy adults? I would be worried about the normal CXR. Maybe his scribe can organise a CTPA?

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Locum Casualty Doctor

@CasualtySurgeon

7 months

@EmergMedDr I haven't really followed this story or read the judgement but I do think that a 15-year-old can be held responsible for their actions whether or not they are a child in law. The age of criminal responsibility in the UK is 10, although I struggle much more with that concept.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@nela_lana ...but it is a huge step backwards for emergency care to try and solve the current (artificial) medical recruitment crisis by pretending that ACPs and doctors are fully interchangeable at all stages.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@dob86 It is perfectly rational to say the Q-word when you are a student there for interesting experiences but not responsible for anything...

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@DrPeterWeeks1 I'm just surprised GPs haven't developed a form for each task the hospital would like them to complete... 3+ pages, lots of random data fields, ink signature of responsible consultant and name of exec authorising reimbursement of any excess costs...

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Locum Casualty Doctor

@CasualtySurgeon

9 months

@DrEilidhMaria @LukeAmos__ They might not be registered with the GMC but the GMC is responsible for stopping people pretending to be registered medical practitioners when they are not. They are still the correct body to complain to and have legal powers to act if they wish to do so.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@DrEilidhMaria Yeah an ST3 that can't prescribe because that's a thing...

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@doctor_dru_ I saw a patient a couple of years ago sent with a note from his GP that said "this 22-year-old man has no medical history but now has a left basal pneumonia". In retrospect I don't actually know why he was sent to the ED but the diagnosis was confirmed and I loved the confidence.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@NHS_HealthEdEng @DHSCgovuk @educationgovuk As well as learning the fundamentals (anatomy, physiology, etc), are they going to rotate through all relevant specialties and be supernumerary throughout their training? If not, the programme is not equivalent. If so, how is this different to just paying a student bursary?

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Locum Casualty Doctor

@CasualtySurgeon

8 months

@drcolinm @gmcuk I've long lost patience with trying to explain or justify any of this. What does "medical profession" mean to you, @drcolinm ? To the rest of us, it means the body of registered medical practitioners. The medical profession died on your watch.

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@DrEilidhMaria You will know as well as I do that a thoughtful handwritten note is more valuable (and useful) than any bottle of wine, box of chocolates, or hamper. I have never thrown a thank you note away and still flick through them on occasional dark days.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@Andrew_Jordan_ @UHNM_NHS @Doctors_Vote @BMA_JuniorDocs Hah. This should tip a few unsure doctors off the fence into striking. Any nurse that participated in their own strike and takes on these shifts is a hypocrite.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@doctor_dru_ Once you have found investors, overcome all the regulatory hurdles, and managed to appoint staff (possibly the hardest part these days...) you would find it immensely expensive to run a 24 hour nursery and be pilloried on Twitter for cashing in on desperate health workers...

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Locum Casualty Doctor

@CasualtySurgeon

9 months

@mancunianmedic I teach a lot and rarely encounter a medical student these days that isn't crafting a non-NHS Plan A.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@Xeon4f145d96s1 @HullHospitals I work with lots of excellent ACPs but this is clearly ridiculous. I wouldn't presume to directly supervise the development of trainee nurses or any other professional group.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@DrLindaDykes "ED consultant arrives at the trust board meeting".

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@muddy_gas_doc Particularly now when I can barely get an ambulance within 2 hours for a young patient who's coning in a DGH and the neurosurgical theatre at the regional centre is ready and waiting for them...

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@Aidan_Baron Her Nobel scored max points (3) on the "prizes" section of the application form so a gold medal wouldn't have added anything anyway... she should have focussed her efforts on publishing a case report as first author.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@ivabrodine The @RCPhysicians have slapped a dead cat on the table to provide cover for @RCollEM . Very collegiate!

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@parthaskar @TomStocks1982 Strange that the name Caroline Leach returns no hits on searching the NMC register but does appear on an old British National Party membership list living at an address in Newcastle where this person says they are based. Hopefully just a coincidence 🤷‍♂️

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@morefluids Found a patch of eczema on my knee. Very annoyed as never had eczema before so applied betnovate for weeks without any improvement. Eventually showed my (non-medical) wife who said "it doesn't look like eczema; it looks like a graze". Then remembered I had fallen on my knee.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@juliaisobela I asked a charter company to quote for helicopter transfer between med school and hospital. They sought permission from the trust to land on site. Trust COO contacted med school Dean. Absence from med school commitment was agreed. Maybe there were easier solutions in retrospect.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@ivabrodine This would be hilarious if it wasn't directed at FY1s and new nurses who won't yet have a grasp of their rights as workers. I'd have expected a lot more of @uclh , to be honest. @UCLHMedEd @MrRMDuke

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@NadiaKamil I'm pretty sure that Sisyphus was actually just an Ancient Greek SHO on weekend ward cover.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@ShaunLintern I have been thinking about this. Perhaps the BMA should show some good will and agree to accept an increase in line with that of MPs since 2010 (31%) in addition to some other small contract changes, e.g. professional fees paid by employer and greater access to study budgets.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@hayleymagill On-calls are definitely miserable for this reason. Also sympathise with GPs spending 15 minutes getting through to each specialty SHO only to be told "that's not for us".

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@RoshanaMN How are any *not* making a surplus when they own the buildings and don't pay either the question writers or the examiners ??

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@JohnRentoul I once sat next to an Oxford don who has taught PPE for decades. I said he must have met some really interesting people during this time. He gave me a sad look and said "some of my best students have gone on to be my greatest disappointments".

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@adi_kumar1 I only know that something isn't an emergency with the benefit of a history, examination, investigations, period of observation, and 16 years of study/experience... even then I'm rarely 100% certain.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@cruncherwax ...find a working computer (3-4 min), log on (2-3 min), request bloods (1-2 minutes), reprint labels (1 min), find label printer that is full and works (2 min), find kit (1-2 min), take blood (1 min), dispose of rubbish (1 min), label/bag samples then find a pod (2 min)...

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@dr_nigel_lane If you think all members of the healthcare team are being appropriately "valued" at the moment then you haven't been paying attention.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@poorscousertom Lots of people saying they see a raised anterior fat pad. I only see a normal anterior fat pad. I'm not sure I understand how your child ended up with an x-ray without a clinical review and - if there was such a review - why no-one could look at the imaging... 🤯

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Locum Casualty Doctor

@CasualtySurgeon

7 months

@SecretPhysician Why didn't I think of this? Nevermind training - I can just get one of my consultant friends to sign off a certificate of competence in lieu of CCT.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

It's August. As usual, lots of rotating doctors have gone unpaid. I have been paid twice, including a random amount by a trust I haven't worked at for years. Better check my payslips... oh wait... #MedTwitter

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Locum Casualty Doctor

@CasualtySurgeon

11 months

@HeySamuelHey I understand treating an intercalated BSc differently (1 vs 3 years) but not an intercalated MSc. It is clearly irrelevant whether that year happened during or after your primary medical qualification.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@hayleymagill PAs to write discharge summaries. Pharmacists to prescribe TTOs. Junior doctors can train and CCT in less time so the medical workforce is flooded with fully trained consultants and GPs. This strike is showing you the way, @DHSCgovuk !

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@laurevans311 No-one should be rude to GP receptionists. I do think that there is an important conversation to be had about the role of receptionists in performing clinical triage, which happens whether by design or otherwise.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@DrAsifOfficial If the system had any financial literacy, it would ensure that professionals who've trained for 5-15 years to do job X don't have to spend their time doing job Y instead.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@RobLaurensonD4P @UHSussex @TheBMA should seek to include penalties (e.g. 100% of missing funds) for non-payment of salary in the next JD contract iteration. Will feel like an easy giveaway for @NHSEmployers negotiators ("of course doctors should be paid") but will end up as a large pay rise for many!

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@noodles_nood @reachmeerahere @LG_NHS Wait... are we saying this is the same ICU that threw @drcmday under the bus...?

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Locum Casualty Doctor

@CasualtySurgeon

11 months

@marcus_baw You're assuming the data was harvested from the GP's side and wasn't collected by his browser or any number of apps they had open at the time... They should ask the question of @circlehealthgrp .

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@Xeon4f145d96s1 Birmingham is so far ahead I'm not sure it's even worth the competition... @uhbtrust

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@AJfonzarelli @clhubes My 4-year-old loves to take busses for absolutely no reason other than the joy of the ride. Almost any other hobby would be cheaper!

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Locum Casualty Doctor

@CasualtySurgeon

11 months

@Dr_BellaR @JohnMcManusDU It seems reasonable for @JohnMcManusDU to seek the correction and for @Dr_BellaR to offer one. @JohnMcManusDU should have been more polite but nothing in his reply suggests he thinks patients should wait on a chair for 24 hours.

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Locum Casualty Doctor

@CasualtySurgeon

7 months

@DrEilidhMaria Even without the consultant part, it will soon be possible for a PA to casually say "I am a medical professional registered with the GMC".

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@drcolinm @gmcuk I think the problem is much broader than this and one that you probably can't solve or even really address head on. Doctors in the UK no longer trust the GMC to the extent that even a suggestion that we should be nice to our colleagues has led to 2 days of teeth gnashing.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@medicperspecti1 I'm confused. The surgeon actually saw the patient? ED didn't insist "you touched the patient so they're yours"? And no-one did a CT? The whole thing is weird.

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@Dr_Done_ @iDrSunny @drphiliplee1 @BMA_James_Steen @UKGastroDr @drmattuk @Doctors_Vote @Xeon4f145d96s1 @DrEilidhMaria @doctor_oxford @drcolinm @RoshanaMN @EmergMedDr @DrLindaDykes @clifford0584 @Dr_BellaR

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@davehartin @DWphototaker This a pretty sad response. The current generation of SHOs (tuition fees, Covid, unaffordable housing, runaway selection requirements, high competition even for under-recruited specialties) have every reason to be "afraid for their jobs". Easy for consultants to be scathing.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@tsharp1093 It is not within the gift of *anyone* at UHL to increase the pay of consultants or trainees.

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Locum Casualty Doctor

@CasualtySurgeon

8 months

@DrHuw They will recall the 4 weeks of anaesthetics they did as a medical student 50+ years ago... Such people often also have easy solutions to the emergency care crisis based on their 6 month casualty job in 1974...

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@nochillnhs @NHSLanarkshire Why is @NHSLanarkshire employing someone that is too thick to understand that the rates for extra-contractual work are not defined by the contract...?

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Locum Casualty Doctor

@CasualtySurgeon

7 months

@caroll_ste87889 What system allows people to "accidentally" place a prescription? I understand prescribing on the wrong patient or even inadvertently prescribing while logged in as someone else. I don't really see how a non-prescriber could accidentally start prescribing, though.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@Jubilee4Jesus Atelectasis is not usually a disease process and probably isn't the cause of you feeling unwell. It is easy for a doctor to order a dose of radiation to the chest (i.e. CT) but not always the right thing to do.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@JolyonMaugham Professor of Tropical Medicine at Oxford then Director of the Wellcome Trust and now Chief Scientist at the WHO. And @MattHancock (of all the people to talk about seriousness) says Sir Jeremy Farrar is not a serious scientist 😬

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Locum Casualty Doctor

@CasualtySurgeon

11 months

@NotAdoctor0000 The tACP was clearly undergoing an Extended Supervised Learning Event (ESLE) and their supervisor wanted to assess them giving advice / discussing cases with colleagues. I'm not sure there is very much to see here.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@Dr_Done_ If this is the case for PAs, why not also ANPs, ACPs, etc? The only reason this group are being singled out for special treatment is because short-sighted policy makers see them as a cheap substitute for the dwindling doctor workforce.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@k_d85 By hiving off tasks that do not require a doctor (e.g. phlebotomy, cannulation, some discharge summaries) and discarding others entirely (nonsensical EPR forms)? Replacing bleeps with portable phones. Paying someone to keep the workstations and printers working.

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Locum Casualty Doctor

@CasualtySurgeon

9 months

@DrRichardPile Are you truly baffled by this or just trolling? PAs can train to become a doctor in the same way as nurses, physios, paramedics, etc... They just have to go to medical school.

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@FearneHill @morefluids Reminds me of the time I used a drop of tissue glue to stop a bleeding frenulum of the penis. It worked wonderfully but that stuff gets around and somehow the urethral meatus ended up getting glued shut...

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Locum Casualty Doctor

@CasualtySurgeon

7 months

@Dr_BellaR I suspect that married senior doctors seeking interest from younger women are a particular type that come with a cluster of character imperfections.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@NemmaD @EmergMedDr I'm sorry but you can't have hot drinks in a clinical area.

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Locum Casualty Doctor

@CasualtySurgeon

7 months

@gmcuk They will be needed to replace all the doctors that are going to leave. I have held steady through years of negativity but even I am now planning my exit.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@Wardsandra4Ward @DrHannahBB Our local vet anaesthetised our dog and did an orchidopexy... then 6 weeks later turned into an oculoplastic ophthalmic surgeon to repair our cat's entropion... and then did an echo when the cat wasn't behaving as expected under general anaesthesia... Wild!

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Locum Casualty Doctor

@CasualtySurgeon

9 months

@idruprofen Painful isn't it? There's plenty to argue about how much doctors should be paid and how that should be decided. We're a long way from those discussions when non-doctors think they know better than us about how much we are paid, how our pay is structured, what "on call" means etc.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@georgebellstarr Show me someone that isn't tachycardic on getting into the back of an ambulance and I'll show you someone on a high dose beta blocker.

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Locum Casualty Doctor

@CasualtySurgeon

3 years

@rosannasweeney @eoconor209 That isn't what has been said. The OP is noting - and I think expressing displeasure at - the realisation that different members of the treat are treated worse than others. This presumably wasn't obvious to her when she was easily identifiable as the consultant.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@RCollEM @EMTAcommittee @EMSAS_RCEM @RCEMACPForum @RCEMpresident @RCEMdean @RCEMPolicyVP @RCEMmembersVP @dsdarbyshire @RCEMACPChair @RCEM_VP @6bd20de2260e4ea It would be helpful to know at what level this statement was approved. @RCollEM is too small a college to alienate its members - this isn't the kind of specialty representation that I expect for £756/year.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@ABarotchi1 @Plum47962139 @Molly2323232323 @TheEMboardround A lot of PAs do talk about having gone to "medical school".

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Locum Casualty Doctor

@CasualtySurgeon

8 months

@DrHuw They are not "medical professionals" because they are not part of the medical profession. If the @gmcuk ever had a role in safeguarding the integrity of that profession, they certainly don't any longer.

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Locum Casualty Doctor

@CasualtySurgeon

9 months

@BMASevernJDC @gloshospitals My list of places to never work is getting longer each week...

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@Alexandra_nidd Suspect deliberate as - once you identify yourself as available by asking for the rate - you will feel pressured to cover the shift. In reality, I simply ignore requests without this information because I don't want the awkwardness of asking then saying "no".

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Locum Casualty Doctor

@CasualtySurgeon

10 months

@RichardBentall @drphiliplee1 @drjanaway Yes, graduate entry medicine, which is a well-established route for graduates to embark on an intense 4-year medical degree. Most PAs would have been eligible for this route based on their first degree and so wouldn't have needed to complete the PA course.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@SamGoodhand HCPs working within an advanced (but correspondingly narrow) scope such as minor injuries or deteriorating physiology is a very different concept to managing undifferentiated patients after only two years of clinical study, no regulation, and no structured postgraduate training.

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Locum Casualty Doctor

@CasualtySurgeon

1 year

@walsh_joe @nhsesr Problem solved.

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Locum Casualty Doctor

@CasualtySurgeon

2 years

@Westsaeed10 @PoleDoctress Ah the locum trap. As you are the one who says "yes", rota coordinators start asking you to cover first... then when you say "no" they put the rates up until you say yes again. Before you know it you've worked almost every weekend for 6 years... been there and still there!

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