🖐️ 5 Things You Missed In Medicine

Yes, you did come here for the medical news.
But you’ll leave with more than you bargained for.
For a medical easter egg is hidden somewhere in this newsletter…
(It’s at the bottom. Sorry, terrible at secrets.)

👋 Happy Friday. Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

Please join me for a trip down memory lane…

In the 19th century, we had proper, no-nonsense surgeons. 
Anything that looked even slightly suspicious was swiftly removed.

An ulcer on the foot? 🤔Amputate the whole leg. 
Think you're followed by evil spirits? 🤔Frontal lobectomy will do the trick!
Suffering from a stomachache? 🤔Let’s cut you open and remove the appendix. That’ll solve that.

With time, science, and a bit of common sense, we collectively decided perhaps some of these surgeries were a little bit unhinged. 

While lobectomies fell out of fashion and amputations were reserved for the diabetics. One surgery persisted.

Appendicectomies for anyone with uncomplicated appendicitis.

Simple as that. No questions asked. Age Six or Sixty. Mild or Severe. That appendix is getting gone! This was the law, and the law was good.

Until, of course, the 21st Century…
The century the world got soft

Modern medicine looked at the prevalence of appendicitis in children and thought:

Surely, we don’t have to put those poor babies through surgery🥺. Won’t non-operative management (NOM) like antibiotics do? 

Studies started to emerge speaking on the effectiveness of NOM: "Look! no surgery, no scar, and little Timmy’s back at school in a week!"

But what they all failed to do was look into the future 🔮– aka more than three months.

So… Is NOM actually non-inferior to surgery in terms of safety and effectiveness? 

Published in JAMA Paediatrics, this meta-analysis and systematic review aimed to investigate just that.

After scouring high and low for relevant RCTs, 7 were included with 1,480 paeds patients total. The primary outcome being treatment success and failure(within 1 year).

They had 5 key findings:

So yes, antibiotics will get little Timmy back on the playground slightly faster. But it’s likely delaying the inevitable - his appendix on a stainless-steel kidney dish.

So in the end, tough love prevails after all. 

Got an angry appendix?
See it. Say it. Surgery.
Simple.

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Months of prep.
Hundreds of group sessions.
Thousands of questions completed. 

You open the paper.

The first question isn’t like the question bank 🤔
Nor was the second, the third… or the 50th.

You may be too clever for a +44 HMRC text or a Nigerian Prince email.
But you still fell for the infamous question bank scam.
Practising questions that feel useful… but just miss the mark. 

Format off. Difficulty low. Stems predictable.
Now you’re playing 50/50 with your future.
(Literally split between answer A or D 😵‍💫)

Avoid the toss-ups and enter test mode with confidence using BMJ OnExam.

The BMJ Group have taken decades of clinical experience and peer review then distilled into a bulletproof revision resource engineered to mirror the real exam, not just resemble it.

This is how:

So remove luck from the equation.
Join over 100,000 HCPs from UKLMA to MRCP, revising right with BMJ OnExam. 

Test drive for free with the 10 daily questions.

The Autumn Sale may be over, but the party isn’t quite done yet…
Use HANDOVER40 at check-out for 40% off all resources 👇
(6 days until it expires)

Medical speciality recruitment opened yesterday. 
Let the Hunger Games begin.
Ready to catfight for a stethoscope at the Cornucopia? 
May the odds be ever in your favour.

If you’re trying to apply this year… I’m sorry.

NHS England made some under-the-radar tweaks to the 2026 recruitment process last month. Then yesterday, hosted an AMA so low-profile, even my colonoscopy pulled a bigger audience…

Spoiler: Have they solved the bottlenecks? No.
Are they rearranging deckchairs on the Titanic? Definitely.

The Changes (there’s only three)

1: Application cap

Apparently, last year, one person applied to 17 specialities. Gotta respect the hustle (or just sheer panic).

You can now only apply to five specialities max.

This will reduce competition ratios, and a greater percentage of applicants in each speciality will get an interview.

NHS England says it’ll encourage applicants to “focus on the specialities they have a genuine interest in.” Cute. 

However, the average applicant last year only submitted 2.37 applications, so it’s unlikely this will actually change much. 

Plus, reality check - It won’t reduce the basic maths of job competition. Last year, 33,108 applicants for 12,833 jobs, the highest number yet. 

2: GMC registration

You now need to have GMC registration before applying. 

It’s to avoid late withdrawals that leave rota gaps and ‘waste training capacity.’ Reasonable. Currently, you can apply before knowing you’re approved.

Except that GMC registration can take months, and the announcement dropped a month before academic clinical fellow applications opened. That’s like being told you should’ve brought a parachute when you’ve already jumped. 

So yes, technically it’s to protect ‘patient safety.’ But it’s also treating IMGs as expendable. It’ll reduce competition ratios, but who knows by how much.

3: IMT points

IMT is getting a loyalty scheme.
A new 5 extra points (total of 35) if you only apply to IMT or ACCS-IM.

It “rewards commitment to the speciality.” But it kinda feels a bit like emotional blackmail. Never took NHS England for a Toxic King.

Did Someone Say Strikes?

What’s missing from all this, of course, is more jobs. No new ones for 2026. 

The NHS 10-year plan promises an extra 1,000 speciality training posts… in the next ten years. Just a cup of water on a bonfire.

Last week, the new BMA resident doctor chief, Jack Fletcher, said more training jobs might be on the table with the government. 

But there can’t have been much love in the room. Yesterday, the BMA announced strikes from the 14th to the 19th of November, for all resident doctors in England.

The rebellion begins. Panem now, Panem forever. 
Good luck. May your GMC number be valid and your interviews plentiful.

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The French have only gone and done it again.

No, no…not another jewel heist 👀
But a trial proving steroids are still the GOAT of modern medicine. 

Which condition’s getting the steroid smackdown this time?

Bingo. Pneumonia.The Community-Acquired flavour.
No CAP. Literally.🚫🧢

In the CAPE COD trial, published in NEJM, French researchers recruited 795 ICU patients with severe community-acquired pneumonia and split them into two groups:

Hydrocortisone 200 mg/day IV (8-14 days depending on improvement) OR placebo. All patients got standard antibiotics and the usual ICU support.

The aim of the (phase 3, multicenter, double-blind, randomised controlled) game was to investigate differences in mortality at 28 days.

Here’s the key takeaway:

That’s 22 fewer deaths for team steroids. I pneu they’d pull through. 👈😏👉

(A note on safety: hospital-acquired infections + GI bleeds were similar between groups. However, more insulin was needed in week 1 for steroid-induced hyperglycaemia).

Simply put, it’s clear steroids have earned their spot in the severe CAP toolkit.

Even NICE (1.8.1) has joined the party, now explicitly recommending corticosteroids for adults hospitalised with high-severity CAP for 4 to 7 days (as of Sept 2025, in case you don’t peruse NICE for fun like we do)
— comme les Français, they start with IV hydrocortisone. 

Yes, steroids still pack a punch. And yes, they still bring their usual entourage of hyperglycaemia, moon faces and more. But this trial shows they can make a serious, life-or-death difference.

We’ve sequenced genomes, built CRISPR, got a host of monoclonals at our disposal and yet, once again, the oft-repeated clinical question is: Have you tried steroids?

It's Medicine's equivalent of turning it off and on again.
Yet somehow, it still does the damn trick.

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Let’s talk medical indemnity. We’re due to write a deep dive on Medicine and Law(The State of Defensive Medicine).

We want your insight and to include your views in the article. Which Indemnity Provider are you subscribed to, and what are your thoughts on them too?

Vote, then give your opinion in the poll below 👇

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