Anahita
@AnahitaS
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30, doctor, gastroenterology/med SpR in the North West.
Liverpool, England
Joined March 2009
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Silence in medical handover at Blackpool Vic this morning as we are advised to promote "admission avoidance" due to riots planned to take place later today. Large majority of the hospital on-call team are immigrants with a large proportion of Muslim background. No words, really.
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Moved to a different deanery today for higher specialist training. Decided to go for hospital accommodation due to personal circumstances - all sorted in advance.
Checked in... stained walls, mold behind the bed, flickering lampshade, an overwhelming sense of dreariness & gloom.
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PACES. £650 out-of-pocket for a mandatory exam, weeks of unpaid out of hours practice, 2 hours of assessment under scrutiny, 6 weeks of anguish waiting for result, all to be failed on what feels like pedantry. Not only a social, psychological, emotional and physical cost...
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"Can we please continue to do the job that we have already been doing"
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@DiedSuddenly_
@VigilantFox
No, these patients would have died much, much earlier had they not been put on a ventilator. Stop negating the knowlege/experience of actual healthcare professionals who are already traumatised by Covid. I cared for many patients who rapidly died who were NOT put on ventilators.
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I remember the feeling when I was first handed a list of prescriptions, TTOs & scan requests for patients I hadn't seen, by a PA. The role is intended to support, but realistically at the moment, a ward cannot be staffed solely by a PA. I feel it explains many teething issues.
Oh here is also the list of jobs I was given by the reg level PAs when I was busy on call holding the bleep. So they can go to theatre/clinics ASAP.
I had seen none of these patients. And I had to prescribe all these. Not from a consultant or a doctor but a PA.
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Long story short, I'm out of there. Booked a last minute airbnb for induction, & need to work out housing options. Away from a very lovely home & partner. Why am I in training again?!
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@ITVNewsPolitics
@SteveBarclay
But it was okay to sustain/justify a 32% pay rise for MPs over the past 13 years?
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No functioning WiFi, bleak & bare rooms, old ceramic stoves. A sense of apathy for whoever has to live there. & it's not for free... £425pcm/person, in a 2-person houseshare.
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@erinisasnake
@siandlloyd
@DianaSheridan11
@VirtueOfNothing
@MaaloufMD
Can't we just appreciate that doctors have more experience in making a diagnosis than other HCPs & respect our training as well? I'm quite clear that I will defer to pharmacists for all matters pharmacological as their knowledge far exceeds mine in that domain.
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@Dr_Done_
Unfortunately had a similar experience, but as IMT on a specialised ITU for only 3 months, so very short. They were brilliant/highly experienced... just found it odd they could perform highly invasive procedures, but not a PR exam for indemnity reasons! That came to me 👍🏽
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@CCWearmouth
As a medical registrar, I literally cannot even believe this is a debate.
Undoubtedly all foundation doctors, who routinely cover the MET/arrest bleep & are first port of call for the deteriorating patient.
Foundation doctors go ON to become SHOs and registrars.
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NB - my expectations weren't that high. I've stayed in hosp accommodation many times (as a student). Received no photos/specific info in advance (despite requesting) but proceeded as it seemed an ideal solution. Perhaps my fault for taking a chance!
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@UKGastroDr
Everyone instinctively knows that if Lucy had been a nurse from India, the Phillipines or Nigeria, she would've been sacked at the earliest red flag, & rightly so given her crime.
This case clearly demonstrates how white privilege can prove detrimental to *everyone*.
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Felt magnanimous today & went to offer aid to the ward struggling with a cannula, but dismayed when I was handed this.
Wtaf is this, is it a good thing, & please can someone grab me a good ole Venflon?!
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Simultaneously, PAs can do clinics/procedures/theatre/endoscopy. I think that rightly raises the Q: why no scope to do the perceived basics, but to do highly advanced procedures?
& I feel so awkward saying this, because I've worked with some great PAs, some of whom are friends.
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...but also a financial one. I know it's not the end of the world and I know I'll get over it, but it feels a bit traumatic facing the prospect of doing this... 𝘢𝘭𝘭 over again.
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@SamuelBS85
- Lack of integrated digital infrastructure
- Portfolio requirements
- Training applications which expect doctors to be at the forefront of research, QI, and education whilst simultaneously working full-time with out-of-hours commitment
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@mevparekh
I love how "work-life balance" is in passive-aggressive quotation marks, as if that's an unreasonable expectation
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@iDrSunny
Evidently, the subtext here is that medical students are competing for learning opportunities with PA students on the wards, which is causing friction.
@StGeorgesUni
, wouldn't it just be easier to keep these groups distinct in the current climate of confusion re: scope?
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A consultant I work with always emphasises how it's important to leave patients feeling warm and cared for after any interaction - & how that's just as important as all the medical bits.
As he has the same approach for the juniors as well, I totally understand why it matters.
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When I was at medical school, CMT (as it was known) was widely considered to be a shoo-in. It started to get worse when I applied (plus a year shaved off specialty training), & now... I just really feel for more junior colleagues to be honest.
I applied to IMT this year, the competition ratio has gone up by 43% in one year. If I see one more person say “there’s enough work to go around”, I may fully lose it.
We’re fighting each other like dogs for these posts, when there are gaps on every rota around the country
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@dx_mighty
@DrEilidhMaria
Bizarre, ostracising behaviour. You clearly have an important perspective & it's a shame they don't want to use that!
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@Edwina_Currie
Edwina, junior doctors staff a 24/7 service with LOTS of unsociable hours. Our usual contract is 48hrs per week (unlike the AfC contract). Going "part-time" is really not the "gotcha" you think it is.
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@josemehrinho
This. Honestly, I am just so tired, every shift is so intense, and our working patterns are unstable and non-conducive to doing these expected extras.
We need to celebrate just getting the job done.
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@pkonline84
To be honest, your tweet made me think about the issue a lot more and realise how impractical we can be in hospital when advising patients to self-cert. I would also have been annoyed in your situation. I think it's a misunderstanding about who's responsible; we all are.
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@Dr_Done_
Also no mention of what time it was documented that the case was escalated to the SpR, only that assessment concluded at 15:00 + PTWR occurred approx 2 hrs later. Was Dr. Z actually informed regarding urgency of case/need to R/V, because how else does one prioritise?
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Induction as a brand new ST4 today, and the impostor syndrome whilst all the regs make inside jokes about your specialty is real...
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@CatrionaRennis1
If you're reading this thread & are considering telling her:
a) how she needs to learn to prioritise;
b) that if she can't hack it, maybe she should consider an alternative career;
c) that x and y is normalised in many other professions...
...you've COMPLETELY missed the point.
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@DrGoblin3
Medicine makes us consider the worst-case scenarios, & we've all had patients who had wildly unexpected findings or rapidly deteriorated after only subtle signs at first. I've only become more paranoid with time to be honest.
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How do gastroenterologists unwind? Shots of Fortisip Compact at a nutrition course 👌🏾
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@BucksHealthcare
Are you able to share what your extra-contractual rates for these professional groups are outside of periods of industrial action to enable what you deem to be a valid comparison? I'm assuming rates for Drs are unchanged, based on this statement.
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Some consultants don't appreciate this hidden workload.
But I've worked in places where the role has worked really well (particularly acute med), & do feel a lot of tensions are created within individual departments who are directly responsible for how they implement the role.
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@FacialPlasticMD
@TPP_MD
Either I'm glad you've made no mistakes in your career, or I feel sorry for you if you have. You can be an excellent doctor & *still* make mistakes. Every intervention/decision carries inherent risks and you simply can't survive in medicine with 0 self-compassion.
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@SusilPallikada1
NGL, I think this sentiment will attract a lot of ire from a lot of medics (generalists and otherwise) & I think betrays not enough experience in other areas of medicine! 😖
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@bykatewomersley
I do wonder why, when the suspicions about her were raised, her practice wasn't supervised for a period of time (as would be the case for a Dr)? I imagine the unit didn't have the resources to double up on her shifts.
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Cannulating an anaesthetist is nerve-wracking but simultaneously quite handy... they selected an appropriate vein, then immediately compressed proximally so it wouldn't bleed back & cause a mess. If only every patient made it so easy. 👍🏽
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@Dr_BellaR
Non-anaemic hypoferritinaemia. It's considered to be a precursor to iron deficiency anaemia & the BSG guidelines currently advocate investigating as IDA. Ferritin 20 is borderline though, but if symptomatic a therapeutic trial of iron supplements is probably reasonable.
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@RStomel
@kaypeei
@22_Lex_kate
@RachelLyon99578
I always thought I would prefer a C-section until I observed one vs a natural birth (as a medical student)...
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@PaperWhispers
They know exactly what they're doing with the statements and the word choices are SO passive-aggressive.
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@Lawrenc28443726
@SaraTon08500527
@MichelePaduano
@mi
It's true & I'm not anonymous. A PA at the Royal supervised me doing a therapeutic pleural aspiration. They were very good & trained in US. At the same time, IMTs have nowhere near enough exposure to pleural procedures, particularly as the senior decision-makers to-be OOH.
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@Drmehaktahir
I started learning ECG interpretation in 2nd-year so had 3 additional years to apply that to practice. I don't know why this is being conflated with PA issues!
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@medicalmodelbri
@AlisonGeorge10
@DrSteveTaylor
@DrNeenaJha
Fair play to this PA. What a shame they're in this situation.
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@BucksHealthcare
@Xeon4f145d96s1
@NMacdonaldBHT
@AndrewMcLBHT
@BucksHealthcare
I'll give you the benefit of the doubt - are you aware PAs can't prescribe (including for discharges) or request radiological tests? This will fall to other colleagues (& more so on strike day) & that should be reflected in the hourly rates.
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@Larocatain
@Saints_Mike7167
@notcapnamerica
As a POC & non-royalist, I was pretty indifferent about MM (beautiful, but also who cares).
I remember being shocked realising that she was *actively* disliked by the british public. Her behaviour is constantly policed. You have to ask why not her peers.
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@noodles_nood
Bad enough, but let's just throw a stigmatising jab about mental illness whilst we're at it.
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Formula for a shift worth remembering...
- Great seniors who get stuck in
- Old & new faces
- Lovely patients
- Variety of cases
- Opportunities to learn (mistakes included)
- A sense of satisfsction
The ones to treasure, that's for sure
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@cannula_service
After 5 years postgrad medical training, I know I simply wouldn't possess the knowledge/training/skillset to independently deliver anaesthesia in only 2 years. Where does this level of confidence arise? Do the majority of AAs have ODP/crit care background?
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@TVRJDC
@BucksHealthcare
@AndrewMcLBHT
By this very logic, an F1's salary isn't half of that of a PA's. So why the disproportionately higher hourly rate?
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@ProfGrahamTowl
@thatsnotmine125
@LeanneHPatrick
@SaraTon08500527
@caspertown42
@Erin_Dean_
@ASiTofficial
@ExplosiveEnema2
@RCPLTrainees
@HSJnews
@AnalysisDrawer
@JamesLynchGTC
@keepnhspublic
All for it if there's an abundance of training opportunities. Equally, can we share rotational training, staffing unsociable on-call rotas, cannulas & discharge summaries/TTOs in an egalitarian way as well? Or are we just going to cherry pick which skills should be shared?
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Post-work run 10 mins away from my hospital today. Absolutely in love with Lancashire countryside, & dreading the winter evenings to come!
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@Doc_IonaCollins
@drokane
For a 4-year course, you have to ask why the funding hasn't just gone into increasing capacity on medicine/Pg medicine courses. Why would a student apply to become a PA at an undergraduate level over medicine, when the advantage of the MSc is always cited as shorter training?
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@dx_mighty
@anonPA5
@timricketts_
I remember reading
@dx_mighty
's tweets quite a while ago & I thinking that she's genuinely really proud of her PA background & was keen to continue working in her scope as a PA post-medical school. I don't think it's fair to turn the bullying accusation on her?
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Literally NOTHING makes turning off this graduate physician's computer off during the most stressful high-stakes exam of her career okay.
@PrometricGlobal
@TheUSMLE
you absolutely MUST make an enquiry into this employee's behaviour & how it affected her
I thought coming home after finally finishing the USMLE step series would be such a victorious moment. Instead I’m replaying the moment where my examiner told me he “did not like my attitude” and proceeded to turn off my computer MID-EXAM.
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@TheSalariedPA
This would be great. However, in a particular department I worked in, each week a PA was allocated to be "off the ward" to pursue CPD, attend clinics (including procedural ones), audit/QI. Forget the IMT3s who actually had to hold the referrals bleep PLUS do WR/jobs.
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@KHoulgate
Yes. I really like & get on well with my ACP colleagues. At the same time, medical trainees are downskilling & it often feels like we have to fight for opportunities. I wish there was a healthier way to have these conversations & foster a good training environment for everyone.
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@DrHethWeth
@angela_sheard
I’ve worked as a care assistant in the past so know the ropes. As a student in A&E, I firmly asked family to leave resus then scrubbed the bed of and washed up a withdrawing heroine user — a lot of faeces — with an HCA. We signed up to look after and maintain people’s dignity.
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Recently watched an ED SpR bosh an EJV line into a patient we were really struggling to cannulate (even with US). Makes me nervous cannulating in that general area, but I'm not sure my anxiety is justified. Is this one to more readily go for in difficult access situations?
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@leadingmeded4u
I think you're right: I will. I've written to the accommodation team at my new Trust, but that's also a really good shout (once I figure out my actual accomm!)
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Survived my first days as a junior doc in the NHS... whatta bag of emotions!
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I don't dislike nights, I just really dislike the lack of downtime (sleep to work, work to sleep, feeling like a cog in the machine). Particularly depressing on short, winter days.
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@PhilSmithIsBack
@mancunianmedic
Bizarrely on my last set of nights a clin fellow on AMU told me an opportunity arose for paracentesis on AMU, seen by PA on WR. Both he and IMT expressed wanting to do procedure; IMT ofc needs exposure.
Consultant supervisor of IMT *ASKED PA if IMT could do procedure*, but
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UK government offers 6% payrises to public sector workers, but cites extortionate 50%+ increases in visa fees are required to fund this.
Who would've thought an Asian-British prime minister could sign off on some of the most xenophobic policies we've seen.
So disappointing.
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Missed shadowing good family doctors! Just love the infinite tips, remedies, and tried-and-tested wisdoms, that G.P.s hide up their sleeves.
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@DrSelvarajah
Most of my colleagues I worked with this weekend on the acute medical take (+ A&E!) had an exit plan. The NHS should be really, really worried.
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@ZainKhanMed
I always wear scrubs on nights. If I'm driving into work in fresh & clean scrubs, there is zero problem with that. Alternative being coming in even earlier on back to back 12h shifts to change fron clean clothes... into clean clothes.
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@IncogAssociate
@Adam_Skeen
Adam has not denigrated or called the PA route 'inferior'. He has insight into the important differences between the training & highlights how it links to scope of practice. Do you not think the latter is an issue at all?
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Thanks for all the lovely replies to my tweet this morning. I wasn't expecting it go viral (& to be honest... I'm not cut out for it!)
I've decided to go private due to the much smaller share of hate messages received as well, that I worry put my colleagues at risk.
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Ironically, the anxiety is not in admitting sick patients (because even if your first suppositions are incorrect, the hope is that the diagnosis will reveal itself through progression or investigations).
The anxiety lies in discharging the apparently well patient home.
Just read a thread about someone’s experience of having a stroke, with symptoms seemingly being isolated to upper limb coordination difficulty & headache. Reading the thread & replies I’ve realised one of the reasons I don’t think I can do medicine any more is the weight of 1/n
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Whilst I've been endlessly taught this over five years, the significance of the axiomatic 'history is everything' is finally sinking in.
The conversation between doctor and patient the medical interview is the single most important diagnostic tool in medicine
By
@danielleofri
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@JimBethell
Okay, but none of this list precludes or invalidates the definition of a physician?
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@jbcarmody
Maybe just ask why your application is rejected instead of building a case against those less privileged than yourself? Who can probably demonstrate far more examples of genuinely negative discrimination over the course of their lives.
The scale on the MCAT scores too...
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@Dr_BellaR
I honestly can't cope with the quality of replies you're getting. As a doctor I am *more* than happy to denigrate the system which isn't allowing us to deliver good care & basically makes rocking up into ED a hellish experience. There is 0 blame on medical/nursing colleagues.
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“There’s no systole without diastole,” said my old anatomy professor, advising us on the importance of rest.
Words to remember as I lie comatose on day 1 of annual leave...
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@LaineyL10
@JakeMaverick5
@halfpennychew
Why scapegoat the most vulnerable people in our societies who survive on virtually nothing, make up a tiny fraction of migrants, have suffered endlessly, & lost their homes & all their savings?
It's needless. It's another lie sold by the tabloids. This doesn't deserve your anger.
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@KeeleyMP
@gmcuk
Thank you so much for speaking up on behalf of doctors who are urging for clarity on this matter. We are merely asking for clear definition of a scope that supports/enhances the work & training of Drs, public education regarding the role, regulation that doesn't cause further
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@anonPA5
@dx_mighty
@timricketts_
I think the truth is apparent when she's been systematically removed from every PA group explicitly for "divided loyalties". Why does loyalty even come into this? But as she's eloquently said, the other side is welcome to explain its position.
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@jdrwilcox
@pepemac27
@rosskeat
@TfL
I would 100% pull the card if I'm on the way to work. It could potentially cause patient harm to leave the shift uncovered. There's a public interest there.
Besides, a bus driver helped me out when I had a bike puncture (pre-doctor days) just because, uh, he was nice & had space?
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The irony when 30% of doctors and 20% of nurses are immigrants, and anyone who has even worked a day in the NHS and looked after patients knows this rhetoric is completely wrong.
SO done with this. When do immigrants get to go on strike so the public can understand their worth?
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@Larocatain
@Saints_Mike7167
@notcapnamerica
I remember a friend of mine (white), said "I just don't trust her. At all".... I was like, why? And what makes you trust any other celebrity? There is definitely a subterranean instinct against her.
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