Sarah Nicolle (she/her) 💙🌈🎵
@DocCSarah
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Hoping for happy (music helps), mum, wife, red cell Haematologist, GTTO
Joined September 2017
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My hubbie said something quite terrifying when I showed him the Barclay PA video. He thinks doctors are to Barclay what miners were to Thatcher. He wants to break us and then get rid of us. I don't understand what the endgame would be though. What's the advantage of no doctors?
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My mum (retired physio) was asking her GP how he was doing and what impact the introduction of PAs has had. His practice doesn't have any, but he has had patients discharged from specialist clinics after one appt with a PA. No doctor review, no specialist opinion
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Just done my end of consultant diary maths....
Yes, I am relatively well off, but that's based on at least 52 hours a week worked.
I have earned...
£19.06 per hour take home
I qualified in 2000
Does anyone really think this is OK?
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He is now having to re-refer those patients back. I think any services doing this should be made to offer immediate new appointments with doctors to those patients who did not have the specialist review they were referred for. Those patients should not be made to wait again
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@nursekelsey
One of our friends died the year we got married. His wife brought his urn to our wedding. The three of us danced with him between us in our arms. He was always the life and soul of a party, it was just the perfect thing for her to do.
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My turn on advice and guidance today. Over 50% of the queries (unusually) were about patients already under haematology, about their haem stuff. Not one patient had called us (all have direct lines), all had gone to GP!!! If this is replicated all over, no wonder GPs are drowning
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@Vidar161
I hate the comments below this post which are still victim blaming... well, even if it's not what you are wearing, you could walk in a better way or be more forceful in how you say no or carry pepper spray.. from women, women are saying those things!
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@KatyMontgomerie
I have tried to follow logic through this story without pre-judging, but can't! We are usually happy to facilitate a female member of staff where possible (often older Muslim ladies ask) but could never manage a whole team, or no men at all, even without trans coming into it
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I have worked (actually worked) 116 hours since last Monday. Many of these were "on call", so paid as if I am at home chilling, but in fact have been in, managing incredibly complex patients. I come on twitter and see comments about overpaid/rich doctors and it feels rubbish
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Thoughts on the BMA publishing scope for PAs
1. A doctor's union are probably not the right people to do this BUT
2. GMC have said they will NOT and
3. Why should RCP set scope for PAs in surgical/radiology/pathology/GP specialties?
So, a good starting point, colleges' turn now
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@DrEilidhMaria
Even our most amazing nurses who have been in haematology for 30 years are not the equivalent of a registrar, because they have not done medicine, they are not doctors. Time does not equal knowledge and competence. They are fabulous nurses and this is what we need them to be
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@AngryBlackLady
I was ghosted by one of my oldest friends after my dad died and I couldn't see my way clear to having a social life immediately. No calls, texts, card nothing. She is my daughter's godmother. I feel like I should try and get back in touch but it has been 5 years
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#teamGP
what should be the purpose of the repeat prescription/medication review? Had mine with a non-GP for the first time today, no structure and I don't really know what happened or what I now have on repeat...and I am a doctor. Confused
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it was my band playing.
Just reflecting that some members of the public see doctors as completely rounded "people" and some seem to think we cease to exist outside the hospital. I don't think she meant it as criticism, just couldn't compute
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@Xeon4f145d96s1
So as a haematology consultant I have phoned the stroke consultant for advice because I haven't known the answer to a question. In what world would a PA answering that bleep be even vaguely appropriate?
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Oh my poor GP colleagues! I am getting Consultant connect messages through sent after 10pm, when do you switch off??
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Anyone seeing this needs to know that doctors are not in short supply. Jobs for doctors are though and this is a political/funding decision. We are heading for a situation where we will have medical graduates with no career path in this country
"Physician associates can be a vital support when doctors are in short supply.
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@UroLizzie
My 14yo gleefully told her teacher that thalidomide isn't all bad and her mummy prescribes it a lot. She is also looking forward to telling her I have been giving patients arsenic this week. For clarity, I am a Haematologist, these are real treatments
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@DrEilidhMaria
I had to explain to med students in my clinic the other week that one would be in with me and the other with my fabulous associate specialist colleague, and yes, she is a doctor, as they thought she wasn't. If they aren't sure how is the public meant to know? So dangerous
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Bumped into a very long term patient at a gig in a pub tonight and she asked if she could introduce me to her friend. Friend asked what I was doing in the pub....listening to the band...I think her head might have exploded if it had been a Saturday night when
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@Dienekes_
I have put on a tonne of PPE to give big cuddles to patients or relatives after devastating news. It is the humane thing to do
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@energizerapid
And will happily tell doctors to "go and find another job then" but simultaneously complain about the waiting lists/not being able to get appointments and not see the link between NHS staff leaving and nobody being there to provide their healthcare
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@Sonia_Sparkles
Every time a manager or admin person or quality person is cut,more falls onto the clinicians. All those jobs need doing. If clinicians are doing them, guess what they aren't doing? Direct patient care. We need good management, they can make a huge difference
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@doctor_oxford
@BorisJohnson
Or even try being the other half trying to work from home and homeschool the children while wondering if your wife is safe at work, whether she is safe to drive home, not getting even planned leave time with her. Or a shielding person not seeing their children
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@DrEilidhMaria
Every single time I am woken at 3am to be asked to help with a plan for elective surgery in a few days/weeks etc just because that's when someone happens to think about it that means I am less able to help deal with an actual big emergency worth waking me for.
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@KatyMontgomerie
@Weedleplop
I am a Haematologist. Some of the normal ranges we use are different depending on hormones, so trans women on HRT will have levels in the female range and trans men on T in the male range (or sometimes too high if overegged!). It's not difficult to understand
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Just doing the haematology on call rota for the next few months. As consultants we cover a whole county, 4 hospitals. We will have a registrar on with us only 1 in 8 of the shifts we do. For those saying "life gets cushier when you are a consultant" it absolutely does not
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@PoorDecisionsMW
@BadMedicalTakes
This feels a bit meta, a bad medical take as a response to
@BadMedicalTakes
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@andyheeps
@thetimes
He absolutely is condoning it!! Just gets more disgusting each time. The fact that he thinks there is any such thing as "trivial" sexual assault is a massive red flag!!
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@chrischirp
Half our (triple vaxxed, previously infected) department currently down with the stupid virus again. And we are not well, not just isolating. Definitely not over
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@JimBethell
The problem is without having gone to med school and having the knowledge and training, complexity will not be (and is not being) recognised and patient safety is being compromised. No doctors can work in GP unless they have GP CCT, why do you think it's safe for a PA to do so??
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@SteveBarclay
@Conservatives
I am not sure you can "order" the NHS to do anything, Steve, we are not your servants to push around. I fail to see how being inclusive is a bad thing. We are not pushing anyone out or removing their right to care by including everyone who may have a certain condition
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GPs, do you give your pharmacists/paramedics/physios/ANPs access to do advice and guidance requests? I am noticing an increase in them sending questions to us which I am 99.9% certain the GPs in the practice could have answered.
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I don't know why healthcare workers would assume this. We are certainly taught in med school what we should be requesting and what we are allowed to. Surely other professionals are taught similarly as part of robust training?
@Dr_Rajiology
A lot of healthcare workers assume that they have the right to "order tests" unless they have been informed otherwise. A rigorous screening system is needed for all healthcare staff, not just PAs.
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@Academic_owl
I saw someone in a gen surg clinic who, despite me asking multiple times (and being a consultant in that hospital), refused to give me name or role. I complained to the consultant who couldn't actually work out who had seen me as she hadn't documented
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@iDrSunny
More advice and guidance requests to specialists as it doesn't appear the PAs discuss with GPs, they just send in "patient anaemic, what shall I do?" is now quite common for us to get into haem from PAs and we would never get this from GPs
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Attending haematologist this week. We do A&G as part of this. I love writing responses to GPs who have done everything beautifully and I have nothing left to add, but don't think I can put "you are smashing it, don't let the f***ers grind you down" like I want to!
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@ParisahHussain
Qualified for 22 years, scrubs with DOCTOR in huge capital letters, still get nurse/secretary/cleaner. I have no solution for you, sorry
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@frenszie
@riflesandlures1
If an adult feels that an 8 year olds shoulders and neck are "sexual" then they should be nowhere near children
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Genuinely horrified by some of the work dump from secondary care colleagues to GP today, all resulting in delays to patient care and some in patients angry at us (due to meandering, rather than direct, referrals). All of us in the big shiny building must do better
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@AndrewJD
@AusterfieldM
I have ended up in joggers half way through a shift because a patient urinated on me. Would they be my usual choice? Absolutely not. Did they let me continue providing care in a timely manner? Yes
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@DrEilidhMaria
I was also an HCA. Continued doing some HCA shifts during my PRHO year. On those shifts it didn't matter that I was a qualified doctor. I was there to assist the nurses and do personal care etc for the patients. HCAs are the bedrock of our team!
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@DrRanj
Very proud that my daughters have both been very clear that any male friends of theirs admiring Andrew Tate will no longer be their friends. Even prouder of some of the boys for breaking with the peer pressure and calling out the misogyny
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@DrEilidhMaria
Eilidh please get the BMA involved. This is not right. The trust will tell you nothing can be done, but it should be. In the olden days of banded rotas, we managed to get upgraded from 1a to 3 with BMA help. Do it as a group and see if you can find a consultant to get on side
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@JaneEMCallaghan
There was a similar fuss made about a male ED "consultant practitioner" last week. There are many things going on here but actually for once I don't think sexism is one of them.
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@MikelGunners
@jackypetal
@idruprofen
@AndrewG97440406
Doctors are not plumbers, we don't get paid differently if we have to go in on a non-resident on call! But FY "on call" isn't at home anyway
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@OReillyGem
@BBCBreakfast
Hi Gemma, are you interested in hearing from doctors (GPs especially) who are being affected by the introduction of PAs? Many of us are concerned by the way they are being utilised
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@FifeRight14
@TheatreSpoonie
@MForstater
I am very happy with the progress pride flag, speaking as a bi woman
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@IndiaWilloughby
@Tesco
@tesconews
I love the "dressed as a cis woman"....so wearing some clothes? Why have we gone back in time half a century and clothes now have genders again?
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@TharushaGunawa4
On induction to our ward, our juniors get "this is the ward kitchen, staff room and fridge-freezer, you are encouraged to use them all, bring a mug in for your tea and pop your packed lunch in the fridge". I see no reason for it to be otherwise
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@dr_dru_
Responses calling medics thick for not knowing that non-doctors can request and not knowing how radiology depts work....The point is that PAs are not regulated or trained and it is NEVER legal for them to request and it's worrying that some radiology depts don't know this
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@EmergMedDr
@gmcuk
@ShaunLintern
I think this is the worst PA "use" I have seen so far. They absolutely are not qualified to be having these conversations and making these decisions. And how many patients/families think they are talking to doctors about end of life planning? So important to get right
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@DrEilidhMaria
They cannot be equivalent because they haven't been to med school. I am going to keep saying this until I am blue in the face. They haven't studied medicine therefore they are in no way equivalent to doctors of any grade
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@DrEilidhMaria
Just basics- he does realise that PAs and ANPs aren't the same thing, doesn't he? Because I feel like he might be talking about ANPs
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@AerodDr
I went to assist at a concert, several people already there, man stands up and says " ah, I presume you are a doctor"....I nearly fell over in shock!!
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@iDrSunny
@HCAhealthcare
@ClevelandClinic
They cannot provide "expert" care in all those specialties. There seems to be this weird acceptance that PAs come with expertise built in despite no medical training/exams etc and it just makes no sense. It's magical thinking
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@greycoupon
@BadMedicalTakes
I must have imagined treating postpartum eclamptic women then...
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@DoctorMayJay
And many on benefits are actually working but still need PIP to be able to afford the extra "stuff" they need because of their ill health/disability and it is such a huge battle to get this for them
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@ChrisWoodPhysio
@dr_shibley
I am afraid before this Dr Shibley had threatened a number of other doctors with referral to the GMC. However, they have received vitriol and he support. I am unsure why but it does not appear fair from outside
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@KatyMontgomerie
The first thing which is ridiculous about this is that sex is provably not binary
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@Claire_M
@drmattuk
@philbymctait
@mouseter_chef
@dr_shibley
@Moham1287
@djnicholl
@trishgreenhalgh
@martinmckee
@parthaskar
@DrLKVaughan
@TheDA_UK
@TomStocks1982
@TheBMA
@RobLaurensonD4P
@Sandeep
@Iona
@Xeon4f145d96s1
@DrEilidhMaria
@AnaesUnited
@katlay
@JanetEastham
@DrAsifQasim
Completely agree....if I have largely self-diagnosed and I know what I need I have always been fine with the ANP, but if I can't work out what's wrong I need someone with more gen med knowledge than me and that is the GP, certainly not a PA.
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@veggieequallife
It's more basic than that. The patients are being referred by a consultant in primary care for a specialist opinion. How is a PA a specialist opinion? Without the grounding in med school, without the post-grad specialist training and knowledge?
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@KatyMontgomerie
I was initially horrified as Chapatti flour adds to iron deficiency, but couldn't believe what I was reading further down! I wonder if any of those women have ended up under our care with bone marrow issues?
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@DrLaraibKhan
This week, I have been shouted at by a nurse, GP, hospital admin, GP admin, SHO from a different specialty, lab in a hospital I don't cover, pt's relative and radiology. I wish I could tell you it gets better once you are senior....(I am a consultant)
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@quackophage
This surely is illegal, definitely impersonating a doctor, should be GMC acting here and if she wasn't a PA they would be, yet somehow once it's a PA they can say whatever they want
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For those thinking that doctors shouting loudly that neither Tory or Labour want our NHS to continue are paranoid, please, we just care about you, we do not want this nightmare to happen, and make no mistake, it could if we sleepwalk into it
This is the future folks...Hellcare. Read this on Reddit..breaks my heart. What follows is my perspective on what I believe is happening in countries like the U.S. and the UK and why. I'm going hard and may seem paranoid..I don't give a f**k. Long thread.
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@DerpyErika
@ActivateAmyMode
@marketdoctor
Where else will they put random bits of gravel, sugar packets, feathers, grass and other "treasures" to wreck your washing machine with
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@alexhern
Why, why, why do the DWP realise that people do not grow out of/get cured of congenital conditions and demand this fiasco every few years too?
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@ShaunLintern
I work at UHCW. Yes, our switchboard can be incredibly busy (as an SHO I audited time spent on phone waiting in a week, over 2 hours), but surely you keep trying? That's what I do when I need another specialty
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@Dr_JSA
It is also written in actual English rather than the word salad which seems to accompany most PA "scope" or "job description" documents
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@RSylvesterTimes
@wesstreeting
GPs ARE specialists, in preventative care, in diagnosis, in managing uncertainty, in continuity of care, in signposting, in management of the millions of problems which do NOT need secondary care intervention
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@MarkDen37422286
@raj_vigneshwar
No, doctors do not. As several people have pointed out, this information is freely available. We are not on agenda for change and do not get supplemental rates
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@DrEilidhMaria
Also, why are mental health and chronic neurological diseases together?? And is this why they seem to like labelling lots of people with anxiety?
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@CaelanConrad
It really bugs me that one of my favourite colour combos is purple and green and now I feel slightly queasy contemplating wearing it due to this bunch of bigots
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@DrPeterWeeks1
I hate to be picky, but if a GP is suspecting a haem cancer, I would like to see the patient quickly and then organise the correct onward tests, once I have seen them (for an hour, not the 10 minutes GP has) so we don't waste resources
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@LeftieStats
@wesstreeting
there aren't enough beds for people to be nursed in safely, people are being treated in corridors. The number of trans patients are tiny. Why and how on earth is this a priority over simply starting to fund the NHS properly?
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@dr_dru_
"the lady in bed 3 hasn't passed urine since midnight" "Is she catheterised?" No..."Is she asleep?" Yes.... Multiple times, every set of nights, same ward, without fail. Most people are not incontinent when they are asleep
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@NHSuk
I am as pro-vaccine as they come, but it is disingenuous to expect people to put all their faith in this booster stopping them "catching" Omicron when the data is clear that it doesn't. Maybe we should be emphasising the reduction in severity instead?
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@LeSouness
@Bouri_D
Lots of doctors don't earn above the threshold, is medicine also a pointless degree?
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@TakeThatNurses
I have been wearing a surgical mask at work all day every day since 2020. I have a slightly sore top of nose and back of ears when we get one particular make but otherwise no issues
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@itvpeston
@VictoriaAtkins
@ITV
She hasn't actually offered to come and negotiate and it's been a lot longer than the "twenty minutes" she said she would be there in. How on earth can anyone accept anything if there is no offer on the table and she hasn't entered into any talks?
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@DrEilidhMaria
Lots of people who have done previous science degrees and do GEM say their science degree did nothing to prep them for medicine, and we don't say that GEM medics have done 7 years etc. It just doesn't add up
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Phenomenal GP interaction today. I am lucky to be registered at a practice with great docs, but historically hard to negotiate changing ways of getting appointments. They have moved to total triage with online requests recently. I was phoned back and sorted before 9 this morning
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@KatyMontgomerie
I don't mean it didn't happen, just doesn't make sense to have happened as reported. There's something else on one or other side that this is missing
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@Depheruk
This sounds like elder abuse and could warrant an adult safeguarding referral, either through healthcare or police
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@Nurseborisbash
One of my colleagues had a long term patient dying on the ward. Patient asked if he could "share one last beer", colleague nipped to Tesco's for a proper beer for patient and non-alcoholic one for himself and just sat in companionship (doctor, sorry, hope it's allowed!)
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