Dr Goblin
@DrGoblin3
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Following
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Is this a serious question? I’ll assume it is. Let me explain. You go to the GP a with a sore throat. GP talks to you, examines you and feels it’s nothing serious. GP sends you away but gives you weirdly strict safety-net advice for a sore throat. 1/10.
@drphilhammond High risk? What about a Drs job is high risk please?.
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PAs being offended by the @TheBMA document on their scope is pure narcissism. Their scope is dictated by the supervising doctor, and that's who this document is for. And my GOD is it overdue.
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God give me the confidence of a patient who, the day after 16 pints of cider and 8 lines of coke, won’t accept “hangover” as a diagnosis.
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So, being a doctor really is hard and risky. We either overdo it and cause problems, or under-do it and cause problems. Striking the balance is so difficult, and we’re always learning from our mistakes and those of others. It never stops. 10/10.
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A patient unironically said to me “I pay your wage” after I said no to something. Which was amazing. I thought people only said that on X.
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I’m fairly hardy but occasionally things get me. Palliative patient, in a state. Wife doing her best. Awful. I noticed his and her phone numbers separated only by one digit. Couldn’t stop thinking how they probably went to the shop and bought them together.
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If I were to say someone “has got a cob on”, what do you think I meant?.
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FY2: They came in with an AKI so I gave them a few litres of fluid, but then they got a bit short of breath with their heart failure so I also gave a bit of furosemide 🤝👊🫠. The post-take acute medical consultant:
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I suspect most people looking at this would still assume Raj is a medically qualified doctor. He should not use the title in a workplace setting. @drammarahughes this isn’t going to go away.
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A trained PA is Employed. Full stop. No more formal training. No more mandatory exams. What's the doctor equivalent of that? 🤔.Oh yeh, it's a GP, Consultant, or non-training doctor. So let's show how we get to that point, compared to the PA's journey:.4/5
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Personally I don’t want @gmcuk regulating PAs. But they will. So, at the very least I want:.- a separate register with an individual identifier that is immediately and obviously different to doctors’ 7-digit e.g. PA12345.- their fees to be the same as ours.
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Clinic: This pt must have bi-weekly bloods. GP to do. Me: No. Clinic: OK fine then they absolutely must have weekly bloods. Me: No. Clinic: Well alright but twice monthly at a bare minimum. Me: No. You do them. Clinic: …we’ve had a think and they don’t need bloods.
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My last one. Saving it for a troponin in a 20 year old with chest pain 👍
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This reminds me of the time I was "called upon" mid-flight to flex my medical muscles. Patient w LoC. The call put out. Me and the wife looked at each other and sunk down in our seats a bit. When nobody else stood up we felt guilty and sheepishly went over. 1/7.
Had an incredible in flight emergency experience on @AmericanAir Yesterday. Patient w LOC & about 30-40 min until landing. Team rapidly assembled (Akeila - an ER Nurse from @BayhealthDE, Eddie a cardiologist from @MaineMed, and Anna the flight attendant) to care for the pt .1/7.
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3x F2F appts DNAd today. All 3 “insisted” on F2F and all were “urgent”. One showed up 4 hours late with “I forgot”. Absolutely incredible.
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It’s not about a PA missing complete heart block. It’s about a PA either 1) not wanting to ask their supervising GP for help, 2) not feeling they could ask for help, or 3) not having an accessible supervising GP. 1 is a meeting without coffee. 2 and 3 are the Surgeries’ fault.
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Have kids they said. It’ll be the best thing in your life they said.
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It’s terrifying when experienced, stoic GP partners crack under the pressure and go off. No warning signs. You can’t know what people are going through. I’m a bit shaken.
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A certain Newbury GP comes out swinging in defence of PAs, referencing their 1st PA. That PA - now a medical student - suggests PAs might want to plan for redundancy if ARRS changes happen. *sips tea*.☕️.
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Why are non-diabetic rich people sticking glucose monitors on their arms?.
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Patient with his new walking stick (and some memory issues): “this is my lightsaber!”. Me, over-caffeinated: “whoa yeh!”*makes saber noises and pretends to spa like Darth Maull*. Patient, looking blank. His wife: “he said it’s his life saver, doctor…?”.
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At a wedding. Loads of doctors, some of us are GPs. It’s all kicking off as the hospitalists declare they’re seeing patients as we refuse. Oh ffs. Sigh.
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It’s not about a PA “missing” an aorta. It’s about the consultants using them as junior doctors.
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If a sentence starts with “it’s not Covid because…” . and doesn’t end with . “…I’ve had a negative PCR done in the last few days.” . then I really don’t want to hear it. So bored of this game now.
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Read this from the new Good Medical Practice. With PAs being used as they are, we’re beyond parody at this stage.
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I won't say we got a round of applause as we returned to our seats, because it didn't happen, but you could tell everyone was impressed. The stewardesses gave us both a sandwich and a can of coke, and insisted we only pay cost price. 8/7.
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If you’re ordering a D-Dimer “urgently tomorrow”, you shouldn’t be ordering a D-Dimer. Or seeing patients, probably.
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@DrNeenaJha @gold103x Badges with job titles won’t solve the more broad issue of role confusion unless role titles are crystal clear. “Advanced practitioner”.“Clinical practitioner”.“Clinical specialist”.“Surgical care practitioner”.“Highly specialised X scientist”. None of these mean anything.
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“I’m one of the clinicians/practitioners” is not good enough as an introduction. It says nothing.
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Medical people, do you ever get that cringey dread feeling that you’ve overreacted over a patient and everyone down the line is judging you?. How do you deal with it?.
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Not going to lie: NHS execs getting arsy about the BMA consultant rate cards is getting me a bit excited. The only tool they have is guilt trips and they know it.
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Good doctors will review, think and judge likelihood. And accept the “risk” of getting it wrong. All health systems would collapse if every symptom is investigated to the nth degree “just in case” - this isn’t unique to the NHS. 9/10.
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Non-doctors will accept less risk for any given case. This isn’t a slight - they just aren’t trained for it. A computer will never allow risk - why do you think 111 sends an ambulance so much?.7/10.
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Oh and by the way: over-investigating and over-treating literally anything is its own quagmire of avoidable harm, but that’s a thread for another time. 5/10.
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Having a rough time at work at the mo. Totally entitled, unreasonable patients treating me like a checkout assistant. No back-up from partners when push comes to shove. Poor medicine due to historical inertia and complaint avoidance. Not sure this is sustainable for me.
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If you hear hoofbeats a 1000 times, it’s probably horses. Except when it’s a zebra. This is the risk. The doctor might get it wrong. But look at the alternative of accepting no risk. 6/10.
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Yeh. That PA education flowchart thing is a disgrace. So I made more honest ones. Let's break them down. 1/5.
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Our ST3 can’t pass one of our exams. They’ve just been Dx with dyslexia. Mid-30s, and achieved these heady heights despite it. Always struggled, but tried harder, compensated and push on. I am genuinely in awe of them.
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Seems I’m expected to take up the slack for NHS emergency dentistry tonight. I do not, under any circumstances, give dental treatment other than appropriate analgesia. Why am I expected to?.
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Patient asks for a specialist test not available to the GP. GP says he can't, but he'll ask the specialist about it. Specialist says No, as it doesn't change management. GP passes along the message. Who gets the complaint? Correct. 😂.
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I've probably missed something, but you get the idea. To try and claim equivalence in the training of these two cohorts is, frankly, appalling. It misleads ALL stakeholders, and undermines any credibility PA-supporters have. Let's have more grown-up discourse than that. 5/5.
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Hospital docs at teaching days: we’re always happy to hear from you, please drop us a line we’d be only too happy to help with anything 🥰😘. Hospital docs on the phone: Who the FUCK are you and why are you calling me?? 🖕🤌.
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Other professions have their role to play. But there is a reason that when things become difficult, vague, off-piste and unclear, the buck will ALWAYS stop with a doctor. 8/10.
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What about that MP who wrote a snotty reply to a doctor constituent about the ongoing pay dispute?. “I can’t believe you have the nerve to write to me…” etc. Is he out on his ear?.
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In fact, the specialist can’t cope with that many pts being referred like that. The guy with the cancer now can’t be seen quickly. Not so great, eh?. And what about all the stress and anxiety those 9,999 people had while they waited? It was just a sore throat. 4/10.
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I explain the prostate cancer and PSA thing for laymen:. The UK doesn’t have a prostate cancer screening program, for various reasons. If it did, it probably wouldn’t be done by your GP; it would probably be a centrally arranged test, like we have for aneurysms and bowel cancer.
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As an FY1 I had to tell a patient and their angry family that they likely had a new diagnosis of lung cancer. Weekend, no seniors about. Ward team hadn't T'd patient up at all. Lung and Onco CNS both there but "you as the doctor need to tell the patient".
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Me to pts:.Seriously, don’t worry. Life’s too short to live in fear. You could be run over on the way home. Relax. Hug your children. It’s fine. Me to my doctor:.My eyelid twitched 3 times in a row I don’t think an urgent referral to neurology is too much to ask.
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Let’s say the GP referred you to the cancer specialist as soon as they saw you. Great, right? But what about the 9,999 other patients just like you who were also referred straight away that didn’t turn out to have cancer?. You might say they didn’t need the specialist. 3/10.
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@Xeon4f145d96s1 So little self-awareness or understanding of the system. The ED consultant doesn’t want your guidance of recommendations, mate; he wants your team to send someone useful who can do the job and move the customer along 🙄.
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What we're seeing, finally, is a cohort of doctors unwilling to subsidise UK healthcare with their goodwill. If your health service doesn't run without goodwill, it's not a good health service.
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Why do I feel like a cold caller trying to flog statins when I phone an unsuspecting patient with a QRISK of 11%.
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@DrLindaDykes Junior docs were gaslit. Consultants were ignorant or complicit. I’m biased, but it’s the anons on SM that brought this issue to the fore and ensured it finally got the scrutiny it needed.
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An A&E want my advice on how to do discharge summaries for us GPs. I know how I want it. You?. I think:.- Why attended.- Diagnosis.- Tests done + any abnormals.- Follow-up (admitted, discharge to GP or specify clinic/2ww). That’s it. I don’t want a story or “GP to do”.
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I feel awful. No energy. Everything hurts when I leave bed. Nauseated. Guts feel like a bag of jelly. No fever, just persistent tachycardia. 🤷. Made me think though:
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@drammarahughes Being a Partner, Phil and Ammara probably can't force him to stop using "Dr". But they're complicit in this, and the Practice risks criticism. Ideally this would be sorted in-house, but I think unfortunately this is going to need scrutiny from @gmcuk.
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The spin will be:. Work shy GPs reject generous Government help and vote to strike in response to being asked, reasonably, to actually see their patients. Strap in chaps. This is gonna get tasty.
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This is referring to PAs replacing GPs. People never think it’ll happen to them. Surgeons in particular have thought this for years. They’re going to be in for a shock when the Consultant PA starts disagreeing with them.
@StevenMAlderson I don't think it'll be ED Consultants. The job is too hard. A question every 90 seconds, on anything, no chance.
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One of the best things about Twitter is seeing unpleasant, jumped-up healthcare people taken down a peg or two. You just know they throw their weight about in real life. I’m going nowhere.
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You don’t get better, but don’t get too much worse - but the advice hits home so you go back. GP checks you over again and refers you to a specialist, quickly. You’ve got cancer. So where’s the “risk” here?.2/10.
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@Azeem_Majeed Simple cases are nice to have, I agree. Personally I don’t mind just doing complex stuff. I can, others can’t. BUT. What I can’t do, is the same volume of work with all my cases complex. I can do fewer complex or more simple. Govt want both, of course.
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I sat in with some 111 call advisors - the ppl who talk you through the questions - and it’s totally changed my view. These people aren’t robots sending ambulances to everyone; they’re saints, doing a tough job with little thanks. Tune in next week for more non-PA positivity.
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The pt hesitantly nibbled a couple, proceeding to gorge themselves on the pack at our urging. Their eyes lit up, the colour came back to their cheeks, and their ideas, concerns and expectations were well and truly sorted. Success. 7/7.
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Doing some OOHs. One local GP surgery was shut in the afternoon for training. Just one surgery. Just the afternoon. The OOH screen looked like a car crash as a consequence. We’ll miss primary care when it’s gone.
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We’re now seeing the 2nd wave locally: parents who got antibiotics (sometimes 2 lots) and are coming back because nothing’s changed. This isn’t healthcare, this is absolute madness.
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Apparently the Jnr Doctor strikes have caused relationships with Consultants to become so fractured that some have even started stealing their shoes.
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Nothing like a young, palliative cancer patient on a Friday to really put things into perspective and force you down a black hole of existentialism and introspection. How do y’all cope with this?.
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Guys. Don’t offer a locum GP a salaried post halfway through their first shift with you. It doesn’t scream “well-run stable surgery” 😑.
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I don’t have anything useful to add to the debate about Junior Doctors. Know only that:.- I support them fully.- I wish it had happened in my time as one of them.- I really want one of those orange beanies.
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So I just did an OOH shift alongside my own GP. I think the awkwardness was mutual.
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I can’t even get patients with a QRISK >10% to take statins 🙄.
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If I’d had to contend with PAs or ANPs dictating what I did and prescribed while they were in clinic or theatre, I’m pretty sure I would’ve been kicked out of the Foundation Programme for the rampage I’d have eventually gone on.
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I’ve been using this supposed piece of shit for a week since my Cardiology 3 went missing. It’s fine. Absolutely fine. Expensive stethoscopes are a con.
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Speaking to medical students and early doctors and I just can’t convey how bonkers and unprecedented the current situation is:. Our union really fighting on every front at every level; a royal college imploding in real time with severe criticism from non-anon people. It’s mad 🤯.
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Quinsy, again. Bastard tonsils. I used the 111 website to see a man about a dog, answered honestly, didn't just play the system. Callback within 30 mins by paramedic to triage, call from GP within 2 hours to discuss. Rarely gets said, but 111 worked really well for me.
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@ShaunLintern No mention of the GPs they employ who act as the patients’ registered doctor. Probably also acting as the go-to when things get a bit dicey….
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Nobody:. Not a single soul:. New mothers to the GP:.I brought the vomit and poo with me if you want to see it?.
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@HelenBevan @PennyPereira1 @DrAmarShah @NHSConfed Christ, this really is popping a bit of tinsel on a turd isn’t it. Cracking management speak though - beautifully verbose and meaningless 👍👌.
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I don’t want to do Med3 “sick notes”. I’ve no interest. It’s not a mark of being in a trusted position; it’s a total pain in the arse that complicates patients’ relationships with me and adds to my workload. “Take them away” from me? Pfft. You’re welcome to them.
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Stevie Nash has just shot all PAs in the foot. GP surgeries/PCNs aren’t going to want any PAs if they’re damned if they do and damned if they don’t.
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@Xeon4f145d96s1 I’d love to have been a fly on the wall at the meeting where this was dreamt up, agreed and planned.
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Appraiser: Hmm you haven’t really done much CPD this year…?. Me: I’m on Twitter a lot discussing medical stuff and it’s been really useful. Appraiser: Oh? Show me your account and I’ll have a look. Me, remembering my anon Goblin account: Lol no babes.
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This isn’t a criticism. I’m getting calls from paramedics at pts homes. They’ve been there for ages trying to figure out a complex history and make a diagnosis, and they want my help. It’s obviously not an emergency. Is this really the best use of their time?.
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@Dr_Done_ @ExplosiveEnema The FY homework jibe is the cuntiest thing I think I’ve ever seen.
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You are not officially a GP until someone asks you “so when are you seeing patients again?”.
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@DrAsifQasim @TrinCollCam For gods sake. Which GPs think it’s OK for a PA to supervise their medical students?? Have the students complained to the university? What is the university doing about it?.
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