Harriet Feldman
@HattyFeldman
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Psychiatrist holidaying in the ivory tower. Moderately well kempt, killer of plants, good enough mother. South Eastern PTC rep.
Oxford
Joined October 2019
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@clhubes
Yes! In my dreams I’m married to someone and they are fine but I have a nagging feeling there’s someone better out there, and then I wake up and remember my wife ❤️
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@BadMedicalTakes
This is not entirely nonsense. People with 2 X chromosomes can sometimes carry two slightly different copies of one of the cone pigment genes, theoretically giving another dimension of colour perception. /1
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@JuliaIsobelA
Me: So your ‘lungs’ are in your chest and they get oxygen to your body in a process called ‘breathing’
My patient: I’m an ITU nurse
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As a medical profession, we are transphobic.
We ignore the real harm done to trans people by care delayed and denied every day, because our systems cannot acknowledge that someone can be assuredly, happily trans.
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@parthaskar
Some of us got our PhDs pre med school and nonetheless managed to wait until the GMC number came through before calling ourselves ‘Dr’ in a medical setting
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I'm sure there are excellent private psychologists out there, but today I am furious for my not particularly weathly patient who used £1500 of inheritence money to pay for private therapy, in a modality which completely lacks an evidence base in the difficulties he is having.
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@mstotty88
The difference is, if someone messes with your rota or placements, you go to the gym
and see your friends less.
If someone messes with mine, I can’t sort childcare and drop out of training.
And the motherhood gap in pay and consultant numbers backs this up.
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@drphiliplee1
@DrSdeG
PREACH. My burnout was directly due to the amount of time I spent sorting out shit that someone without a professional registration had dumped on me.
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@DonnchadhaD
Yup because doctors are trained from day 1 to hold risk and live with uncertainty and the whole system collapses without that.
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@mevparekh
"I want to work towards a system where the average doctor gives excellent care, and I think QI and governance are key to this."
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@BadMedicalTakes
However, people with XX or XY chromosomes can have anomalous trichromacy, where the sensitivity of one of their cone pigments is shifted. This means that colours that look similar to the majority look different to them. /2
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@BadMedicalTakes
Anomalous trichromacy is more common and expressed more commonly in people with XY chromosomes, so actually you’re more likely to find a man who can distinguish easily between these two colours. /3
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@NHS_HealthEdEng
When I had arranged in April to change a rotation and in October the rota coordinator from the original rotation gave me an earful as she hadn’t been told and now had a gap.
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@jamiebrough
@Dr_Done_
@trentconsultant
All experience is not equal though. 20 years experience nursing stroke patients makes you well qualified to run wards, train other nurses etc. Does not remotely equip you with the theory and practice to make complex medical decisions.
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I said to my wife: “Young woman comes in with a swollen tender calf and short of breath. What’s the diagnosis?”
She said: “ooh! Isn’t it that thing where a deep vein clot goes to your lungs?”
Ladies and gentlemen, she is a chemist.
The cost of cheapening our health service by rolling out under qualified PAs and AHPs to play doctor. Always demand to see a doctor. RIP.
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Just want to say thanks to all the lived experience people on here! Starting to apply for funding to pay some patients to help us make our research processes more comfortable. I’m applying lots of what I’ve learned on here - you’re not shouting into the void!
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@strivin4janahh
@DrEilidhMaria
@Xeon4f145d96s1
“Physician” is a protected title under the medical act - I.e. it is legally equivalent to calling yourself a doctor
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@strivin4janahh
@DrEilidhMaria
@Xeon4f145d96s1
This u? Because that there is a breach of the medical act.
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@Botanygeek
No way!!! I had always assumed sultanas were from white grapes and raisins from red grapes. What about currants? Blow my mind!
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@Ask_foradoctor
“stood on my feet 5 hours straight just discharging patients”
Are they talking about the ward round??
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@jamiebrough
@Dr_Done_
@trentconsultant
No, it isn’t. Not ‘led’ in the sense that they are the source of the most authoritative opinion on, and bear responsibility for, decisions about medical treatment. Nurses are very skilled but do not make decisions on medical treatments.
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@abi_carey
@LeylsTurk
This is nonsense. Kids use up this strange separate store of energy you never knew you had. It’s inaccessible to non parents but somehow when you have a small person who totally relies on you, you can dig into it.
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@drcolinm
Ask yourself why these anonymous reports are getting so much attention from med students/ doctors if they themselves would report via formal routes?
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@wendyburn
@Parody_RCGP
@Jcalcolado
Wendy you led in developing the PA role in psychiatry. Was that all because of the demands of grassroots members? Would the college have even considered this if it wasn’t the policy of the government??
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@KatyMontgomerie
My IVF was not normal or natural. It was a technological wonder which has massively improved the lives of everyone in our family.
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@NHS_HealthEdEng
Oh I also love how you send me invitations to Zoom yoga which I never have time to attend because I have to do my eportfolio after I finish my clinical jobs.
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@EmergMedDr
Even this ‘hellhole’ has managed to give him 18 blood transfusions in less than a month
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@mstotty88
Oh I get it. Yea it’s tedious explaining to people you can’t do the extra shift. It’s also tedious explaining every six fucking months that no, you can’t just move your working days because that’s not how nurseries work. So I’m not that sympathetic.
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@mstotty88
As should you. So if someone is making you do this, go complain to them. Don’t make it a squabble with your colleague with caring commitments.
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@jamiebrough
@Dr_Done_
@trentconsultant
It’s not just the undergraduate degree. It’s the 8+ years of structured postgraduate training, courses, exams, teaching, making decisions yourself under supervision and mentorship by senior doctors. Nurses are not doing this - they are busy nursing.
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@MedCrisis
Absolutely agree. There is a psychological process here of an anxious patient asking you to hold/contain the anxiety of the situation and the decision for them. By refusing to do that, we don’t meet the psychological need in the consultation.
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@RCoNoctors
@ExplosiveEnema
Perfect, lovely. Because nothing about modern nursing is complex or technical. I look forward to the kind person who failed GCSE Maths kindly miscalculating drug doses and compassionately failing to work out an infusion rate.
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@CrimeGirI
Apart from you, I wonder how many people in Liams life have been 100% on his side?
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£19 for a full psychiatry assessment. Less than 1/3 of what you’d pay for a single counselling session in the private sector.
The doctors performing a c-section are paid a total of £50 between them*.
With F1 doctors being paid £14 an hour, and ST8 doctors being paid £28 an hour, we want to hear what you get paid for completing life-saving/improving tasks.
*based on the average time taken.
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@SteelCity_ENT
Seeing that you are their senior and very committed to the post, do you feel confident they could express dissenting opinions in that forum?
Do you feel confident the JDF accurately represents the views if junior doctors in your trust?
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@ClareGerada
@bykatewomersley
Really? You want to wade through every ward round note from a 3 month admission to figure out what you need to know for ongoing care?
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@KathaSchmack
That all sounds rather useless. Mine know that between them there needs to be a plumber, carpenter and electrician. I might settle for hairdresser or chef.
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@wendyburn
@Sectioned_
I really worry about delegating ‘physical care’ esp for inpatients to less well trained people. Psych inpatients have complex health needs and often come to harm due to diagnostic overshadowing.
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@nuwandiss
“Patient safety” just hasn’t really matured as a concept in psychiatry. We don’t even think about keeping patients safe from relational injury.
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@medicalmodelbri
This was a patient with schizophrenia, detained under the MHA. Very vulnerable, and family do indeed report that his pain was not being taken seriously 😢
Exactly the kind of complex patient who needs the most well trained professional to see them.
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@MemeRegOnCall
"Ask the med reg about antihypertensives"
"Actually, I'm a GPST2 and I'd be very comfortable just..."
"MED. REG."
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I hate that psychological therapies can feel so inaccessible on the NHS, especially for people who don't fit IAPT and aren't sick enough for the AMHT. But that's the reality right now and looking unlikely to change.
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@trufflepotamus
As a psychiatrist, why are olanzapine and aripiprazole not an option? What about his family history of diabetes? Is he sleeping well? What’s his BMI? HAVE YOU CHECKED THE PROLACTIN?
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@MedCrisis
Blindly randomise patients when their doctor is about to decide between two treatments and no good evidence exists either way.
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Diagnosing/formulating, suggesting a therapy modality, duration and timescale, and advising on how to find a good therapist has become a key part of my assessment work in the AMHT, and maybe we need to lean into that a bit more.
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@ProfLAppleby
We trap mental health professionals into an alley between “admission would not help” and “patient may take their own life in the community”. These phrases feel like a way out.
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@pepemac27
If I'm feeling cruel and cynical, it's because we as a culture don't value children with disabilities - so stillbirth feels less scary than microcephaly
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@AmySpitzfaden
@clhubes
Yes I have these too! With a sense of weariness and confusion - “I thought I ditched you. Do I have to do it ALL AGAIN?”
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@wendyburn
@acrobaticlama
@DrElleMorris
@helencrimlisk
@Jamesbr42538384
@Dr_Done_
@rcpsych
@DrLadeSmith
Last ‘physical health’ issue I had to sort on an ED ward was to negotiate laxative prescription for a pt with bulimia with both a history of laxative abuse and a severe complication of chronic constipation, so I’m not confident the PA would be much help.
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@rcpsych
@DrLadeSmith
this will be a catastrophe for psychiatry inpatients and deeply compromise the recovery of trans patients. Please can the college respond robustly?
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@doctor_dru_
This discourse is giving me flashbacks to all those relatives conversations when I could not seem to convey the gravity of the situation despite saying both “We are quite concerned about them” and “They really are rather poorly”
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@bronactitley
Also, being annoyed that she’s wearing your pants, then realising they were never your pants in the first place, you’ve just been wearing them on and off for six months because all of yours have holes.
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@JuliaIsobelA
@ClipboardUK
I now start my is medical appointments with JUST SO YOU KNOW IM A DOCTOR to save them the same embarrassment
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@ProfLAppleby
I’ve sat across from patients who’ve self harmed at 3am, knowing I lack anything that can stop them feeling suicidal but worried that any harm that befalls them will be my fault. I write these things in the notes to exculpate myself; to get a little sleep the next day.
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“I, a White Man, have faced adversity in my life therefore all EDI is bullshit”
Some really need to check their bias when they stand on a platform of EDI.
Training is not easier for single people without children. Living alone puts financial and social strain on individuals that many don’t appreciate.
And those vocalising this are often silenced.
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@drjanaway
@nuwandiss
I guess she had never sat and listened to some describe what it is like to have thought disorder.
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If you’re a mad student reading this tweet:
I have had bouts of anxiety and depression all my life. I am on a medication which keeps me well. I have coped with being a doctor better than being a med student. (1/2)
@kristinhamill
@DoohanRachel
I’ve noticed it indeed!
Hence my concern that if someone is unable to withstand the relatively pedestrian pressures of the undergraduate course without medicating their anxiety, they’re unlikely to sustain a career as a doctor.
It’s tough out here!!
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@drjanaway
One of the major lessons I have learned about being a mother is not to offer solutions, but to verbally reflect back to my child what they are frustrated about. Then tell them to tidy their room.
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@richardtill
@Aleexxies
Dear consultant: if this is the case, reconfigure the junior rota so days end at 6.
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@jeandavisonTDT
Psychiatry trainee here: yes, almost always. Particularly in ED after self harm - often no mental illness present and we are the first doctor to assess.
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@noodles_nood
As a psychiatrist I hate hate hate this. So many causes of insomnia and with a psychiatrist at the front door you could actually spend that hour identifying them and thinking about how to address them.
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@mevparekh
I have watched with resentful despair while a professor took time out of a five hour ward round to performatively make tea for a patient, while my jobs list remained untackled...
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Me: See you in the morning!
Baby: Nay, thou and I shalt meet ere long, and many a time anon, afore morning cometh...
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@wendyburn
@helencrimlisk
@Jamesbr42538384
@Dr_Done_
@rcpsych
@DrLadeSmith
Also a more general concern that this sort of ‘opportunity’ can easily become exploitative, with trainees spending most of their time doing admin work rather than providing medical expertise and developing skills.
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@ShaunLintern
Make junior doctor rotations > 1 year and no more than 3 trusts per program. Actively engage with QI projects from residents - they are good at recognising efficiencies.
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@rsdrummond
@clarissascortex
Make it an attractive job then! The problem isn’t the actual medicine, it’s the dysfunctional hospital system, bureaucratic burden and lack of training opportunities. Solve that rather than forcing people to do it.
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@drraja_
Yes yes yes. We need to choose the people who choose psychiatry. Planning to raise this as PTC rep from June.
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@NadiaKamil
I think that’s because the job was designed when everyone doing it had a flesh and blood wife
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The way to put this without turning it into some twisted competition:
“You shouldn’t have to justify predictable rotas, leaving on time and sensible placement locations by saying your kids will suffer. These should be basic expectations for everyone.”
My life pleasures are work, gym and having fun with friends.
It often gets assumed (and translated into real life) that because I chose not to have a family and children that my time off and commitments are somewhat less than those that chose otherwise.
…
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@adamfare1996
Potentially not a terrible idea? Not all consequences of trauma are MH problems and helping people normalise and understand trauma responses shouldn’t need a diagnosis.
Run with an *anti* diagnosis/medication ethos? Potentially v harmful.
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@DrEilidhMaria
@Xeon4f145d96s1
@strivin4janahh
And I’m particularly enjoying the juxtaposition of these two tweets
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@lifeinunreality
UGH. Good evidence that even with very good diet/exercise support it’s v hard for ppl with SMI to lose weight. Plus being hungry is miserable. “Would you like to make any changes to improve your health? How can we help?” is so much better.
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@noodles_nood
Honestly unless you've replaced the cigarettes with arsenic you've massively improved your health. Well done.
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@dr_shai
Pt went to theatre for removal of a stuck food bolus. No bolus found. I was called as the F2 when he came round delirious and aggressive. Noticed a ptosis, checked his facial temperature sensation with an alcohol wipe. He had Wallenbergs syndrome.
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@ItsEmilyKaty
Yes completely agree, diagnosis of EUPD should be minimum of 2 assessments of >45 minutes, at least one with senior psychologist/psychiatrist and >3 months apart
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@autinveniamviam
Correlation =/ causation. Needing pain relief in latent stage, or not having progressed to 4cm by the time you get to hospital, are probably early signs of dysfunctional labour.
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The personality traits which make me prone to anxiety and depression - conscientiousness, sensitivity to other’s thoughts and feelings, an ability to play out future events mentally - also make me a good doctor.
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@FirehorseP
@KatyMontgomerie
@ElohElae
@SoozUK
Sadly I don’t think you need to pay them to spout this hate
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@_garmc
PAs are paid at what the market needs to pay to attract them. Junior doctors are locked into the jobs by training programs. PA job is easier, working conditions and less training, and the fact that pay is still higher shows how much junior doctor pay is falling short of worth.
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@themichjam
Nice thing about working in Oxford is that if someone comes in the ward and claims to be a professor of something, everyone believes them (and it’s always been true!)
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@_BarringtonII
Hooo boy, there’s a whole lot of parents who needed IVF who might want a word with you 🙄
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@Ask_foradoctor
Because if you're not interested in the decisions being made on ward round and the reasons behind them, you have no place in even pseudo-medical training.
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And it seems that people will spend the money anyway at times of distress, and we might as well help them spend it in a way that's likely to reap long term benefits.
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@juliaisobela
Seriously how many people would opt for a depot of their regular meds if there wasn’t such a stigma about them.
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@EmergMedDr
@mancunianmedic
This can be the slang term for shuffling your most unstable patients between majors and resus when there are more critically ill patients than resus beds.
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Seeing plenty of “I failed my exams and am very successful!”
But no “I got 15 A*s and I’m a miserable failure”
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@Gastronaut89
@issypips
Quick! Down a glass of wine and take a sleeping pill before they call you again!
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@wendyburn
@Xeon4f145d96s1
Is that due to lack of need, or centralised constraints on the number of training and consultant posts?
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@AlysColeKing
Recovery from self harm is a process; repeat presentation does not mean failure. Accept your role in keeping that person safe until they reach a better place.
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