Jonny Blackwell
@JonnyBlackwell
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Exhausted father, amateur gardener, Gastroenterologist, IBD researcher & on hold novelist.
NHS Lothian
Joined February 2022
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Pinned Tweet
“I fell in love with people with Schizophrenia”
The reason a porter in a psychiatric hospital went to med school & became a Psychiatrist.
A 🧵 about my dad & good advice for a career in medicine.
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@drkeithsiau
This was in my cheese & onion for giardia. More appropriate than “smiling faces” IMO
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A decade ago before an interview, my dad said to me
“God has a plan for you. It may not be what you thought you wanted. It will almost certainly not be what you expected. But it will be what is best for you.”
Who knew that plan involved a consultant IBD post in Edinburgh?!?
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@Dr_Done_
@JamesLynchGTC
@BritSocGastro
As a consultant gastroenterologist I am very concerned by anyone who hasn’t CCT’d or acting up in ST7 being on the consultant rota (if true).
I took 18 years to train to be a consultant & it is still difficult, unique challenges every day. PAs have a place, it’s not this.
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@drkeithsiau
@NEJM
The textbook wants me to say plummer vinson. I say oesophageal ca until proven otherwise
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@Botanygeek
One time I really wanted to ask someone where she was from and eventually I did…
“I’m half-Chinese”
“Me too!”
“I knew it! I really wanted to ask you! You look just like my brother!”
😂
It can be such a lovely feeling sharing your heritage with someone. Shame racists ruin it.
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My little girl received world class care today, free on the
#NHS
.
I’m beyond grateful to all the amazing staff & volunteers
@GOSHCharity
Our
#NHS
is one of the greatest things about the UK.
The last few months of care could have bankrupted us in the USA.
So grateful.
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I bought a home for our family today.
Months of unbelievable stress, locuming my socks off, chasing legal documents, new job, commuting >600miles each week, doing bedtime on WhatsApp…
That ends today & we can all live together again. I think we’ll be happy here. So grateful!
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I can never remember the rules on timing of bile acid sequestrants so I made this crib sheet a while back.
Mainly posting on twitter for myself so I don’t lose it again when my WhatsApp crashes but if it helps anyone that’s a bonus.
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It’s sinking in.
I’ve defended my
#Thesis
and am now Dr Dr Blackwell (insisting family call me this for a week).
I am profoundly grateful to my incredible supervisors
@RichardPollok
@SoniaKSaxena
Huge thanks to
@alex_ford12399
& Joel Mawdsley for examining & improving it.
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1 year ago I interviewed for a job
@NHS_Lothian
100% right decision to take the leap, move to Scotland & work in a fantastic IBD team with brilliant colleagues.
I’m just walking into work now & feel excited about what I might learn & trying to provide good care.
V grateful!
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@RCPhysicians
please release the results for all 6 questions in the survey without combining the parts of the Likert scale.
Your presentation of the data is so patronising to your members. You might as well have put “100% of respondents chose an option”. Disgraceful!
#RCPEGM
At yesterday’s
#RCPEGM
, a senior officer presented the results of a survey of MRCPs on their views about Physician Associates (PAs). They unwittingly supplied some good teaching material about how NOT to go about doing a questionnaire survey and how NOT to report the results.
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My rule: Don’t tweet politics.
I’m breaking that rule.
It’s vital the 15 years of real-term pay cuts are reversed. Before I left 🏴 every 1 of my junior doctors had plans to leave 🇬🇧 for 🇳🇿🇦🇺.
We need the
#NHS
and it needs junior doctors!
My full support!
#fullpayrestoration
11-15 April will be the next round of Junior Doctors strike action in England.
The Government is still refusing to make a credible offer - or any offer at all - to resolve our dispute. Read more:
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So, if you are going to be a doctor, aim for that unsolicited letter when you are old and frail.
Love your patients and you will love being a doctor.
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I’ve been contacting my old bosses regarding
#RCPEGM
vote.
Don’t let this be just a twitter storm. This has been shocking.
Strongly recommend all trainees & non FRCP consultants speak with Fellows to let them know the truth of the situation.
@BMA_JuniorDocs
@Doctors_Vote
BREAKING
The senior officers of the Royal College of Physicians commissioned a survey of MRCPs’ views on physician associates (PAs). They have today released the actual findings, but the back story is shocking. I’ll link to the raw data at the end of this 🧵.
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@carolvorders
Labour need to get their act together!
I’m slightly left of centre & and completely uninspired by them right now.
Stop offering nothing
@Keir_Starmer
Please end child poverty - scrap the cap - 3rd children deserve child benefit too
Fight for NHS & teachers’ against pay cuts
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Fantastic talk from
@AntonEmmanuel2
on tackling racial inequalities in the NHS.
The scale of the problem is vast, awareness of the issue is improving, but how do we build in lasting change?
I’ve got so many questions.
Anyone have examples of how they are tackling this locally?
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@LondonAllergy
I feel so angry that this could happen. It’s unspeakably evil. Those poor families and those poor poor babies. When things like this happen it makes me want to do my job better. So sad
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Is anyone using Tofacitinib as a second “rescue therapy” in ASUC after infliximab fails?
What’s your experience? Worth a shot or just delaying colectomy & risking perforation?
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@goldstone_tony
@SteveBarclay
@Jeremy_Hunt
If consultants went on strike over this I assume this could actually also directly reduce the tax liability of lots of them by reducing their income and pension contributions. Ironic.
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Just realised our paper was discussed (briefly) in Parliament! 🥳 definite first for me!
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This is a hilarious and lovely.
Former Royal protection officer Richard Griffin reminisces about a picnic he went on with the Queen at Balmoral and an encounter they had with two American tourists who did not realise they were in the company of the monarch.
#PlatinumJubilee
:
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I’m mid-colonoscopy & use the foot-pump to flush away some stool.
Patient: “Haven’t you heard there’s a hosepipe ban?”
😂 😂 😂
#GITwitter
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Pregnancy in IBD
@JulsgaardMette
+ Irit Avni Biron 👏
Faecal calprotectin levels are not affected by pregnancy & still reflect level of
#IBD
activity.
In active PA-CD increased risk of tear so plan caesarean section.
#ECCO24
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1 year ago I started as a consultant at
#NHSLothian
.
It’s been a great year. Definitely the right decision to move 300 miles to Scotland 🏴 Great job, great colleagues, great country 😊
So grateful to all my colleagues, especially the IBD CNSs
@croydonhealth
for all your support and thoughtful presents! I’ll miss you all.
I think these socks are my favourite, wearing them for my first day
@NHS_Lothian
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@nik_henderson
@timricketts_
I remember the first time I diagnosed this. It clicked when I asked about hot showers and he said they made him better.
I felt a bit silly when I only then noticed the big cannabis leaf on his hat.
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Getting acquainted with my new home city on the way home from
@WghLothian
Almost makes up for not being in Copenhagen for
#ECCO2023
almost…
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Just finished my last ever night shift as Med Reg. Boy did we go out with a bang.
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2023 was a rollercoaster!
New job ✅
Commute London to Edinburgh 😱
Move to 🏴
New house ✅
New baby ✅
Lost 3 family members in 9 days 💔
All 4 kids healthy 🙏
New friends 🥳
In touch with old friends 😊
Dad sick 😞
Dad happy 😌
Still married to love of my life 🥰
HNY!
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@drkeithsiau
@MunjedSnowber
Glad you said this. Every time I see this crop up on Twitter my brain itches because it’s definitely possible to have a GI bleed and biliary obstruction from separate causes.
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This is such an important message.
Delays in diagnosis of
#IBD
increase the risk of complications including strictures & fistulae & the need for surgery.
We need to improve
#EarlyDiagnosis
of IBD.
Exceptional amount of work from
@jaya_nish
&
@SamanthaIBD
#ECCO2022
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Driving in the car with kids & my wife speaks in code about FC. I immediately say “faecal calprotectin?”
Yes, Father Christmas will forever now be known as Faecal Calprotectin!
🎅😂💩
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Great to be involved! Our patients want to support
@IBDResponse
because it’s obviously such an important study.
We have a great team with
@debz_kerr
, Matt Murray, & Alex Elford doing lots of the leg work!
Thanks also to
@victoria_moffat
who’s holding the fort next week!
A huge thank you and well done to Edinburgh who have recruited 9 participants in just 6 months! 🎉
Thank you to
@charlie_lees
,
@JonnyBlackwell
and the team! 👏
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So far today I’ve been out to Tesco and seen 11 🐴, a bazillion 🐑, 4 little lambs, a dozen blue tits, ravens, coal tits, and the 4 pheasants who come to the bird feeder every morning.
I think we made the right decision to escape the big smoke!
#Scotland
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@JosephineCumbo
Glad to hear it. It’s pretty terrifying to be starting as a new consultant and all my senior colleagues planning to retire because of this.
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@TAkbar
@lemonslip
@ShaunLintern
Irrespective of the whole PA debate the evidence shows that nationally we are not able to provide good training for our current gastroenterology registrars let alone a new group on top.
This is a major problem.
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When will spellcheck in Word stop changing “stricturing” to “structuring”? Far more obscure words in the dictionary.
Just reading a paper that has fallen prey to that autocorrect. Glad I’m not the only one who gets caught out by that.
#IBD
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@FrontGastro_BMJ
@sheiybani
@nuru_noor1
@GastroMJB
@HelenSteed1
@FarhadPeerally2
@NabilQuraishi
This is clearly madness. Research mustn’t be a tickbox exercise like audit before ARCP.
Research needs curiosity, time, and most importantly passion. Let great researchers do great research.
Exceptional clinicians often don’t do research.
EqualOpportunities? Yes
#FGDebate
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What would you teach trainees about IBD?
I want to create a clinically useful local curriculum (happy to steal wheels instead of reinventing).
5 key topics. What do you choose?
I’d love your ideas!
@RichardPollok
@rahul_kalla
@DCharabaty
@dradamharris
@ibddoctor
@DrChrisLamb
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#GITwitter
Can we make a reading list?
1. What is the most clinically useful paper you read this month?
2. What was your key learning point from it?
@RichardPollok
@charlie_lees
@ShahidaDin1
@Jonathansegal85
@ChristianSelin3
@dr_aditi_kumar
@DCharabaty
@ibdseb
@DrChrisLamb
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Brilliant exposition by Phil Tozer of why the same patient might choose different surgical options for their
#UC
.
#Frontiers2022
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He loved his patients not just as patients but as people. He was interested in their lives, their happiness, and in how he could help them. He wasn’t interested in the disease, rather the person afflicted by it.
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Glad I managed to tune in for Dr Ollie Brain’s talk on Immune-Checkpoint-Inhibitor Colitis!
My key takeaway is that 30% is microscopic so do a flexi & get those biopsies coz you might only need Budesonide.
@BowelsOfStMarks
#Frontiers2022
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Last week an ex-patient contacted my mum. My dad had treated her depression a long time ago. She wanted dad to know she is now a consultant psychiatrist and wanted to thank him on behalf of everyone he has ever helped.
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When dad retired, his registrar gave a speech. It ended “Dr Blackwell, if I can retire as even half the psychiatrist you are then I will be very happy.” She really meant it.
So what made dad such a great doctor?
It’s pretty simple, he did everything with love.
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I know this may only last a few minutes but at this moment I have emptied every NHS inbox including results, clinic letters, email, correspondence, and triage!
Time to buy a lottery ticket!
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@DrJSherrington
May all your “DNA appointments” be sitting in the waiting room but didn’t tell reception
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@Urodoc46
@DacreJane
It was a key issue for us. Childcare was more expensive than my wife’s band 7 salary and we couldn’t afford for her to carry on working in the NHS.
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@alex_ford12399
@ibdseb
@UKGastroDr
@MohsenSubhani
@BritSocGastro
@JAG_Endoscopy
@PhilSmithIsBack
@parthaskar
@anjan_dhar6
@ThoufeeqMo
@AntonEmmanuel2
@NEndoscopy
I’m very disappointed the membership has not been consulted before
@BritSocGastro
issued our position statement.
As a trainee rep (not BSG) I once saw another rep sell trainees down the river to please the powerful people in the meeting. I really hope this isn’t what happened.
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@DrEilidhMaria
@mmamas1973
It would likely be a 2WW referral but IBS is not a diagnosis of exclusion (you’ll upset a lot of gastroenterologists with that phrase).
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“Everywhere is within walking distance if you have the time.”
Took a long way back from work today.
Proud terraces and dark alleys all waiting to be discovered. My favourite route so far.
#Edinburgh
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Fantastic presentation from James Lee who found a master regulator of gene expression in IBD inflammation in “the gene desert”. ETS2 signalling may be a key target for IBD therapies in the future.
#ECCO24
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So true.
Tricky conversation as neither patient/physician can predict if the CD will progress and the medical maintenance option at this point (thiopurines) may have worse side-effects than mild Crohn’s.
Monitoring and patient choice needed.
#IBDtwitter
what’s your approach?
Management of mild CD is arguably more difficult than management of severe CD due to lack of data
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At
#ECCO24
some of you may have heard me singing Dr Clark’s praises.
This is so well deserved. A brilliant TPD, endoscopist/trainer, exceptionally dedicated clinician, and boss! I learned so much from Sarah & am delighted her dedication has been recognised.
We are thrilled to congratulate Dr Sarah Clark on winning the BSG Dame Parveen Kumar for Education and Training Award 2023 for her impressive achievements and work as a trainer! 👏
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I’ve had a run of symptomatic patients (pain, diarrhoea, FC⬆️) with macroscopically normal ileocolonoscopy but granulomas on ileal and colonic biopsies (no typical feature of microscopic colitis).
Any thoughts on what to do with this? Would love to hear your approach
#GITwitter
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So grateful to all my colleagues, especially the IBD CNSs
@croydonhealth
for all your support and thoughtful presents! I’ll miss you all.
I think these socks are my favourite, wearing them for my first day
@NHS_Lothian
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Fantastic to catch up over dinner with my old supervisor
@RichardPollok
to whom I owe so much! Best part of
#ECCO24
“Tarragon emulsion” was amazing but my first thought was what would
@ProfWhelan
say?!
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Dad always saw that beneath all the layers of mental illness there is still a human person and the only adequate response to the human person is love. I’m glad he helped me to see that in him.
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@jfoster2019
@TalkTV
@JuliaHB1
‘London weighting’ for doctors is nothing like 20%. I just checked a payslip from before I left for Edinburgh and it worked out at 2.6%.
I think you’ve got this wrong or I am owed a lot of money.
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@PaulAshYoung
I wrote the medical rota as CT2. I should have asked for time in lieu but it never crossed my mind. I did end up marrying the sister who was writing the nursing rota that same weekend though so all good
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Had a great time
@BritSocGastro
Leadership & Management course organised by
@AaronBancil
& Charlie. All brilliant speakers,
@Inspire_Change
were amazing, and special thanks to
@UKGastroDr
for job interview coaching.
Learned loads!
Thoroughly recommend to any ST7s.
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I didn’t expect this.
I’m not surprised Her Majesty Queen Elizabeth II has passed.
But I’ve been completely caught off guard by how deeply I feel her loss.
I suspect many of you feel exactly the same.
Watch this and have a cry.
God save the Queen.
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Just beyond my garden is the most peaceful place I could imagine.
In a world with so much strife I am truly grateful to have found some serenity.
I am grateful every day.
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Brilliant 🧵 about head to head studies in IBD.
It reminds us that the changing landscape is both exciting and at times depressing (eg. Adalimumab’s relatively poor performance in Burr’s UC N-Meta-analysis).
Are people moving away from Ada in UC?
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@ShahidaDin1
@RichardPollok
@charlie_lees
@Jonathansegal85
@ChristianSelin3
@dr_aditi_kumar
@DCharabaty
@ibdseb
@DrChrisLamb
Alright, this week I wanted evidence for Aza dosing in TNFi combo to prevent antibodies.
Roblin shows can use 1mg/kg if TPMT normal. Aim TGN >105.
Mogensen says aim TGN > 117
Yarur says aim TGN > 125
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Dad focused on the important things. He only published 1 paper and retired in relative obscurity. But he was a brilliant teacher. He taught not with cold and intimidation but with sunshine in Greenwich Park, where he’d often take his students for walks discussing psychiatry.
11/
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1st day of annual leave so finally got a chance to sort the garden.
First blossom of the season!
#GardeningTwitter
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Flowers from the garden in a £3 recycled glass vase. The best things in life are (almost) free.
#gardening
#GardeningTwitter
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Old man in GI clinic. Tired & anaemic.
While I took the history I could see his brachial pulse bounding & wondered what his pulse pressure was. Examined - waterhammer pulse, EDM, splinter haemorrhages.
Abx for endocarditis & transferred for aortic valve replacement next day.
Best way to recognise the value of medical education is to see it in action at fruition.
Tell us all about that clinical diagnosis you made from your own clinical gestalt.
Where your training, experience and reasoning (conscious or sub) led you to a make an inspired call
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@DisneyBen
@ibddoctor
@moss_md
@Jonathansegal85
@ChristianSelin3
It’s controversial. This brilliant study by
@ShomronH
suggested a benefit of starting early in Crohn’s but not UC.
But our recent meta-analysis found diagnostic delay in UC (and therefore delayed treatment) is associated with increased rates of colectomy.
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“Opiates precipitate toxic megacolon in ASUC & risk perforation.”
Sound familiar? I’ve always believed in this received wisdom but have really struggled to find an evidence base beyond case reports to support it.
Is it true? Or is it a myth that denies
#IBD
pts analgesia?
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I get back home & my wife tells me this is waiting “for daddy to get out of the toilet”. What do you reckon?
1. Flush & risk losing the key.
2. Just grab it & wash off the urine.
3. Go out & buy some rubber gloves.
4. Find new wife.
#GITwitter
#Parenting
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Every year my father-in-law would send us lobelia he’d grown from seed. Sometimes we’d have the most incredible uproar of colour.
He passed away this week.
Archie, these are for you.
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7 years ago my dad had a deeply debilitating stroke. Now he has dementia and has lost many of his faculties. I still love him as a person, despite the fact he is paralysed, his brain doesn’t work, and he can barely speak.
12/
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I think he loved their innocence. He often told us that “schizophrenics are probably the nicest people you’ll ever meet”. He was forever dispelling stigma around mental illness. He really was in love with his patients. He could see their humanity regardless of their illnesses.
5/
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You will really enjoy reading this over breakfast.
Authors say for decades
#IBD
academia has been stuck in an echo chamber when it comes to ideas and we need to follow oncologists’ lead in pursuing precision medicine.
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My dad, Mark Blackwell - a hospital porter, fell in love at Brookwood, an Asylum in Surrey.
He fell in love with my mum, a psychiatric nurse, and secondly with the people he ferried along the corridors. The patients. People with Schizophrenia.
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The city of the Raven King
Learning loads on the Train the Colonoscopy Trainers course!
I’d strongly recommend it to anyone who wants to be a better endoscopist or teacher in general.
#newcastle
#gateshead
@JAG_Endoscopy
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Dad gave everything he had to his patients.
I don’t mean he worked late, he came back to his wife & 7 kids for dinner every evening.
No, he didn’t do extra work, but at work he tried to do it extraordinarily well.
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My Auntie Kate died a few months back. She loved gardening, a passion we share, and at her funeral we were given mystery packets of seeds.
It’s been a lovely way to remember her. I’m so excited to see what grows.
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43% perianal fistula closure on Vedolizumab in the ENTERPRISE study.
Sounds great... but why so much higher than previous studies of Vedo (~20%)? Is this really an effect of seton placement, which was done in 93% here?
Good news for CD patients either way.
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Stunning gardens
@hevercastle
it looks like another world.
Definitely recommend a trip if you’re in the area.
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@DrRichardPile
I disagree. Maybe for people much smarter than me large chunks can be missed out but I worked hard for 5 years and was still unprepared for F1. Learning on the job requires doctors to teach on the job, leaving learning up to chance. Formal teaching is needed to maintain standards
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First time I’ve grown Frittilaria in the garden 🙂 and the bluebells are really making a comeback this year!
#gardening
#GardeningTwitter
#sixonsaturday
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How do I know this? Well he told me of course. But also over the years several people have come up to me and asked “Are you related to THE Dr Blackwell?” and then told me how much he helped them.
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So dad worked day and night and eventually became a doctor. I always envied his sense of vocation. He knew from the very beginning why he wanted to be a doctor and who he wanted to care for. Loving his patients, what a wonderful foundation for a career in medicine.
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@lauraa_lexandra
Thanks Laura!
I was thinking about how much I loved covering the wards this week & realised I’ve finally got to the point where my dad started.
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For anyone doing a business case to improve your IBD Service this is the paper you should quote to your board.
It shows so powerfully what we already knew, IBD Nurses make things so much better for people living with IBD.
What a team!
>10k people living with IBD
Clinicians from 166 IBD services in the UK
@IBDUKTEAM
led by Barney Hawthorne &
@DrChrisLamb
This mammoth study validates the 2019 IBD Standards as being associated with pt perceptions of quality care.
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