'Jihadist T*rrorist parading as a Doctor' award winner 2023. Posts do not constitute medical or holy war advice, or views of my terrible national employer.
It's true, doctors who dare speak out against dangerous associate practitioners are TERRORISTS. We're probably the terrorist skin colour too, right? Allopurinol akbar, etc etc
@ReddicalMedge
@CasualtySurgeon
@ABarotchi1
@Molly2323232323
@TheEMboardround
You claim that PAs are degrading your profession yet you're doing a pretty good job at it yourself. Doctors used to be models of society now we have jihadists parading as Drs. For introductions people like you should tell your patients how you promote terror
If a PA took a prescription pad and hand-wrote and signed a prescription, that they know full well they cannot legally do, with a biro would it be a 'Pen and Paper blunder'? No, then this is not an 'IT blunder'...
@Telegraph
I said I would send out an FOI to find out more information and would share when I heard back. (As apparently it’s my job to chase illegal prescriptions and not the CQC’s). Thank you
@JanetEastham
for investing this properly and thoroughly.
A short🧵.
Whoever is responsible? This Wikipedia edit should count as a publication for your CV.
Who could object? It's certainly no less academically rigorous and ethical than Jeannie Watkins' pseudo-research via corrupt editorial board...
@julianhartley1
Wouldn't it be amazing if, one day, an NHS Chief Executive actually had the moral courage to turn around and say 'perhaps you should reverse the pay cuts you've imposed on doctors so we have enough staffing this winter' - instead of whatever this mealy-mouthed nonsense is.
The most important thing about this EGM isn't really the vote outcome but what has gone on display tonight: a leadership concerned only about RCP finances, protecting Project PA, willing to ignore all inconvenient truths and questions, uninterested in concerns of doctors...
#VONC
This madness needs to be brought into even sharper focus than this chart does, as it skips over the vast difference between a doctor and a PA at these 'levels'. I therefore present full and direct comparison..
Assured it's safe yet?
For a Reg to be on that rota they would have completed ST4+ (intense exams & rotations across numerous departments)
How do they ensure a PA whose 1st job from uni is at
@BWC_NHS
has the same level of rigorous training/experience/knowledge as an ST4?
@docib
Sure, let me just get a load of paper copies of..
BNF
NICE guidelines
Renal drug database/handbook
MDCalc
Microguide
Induction/Switch
eRostering app
Toxbase
And the... mobile version of the EPR?
Given limited PCs (that work poorly) in the NHS is the norm, enjoy the inefficiency?
@UKGastroDr
What is starting to become apparent to me is that many consultants view the idea of PAs 'freeing up doctors from simpler work' to mean specifically 'freeing up me, the consultant, from the type of work I'd normally have to train an SHO or SpR to do every 6 months'.
@rahttled_doc
Cut off top end of the hollow handle with scissors. Introduce flexible suction catheter via the exposed hollow handle and use suction device to evacuate the urine into suction bag for disposal. Lift now empty bottle off the floor and mop residual.
What pretty much all the debate (with or without toxicity) comes down to online is this: the role of the PA, as currently deployed in the NHS, should not exist and need not exist if doctors were trained, valued, retained and supported (by assistants where needed) well enough.
@InfoPars
@AWJChadwick
@KeeleyMP
Yes because you state your mortgage number on clinical documentation or when asked to identify your profession and role...
What a non-argument.
It's ALMOST like
@RCPhysicians
are corruptly concealing data that might not suit the unelected officers' agenda to try and manipulate voting.
Oh wait no. That's EXACTLY what they're doing.
A reminder that - along with the foetid rot that occupies the colleges, GMC & NHS - within the BMA there still exists a core of corrupt, self-serving 🦖 who have long abused local processes to ensure their interests, and not the profession at large's, are served. NW London div:
@DrEilidhMaria
Gosh if only there was some sort of assistant role that could mop up huge amount of these simpler tasks to free up doctors en-masse for medical assessment and decision making, surgery, and training? An assistant to the physician, if you will. A physician's... helper..? Alas.
Just a reminder of the 2023 competition ratio for a post-CT2 doctor - with 5+ years medical school, 4+ years post-graduate training and full MRCP(UK) qualification - to try and get a job as a FIRST YEAR Microbiology doctor. Utterly disgraceful.
@thomaswoodcock
The madness of arrogantly criticising others that 'putting pay first' is unreasonable for any sane working person in this world. Doctors are not monks, besides which poor pay is only one of dozens of abysmal things driving doctors away from the NHS
@mmamas1973
@RCPhysicians
And not just the reputational damage they are causing, but the damage to doctors, the very institution of the medical profession, and - of course - patients as well...
@UKGastroDr
There is an interesting generational divide. It seems many consultants I know well and speak to don't see the current FYs and SHOs as 'real' doctors, or else feel they're 'not the same' as them. As a result don't feel responsible for or to them, compounded by rotational training.
Now would be the moment for the President, Registrar, & all other complicit senior officers to resign in disgrace. And by that I don't mean lie through their teeth about standing down for planned portfolio career or claiming that their lies and corruption are 'confusion'.
#RCPEGM
Dr Clarke is entitled to her (in my view, bad) opinion, and to share it, just as others in RCP like
@parthaskar
do. The difference is only one of them is due to be CHAIRING the
@RCPhysicians
EGM tomorrow...
Impartiality doubtful?
On the eve of an EGM to debate the future of physician associates,
@DrSarahClarke
President
@RCPhysicians
argues that there is a role for PAs in the NHS
Tomorrow's EGM is an opportunity to contribute constructively to the debate, she says:
@EmergMedDr
Everybody forgets that NICE is ultimately a non-govt body akin to a quango set up by govt in 1999 whose real role is to make rationing decisions so that government doesn't have to take direct responsibility (and blame) for them. We shouldn't assume EVERYTHING it does to be good.
The competition ratios for IMT would be less outrageous if it weren't for A) the fact that it is an utter shit-show and a disgrace to refer to it as a 'training programme' with a straight face and B) the continuing supposed lack of 'doctors' on SHO rotas being filled by MAPs...
@BMA_James_Steen
To summarise just how ludicrous them being on tier 2 rota is in one graphic adapted from the already circulating one that only focuses on paediatric ST training:
If a PA can ever be 'equivalent' or even 'senior' to an FY2 or CT let's just for a second look away from the PAs and ask the consultants responsible: how have you, and the debacle of rotational training, FAILED in the training of medical graduates so *spectacularly*?
If your early warning score is high you need urgent medical care.
That should mean a qualified doctor.
An F1 is a qualified fully trained doctor.
This hospital however, doesn't want you seen by the qualified doctor, they would rather a PA with just 2 years training, treat you.
@Xeon4f145d96s1
Discussed with the PA! A student 'discussing' cases with an unqualified unregistered lightly trained assistant for supervision. Utterly terrifying
@NNUH
@AnnonMedic36970
💩Minimal fibre content. Copious use of undigested nutritionless corporate waffle. Highly offensive odour. No recognition of any of the major problems raised about NNUH misuse of PAs. Floats in the bowl, won't flush. A truly worthless stool, 0/10. 💩
@timricketts_
This is the problem with an NHS ecology which tells other staff groups that medicine is just a series of tasks that you can do 'competences' in & then take over part of a doctor's job. This listed example clearly reflects a 'taskified' world view, ignorant of actual medicine.
In case it's not plainly obvious for all to see, the ARRS funding debacle with GPs struggling to find work is just an intentional scheme to artficially suppress GP salaries. Dry up the work until GPs have to choose between unemployment or accept lower paid work.
@Hinesh_
@NNUH
Every minute a PA is in theatre is a minute that a doctor is not, it's as simple as that. The PAs shouldn't be in theatre unless every single doctor is there and there is still more work to do in theatre. Until that point, they can only be possibly be taking training away.
@ClareGerada
@ExplosiveEnema2
@rcgp
They don't have an important part to play. PAs bring nothing unique to the MDT, and are inferiorly trained in every respect to an actual doctor.
The main purpose of a healthcare system - and the RCGP - ISN'T to foster comfort and avoid anxiety in professions. Forgotten this?
@dawnashley13
@NTeesHpoolNHSFT
@MADEinHEENE
*Noctor of the Week. And no matter how good Hannah is, let's never forget you've created an award to help highlight good doctors, and immediately shat upon all of them by ignoring EVERY LAST ONE OF YOUR DOCTORS to give it to a PA instead.
@doctor_dru_
That's ok, you just take off the note, put it in the bin, and eat the pizza anyway. Only way of dealing with this culturally-encouraged doctor-hate in the NHS.
@trishgreenhalgh
There wasn't a debate. There was a self-righteous panel lecturing the rest of the profession about why we're all delusional and don't know what we're talking about, and distracting from, filibustering or outright ignoring any attempt to genuinely challenge them.
#RCPEGM
#VONC
@Molly2323232323
@drkeithsiau
There is a major problem here - doctors who speak up are labelled as 'abusive' just for confronting established figures and views and opinions about medicine in the UK that go against current NHS groupthink are labelled 'extremist'... ⏩
@ClaaareKirwan
NHS
#BeKind
&
#OneTeam
browbeating are a 1-way street: doctors must be kind, obsequious, never stand up for themselves, always do what they're told & humble themselves before all other team members in perverse penance for historical social hierarchy. But doesn't apply in reverse.
@AliJaneMoore
We need to push back against this puritanical nonsense. Across the board of topics (private messages!) the GMC has vastly overstepped what should be its boundaries and is now self-defining its own outrageous scope creep.
Thought for the day: Hyper-rotational 'training' programmes do not make more well-rounded doctors, and never did. They actively impede learning, minimise the value of doctors as a training investment to trusts and consultants, and only exist to subsidise NHS staffing.
@Xeon4f145d96s1
@BucksHealthcare
@NMacdonaldBHT
@AndrewMcLBHT
And the CT/ST1-ST3 doctors who are inexplicably paid *the same* as medically unqualified 'associate' assistants despite having not just a much higher level of qualification, but vastly more training and experience (minimum 7-10 years).
@EmergMedDr
This isn't right. Our actual apprentices - med students - are not paid at all, in fact levied huge sums of debt. PAs aren't apprentices in this analogy, they're random handy-men having a go at the electrician's job with no qualification & minimal training. And paid more for it.
@DrEilidhMaria
Interpretation summary: 'They make MY life as a consultant easier and that's the main thing, patients and doctors in training be damned, we never needed intensive, standardised, and strictly regulated standards to safely practice medicine anyway'
@NHSBartsHealth
Imagine you have 5+ yrs of medical school, at least 7yrs of post-grad training, a post-grad internal medicine diploma, work at senior level and train and supervise other doctors & students... and be called a 'junior doctor' on your employer's social media. Only in the NHS.
@calderdalecares
Strange how the video focuses on a door saying 'GP Registrar' when she's talking. When she's not a GP registrar, who is a fully qualified doctor multiple years out of medical school in specialty training. And she is an unqualified, unregulated assistant. Misleading to public.
@AndrewJD
Not on: lacking self-respect and respect for the profession. But then - given how we treat and use FY1s and leave them without value or training, is that really a surprise?
@gmcuk
So many words across so many posts for something of absolutely no value, all in an attempt to disregard what doctors are screaming at you. Add it to the piles of the other scandalous disgraces that the GMC represents, as usual it is clear that GMC is an unfit regulator.
@DrNeilStone
This reads as a limp protest against the fact that establishment viewpoints are being challenged - successfully - by docs that by their anonymity avoid the traditional mechanisms of coercing doctors to 'shut up'... And an attempt to smear them all as trolls as easy alternative.
@EmergMedDr
The hierarchy has not just been flattened (itself a misguided extremist ideal), but inverted. Not only are 7 consultants ignored, they are actively victimised to silence them. Consultants not in control of their departments any more.
#NHShatesDoctors
@UKGastroDr
So they give the actual training to the MAP instead of their actual trainees, who are languishing doing valueless scribing and ward cover wishing there was a PA there do be doing this so they were in clinic, in theatre, or making medical decisions.
@DrEilidhMaria
@drkeithsiau
@AmarHujan
Predictable. It's the get-out-of-jail free card now on Twitter: if you can't justify your position, acknowledge or rebut valid criticisms or are caught either in poor behaviour or a lie then you change the topic to 'I'm being abused, I'm being personally attacked' to deflect.
@Dr_Done_
@FPARCP
@itvnews
Even disregarding the flagrantly obvious use of 'Dr' (maybe even pre-doctorate here) to impersonate a medical doctor, he has clearly misidentified himself as a GP to them. Which is surely completely in contravention of the Medical Act 1983?
@DrEilidhMaria
My main objection is that, since PAs largely take training opportunities and are prioritised for the more desirable/medically valuable parts of the service provision between 9-5, it's dishonest to call them an assistant. Because they are not assisting at all, but hindering.
@ClaaareKirwan
Ibuprofen is a fantastic analgesic that for the overwhelming majority of people when used appropriately is safe and is vastly underused in an NHS pre-occupied with dogmatic ideas of great risk.
@trishgreenhalgh
Ah but as you can see if we look at the combined 'Against' and 'Abstain' vote it's clear that the fellowship support the college 'leadership' positi- no, wait, nevermind. Not even close.
@trishgreenhalgh
Ah you see - no options to vote against or abstain is the purest form of the composite 'positive and neutral responses'. Which, thanks to
@RCPhysicians
we know is precisely how we evaluate things.
@UKGastroDr
Complex (and non-uniform) underpinning reasons. Some going as far back as effects of MMC - apart from the abject failure that is rotation, the destruction of the consultant-led vertical firm has broken the sense of team and shared ancient master-apprentice relationship.
@neurosurgerySpR
@gem1509
100%. Consultants who intepret MAPS being to 'take the burden off of doctors' to mean specifically 'to take the burden off *me*, the consultant, so I only have to train someone once and can get on with my cosy life. The trainees can continue to cover wards, not my problem'.
@DrEilidhMaria
We talk about a swiss cheese with all the holes aligning so that error can pass all the way through. A PA in this situation is like having a special bypass around the entire block of cheese, so that the error no longer has to find a series of holes, just go straight around.
@iDrSunny
The complete lack of insight, open demonstration of amateur practice (which they clearly think is worth showing off), & likelihood that they're confidently falsely reassuring and miseducating patients is terrifying. There is something about PA courses that instils such hubris.
Did anyone read the official RCS Handbook of Ladder Pulling from back in 2016? Be in no doubt how empty their statement today is - they are entirely committed to the 'EST' and blithely pretend it actually helps training. (Spoiler: it doesn't.)
@UKGastroDr
Which wanted to break consultant power within hospitals, and permanently disrupt the vertical transmission of sense of shared medical identity and esteem from each generation of doctors to the next in order to produce a more compliant, cheaper medical profession. They succeeded.
@DrEilidhMaria
FY1 - a doctor who has completed their medical degree with a minimum of 5 years intensive medical educational, practice, and examinations: needs close supervision (ok). A PA with 2 years of simplified crash-course and far less practice and experience? No such comment. Ridiculous.
@dr_irfan_malik
So is this 'fact' something that Helen Sharp, Deputy Sister, Colchester Hospital was compelled by her line manager to spew out on camera to excuse the hospital's performance, or is it just her unevidenced and unqualified opinion?
@DrNeilStone
Correct. Because the *overwhelmingly* large proportion of that time is not spent actually training our doctors. They are all just human sacrifices for ward and rota cover to keep the endlessly ravening NHS running for another year.
@bduric_
The fact that a 'professional' can spout naturalistic fallacy and (expect to) be taken seriously reflects something very rotten and repugnant in the NHS and its quasi-egalitarian culture... especially as it seems to disproportionately to be applied as here to women...
@veggieequallife
@Dr_Done_
@UHP_NHS
@AnnJamesNHS
And if all of these trials and years and years of commitment and on calls and learning and exams aren't necessary to practise as a surgical reg, why is the RCS still making surgeons in training do them? Either they're vital & necessary, or else doctors shouldn't need to do them.
@Xeon4f145d96s1
I have to be frank: the infantilisation of doctors will continue as long as doctors accept it. I know medical school tries to systematically squash out every iota of self respect and inculcate NHS and GMC obedience, but doctors need to turn arouns, as adults, and say 'no'.
@TomStocks1982
'Be kind' is the single most dangerous phrase in the NHS. It can be used to silence, victimise, and nullify anyone who speaks up because ANY criticism (and anything) can be framed as 'unkind'. It needs to be recognised as a tool of control and rejected by professionals.
@TomStocks1982
At the end of the day, this is on doctors. If we don't have the spines to say 'no' & refuse to work for their worth, then we don't deserve to be treated or paid better.
Stop letting such people talk to you as if you're children, or their inferior. Act like adult businesspeople.
@Xeon4f145d96s1
What a feeble attempt to paint PAs as a discriminated against minority group with equal capabilities to doctors, as opposed to mis-deployed lightly-trained assistants.
'AHA but this is just like x-ism! You bad elitist doctors! PAs are *victims*!'
@UKGastroDr
When I first heard this reasoning was briefly horrified, but when you listen & look back how this sentiment has come to pass you can see how we got here. Sadly I think the dis-establishment of consultant-led teams, practice and training was entirely intentional by NHS and govt...
@ExplosiveEnema2
@alisonleary1
Apart from the outrage I feel on behalf of nurses, how could anyone ever truly classify a PA with a 2-year, unregulated unaccredited degree, with no prior healthcare education or experience as even CLOSE to equal with a QUALIFIED NURSE, let alone 'higher'?!
@thomaswoodcock
You can't seriously say 'noble profession' while misappropriating terms of 'oppression' like 'supremacist' in the same sentence. You're actively facilitating the denigration and destruction of what you supposedly claim was 'noble' while tarring all who oppose you as villains.
@GasmanMax
@veggieequallife
'Be kind' has been the refrain we have permitted pay, conditions, training, and basic respect at work to be utterly destroyed to over the last two decades. Don't kick up a fuss, don't criticise those who do wrong by you or your profession, because it's not 'being kind'. Tired.
@SnotSurgeon
@fessdoc
@ENT_UK
@HelenCocks5
It exists and is called Graduate Entry Medicine.
Very happy to get on board with schemes that help noticeably excellent PAs get into such courses, however.
@parthaskar
@RCPhysicians
It's a disgrace that the RCP has indulged so deeply in the govt & NHS trough to detriment of its members. Its continued gaslighting of doctors & hosting of the FPA are kicks in the teeth for all the actual physicians who worked damned hard (and pay ++ fees) for their memberships.
@DrEilidhMaria
@MsahWu
'Trust policy' is an irrelevance when it comes to employment law. In fact, 'trust policy' is an irrelevance when it comes to many things, yet frequently is quoted by NHS administrators to justify the illegal or else reprehensible as if it cuts the mustard.
Sorry I'm too busy stamping my bingo card - 'We are one team', 'HEART values' and of course, disciplinary threats against every doctor in a department as if a class of school-children as opposed to whichever specific individual is supposedly at fault if proven.
#BeKindisBullshit
@TheENTSurgeon1
@cannula_service
Wow, those specific procedures that CSTs who want to have even a shot in the ENT ST3 application bottleneck have to get multiple of to score points, and struggle to get the opportunity and go to theatre in their own time to get the bare minimum? What a SURPRISE. /s
@theRCN
This is entirely your responsibility. You pulled off half-baked strikes, recommended the shit deal you now have, and are now basically having a tantrum that it's not fair that people who went out and fought for better pay instead of immediate capitulation got a bigger offer?
@mmamas1973
This is the culmination of the madness. A PA is not trained and not safe to see undifferentiated patients. That they jumped to a *diagnosis of exclusion* in a 69yo w/ severe abdo pain shows not only the lack of knowledge but also their blissful ignorance of their own limitations.