Dr Roddy Neilson
@Roddy_Neilson
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Consultant Haematologist, ex reservist military doctor and QHP. Into excellence in medical and organisational leadership. Views are my own.
Glasgow, Scotland
Joined April 2023
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Sadly, as a Glaswegian and with a juvenile and medical school influenced sense of humour that 60 years on this earth hasn’t tamed, I laughed at this. I laughed lots. Sorry.
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My finest clinical moment.
A patient attends clinic in floods of tears stating their lymphoma is back as they have a purple lump on their back.
My assessment:
1. They don’t have relapsed lymphoma.
2. They shouldn’t eat wine gums in bed.
I am a diagnostic god!
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I was a commissioned officer for 30 years. I’ve served as a medical officer in Bosnia, Iraq and Afghanistan and seen what conflict is like.
This is insulting bordering on crass.
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@Johnincarlisle
Dear John,
It’s called a chicken fat thrombus. It occurs post mortem due to blood stasis. It’s been observed for decades. It’s not a new ‘pathology’.
How would I know? I’m a haematologist who used to do post mortems in the past.
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This may upset some people. My job as a consultant is to treat patients and to educate trainees in my specialty. It is not to give validation to unregulated, dubiously qualified individuals who believe normal training in healthcare need not apply to them.
As an aspiring cardiologist i didn’t take A/L on my Cardiology F1 rotation so i can make the most of the exposure on Cardiology. (Major L, I was left on the ward to do ward jobs anyway). I requested STUDY LEAVE to attend clinics. Can you appreciate why this is infuriating?
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@Nomoretrust8
@Johnincarlisle
They are a post mortem finding that will be there in all dead bodies if you look for it. It has nothing whatsoever to do with Covid vaccines.
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This is a thread.
Today I carried out an enhanced appraisal on a colleague who I rate very highly. They are clearly able, skilled and caring. No issues as regards ability to practice. I myself would be ecstatic to be treated by them and my standards are stratospherically high.
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Well done this doctor!
🚨 Does anyone know who this GP is??
She should be PRESIDENT of the RCGP!!
📢 What a smashing statement to a complete bellend of a PM & Tory supporters who have no clue about general practice.
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IV fluids in someone in heart failure.
A nebuliser for some reason.
An interpretation of a CXR that a new medical student could have done better.
Auscultation through clothing.
For the pedant - examining (sic)from the wrong side of the bed.
Handcart/ hell
🚨Stop & watch the future of the NHS‼️
My blood is boiling:
‘I’d not heard of physician associates until about 3 years ago’ (now in Resus alone)
‘We work exactly like doctors do just different training’
&
‘The medic is confident she’s addressed the most urgent of issues’
☠️
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What a way to run a country - an unelected member of parliament with a very suspicious record on PPE acquisition during COVID believes he can comment on medical practice and patient safety.
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And if my medico-political career and ambition dies a death for saying so, at least I’ll go out speaking truth to power.
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As a consultant haematologist I find this position by my professional society disturbing and I disagree with profoundly. There are many doctors who wish to pursue a career in haematology which is understaffed medically. PAs are not the answer.
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Put bluntly, you don’t replace a highly educated medical or nursing based silk purse, with all the skill acquired over years; with a pig’s ear of unregulated, poorly trained individuals with attitude.
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@LouiseAllard18
You qualified in 1991. I qualified in 1985 and would not have the temerity to post what you have given the entirely different circumstances being a junior doctor involve now compared to then. You should take a hard look at yourself.
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The irony of doctors being accused of snobbery and defensiveness over PAs by an old Harrovian, Conservative hereditary peer, with issues surrounding his role in PPE acquisition, is interesting.
In any event, I doubt any medical care he might need will ever involve PAs
@DrAsifQasim
Are you seriously saying that PAs dont have a role? That the old set of clinical roles can keep up with the operational demands of an aging, sicker population? That you can guarantee that the existing workforce and training capacity for new staff will meet the nation's needs?
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Shrödinger’s PA. The one that didn’t want to study hard to become a doctor, but yet found their training as a PA more ‘intensive’ than genuine medical training.
@dgraemestewart
Amazingly a lot of PA propaganda will state something similar to “I didn’t want to have to study so much to be a doctor” and yet their doublethink allows them to state how intense their PA course was
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My appraisee is not the only doctor to feel this.
As such, can we not just accept the most highly educated and trained members of the NHS are fed up with being taken for granted and thought to be easily replaced by PAs, AAs or other quasimedics.
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A PA stating they follow the same pathway as medical practitioners in haematology and ‘run outpatient clinics alongside my consultants’.
When you’ve acquired an MRCP, a FRCPath and a CCT we’ll talk. Until then you appear to be an egregious self promoter with no right to be so.
Current President of
@FPARCP
asserts that PAs follow a similar pathway to Drs post graduation & that it would be appropriate for a PA to answer OOH referrals in haematology
This is not in keeping with a *dependent* role
It is vital that this view is repudiated by
@RCPhysicians
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This is Nadeem Moghal the ex CEO of a private company (DMC Healthcare) that provides outsourced medical care to the NHS stating an absolute untruth about medical school training v PA training. Given this role I wonder why this might be?
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These clots were removed from a fully boosted male. They are not normal. Why is MSM not talking about this?
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I also want to be sure when I personally need medical care, the individual providing it isn’t pretending they’re medical/nursing qualified when they’re not.
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@Nomoretrust8
@Johnincarlisle
Can’t say why morticians haven’t seen them but pathologists (myself in the past) included have.
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The GMC Director of Education and Standards who prefers retweeting the wittering of a Tory peer with the reverse Midas touch on PPE to engaging with the clinicians who actually employ him.
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As a haematologist this is chilling.
A PA told a nurse that antibiotics are not needed for a patient because they are in neutropenic sepsis.
So the immune system is non existent.
And let’s give it no help to fight the infection
🤔
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However, this ability has come at a personal cost to them in relation to their emotional health. The current state of the NHS in Scotland is that it demands more in delivery than it gives in support. Most particularly of its senior medical staff.
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Always the stethoscope.
A "Consultant Practitioner" in EM
@NHSGlos
A vague, non-title which puts patient safety at risk by not making clear that they are not a doctor. Utter madness.
#patientsafety
#scopecreep
@Dr_Done_
@Xeon4f145d96s1
@DrEilidhMaria
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Words that don’t mean what they say if you work in the NHS as a doctor:
Kindness
Resilience
Flexibility
Any others?
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The GMC isn’t covering itself in glory over the PA issue. ‘Sure, we’ll register you and give you a number but we won’t regulate you’.
Why can we not just admit PAs are not the solution but proper training and career structures for actual doctors is? Is it that difficult?
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@DrEilidhMaria
I was called a, ‘house plant’ when a JHO by a SR. It was overheard by the consultant who said, “If you can call him ‘house plant’ I can call you ‘c*ntface’. That work for you? Alternatively call him Doctor, got it?”
Thank you the late Mr Gordon Waddell.
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The ‘new reality’ is whatever a regulatory body is told to do by government it must do. It’s not about experience of fitness for role, it’s about acquiescence.
PAs and the nonsense the GMC pretends is the way forward is based on cowardice. 3/3
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The Medical Practitioner Tribunal Service is used by the GMC to hear complaints against doctors. Notice anything unusual? Proportionality?
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Dear
@gmcuk
,
Are you absolutely confident; with the BMA, several Royal Colleges, other doctors’ organisations and individual clinicians expressing deep and growing concern over them; yous stance on PAs is correct?
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PAs using Facebook to diagnose patients. Well I say diagnose, it appears to be the blind following the blind.
Attempted to hide identities as much as pos. Sent this and found it too damning not to share.
PT presents around 3pm. A doctor doesn’t appear to be contacted for support or help, and instead a Facebook group of PAs (PAAUK) consulted instead. PT in HB sent to a&e not until 6pm.
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PAs have neither the training nor ability to provide patient care. Being ‘resilient’ when you diminish the quality of medical care to patients is nothing of which to be proud.
Imagine the resilience you've got to have to be a Physician Associate right now.
Stay strong 💪🏽
#physicianassociate
#BeKind
@FPARCP
@gmcuk
@RCPhysicians
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The chance of me or any other doctor ever being jealous of a PA is nil.
The chance of a PA having any insight into how poorly trained, arrogant, personally unaccountable and dangerous to patients they are? Nil as well. The PA experiment in the UK needs to stop.
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@JimBethell
@DrAsifQasim
The irony of doctors being accused of snobbery and defensiveness over PAs by an old Harrovian, Conservative hereditary peer, with issues surrounding his role in PPE acquisition, is interesting.
In any event, I bet any medical care he might need won’t ever involve PAs.
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@e_mmarussell
And your knowledge of medicine , paediatrics and endocrinology is what, exactly?
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Hi
@drcolinm
and
@gmcuk
,
Hope your bank holiday was fun. Care to comment on your complete abnegation of standards re medical practice in the UK? Asking on behalf of the profession you’re meant to support and regulate but appear to despise.
🚨PLEASE READ🚨: Earlier today, a video recording of a
@gmcuk
seminar ("Frontline perspectives on integrating PAs and AAs into multidisciplinary teams") was shared onto Reddit. With
@AnaesUnited
cooking something big, a more strategic time to share the video was planned. (1/15)
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The fact the GMC is responding at all is an indication of how fragile their position is.
Over the past few days, we’ve had questions and comments about a recording of one of the workshops from our 2022 conference. We’ve been reading and reflecting on all of these and wanted to share our response:
🔵We recognise that there are differing views about the role that
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It took me 12 years from graduation plus two sets of PG exams to become a consultant. 7 years ‘experience’ on top of an unaccredited degree does not a specialist make…
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I spent 5 years at medical school and a further 12 years in postgraduate training to become eligible to be a consultant.
Apparently this was a waste of time.
@Xeon4f145d96s1
@Dr_XYZ
@mmamas1973
@RoshanaMN
@parthaskar
@r1chardf1tzg3r1
@Roddy_Neilson
"Foundations in Surgical Skills & Anatomy" for PAs - two weeks
Foundation training for medics - two years, then many years core training and specialty training
Who do you want operating on your family?
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I just wonder how the current; poorly educated, inadequate, but chippy; PA cohort would cope if faced with old school consultants from when I was a medical student and junior doctor in the 1980s.
It would be a bloodbath of the vanities.
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The utter disrespect for a patient shown by this PA. Lack of understanding about how a consultation works, lack of knowledge about hidden agendas and a toddler level of petulance to boot.
Want a doctor? Ask for a doctor.
I can't conceive of a GP (or any UK doctor) posting something so disrespectful & inappropriate as this - shared by a PA on Instagram, where there seems to be a vogue for endless such posts from PAs, often breaking patient confidentiality.
Completely wrong.
H/T
@medicalmodelbri
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Dear Colin,
Why exactly are you and the GMC tone deaf on the concerns of doctors over PAs? It’s now moved from being patronising to downright insulting.
To be clear - the below message is incorrect and constitutes deliberate misinformation - I did not say Consultant Physician Associates are planned - and indeed it would not be for the regulator to make such a decision.
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No. No. Just no. Not ever.
The PA ‘experiment’ in my specialty, as well as in every other one, needs to stop.
🆘 Another PA student let loose on patients on Harmatology ward.
She is allowed to assist in LP( needle in the back) and bone marrow biopsy on 1st week of placement 💀☠️
What do they know about
-aseptic technique?
-Anatomy?
-Why not just watching and learning ?
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Twitter/X is fascinating.
Me - I’m a doctor, an ex army officer, vaccine advocate and a PA critic.
X-land - You’re not a real doctor, a useless reservist, shill of big Pharma and ‘not kind’.
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It’s time to realise this experiment was poorly conceived and promulgated, enabled by clinicians with an agenda that didn’t involve proper patient care and enabled by a GMC that gives every impression of being bought off by a government looking for a cheap fix.
Physician associates were first introduced in the UK in 2003.
The BMA has had 21 years to act on concerns.
Perhaps the role isn't the issue but the implementation is the real problem.
We need to address the inadequate regulation of healthcare services in England.
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One wonders what the GMC will say about the products of Aston Medical School having been assessed by non regulated individuals with less training than those they are assessing.
@drcolinm
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Can somebody tell me why so many pulchritudinous Asiatic young ladies find my posts on UK medical practice so fascinating that they wish to be my friend? I’ve asked my online Nigerian Prince friend who’s managing my finances but he’s not got back to me.
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In 1995 I as the very senior SR and a brand new SR in haematology argued vehemently about the management of a patient. Lots of growling, dislike and crossness was generated.
Our 26th wedding anniversary was last May.
Two med regs reviewing a complex patient together - it’s great being able to chat through ideas and bounce off one another. Satisfying ++
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Hi Effie,
Like most of my medical colleagues we are of above average intelligence otherwise we wouldn’t have got to where we are. We don’t earn a ‘fortune’ and I, as a consultant, drive an electric Audi, not a Porsche, which I can’t really afford but like.
Junior doctors are the modern equivalent of aristocrats. They rarely have above average intelligence, but worked hard at school & now earn a fortune more than those who pay their wages. After buying their Porsche Cayenne they spend the rest of their life bossing us around
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The GMC is no longer fit for purpose. It’s tone deaf to the medical profession and poorly led.
It is, in fact, the Post Office Scandal of the 21st century in embryo.
Clare Barton, Assistant Director of the GMC, explaining that the GMC wants new legislation because the Medical Act apparently hasn't been updated since 1983...
...I take it we just ignore the reams of amendments then?
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There’s deaf and then there’s GMC deaf.
We’re in Belfast for the last of our UK education round tables.
-
#GoodMedicalPractice2024
- Transforming medical education
- Fairer training cultures
- Update on AAs and PAs
#MedEd
#MedTwitter
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I have yet to meet a PA that has aided patient flow, released a doctor’s time or provided continuity.
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@r_hirschman
@Johnincarlisle
Dear John,
@Johnincarlisle
It’s called a chicken fat thrombus. It occurs post mortem due to blood stasis. It’s been observed for decades. It’s not a new ‘pathology’.
FYI I’m a haematologist who used to do PMs in the past when a histopathology trainee.
Stop misleading people.
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Not just PAs but senior PAs! Ones that can provide advice to actual doctors! We are truly through the looking glass now.
This needs to be stopped right now.
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I think a first step in regaining trust in the GMC is if Colin, Charlie et al resigned.
Excuse my bluntness
@drcolinm
but like so many of my colleagues, I’ve reached a bit of an impasse.
The disrespectfulness & utter contempt shown to 🇬🇧 Drs by ‘the powers that be’ has been off the scale.
Most of us stopped trusting
@NHSEngland
&
@DHSCgovuk
some time ago….
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@IncogAssociate
@makepumps666
@TheSooperCynic
When I was a non consultant but a doctor I introduced myself thus. “Hello, I’m Dr Neilson, the (insert grade here). That’s called honesty.
When a PA introduces themselves as, ‘a medical specialist’ or ‘one of the medical team’ that’s disingenuous.
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There is no job for which a doctor is overqualified. I take bloods and put in venflons etc etc. It’s an essential part of any doctors skill set at any stage and demonstrates to trainees that these skills matter.
76% of Drs do tasks for which they are overqualified -
@drcolinm
justifies for extending scope of practice of other groups
How do you define overqualified though?
Like if I never do another inter hospital transfer so what, I’ve done tons, but I’m not overqualified for it..
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If PAs in your radiology have revolutionised your day-to-day practice it must have been pretty poor beforehand.
We now switch to a consultant perspective.
What sort of consultant? Unspecified, could be the consultant ward clerk.
"Having an IR PA has revolutionised our day-to-day practice."
Really? Are these words you wish to be remembered by?
It sounds ridiculous.
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Professional discrimination? No it’s not. Stop making things up.
We have recently seen discussions across social media about upcoming graduation ceremonies for our Medicine and Physician Associate programmes.
Read our full statement in response to these discussions here:
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If you want an example of a post that is both patronising and tone deaf to what the reality of medicine is currently, this is an excellent one.
#ladderpuller
I am looking forward to sharing all of the amazing positive stories I have about our PAs here at
@sashnhs
at the
@RCPhysicians
EGM this week. I know many of you are feeling low, but please remember how awesome you are and such a valued part of our
#oneteam
.
#Medicineisbrilliant
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The PA here must have missed the 30 minute histopathology part of their ‘high intensity’ course. ‘Harmless things’ isn’t a tissue diagnosis.
A PA experienced in removing skin cancer now has his own business removing ‘ harmless things ‘ looking for a local anaesthetic prescriber online .
What could possibly go wrong ?
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Does anybody in the GMC possess any moral courage whatsoever? Discuss.
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It’s very simple. If you are a consultant you train those less senior and experienced so they can become senior in their turn. It’s part of the deal. If you rely on PAs it potentially calls into question your integrity on this.
@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'.
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Can you not just read the room and realise actual doctors who care about patients do not want PAs or AAs to have ANYTHING to do with patient care? Is it that difficult?
‘Oh look! An iceberg! What could possibly go wrong if we engage with it? We’re unsinkable!’
🗓️ Our public consultation on the rules, standards and guidance needed to implement the regulation of physician associates and anaesthesia associates will close in 2 weeks. Thank you to everyone that’s already responded so far.
There’s still time to give your views on our
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In my medical career I’ve never encountered a ‘health minister’ (sic) quite as tone deaf to doctors as my Lord Bethell of Romford.
The past few days have truly highlighted how compassionate and caring Lord Bethell is.
Remember: Lord Bethell wants you to be happy and well...
Unless you're a doctor.
Or a patient.
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The contaminated blood enquiry report is so sad. I am referred to in the report in my various roles as a medical adviser to the MDDUS and as a consultant haematologist. What’s not mentioned is that I was, for a year, the consultant in charge of the Treloar Haemophilia Centre.
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On each and every application I’ve failed. I asked a friend well versed in recruitment why this should be? Am I not qualified or experienced enough? What is the issue?
Her response? ‘You’re too white, too old, too male, too able and too likely to challenge the new reality’. 2/3
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@drcolinm
@DrLKVaughan
From your own X profile you work for the regulator that’s enabled this anger and hold honorary and visiting professorships at two universities that offer PA degrees. As such, you’re not exactly neutral.
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Remember to ask if the person treating you is actually properly medically qualified.
Bad news for this country and what people can expect from the NHS going forward.
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It is time, surely, that Jim ‘WhatsApp’ Bethell resigned.
"It is time the doctors faced into the problem of this toxic workplace culture and started holding colleagues accountable for their professionalism."
My comments in
@pulsetoday
on workplace bullying by doctors in the NHS.
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@karimbrohi
Have you actually considered doing it yourself? Or do you consider yourself too important? Just asking…
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Why? It’s not as if there aren’t enough medical graduates, the ones that have trained for years rather than months, that could do the job better, more quickly and with less supervision.
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Sooo!
RCPL has produced a ‘hidden’ document on PA activities without its Council being aware.
The GMC’s consultation on PA implementation etc has been ridiculed by the PSA.
PAs are unregulated, unreliable and increasingly unwanted.
Does that sum it up
@RCPhysicians
@gmcuk
?
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Good luck with that. The days of getting to play at doctors are coming to an end.
'Each PA should have a named consultant or GP, who agrees on the scope of practice for that individual PA.'
Not just any Tom, Dick and Harry.
Certainly not anti PA BMA members.
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Ever get the impression it’s being made up as it goes along? All doctors are regulated by the GMC, not just those in training. If a registered (sic) PA is in breach of GMP what will the GMC do exactly?
@drcolinm
@Molly2323232323
@Xeon4f145d96s1
@VincentVanGrump
@ukmat82
@GMC
OK, what it says is we wont regulate any post qualification training for AAs and PAs. Like Consultants, SAS and LE doctors - they're not in training either. But all registrants will follow the same professional standards set out in Good Medical Practice.
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A PA pi**ing off a consultant vascular surgeon? That’s going to end well…
@medicalmodelbri
@ClinOncDoc
@ExplosiveEnema2
Thank you for forwarding this.
Let’s get one thing straight.
I am FURIOUS at being called a clown as it undermine team ethos.
There is a clear lack of understanding of what it means to be part of the MDT and an arrogance that I have never seen in medical students.
I called
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The GMC
@gmcuk
not understanding those that fund them yet again.
Today we have responded to the BMA, strongly rejecting the basis on which they have proposed to bring legal proceedings.
You can read our statement on our website -
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The public consultation wasn’t that public and the majority of responders were PAs&AAs.
Accordingly, mibbe you should do it again more fully this time? No?
There are ongoing conversations around the future regulation of PAs & AAs. We recognise there are strong feelings about some issues. In this thread we address some of the key points we’ve heard. (1/8)
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I qualified in 1985. I endorse everything Peter says.
When I graduated in 1984, and became a junior doctor, I had to pay my GMC membership, professional indemnity insurance, and for ongoing professional exams and Royal College membership. Just as junior doctors do now. BUT…
1/
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Dear GMC,
On the basis that shutting the stable door after the horse has bolted is your preferred modus operandi re scope and regulation of PA practice, care to comment on this?
Can someone at
@NHSHighland
please explain why PAs are now supervising doctors at Raigmore Hospital? Is this a joke? Job advert posted 14/12/23.
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It gets worse. We must all be nice all the time even when faced with incompetence.
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Dear GMC,
You have stated that legislation to allow regulation/registration of PAs would be completed by the end of 2023 with registration starting in 2024.
There has, in fact, been no legislation listed for the 23/24 parliamentary session at all.
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Stephen Nash isn’t the sharpest knife in the drawer if he thinks medical practice is ‘competition’.
Why is the director of the MAP union seeking to break “doctor’s monopoly” anyway?
I thought they weren’t here to compete with doctors or take their jobs? I thought they were essential to the MDT in their own unique way?
Since when did PAs start to become doctors’ competition?
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Working without PAs is like working without an accordion. You don’t have to worry about noisy baggage.
Doctors to government: “Physician Associates are making our jobs harder.”
Government to doctors: “no, they’re making your jobs easier.”
Theres a word for that.
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Dear
@wesstreeting
Call off strikes and, ‘prepare for negotiations with a Labour Government’? Do you think my profession is stupid? You’ll forgive us for knowing that politicians of whatever hue are not to be trusted unless continually challenged. Get used to it.
Rishi Sunak has refused to negotiate for 18 months, and clearly won't do so now.
I've appealed to the BMA to call off the strikes at the end of this month and instead prepare for negotiations with a Labour government.
We must end these strikes.
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No, they should have nothing to do with healthcare as they bring nothing to make healthcare better.
“Physician Associates should be a core part of the healthcare team”. Do you agree?
Have your say at The Great Debate on
#PhysicianAssociates
, Monday 3 June at the Royal Society of Medicine.
Free event with a £20 refundable deposit.
Tickets 👉
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@mehercle
It’s not. It’s everything to do with self promotion. He’s wearing that uniform as a prop and posturing for publicity.
He is taking the piss out of those who serve, who have served and who have died for their country. He’d never serve. To me, who has, this is grotesque.
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@ClareGerada
@Cleverclog67596
@ExplosiveEnema2
@rcgp
You’re floundering Clare. You have an opportunity to make this all better but you won’t take it.
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