Jan Hansel
@VirtueOfNothing
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NIHR Doctoral Fellow in ICM @OfficialUoM | Anaesthetics & ICM SpR | ‘The truth is not always beautiful, nor beautiful words the truth.' –Lao Tzu
Manchester, England
Joined November 2009
A good friend phoned the GP for a bullseye rash (example image) following a tick bite this morning, and they got 'referred' to a pharmacist by the receptionist. They prescribed an antihistamine. I guess this is the excellent state of our primary care, yeah?
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They have since been seen by an actual GP and got prescribed a course of doxycycline.
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To raise some awareness as this post has gained a bit of traction, and posted with permission, here is the actual photo of the rash in question. For more information on Lyme disease:
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‘Hiya is this gastro on-call? I’m Rob from Prestwich, 54, bit of a boozer. CGV last 24 hrs, melaena 2 days. Glasgow-Blatchford 8, but that’s without an Hb cause I’m calling from home to self-refer. Am I alright to pop in for a quick OGD +/- transfusion later today? Ta.’.
"One of things we've put forward. self referrals so individuals dont have to go to a dr in order to get referred to specialist help. if youve got internal bleeding & you just need a test there ought to be a way that doesn't involve going to see a GP". Keir Starmer on #BBCLauraK
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‘Tell me you work in the NHS without telling me you work in the NHS’
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Mate getting the NHS PCs to startup and let you login in less than two minutes would be a start. What are you smoking @RishiSunak?
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So we heard today at the select committee debate @gmcuk will be charging £221 per annum for PA/AA registration. Why do I as a doctor have to pay £433?. I would much rather pay £221 as well, and come to think of it, I just might cancel my direct debit right now. 🙂.
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A young woman died as a result of a barndoor pulmonary embolism presentation missed on two occasions, under the impression that she had been seen by a GP. This is not the standard we should comfortably walk past.
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Literally saw a porter fight off a rogue pigeon that made its way into the hospital through a window while transferring a vented patient. He grabbed it by the neck and threw it back out. 😳 Peak NHS. Highlight of my medical career thus far, hands down.
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👀
I’d like to thank everyone that contributed to the survey. Important issues are being raised (and I don’t love that it’s the MoS trust me).
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£10,000 a day for a Kwasi Kwarteng. Versus £14.09 per hour for a fully qualified doctor. Let that sink in. That’s a factor of 89. And @SteveBarclay is calling on @BMA_JuniorDocs to ‘check our conscience’.
🚨MPs FOR HIRE: a Led By Donkeys undercover investigation🚨 . Watch the trailer…
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@EmergMedDr Appreciate the ambiguity in the wording of the original tweet!.
@neilorpen I can see now how I worded it awkwardly! They phoned this morning, rather than having been bitten this morning.
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1/ We just published our full @Cochrane_ACE systematic review and meta-analysis of videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. The full review is here, but first - some of our key takeaways 👇.
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@neilorpen I can see now how I worded it awkwardly! They phoned this morning, rather than having been bitten this morning.
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What THE HELL did I just read 😳. Was nobody in the entire chain of numbskulls able to exercise a MODICUM of common sense?. This is another example of a system broken by Kafkaesque rules and blind adherence to ‘policy’. What a disgrace. I hope they sort it soon.
A few days ago I found out my 86yr old mum with dementia had had a fall & been admitted to hospital.I didn’t know which hospital so had to cold call the ones in the area.No luck.I thought this can’t be so called them all again.Fortunately I got a different receptionist at one….
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#oneteam. Yet one group of NHS workers seems to be missing. Can’t quite put my finger on it.
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PAs have a narrower skillset than junior doctors, yet somehow get paid twice as much for the same shifts. “But Jan it’s dehumanising to compare anything to anything.”. Make it make sense please. This is just an insulting constellation of managerial decisions.
How is this acceptable @BucksHealthcare? . Doctors are NOT worth half a Physician Associate. FY1s, this is how they value you. Look how they value your replacements. STRIKE.
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A prefrontal cortex.
Dear men, what is preventing you from doing this?.
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The BBC mislabelling AAs as anaesthetists. Thing is, ‘anaesthetist’, unlike doctor or surgeon, is not a protected title. What’s even funnier? The GMC will make ‘Anaesthesia Associate’ a protected title. You couldn’t make this up.
Lives 'in hands of underqualified' anaesthetists
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Nothing quite like an NHS manager gaslighting doctors and siding with the serial killer, allowing further baby deaths. Tony Chambers was appointed interim CEO at @qvh earlier this year. When will he be suspended undergoing investigation on grounds of patient safety?.
EXCLUSIVE: The doctor who helped catch Britain’s worst baby killer. Dr Ravi Jayaram spent two years pleading with hospital managers to investigate Lucy Letby. Instead, they made him apologise and attend mediation with her.
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@AlRobPharm Not fishing for medical advice and definitely not keen to plaster pictures of my friend’s body all over Twitter. Fact is, the ‘signposting’ system fucked it. I wouldn’t expect a pharmacist to diagnose erythema migrans - it’s not their job. The fault lies with the system.
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I really find it quite adorable when middle management (what's an operations director?) come to speak at us on AMU to mAkE uS aWaRe that the NHS is struggling and ambulances are waiting and ED is full and we need to also discharge some patients. Me:.'Plan: - Repeat FBC/U&E/CRP'
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I urge all doctor colleagues to complain to the GMC regarding the 7-digit number. The form (Word or PDF) can be found here:. We need to make our voices heard and let them know that we will not stand for this. It also demands a top-level response @TheBMA.
The entirety of the upper echelons of medical governance frameworks in the UK are currently *that* Spiderman meme…. Honestly, is this a joke?. And the 7-digit number as a cherry on top…. One word for you, @gmcuk: No.
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As a clinician I find it extremely unrewarding working in a system that is in near-constant triage mode. The moral injury of knowing what the standard of care looks like, and not being able to deliver it because of shockingly poor resources, is real.
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So this is great. Is it a doctor’s QI job though? No. This is the sort of thing an NHS manager should be doing. Speak to clinical teams and ask what about the ergonomics (or lack thereof) is frustrating. Then go back to the office, make it happen and measure the impact.
In F2 I needed a QIP, and instead of the usual VTE crap I decided to do something useful. The state of our doctors’ offices had always pissed me off and so I went about improving things, new chairs, more computers, more phones etc. Small things but made a big difference! 😎😎😎
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Pray tell @ELHT_NHS what non-medical clinical professionals work at ST6-8 level to cover at BMA rates? I expect some concrete and specific examples. @Dr_Done_ @Xeon4f145d96s1 @BMA_James_Steen
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Didn’t even need to read who authored this piece to know.
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@gmcuk So, you're going back to the drawing board, right? . Based on less than 30% overall agreement from patients/public and an abysmal 13% agreement from >1000 medical pracitioners, one could only hope this would prompt you to reflect and revise. Who will mark your homework?.
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I will just leave this table here to do the talking. The @RCPhysicians leadership has attempted to mislead its Fellows at the #RCPEGM. 🔗
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Because ARCP season is near. And we all love a good audit.
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A bit conflicted about this. How broken is an educational system that does not simply make arrangements to defer an exam in case of illness? I appreciate there is likely nuance here. But what does this signal to other medical students . .
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Should I be the first to ask… where is the MDT now? Sounds like a perfect opportunity for the entire team to step up?. Jokes aside. Have the private company that ballsed it pay them ffs. What an absolute joke.
🚨 NEW: Medical students have been drafted onto wards in the wake of the NHS cyber attack. They will work as floor walkers, hand delivering blood tests to and from the crippled pathology labs. Bosses at @GSTTnhs say disruption will last "at least 2 weeks" 1/2
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Gosh, the GMC seem to take about as many liberties with the word 'research' as they do with what defines a medical practitioner . .
Today, we’ve published a report on the outcome of our public consultation on the proposed rules, standards and guidance that we’ll use to implement the regulation of physician associates (PAs) and anaesthesia associates (AAs). The report:. - details the key changes we have made.
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This was one of the biggest culture shocks after coming to work in the NHS from Scandinavia. For some reason organising a CT scan as a default needed a phone call to both the radiologist and the radiographer. As if they could not read a written request and action. 🤯.
It's bizarre that when things don't happen quickly in hospital the default response is 'requesting doctor needs to chase it up'. It's tackling the problem from the wrong end. If I request something, it should happen without multiple further interventions on my part.
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@ybees3 A doctor to review and treat appropriately. This is bread and butter medicine. And it is our remit.
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Not to draw comparisons, but when I moved to Iceland in 2015 the doctors had just secured a collective agreement with the government, where all grades got more than a 20% pay increase (minimum!) compared to the previous financial year. It. Is. Doable.
@_jaytalbott_ @Dr_XYZ @VirtueOfNothing @Ssj3Sa @_VivekTrivedi Politically impossible. Imagine effect on other workers seeing what they perceive as (and in reality is) a high earning group getting 35% rise.
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So. the basis for your rejection is that they hadn't objected to this clusterf**k two years ago? Right. 'No takesies backsies BMA!'. It is truly astonishing that you are not able to reflect and listen for one second, to what the entire profession is so clearly telling you.
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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I really hope this was a misprint or some other error, but ‘management of AAAs’ axed via the NHS?. ‘Hey John, so you have this 3 inch ticking timebomb in your belly that we could operate on and save your life, but now you will die within the year. Good luck.’. What am I missing?
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Management are in for a rude awakening when the incoming generations of consultants CCT. There will (in my view quite rightly) be little in the way of sacrifice *for the benefit of the employer*. Guilting staff into work won’t cut it either. Alongside pay, trust has been eroded.
Cognitive dissonance; ’please work harder and more efficiently to reduce the backlog’ vs ‘we accept your pay has been hugely eroded, including against comparators but regardless that you need 14% each year to return to trend you can have 2.8%’. Cloud cuckoo land.
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Behold… The ‘I could teach my mum how to intubate a neonate’ argument in favour of taskification. 👏 Right after equating it to putting a cannula in. Couldn’t make this up. 🤌.
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I suppose @NavinaEvans supports PAs making veiled threats to doctors though? Please correct me if I am wrong, and call this out.
@cannula_service Balazs, I still really want to confirm your full name. I have some questions for a "Balasz" but I want to know if you are THE Balasz I want to speak to. You have identified yourself as a doctor here so you are supposed to confirm your identity. I don't want to GMC you or anything.
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Get in the bin. ‘Anaesthetist associates’. First you need to learn to get their titles right. Amateur hour. And to think the public or the profession should trust you lot to ensure patient safety?. Get serious. Sincerely,.An actual anaesthetist (in training).
On behalf of Professor Sir Sam Everington, we share his thoughts on the process towards the regulation of physician and anaesthetist associates.
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And another one. The embodiment of 'junior doctor' infantilisation in the UK. It is rampant and quite frankly toxic. I for one am happy to call it out. Out of interest, what do you ignorami define as 'the junior doctor'? The ST8 with a combined 14 years experience?.
@DrHuw @VirtueOfNothing @telswood @Matt_L_Nash Why wouldn’t an experienced ANP be able to be above the skill of the junior doctor, maybe the consultant is busy.
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Having just moved prior to changeover, wanted to explore the area a bit and somehow made this happen accidentally 😳 what are the odds…
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A very positive dichotomous outcome 🤓.
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@AngJones76 Glad to hear you had a good outcome from this pathway – I’m sure many do. Some not so lucky, it seems.
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This ICU nurse chose ‘violence’ as her mode of postop PEEP weaning.
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@Vocal_GenX Where is this aggression coming from? Nobody will try blocking the road. Also, the doctors you seem to be comfortable hypothetically running over likely helped your loved one beat cancer. Please reflect on this and consider apologising.
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@pa_StephenNash @cannula_service @NavinaEvans here's some good old fashioned bullying for you. We will patiently wait for you to call it out.
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The annual GMC retention fee is £455. If we each pledge just 10% of that … I would consider that a sound investment in the future of UK healthcare. Let us hold the GMC to account.
We are commencing a legal case against the @gmcuk over their regulation of Physician Associates. We need your help to fund it. Writing letters didn't work. Time for action. #telltheGMC
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Funny thing is, if the GMC, the Government, NHSE and Trusts hadn't treated UK doctors like absolute dogshit over the last decade, there would probably be much more sympathy for a carefully integrated MAP roll-out.
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This needs to be vetoed by the profession. Hard.
Out now: our self-assessment tool supporting the career progression from Advanced Clinical Practice to Consultant Practice! Track your development as an aspiring or consultant practitioner 👉
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Did you need a bloody promotional infographic to say that you'll pay your employees on time and correctly? Honestly. .
The NHS is setting out measures to improve the working lives of postgraduate doctors. These include improving payroll accuracy, reducing admin burden and enhancing choice and flexibility with rotas.
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Not to be a snob, but does BMJ Open even proof read submissions anymore? This is barely English. The peer review process was clearly sloppy as well. As for the ‘science’ … well. Some wild conclusions here.
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This is becoming an absolute joke in the UK. We are devaluing education and training. These are VERY BASIC life support courses that are the alphabet of in-hospital resuscitation. Every doctor needs to have done it. Not on their own dime as an optional extra.
@DrEilidhMaria @mattdoc1988 Isn’t it a bit depressing that they say -“if you want to take ALS to progress your career”- like you will never actually use the skills in your current job 🤷♀️🤦♀️?? and who decided it wasn’t compulsory to be highly skilled in literally saving someone’s life?.
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This . is insane. That nurse needs to be fired. Actually, I would argue that this needs naming and shaming. Such behaviour should not be tolerated from anyone. Fucking power trips these people are sometimes on . .
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Surprised? Hardly. This is the equivalent of “fire up the paper shredder” if I’ve ever seen one. Astonishing that an e-mail like this would be openly circulated among a group of consultants. This is worthy of national news. The public need to know what is happening.
Now, I get lots of DMs. But this has to be in the TOP 5 WORST❗️. ‘Unhappy vocal minority’ - how dare you raise concerns?. ‘We need to be careful, but only while we’re under the microscope’. Storm analogy again when in fact a tsunami is coming 🫠. @SheffieldHosp @MajorKirsten1 ?
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For anyone following the discussion, a few wise insights from Prof Cook. We seem to have reached a farsical point in the conversation where it is impossible for a group to acknowledge that a high-risk & high-complexity procedure is best performed by experienced medics.
@thatsnotmine125 @VirtueOfNothing @telswood @Matt_L_Nash This does seem a bizarre conversation. Intubation of the critically ill adult is rife with risk & complications. Harm is common. Intubation of the neonate (especially when critically ill) is a league up in failure, delay & complications. Harm is intrinsically less easy to.
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This to me reads like the straw that should break the camels back, once and for all. I note the hearings (listed on the doctor's registration) are no longer available on @gmcuk website. These should be made openly available again, immediately.
⚠️ For those working with PAs. MPTS case published 2017 where a ST3 Junior Doctor was suspended for failure to adequately supervise a physician assistant’. The PA was known as ‘Dr G’. There may have been other issues too - irrelevant. Read the following:.
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Hive mind, can you please help? Delivering a tutorial on approaching the deteriorating inpatient out of hours as a junior on-call. This is what I’ve got so far. 🤔 Further thoughts? NB small group, discussion-based.
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With 3250 PAs currently working in the UK, these data by @Telegraph suggest that at least 15% (likely more) have no relevant background qualification. Degrees such as homeopathy, management and English literature have been accepted.
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Good to know that my practice can stay the same. One of my favourites on ALS special circs stations is appending the phrase “… will do f*** all.” to the often recited “10 ml of 10% calcium gluconate…”
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Look at this badboy just casually chilling next to some bins unattended. Rare to see one in the wild like that 👀
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Amidst a lot of negativity on Twitter—and #MedTwitter in particular—this sendoff by @MFTnhs prior to changeover was a lovely little gem. Thank you.
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Interesting to note that the CEO of the Royal College of Physicians is a nurse.
Only one month ago, Dr Ian Bullock (RCP CEO) (Nurse) @Bullock1Ian retweeted this. A call for responses to assess concerns of doctors about physician assistants. To ‘be better informed prior to voting on proposed motions.’. @RCPhysicians then obscures the data at #RCPEGM
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That pesky critical desaturation won’t stop this task fixated anaesthetic team from putting a 17G venflon in the wrist!
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AV fistulas should be done by vascular surgeons. Or vascular surgeons in training. This shouldn’t be a controversial take. Yet….
@scrivvyfloor @pcricoarytenoid @ABarotchi1 Afraid an AV fistula is are far too important such that you have to get them right. Dialysis patient's life depends on them working and cannot waste access.
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Funny how in cardiac theatres every single dorsum of the left hand seems to magically take a 14G cannula without issue all of a sudden
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@Dr_Done_ This will all very soon be landing on the GMC's doorstep. Just imagine, scaled up nationwide, the additional staffing requirements for the rigorous FTP procedures . .
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There we go, an unregistered anon ?PA is weaponising GMC guidance against me. You couldn’t make this up. 🥲.
@VirtueOfNothing @iDrSunny I don't take kindly to threats Jan Hansel and please read your own GMC guidelines in relation to social media. Thank you.
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Just published: The impact of PAs on surgical training. Four domains of key recommendations from @ASiTofficial
📢 New #ASiT Report on Physician Associate Impact on Surgical Training and Patient Care 🏥👩⚕️. 🔍 Largest ever ASiT survey: 1,978 doctors across all surgical specialties in the UK. 🤝 Focus: Physician Associates (PAs) impact on surgical training and patient care.📈 73.8% worked
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Channel 4 is the gift that keeps on giving. In the delirious wee morning hours of the GE-a-thon Alastair Campell just told Nadine to ‘show the Prime Minister some f**king respect’ 🤌.
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If you’re reading this and thinking ‘well why not’ …. Then you have a fundamental misunderstanding of healthcare roles and training for them.
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Anaesthetics ST4 job offers due today . 2pm: ANRO sends this e-mail to candidates. Colleague: "My BP has been through the roof since 9am waiting for the result.". Thanks ANRO . This does NOTHING to restore any faith in your utter lack of competence. @RCoANews, comment?
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A business case from UCH published March this year on the RCoA website: Back-of-the-envelope calculation. 2x Consultant Anaesthetist = £277,240.2x AA + 1x Consultant Anaesthetist (2:1) = £287,546. Make it make sense 🙏
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'The judge ruled that Dr C was in breach of her “duty of care” towards the child and was 60% liable for the incident. The child had stepped on to a pedestrian crossing when the light was green for traffic and was 40% liable.'. What did I just read?! 😳.
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I would be keen to hear how patients/NHS service users have been involved in the decision to introduce PAs/AAs. While the DHSC would love you to believe the horse has bolted, it is not too late to turn this around and set things straight. Read this article. Write to your MP.
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Entirely irrelevant whether doctors’ fees are used for the AA/PA register or not. We expect to see an exact breakdown of costs to justify a twofold (or more) difference in fees. We definitely pay you enough to be transparent.
2/2 While we’ve said we plan to set initial fees for PAs and AAs close to the current fee for the FPA voluntary register, this is subject to change. PA/AA & doctor fees will differ as we take a range of factors into account when setting fees and align them with the cost of.
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An appropriate scope of practice for AAs?. Some hard-hitting statements about the role from senior AAs introducing it to prospective students. DNACPR conversations, very liberal solo regional lists, misleading introductions, and more. My view: This needs addressing at the EGM.
'An introduction to the AA role' from Lancaster University. We have compiled excerpts from three talks by senior AAs. Names and other sources of identifiable information have been removed.
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Does it really hurt anyone to give a bit of ketamine… or some midazolam?. Doesn’t have to be whole log, I get that in higher doses it can potentially have deleterious effects. I honestly struggle to see a strong rationale for a paralytic-only intubation.
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Should the BMA start cracking down on such highly imaginative use of public-facing language?.
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📌 Important for all doctors working in the NHS. NHSE are welcoming comments on a framework for MAPs. Link here: Have your say to avoid another regulator snafu. It is designed to comment on ‘clarity of language’ but should be fundamentally rethought.
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Are these just random musings? We cannot have PA/AAs be medical practitioners for the purposes of this joke of a guidance, but not when it comes to the Medical Act (1983). Or… are you suggesting they are in fact medical practitioners according to the Medical Act (1983)?.
Interesting debate on titles-. The Medical Act (1983) almost always refers to ‘medical practitioners’ not doctors (or medical professionals). #GoodMedicalPractice2024 means AAs and PAs once in UK regulation will have to follow the same high professional standards as doctors.
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And this is the crux of it. In the UK, yes, everyone is deskilling left right and centre. I’ve been fortunate enough to do a proportion of my early EM training in Iceland, where exposure to these basic procedures (chest drains, paracentesis, LPs, CVCs) was plentiful.
@scrivvyfloor @dr_lungs @sh_abbers @dannyjnwong @pcricoarytenoid @ABarotchi1 I'm amazed placing a chest drain isn't within the compass of any medical SHO. What are doctors doing now? Is everyone totally deskilled?.
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@Forward_Focus96 They sent me a photo of the rash and I told them to get doxy immediately. I am dismayed at the thought of all the people who may not have ‘medics on tap’ in their friend circle. They come to harm.
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And here it is. The pernicious argument that always seeks to lure doctors into self-defeating submission. Because we need to pretend that everybody is the most skilled at everything and anyone can do our job, right?. This doctor is tired of the constant lane-jumping.
@VirtueOfNothing @telswood @Matt_L_Nash The assumption that it’s the medics who’d always do the bailing is an interesting one.
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And a massive thank you to @ProfRWinston, also from @UKLabour, for standing up for the profession.
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At a doctor in training in the North West, I am having to pay £240 for the duration of my rotation at @WythenshaweHosp @MFTnhs. For this. On a side note, why can @SalfordCO_NHS provide (much better) parking facilities to trainees free of charge?. Can we do better @MCubbonNHS?
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Has the @gmcuk completely lost the plot? You must be literally insane. How is it in the public’s interest to lose a doctor for half a year over this? You lot are denser than fog.
This is an absolute travesty. I cannot put into words the amount of contempt I have for this. @drcolinm, I know you're not involved directly but as an Executive Officer - would feel comfortable defending this decision to @bbcnickrobinson on @BBCr4today?.
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When NHS corporate sass backfires.
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The entirety of the upper echelons of medical governance frameworks in the UK are currently *that* Spiderman meme…. Honestly, is this a joke?. And the 7-digit number as a cherry on top…. One word for you, @gmcuk: No.
“PAs and AAs who register with us will receive a seven-digit number in the same format as a doctor.” - a deliberate attempt by the regulatory authorities to further obscure the differences between PAs and doctors.
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