Danny Wong (黄永年)
@dannyjnwong
Followers
7K
Following
21K
Media
3K
Statuses
24K
Husband & Father of 2 | Anaesthetist | PhD in Health Services Research | Geriatric Millennial
Singapore
Joined November 2014
Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes. - James 4:14.
11
15
123
There were 9 people in the operating theatre last night when I was on call. Only 2 people were not "foreign". One of them was the patient. 7 of the other 8 delivering care were "foreign".
167
3K
13K
My wife's COVID positive. But she's currently in the spare room on the computer seeing patients remotely as a GP. Nobody can tell me that GPs don't work hard.
193
1K
13K
I'll say it now. If we survive this wave, the NHS will be broken and barely recognisable. The things we are asking the staff to do now in the full to overflowing ICUs will break many of them. .
154
2K
7K
Do the general public know that because of Brexit we are now finding it difficult to import controlled drugs into the UK for medical use? So we are running out of Remifentanil, an important drug used for anaesthetising patients, and we have to use alternatives techniques.
122
2K
4K
I'm exhausted. Been helping to transfer intubated patients around the hospital and resuscitate deteriorating patients on the ward in conjunction with colleagues from ICU. But there are still urgent and emergency operations taking place. Its relentless. Our ICUs are overflowing.
134
930
3K
However, I doubt the reason why Dido Harding is talking about reducing reliance on foreign labour arises from altruistic reasons to reduce the brain drain in other countries. More likely it is a dog whistle pandering to the nationalism and xenophobia linked to Brexit.
20
160
1K
Things do not look good. The public needs to understand "Protect the NHS" in the government slogan does not mean protect the NHS for the staff working within it. It means protect the NHS so that it can continue to deliver safe care for all. Now and into the future.
27
305
1K
Many NHS staff from abroad who have come to the UK to work have realised the pandemic is better managed in their home countries and that this gross mismanagement has come at an extreme cost to their own personal safety and health.
8
342
1K
@jasonvanschoor Similar to the account here I am worried this sounds like a warzone.
1/ I may be repeating myself, but I want to fight this sense of security that I see outside of the epicenters, as if nothing was going to happen "here". The media in Europe are reassuring, politicians are reassuring, while there's little to be reassured of. #COVID19 #coronavirus.
10
397
1K
Why is it controversial that a professional, who has studied for >5 years of university and picked up skills that most other people cannot do, should earn more than someone who does a job that doesn't require as much training or expertise?.
53
110
1K
The Chief Exec is thinking "We gonna redeploy this fella to MEDICINE."
47
53
1K
Actually. If you wanted to fund the health service well, it is possible. The average nurse's salary is £33-35k per year. Lets just round that up to £37k for easier maths. Dido Harding oversees a £37 BILLION budget for Test and Trace. That could fund a MILLION nurses for a year.
20
217
1K
If the NHS wants to wean itself off "foreigners", it needs to pay everyone better, increase training numbers across all roles from medical, nursing to allied healthcare and support staff. The reason why we're needed, is that the demand is high and donestic labour supply is low.
12
122
1K
There is dramatic moral distress going on. Surge nurses unused to caring for ICU patients have been asked to step up and are doing things beyond their prior training. Experienced ICU nurses are being forced to cut corners because there's just no other way.
6
185
957
The COVID deniers, anti-lockdown brigade and "Great" Barrington liars have brought us to this point where access to healthcare is being affected for EVERYONE. And for what agenda? "Free speech"? "Balanced debate"? Try telling that to the people dying.
40
271
857
@Bob_Loveridge I'm angry Dr Loveridge. Livid at the people. In power who let us get to this point. First time around we could call it a mistake. Second time around it is just incompetence.
13
128
870
Many junior doctors are experiencing more death in a short space of time than they've ever had to before. Exams and training have been suspended. There is loss of autonomy due to rapid changes to rotas. Promises of staff vaccinations have been changed with delays to 2nd doses.
5
161
877
Another week, another advert in the BMJ from Australia for FY2/FY3 equivalents to work down under. Note the pay.
38
162
875
If you're a 60+ year old doctor who graduated med school with no debt, lived in hospital accommodation during training, and has paid off your mortgage on a house you bought for £90k, you don't have the right to dismiss the financial difficulties faced by your younger colleagues.
7
119
839
The countries from where the NHS takes staff also suffer from brain drain as their skilled labour gets poached by the UK. Often the training and investment put into developing people in the countries that supply the NHS doesn't then benefit their own populations.
6
76
780
There will be serious elective work backlogs to work through in between waves that mean staff will not get a chance to rest even after this lockdown ends.
4
105
783
This is the story of Empire through and through. Colonialism played out as in many other aspects of UK society. Previously it was labour and resources from the colonies to supply wealth and riches, then troops for the World Wars, and now healthcare for an ageing population.
6
103
728
There's about 12 hrs to go before I depart the UK. Thanks for all the memories and lessons. I hope with the new government that the NHS will receive the support it needs to flourish again. Staff must no longer be expected to prop up the service with goodwill.
36
67
718
We need to recognise that serial government spending reductions has left the NHS with little choice but to seek recruitment from abroad. Hospitals go out to the Philippines and India on nursing recruitment drives. Middle grade rotas depend heavily on doctors from former colonies.
5
82
688
I use my wife's Tesco Club Card to accumulate points. Is that a GMC referral?.
26
39
712
There are multiple occasions where we overbook operating lists and finish hours later than expected. A daily occurrence now. Staff are working harder with less resources. Only to be told by newspapers and politicians that we are being inefficient. No wonder staff are quitting.
9
136
568
Meanwhile professional organisations that govern healthcare have a glass ceiling which "foreigners" struggle to break through. If you're a foreign-trained doctor you will find it harder to get onto the specialist register and are more likely to get struck off, for example.
3
63
576
This is the result of allowing the pandemic to get out of hand. We are running out of capacity to treat people for both COVID and non-COVID illnesses. By not staying one step ahead of case numbers we have allowed our health service to become overwhelmed. We are firefighting now.
8
168
562
It feels like we are having to adjust our practice because of resource limitations, completely self-inflicted by the political situation, and patient care suffers. Frustrates me to no end.
3
114
544
Just as I was leaving hospital there were 2 more patients still needing to be intubated and ventilated. Nurses are all running ragged. We are stuffing beds into spaces that can't even be properly called bedspaces anymore. I've never felt desperation like this in the NHS before.
10
173
509
UK mortgage rates are currently 😭. My current mortgage rate is due to end soon and I've just been on the phone with my lender about the new rates I can go onto. I never imagined that as a Consultant in the NHS that I'd be left with so little every month after mortgage taken out.
36
64
460
NHS doctors seem to be facing an existential crisis. Recruitment, retention, remuneration seem to be completely broken.
18
69
462
Add to that the shortage of staff, in both care homes and hospitals, and TBH is largely due to Brexit, which basically exacerbates the long waiting lists and queues to be admitted hospital, and the languishing morale of staff who haven't yet really recovered from the pandemic.
7
106
418
"But there are alternatives so what's the big deal?". Well, firstly it is just one of the drugs we are facing shortages of. Many more drugs are in short supply too. Secondly, Remifentanil is an ideal drug for many types of surgery, and alternatives aren't as good in many cases.
4
94
420
So the vaccination green book has been updated. I'm wondering whether this is legitimately going to work? 🤔 If you had the first Pfizer/BioNTech vaccine dose and they run out, the second dose can be AstraZeneca/Oxford
110
269
431
The argument that because highly skilled and trained professionals make mistakes, and therefore less skilled and less comprehensively trained professionals should take their place (and that their mistakes should be overlooked) is completely illogical to me.
@drclairetaylor @UKGastroDr @NHSEngland @RCPhysicians @parthaskar @DrLKVaughan Claire. Patients have died having seen a GP. Again this is so unfair to PA’s. We make errors. Sadly patients die because we do this.
10
77
457
This weekend, as "junior" doctors are striking and consultants are also on the brink of their own strike, I'm contemplating a return to Asia. Doctors are better respected and paid well over there. But I've lived in the UK for >20 yrs. I don't want to leave, but I might have to.
21
53
432
People need to realise that training Medical Associate Professionals to do things that resident doctors in postgraduate training should be doing takes away opportunities from doctors, and drives them away. Unsurprising how much anger it generates.
18
100
436
This is what doctors 3 years postgraduate are being paid in Australia: £61k-92k per annum. I didn't earn £61k per annum until the final few years of specialty training, more than ten years after first graduating as a doctor in the UK. I still don't earn £92k.
41
76
436
At least 4 of the anaesthetic registrars in my trust have had to self isolate this week because their kids have had fevers. The testing needs to be easily accessible, or we will start losing a grip on workforce resources.
16
121
415
Someone published the logbook from ONE SINGLE surgical care practitioner in a peer-reviewed journal and then made the leap to suggest that care given by SCPs in general is safe. How did this pass peer review?.
14
66
411
For those who want to deny the junior doctors of their right to strike on "patient safety" grounds, would you also please denounce the additional bank holidays for the coronation? Additional bank holidays means fewer staff in hospitals and cancelled elective appointments too.
8
33
396
They call it a vocation when they don't want to pay you fairly for your work. Remember that.
2
101
399
We are now having to consider giving what we feel are less ideal drug combinations to anaesthetise patients for the same procedures. This change in practice takes getting used to and some adjustment, I wonder whether care delivered suffers as a result of the mental gymnastics.
1
80
364
This shows a worrying lack of insight. 1. Nobody has a right to treat patients. The ability to treat needs to be demonstrably safe. Doctors acquire it through accredited educational qualifications and continued professional development. Rigorous exams all the way through.
5
68
401
The patients I intubated yesterday were under 60 and had the mildest of pre-existing medical conditions. They were independent and are loved by their family and are no less deserving of medical attention compared to someone younger and without comorbidities.
1
61
393
The slippery slope. Mark my words, in a few years UK undergraduate medical degrees will be indistinguishable from other routes into medicine. My worry is that standards & quality will be eroded, and other countries will no longer recognise GMC registration or UK medical degrees.
"If we want to tackle the crisis in GP numbers, we should establish a pathway for physician associates to go on to train as doctors and for newly qualified doctors to go straight into five years’ training as GPs.".
17
71
399
Not sure whether this is something that will get me hung up and lynched, but I think the Royal Colleges, especially mine, need to resist the rapid expansion of medical allied professionals being pushed by the government. It will be detrimental in the long term. A slippery slope.
12
67
390
Hooray! Thesis corrections accepted and PhD has been awarded! I can start using the letters after my name from today! Take that 2020!.
43
5
380
Three days after starting as a locum consultant at @GSTTanaesthesia, I'm grateful to say that I have been appointed as a substantive consultant in the same department after quite an enjoyable interview on Zoom today. Relieved that I didn't ruin my chances over the last 3 days! 😬.
88
5
376
Somewhere out there there is a trainee who was CT1 in March 2020 who was redeployed to ITU during the first wave. Then got told this didn't count for ICU module sign off. 1/n.
8
95
358
@CatrionaRennis1 @OrthopodReg @NHSBartsHealth Sums it up. Conform to rules you cannot conform to, or we will punish you. NHS management style.
8
17
342
@jamierusso @bythebookpod @kristenmeinzer @JolentaG this is classic fetishisation of Asian cultures. .
1
2
328
Ironically doctors are not allowed to apply for PA jobs even though they have all the necessary skills, and more, to perform all the tasks a PA is expected to do. They've got that "market" cornered. Stephen should look in the mirror before spouting nonsense.
Interesting that the founder of @UMAPsUK sees PAs as "competition" with doctors. What happened to not replacing?.
6
78
340
As an ICU registrar at a big teaching hospital, I could lie down in the doctor's office on a little foam mat on the floor under a desk if the chairs were moved away. One night my consultant, who stayed in for a particularly sick patient, took my spot. I then resolved to quit ICU.
🚨 Call out to @NHSEngland resident doctors 🚨. Please send photos / descriptions of your overnight sleeping arrangements in 🏥 . I would like to collate a database of how poor your conditions are. I’ll tag @wesstreeting and @TheBMA so they can improve conditions!.
12
41
352
Today as I brought an patient onto the Paediatric Intensive Care Unit converted now into an adult ICU, I was greeted by paediatric ICU nurses, paediatric doctors and other people redeployed to look after adults. I 💙 them.
8
27
336
I went in to visit my new hospital. There is a canteen in the main operating theatre suite and there's free food!.
12
20
316
Our local kids' holiday club is hiring for a holiday activity & food coordinator. Decent salary £38,500 per year. No nights or weekends, 36hrs per week. Travel expenses paid. 7 weeks annual leave. Opportunity to work from home for some of the week. NB: FY2 salary is £34,012/yr.
6
45
310
7) We cannot simultaneously claim that to deliver a safe anaesthetic you need a medical degree and years of training, whilst also claiming that all you need is a undergrad science degree and 2 years additional training. This fails logic.
2
55
313
If anybody is wondering how General Practice is doing in the UK, my wife's practice is losing 1 partner to early retirement in the next 2 months, and 3 Salaried GPs have given notice: one to go to work abroad, one to got work in private practice, and one to reboot themselves.
13
103
298
This is the same Singapore that offers consultant doctors ~£180k salaries upon completion of training. .
Oh yeah sure Wes, we love holding our hand out for more money when the corridors are full of patients, people can't leave hospital, and we can't offload ambulances. Yep we just ask for money for no reason at all.
5
47
301
Today it has been 2 months since I started working at Singapore General Hospital, and I've really enjoyed the transition. I've anaesthetised just over 100 patients during this time, and I think I have a sense of how things work in a new healthcare system now. It's been great!.
8
9
297
A resounding mandate if you ask the government about the Brexit referendum.
BMA consultant members in England have voted 51% against the offer in the pay referendum. The result demonstrates that consultants still have considerable concerns about the offer. Read the full results and next steps 👇.
1
31
288
The UK has been both the leading light (vaccines, research, NHS ICU capacity ramp up) and the most disastrous country (high death rates, appalling numbers, useless track and trace) during the pandemic. I cannot square the two sides in my head.
38
35
275
Medical doctor edition.
5
34
286
On my way home from work. Another long day shift done. ICUs are rammed. As the anaesthetic registrar on call today, I was floated between ICUs and resus today transferring patients to CT and proning patients. We had 4 other anaesthetists doing similar jobs.
16
62
254
The UK has some kind of perverse cultural norm where someone with expertise is labelled as elitist. Elitism in itself is seen as fundamentally wrong, and therefore expertise should be expunged. Same reason why able kids are labelled as swots or geeks at school. It has to stop.
Why is it controversial to say that someone treating me in hospital, or performing an operation on me, should as a bare minimum hold a medical degree? Am I an elitist bully for saying this?.Sure medical school is hard. Getting in is tough too. But for a very good reason.
11
43
268
@rosieICM There is much anger. The anger comes from a real place. To completely brush this anger aside and label it as some kind of irrational reflex reaction is also not right. Postgrad docs in training feel abandoned in favour of allied health professionals. That's where it comes from.
22
19
265
So. Not enough money for doctors, but enough to expand the role of Medical Associate Professionals? Simultaneously telling trusts to cut doctor number, whilst also telling them to expand PAs and AAs. Clearly there is an agenda here.
ICYMI: NHS faces severe cuts as £4.5bn budget blackhole emerges. Chief execs have been told to "think the unthinkable"
7
92
267
On training, expertise and minimum standards:. Currently there's a lot of talk about alternative practitioners delivering care in medicine. Many people claim to have undergone different pathways in their training but are still able to deliver the same level of care to patients.
10
92
255
This is a load of bollocks. The critical care capacity has been ramped up. We are nursing patients 2 to a space in some units and therefore now counting one bedspace as two. Without showing the denominator the percentage occupancy only tells half the story. .
New chart: How full are NHS critical care beds? From The Spectator's live data hub: (Red=latest, blue= 5yr average.)
8
93
252
To all NHS consultant colleagues striking today: good on you! We will no longer tolerate real world wage reductions!. To those who aren't striking: you're entitled to your views, but please don't undermine the majority of us who have chosen to strike with self-righteous tweets.
2
29
262
This is a backdoor to conflating MAPs with doctors. If Doctors, PAs and AAs are all going to be known as "medical practitioners", then why should anybody bother pursuing years of gruelling training? This is selling the professional identity of doctors down the River Styx.
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.
8
40
262
Medical associates (PAs and AAs) and nursing associates, are two sides of the same coin: the government is clearly cheapening and dumbing down both the medical and nursing profession. The next government must reverse this.
Newly qualified nurses unable to find jobs in the NHS while hospitals cut posts and substitute nurses for nursing associates.
2
57
235
@NoStaticAtAll You can ask your junior colleagues how to do their tasks over the next 2 weeks. There's enough time to cover everything. That's more time than a new FY1, SHO or Reg gets to learn the basics whenever they rotate into a new trust with totally different systems.
1
16
244
Anaesthetic charts over the course of a 12hr operation.
5
14
241
@RCoANews Are we sure this is the level of supervision that the college members support? I recall the 2nd motion of the EGM suggesting that level 1 supervision was what was being proposed. The @Assoc_Anaes also supports 1:1.
3
28
232
@LordPhilofBrum Where's the #bekind for doctors who have had their training opportunities and funding cut? Thousands who apply every year for smaller and smaller numbers of training jobs? And once they're in those jobs they're told opportunities are reserved for PAs because they don't rotate?.
3
27
242
Given the events of yesterday's @RCPhysicians EGM, I would like to remind people that members do not need to keep paying into their coffers. If their worry is more about the finances than patient safety or the welfare of their physician members, give them more financial worries.
4
56
239
@RCollEM @EMTAcommittee @EMSAS_RCEM @RCEMACPForum @RCEMpresident @RCEMdean @RCEMPolicyVP @RCEMmembersVP @dsdarbyshire @RCEMACPChair @RCEM_VP @6bd20de2260e4ea Just leaving this here.
7
14
234
And another one leaves the NHS. I will say this though: leaving the NHS has made me regain my joy for practising medicine now that I have moved to another health system and another country.
I’m tapping out. Anyone that wants to throw their hat into the ring of medical leadership is still just as egotistical and unhelpful as their forebears . After seeing out my current commitments you can find me in private practice and I tried as hard as I possibly could. I’m sorry.
13
25
240
If the argument is that the RCoA can only advocate but is unable to control the numbers of training posts, as that is under the control of HEE, then it cannot give assurances that the number of AAs being trained is also going to be constrained. This too is HEE's remit.
15
23
232
Many of the original proponents of the PA/AA experiment are now waking up to the damage they have caused to patient care and the medical profession. I think they never really contemplated the long term effects. They opened Pandora's Box and we are now stuck with a mess to clear.
@doctor_oxford @NHSEngland Well I am a huge advocate for PAs and was one of those who wrote the original guidance, ran one of the largest programs, and chaired the national exam. But if these posters are true, I am equally horrified!!!.
8
35
225
My grandmother died today aged 103 from a massive stroke. She was a loving, thoughtful woman and will be sorely missed by all her family who love her. We are fortunate that she was in our lives.
A bit belated, but in the spirit of #InternationalWomensDay, I want to pay tribute to my maternal grandma who turns 100 in a few days! She raised 7 children in rural Indonesia, while running a provision shop, and surviving WWII occupation by the Japanese. Can we get 100 retweets?
38
6
227
This is worse than previously thought. I had initially understood it to be PAs using doctors' logins via unattended computers, but it turns out they had IT login privileges exceeding their legal responsibilities, and prescribed using them, despite being told they shouldn't do so.
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🧵.
16
61
227
It's been about a 100 days since my friend Kar Hao Teoh, an orthopaedic surgeon at the Princess Alexandria Hospital in Harlow, was murdered on holiday in South Africa. The police didn't render aid as he lay dying. The murderer is still at large.
28
38
220
Looks like we might have started the dominoes falling. From Reddit.
7
29
221
This issue is now getting into the main stream media.
The parents of Emily Chesterton who died after a fatal misdiagnosis by a physician associate, are calling on the government to overhaul the guidelines on how PAs work. Emily's mum explains what happened to Emily while GP Dr Sophie Newton tells ＠susannareid100 and ＠edballs that
1
102
216
We need to acknowledge that either it takes 5 years of undergraduate medicine, 2 years of Foundation Training, and many years of postgraduate training and exams and portfolios to train doctors to care for patients, or it doesn't.
4
39
213
1. Following discussions elsewhere, I present to you:. *A quick tutorial on conditional probability for medics*. Imagine you receive this one line referral, with no additional information: a patient with a raised Troponin I. What's the probability the patient actually has an MI?.
11
77
221
"I looked into medical school. I didn't want to be a doctor. I didn't feel that I could commit myself to studying a number of years.".
We’re taught a bit of everything therefore we are generalists which makes us perfect for seeing undifferentiated patients in GP ‘ . @rcgp is this safe ?
12
31
211
People need to recognise the reason why so many doctors are now using collective action to get their voices heard. There's a palpable anger in the veins of many NHS doctors. Address the issues, stop telling them they're wrong to feel angry, or tell them to tolerate things.
1
42
202
Everyone knows their arguments are weak when they resort to "You're being mean to us!" This is appealing to emotion, and poisoning the well. Our arguments are based on quality of training, fairness, equity and patient safety. We have the moral high ground in this debate.
I just think that the personal abuse PAs have encountered is unacceptable. Unfortunately the NHS has tolerated this sort of behaviour for far too long.
6
40
195
Initial thoughts on this pay deal offer: the ones who will benefit most will be year 8 consultants and higher, ie those who are more likely to have had their mortgages paid off. The younger consultants will see much less of a pay rise than their senior colleagues initially.
28
24
201
What the NHS needs is help with administrative tasks that doctors get bogged down with. Doctor's Assistants can potentially free up time and headspace for doctors to go and do more doctoring. Ask any doctor and they'll say their time is wasted on admin instead of seeing patients.
Hi 👋-Doctor’s Assistant here! I’ll do those bloods/cannulas AND chase the things for you.I’ll also summary draft your discharge letters,ready for you to approve/prescribe on,&remind you (and the consultant!)when it’s time for lunch. No one skips lunch unless doing compressions!.
7
28
201