Dr Gordon Caldwell
@doctorcaldwell
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I worked as a Doctor for NHS for 42y from 1980. I live in Ballachulish, Scotland.
Ballachulish, Scotland
Joined February 2009
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Pinned Tweet
#DiagnosticDoodling
to support Clinical Reasoning when assessing new acute patients. Senior jots notes as case is presented by Junior Doctor. Widens reasoning, shows Senior's thought processes.
3
1
15
I get angry that we should teach & train in
#Resilience
rather than create work environments in which less resilience is required
#AMEE2017
75
455
1K
Nursing Assessment Forms for One Admission
@helenbevan
@DrRHelliwell
@nhshBoyd
@TheIHI
@danielleofri
@Atul_Gawande
@donberwick
@maureenbis
@fgodlee
@nmcnews
Oops
Forgot the Treatment Escalation Plan and
#DNACPR
@ianmcnicoll
228
396
767
#NHS
Mandatory Training under the spotlight. I've been arguing for over a decade that it's worse than a waste of time. We learn to cheat, we learn nothing useful, antagonises us against management, takes time away from doing patient care.
@somersetwyvern
@pamkato
@GavinLarner
70
114
747
In memory of
@GrangerKate
from tomorrow vow to know the person BEFORE making the person into a patient
#HelloMyNameIs
and
#WhoAreYou
5
517
727
During 29y as
#NHS
Consultant I saw empathy in Doctors, Nurses, Admin staff being crushed by Target driven culture set by Governments. I saw abuse of staff eg no food during relentless 13hr night shifts. Don't mistreat staff then blame them for lack of empathy.
@jotalbotbowen
37
143
620
Why can't I prescribe ice cream and milk shakes in Hospital? Its about the only food the patient with dysphagia wants and can eat. Gets presented with pureed shepherd's pie, b***** Fortisips but not ice cream & milk shakes
What happens to our minds in hospital?
@DrGrumble
82
111
410
How often do we bother to thank people for well done mundane work? eg well written Discharge Summary
@vincentconnolly
@PeteGordon68
@stephen_t_webb
@StephenHearns1
@DrGrumble
@DrUmeshPrabhu
@TheIHI
@helenbevan
24
71
403
Think Sepsis
does not mean
It is Sepsis and you must treat for Sepsis
Patient yesterday about to be given 2 iv antibiotics because WBC 20 lactate 5 after major blood loss from bleeding from leg
Think Sepsis includes deciding it definitely isn’t Sepsis (then still go back)
16
76
374
I anticipate a great career for this Neurosurgical Registrar based on how she handled a phone referral yesterday
#ExcellentIncident
- only takes a moment to say ‘Great work’
@stephen_t_webb
@somersetwyvern
@rakeshspatel
24
34
356
@Roddy_Neilson
I had a patient told me she had a headache that came on as suddenly and badly as if she had been shot, so I presumed subarachnoid haemorrhage until testing neck stiffness I found blood and an airgun pellet in back of the neck.
10
5
302
Should all Junior Doctors now resign to avoid future conviction for manslaughter
#BawaGarba
? They all work in similar dangerous systems conducive to clinical errors. This is a terrible day for everyone
@djnicholl
#DavidSellu
@DrUmeshPrabhu
24
202
242
This is not News, it's well known stuff,
Seeing same GP each visit cuts workloads and improves health.
I'm sure same applies in Outpatients and for
#WardRounds
, but UK Governments,
#NHS
& Colleges have happily destroyed Continuity of Doctors & Nurses for Patients.
18
63
252
@gmcuk
@DrLKVaughan
@DrGrumble
I was offered a PA in Worthing and was told they would 'See and treat acute patients so my Junior Doctors could get on with Discharge Summaries'! I did not take up the offer. I asked for a 2nd Ward Clerk & was told there was no £.
17
71
245
Tragic case, man died after fall & head injury. Ward was understaffed, ward asked repeatedly for more staff, but one of the responses, according to Director was more training for staff? Staff did everything correctly
@NHSwhistleblowr
@drcmday
@danielgoyal
19
106
233
@drkathrynmannix
@K_G_Spearpoint
@DrLindaDykes
@katemasters67
@ResusCouncilUK
@gmcuk
@theRCN
@nmcnews
I want a nurse like this in my last moments, not one who follows the letter of the law. A nurse who follows the 7 Cs.
40
29
227
I'm bowled over by this email from someone who was a Foundation Doctor in our Team at Worthing and now has their Certificate of Completion of Training.
#ReverseRoleRounds
True
#Apprenticeship
in Medicine
The value of descriptive Thank you
@christiplady
@somersetwyvern
23
26
227
.
@julia_prague
I advise all Junior Doctors in England to read details of this case & reconsider continuing to work in England
#BawaGarba
- understaffed department, 1 Reg not 2, very busy day, inadequate Consultant supervision, patient dead, Junior struck off for life by
@gmcuk
I now have no confidence in the
@gmcuk
to protect me if I have acted professionally but the outcome is poor because of the very poor working environment we all now work in
@TimRayment
@vsmacdonald
@DrUmeshPrabhu
15
67
141
11
204
213
Chair of Medicine
Professor of
#WardRounds
A relative commended me for using this on rounds because it improved the bedside communications.
Ward nurses also think it’s a good idea.
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38
216
We have set up 2nd desk in my office for Death Certification. FY1 & FY2 undisturbed for 20 minutes including doing Discharge Summary - on the Ward they were being interrupted 4x in same period of time. Interruptions slow work down & disrupt thinking
24
19
212
Same themes as in Mid Staff's, Managers and Leaders not listening to frontline staff. Yet another Inquiry and the NHS will say Lessons have been Learned ...
@peter__duffy
@NHSwhistleblowr
@drcmday
26
77
203
I can fully support this paragraph in Advanced Life Support from
@ResusCouncilUK
@katemasters67
9
109
191
@iDrSunny
Can we see evidence that hereditary peerages are a good basis for national decisions making?
Can we have evidence that our current parliamentary practices are fit for purpose in a complex modern society?
2
21
190
@MichaelWarbur17
@DamianShields1
I asked Leaders 10 Questions about Leadership and
#TonyBenn
replied
8
34
182
@nialldowney
Medical Student ‘Who could possibly object to
#Checklists
, I use them all the time?’
Me ‘Who could object? In my experience nearly every senior
#NHS
Doctor.’
21
30
180
I have submitted my response to
@gmcuk
on Physicians and Anaesthetics Associates
I cannot understand why the
#GMC
thinks it can regulate a "Profession" that has no definition, no mandatory minimum learning, no standard validated exams
@DrLKVaughan
6
61
183
FY2 ‘So Dr Caldwell what treatment do you recommend for my patient?
Me ‘A cup of tea, some toast & certainly don’t run that drip after 10pm disturbing everyone’s sleep’
FY2 ‘Can I really write that as the immediate review management plan?’
Me ‘Yes, of course’
One happy FY2 😀
10
8
180
As a Houseman I saw the patients in A&E, then it became the SHO’s role when I was SHO, then the Registrar’s as Registrar & now on my last night on take after 28y as a Consultant I’m waiting for the arrival of a patient in A&E …
@DrGrumble
@IamBonglie
@LuiForni
@Siggers1000
19
19
176
My flight to Glasgow is 2 hours late because the Pilots did not have enough time and fresh pilots had to be found. Imagine if
#NHS
had to do same once Nurses and Doctors had worked 13hours? If employer had to insist work stopped or employer was accountable?
@gavin_larner
22
53
176
One of our frail patients was missing on
#WardRounds
today - our Nurses & HCAs had seen the sun, dressed the person in warm clothes and wheeled them out onto the balcony resulting in refreshment and renewal - that’s excellence in Nursing Care
@K_G_Spearpoint
@maggiedavies
10
5
174
6y living here and each day can still create stunning moments
7
7
173
What’s going on?
94 Applicants for one Clinical Fellow post in
#Oban
Hospital!
I know we are good people and the lunch is fantastic, but 94 😀😀😀
It is back to the days of the
#LostTribe
?
@pdbyrne
@DrLKVaughan
@DrGrumble
@drlynnmccallum
35
12
166
I feel very disgruntled this morning
Judge made
@gmcuk
pay full costs of
#BawaGarba
Appeal
My mandatory
@gmcuk
Membership costs of about £800/y have been used to hound Dr
#BawaGarba
& then pay for the the costs of
@gmcuk
folly
Can we have a Shareholder meeting?
@djnicholl
13
42
151
Kitchen window whilst cooking dinner
@s_iwanczak
@cpicker_cp
@rongord
@inveresregan
@bluerhodfa
@Trisha_the_doc
@valle_erling
15
5
150
The promise of a perfect first day in 42y not working for the
#NHS
....
@somersetwyvern
@RoyLilley
@drkimholt
@rogerkline
@TracyBoylin
36
4
153
I read quite a lot I object to on Handovers but ‘Not coping at home’ really rankles, implying patients families & carers should just pull their socks up & manage to cope against overwhelming clinical emotional & survival challenges. ‘Let down by society’ might be more truthful?
21
19
150
Avoiding
#Misdiagnosis
Imagine if the patient asked
How certain are you of my Diagnosis?
What are your top three alternative Diagnoses for my case?
What Diagnosis must you not miss that would fit my symptoms?
@IMreasoning
@TheIHI
@rakeshspatel
@ImproveDX
@jasonrmaude
29
62
147
I now have no confidence in the
@gmcuk
to protect me if I have acted professionally but the outcome is poor because of the very poor working environment we all now work in
@TimRayment
@vsmacdonald
@DrUmeshPrabhu
15
67
141
@DrLindaDykes
When Consultants were allowed time to eat lunch together at least half the conversations were picking each others' brains to improve their current patients' care.
Not asking for support is far more dangerous than asking too often.
Boasting about not asking is a Big Red Flag.
9
23
143
Ideal ward design - each patient visible each patient has own en suite - lets get building post
#Covid19
Hospitals
@christiplady
@chrisbiggin
#NHS
@WHO
@TheIHI
@TheKingsFund
@nedwards_1
@DrLKVaughan
@NHSHighland
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24
145
@Trisha_the_doc
last year a very elderly patient had a stroke and determined
1 to reach 100y
2 to knit me socks to wear with my kilt, they were delivered today!
4
4
143
New view of our Cottage after clearing out of control trees in back garden.
@inveresregan
@JonMeeten
@CarolynFahm
@DrFulli
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6
145
#Covid19
#NightShiftGift
If you were coming off a gruelling night shift in
#NHS
Hospital or a Care Home etc what small gift would give you a lift? A carry out coffee? A soap? Ideas please to boost our night staff.
#Covid19
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26
141
8
11
142
Feeling of gloom descending starting a 6hr phone clinic - I went into medicine to consult with humans face to face, working in a team, not imprisoned in a cell talking on a phone with people I’ve not met
@Iona_heath
@trishgreenhalgh
@somersetwyvern
@JohnLauner
@rakeshspatel
30
14
140
@kilgore_cliff
When I did deprescibing ward rounds with a Prescribing Pharmacist the common meds we stopped were:
Alendronate
Omeprazole
Statins
Aspirin or Clopidogrel
Blood pressure lowering agents
Anticoagulants
Benziodiazepines
Calcium (but continue Vitamin D)
@mgtmccartney
15
18
140
@HRHMHowler
One of my patients with dementia said her job had been a call girl and she used to be very busy. Her work had been a switchboard operator.
4
1
136
@DrCArmitage
That's only 1/2 of the forms! There are two sides on each. And more on the computers.
10
33
140
I may look a Wally but Dragon Voice To Text in Outpatients means my Letters have reached GP before patient has left the Hospital - used to be a 12 weeks delay. Local GPs very happy. Copy to patient by
#RoyalMail
within 48 hours
@helenbevan
��
@DrUmeshPrabhu
@theIHI
15
38
135
Life is a mystery
How come the duvet cover always unbuttons itself in the tumble drier then swallows the pillow cases so they are damp balls trapped way down at the bottom? 😤
26
7
135
I was having my usual rant about pain scores which I abhor. A&E nurse then told me ‘We use them to triage patients’!
So if you go to our A&E just say your pain score is 10.
45
24
135
@patientsafe3
Today’s crazy idea - made a sticker of my face and name to stick on scrubs when I’ve got a mask on
#HelloMyNameIs
#Covid19
#NHS
17
12
132
A Driving Licence is mandatory to be able to enjoy the freedom of the roads
A Yellow Fever Certificate is required to enjoy the freedom to explore many countries
HepB vaccine needed to enjoy frontline hospital work
A Covid19 Vaccination Certificate could reopen many freedoms?
11
16
132
How did our UK Medical Profession come to accept that Triage and Diagnosis can safely be made from a Predetermined Script? That's not the mental process in Triage and Diagnosis and dangerous to patients & unfair on call handlers.
@peter__duffy
@somersetwyvern
@RCPEdin
17
38
133
At last! Evidence that continuity of Consultant is good for patients, training, reducing length of stay and complaints and improving discharge planning. Superb work!
@TheKingsFund
@DrLKVaughan
@somersetwyvern
12
33
132
97% of Junior Doctors vote for Industrial Action.
How can a Government alienate so many co.mitted staff?
5
25
128
Jack Adcock
#BawaGarba
#IsabelAmaro
It comes down to this
Were the Doctor and Nurse criminally dangerous
Or was the situation and context dangerous
I go for the latter and what I say is that similar situation & context are now ordinary at NHS frontline
10
46
127
#Repersonalise
the
#NHS
How we name & label patient shows how we think about & treat
Bed blocker in 5 = Target Centred Care
Aneurysm in 5 = Disease Centred Care
Mr J Retired primary school teacher desperate to see his grandchildren had major aneurysm surgery = Person Centred
7
60
127
The cleaning required after one person with flu attends A&E is huge - if you have an ordinary dose of the flu, please stay at home
@DrLindaDykes
@vincentconnolly
@DrUmeshPrabhu
6
69
127
Arrival of dual screens has caused such happiness in our Junior Doctors - small investment, big return in efficiency and safety in patient care and doctors’ mood
@PeteGordon68
@jotalbotbowen
6
13
126
3
8
120
I could almost be tempted to have a dog ..... one of the
#Ardnamurchan
lighthouse cafe resident dogs
16
1
120
Today I have learned that a lot of UK Doctors believe patients should not have easy access to their health record
And many of those who believe they should, won’t because record is so shamefully badly organised & often wrong that it’s not Fit For Sharing & will upset patients
36
62
120
It’s interesting I’m being told how long is ideal in
#NHS
for Clinical Consultations in Outpatients by ‘management’, who can hold as many meetings of undefined purpose and length as they wish at short notice & expect my participation
@djnicholl
@PeteGordon68
@vincentconnolly
9
22
117
I bought the only home in the world with this view!
I see this as I eat my Sunday bacon butties
If your dreams are not big enough to frighten you, they are not big enough
#Ardea
#SouthBallachulish
@angleseyboy
@mmbangor
8
9
114
What episode of avoidable harm to a patient had the greatest impact on you as hands on, observer or Investigator? What did you learn?
I was in a team when new Doctor mixed antibiotic with potassium not sodium chloride & injected into central line, patient died.
Systems matter.
54
24
114
Physician Associates Job Ad blunder, from today's Glasgow Herald.
I recommend that the professional title is changed to
Doctors' Clinical Assistant
To reduce the confusion about their role.
@gmcuk
@TheBMA
@HCSANews
@trentconsultant
8
42
109
@WelshGasDoc
It's not Work / Life balance its essential refreshment time away from work. HGV drivers, Pilots, Train Drivers all have strict limits on hours & mandatory refreshment time, but not Consultants, who are already working 48 hours weeks. No guarantee of 11 hours between shifts.
3
9
114
@danielgoyal
Reminds me of having to go into work the morning after the
#Brexit
vote. Why did UK citizens vote to send 1/3rd of ward staff out of UK?
15
12
113
Nurse Tutor to naive Student
What do you think this patient needs?
Student
Good meal, cup of tea
Arm to lean on way to toilet
And a chat
Oh no, don’t be all smart on me, she needs a 32 page assessment form, & referral forms to OT & Physio
Let’s get started at the basics
9
22
110
@gmcuk
@DrLKVaughan
@DrGrumble
The
@gmcuk
is completely out of touch with frontline working eg I had to handwrite 4 identical request forms per patient for imaging in TIA Clinic in 2021. Change the process or give me a Clerk, but instead they've developed PAs to work in same gross inefficiency.
@wolvesboy
3
23
109
Sunday Lunch
#Oban
Hospital - today it’s Rhubarb Crumble under the custard
@pdbyrne
@cpicker_cp
12
0
110
Local GP ‘I did a shift in local Hospital and couldn’t believe you have to print GP list of medicines then write onto paper meds chart - it’s so dangerous.... ‘ It’s everyday ...
11
30
111
Looks like an artificial backdrop but this was real! 😊😊😊
@CarolynFahm
@jotalbotbowen
@beans2er
@whole_patients
8
3
110
I remember the best starting to leave from Department of Medicine in
#Worthing
Hospital whilst Dr Rob Haigh was Director and now seen same at
#Oban
and
#FortWilliam
Hospitals under
#NHSHighland
and
#ABHSCP
@peter__duffy
@NHSwhistleblowr
@LuiForni
@Siggers1000
@pressjournal
8
25
109
The conversation between doctor and patient the medical interview is the single most important diagnostic tool in medicine
By
@danielleofri
21
67
106