Margaret McCartney
@mgtmccartney
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evidence https://t.co/pg9KPl5Lyq https://t.co/P4TX6wBDK1… Director, @beirasplace
Glasgow
Joined April 2010
if it's easier to get assisted dying than a place in a hospice we have utterly, royally screwed up.
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‘Why didn’t you speak up sooner’ - I did along with hundreds of other women. But you can’t force others to listen. And it seems that middle aged women are often written off and ignored.
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Could not agree more. These 3 women have done, unpaid, the work that the Scot gov/committees should have done. That evidence based critique has had to be done on this way is damning to @scotgov.
“Human beings can’t change sex. We’re not clownfish. Sex is fixed at birth.".The wonderful @mbmpolicy telling it like it is!.
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Palliative care: most is provided in primary care. The stalwarts here are the amazing DISTRICT NURSES who are one of the most under appreciated professionals and whose numbers have been DECIMATED in recent years.
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just a reminder that doctors have been getting things wrong since the start of time. overwhelming evidence that we don't judge quality of life the same as our patients do, and that discrimination happens against so 'normally' it's almost invisibly;.
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Had a lovely day today @univofstandrews : yes you can do a PhD aged 53. Here is Prof Frank Sullivan who was my fantastic mentor. And yes you can read it here
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Pleased to announce that am I leaving the NHS for Harley Street, where I will be offering a monthly subscription service of total body MRI, 300 innovative blood tests of various sorts and a specialist interest in prescribing off license drugs via remote AI enabled consultation.
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Possibly controversial but. I fear that more less qualified staff create more work and more inefficiencies while also doing more stuff. More gets done but not necessarily the things that need to get done. Costs go up, appts go up, but stress on drs goes up esp in 1st care .
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one of the most shameful things about many parts of the NHS is that it works on the premise that unless you 'engage' you don't really want help. But it is made inherently difficult for the people who most need help to 'engage' to obtain it.
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I am standing again for council for @rcgp . the college needs to stand up for evidence based practice: for example, policy on PAs should not be written by people who are profiting from it; education about eg obesity should not be via companies who are prescribing for it,.
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me in the FT: GPs and the NHS. we (should be) the solution, not the problem. (so lovely to be writing for the FT again, sorry I look so washed out) .
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used to think 'be kind' was nice to advocate for in health services. now I think is used to stop people speaking up, police language, make us feel bad for saying what we see/hear. being truly 'kind' can also be about refusal to comply +should never be about popularity @gmcuk.
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My prediction is that 5-6 years time NHS general practice supply will be akin to NHS dentistry. I fear this is by design.
What an absolute joke. They really are trying to kill off General Practice aren't they?.
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Yes @wesstreeting . Bizarre argument from @sianberry . Evidence of safety and benefit in one cohort with an endocrine disorder is not evidence of safety and benefit in an entirely different cohort without an endocrine disorder and prescribed for an entirely different reason.
“Does he understand that this is at heart discriminatory?”. @TheGreenParty MP @sianberry says the government's indefinite puberty blocker ban makes her “extremely worried and fearful”. For more politics content: ✅
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Delighted to announce new venture. For too long medical tests have been too restricted to only people where there’s evidence of benefit. We think different. Everyone should be allowed them.
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Medical institutions must treat the Cass review as a significant event and act upon it | The BMJ free access
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it's a bit disingenious to say that most NHS contracted GPs are private practices; the contract is very restrictive; the private work is limited to stuff NHS doesn't fund(eg insurance reports), we don't have private patients, our hours/workload/ is heavily held to contract/. .
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I would like AI to:.- work out which of the blood tests I requested never got done.- give patients real time information on how long it's likely to be until they get their secondary care appt, without going through me/secretaries.- populate tickbox referral forms from notes (NB /.
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Disagree. It’s not the NICE decision that’s disappointing , it’s the drug .
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I hope every single clinician who criticised those asking for evidence reads this report. The personal abuse/defamation has hurt. But healthcare leaders failing to listen when asked whether the evidence based thing is being done has hurt many, many more.
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Misleading and unfair to men @ProstateUK. This will inevitably lead to direct and indirect harm. I again implore you to stop with the partial information and refer men to independent evidence based advice.
[4/5] That's why we're calling on the Government to overhaul outdated @NHSuk guidelines so that GPs can start conversations with these men about their higher risk and the option to have a PSA blood test. This move will save thousands of lives every year.
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NHS GP will end up 'doing a dentist'; GP led care will end up being available only to those who can afford it privately. Waiting lists in NHS, already too long, will get longer. good GPs will get burnt out and leave.
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What a joke. Putting responsibility onto doctors for detecting coercion via ‘sincerity’ amd saying this is possible through ‘training’ is just woo-woo. Doctors are not mind readers.
I asked 4 times how a doctor would know whether or not someone had been pressured into assisted dying .👇.
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hello @wesstreeting : honestly, the best thing to do is ensure that the UK National Screening Committee are doing the best job in critically appraising up to date evidence and making fair recommendations;.
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I can never get over the fact that unpaid volunteers are doing more forensic analysis and holding to account than the people paid to do it by taxpayers.
We and @ForWomenScot are calling on the Minister for Victims and Community Safety to stop misrepresenting the law.
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I have reflected and concluded that the reason why women of a certain age often say certain things is because they are often lucky enough to be secure enough in career/ out of four letter words to give/that allows us a little bit more freedom than other women might have.
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except that the NHS National Screening Committee does not recommend screening because harms>benefits. I despair.
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I don't think employers should be paying private companies to 'educate' women about the menopause. I think employers should spend these resources making sure that women are not disadvantaged because of their biology and audit themselves on their perfomance. #actionnotlipservice.
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If you are interested in the way politicians try and influence the decisions that NICE takes about what drugs to approve, and what general practice does, and how evidence is regarded. please do read this. (I cannot tell you how many hours this took. What we found was shocking.).
A year-long investigation by @deb_cohen and @mgtmccartney has raised questions over the influence of the UK government and NHS England on NICE’s approval of cholesterol-lowering drug inclisiran.
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except most winter viruses will go away by themselves and don't need specific treatment let alone appts with healthcare staff - and most members of the public know this and wouldn't dream of going to a GP with a cold!.
But the public can play their part too - please do seek help when you need it. We would rather see you sooner when viruses are easier to treat, than later when it is more difficult.
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Where is evidence that more pharmacy prescribing will reduce workload of GPs? Fragmented care and net result of more activity won’t help. Far better to sort the small everyday time consuming things eg request to change rx from a 200mg tablet to 2X100mg due to ‘stock shortages’….
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Hi @drlouisenewson this looks like non randomised study with no control group of selected patients attending your clinic and has not been peer reviewed, am I right? I can’t find a pre published protocol or registration, can you direct me? Thankyou.
I’m so excited to share this new, observational research with you. Current UK NICE guidelines recommend testosterone should only be considered for perimenopausal and menopausal women who have reduced sexual desire, but actually our research reflects what many of us notice in
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There is no way I would get into medical school now amd I would totally fail all those SJTs. But they are also horrific: what happened to encouraging people to think for themselves? They don’t reflect reality. Medicine NEEDs rebels.
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not yet seen a fatal accident inquiry/coroners report that concludes that less training is required for healthcare professionals.
Richard Meddings - Chair of NHS England ‘Doctors are over-qualified’.Asked if it should be possible to train a doctor in less than 7 years.‘I would have thought so. Or you go to physician associates – so you change the skill levels’. NHS England Board has Post Office Board ‘vibe’
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Who is advising @wesstreeting ? You urgently need people who understand recent history and NHS. Underfunding leads to ‘reform’ because the system shrinks to fit. General practice (scotland too) is on its knees. Does anyone care enough to offer an evidence based response?.
This week I saw first-hand the difference that the @AustralianLabor government is making in Australia - with urgent care clinics that relieve pressure on GPs and A&E departments. @Keir_Starmer’s @UKLabour government will adopt this approach with new Neighbourhood Health Centres.
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oh jeez @BBCr4today : prostate cancer - you are not giving useful information. screening is complex and contains harms. lead time bias needs accounted for. lobby groups need their campaigning information caveated and questioned.
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Preventive care is primarily about reducing social inequalities, population health, wages and work, pollution, childcare, travel infrastructure, etc etc - the nhs can’t do that. Statins don’t remove poverty. Real public health prevention takes place well away from NHS.
“I’m concerned that we patch people up and send them back to rubbish lives. We’re a sickness service and we need to become a health service.” - Professor Dame @HelenStokesLam . #TacklingInequalities #Narrowthegap.
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If we were truly a private business we would make more money for less stress:.-Refuse to register highest need patients.-Offer woo-woo ‘health checks’ for £££.- stop doing house calls (too much time).- give customers a glossy brochure of health test results to take to NHS GP.
it's a bit disingenious to say that most NHS contracted GPs are private practices; the contract is very restrictive; the private work is limited to stuff NHS doesn't fund(eg insurance reports), we don't have private patients, our hours/workload/ is heavily held to contract/. .
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One of biggest current problems is that multiple well evidenced scandals in plain sight, but unless a popular drama is made, our public service /elected representatives fail to recognise, far less respond. And even when they do, response is inadequate/superficial.
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@doctor_oxford is absolutely right. it is appalling that @NHSEngland are deliberating obfuscating and confusing people - they are making a choice not to fund GPs. what an absolute mess. are we to just to wait for the inquiry in 10 years time to tell us 'mistakes were made'?.
I’m simply horrified to see @NHSEngland now literally breaking the law in how it misrepresents physician associates & other allied health professional - who are NOT doctors - to the public. These posters are from the Bradford District & Craven Health & Care Partnership. 1/n
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an observation, the doctors who I think really are totally skilled, smart, dedicated, good ethical people. don't go around saying they are a 'top doctor' on their websites.
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it can be very hard to publicly change your mind. but when people challenge themselves through reading, critiquing and reflecting on evidence/actions, it can be a sign of great personal character to do so.
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I am still reading this NHS doc and having the uncontrollable giggles because the alternative is sobbing for what we have lost by design - GP led, expert generalist, professional care as point of contact for UK population. maybe this will wake us up.
I looked at this and confirmed this is the main problem with the NHS plan . By removing the skilled clinicians at the beginning of the pathway it has massively raised the cost and time of the whole journey . A GP would have managed this without all this time wasted and imaging -.
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"prescribed". I give in, I can't take it any more.
Nature to be prescribed to GP patients in England for first time
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this is frankly wild.the number of investigations done does not equal quality, cost effective, or sustainable care!. PS @DrSteveTaylor end goal here is to reduce GPs. the NHS will end up doing lots more of far more costly stuff but be far less effective and eat itself.
So this is the new great idea🤔.I’m pretty sure if Sarah had seen a GP she wouldn’t have needed to have a CT scan, no need to speak to the ENT registrar & yes it could be managed in the community .Why does NHS England always underestimate the skills of GPs.
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if someone is confidently talking rubbish about one thing maybe consider that they are also confidently talking rubbish about lots of other things.
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So many folk who would not have dreamed of going private a decade ago now are as nhs waits appalling. GPs leaving the NHS as it’s unsustainable. GP will end up like dentistry - harder to get NHS care. A tragedy in plain sight and a governmental choice.
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It’s very tempting to think that a positive screening test ‘saved a life’. But the only way we know about a mortality reduction for a population is via controlled trials. And even then we can’t predict well for individuals. Meantime, the worse a test is, the more/.
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Just wondering what the criteria are for ‘leading clinician’ and ‘top doctor’ if anyone can let me know ta.
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I really don’t think I’d apply to go to medical school again.
This is the job where I was the on call doctor (extremely busy) & got messages from a PA working as 'registrar level' about ward jobs like prescribing & ordering scan etc. for patients whom the PA saw on the ward round. So that the PA can go to their own clinics & theatres.
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hello @KPMG , I would love to see what evidence you have that fragmenting primary care into tiny little shattered pieces is good for patients, staff, the NHS, or taxpayers
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Where does the leader of this political party get science/health advice from? . This is the new antivax movement.
Patrick Harvie, co-leader of the Scottish greens spreading misinformation about the Cass Report and stoking a culture war by refusing to deny or condemn his colleague Ross Greer’s description of it as a transphobic conservative report. This is irresponsible and dangerous.
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if someone is giving you health information but also trying to sell you something, there is a conflict of interest. .
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This stuff is heartbreaking. Does @wesstreeting think that people should be forced to come in face to face to speak to a dr for few mins for something that could have been done more conveniently on phone? The judgment on a broken profession is staggering.
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critical appraisal of evidence is a key skill in medicine. It is far, far better to admit that you don't understand something than to defend the indefensible - and far worse, harm patients- because you cannot discount your personal belief system in the face of evidence.
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This is totally, totally nuts. Either you need standards and exams and years of training or you don’t. We are going backwards . UK primary care used to be ‘jewel in the crown’ of NHS. Now, esp with appalling %uplift in England, is designing it to fail. Utterly preventable tragedy.
The most vulnerable and complex patients to the untrained, unqualified ‘professional’. And worryingly that’s also the GP practice where I’m registered.
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When one considers the current concerns for actual patient safety in the UK, this seems …. Somewhat misjudged @gmcuk . doctors involved in climate protests face threat of being struck off | Environmental activism | The Guardian
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professionals who block other professionals who (politely) critique their critique isn't quite how I'd recommend doing evidence based medicine.
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Is anyone collecting data on private sector ADHD diagnosis which are/aren’t validated in an NHS assessment?. Also interested to know if any NHS GPs have seen private clinic assessment reports which concludes that ADHD is not diagnosed / serious question.
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What I would really like is for us to be having fewer distracting convos about how big a bunch of flowers/box of chocs are and more about what GMC recommend should be done about doctors who conceal large important financial conflicts from employers, patients or colleagues.
From the end of this month, doctors should not accept ‘an unsolicited gift’ unless it is ‘of minimal value’, defined as gifts such as flowers, fruit, sweets or cake.
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this survey by the @rcgp on PAs is terrifying, basically, and the question must also be how on earth we got here. the @gmcuk @RCPhysicians and gov have serious questions to answer; meantime there are GPs who can't get jobs. what's the plan, @wesstreeting ?.
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Oh dear oh dear oh dear. Real prevention is primarily; eradicate poverty, good housing, active transport, adequate childcare, green spaces, tobacco/food/sugar/alcohol/gambling legislation - and over that, a well funded primary care service.
Personalised prevention. Not *necessarily* a bad idea, but big holes in the evidence base, significant potential for over-treatment and might have fitted better with a Conservative govt than Labour. What do you think @felly500 @SebRees1 @rcsloggett @mgtmccartney ?.
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just as well UK health and social care is so well resourced and organised, with no concerns about medical power , evidence and whistleblowing, that surely nothing could go possibly wrong.
Less than 3 weeks before it's due to be debated, Kim Leadbeater MP has finally published the text of her assisted suicide bill. It's 38 pages long, has 43 clauses and 6 schedules. MPs will have a maximum of five hours to debate it.
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Hi @BBCr4today you seem to have just advocated a screening programme for dementia for 50year olds with no discussion of the multiple issues this raises. Where is balance ?.
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have had accusations that I am too serious and no fun. I am a lot of fun. (unpublished evidence, but peer reviewed).
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the only reason why medicine should have power is because it should act on evidence, and acknowledge and reduce uncertainty. anything else may as well be homeopathy.
People who passionately believe they are doing good can do grave harm. What matters is evidence. #CassReview.
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call me old fashioned but if you politely ask a healthcare professional the nature of their relationship with a commercial organisation they are endorsing/publicising, I think it's a good idea to answer.
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The job of a doctor is not necessarily to be kind | The BMJ
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now is a good time for easy spots on who really does not understand evidence based medicine, and are basing their practice and views on ideology instead.
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People going on about the importance of prevention. Well of course. But without acknowledging the conscious underfunding and undermining of UK public health it’s just sound bites/‘public health’ lite, not the hard deep work of addressing inequality.
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hey @BBCr4today - who didn’t respond to my emails / here’s a critique of your dreadful coverage . Prostate cancer screening: what work should GPs stop doing so they can do this work instead? | The BMJ
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yet it's ok for drs to: conceal large financial conflicts of interest, offer utterly non evidence based £££ whole body screening nonsense, prescribe garbage for autism, spread myths about vaccination harm, or inject people with expensive evidence-free vitamin infusions for lucre.
BREAKING: Doctor Sarah Benn found guilty of professional misconduct after being imprisoned for upholding vital sign. Full Story Here:
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I'm really hoping this will be done: .-guided by evidence.-wary of unintended consequences.-without incurring target distortions.-without (further) compromising discontinuity of care. fast access/quality/continuity pick two etc.
My Labour government will end the 8am scramble for GP appointments.
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the attack on rationality and evidence continues. you can't change your sex.
'How the UK's highest court is about to decide what a "woman" is.'. Whatever the outcome of the case, it won't change what a woman is. What the court's really deciding is whether or not to remove rights from women and girls.
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for all new guidance/lobby requests, 'gps should' etc, need to work out what % of primary care time the new *thing* will take up, and either 1)what we will stop to fit this in 2)what new resources we will need to do this. and don't start until you have sorted that. #NHSCrisis.
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Why do royal colleges exist?.Why were they set up?.Either we need training and standards and accountability for everyone doing certain jobs, or we don’t.
@Dr_Done_ @RCRadiologists “What qualifications do you have for this role” “oh well, X consultant said I was competent to do it”. Does anyone know why national training programmes, standards and examinations exist? Anyone? 🤯
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The power of someone you admire believing in you and making contact in the worst times should never be underestimated. Write letters to people you appreciate. Keep all your Thankyou notes ❤️.
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to all the people who send 'keep going' messages, I cannot tell you enough how much I appreciate it thankyou 💕💕💕.
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as an NHS dr, it makes me sad and angry to see the NHS being underresourced +politicians spending money on projects of little value to patients, which I believe to be unethical and unforgivable.
As a former NHS doctor, it makes me sad and angry to see doctors involved in action which I believe to be unethical and unforgivable, given the harm being done to patients and the NHS itself.
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there are upteen private clinics offering these drugs to people unseen and remotely. it is absolutely NOT ok to pass info to NHS GP with the expectation that we will safety net/
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menopause has become a marketing extravaganza. herbal tea. wellness. do send me your most egregious examples. would love to see an RCT of fair pay and conditions vs workplace 'menopause awareness' sticker days.
dismaying proposals from the APPG on menopause . many not evidence based. true 'menopause revolution' would recognise that conflicts of interest in healthcare -> bias and skewed information. no reply when wrote to the appg either. women deserve better
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and just a practical point. if you want to accuse me of fearmongering, I assume you know the special secret password to finding a hospice bed for a patient whenever it's needed and have neglected to tell the rest of us who actually do this work.
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Making the most disadvantaged students into disadvantaged doctors is…. distinctly regressive, unfair and solving the wrong problem.
A four year undergraduate medical degree, separate from graduate entry degree programmes, is set to launch in 2026, NHS England has said.
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Happy Christmas , esp to everyone keeping the NHS going today. And to everyone else who seems to have forgotten several vital ingredients to make lunch.
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‘Disrupting’. What does this even mean? If it’s not evidence based it may as well be homeopathy …. .
🙌🏾 It’s OPEN! @NekoHealth is now in London - proud to have had a tiny part in disrupting the prevention landscape. Want to know more about it? Watch my (amateur) reel and check out for more info:. #prevention #NHS #healthcare #neko
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I’d quite like to be in the House of Lords, but via being competitively interviewed, and on the basis of my experience, abilities, and knowledge.
What a way to treat your colleagues. Shame on the @RCGP.
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deeply amused that gov think that reducing time to train drs will help. hahhahhahaa. retention, retention, retention.
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Gisele Pelicot ❤️.What a woman. Shame must indeed change sides.
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Being an employer of PAs (ie a GP partner is choosing to employ a PA >GP and saving £ as a result) is a COI. Profiting from training programmes is too. Transparency is not enough. Conflicted people shouldn’t be allowed to make decisions for the college membership.
Some RCGP leaders are either employers of PAs or have/had roles in training . In terms of the current discussions this may be useful as these GPs are experienced in the use & potential scope of practice. But it’s important there is complete transparency in meetings at RCGP re PAs
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Dear @StanCollymore @ProstateUK please stop this misleading advice. It’s grossly unfair to men. Listen to this for balance and information about the profound uncertainties
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This is rather a mess. I don’t think this can be effectively regulated . What is the impact going to be on applications to medical school and doctor burnout ?.
Literally mins before House of Lords debate @gmcuk release >200page report confirming scope is NOT their problem. Employers can do whatever the hell they wish. A true medicolegal Wild West. #PhysicianAssociates Peers you and the public are being played
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Just a reminder that many people claim they write things that are ‘evidence based’ and they are not. They may be garbage. Many citations ≠ evidence based. Citing stuff in preprint ≠ evidence based. Mistaking association for causation when it suits you is not evidence based.
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sometimes am reading something by expert I respect ++ but they are now out of usual area, writing on something I happen to know a lot about, and they are v wrong, and then I have to question absolutely everything I've ever read by them, this is immensely disappointing.
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I do wonder of the wisdom of prioritising individual healthcare interventions (with long term effectiveness uncertainty) before mass public health interventions. One supports industry while the other challenges it.
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Which political party has the best strategy for creating evidence based health policy?. Right now I’m seeing very few politicians even acknowledge need for evidence let alone doing it.
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Hello health journalists. If reporting a ‘break through’ may I suggest 1) reporting any relevant conflicts of interest of experts quoted 2) referring to actual study for data rather than interpretation of meaning of that data by aforesaid experts 3) include info on effects.
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