Owen Scrivens
@scrivvyfloor
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@TaurenDruids
@agentbizzle
Presidential elections should be held to a different criteria than a sports event
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@dx_mighty
You have a unique perspective- but it also highlights just how far back f1 pay has fallen.
Doctor pay really needs addressing
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@elainefrog
@nurse_charming
Palliative care team input should be so much more common on ICU - one hospital offered a training post for an ICU consultant to spend time at a hospice to improve those skills - that would be a dream job for me
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@ajpigott_anna
@DrNeenaJha
Interested in how this was escalated?
A child possibly needing admission with no doctor on site to supervise is surely a huge near miss.
I'd argue that needs reporting to CQC
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@dannyjnwong
@glurcher
@pcricoarytenoid
@ABarotchi1
Then it is 3am and someone needs an urgent chest drain and no one has done one for the past two years.
It is a set of affairs that needs some serious discussion.
The too dangerous for anyone but a specialist until its an emergency paradox
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@DrEilidhMaria
Cannot understand why ICUs would have PAs - when they have a proper system in place for ACCPs. That are actually organised appropriately by the faculty and are in my experience supportive of doctors on rotation.
They are also all regulated and can do the things PAs can't.
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@glurcher
@pcricoarytenoid
@ABarotchi1
Often have this argument when discussing F2s/IMTs on ICU - if they are not going to do ICU is there point in doing airway manoeuvres/CVCs?
If appropriately supervised they may learn skills/be enthused to learn more. Training is more than that specific skill.
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@emeowgencydoc
Having come from a family with mining in the last few generations I am very surprised with how little doctors are angry at each other stepping over the picket line.
It weakens the action - making it more likely to be prolonged - hurting those taking the action.
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@JosephCosgrove7
@RCoANews
@FICMNews
@AnnaBatchelor
@rupert_pearse
@montymythen
@AlisonPittard
I genuinely once had the son of the consultant haematologist shout "Start Taz and Gent" down the phone at me... the answer was the same from his dad
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@TWMCLtd
@deirdreheenan
@FulhamJon
So that article looks specifically at fully qualified specialists (UK consultants) and general practitioners.
Those are not the doctors on strike - although they have had real terms pay decreases as well.
What different countries consider specialists is very varied.
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@ExplosiveEnema2
Is the practice identifiable from the posts to refer to CQC?
I also think there is an argument that this person without any named supervision or debrief is actually practicing medicine without a license
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@arcl
Mid second covid wave - having spent a long time discussing the ins and outs of ICU treatment with a patient we decided that it would not be in their best interests.
The Nephrologist replied with "You are just letting everyone die then" - I'm still angry 7 months on
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@Dr_BellaR
This is one of those mixed things - outcomes - especially in the elderly are improved by bays.
But privacy can massively benefit others.
My dad could not cope with being in a bay when he was dying (likely undiagnosed autism).
Private rooms to sleep - shared day rooms
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@jabberwock951
@cruncherwax
Call the boss in.
Clinic is cancelled
Proof of business case for more consultants/SAS doctors.
This is what needs to start happening. Rather than the strain being focused on medical/surgical resident doctors.
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@hayleymagill
Also - women definitely get patronised more than men.
There is a significant amount of in built misogyny in the NHS workforce that needs to be combated at every level.
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@hayleymagill
I still think medical hierarchy is incredibly damaging to patient experience.
It stops appropriate conversations happening early. Can mean important information is lost.
Speaking like equal colleagues improves communication and that will improve outcomes.
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@juliaisobela
Your ability to talk about yourself and your experience will be helping a lot of people. Whether that be other medics/other people with psychosis or others that have been hospitalised.
I hope you continue to improve and are supported back into medical school.
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@ShaunLintern
It's a massive gamble to do this with almost no evidence behind it.
I've had my first dose (ICU doctor) - second booked for march 11 weeks after the first.
I think this is the first time a drug has been rolled out entirely differently from its trial data
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@sbattrawden
@WomenICM
I'm currently having espresso martinis with my wife to celebrate the same thing.
Well done!
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@noodles_nood
I still think casual homophobia and misogyny hang around the NHS like a terrible stink.
So many outdated views like watching a 1970s comedian passed off as normal.
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@trentconsultant
My concern (icu consultant) is they stop me doing my education/rehab/end of life/patient experience work because it does not fit priorities. When those things need to be priorities.
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@parthaskar
This is a pressure I feel as a new consultant. But have been told by others I "care too much about trainees - you are a consultant now you need to acr like one"
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@ShaunLintern
We should really have electronic systems in place for all tertiary referrals now.
A lot of services have had this improve over the past 4-5 years. Should still be a point of priority.
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@olsonplanner
As a UK doctor it seems insane that it is so competitive to get onto residency programmes, but then residents work insane hours.
Why not create a safer working environment with more doctors?!
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@timricketts_
-One cough while drinking ->NBM until SLT review
-Contrast induced nephropathy
-The only reason for 88-92 Sats target is COPD with previous T2RF
-Self discharging patients should not be supported in their autonomous choice with medications and discharge planning
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@dr_lungs
@sh_abbers
@dannyjnwong
@glurcher
@pcricoarytenoid
@ABarotchi1
I've had to do a couple as an ICU registrar/consultant because of acute responsibility failure with both effusions and pneumothorax.
The issue is that it is rare that it is needed but also the point where you could do with someone experienced.
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@zackferguson
@Rushdie79
I made the mistake of engaging with the lockdown protesters in Sheffield today... refused to believe I'd seen anyone die.
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@glurcher
@pcricoarytenoid
@ABarotchi1
We can agree to disagree here.
I think some trainee involvement in even the most high stakes of procedures is justifiable. It is part of being a consultant is working out just how much you can involve them safely.
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@auakhan
@GasboardChloe
@arcl
If it was my family member I would want the best for them - this is also the same I want for all my patients.
The idea that I would make one decision for a patient, but want different for my family is so insulting.
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@glurcher
@pcricoarytenoid
@ABarotchi1
You could end up with non-consultant doctors never doing anything unless they are on a specific training track.
AV fistula work will be great training for anyone working in surgery that involves vessels (arguably all - as all surgeries can accidentally damage vessels)
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@DJ3370178658
@PIWoods1
This is true of a lot of degrees. The 9000 pounds is still consistently less than the profit making international fees.
It only seems to get mentioned with doctors.
You never hear "engineering degrees are subsidised" why are they not forced into public service for a period.
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@singived10
@skysports_bryan
Respecting homophobia and respecting racism are absolute non starters for me.
No discrimination. There is not a hierarchy of discrimination with racism higher than sexuality.
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@jabberwock951
The answer is massive expansion of the consultant body.
Several specialties are so complex/busy they would benefit from senior decision makers.
ICU was busy on the weekend - I spent 12 of my "non-resident" hours on the unit supporting the docs there.
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@cliffreid
I think this thread is fascinating - it shows how little we know about best practice in emergency situations.
So many - not just different - but significantly opposed views. Some directly critical of other choices made by other experienced experts.
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@juliaisobela
It's ridiculous - it's like the fact the world discriminated against left handed people for years.
A lot of clinical examination is also taught with minimal concern for the patient.
"Expose them from nipple to knee"
As with investigations each examination should be bespoke
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@wesstreeting
Please say you will also fund post graduate training posts.
This is the greatest need.
It will go a long way to getting doctors on your side after earlier statements that were adversarial
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Wow.
Thank you again to everyone involved.
Now to get it seen by more people.
#THEATRE
#REVIEW
: Living.Dying.Dead
@FOILiv
at
@unitytheatre
"Scrivens and Jenkins along with the cast have created something which is much needed – an honest conversation about death." ★★★★★
#Liverpool
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@ShaunLintern
As an icu consultant I think there is a retention crisis that needs addressing.
I back the NMC standing up for undervalued nurses.
It will cause mass disruption.
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@AliJaneMoore
The BMA should be pushing for some level of compensation for these doctors.
It won't fix things.
But a few thousand pounds to smooth the late transition would definitely help.
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@RuariJM
@DocShivSharma
@Harris12354
@ABarotchi1
@Doctors_Vote
@KateAndrs
All doctors would be paid more in a privatised system - I do not want to ever decide treatment for a patient on their insurance/ability to pay.
I want is a similar level of investment in healthcare as a proportion of GDP to other nations - and a large amount of that on staff
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@dr_lungs
@sh_abbers
@dannyjnwong
@glurcher
@pcricoarytenoid
@ABarotchi1
That was meant to say "acute respiratory failure"
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@andrewpunton
I'd be willing to do this if it was required, but currently our ICU still has no space.
ICU nurses are often redeployed - a reason given for leaving by several recently.
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@Higgidec
@noodles_nood
@SteveBarclay
The GP brother was in medicine before the big fall in pay vs inflation. That is what these strikes are about - returning medical pay to where it was 20 years ago. 1/2
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The number of senior medical training posts has flattened as demand increased.
We are stopping doctors becoming consultants when we need more consultants.
If I was asked the number one place I would put extra funds it would be here!
It would pay for itself in reduced locums
These graphs are *terrifying*👇
It all feels a bit like the MMC/MTAS debacle all over again
So important that we open up sufficient training numbers to fill workforce shortfalls *and* ensure those not in formal training get mirrored T&Cs
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@realQrampage
I think I've said before - but as a UK doctor I am always fascinated/horrified by your tweets about the pre-hospital system in the US
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@scottshillum
@ShaunLintern
@chrischirp
@UHMBT
I was off a week over Christmas with covid - I would not have been fit to work if I didn't legally have to isolate.
I also could have probably killed the ICU patients that I work with by spreading it.
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@pete_hennessy
@johnghughes3
@sal_mahmoudd
The issue Pete - is that this is too often overlooked so that these sexist (likely accidental) build up until you have sexist views across society.
Sadly women are still treated badly across the NHS and calling out errors like this is a part of solving the bigger problem.
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@antongyan
What are medical schools/skills labs teaching?
I'll be honest it was barely taught when I was at medical school. I think the first ABG I did without supervision was on my first night shift.
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@FullFact
The union has not "agreed" anything.
The union has had an offer from the government that they felt they should offer to their members.
For SAS doctors (of which specialists is one section) and consultants
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Been in Dublin performing
@improvfestirl
.
So proud of Living.Dying.Dead - our improvised theatre show that helps people engage with Death/dying/bereavement.
A lot of subsequent conversations and recommendations for
@drkathrynmannix
books
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@Dogtor_Erin
I was feeling down at work the other day and one of the other consultants really clearly asked me whether I was any risk of harm to myself.
I wasn't - I just was having a bad day.
But I really appreciated the question - being open about those risks.
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@adamgordon1978
@ShaunLintern
@GeriSoc
I also felt yesterday's pile on went to far based on an original point well made.
The anger is not much less off twitter in my recent experience - doctors have been treated so badly they are lashing out - any discussion of non medical roles is seen as selling out the profession
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@Anna_L_Mitchell
A consultant said to me not too long ago that I care too much a out the trainee experience and need to focus on the permanent staff and patients because the trainees leave after a few weeks anyway.
Really sad situation.
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@DrNeilStone
As the information was misrepresented in a way that would encourage people to vote against the 5th motion- and they all passed easily - that would just be a waste of time?
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@mevparekh
This always reminds me of friend who used to complain everyday about a fellow foundation doctor - this F2 could not do the job at all, but had an incredible cv because he was ignoring his foundation job.
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@VirtueOfNothing
I think it is worthwhile talking through why NEWS developed - the death of inpatients with a predictable decline that can be intervened with.
NEWS is not a good tool for doctors to use to make decisions - but the concept of identifying those at risk of deterioration is important
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@CentristPond
@DrAdrianHeald
I'll bite... As a medic I'm not more scared of covid because of the media, but actually because of seeing people die with my own eyes.
Having to set up temporary ICUs in hospitals because the normal system is overflowing.
I've had enough of watching people gasp for breath
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@CentristPond
@DrAdrianHeald
Look, the answer is not clear. I have my first leave of the year booked over the next month... but if I have to give it up to avoid further unnecessary deaths I will..
The growth of cases looks bad.
The deaths will be seen in the next two weeks.
I'm hoping for the best
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@WhistlingDixie4
@TheBMA
@BillyardTom
I think when you consider that those later in their careers, did not get as screwed with the pension changes, have had a higher wage as a doctor in comparison to cost of living, most likely did not pay for higher education. The benefits should have been front loaded.
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@drkathrynmannix
I have a lot of these conversations as an ICU doctor - I hope I am good at it - because good decision making/communication is what I am most passionate about.
Would be great to know how it is perceived by patient and family (hours/days/weeks) following the discussion
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@drandrewhardman
@drbenwhite
You identify the problem. Explain the problem and its consequences.
You ask if there are reasons if this is happening.
Then you try to target those issues.
If it continues to happen - you call a meeting with representatives of those you are trying to target.
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@thatsnotmine125
@Microbedoc2
@BMA_James_Steen
@FPARCP
I don't think it is hard to understand that doctors want more hourly pay for equivalent work than someone that has a lower level of responsibility than them.
I never worked less than an average of 44 hours during my PG training.
It does not mean my basic pay was unimportant.
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@thegradmedic
I think you should be proud of yourself for not taking it for the whole Christmas period.
Too many people forgive horrible behaviour in their family. An abhorrent view is an abhorrent view.
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@DrBenLovell
This is worrying - as a new consultant that has literally no interest or knowledge of how my pay/pension works as long as I get paid each month...
Another aspect of growing up that I should probably deal with.
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@BellaRoscetti
I do drink - but it is so clear that we need a better job of organising social events without alcohol.
I don't think there has been a big work night out without drink in my whole career.
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@drphiliplee1
I was a bit surprised by how negative the response was.
More than willing to help personally if ICU ever gets less busy.
Morale is so low with nursing staff that I would be very protective over them being sent elsewhere.
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@texutree
@ShaunLintern
It was me - Shaun posted it anonymously as I am not a doctor who posts significantly online - the situation is tough and covid is still putting significant strain on ICUs and I am worried about the well being of our nursing staff.
What is in the gutter about that?
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@hayleymagill
@_Conor_Hennessy
Much of the work done by foundation trainees in UK is done by medical students on rotation in the state.
They pay 10s of thousands to do it.
The American system does not seem like a bed of roses to me
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@VirtueOfNothing
I seem to have made a typo and now the accidental phrase used has become popular..
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@bduric_
No hate from here, but I am really glad they aren't there personally.
I have never seen a doctor in a white coat - they are associated with labs to me.
Therefore the idea of doctors in white Coats dehumanises the doctor patient relationship.
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@Dr_BellaR
I thought post pandemic would answer many of the questions we had for years in unexplained post viral syndromes.
It was a huge cohort to follow and Research- it seems the political will to minimise the long term effects of covid in non critical circumstances reduced that
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@Milzhino
I once had a family member put through to me as the ICU on call. They were also confused.
On investigation there was a new switchboard member - when the family member asked to speak to ICU - they were put through to the on call registrar.
Wanted to know visiting times
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@eilidh_garrett
The anaesthetist was telling my lack of physics made me an "unconscious physician"
I replied that his lack of communication skills, educational theory and empathy made him an "inhumane physician"
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I am re-writing our unit induction for the rotation of doctors tomorrow.
Really determined to make it a pleasant and informative day that makes them excited to work on ICU.
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@simonkensington
@NickStripe_ONS
@dacook42
Hospitals have not been closed! There has been cancellations because of the Covid workload not because of scaremongering.
If we had actually taken covid more seriously it less services would have been affected
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@SecretNHSCEO
I think the anger is real and present in real life as well. I've definitely witnessed conversations you would see on here in real life.
I think it is also present in all of society - the previous generation were better rewarded financially, bought up houses, etc.
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@Resuspiece
Maybe controversial. I don't think it is essential to have an up to date certificate for registrars/consultants for those in specialties with appropriate skills. EG. ICM, EM, Acute Med, Anaesthetics.
I will be re-doing mine in a few weeks as an ICU consultant (previous GIC etc.
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@jabberwock951
Absolutely - it is our job to explain to the team/patient/family. I will normally also have do a DNA CPR if appropriate and explain that as well.
What I would ask is that the referring team has made the patient aware of the risk to their life/reason for referral to ICU.
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@Sfisher0404
@nohandsup
One of the issues is that the UK is relatively unique in these being extended procedures - with increased F1 workload we are losing good doctors because they would not be expected to do these tasks in other countries.
It needs a global mdt review of competencies
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@mjv__1
It conceptually comes from the idea that doctors are "professionals" so it is about total contract worth rather than specific hourly rate.
But the hours worked became more variable - so the 2016 contract tried to recognise that a little. And did a terrible job.
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That was one of the worst speeches in history.
And also one of the funniest things I have ever seen.
#Thingscanonlygetwetter
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@dannyjnwong
@glurcher
@pcricoarytenoid
@ABarotchi1
I was lucky to do a number of awake fibreoptics during my anaesthetic year.
As a single specialty ICU consultant I will likely never do another electives, but it has helped my airway skills/scoping skills.
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@EdanStarforth
Back handed compliment from a patient I overheard from behind a curtain in a bay.
"Nurse, can you thank the doctor who saw me earlier, he was really nice. I can't remember his name - the one that looks homeless"
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@drraja_
I extended my training 3 times because of my portfolio - never had a negative thing said, but was terrible at evidencing my competencies.
Find it very hard
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@hines_stephen
I was once called to an emergency on a train - there were 4 of us there. I was an ICU reg, there was a radiologist and a GP... and a "medic".
While waiting for the ambulance I asked the medic where they worked.
They were a first aid trained private ambulance crew...
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@vanessa_b72
@ShaunLintern
I think the deaths within 28 days is an underestimate- there will be a number without tests and a number that died more than 28 days post original diagnosis.
I've not seen someone with covid die of something other than covid
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@ShaunLintern
@Zudin_P
This is an important story - ICU care takes an enormous toll on the body and mind.
We are working hard on better patient support and rehab. We need to continue to strive to improve this support as well as improve family support.
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@CentristPond
@LeftBrexit
@DrAdrianHeald
Centrist, Do you know how frustrating it is to try and communicate what we have seen because of covid in hospitals - only to be told we are making it up, over-reacting, blinded by the media.
No - we have seen a lot of people die, so rude people on the Internet deserve blocking
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From this angle Julia Sanina and Hannah Waddingham become one supreme Eurovision presenter
#Eurovision
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@drkathrynmannix
My Dad is dying currently and the stress on my mum and brother who are caring for him is immense.
There seems to be little in the way of support and education.
And we are a family with a doctor that has an interest in end of life care and my mum is a priest. It's tough
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@SecretPhysician
This is one of the more worrying things I've read - if you cannot prescribe - you should not be writing prescriptions to be countersigned.
You should be referring the patient to a colleague with prescription skills.
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@DoctorMayJay
We should soon be at the point where senior doctors are whistleblowing in the national press every day.
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@SonjaCowling
I've noted before where a staff nurse has been with a delirious patient, but instead of continuing to comfort and re-orientate the nurse felt she had to leave the patient to document the obs on the NEWS system.
They would have been criticised if they did not do this..
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@Jack98283076
@Doc012802251361
@TomStocks1982
@NHSEngland
Because GP Training needs an understanding of acute and chronic illness from hospital placements.
Same as hospital doctors needing to have worked/had community placements.
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