Dr Mark Wright
@Marktheliverdoc
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Consultant Hepatologist and Gastroenterologist. Views my own, mostly Panglossian. Passionate about patient flow, Retweet’s don’t necessarily imply endorsement.
Southampton
Joined February 2015
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Anyone recognise this?
I finish my morning ward round. Pleased with my self because I've said 5 people can go home. The patients were delighted. I told the team, I told the ward sister, there were no therapy issues.
3 of them are still there the next morning.
Now why is that?
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There is a problem inside hospitals caused by our reliance on specialists.
Day1: Plan: XXXology review
Day2: Plan: await XXXology opinion
Day3: Plan: Chase XXXology
Its actually a "system trap" known as "shifting the burden to the intervenor". An addiction leading to bottlenecks.
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Just about to do an ERCP in theatres. Introduced myself to the consultant Anaesthetist- “I think we have met before”- yes I used to be your F1 she said…😳😵💫
#bitoldforthismalarky
🤣🤣🤣
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Here are a few common ones:
“CRP’uo” - we’d booked some tests just to be sure- (Educate)
Too many other jobs- HMR done too late -missed transport- (process problem).
Patient was due to go at 7 pm- query about meds - “own team to review mane” 😡😵💫- that’s why they need to go early
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It’s very easy at the moment to slip into the habit of having a few drinks every evening. Nice though that is, please try and have 3 or 4 days off each week. I don’t want to be seeing y’all in my clinic when the lockdown lifts!😉
#loveyourliver
.
#britishlivertrust
#liver4life
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Massive thanks to UHS security tonight- just got back to car after long shift- flat battery 🙄😗😳
Phone rings: “we heard you left your lights on- do you need jump starting?” Sorted - Cheers “D” you’re a top bloke.🙂
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Myself and Banksy earlier today!
(1st I knew was on the 10 o’clock news!)
#uhs
#COVIDkindness
Cheers
#Banksy
Well done to all my superhero nurse colleagues 🙂
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I’m not saying specialists are bad ( I’m one myself) but we often forget that we all trained as medical professionals and we shouldn’t just delegate anything slightly out of our immediate comfort zone to someone with a fancy title!
#dependency
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Giving up alcohol for a dry January as some sort of “ annual detox” after a year of excess, makes about as much sense as maxing out your credit cards all year and then trying to fix your finances by just eating toast for a month.
Our consultant
@Marktheliverdoc
warns
#DryJanuary
can be "perfect decoy" for problem drinkers 🍻 🍷 🍸 Read more at
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Its annoying when we are asked to prioritise discharges. Like we don't do that already? We don't keep people as pets you know!
And we only get asked when there's a crisis. Thing is if we are honest, we don't see a few extra hours or even a day as a big deal do we?
#thinkaboutflow
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Lots to be worried about currently- loved ones, long held plans, finances. All very acute to the individual. Take time to find out what your colleagues fears are, support them and share your own. We will all get on better.
#COVIDkindness
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You can curse the darkness or you can light a candle. We have so many resources at our disposal, but even if we think we have nothing, we always have kindness and compassion. Let’s make sure we feel proud this time next year.
#COVIDkindness
#backtoworktomorrow
#NHSheroes
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UHS Hepatology virtual away day this afternoon.
Off to a great start with announcement that we are the 1st UK liver centre to achieve IQILS level 2 accreditation!🙂 big thanks to
@janishapatel2
for all her hard work pulling it together.
#UHSFT
#IQILS
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Very impressive service from UHS staff Covid testing.
Monday night: Daughter coughing (probably a cold but...) service contacted, Swab Tuesday morning, negative results Communicated 7am Wednesday morning, back to work straight away!😉
Thank you!
@UHS_IPT
@UHSFT
@UHSOccHealth
🙂
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Not just talking about medical specialists- safe guarding, TVN, SALT, all sorts of outreach services. All set up for the best of reasons but then people become dependent on them
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Well done to our amazing Hepatology nurse specialists for their terrific work among the underrepresented patients of Southampton. Eliminating HCV. Treating the untreatable.
@UHS_LiverTeam
#UHSHeroes
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Just waiting for the train to Bristol.
BASL end of life care in liver disease Meeting. Excited to be presenting our work to produce a ready to go business case for advanced liver disease services. You can download it.
#letsscaleup
#BASL
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Who actually has the final say on when someone goes home?
The Doctors?
Therapists?
The patient?
The patients relatives?
Safeguarding team?
The porters?
Transport?
Social services?
Managers?
None of them think they do when you ask them. (I have).
#whoisincharge
#uhsft
#nhs
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Here we go! Niamph presenting our work looking at the impact of a nurse led paracentesis service. Reality is that nurses do it much better than Doctors!😉
#uhs
# AASLD
@UHS_LiverTeam
@CharlieCSmith1
#endoflifecare
#LiverMtg19
#liverdisease
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Anyone else noticed? A lot of former drinkers with cirrhosis have started again. Lots of decompensated liver disease coming in this weekend. They are all bored, stressed or depressed.
😕
#covidcollateral
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GIBLU
Right patient, right time, right place.
Thanks to everyone who’s made this happen
🙂🙏👍
GI Bleed and Liver Unit looking good for a Monday start on D8
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When you have a deadly disease and a readily available, side effect free cure, there’s a moral imperative to treat everyone infected.
It’s not a new idea that how a society treats its most vulnerable people is how it should be judged- we hope by 2025 we can feel justly proud.
Great to be part of
#Southampton
#HepC
elimination steering meeting today. We are so excited to work in
#partnership
& share best practice & learning from our
#Peer
project. Fantastic ideas shared & coupled with well tolerated & easy treatment the project is going to be amazing
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Lots of things can be done to bring forward discharge by a few hours, which makes a massive difference to those waiting on trolleys or hoping to get their op. The discharge paperwork may not be sexy, but it has a bigger impact on health than ordering another CT scan- so do it 1st
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No Flow in the whole hospital = very bad.
Those people on the trolleys have worse outcomes the longer they spend there.
We need to make flow central to all that we do (because it is).
Central to patient safety, central to our elective programs, central to staff well being.
#nhs
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We’re expanding 👍.
2 new locum luminal Gastro consultant posts (with a view to becoming substantive) and 2 clinical fellow posts- out now!
Join our dynamic, forward looking team in Southampton. (great hepatology support as well😉)
#uhsft
#Gastroenterology
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Same down in Southampton- it’s like people in the know have seen what’s happening and don’t want to catch it!
Funny that🙄.
Had mine this morning)
Very slick operation from the vaccine team by the way- thanks
#uhs
Vaccine hesitancy is clearly not prevalent amongst hospital staff judging by the queues that appeared when the
#CovidVaccine
became available at
#ICHT
. Surely food for thought for those who are still resistant
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I wouldn’t have expected a new petrol car to come with a full tank, but for some reason I did assume my electric car would be fully charged when I picked it up!🤔
Made it home with 5 miles to spare!😳
Pleased with it though🙂
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Sadly the wards are full of people with alcohol related issues at the moment- some of them who are having problems for the 1st time, some who thought they had left it behind. It’s an all too common entry in the notes “has been drinking +++ since lockdown”
😕
2020 has been tough. 😢
When things get difficult, alcohol is often the first thing we reach for to handle stress, worry or sadness. But over time, that can actually make us feel worse.
On
#AlcoholAwarenessWeek
, find a better way to cope:
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Remember when it used to snow and the kids got excited because the school would be shut for a day or 2?🙄
#neverendingsnowday
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Come and join our team. This is a great opportunity for an ambitious nurse, looking after people with the full spectrum of liver disease. Bring your 6 Cs and be the the 7th (continuity) for our patients!
DM me if you want to know more🙂.
@UHS_LiverTeam
A great opportunity to be a part of a forward thinking Hepatology in-patient team and develop & lead a vital paracentesis service
@Marktheliverdoc
@RosemaryChable
@sarahjherbert
@blacksladder
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Might have over done it when planting my “apocalypse potatoes!😳
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Manchester airport, waiting for a delayed flight. Great opportunity to conduct an impromptu appraisal for poor Nadeem!
#neversawitcoming
@UHS_LiverTeam
@NadeemTehami
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Big day tomorrow.
Our 1st local Southampton meeting for sorting out end of life care in liver disease. Hospital and community services working together.
#uhs
#liverdisease
#endoflifecare
#cirrhosis
@Charlie84634307
#palliativecare
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Intentional foreign body ingestion- see our Southampton experience in the latest issue
@FrontGastro_BMJ
.
Seems to be a growing problem nationally, in need of a coordinated response. DM me if you have experience to share.
Endoscopic management of intentional foreign body ingestion: experience from a UK centre | Frontline Gastroenterology. Great work
@Marktheliverdoc
@helpatologist
@ryanmbuch
@bernardstacey
💪
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This has been a game changer for me-that extra bit of time has allowed me to set up studies, establish some university collaborations and publish papers (all in the 1st 6 months!). Previously I was sitting watching my ideas slowly evaporate as there was no time to properly think.
“We know that research-active organisations achieve the best outcomes for patients.” 💙
Hear our Deputy Chief Medical Officer, Dr Trevor Smith (
@GastroDrSmith
), explain why
@UHSFT
is investing in research.
Could you be a future research leader? 👇🏥
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Great energy from the Southampton Gastro- Hep team at our away day. Thanks everyone for all you great ideas and enthusiasm. Super excited about the next few years.
#uhs
#gastroenterology
#hepatology
#NHS
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Thanks Louise
This was always a team effort.
Without you guys we would have achieved very little despite the Fantastic drugs we now have.
We have to get them to the people who need them and that’s what the peers do so well.
Thanks so much!👏👍🙂
In in view of
@HepC_Hants_P2P
11th birthday, todays
#HepC
hero is Dr Mark Wright
@Marktheliverdoc
who supported us from the very beginning. This is especially poignant as back then peers were yet to be established and it was a fairly new concept. Mark empowered us for
#HepCULater
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Given the normal rates of blood clots in the population, it looks like the AZ vaccine actually PREVENTS them!
( it certainly prevents the very high rate of thrombosis in people who would have otherwise got Covid)
#eurovaccinemadness
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Very excited about our symposium on parallel planning in advanced liver disease. Wednesday day, Hall 5, 9am start. See you there?🙂
It’s not about palliative care, it’s about good care.
#BSGLIVE22
#BSGLIVE2022
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When I was 10 I got dragged along to a family wedding. My brother and I were told we had better behave or else “there will be no Christmas”. It’s almost like Boris and Matt were my parents!
( It did work though so 🤞)
#covidchristmas
#COVIDIDIOTS
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It’s working really well. combination of 1. Going to the patients, 2. Treating in cohorts, such that you always have the previous cohort encouraging the next one, 3. the fantastic peer support. We are on a roll.
#NoHep
#hcvelimination
#hcv
#inclusion
#uhs
Phenomenal ‘Accessing the Inaccessible hepatology outreach clinic led by Mark
@Marktheliverdoc
& his wonderful nurses Liz & Becki 1️⃣1️⃣ patients screened for
#HepC
treatment 💯 % attendance- just shows power of
#partnership
working & incredible impact of
#PeerInterventions
#NoHep
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It’s time to “furlough the festivities” and “leave it out for lockdown”
#loveyourliver
Hello January! Hello
#LoveYourLiver
Month!
Throughout January, we're calling for every person in the UK to consider their liver health.
Find out more:
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All good on the wards at UHS today, Keen new junior docs and plenty of senior support.
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Another thing that strikes me is the youth and enthusiasm of the key players in this field - this is setting the scene for the next 30 years of Hepatology, so even though palliative care in liver disease is in its infancy, it’s going to grow up fast!
#BASLEOL_2020
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Just randomised our 1st patient for the CALIBRE trial in Southampton! Here we go😀.
#uhs
#calibre
@janishapatel2
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Ryan and Charlie with our Mayor at the launch meeting of the program to eliminate HCV from Southampton by 2025. Great collaboration from community partners and pharmacies.
#hcv
#nohep
#inclusion
#cgl
#uhs
#wessexodn
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@javediqbal_123
But does said respiratory physician need a GI consult every time their patient get diarrhoea?
Or does the GI team need a respiratory consult every time a patient with UC gets a cough?
We need specialists for complex conditions not every symptom 🙂
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100s of patients like this nowadays- the end of HCV is in sight. The only effect people notice from taking the pills is that they feel better and they are virus free at the end of the course. 😀
We just need to find them all. Tell your friends. Tell everyone.😉
#HCV
hepCULater
Best part of my job giving someone their sustained viral response to
#HepC
treatment. Second only to them starting treatment after several years of trying to engage them!
#HepCULater
#BeFreeOfHepC
#LeaveNoOneBehind
#EuroTestWeek
@EuroTestWeek
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Fantastic collaboration between the BASL end of life care community and some fantastic NHS managers. This is a tool to make it easy to set up palliative and supportive care services for liver patients around the UK. Down load from the link below or from the BASL website.
#BASL
Just out! "Developing a generic business case for an advanced chronic liver disease support service"
A support service for patients with advanced liver disease in their last year of life self-funds and saves bed days.
@marktheliverdoc
@hudsonbe81
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Have also started doing this in the last few days. Actually the patients loved the idea- apart from being relieved by reduced exposure they also relished the thought of not spending a half/whole day on a 15 minute appointment.
Maybe we should do it AV as well?
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Good idea from 16 year old this evening. “Your grandparents asked me what you want for Xmas”
“No presents please- I’d like them to vote for the party of my choice in the general election”
She’s lucky to still have 4 of them... 🤔
#GeneralElection2019
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Asking the Drinks Industry to self regulate on behalf of the Government makes as much sense as asking the Arms Industry to negotiate peace treaties on behalf on the UN.
#minimumunitpricing
Adrian Chiles: “It’s plain wrong to sell three litres of strong alcohol for almost nothing. Our labelling rules are plain wrong. Why don’t beer taps say, ‘3 units in a pint’ on them? This self regulation of the alcohol industry needs to change. It’s not working.”
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Thanks for coming up Joe- they are a great team and as a visitor consultant doing my current “tour of duty” on the Covid wards, I couldn’t agree more!🙂
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1 week to go until our palliative care in advanced liver disease meeting in Southampton. Aiming to get good debate going with our community colleagues. Thanks for organising
@Charlie84634307
and for supporting
@rocketmedical
#uhs
#endoflifecare
#hepatology
#liverdisease
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Say hello to people wearing masks and hold doors open for people (stops them touching surfaces as well as being kind and polite)
#COVIDkindness
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Fantastic work from the Gastro Hep nursing team, who have through their amazing work created this important improvement in patient care effectively for free ( financially anyway) by smart use of resources.
#uhs
#GIBLU
Amazing presentation! Recognised by the BSG as best oral presentation for Tilly! Lots of networking! Exciting time for gastro/hep
#BSGLIVE22
@UHSFT
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Great to see all the great work going on “talking the talk” about various micro elimination strategies for HCV. Meanwhile my specialist nurse team and I are “walking the walk” at Andover inclusion this morning with 7 new patients for treatment!
#inclusion
#HCV2018
#nohep
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Screening another 9 in Andover on Monday- real progress now. No way we could do this without the peer to peer support and the set up at the centre.
#NOhep
#hcv
#HepatitisC
A whopping 5️⃣3️⃣ people seen in our 6 hepatology outreach clinics this month. With another 7️⃣ starting
#HepC
treatment. We 💕 our model of
#PeertoPeer
intervention, specialist nurses & familiar surroundings, together we are eliminating
#HepatitisC
privileged to be part of
#NOhep
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Brilliant day in Bristol.
BASL end of life care in liver disease SIG meeting.
Great energy, great ideas and some great plans. Thanks for coming everyone and thanks for organising Hazel. Time to scale up!🙂
#basl
#endoflifecare
#liverdisease
#hepatology
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Don’t forget to order an ELF test as well- lots of undiagnosed cirrhosis in diabetics ( especially type 2)
Day 3 - Dot the elf took
@PaulaJo97203104
to ward E8
@UHSFT
to talk about
#insulin
needles. They had a simple solution to remind nurses which one to use when administering insulin!!
#ElfandsafetyDM
#diabetes
#SafetyTips
#knowyourneedles
#elfontheshelf
@BDandCo
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I’ve only been 50 for a couple of months and already I’m finding myself on all sorts of new mailing lists!😳🙄😐🤨
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Just submitted my application for a John Muir Trail wildernesses permit 😬.
Fingers crossed!🤞
#JMT
#midlifecrisis
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Good luck to all of the Southampton team presenting their posters at
#BASL
this afternoon. Proud of you.
@UHS_LiverTeam
@HepC_Hants_P2P
@CharlieCSmith1
@ryanmbuch
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Maybe I just can’t find it, but is there anything on parallel planning, symptom management or end of life care in liver disease at this year’s international liver congress? (Asking for a patient) 😬.
#ILC2022
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Existential threats in hospital from not improving patient flow:
2. Moral Hazard to staff- Choosing who comes in and who doesn't, balancing "unsafe" discharges against unsafe trolley waits for others. Burnout and exhaustion.
#NHSCrisis
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Most palliative care in liver disease is delivered by good will- we need research to demonstrate the health economic benefit to roll it out.
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I'm fundraising for Southampton Hospital Charity. Check out my
@JustGiving
page and please donate if you can. Thank you!
#JustGiving
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Just a thought- wouldn’t be too much of a stretch to apply the same methodology to other non “malignant” chronic disease in need of palliative and supportive care.
Just out! "Developing a generic business case for an advanced chronic liver disease support service"
A support service for patients with advanced liver disease in their last year of life self-funds and saves bed days.
@marktheliverdoc
@hudsonbe81
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Bit slower than last year, but I still beat the 18 year old version of me who 1st ran one 30years ago.
#Newforestmarathon
#newforesthalf
marathon
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That’s just such a brilliant term for this sort of patient group!
Nice one and congratulations
Tony and
@DrDSheridan
's poster was nominated joint
#bestposter
- good work guys
@PHNT_NHS
@DIGBEY
@NurseGregDix
@BevAllingham
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It’s going to be a fascinating evening- This is right after the BSG controversy in endoscopy webinar on similar topics! Look forward to meeting you all 🙂
Join us this Wednesday evening to discuss GI symptoms in the setting of mental illness, including the management of anorexia nervosa and intentional foreign body ingestion
@Marktheliverdoc
@GastroNW
@pubmentalhealth
#FGDebate
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In the long term the NHS needs investment and it needs to expand things like palliative care, psychiatry, medicine for older people as well as more GIM training and less reliance on specialists. In the short term there are a lot of things we can do around system change.
#Flow
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UHS Grand round "season 2" starts this time next week.
Title "Earth as an analogue for human spaceflight" by Dr Deepa Bangaru-Raju- AMU consultant and Space doctor at the ESA.
Super excited. See you there. There is lunch and the CPD is free!
#UHSFT
#UHSgrandround
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Not only individually clever, conscientious and committed, but even more importantly worked as a great team.
Well done, thanks for all the hard work and good luck in your careers.
You are welcome back to
#teamhep
anytime 🙂👍
Another batch of brilliant young doctors 🌟 complete their hepatology placement
@UHS_LiverTeam
Working with such a talented and dedicated team was a real joy 🤩
Thank you! 🙏
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Virtual End of Life Care in Liver Disease Conference today.
Great to see such high attendance but even better to see how far We have come in such a short period of time.
#BASLEOL_2020
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Magnificent 😉😀😀😀😀😀👍👍!!!!
Accessing the Inaccessible
#Andover
hepatology outreach clinic is on fire 🔥 today 7️⃣ patients started their
#HepC
treatment today & will be managed totally in the community. Well on way to
#MicroEliminition
in this rural community. Fantastic work led by Joel & Piers
#Recovery
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Thanks to my amazingly efficient ERCP team- 1st patient sorted out and fixed by 9.15am! 2nd by 10am. Bring me some more!
#almostunheadofefficiency
#ercp
# UHS
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UHS HCV SWAT team down at Inclusion New Milton this afternoon- 3 more patients ready to start treatment for Hep C!
#uhs
#hcvelimination
#inclusion
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On Safari. Haven’t seen a leopard yet though- thought I might phone the Zambian fire brigade and ask if they have had calls about cats stuck up trees!
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Agree also.
We have robust comprehensive plans in place as well as huge resources mobilised. The teams are highly motivated and fired with a passion to do everything we can to help our population. This is why we chose to do what me do.
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👇
The average ERCP produces as much radiation as 120 chest X-rays.
How much do we know about radiation safety in ERCP? Proud to see our paper out today in
@FrontGastro_BMJ
Thanks to my co-author mentors and to
#GITwitter
#GIGang
for your input! 👏🙌
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And they have the cheek to moan about test match cricket 🏏-That only goes on for 5 days!😉
#USAelection2020
#USElectionResults2020
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I’m interested to know what nursing colleagues think.
You also have specialist teams to refer to- safeguarding, infection,TV, SALT etc. That also produces big bottlenecks. Being quite old, I have seen an erosion in confidence to deal with these things over time.
#RCN
#nhs
There is a problem inside hospitals caused by our reliance on specialists.
Day1: Plan: XXXology review
Day2: Plan: await XXXology opinion
Day3: Plan: Chase XXXology
Its actually a "system trap" known as "shifting the burden to the intervenor". An addiction leading to bottlenecks.
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Unfortunately it’s not 1914 and it’s not us vs the Germans.
No truce vs the Germs sadly.
Stay safe.
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No quick fixes to the problem of having long stay patients waiting for under resourced community services but we may recognise some of these:
-Discharge planning not starting until optimised for home.
-Not clear when optimised for discharge.
-NH wont take patient until next week.
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When I 1st became a consultant we used to joke about needing “a teenager” to come and fix the IT. I’ve been here long enough now that those “teenagers” are now my consultant colleagues! Easy life, Happy days!😉🤣
#uhs
Shout out to the UHS IT Tech chaps, who kindly managed to tell my new work mobile phone what it needed to do today. Thank you 😊 sign of my old age, it was so easy when a phone was a phone🤣
@UHS_siteops
@hettie1972
@JoeTeape
@brookj3
@UHSFT
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Should have gone to specsavers
Well, if the new test for recovery from Covid is whether you can drive to
#BarnardCastle
and back that’s going to make it bloody awkward pre-screening cases for Endoscopy here in Southampton.
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Advanced liver disease MDTs, with the support of advanced liver nurses, allow bespoke care for Hepatology patients nearing end of life.
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Ground breaking, paradigm shift, game changer. There. Got them out of my system. Off to the conference now.
#easl
,
#ilc2018
,
#proportionate
tweeting 😉
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