Luke Mordecai
@Shr_Nottingham
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Consultant Anaesthetist @uclh. co-director @AnaesUnited. Views my own
London, England
Joined September 2021
I’m doing some book keeping as a diversion for the next time someone tries to talk to me about basic science. An #anaesthesia 🧵 of 🧵’s regarding some of the things I think about during my day job. (Thank you to everyone that has contributed to the discussion) 1: Alfentanil
I don’t normally geek out about #anaesthesia but given the ongoing Remifentanil shortage in 🇬🇧 I thought I’d post my alfentanil TIVA recipe. IMHO it’s elegant, precise and allows for absolutely minimal anaesthetic poly pharmacy. (Very boring for non anaesthetists…..) 1….
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Listened in full to what is a pathetic public statement Appropriate training places are not a bargaining chip & repeated UNQUANTIFIED references to pay are meaningless Strike hard Residents Wes is a thoroughly unserious Secretary of State
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Genuinely curious if there’s any logical explanation for opposing the outright substitution of nurses by nurse associates but not the exact equivalent with regard to doctors and PA’s? If anyone has something other than just good old fashioned double standards I’m listening 🤷♂️
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The biggest problem I see is that so few people feel they can be honest atm Where does a vocal minority end & a silent majority begin? Truth might be unpleasant but whilst plain facts are shut behind closed doors we can never have an honest conversation about anything 🤷♂️
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And that’s not to say there aren’t extremely bright and able people in all healthcare professions But as a population curve I will die on this hill It’s not politically correct, or #bekind , but it’s just fact
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There’s a fundamental truth that few are prepared to say Any medical student could walk into physio, pharmacy, nursing etc with their eyes shut The reciprocal is not true 🇬🇧 needs to work out if it wants the brightest to be their doctors? If you do, treat us better! 🤷♂️
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I reckon about 15 years ago HMG extrapolated out the % GDP on healthcare & shat a huge brick Since then they’ve enabled people with an enormous aptitude / ambition mismatch to create a cost cutting world of cReDeNtIAlLeD illusion If you want to be a doctor go to medical school
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That fact that this question isn’t parody should concern anyone paying attention to healthcare in the UK
I'm interested in the publics opinion here. Free choice, base it on what you want not what you can currently get. If you go to your GP surgery or hospital with a worry or injury, who do YOU want to see? You can explain answers or ask questions if you wish Please RT for more n
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Medics do AT LEAST four post graduate years before specialising Siloed care can be an issue but if you want to fix flow I’d start by looking at the ever decreasing number of hospital beds & an almost total absence of social care slowing discharge These think tanks make me laugh
Everybody wants to talk about Our NHS. But nobody wants to talk about R NHS, where R stands for “Rate of flow through hospitals”! Our new paper @restate_thinks explores how to fix hospital gridlock. Great to see it written up in the Times, well done @BeaconRosie @AliceKSemark
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In 1991 Gerald Ratner said the quiet bit out loud & his company lost £500 million & almost collapsed @wesstreeting just said the political equivalent on live TV acknowledging holding doctors’ training, & the public’s health, to ransom over a very reasonable pay dispute 🤷♂️
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🇬🇧 cannot privatise infrastructure fairly Profit chasing tramples the little guy every time See 🚂 🚿 etc Yet here is Wes actually celebrating an explosion of private provision whilst refusing to pay doctors >£19ph & threatening to cut resident training jobs if they complain
🩺 Over 6.15 million tests & operations were delivered by independent providers this year for NHS patients free of charge. Nearly 500,000 more than last year. By using spare capacity in the independent sector, we've cut NHS waiting lists by 200,000 and treated patients faster.
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I’ll look forward to The Royal Colleges condemning what is clearly a detrimental & childish decision Oh wait ……
Today @wesstreeting has put junior doctors on notice that taxpayers’ cash will not fund more training posts if they continue to strike, in interview with Sunday Times @cazjwheeler READ:
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The NHS annual budget is ~ £200 billion Let me show you and explain how £40 billion a year of it is being wasted 🧵 👇🏽
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This article is absolutely spot on @wesstreeting can no longer blame the Tories for the state of the NHS and his poor leadership fully justify this criticism 👇 The recurrent bad decisions are starting to look intentional…. 🤷♂️
For the NHS, it’s another escalation in a destructive cycle brought about by an inexperienced health secretary, advised by people who want us to make the same mistakes they made 20 years ago. It’s time for a change.
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GP is in meltdown @ClareGerada was highly influential in enabling the mass substitution of GP’s much to the detriment of patients & her own profession It’s incredibly hard to even see a doctor in primary care atm There’s only one moral to this story Sell out, get rewarded 🤷♂️
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Endemic doctor substitution is finally being properly called out Personally, I’ve never felt it controversial to say if you want to do the job of a doctor - go to medschool 🤷♂️ Is sanity starting to prevail?
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If you have to go to A&E, do you want to see someone that understands illness and pathology from the ground up, or someone that’s been taught to dial up 900W for 4 minutes? IMHO comparing a ST3 registrar to any ACP is no different from the below Just stop it!
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The past generation of leaders have gone all in on Dr substitution It only worked while Dr’s were prepared to smile & nod, & patients didn’t know The🐱out the 💼 now & new ambitious would-be leaders are soon going to realise the political capital in throwing people under a 🚌
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I may well regret this, but for what they are worth here are my thoughts on the ACP debate in one thread. Please do read them all, remember I am just a consultant in EM with no RCEM responsibility and hopefully my passion for EM is evident after a quick google of my name.
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In 🇬🇧 healthcare, consultant should solely refer to people that are on the @gmcuk specialist register & that all doctors should have far more professional respect for both themselves & for what that means for patient care
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