Tom Marshall
@TomPMarshall
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Researcher in Public Health & Primary Care, University of Birmingham, UK. #electronicmedicalrecords #Cardiovasculardiseaseprevention #healtheconomics
West Midlands, England
Joined July 2017
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@WavandaV
@Lageraemia
@metpoliceuk
I understood this as a simple request to help identify a suspect.
Many replies appear to have understood it to be a request for advice on how to avoid being robbed after the robbery has taken place.
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This made me laugh out loud.
It's a GP's experience of trying to attend a hospital outpatient appointment on Monday 26th September.
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@t_sfea
@jkaffash
It is also economically illiterate
a) Price is not cost (time & travel). Supermarkets are located far from poorer populations
b) We eat meals, not ingredients. Producing meals requires time (more cost) & skills (human capital, acquired from previous formal & informal education)
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A story from GP land
Ginger-haired, pale-skinned adult male consults with a red hot rash, affecting tops of thighs (stops at shorts), forearms & face.
Spent all day yesterday playing cricket in the sun.
GP: It's sunburn.
Patient: Google said it might be cellulitis.
🤷
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As a public health physician here is the biggest mistake I see cardiologists make.
Assuming people choose to be unhealthy rather than find their circumstances constrain their choices so that they can’t avoid being unhealthy.
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@tumithekoko
This may be illegal.
In a recent case Magdalena Konieczna was banned from speaking Polish by her employer, Whitelink Seafoods. An Employment Tribunal ruled she suffered discrimination & awarded her more than £5,000 in compensation.
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My father died yesterday: at home, with my mother, 2 sisters at his side & his GP Dr JP McClung present.
Thank you Paul.
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@DrLKVaughan
This has a name: suboptimisation. It’s where one bit of an organisation optimises a process for itself but to the detriment of the overall organisation.
It happens because one part of the organisation forgets or is unaware of the overall purpose of the organisation.
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@EmergMedDr
It’s an interesting thought experiment. If Hamas tunnels were found under Tel Aviv would we see the population given 24 hours to leave & then bombed?
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@drquinngyn
...do I dare to look at the replies to this? Are they going to veer off into beliefs about the symbolic significance of menstruation?
🤔
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@MikelGunners
@FHawksworth
@jackypetal
@idruprofen
@AndrewG97440406
He posted his payslip.
You can check the payscales on the BMA website.
No, junior hospital doctors don't work from home.
No, doctors don't receive a fee for a callout (neither GPs nor hospital doctors).
I think it is clear not everyone here knows what they are talking about.
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@PriyamvadaGopal
I’m not sure what point The Daily Mail are trying to make:
The royal family aren’t white? The descendants of the Empress of India didn’t profit from the Empire? Don’t they still own a fancy hat with a big Indian diamond in it?
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@DrPeterWeeks1
There's a strict protocol.
Basically you wash them, stack them & save them in a cupboard. When the stack is so high that it is in danger of falling over, it is time to photograph them and put them on Freecycle for someone to use to make crème caramel.
I think that covers it.🙂
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A tale from a GP today.
Patient calls. She’s Covid positive & wants “antibiotics for her cough”.
Q: are you vaccinated?
A: No I wouldn’t have that poison! And anyway it doesn’t work…
But she does want antibiotics for her viral infection 🤷🏼♂️
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@MikeWarrington7
Mike, can you explain why you included your skin colour in this Tweet?
Do you think it affects your entitlement to access to a NHS GP any more than another characteristic e.g. being right or left handed?
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How many UK citizens outside of Northern Ireland know?
1) There'll be another NI election on 15 Dec 2022
- as the Democratic Unionist Party (DUP) won't take part in gov.
2) Majority of NI electorate are happy with NI protocol
3) Support for DUP is falling
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@hannahgib81
It's a lovely gesture
I have to say I am still struggling with the concept of "incomplete awe"
🤔
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@DrSelvarajah
@BBCNews
"rises quickly" & "10 years"
I guess that's true if you're thinking in terms of geology, but 10 years seems like a long time in my life.
🤔
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@sahouraxo
Funny isn’t it.
One undemocratic oily producing country invaded its neighbour & the west supports them; another does the same & the west opposes them. 🤷🏼♂️
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@Azeem_Majeed
In some cases the very fact that they’re there!
If someone hasn’t consulted for years & they show up…🤔
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@EmilyBronwen
Maybe tag in M&S? We ought to be supporting mothers, not actively discouraging.
Strangely I recently came across a reservior of anti-breastfeeding sentiment on Twitter. I even ran a poll and "everyone" (i.e. in the thread) seemed to think women were being coerced.🤔
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@ElaineYoung94
@HelenRSalisbury
Just for the record, abortion is legal in Iran up to 19 weeks.
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@ben_urmston
@fen_ken
@DoctorChrisVT
@themonkeycage
Takes 10 years to train as a GP but only seconds to say something silly on Twitter.
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@CarryStrategy
Most English people have forgotten that ultimately England lost the 100 years war.
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@alisonleary1
Based on the principle that if you repeat a lie enough times people start to believe it.
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83 articles described the relationship between continuity of care and health care costs or various measures of health care use.
Higher continuity was associated with significantly lower costs or less health care use for 109 of the 160 outcomes.
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@m2aty
@PoliticsForAlI
Lots of lessons here
Don't sit in the road
Don't drive an untaxed car
Don't use your untaxed car to commit an assault
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Just came across a plea for advice from a salaried GP. They are about to find themselves to be the only GP holding the fort, along with a few remote ANPs, for a practice of 10,000.😬
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@billybragg
Sorry Billy, this isn’t correct. Clinical trials assess the effectiveness & adverse effects of treatments, whether they’re drugs, vaccines, surgery or screening programmes. Is there a reason for making this an exception? Is an informed decision possible without evidence?
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On Wednesday my sister goes back to work. Because 2 partners have Covid she will be the only GP in a practice serving 8500 patients after a 4 day break.
What could possibly go wrong?
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@In_communicado_
@jasonhickel
@darth__mouth
It is certainly a social experiment
Just like every country's policies are a social experiment (e.g. choosing to imprison 0.7% of the population or to tolerate mass homelessness)
But this proposed experiment doesn't much resemble the USSR
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@BatScientist
@nathaliejacoby1
Since you quote from your holy book may I quote from mine?
“The notion of a god is a logical absurdity.”
Tom 1:01
[maybe I’ll write you some more later]
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@mattsmith_news
To avoid errors, look for system failure, staff don’t come to work in order to make mistakes etc
Here we fire the individual.
Lesson: make a mistake? don’t own up.
We assume malevolence & say “deliberately”
We still don’t know why this happened or how to avoid it in future.
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@NeilDotObrien
I see you've joined the anti-growth coalition in your desperate attempt to blame the housing crisis on migration?
Biggest source of migration?
1) students - x9 return on investment. Huge value to UK economy
2) people coming to work - also boost to UK economy
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My rough calculation of NNT for antibiotics to prevent invasive GAS.
NNT ~6000
Heroic assumptions about relationship between sore throat & IGAS and about effectiveness of antibiotics. These give the lowest possible NNT.
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@rosieICM
@thetimes
Completely illustrates a culture of enabling & condoning harassment. Would we be surprised to learn some of today’s medical may students share these attitudes? Perhaps not expressed so openly.
He didn’t retire long ago. Be interesting to hear from anyone who worked with him.🤔
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@trendylefty
@stevieinselby
@t_sfea
@jkaffash
Good point!
In economic terms it's a risky investment to try out a new recipe.
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@k_bezier
@spectator
0 following 31 followers
Anon account
Not at all like an internet troll.
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@malinga_r
When I hear stories of folk undermining each other within the NHS I always think of this quote from the film aliens
“You know, Burke, I don't know which species is worse. You don't see them killing each other for a percentage.”
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@DrSdeG
"she "begged" the doctor not to perform the highly intrusive examination.."
Isn't an unconsented intrusive examination a sexual assault?
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@lucymajor_SLT
@DrLindaDykes
Yonks ago I did an assessment of health needs of the prison population. Came across a (S&L) student dissertation on speech impairments among young offenders.
Guess what? A lot have speech difficulties. Harder to stay out of trouble if you can't make yourself understood.
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@SalemLola
A painting of an early 20th century politician not quite as significant as two unique 1500 year-old statues.
Vandalising one painting isn’t quite the same as destroying all art as idolatrous.
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@Microbedoc2
There is no point in blaming the estate agents.
There are not enough homes. It has many ramifications.
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A considered look at evidence on face coverings
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@DoctorMayJay
Name the constituency & inform the press. This is exactly the sort of publicity the Tory party needs
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@JeremyClarkson
This is a pretty half-witted analogy. Who consults a farmer on a one-to-one basis before every meal?
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Twitter topics on which GPs "need more education":
Eating disorders
CSF leaks
Ehlers Danlos Syndrome
migraine
childhood cancer
adult onset T1 DM
trans health
radiotherapy (long-term effects)
dementia
antidepressant withdrawal
migraine
ovarian cancer
opioids
menopause
ME
HIV
etc
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@johnaldis
@teachbk
You’d think someone would have figured out that the best use of teachers’ time is teaching…
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@knockamann
@liambarker
If the anecdote described a particular patient, this would be ethically dubious as the individual could be identified.
If the anecdote refers to a general phenomenon & doesn't specify an age, sex, date of occurence etc would that be a unethical?🤔
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"The majority of outstanding tasks in the hospital setting were followed up by hospital clinicians. A considerable volume of tasks were delegated to GPs, of which a significant proportion were inappropriate."
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A friend (48yr old, while female, no CVD risk factors) has a ‘routine’ cholesterol check. TChol: 5.6
GP: “it’s high, you need a statin”
She declines.
GP: dietary change & recheck in 3 months. TChol 5.7
GP: “you need a statin”
I calculated her QRisk 10yr CVD risk: it’s 2%
🤷🏼♂️
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@FlorenceHRScott
I see The Daily Mail now considers the Welsh language is now some sort of “woke” affectation. If I remember correctly, Brythonic languages predate Anglo-Saxon in these isles.
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@AmnestyUK
Imagine - a society that forces citizens to cover their faces when they go outdoors. We’d never put up with that...
...would we?🤔
(PS: I do realise that Iran requires hair covering for women, it’s our ally & arms customer Saudi Arabia that requires face covering)
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Medical school decreases empathy.
It's attribued to patient/disease complexity the hidden curriculum (workload, prioritisation of biomedical knowledge & poor role models).
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@RSylvesterTimes
@wesstreeting
In fact this is the case in Sweden. But Swedes have confidence in their GPs and rarely self-refer to specialists.
It is an option in Denmark (with a small co-payment) but 90% of Danes opt for the alternative where they are referred by their GP.
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@drewseybaby
Biggest lie was on day 1: "you are the elite, the cleverest students in the university"
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@alanmcn1
@Femi_Sorry
You’ll need to translate that into a housing-market analogy for Kirsty.
Like the fact that having a couple of derelict properties on a street affects the value of other properties.
The impact of dereliction goes beyond the individual property.
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@_SandraWindsor
@Somerstown4
@AllisonPearson
It may be clear to you, but the data say otherwise.
1) Numbers of A&E visits are at similar levels to pre-Covid
- it is the delays that have increased
2) GP visits are at higher levels than pre-Covid
Sources:
GP data:
A&E data:
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@LauraMStuart9
@Dr_BellaR
“Junior doctors don’t do life-saving surgery”
Who do you think does most Caesarean sections, appendicectomies, laparotomies for acute abdomen etc?
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@tobyontour
@fesshole
I don’t think you can grow a banana from a banana-skin, whatever the climate!😂
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@omid9
Meanwhile in another Twitterverse folk are complaining that someone might feel able to exercise their freedom of speech. Or even just state the facts.
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@emscomplex
@c3convertase
@KopiBin1
@lostinhist0ry
And life expectancy for women in 1940s was 67 years…
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@Lawrenc28443726
@mbismark
Interesting use of language
"Uk doctors go to new Zealand"
- active voice. UK doctors have agency & make their own choice.
"UK then poach doctors from Africa and Asia"
- passive voice. African/Asian doctors don't have agency & are lured/duped to UK.
Why the difference?🤔
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@JuliaHB1
Won't affect you as you don't work in the motor industry or have to worry about staffing your hospital. You may not care much about the folks it will affect. So that's all right then.
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@DrJohnCosgrove
This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.
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@DanNeidle
@jburnmurdoch
A key graph in this report:
- people with no tax to pay were more likely to be charged a penalty.
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1/ What will be the effects of the current strategy of overprescribing antibiotics for self-limiting upper respiratory infections?
Based on current evidence, we have a fairly good idea.
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@rickkeen
@kevinnbass
“Because doctors do it” is a completely unscientific argument.
Medical professionals used bloodletting as a treatment for at least three millennia. We’d hardly claim they were right to do so.
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@lucymajor_SLT
@DrLindaDykes
I thought it was a bit crazy. Some appeared to be getting talking therapy when they could barely talk!
& many young offenders have hearing difficulties too.
Can't hear.
Bored at school.
Disruptive.
Expelled...
you can see the trajectory.
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What does the word "lived" convey in the phrase "lived experience"?
It seems to be used as a qualifier. But isn't "lived experience" a tautology?
I am struggling to imagine another type of experience that wasn't lived. Perhaps someone can enlighten me.
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@HKBradshaw
Like the student accused of copying their exam from the boy at the next desk.
Student: “Why do you think I copied?”
Teacher: “For question 2 he wrote ‘I don’t know’ and you wrote ‘Neither do I’…”
😂
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@DrSueMoss
More on the history of inoculation: it seems the practice originated in sub-Saharan Africa.
Perhaps we also don’t talk about it.
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@1972Stealyer
@NoContextBrits
Yeah. The burglar who took my silverware apparently looks after it really well too…
…mind you the magistrate didn’t think that counted as mitigation.😂
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@DrMikeThe2nd
@DoctorChrisVT
You know there's only one thing worse than finding a maggot in your fruit...
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...finding half a maggot in your fruit
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@Effy_Yeomans
Go to Cherbourg.
Ferry to Rosslare.
Bus to Dublin.
Bus to Belfast.
Ferry to Scotland.
There are no border checks between Northern Ireland & Ireland
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@jonlis1
@LittleGravitas
The craziest part is it’s a speech on economics!
She crashed the economy in a matter of weeks. It’s like paying the captain of the Titanic for a speech on maritime safety.
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@billybragg
The effectiveness of heart surgery, antidepressants, cancer drugs are not assessed by “white coats & clipboards”.
To know the effects of any treatment we must compare it to the counterfactual: what would have happened without it?
Some research here.
.
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@bykatewomersley
@BBCWorld
Enoch Powell once said "All political lives, unless they are cut off in midstream at a happy juncture, end in failure, because that is the nature of politics and of human affairs."
This is Jacinta Ahern's best decision yet: leave the stage when the audience is still applauding.
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@drclairetaylor
We found 3 distinct types of
#LongCovid
Several syndromes?
Class 1: broad range of symptoms eg: pain, fatigue & rash (80%)
Class 2: respiratory symptoms, cough, shortness of breath, phlegm (5.8%)
Class 3: depression, anxiety, insomnia, brain fog (14.2%)
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@keithgrimes
@drmarkporter
Sounds very much like a policy written without any patients in the room either....
- Who wants to be sent from pillar to post with a painful tooth?
Nor anyone with any knowledge of systems
- introducing unnecessary extra steps into a process
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@talismanbassman
@KEdge23
The problem is that KE is a rich person, so he is conflating his personal gain with the UK's wellbeing. It is a common mistake.
A more honest response would be "yippee, I'm better off" but instead self-interest is dressed up in pseudo-economics.
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@mina_el_naguib
There’s a legendary interaction between a Dr B & his consultant from when I was in Edinburgh.
Dr B: May I do this appendicectomy?
Mr C: mmm a monkey with a sharp stick could do this op…. Can I trust Dr B to do it? No. I’ll do it myself.
Dr B: Shall I get the sharp stick?
😂
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@VPrasadMDMPH
This is spectacularly ill-informed. A 43 year old is like to have many incidentalomas. East potentially leading to years of further investigations and useless treatments.
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@RosieSh97182906
I'm objecting to the pompous rubbish written by rich hospital specialists (often in USA) essentially ascribing their patients' ill health to 'bad life choices'.
If they don't know anything about social determinants of health they should stick to looking at ECGs
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