๐๐ฟ ๐๐ท๐ฎ๐ ๐ ๐ฉ๐ฒ๐ฟ๐บ๐ฎ
@UKGastroDr
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Consultant Gastroenterologist | IBD & BCSP | Hon. Associate Professor @uniofleicester | CI @coloprevent | FRCP & EC @RCPhysicians | โค๏ธSports | ๐ฅฐ Family
Joined May 2010
If you are on iron - after taking a tablet you cannot absorb anymore iron for ~36 hours. Optimal dose =. one tablet. every day.or.every other day. Depending on tolerance & if short / long term treatment. Higher doses are not absorbed & cause GI side effects. #GastroTwearls.
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On Friday 15th May 2020 at 1 pm we held a minuteโs silence on our ward (and throughout our hospital) in memory of those who died from Covid - little did we know that the PM & friends were enjoying a garden party that same afternoon.
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My patient today owns a multi-million pound business. He was telling me that allowing staff to work flexibly, finish early on Fridays and paying them more than โstandard payโโฆ. Productivity & retention is higher, sickness rates much lower. These benefits exceed the costs. 1/2.
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My son Luca and my daughter Bella have received this letter from our CEO @simonweldonkgh. This is a real class act. I am proud to work for @KettGeneral. Thank you Simon!. #Heroes #COVID19
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@RishiSunak Your โstop the boatsโ rhetoric from a Govt you lead is a major cause of this.
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It isnโt rocket science, pay & treat staff well - theyโre happier & more productive. There is evidence that a standard 4 day working week is cost effective. Yet so many in this country including the right wing press dismiss this & call it woke. Utterly baffling. 2/2.
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Iโm just a Gastroenterologist.Stood before my colleaguesโฆ. Asking them to co-prescribe laxatives when prescibing codeine / co-codamol
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Three patients during their phone consultations asked how I was and thanked all NHS for their work during the pandemic ๐ฅฐ.
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Throwback to March & April 2020 in the first lockdown due to Covid-19 surges. A really challenging & frightening time. My wife & I completed our wills in April 2020. My #Breathtaking moments
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I cannot be happier that @NHSEngland will be disbanded. A failing organisation that has undermined Doctors and patient safety. Time for change.
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If your colleague is great with patients - tell them.If your trainee is organised & diligent - tell them.If your Consultant is calming & kind - tell them.If your nurse in charge is bright & hard working - tell them. Normalise giving compliments when deserved - it means a lot.
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I was complaining on the ward today about how tough the last few days have been. The sister handed me thisโฆ.
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So here is the best visual representation of why constipation can cause overflow diarrhoea!.
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As a young child growing up in Middlesbrough, I was bullied by racists. Venomously calling me โPakiโ, Sometimes this led to physical assault. I remember a particular hurtful song โLetโs all spit on Verma, it might just change his colourโ. Racist terms are ๐ฏ๐ฆ๐ท๐ฆ๐ณ โbanterโ.
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If Lucy Letsby was non-white & Dr Jayaram was whiteโฆ.I wonder if more babies would be alive today. It may feel crass to highlight race in this case. However there is data that shows the discrepancies between race & process of complaints.
EXCLUSIVE: The doctor who helped catch Britainโs worst baby killer. Dr Ravi Jayaram spent two years pleading with hospital managers to investigate Lucy Letby. Instead, they made him apologise and attend mediation with her.
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Just found out Sarah Everard was abducted on the same route my sister goes for her regular run. She feels scared; โtoo close to homeโ. We must accept that:.โข Itโs not all men but it is always men. โข Men also get killed - by other men. #SheWasJustWalkingHome #ZeroTolerance.
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@LouiseAllard18 Hi Louise. We should make life better for future generations. However the boomer generation reversed this. Our junior Doctors are the future of our health service, they will look after you & I as we got old & inevitably unwell. They are treated appallingly. I as a consultant (as.
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Maybe a way to explain this is COVID is like kids with glitter. Doesnโt always bother kids too much but as soon as they go home, it ends up on the hands & face of every family member.
Covid is a horrible disease but it is very, very, very rare for it to impact children. They are still at far more danger from journeys in cars, or swimming, or trampolining than Covid. Please do not let anyone persuade you otherwise.
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Very grateful to my secretary Sharon. She has been calling my patients to give them scan results today with the aim of giving peace of mind before Christmas instead of waiting for a letter into the New Year. @KettGeneral.
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It is unfathomable that we have shortages of Consultants and GPs, yet resident doctor colleagues cannot get training posts. We have unemployed Doctors. It is important we all appreciate this and ensure the general public know this too.
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It has become clear that employing PAs is fraught with challenge to define scope, prevent scope creep, and protect trainees. I and colleagues locally, as well as other colleagues elsewhere in the country have decided not to recruit PAs to our teams for the foreseeable future.
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Step 1 - PA expansion, with salaries at SHO level. Step 2 - A single body regulating Drs & PAs in parallel. Step 3 - GMC lowering standards - fewer exams, less knowledge. It is all to blur the lines between Drs & PAs to make it acceptable for patients. It was always the plan ๐ฑ.
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My personal view? I donโt like the term Physician Associate. โPhysicianโ could confuse patients & does not make sense if working in a surgical or primary care setting. I suggest Physician is replaced with clinical. I have made this point at many meetings incl. one with NHSE.
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A beautiful story in 4 parts. ๐
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Clinical condition - ๐๐๐ฎ๐ฏ๐น๐ฒ
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A plea to hospital colleagues - if you make a patient NBM, please have a plan to review this. Leaving a patient NBM over a weekend is cruel and should only be done if absolutely necessary. Imagine not having a drop to drink for 60-70 hours in hospital ๐ฅ.
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I used to do 100 hours when on for a week of night shifts on call as a house officer - it was awful. Detrimental for my mental & physical health, and unsafe. I am glad rotas like that are no longer. Also pleased to get rid of faxes, paper requests for CT scans, and having to.
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To be a medical Doctor - you need to do a medical degree at medical school. Here ends my TEDx Talkโฆ.
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As a Consultant Gastroenterologist with a specialist interest in IBD, I am challenged every week to manage patients with complex IBD. It is not a condition that is classified as anybodyโs โbread and butterโ.
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We were told to discharge patients back to care homesโฆ we were told care homes had sufficient resource to manageโฆ. #Breathtaking.
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A slap in the face. Ignoring the struggle to get into medical school, A-levels, med school exams, finals, huge debt. And now we are grouped together. No consideration for the on-calls, nights, post grad exams? . โMedical Professionalโ like PAs & AAs. An insult to Doctors.
๐งตThe updated #GoodMedicalPractice2024 uses the term โmedical professionalsโ as a collective term for doctors, physician associates (PAs) and anaesthesia associates (AAs), rather than listing out each individual role for every reference. We haven't removed doctors from the.
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The BNF still states the dose of iron incorrectly despite the evidence. The correct dose: NO MORE THAN ONE TABLET DAILY. Higher doses arenโt absorbed. This is negligent from @NICEComms. Patients prescribed higher doses get GI side effects causing significant morbidity.
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Empowering PAs has led some to think they know better about a medical condition than Consultants with a specialist interest in said medical condition. A perfect example of the dangers that lie ahead to the unsuspecting public.
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We had a Tory Govt dismantle a functioning NHS over 15 yrs with underfunding & consequential understaffing. To plug the gaps, the Govt expanded PA posts. The appeal? . Cheaper than GPs & Consultants, shorter / cursory training. This is why we are in such a mess. I blame.
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If a Physician Associate needs to be supervised by a Consultant, it means they can be part of daytime inpatient ward teams assisting with Consultant led ward rounds and assisting the MDT to deliver patient care. With the GMCโs guidance, it means that Physician Associates can be.
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Roughly an hour apart both @NavinaEvans & @NHSEnglandNMD posted comment today on a times article regarding PAs. These were their first posts on X in 2025. Smacks of a coordinated comms strategy. Frankly NHSE are an embarrassment.
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I found this sign on a door in my house. Howโs your day going?
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I always suspected this was the case somewhere in the UKโฆ. A Physician Associate doing GI bleed endoscopyโผ๏ธ. As a Consultant, GI bleed endoscopy can be the most challenging work we do. I can categorically say this is unsafe & unacceptable from a patient safety PoV. #Frightening.
FOI from @RCHTWeCare. States that all 9 of their PAs are prescribers. Seems very unlikely, and would be against @FPARCP guidance ๐ค. One of their PAs in Gastro is even endoscopy trained, doing a GI bleed list every week. Is this safe?. @BritSocGastro
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None of this passive aggressive BS when Junior Doctors were in hospitals during the COVID lockdowns - caring for the sickest & putting themselves & their own loved ones at risk.
Are the Junior Doctors still after a 35% payrise or did they put patients lives at risk just to wait for a Labour Government to settle for way less?.
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Iโm really proud of being a Doctor & all I have achieved. I started medical school in 1997. I have worked hard for >25 years & made lots of sacrifices. I have no regrets. Being proud of being a Doctor & being protective of the Doctor role should not be controversial to anyone.
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My opinion:. The title Physician Associate is there to confuse patients & lead to an acceptance of care from a non-Doctor. That is why PAs & their advocates insist & defend the use of this title. Change the title to clinical assistant & this problem goes away.
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We as Consultants have commitments to our families tooโฆ. Why should I potentially lose my career - with detriment to me & my family by whistle blowing?. Doctors are constantly dehumanised by the public & the media - the vast majority of us want to do the best for our patients.
Iโm very queasy about the number of doctors going on social and news media who are almost trying to make doctors into the victims of the Lucy Letby case. Whatever the specifics of this case, the NHS coverup culture definitely involves frontline clinicians as well as management. I.
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I have prescribed the best COVID PPE possible. FFP10 mask
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Physician Associates doing Gastroenterology clinics - this is very concerning for patient safety. This is from a Gastroenterology SpR close to CCT.
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I as a reg and now as a Consultant always made a point of seeing any member of staff myself. There arenโt many perks for NHS workers so thought this was the least I could do.
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A 4๏ธโฃ tweet guide on investigating and managing:. ๐ฉธ๐๐ฟ๐ผ๐ป ๐ฑ๐ฒ๐ณ๐ถ๐ฐ๐ถ๐ฒ๐ป๐ฐ๐ ๐ฎ๐ป๐ฎ๐ฒ๐บ๐ถ๐ฎ (IDA). for GPs & non-Gastroenterology colleagues. Defined as:. โฌ๏ธ๐ฉธHaemoglobin levels.(based on your local laboratory reference range).cฬ
โฌ๏ธ MCV / MCH. #GastroTwearls 1/.
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The messages keep coming. A Gastro trainee from the East Midlands messaged me about their endoscopy training.
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I have been clear that I have concerns about PAs becoming independent endoscopists:.As they are currently:.โข Unregulated .โข Non-prescribers.โข Need to be under supervision . However when GMC regulation is implemented I suspect this will gather speed. I am not sure if we have.
โผ๏ธ Look at this. this is the future of NHS 'expert' gastroenterology care. Seen by a non-doctor, diagnosed by a non-doctor and scoped by a non-doctor โผ๏ธ
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Innovative teaching on cardiac rhythms - using guns for a positive reason!
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This was the original tweet.
A minuteโs silence - to honour the thousands who have died from #COVID19 @KettGeneral .#EveryFriday1pm
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I ask senior Consultants - those who have been Consultants for 15 years or more:. Hand on heart - how much have you done to advocate for trainees as their T & Cs have been eroded over 15 years?. For the majority - it is little or nothing. Now is your chance to be supportive.
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The number of people (myself included) who are finding it more difficult on days off versus days at work, for a multitude of reasons. The impact of Covid & lockdown on mental wellbeing is profound, and I suspect will be long lasting.
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No one is saying HGV drivers:. Need to work harder.Not work part-time.Only drive & not have other roles.Earn too much money. Everyone including the press are saying โwe need more HGV driversโ. This applies to GPs too.
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I have vetted ~3๏ธโฃ0๏ธโฃ0๏ธโฃ referrals from primary care to Gastroenterology in last 2/52. Pathways vary around the country - nevertheless I have observations / advice about managing common GI problems in primary care & when to refer in 7๏ธโฃ tweets. #GastroTwearls 1/7
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The PA role may as well be dead. Once an appropriate scope is implemented - the safest & most effective deployment of PAs will be in IP wards. However the salary of a PA would be higher than all the ward team (bar Consultant & Matron) - Doctors, Nursing & Allied HP colleagues.
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I stand by my assertion. You are conflating issues. For most GPs 3 days is the same hours as full time for many other workers (37.5-40 hrs). People will get the NHS they deserve. Keep attacking us - we will walk & you will be left with a service similar to NHS dentistry.
@UKGastroDr "The vast majority of us want to do the best for our patients". In a year where lives have been sacrificed to the laziness and greed of NHS medics, that's quite an assertion.
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I have been asked my views on this. I donโt even think PAs should be performing endoscopy. To be ๐ฏ transparent, we donโt employ PAs within our department (never have & never will).
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We have an amazing hepatology specialist nurse who does ascitic drains - a straightforward procedure. Training her to do drains has freed our trainees to concentrate on their endoscopy training (all our trainees are all competent in doing drains). This is how you utilise ANPs.
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Seeing a bullying surgeon from a dysfunctional department deal with complaints from trainees like a bullying surgeon from a dysfunctional department is almost laughable if it wasnโt so awful. Outstanding example of cognitive dissonance & why the profession is broken for trainees.
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I have heard of a NW Gastro dept that has a PA who is:. JAG certified in OGD, providing independent lists incl. 2WW. Does 2 clinics/wk. On the in-reach rota. Answers GP A & G requests. Works autonomously under โindirect supervisionโ of a.Consultant Gastroenterologist. 1/4.
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For full transparency. I co-authored the RCP pre-EGM survey & promoted it. I (nor council) was not privy to the raw data pre-EGM. I was not privy to the EGM presentation of survey findings (I absolutely do not approve of what was presented). I saw the raw data for the first time.
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The contempt for Doctors in the UK, is palpable.
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FAO Consultant colleagues who are startled by the disdain shown by junior colleagues at their T&Cs. Remember at university:.They didnโt get a maintenance grant.They paid >ยฃ40k tuition fees.They left with ยฃ75-100k+ debt. Also:.No free accommodation in 1st yr.Inferior pension terms.
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As a Consultant, I say the issue isnโt the ANP, itโs the Consultants who sold their trainees down the river. I can imagine how sick a Cardiology trainee in that unit must have felt hearing / seeing the story / tweet. There are too many Consultants who donโt care about training.
I'm a consultant interventionalist, but was a trainee just 18mo ago. I am an educational supervisor (to doctors) and have mentored ANPs & pharmacists to expand their skills. I am clinical lead for my department, so all too aware of the pressures on trusts. Here are my thoughts.
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When you qualified in the last century, you didnโt pay tuition fees & may have received a maintenance grant. You will have had free accommodation as a PRHO. Also there were no smartphones or internet. As you happy to use both to tweet, perhaps you can also modernise your empathy.
When I was a junior doctor I wasnโt paid well, but I accepted I was an โapprenticeโ and thus couldnโt expect a massive salary. Our junior colleagues need to realise that they are simply doctors in training whose priority should be their patients not income. #JuniorDoctorsStrike.
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Perhaps PA training could be extended to 4-5 years, then post-graduate training for 5 years with exams before becoming a bona fide GP?.
I have cancelled my BMA membership, the primary care team today is much wider than only GPs. This is where we are. PA training may need to be reviewed and made longer and they should be regulated but this tribalism does not represent my views as a GP @DrRichardPile.
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We have to be brutally honestโฆ there are too many Consultants who donโt give a ๐ฉ about trainees.
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Based on this aloneโฆ. I will be rejecting the Governmentโs offer. This is basically limiting SPA further - I suspect some trusts will make it zero.
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My Mum just said to me โwhat an insult the clap for carers was - when you were all left to deal with the horrible situation of Covid without adequate PPEโ #Breathtaking.
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One of the toughest times of my career was managing a patient with abdominal pain & sepsis. Despite multiple scans & other investigations, the cause wasnโt found & the patient died. Even as a Consultant Gastroenterologist - abdominal pain can humble you.
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To all my GP colleagues out there. We know you under pressure, youโre tired, youโre hurting, and youโre fed up. Remember that the majority of hospital colleagues understand, appreciate and support you. Need all HCPs to stick together - weโre stronger that way.
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An ongoing pandemic message. Please get vaccinated / boosted. Do it to protect yourselves, protect your community, and to give you freedoms that being vaccinated enables @projecthalo #TeamHalo.
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The sport I play (not as much as I should / would like) is badminton. Not high profile but no other racquet sport involves hitting an object as hard & fast as badminton. Watch this backhand smash from Lee Zii Jia - at a speed of 372 km/h (231 mph) ๐คฏ๐ฒ๐พ๐ธ
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@AaronBastani @AyoCaesar Poll of favourite day of the week:. Saturday = 35%.Any other answer = 65%. Looks like people hate Saturday ๐คท๐ปโโ๏ธ.
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Furious that every recent error from organisations that run recruitment or exams ends up having a devastating impact on Resident Doctor colleagues. There is a very thin line between โerrorโ & negligent disregard. This is utterly unacceptable.
Doctors received offers for Radiology training posts at around 3-4pm. They were able to accept these offers on Oriel and received confirmation of acceptance. Offers then began to disappear on Oriel. At 6:30pm they received this email. Simply unacceptable.
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I usually have 30 minutes to see a new.patient in clinic, request investigations, prescribe treatment & dictate the letter. I donโt know how GP colleagues do this in 10 minutes. So much skill & expertise required.
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When prescribing iron tablets to correct deficiency, please do not exceed a dose of one tablet daily. There isnโt much more iron that can be absorbed at higher doses, all that happens is an increase in GI side effects. #TipsForNewDocs #TipsForOldDocs.
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I have no doubt that a senior clinician โsigned offโ these rates. This shows huge disrespect for our foundation Doctor colleagues. I never understand why our junior colleagues, especially early in their careers - are treated so badly is so many UK hospitals.
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Happy to make my PoV clear:. I will support junior colleagues & nursing colleagues in their likely industrial action in 2023. I will vote for IA as a Consultant when we are balloted. The issue - fundamentally - is pay. Pay erosion = 20-40% from 2008. We need NHS #PayRestoration.
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I havenโt posted on PAs recently, I have been working within the RCP on improving the issues. However seeing posts RE PAs doing ascitic drains & chest drains ๐ฑ. As a SpR having done 100s of ascitic drains it still scared me. I donโt blame individual PAs for complications. This.
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When the Consultant get the post WR coffees in. Please remember. coffee means coffee!!
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Delighted to have been elected to @RCPhysiciansโ council - to start in August 2022 for 3 years. Thank you all who voted in the recent elections. I am grateful for those who cast their vote for me.
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So no one posts this but on the tube, everyone in masks, 9/10 covering nose and mouth - good to see!.
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I respect your right to work on July 20-21. Please respect my right to strike.
The worldโs gone mad. Iโll be working donโt worry.
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I really want England to win today. I really really do. But I hate the England fans and the culture of hooliganism that goes around with them everywhere England play - even at home in London. These dickheads ruin everything. #ENGITA #Euro2020Final .#EURO2020.
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Being kind as a health care practitioner is an important trait, understanding your working day coincides with the worst day of your patient (and their loved ones) month / year / life. However the GMC deciding to regulate kindness is a mistake. The NHS is such a toxic workplace,.
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Prof Melville - do you think patients understand what a PA is or what they are supposed to do?. All this chicanery with GMC regulation & the choice of title is to mislead patients into accepting a lower standard of care. I suspect you will insist on Consultant delivered care.
โOur professional standards directly tackle issues around working within competence and being honest about experience, qualifications, and current role.โ. BMJ 2024;385:q790
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@gmcuk I have been mistaken for a GI surgeon before. Maybe I should head to theatre and have a go? I am sure a โlocal processโ could be set up for me!. Oh wait - just realised that would be absolute madness - as I AM NOT QUALIFIED to do surgery.
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@drcolinm @parthaskar @doctor_oxford @ollieburtonmed @TheBMA @BMA_JuniorDocs @mmamas1973 @DrLKVaughan @DrAsifQasim Fix this. The GMC must make sure public safety is always paramount. Stop obfuscating. Make sure @gmcukโs language, comms &actions are clear so that the role of Physician Associate is never conflated with that of a Doctor. Our patients deserve this as a bare minimum.
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So there it is. PAs are doing upper & lower GI endoscopy & receiving dedicated, funded & protected training to achieve "competency". Something our own @BSGTrainees struggle with. This is a major problem for Gastroenterology & one I urge colleagues to debate on ASAP. end ๐งต/.
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I wanted to make 2 points at the #RCPEGM (sadly ran out of time) to consider for those voting. My declarations: I work at a DGH that does not employ PAs, .I am a @RCPhysicians elected councillor, chair of the colorectal section @BritSocGastro & a member of @TheBMA. ๐งต 1/.
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Always important to see the apology after the press defame someone. Well done @DrNighatArif for holding the @Telegraph to account.
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A 3% pay rise for NHS workers is a derisory pay cut given inflation is projected 3.7%. Our trainee Doctor colleagues have been at the sharp end during the pandemic. Keeping the service going, making personal & training sacrifices. For them to get nothing is a fucking outrage.
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