Nick (@[email protected])
@nickopotamus
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Recovered geophysicist. Amateur triathlete. Serious stuff @critcarenick . Opinions own etc. #Mastadon @nickopotamus @critcare .social #Bluesky @nickopotamus .co.uk
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Let's continue the conversation somewhere slightly less right wing hell site...
#bluesky
:
@nickopotamus
.co.uk (invites available!)
#mastadon
:
@nickopotamus
@critcare
.social
#threads
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@nickopotamus
#spoutible
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@nickopotamus
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I’m just about to finish my ST7 year of anaesthetics. I’m trusted by my consultants to run the hospital - a MTC and tertiary paeds referral centre - overnight
Yet my nurse wife still leaves me written dosing instructions for Calpol and ibuprofen for my kids when she’s on nights
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@drodutola2022
@WendyHassonMD
It's called probability, chief
A young fit athlete had early CPR, early defibrillation, and the whole chain of survival delivered well and rapidly
Lets not cheapen excellent medical care by calling it a miracle, nor suggest those who die are somehow less deserving of one
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@mario_sofer
@UrologyTLVMC
@KarinLifshitz
@Uroweb
My man, 40% of your adjectives to describe this clinician were related to the way she looks.
Can’t you focus on the smart, motivated, and involved bit of her brilliant work?
I wonder if you would use the same language to refer to a male resident offering a presentation?
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@SteveBarclay
@NHSEngland
@BMA_JuniorDocs
They declined the terms you offered just over 48h before the industrial action began, having failed to secure any intervention from you over more than a third of a year.
Try harder Steve.
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@EssexPR
You pay tax, you get:
Education
Transport
Sanitation
Healthcare
Security
…
Tax isn’t the problem, it’s the Gov misusing the funds raised
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@MStott88
It’s not a race to the bottom Martyn. Our pay has been progressively eroded to a far greater extent than the median UK salary.
All we’re asking is to be paid fairly for what we do. If you want the best doctors you pay the best salary. That’s how the rest of the world works.
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@ABridgen
Bloody hell Andrew, wait until you "uncover" the proportion of drivers dying in RTCs who are wearing seat belts.
This is basic maths mate. Try an evening class on statistics.
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Wife explaining said instructions to kids this morning. “That’s because Mummy has seen how Daddy gives drugs. He puts them all in one syringe and thinks that’s ok. It’s not ok.”
Seems relevant to another discussion on here 🤔
And then when the patient gets to theatre: Everything gets given as a bolus through the same cannula over a few seconds and flushed in with Hartmann’s (and a peripheral pressor)
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@HealthRegLawyer
Divide and conquer. The biggest strength NHS staff have to effect change is solidarity, so by offering a big chunk their own deal HMG can break that and allow the infighting to destroy any movements
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@KEdge23
So you’re saying the essential public sector workers:
Bolster the economy
Prevent disruption
Educate children
Save lives
And support the mission of the government?
Maybe they should be paid properly then
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@KateBurkeNHS
@MKHospital
It’s slightly distressing how many NHS people are replying with how amazing this is. Any decent company employing professionals would supply parking, drinks, and sufficient office space. That
@MKHospital
is such an outlier in the NHS says more about how poorly we treat our staff.
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@MStott88
We’re losing good doctors in droves to Australia and NZ, or from the profession all together into financial, oil, and data industries.
What do all these have in common? Fair pay for intensity of work done, and working conditions commensurate with responsibility.
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And then when the patient gets to theatre: Everything gets given as a bolus through the same cannula over a few seconds and flushed in with Hartmann’s (and a peripheral pressor)
Was told by several recent graduates today that TXA should have it’s own dedicated cannula and only TXA + flush should go through it. I’ve never heard this before, doesn’t really make sense to me why and can’t find any references to support…
Any ideas med twitter?
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@EmergencyBod
@Telegraph
Telegraph tomorrow: WORK SHY CONSULTANT PICTURED LYING FLAT ON HIS BACK IN THE MIDDLE OF THE DAY ON A SEAT THE NHS PAID FOR
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@Microbedoc2
Dunno what you micro lads are complaining about, antimicrobial stewardship is dead easy on the ICU
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@thefourthcraw
I was discharged by a team - at the hospital I was working at - because I "DNAd" a phone consultation
I couldn't answer because they called me three hours after they said they would, and I was doing a solo list by that point
Being a patient makes you realise how bad it can be
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@SteveBarclay
Steve it takes me 4 minutes to log in to access a patient's blood test results in the operating theatre. We can't make use of AI tools until basic IT infrastructure is in place. Invest in that first.
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@KateAndrs
So we’re back to junior doctors being absolutely critical to the function of the NHS… but not critical enough to be paid fairly?
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@katiewiskar
I’d be lost without the pharmacist on my ward round quietly correcting everything I prescribe
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@VictoriaAtkins
It would have already been cheaper for you to have implemented full pay restoration than cover the industrial action so far. This suggests that your stance is entirely an ideological one. Put something credible on the table today and I’ll be back in work this evening.
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@newitt_a
@AndyCoxDCS
@theJeremyVine
Good job you’re here to tell us why the *checks notes* national lead for collisions investigation is wrong on the Highway Code
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Strong believer that all in hospital arrests are worthy of a furl incident report and investigation. Vast proportion
are either a failure to recognise/rescue deterioration or a delay in appropriate decision making.
Saturday morning hypothetical:
Elderly patient arrests. DNACPR form incorrectly filled. Aggressive CPR ➡️ ROSC. ITU: not for escalation. Patient left to die.
Is inappropriate resuscitation, at the very least, moderate harm? And should this trigger
#dutyofcandour
?
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Sad to be spending this
#EdBallsDay
away from my family (I’m in Brum to teach EPALS). Will miss seeing their little eyes light up as they open their presents under the Ed Tree before the grandparents come round for Ed Balls Dinner.
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@theresecoffey
Summarise “ABCD” as “staff” and you might be getting there.
None of it works without staff. Pay them properly, improve working conditions, and get rid of the pensions tax trap and they won’t all leave. Then you’ll have ambulance crew, people to care, and waiting lists cleared.
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@ABridgen
Seems an appropriate response to a conspiracy theory being raised in our centre of democracy
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@johnredwood
If only someone could have predicted the impact that removing access to our biggest market would have
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@NHS_HealthEdEng
My personal favourite was being declined relocation expenses and being told to claim travel expenses instead… then having the travel policy changed so I was no longer eligible for the majority of it. Also twice having ST job offers withdrawn due to failing to Excel properly 🙌🏻
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@MillHillBwy
@Peston
“People with an illness can’t have jobs” is quite an interesting take from all of this
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The
@OutlawTriathlon
Half? Completed it mate.
Swim: Beat the cut off 🙌🏻⏱
Bike: Sub 3h 🚴🏻💪🏻
Run: Failed to plan for heat, got dehydrated and missed my 2h target 🥵
Thanks to everyone who sponsored my humiliation and raised money for
@AnthonyNolan
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OH HAI EMERGENCY TAX CODE AND YET ANOTHER ESR LOGIN SO I CAN’T EVEN SEE THE DETAILS I NEED TO FIX IT
In what other career are you forced to budget to not be able to pay the mortgage every three months simply because our de facto employer refuses to be our financial employer?
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It’s distressing that over a decade after CG174 1/3 of respondents still think “1 salt and 2 sweet” is the right thing
Also: sip until send, please
Patient is NBM for a procedure tomorow. Asked to prescribe fluids for overnight. Whats your regime of choice?
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@danny_mercer
@DrJonathanD
1) Frequently untrue
1A) See above
2) Do they really? “For a CT scan in the morning” was my favourite at 2am
3) Probably fair, but you’re also failing to appreciate my workload
4) It’s your patient
5) You’ll be surprised what regs can achieve when needed
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@MStott88
Me as a FY1:
Tuition: £3225/y
Loan interest: 1.1%
Tank of fuel: £60
GMC: £90
Salary: £22412
FY1s now:
Tuition: £9250/y
Loan interest: ~12%
Tank of fuel: £84
GMC: £161
Salary: £29384
Jokes about Waitrose aside, is it any wonder today’s FYs are struggling?
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@VictoriaAtkins
@DHSCgovuk
Economics? No, it’s cheaper to offer FPR than cover the strikes
Health outcomes? No, staff in work are more productive than on the picket line
So the only reason remaining for not making a decent offer is putting Tory ideology ahead of the people of the UK. Disgusting.
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@TimTerry3
Lovely sentiment Tim, but I imagine w/ no/minimal student loan, free rent during early training, mortgages on 5 figure properties, CEAs, old pension, and (presumably) an established private practice for the bulk of your cons career your experience may be slightly different?
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@nohandsup
Yes, in the same way I'd expect student doctors to do so. It's a common language that allows health professionals to communicate and keep patients safe, and its essentially only five stems to learn.
Why wouldn't that be expected knowledge?
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Miso braised cabbage with tahini butter bean puree for tea after seeing the recipe on
@instagram
Feedback from the four year old: “I tried it but I didn’t like it. I’ll keep it in my tummy though, and poo it out later”
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@LiamFox
As a CURRENT Tory MP, maybe you should do something about it then? Like pay doctors properly?
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@DrAlbertGifford
Plenty of drs do it, but its a v limited evidence base. Zopiclone is popular but much better at keeping you asleep than sending you to sleep, leading to unrousable patients in the morning who don’t rehab and then don’t fall asleep the next night (and this way delirium lies)
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@Polluxe
@DGlaucomflecken
Taxes that cost much less than essentially mandatory private health insurance (so a tax in anything but a name), yet outcomes are better.
People need to stop obsessing about tax being bad. If you get better services for it than paying privately then what’s the problem?
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@AshBrownett
Yeah nah this was done to death on the parameducate Facebook group.
Small squeezes (or even worse, using a paed BVM) doesn’t develop the necessary ΔP to deliver a decent Vt. If you’re in a BVM situation (esp with M) then do whatever you need for a chest rise.
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@MStott88
It may be alright for you and I, but it’s not for the students and juniors following in our footsteps. Bonkers loan debt and costs we could barely manage rising much faster than pay.
We have a responsibility to our colleagues, as they are the ones who’ll protect our patients.
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@SteveBarclay
@BMA_JuniorDocs
@Daily_Express
Nice to see you back from holiday Steve. So will you be meeting with the BMA over the weekend, or waiting until Monday?
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@DrRJWebb
All AfC bands deserve uplift - but AfC also allows recognition of differences in workloads
All nursing is hard. Doing it while also running a vent, vasoactives, RRT all while handling the emotional burden of ICU is next level
ICU nurses are to an extent autonomous practitioners
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@SteveBarclay
This is the point where you admit that 12 years of intentional mismanagement and underfunding has crippled the NHS, and agree to pay rises in line with inflation. Posing in front of an empty ICU bed with a mournful expression on your face doesn't safeguard the electorate's health
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@WeCareAboutMH
@totalguff
@thomasdolphin
My dude wait until you hear about how much MPs rake in with their jobs on the side! Maybe then you won’t support their yearly pay rises?
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Mate, it’s a park run. It’s a volunteer run community event focussed on *inclusivity*. Trans people have just as much right to be there as anyone else.
Today at parkrun a trans-identifying male finished “1st Female” pushing more than 100 females down into a worse finish position.
More difficult for actual females to climb up parkrun’s first finishers lists.
The 2nd Female was a girl, robbed of the joy of being 1st.
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@MemeRegOnCall
Every anaesthetist has a very strong opinion on IV fluids.
No two anaesthetists share said opinion.
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@ICMdoc
@doctorrah
There’s nothing finer than a heated blanket for that 3am circadian dip.
Or so the patients tell me. Obviously.
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@KEdge23
Junior doctors have to work for free to demonstrate that we “give a damn”, while MPs such as your boyfriend get a >30% pay rise over the same period while getting all their expenses paid?
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@dob86
Even if there was one, there’d invariably be a van or taxi parked in it. Yet to see an on-call space occupied by an on-call consultant’s vehicle.
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Doesn’t every Trust have the equivalent of the “seven item breakfast” that makes you hate yourself?
Finished nights and you want a NHS breakfast to sustain you for the final journey home
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@julian_donovan
I want to know specific physiological derangement/concerns, not an absolute number
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@drjohnbayliss
Maybe that’s why I’ve been given the instructions - no ODP around the house to stop me screwing it up?
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@timricketts_
Antibiotics for “sepsis” within one hour meaningfully alters outcomes.
The utility of lactate as a prognostic marker prior to any therapy.
Actually, just most of the sepsis 6 bundle, tbh.
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@armyemdoc
Yep, airway full of blood is going to make your next attempt so much easier 🤔
Yet to find a patient where a NPA makes bagging easier, but then again a jaw thrust and OPA means I’ve never resorted to putting one in during an RSI.
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There are real people with real lives and real jobs at stake on the end of these exam balls ups.
Colleges and Faculties must do better, both in systems to prevent this happening, and actually APOLOGISING and supportive their (paying) members who are effected.
@RCollEM
No you absolutely haven’t offered as much support…. You’ve now told me I’ve failed, 2 weeks before I start my Consultant job… yet you can’t tell me my actual score yet??! Why why why…. You just don’t appreciate the enormity of this ‘technical error’… shame
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Jolly good. Always wondered what to order when I fancied a bit more than 500ml and a bit less than 750ml of wine. Glad that my government are focussed on the important things that are impacting real people’s everyday lives.
We’ve removed burdensome bottle size restrictions for 900 British wine makers 🍾
And consumers will benefit from improved choice 🙌
Read more 👉
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@Medifectious
You'd be a fool to opt out to save a few quid now. AA aside (you're MANY years from that) nothing is more tax efficient than the NHS pension, and its guaranteed by HMG.
Sure, NHS as we know it will be different by our retirement - but how rock solid will your "investments" be?
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@ICMdoc
@Medic_Russell
BaSICS didn’t show much of an improvement (except it kinda did), but the largest meta-analysis (including PLUS and BaSICS) suggests that in a game of marginal gains balanced is still the way forward
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@MStott88
Plus remember that everyone is being hit by the CoL crisis. This includes drs commuting long distances on rotation, and paying for excessive hrs of childcare due to said commutes, early starts, weekends and nights.
Literally thousands of your colleagues are struggling right now.
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@caffeinemedic
Time: As long as it takes to do a good job
Tips: Document drugs (inc doses), reactions (not just "allergic"), and decent social/functional Hx (baseline ex tol, hills/stairs, which ADLs they can/can't do). Discuss limits/DNAR early. "Senior r/v" isn't a plan nurses/FY1s can action
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@emily_fri
I’ve used etomidate exactly twice in my entire career. Amazed to find that it’s your go to? Why do you hate the adrenals of the critically unwell so much? 🤯
Almost all of my neuro RSIs are done with propofol (and a bit of pressor). Special K if they’re profoundly unstable.
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@armyemdoc
@SamGoodhand
After considering the difference between European and US driving standards, healthcare provision, food safety, and gun control, you might have a point. Not the one you think you're making though.
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@VirtueOfNothing
@bobfunn
Nope nope nope. I’m with
@MJTB1987
- unless I’ve given them the OD (or a reliable colleague) I’d rather give them bed and breakfast on ICU than a seizure I can’t treat.
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@hannahmillana
Do nothing. We’ve all had an accidental micro-nap in ED at 7am. This sort of bullying behaviour isn’t on, but any decent ES will either ignore it completely or push back against it, but it won’t trouble you.
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@JoelBrownMD
@Parody_RCGP
Masters is more independent study and generation of research novelty… MBBS (and variations thereof) are still fundamentally rote learning facts with a quiz at the end, albeit over a longer time frame.
So no, I wouldn’t devalue a masters. Medical degree is already its own thing.
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@georgebellstarr
Absolutely not. ACP is a nurse/AHP with super powers. A doctor is a doctor. They’re not equivalent or interchangeable (nor one superior to the other).
I imagine an ACP would make an excellent graduate entry medical student however.
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Proud to have spent my training working in trauma ICU’s where “being malignant” wasn’t seen as a badge of honour. Worked with some incredibly tough, hardworking, and demanding surgeons but they also promote a culture of teamwork and humanity.
@residencyreview
If you read that and it frightens you, surgery might not be for you. The program I trained at specifically had TICU walk rounds (which was notoriously malignant) when we had MS’s interviewing. Our program was openly malignant but that meant we never matched soft applicants.
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@armyemdoc
@sethstarkadder5
Don’t worry, there’s a really easy flowchart in case you’re struggling with the big words
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@danny_mercer
@DrJonathanD
6) Long term access is rarely a surprise, so chat with IR in hours rather than it being a 2am problem
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@memneon
@TabitaSurge
I’m not sure this is it mate.
@TabitaSurge
is highlighting the very important point that normal FAST != not a stroke, which a lot of my colleagues seemingly don’t understand let alone the public, and that how inadvertently male-centric healthcare can be.
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@Faisal_Alshukri
@ArronThind
This group fear of "repercussions" is what stops many JDs improving their own working conditions (and for those following them).
The GoSW is there to prevent there being any repercussions. If you're forced to work late, that's a system problem, not a you problem.
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@georgebellstarr
Because fixed rotas give your life even less flexibility, at the expense of certainty.
Bespoke rotas are not that hard to do - they just need rota managers to care about their staff.
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@danny_mercer
@DrJonathanD
I get the point you’re making, and it may well be true for your requests, but it often isn’t our lived experience. Also asking your senior/boss isn’t us being obstructive, it’s a) part of their job and b) how you learn to do these things
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@danny_mercer
@DrJonathanD
You’ll also be amazed by the number of urgent IV access requests that suddenly become non-urgent once a senior from the parent team reluctantly becomes involved
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@Beska
@timricketts_
I’m all for mocking the physicians and their lack of understanding of pharmacokinetics, but you leave Magic Magnesium out of this.
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@Ivan_D_Crypto
@MikeyCycling
Not unpopular. Just demonstrably unworkable and entirely unnecessary.
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@rosieerooo22
And that’s what NEWS is designed for, to enable b2/3 to do obs and escalate concerning numbers without necessarily understanding the physiological rationale
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And if the answer isn’t “FY1” please just say that. No idea where “one of the doctors” has come from but it’s really unhelpful.
FY1s - how do you introduce your grade on the phone at work when on call/speaking to other specialties
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@BeardedHealth
Why use it though? Any clinician should be able to say “they’re hypotensive and tachycardic” which means something.
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Oh yes, and of course today is the day someone has also hit my car in the staff car park. It just gets better.
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Man who cheated repeatedly gets angry at sportspeople being good role-models
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