Secuti @Secuti

@IDiots_pod While onchomycosis x2 risk of cellulitis it is only 1 of the risks. Rx 50 people with terbinaine will ⬇️ the incidence of cellulitis from 20 to 19 cases per 1,000. Relapse is 30%. Also even if cellulitis develops majority of cases (70-80%) can be Rx as outpatient for pennies.

GP refers child to hospital appropriately Nurse doing a job they should never be doing, ignores referral, misses the diagnosis a third year medical student would make & inappropriately discharges child to worse possible outcome Dropping professional standards causes harm : FACT

The Tiger isn’t really about the tank. It’s about what the tank does to the men trapped inside it. Dennis Gansel turns a Wehrmacht Tiger into a mobile pressure cooker of guilt, denial, and slow psychological collapse. On the surface they’re following orders on a secret mission behind the lines. Underneath, the real war is happening in their heads fueled by Pervitin, sealed in steel, and haunted by the things they’ve already done or allowed to happen. “We were only following orders” starts sounding less like an excuse and more like a last, failing defense mechanism. David Schütter’s lieutenant is especially sharp here: a man whose rigid obedience has become both armor and prison. The closer they get to their objective, the more the mission starts to feel like an internal reckoning. Claustrophobia, chemical haze, and suppressed conscience blur until it’s hard to tell what’s external threat and what’s the mind turning on itself. Gansel has always been interested in how ordinary people become complicit. Here he makes that process feel intimate and suffocating. The ending forces the psychological question the whole film has been building: how much of this was ever outside them? If you like war films that prioritize mental and moral fracture over spectacle, this one digs in. What did the psychological weight of it do to you? #DerTiger #TheTank #PsychologicalWar #MovieAnalysis #DennisGansel

The replacement of fully trained GPs by untrained PAs is a matter of life and death. In a break in the Covid shutdown I was at a meeting where a senior manager of an NHS Trust told us 'In 5 years when you go to a GP you won't be seen by a GP.' Sometime conspiracies are real.

1/4 A ‘simple case’ for team “anyone can play at Drs”🚨 On the screen it said - 🚺 in her 60’s - has run out of medication. Looked simple enough! Patient has T2DM & HTN. On multiple oral meds plus Insulin. @lengreview @rcgp @RCPhysicians @TheBMA @BMA_GP @PrimaryCareNHS

Formal email sent to @DHSCgovuk and @NHSEngland Regards PA protocols @lengreview 1. No role for PA to see undifferentiated patients. The supervisory time asked for is not available - and thus will lead to lesser supervision than planned and thus safety issues 2. Absolute no regards Resident Doctors holding responsibility. If anyone as a senior wants to be a liability sponge? Do it yourself- not lean on RDs 3. Given present suggested protocol- review of pay bands as not cost effective - in environment of other staff being de-banded. That will be position with respect to @RCPhysicians and @gmcuk too You may not agree with it- but in a democracy- I am allowed to have an opinion And that’s mine as a senior clinical leader with years of work as a trainer- and leading on safety issues. You give yours and let’s see what comes out as the final one. @djnicholl @thomasdolphin @mmamas1973 @DrNeenaJha @BMAResidents

Comments on the protocol for PAs: Regards the people who have done this. It's no different to what I saw when RCP was making their interim document of scope. A few of us stopped it from a complete slide at that point- and this panel doesn't have a dissenting voice- so it's mostly an echo chamber IMO. FWIW? I respect Gill Leng- and she has been-IMO- bench pressed by a skewed group. It is why she is asking for as many people as possible to comment on this. If we-as doctors- we want to support her and @lengreview recommendations, we support her through organisations as best as we can. First the good news: 1. With the @TheBMA having put the PA protocol document in the public domain? The @RCPhysicians is saved the hassle of mulling over whether to open it up formally. Now that it's open, let Members & Fellows decide whether they want to take this level of supervisory responsibility. Let the wider democracy give their views 2. It's a national scope work- so we are finally moving away from the nonsense of 'local scope' Now the rest: 1. My personal view? It's a flat No from secondary care perspective No one has that level of supervisory capacity as stated in document due to job plan constraints. And we have the 'Medical Education & Training Review' yet to land @DacreJane Which means- we will have lesser trained people seeing undifferentiated patients- and cause harm. 2. In my opinion, it should be rejected by RCP et al- but I don't speak for all. Write to your College. If you- as a Resident Doctor- or Senior- feel this is ok? Write too. That is my view- and I will not want any of my loved ones to be seen by a PA as per this protocol. I have the privilege to avoid that. Question is- do you. This document goes nowhere without support of @TheBMA @RCPhysicians @rcgp et al I can guarantee you that @DHSCgovuk will not take on a pitched battle if all doctor organisations- the ones being asked to be the liability sponge- says 'No' Over to all of you. I know it feels tiring sometimes- battling the machine- while trying to improve patient safety Yet- You only lose when you give up. @mmamas1973 @djnicholl @Mumtaz_Patel_1 @OGMustafa @VictoriaTzB @SwordsFrankie

Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar

2 weeks ago

The questions must be asked Less obfuscation, more transparency Formal ask in place Over to you @RCPhysicians As a Fellow, we should be able to comment on the protocols as suggested by @lengreview The 'era of transparency' should mean exactly that @djnicholl @mmamas1973

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@DrGoblin3 Paroxetine is one of the more difficult drugs to withdraw from impart due to short half life. Try hyperbolic tapering and consider taperingstrip.com/prescribing-an…

Excited to share the new @medshronline CPD Diary is now live at medshr.net/cpd It’s free and makes it easy to collect all your CME and COD credits in one place, add reflections and be ready for your appraisal Check it out and let me know what you think @ZulkifMehmet @NEndoscopy @ShafiAhmed5 @mmamas1973 @aayshacader @DrHWazir @ShrillaB @JatinderHayre_ @bolton_char @CLawthom @LondonAnaesth @Shr_Nottingham

@patricksrarebks If I recall correctly the illustration is Figure V from the book Cerebri Anatome: cui accessit nervorum descriptio et usus by Thomas Willis The anatomical plates for this book were drawn by the famous architect and polymath Sir Christopher Wren and published in 1664

Why the Crown did not call the actual experts who attended on the collapses—eye-witness neonatologists with live, real-time, hands-on experience—and instead, at great cost, engaged a long-retired non-specialist paediatrician to interpret their results, is utterly baffling.

Guy Rowland @guyrowlanduk

3 weeks ago

The hospital reached their position through contemporaneous diagnosis, post-mortems and 2 reviews. The lead expert witness boasted he diagnosed the first case as deliberate harm in 10 mins over a coffee. The original post-mortem pathologists were not called at trial. (2/7)

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The people who led Physician Assistants up the hill - should step forward A promise of autonomy, higher pay, substitution of doctors With lesser training Poor ++ @gmcuk @RCPhysicians @rcgp @NHSE_WTE Incredible to see a project backed by all & sundry in power in power flounder. Led by a few. Keep raising the alarm. The public deserves better care And appropriately trained staff

TIVA Tim @TheSnoozeDoctor

4 weeks ago

Let’s have it right LBC, they’re Physician Assistants! 🙄 ‘Thousands of physician associates (PAs) are said to be on the brink of leaving the health service over job security fears and 'hostile' culture’ lbc.co.uk/article/nhs-st…

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Just in case AI extinction hasn't given you enough to worry about

Ben Judah @b_judah

a month ago

In today’s @FT I make the case for Britain to throw its diplomacy behind the creation of a new international observatory, to monitor the cooling North Atlantic, against a potential collapse of the AMOC currents. ft.com/content/487096…

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He isn't Palestinian. He isn't Arab. He isn't Muslim. He isn't brown. Because you dont have to be to oppose genocide. @macklemore risked it all to stand for a people he could have considered "other". Lets stand by him. Internet, do your thing. Make him more famous than ever.

Macklemore @macklemore

2 months ago

Wanting all humans to be treated equal should never be controversial.

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Exactly one year ago today this patient experienced a cardiac arrest at work. He’s alive today because his coworkers did CPR until DC EMS arrived and then he received great care by the team at our hospital. He brought flowers today for every unit that took care of him. During a stressful day this was a giant burst of serotonin. (Posted with the patient’s consent)

A story from being on call years ago. A patient was referred to me as Med Reg by AE as being unable to go home. The pt had learning difficulties and needed an assessment by PT/OT which was not going to happen until morning - that was the referral. 1/

Department of Health and Social Care @DHSCgovuk

a month ago

We're making it quicker and easier for people to get the care they need, closer to home. From this autumn, participating pharmacies will be able to assess and treat five additional common conditions. Find out more: england.nhs.uk/2026/09/patien…

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RCEM chose to shoot themselves in the foot, we all know those odious EM Consultants who worshipped at the altar of noctor substitutes practising quackery on EM patients. This is the entirely predicted outcome 😡

Meg 👨‍👩‍👦‍👦👩🏻‍⚕️🇮🇳🇬🇧🏏🎥(BlueSky Name👇) @Megsenmumdr

a month ago

“It means A&E is now the single biggest area for clinical negligence claims in terms of number. Value of those claims exceeded £550 mil last yr” It says lots is from not doing the basics right. Wonder what’s changed in A&Es in last decade. Patients &families bear the consequences

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Nigel Warburton—philosopher, writer, host of the @philosophybites podcast—interviewed 2021 #BerggruenPrize laureate @PeterSinger on living morally, utilitarianism & religion, consequentialism in "the fog of life," why he gave the Prize money away & more. philosophybites.com/2022/05/peter-…

This was almost three years ago. I was fighting so hard for you all, and being told that I was wrong. I remember being called toxic again and again, and other accounts telling other GPs to not follow mine. I was right. They were wrong. Still waiting for an apology.

Parody RCGP @Parody_RCGP

3 years ago

This is a tweet from a locum PA firm who are sponsoring the 2023 RCGP Annual conference. It is terrifying. Perhaps they could find the time to find a place for locum GPs, and salaried GPs and well GPs as a whole?

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@gmcuk chair Carrie MacEwen has now admitted the fitness to practise system is being weaponised against whistleblowers. @Telegraph found 22 whistleblowing doctors referred to the GMC a combined 30 times. Only 2 of those referrals led to a hearing, and neither was upheld. One surgeon, Peter Duffy, was referred anonymously 7 times and cleared every time. 14 of the doctors say the managers who reported them left out the fact they had raised patient safety concerns in the first place. Same playbook I keep finding in insurance and financial regulation. The process gets used as a weapon, and the regulator only admits it once a newspaper forces the point. telegraph.co.uk/news/2024/05/2…