Ed Palmer @DocEd Twitter profile

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Ed Palmer

2 years

The #FragilityIndex has gained significant traction in the medical community. I’ve written a post to help understand why it’s time to put this concept in the bin. Enjoy. @load_dependent @iceman_ex @DrDavidPalmer @ADAlthousePhD

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Ed Palmer

@DocEd

11 months

Honestly this is just getting silly now. I’m a specialist in sepsis, I did my PhD in sepsis, it’s kinda my bag, and I strongly discourage this kind of stuff. I’ve seen MIs, PEs, Addison’s and a number of other serious conditions treated with antibiotics. Stop now please.

Scott

@dob86

11 months

The lift when you get called to review a tachycardic CTG and a febrile mum.

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Ed Palmer

@DocEd

1 year

I really don’t think the public understands what an enormous risk to patient safety this poses. I’m an intensive care doctor with more than a decade of post graduate experience and I would feel uncomfortable seeing undifferentiated patients in general practice.

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Ed Palmer

@DocEd

10 months

So to be crystal clear. While literally hundreds of my colleagues up and down the country have been unable to secure anaesthetic jobs or progress in their career, the RCoA took £1.8 MILLION to expand associate replacements.

Ronald MacDonald (@rmacd.bsky.social)

@quackophage

10 months

So wait, it only cost £1.8m to bring the RCoA to heel? 👀

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Ed Palmer

@DocEd

11 months

People often gripe about GPs “missing sepsis”. But fail to consider that they are actually being asked to diagnosis “pre-sepsis” and not “early sepsis”. Identifying which cases of infection will develop organ dysfunction is incredibly hard when the vast majority do not.

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Ed Palmer

@DocEd

10 months

People often talk about the time critical nature of sepsis. But it may surprise you to hear that the evidence to support “early” antibiotics actually isn't a settled debate. Why is that? The key question is “early in relation to what”? 🧵1/n

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Ed Palmer

@DocEd

4 months

This is excellent. Look at this group celebrating their doctors. The Royal London is a superb place to work and values its doctors. More departments should do this for their annual intake, as our American counterparts have routinely done.

The Royal London Rotation

@RoyalLondonOrth

4 months

An extremely warm welcome to our new ST3s Alex, Bassil, Neville, Kabir and George. They will be joining the Royal London Rotation in October.

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Ed Palmer

@DocEd

9 months

This is a misstep from the PA community. Differences in training are not a debating point as it is irrefutable that PAs have vastly less training than doctors. Ironically, what is at the core of the debate, is how PAs seem to be misrepresenting themselves to the public.

UMAPs.org.uk

@UMAPsUK

9 months

⛔️ Rebuttal An infographic with misinformation is currently being shared on social media. We corrected it for you 😉 🚨 MAPs, share away! #PhysicianAssociate #AnaesthesiaAssociate #MAPs #UMAPs #MedicalAssociateProfessionals #🐙

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Ed Palmer

@DocEd

1 year

My problem with the "why can't PAs just sit the same assessment" philosophy. Exams/assessments/training programs do not live in a vacuum. They rely on a candidate having completed a prior curriculum so that any examination can focus on stage appropriate content. 🧵1/n

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Ed Palmer

@DocEd

3 months

I don’t understand how we allowed ourselves to get here. I was an FY1 in 2011. I often went to clinic and theatre. It was built into my rota. I use those learnt skills even today. How is it sensible to send an assistant to learn to scope, while the dr does admin?

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Ed Palmer

@DocEd

1 year

Shame I didn’t see the “registrar” masters as an option to fast track. Silly me spending the past 12+ years in postgraduate training and sitting exam after exam after exam after exam…

SImon Butler

@SImonBu14712300

1 year

@doctorsp194 @r1chardf1tzg3r1 @SteveBarclay @AACE_org @ParamedicsUK @wesstreeting @TheBMA @rcgp @TheBHF @TheStrokeAssoc @RCollEM Advanced practice training (MSc) leaves a competent paramedic or nurse working at registrar level. Arguable then, that being assessed and treated by them is better than the average FY1 doctor. Doctors should see complex cases and ACPs less so.

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Ed Palmer

@DocEd

4 years

@chrischirp Guess what I’m seeing a lot of. People coming in with clots from long COVID. Even if the vaccine caused clots (and it’s clear that it doesn’t) it would have to cause a vast number to offset the risk of not being vaccinated.

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Ed Palmer

@DocEd

1 year

The massive obs charts that ICU nurses filled out at the end of the bed were amazing. They made understanding the patient effortless. I cannot express how much I miss them. I want a massive monitor at the end of the bed that replicates that from an EHR.

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Ed Palmer

@DocEd

5 months

I feel obliged to say that I cannot attend this conference because I cannot afford to. This is true for many of my colleagues. I don’t think this is the win that @ESICM thinks it is. Great for those who can go free.

ESICM

@ESICM

5 months

📣 This year, #LIVES2024 welcomes #nurses , pharmac(olog)ists, #physiotherapists , #psychologists , #nutritionists & other allied health professionals FREE of charge! 🗣️ Spread the word & join us in Barcelona! Register now! 👉 #CriticalCare #IntensiveCare

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Ed Palmer

@DocEd

11 months

My all time favourite referral was for a patient with “biochemical sepsis” who had an isolated modestly raised CRP but was clinically well.

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Ed Palmer

@DocEd

7 months

In a nutshell this is the issue. PAs, who have a cursory level of training in a strict subset of medicine are given "permission" here to practice at a level above that of a fully qualified doctor. Is this what the public want? Is this safe or appropriate? 1/2 @BMJ_Open

DSmith..®️

@jobbinggasman

7 months

@VirtueOfNothing Ignoring the breaches of scope of practice, the whole article has no credibility because the PAs are directly supervised by an ST4 or above all the time and all discharges were signed off by them. So how can the study outcome be that of PAs and not their supervisors??

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Ed Palmer

@DocEd

10 months

I for one am very grateful that @VictoriaAtkins did the media rounds yesterday. You could see in her eyes that she realised (in real time) that our request is both fair and reasonable. She knows deep down that FPR is the only way forward.

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Ed Palmer

@DocEd

3 months

I debunked this before. But this is complete nonsense. Discrepancy in PaCO2 and PvCO2 is small enough that it isn’t going to impact on clinical decision making in this scenario.

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Ed Palmer

@DocEd

1 year

@dr_nigel_lane @NHSEngland It’s nice that you are happy to keep tightening your belt at the governments request. Volunteer work is also a good option to work for free if you think working 40% of the year for free isn’t enough. 👍

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Ed Palmer

@DocEd

11 months

All this is doing is ensuring that every patient entering the hospital is started on antibiotics regardless of their history. Which is actually very out of step with the evidence on sepsis management.

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Ed Palmer

@DocEd

8 months

A "simple patient" is a retrospective diagnose and not fixed in time. "Simple" patients can have incredibly complex issues, and complex patients can have simple issues. The efficiency gain here is in making sure we get the diagnosis right the first time.

Professor Azeem Majeed

@Azeem_Majeed

8 months

I am increasingly hearing rhetoric from politicians and NHS managers about the need to remove “simpler patients” from doctors; thereby allowing them to focus on “complex patients”. But for doctors, seeing an unending stream of complex patients is professionally very challenging.

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Ed Palmer

@DocEd

6 months

This isn’t normal and it’s not ok. I mean no disrespect to the PAs who have gone into this in good faith. We constantly argue about the tiniest things in medicine. Like 5 vs 8 of PEEP, 2.5 mL or 2.7mL in a spinal. Having untrained people see undifferentiated patients is not ok.

ℝ𝕠𝕓𝕓𝕚 𝕂 💙

@Robbi_K_

6 months

@iDrSunny 🤮 having to look up how to do a referral on day 1 means they shouldn’t be let loose on day 1 .

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Ed Palmer

@DocEd

5 months

@ShaunLintern @NHSBartsHealth Many tragic features here. A key point is that “sick” patients need contrast enhanced CT regardless of renal f(x). The evidence that modern contrast causes renal impairment is questionable at best. Missing the diagnosis poses a much greater risk to life.

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Ed Palmer

@DocEd

5 months

@ExplosiveEnema2 It’s interesting isn’t it. I suspect, even if I said 4x ST7 peri-CCTs, people would still be a little uncomfortable. But you see my point. I am really struggling to understand why undertaking less training and having less experience somehow grants you special permissions.

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Ed Palmer

@DocEd

10 months

Sitting post graduate exams with young children has been one of the most difficult activities of my professional life.

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Ed Palmer

@DocEd

8 months

Listing qualifications and job roles is a spectacularly poor way to reason an argument.

Lord Bethell

@JimBethell

8 months

@HelenRSalisbury That’s not the view of Professor Sir Steve Powis FRCP, National Medical Director, NHS England. Dr Navina Evans CBE MRCPsych, Chief Workforce, Training and Education Officer, NHS England. Professor Sheona MacLeod FRCP, Director of Education and Training, NHS England.

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Ed Palmer

@DocEd

1 year

This highlights a legitimate concern from the medical community. If we could have parity by sitting the FRCA final viva, then nothing prior is relevant. Advanced practice is built on a broad foundation. Skipping steps isn’t just unfair to those who put the time in, it’s dangerous

Chris Rigby

@Chris_Riggers

1 year

@georgebellstarr @Exhausteddoc67 @Xeon4f145d96s1 @donotcallmemike I don't for one moment think I could pass right now. But I think I have the ability. I'd love to be able to work towards an attempt, and it would certainly improve governance if those PAs / ACPs who were working on a medical rota had been examined to the same standard.

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Ed Palmer

@DocEd

7 months

What is this utter nonsense?! Are people seriously suggesting that we should have a legal system where some people are not represented? This is one of the most egregious examples of a lack of ethical standards in politics and reporting that I've ever seen.

Rupert Myers

@RupertMyers

7 months

Keir Starmer explaining what a lawyer does, very well

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Ed Palmer

@DocEd

10 months

What am I watching? This is exhausting. Of course medical students get trained how to prescribe. They become literal doctors at the end of it. That’s the point of medical school. What planet is this guy on?

Eilidh 🦀

@DrEilidhMaria

10 months

Propaganda machine goes brrrrrrr

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Ed Palmer

@DocEd

6 months

Integration of PAs into the foundation program. This is setting a very worrying precedent. If we as a society are prepared to do this, then logically we should be asking if any training is truly necessary in healthcare anymore (hint: it has never been *more* important)👇

Ed Palmer

@DocEd

1 year

My problem with the "why can't PAs just sit the same assessment" philosophy. Exams/assessments/training programs do not live in a vacuum. They rely on a candidate having completed a prior curriculum so that any examination can focus on stage appropriate content. 🧵1/n

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Ed Palmer

@DocEd

1 year

Not a pay rise. Pay restoration. No one thought we were paid too much in 2008. We can’t keep shouldering pay cuts every year for ever. We aren’t even asking for back pay. Just to reset the clock.

Amanda Platell

@amandajplatell

1 year

How do you sleep at night knowing you are endangering patients when you’ve already been offered a pay deal way above other workers?… Striking junior doctors will cost the NHS an extra £1bn by demanding a 35% pay rise! This is on top of the £20.5bn the Govts has put into the

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Ed Palmer

@DocEd

1 year

Skipping out a stage would be like joining a marathon in the final mile, and sprinting it to the finish, to then claim that you are performing at the level of an Olympic marathon runner. 6/n

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Ed Palmer

@DocEd

1 year

@AnaesUnited This is just appalling. AAs shouldn't be anywhere near a DNAR conversation/decision. The ethical/legal considerations alone are frankly mind boggling. This is too much now.

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Ed Palmer

@DocEd

3 months

This is heart breaking on a number of levels. The social contract in medicine is broken at every level. On a practical note, optimal matching (a subfield of CS/maths) is a *very* mature field. I would place money on the bet that @UKFPO did not even know this field existed.

C 🌞

@_cjevanss

3 months

Consistently top 10-20% of my year and won two prizes in 4th year, to be randomly allocated to the bottom of the entire UK. Fantastic new system @UKFPO , thank you for your well wishes for my future career

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Ed Palmer

@DocEd

9 months

These are lies. It’s so disheartening seeing these people lie about absolutely everything. Literally everything they talk in healthcare about is a lie. There should be consequences for lying to the public so freely. These are not differences of opinion. They are lies.

Peston

@itvpeston

9 months

“I very much hope they’ve had time to reflect and they're able to come back with reasonable expectations” Health Sec @VictoriaAtkins says junior doctors' “unreasonable demands” are stopping a pay deal being agreed Watch tonight ⬇️ 💻 LIVE 9PM @itvpeston 📺 1045PM @ITV #Peston

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Ed Palmer

@DocEd

5 months

Thought experiment. 4 theatres, each running elective ASA 1-2 day case. 1 consultant anaesthetist supervises all theatres inside the department but out of the anaesthetic room. Each anaesthetic directly given by an ST3 (post primary) with indirect supervision. Would this be ok?

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Ed Palmer

@DocEd

1 year

@ExplosiveEnema @jeannie_watkins @FPARCP I must say this is concerning. A financial conflict like this really should be declared. The rule in academia has always been “if in doubt declare”.

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Ed Palmer

@DocEd

6 months

@DrAsifQasim But 60% is *way* less than 100%. Surely they should be on the ICU?! 🤦🏻‍♂️

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Ed Palmer

@DocEd

7 months

Prof Pagel who is (checks notes) a professor of mathematics and operations research 👇

Prof. Christina Pagel

@chrischirp

7 months

having a quick look at this data, it's pretty clear that RCP abused the "neutral" category throughout their presentation of the results to massage the message.

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Ed Palmer

@DocEd

2 years

@zackferguson Every day it genuinely gets harder to distinguish reality from satire.

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Ed Palmer

@DocEd

1 year

A truly tragic case. But to remove any doubt or ambiguity. The basic presenting complaint, before you even take a history, gives a probable diagnosis of PE x100 fold higher than anything resembling anxiety. This is what people mean when they say “barn door”.

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Ed Palmer

@DocEd

11 months

This is honestly beyond offensive. 🤮

BMA Thames Valley RRDC

@TV_RRDC

11 months

How is this acceptable @BucksHealthcare ? Doctors are NOT worth half a Physician Associate. FY1s, this is how they value you. Look how they value your replacements. STRIKE.

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Ed Palmer

@DocEd

9 months

Maybe, just maybe, we should be applying evidence based approaches to sepsis management. Since when was it preferable to follow the advice of a charity over that of the global academic community on any topic?

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Ed Palmer

@DocEd

1 year

Genuine question. Has any clinician, at any time, anywhere in the world, at any stage of training, ever found the “could this be sepsis” EHR popup useful? Maybe we could just switch it off now? 👍

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Ed Palmer

@DocEd

1 year

To my incoming colleagues. #tipsfornewdocs 1) return your BMA strike ballot 2) enjoy the immense pride and self respect that comes with standing together as a community 3) ultrasound guided cannulation is a distraction and rarely necessary

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Ed Palmer

@DocEd

3 months

Whoa... this is an extraordinary statement. AAs bailing out anaesthetic consultants in regional anaesthesia.

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Ed Palmer

@DocEd

9 months

Several *times* less training than doctors, *more* expensive, deployed into the most litigious areas of medicine. 😢

Ronald MacDonald (@rmacd.bsky.social)

@quackophage

9 months

The @RCObsGyn would like to tell you about the benefits of PAs within Obs & Gyn. PAs: - Work at ST1-2 level - Are a bit more expensive than an ST1-2 [sad face] but - They don't rotate (unlike those pesky jnrs)

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Ed Palmer

@DocEd

5 months

“I give you my word”:

Victoria Atkins

@VictoriaAtkins

5 months

I give you my word: If the @Conservatives are elected back into Gov, we would immediately re-enter mediated talks with the BMA Junior Doctors Committee to find a solution. If this strike goes ahead it will harm patients. The BMA must now call it off.

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Ed Palmer

@DocEd

10 months

This highlights the issue with PAs quite nicely. A cavalier and boasting lack of insight and situational awareness. A focus on doing a "thing" rather than developing the broad knowledge necessary to care for a patient while carrying out that "thing".

Disillusioned doctor

@Disillu89254799

10 months

4/4 Yes PAs can intubate, under supervision in their role as AAs, but as a doctor I feel this post suggests that PAs can do these procedures independently and potentially at the detriment of training of doctors who ultimately will be the consultants expected to train PAs...

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Ed Palmer

@DocEd

10 months

I still find it grating to see senior intensivists say 7-8% increase in mortality for each hours delay in ABx. Completely untrue.

Shaun Lintern

@ShaunLintern

10 months

EXCLUSIVE: A new blood test for deadly sepsis that can give doctors a result in 45 minutes is being trialled at @GSTTnhs . It could also open the door to new treatments for the condition #sepsis

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Ed Palmer

@DocEd

2 months

@IncogAssociate @doctor_dru_ This is embarrassing. Rather than address any single core issue, or work to strengthen the connections between PAs and the MDT, it's more divisive nonsense. I just feel really sad for the PAs who are trapped by the childish spectacle.

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Ed Palmer

@DocEd

4 years

@DrDavidPalmer @chrischirp London footfall this morning as I walk home is indistinguishable from anytime in the past month. I won’t be taking the tube again. Too busy, wasn’t safe.

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Ed Palmer

@DocEd

1 year

A watershed moment in anaesthesia. We are on the eve of the biggest change to the provision of anaesthesia since the NHS was founded. We have a safety critical culture. We argue over the benefits of different syringe label orientations FFS. It is absurd to sleep walk into this.

Dr Done

@Dr_Done_

1 year

🚨🚨 Ok this is big‼️ A group of baddie anaesthetists have been working behind the scenes to uphold the integrity of anaesthetics in the UK They will call for an Emergency General Meeting to force @RCoANews to represent views of its membership Docs are taking a stand 🔥 🔥 🔥

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Ed Palmer

@DocEd

1 year

Never be afraid to give a GA section. It can be life saving for mother and baby. GAs are objectively safe with an anaesthetist at the helm. Delay in moving to GA can also be very detrimental. Everything is risk vs benefit.

Ed Mariano, MD, MAS, FASA, FASRA 🇺🇸🇵🇭

@EMARIANOMD

1 year

Why avoid general anesthesia for scheduled cesarean delivery? @ruthi_landau gives 18 reasons #CSASummerConf23 #obanes

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Ed Palmer

@DocEd

1 year

@dr_nigel_lane @NHSEngland Mate, you legend! Don’t forget charitable donation. Alternately taking a voluntary pay reduction and asking for those funds to be diverted back into the hospital? Seems only right.

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Ed Palmer

@DocEd

6 months

For many years Danny has been a friend and mentor to me. I wish him and his family every happiness and success for the future. I cannot express what a loss to the UK this is. We’re losing Dannys every single day. This is the brain drain occurring in realtime. 🧠

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Ed Palmer

@DocEd

9 months

It’s a yes yes from me. We can’t go on like this. I will likely CCT before this is resolved, but it is incumbent on us to fix this for the next cohort. @TheBMA

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@DocEd

1 year

@danny_mercer This is such a regressive step for patient care in the UK. Medicine used to be about maintaining the highest possible standards, about promoting excellence in practice. @ShaunLintern have you seen this? A trust is literally piloting PAs as job shares in the foundation program.

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Ed Palmer

@DocEd

8 months

Ben’s story is not surprising. Do PAs have a role? Perhaps. I haven’t been presented with a strong case use as yet. But they absolutely do not have the requisite training to see undifferentiated patients in any context.

Ben Harris

@docbenh

8 months

So here’s a little story of my recent #physicianassociate experience as a patient. On a professional level, I’ve not worked with many but the few I have were……ok….lets leave that there. @Xeon4f145d96s1 and @parthaskar might find it interesting

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@DocEd

4 months

I remember being in many similar situations over the years. Dehumanising and unprofessional. *All* staff should have access to rest facilities over night. I think we should have assigned sleep pods (like in pod hotels). Would need to have good sound insulation.

Doctor Niks

@DoctorNikss

4 months

I remember being ST5 and pushing chairs together in the seminar room.. piling blankets down for bedding, and being so angry at myself.. What a ridiculous way to live.. me a 30 something professional pushing conference chairs together at night.. shame!

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Ed Palmer

@DocEd

4 months

Somewhat surprised by the @FICMNews response to my question “What assurances can FICM provide as to ICM remaining a medically led specialty, where consultants with a medical degree deliver the care of patients as a defined standard?”. This is only the “vision” apparently. 🤷‍♂️

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Ed Palmer

@DocEd

1 year

Controversial opinion. Hyponatraemia is easily the most interesting electrolyte disturbance.

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Ed Palmer

@DocEd

10 months

To close, I’ll say that of course I give antibiotics in sepsis and naturally I don’t dawdle (meropenem is a close personal friend and twitter doesn’t have room for ambiguity!). But I think there is likely more equipoise here than popular doctrine would suggest. n/n

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Ed Palmer

@DocEd

5 months

This is doing to be a defining issue for medicine in the UK. Please take a look and donate if you are able. #telltheGMC @AnaesUnited 🐻

Anaesthetists United

@AnaesUnited

5 months

We are commencing a legal case against the @gmcuk over their regulation of Physician Associates. We need your help to fund it. Writing letters didn't work. Time for action. #telltheGMC

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Ed Palmer

@DocEd

11 months

@doctorcaldwell @somersetwyvern @pamkato @GavinLarner Some of my favourite mandatory training is when I have to do sepsis awareness training. Even though I'm an intensive care registrar and my PhD was on sepsis. Always good to be reminded about the sepsis six; an intervention for which there is almost zero supporting evidence.

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@DocEd

5 months

This reminds me of something, but I just can't put my finger on it.

Jeremy Hunt

@Jeremy_Hunt

5 months

I have this afternoon been on a call with the UKHSA, DEFRA, Thames Water and Asda with Cllr Austin. Thames Water are implementing a drinking water stop notice across much of Bramley Village. Please see the press release below. I have requested that bottled water stations are in

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Ed Palmer

@DocEd

1 year

The number of these examples, and the ease with which they can be found, is frankly alarming. It is the absolute minimum of standards to be clear about your role to patients.

ExplosiveEnema

@ExplosiveEnema

1 year

I mean... mildly amusing that you were blocked for doing medicine, by a PA whose research profile states they're a "medical doctor" Maybe it's just jealousy?

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Ed Palmer

@DocEd

7 months

@wesstreeting Thank you Wes. Bullying is unacceptable to anyone. Always. I would caution against conflating raising safety concerns and bullying in general however. It is important to be dispassionate in this debate. Much like introducing a new drug; it needs scrutiny.

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Ed Palmer

@DocEd

3 months

Unlike previous BMA leadership, Rob and @_VivekTrivedi have *earned* my respect. None of this "I stand with xx" rubbish for having done nothing. They have been consistent and gritty. I will be voting to accept. Regardless of the outcome, I will support our cause.

Dr Robert Laurenson

@RobLaurensonD4P

3 months

Accept, bank, build for April 2025 Reject, escalate now. I recommend accepting but both roads lead to a union that will continue to defend our pay.

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Ed Palmer

@DocEd

1 year

The NHS workforce plan outlines the biggest change to the provision of anaesthesia in the history of the NHS. In safety critical industries, we don’t take shortcuts. It is unthinkable to me that we would go along with this.

Anaesthetists United

@AnaesUnited

1 year

A roll-out of 2000 Anaesthesia Associates would fundamentally change the landscape of anaesthesia delivery in the UK. Let's talk about that.

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Ed Palmer

@DocEd

10 months

Early usually means "early from diagnosis of sepsis" or "early from hospital admission". Both of these are *administrative* time points and have little to no basis in the biology of sepsis. 2/n

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Ed Palmer

@DocEd

1 year

Thinking a lot about what ICM training could look like in the future. My take: include 6m radiology + 6m microbiology training. Encourage surgeons to do placements with us. Anaesthetists need to be supported to develop ICM skills, rather than be used as transfer robots.

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Ed Palmer

@DocEd

5 months

@Ask_foradoctor "heart failure -> too much fluid in blood" is reasonably frightening from a pathophysiology perspective. All totally cool and normal.

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Ed Palmer

@DocEd

11 months

@JNShabz Probably. I can sum this up:

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Ed Palmer

@DocEd

11 months

@DrJohnCosgrove @DrHFRyan I have top respect for GPs. I could never do what you do. I’m supported by a fleet of labs, imaging and near instant specialist opinions. The skills of GPs should be celebrated and respected.

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Ed Palmer

@DocEd

4 months

People should look at these lobbying emails, particularly the ones that compare PA and Dr pay scales. Form your own judgements on whether or not this was a fair presentation of the detail to the House of Lords…

ExplosiveEnema

@ExplosiveEnema2

4 months

Doctors becoming investigative journalists was not something I anticipated happening over the last 18 months Absolutely damning set of emails

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Ed Palmer

@DocEd

2 months

After due consideration, listening to BMA webinars, and speaking to colleagues (particularly those at the beginning of their careers) I have voted yes on the resident doctor deal. Bank and build. Regardless of the outcome, I will support my colleagues. @TheBMA @BMA_James_Steen

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Ed Palmer

@DocEd

4 months

@NHSSTW This is baffling. Endless positivity about a role that is divorced from reality. You can’t lead with “highly skilled” when describing a group with low levels of training by design. At best it’s dishonest. Are GPs “super amazing hyper skilled?” by comparison.

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Ed Palmer

@DocEd

5 months

Can someone put Dominic in charge of rotational training for the country. This is brilliant.

Dominic

@D_Rodders

5 months

@dob86 I did a request for all of the information they hold on me, then forwarded it back to them when it happened to me.

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Ed Palmer

@DocEd

4 months

Paging Dr. Burnout. Dr. Burnout, there's some extra work for you on Ward C. In all seriousness though, I would just quit my job.

DrPrincessNads

@DrNads77

4 months

@Dave__Chambers @cannula_service How about helping out the specialities whose work doesn’t wax and wane? Used to do that as an F2 / CT1/2 when I was done, I’d go to ED to help. After that I only did ED so no waxing or waning 🤷‍♀️

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Ed Palmer

@DocEd

1 year

The great Carl Sagan said "extraordinary claims require extraordinary evidence." I submit that it is an extraordinary claim to suggest that one can skip large swaths of medical education, and then fold into medical training downstream. 13/n

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Ed Palmer

@DocEd

7 months

@glambystefania @manLikeTeaa @SecretPhysician The ultimate responsibility is to the consultant. Respectfully, you shouldn’t be telling a doctor to do anything. You can cascade an instruction to another doctor from a consultant, is that what you mean? Though it seems inefficient for the message to pass via an intermediary.

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Ed Palmer

@DocEd

11 months

We've had enough. This is my BMA. Solidarity with my colleagues. We strike on. 🦀🦀🦀

Resident Doctors

@BMAResidents

11 months

📢 STRIKE DATES ANNOUNCEMENT📢 Junior doctors in England to take further #PayRestoration industrial action. The first strike action will take place from 7am on 20 December to 7am on 23 December. The second will take place from 7am on 3 January until 7am on 9 January.

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Ed Palmer

@DocEd

8 months

This is such a failure. For dedicated, bright and upcoming colleagues to be denied even an interview on the basis of their score (for a GP exam) is grotesque. Forward thinking trusts need to step up and build CESR pathways.

Oli Sims

@oli_m_sims

8 months

Feel like an abject failure despite doing objectively not badly on the MSRA. Scores for both sections inside the top quartile nationwide. Top job NHSE. You go develop that lost tribe some more.

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Ed Palmer

@DocEd

3 months

An interesting side effect of this offer, because of how NHS pension contributions work, and the cliff edge of childcare provision, many senior registrars will likely see a pay cut when they become a consultants. The salaries are very close together, either side of the cliff. 🫠

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Ed Palmer

@DocEd

1 year

Similarly. The FRCA final does not evaluate much that was on the medical school curriculum, as there is a guarantee that the candidate has already been evaluated on that. Exams/assessments are waypoints; checkpoints on the way through medical training. 5/n

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Ed Palmer

@DocEd

10 months

@TheSalariedPA That’s a bit of a misrepresentation. The distribution of PAs in the NHS is heavily skewed; tiny numbers > 10 years ago. COVID is actually a good example of where to deploy PAs successfully. Well differentiated patients and protocolised areas. I could get behind that 100%.

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Ed Palmer

@DocEd

10 months

@ExplosiveEnema @PApodcastUK Learning derm and surgery from instagram 🤮 cool and normal as always!

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Ed Palmer

@DocEd

4 months

Huge congratulations to Prof Mervyn Singer on the award of his OBE for services to Intensive Care. A lifetime of commitment to the specialty. I first met Merv when he gave up several hours to talk to me (then, a complete stranger) about a career in academia…

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Ed Palmer

@DocEd

8 months

Having had a brief look at the consultant pay offer, I still think it's a bad deal. Doesn't seem to do much to address long term pay erosion. Looks like a career in medicine is now synonymous with a lifetime of pay erosion. Relies on trusting the fundamentally untrustworthy.

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Ed Palmer

@DocEd

1 year

Why would anyone want to study medicine in the UK anymore? 😢

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Ed Palmer

@DocEd

11 months

By the time I see a patient with “sepsis” the diagnosis is pretty obvious; but selection bias has done its job for me. GPs can’t predict the unpredictable. The nomenclature around this should change.

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Ed Palmer

@DocEd

1 year

Give this person a job right now. Lateral thinking at its finest.

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Ed Palmer

@DocEd

1 year

I'm sure lots could pass it with sufficient time. I'm not trying to be reductionist, but rather highlight how the core argument breaks down. Assessments are only valid in the context in which they were intended. 9/n

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Ed Palmer

@DocEd

1 year

For the record, I would not vote in favour of 17.5%. If anyone thinks that is madness, then you will have immediately gained an intuition for the extent of our pay erosion. Full. Pay, Restoration. 🦀

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Ed Palmer

@DocEd

1 year

I feel deeply sad for current PAs caught up in the politics of the PA role. None of my critique here is aimed at them. I am arguing very specifically against the proposed massive expansion of PAs and their integration into the FP. 15/n

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Ed Palmer

@DocEd

1 year

The alarmingly high number of PAs trying to present themselves as doctors has officially hit the "broken arrow" threshold.

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Ed Palmer

@DocEd

4 months

@Dr_Done_ Vasovagal syncope is an incredibly dangerous diagnosis to make. Not only can a true vasovagal be life threatening (I’ve seen it lead to an arrest and anoxic seizure) but it’s typically a diagnosis made when people don’t find a cause of the collapse.

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Ed Palmer

@DocEd

1 year

I think we need more doctors, far more higher specialty training numbers, and more consultants (we obviously need a lot of other roles, but I'm trying to keep this on doctors and PAs being used as replacements!) n/n

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Ed Palmer

@DocEd

11 months

@srturaga Sepsis is very important to learn about. But so is the rest of medicine!

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Ed Palmer

@DocEd

7 months

Absolutely on point. I am deeply concerned at the direction of travel in medicine in the UK right now. Paul has articulated my thoughts perfectly. Though I would add, there are specialties that apply a deep understanding of both the brachial plexus and Krebs cycle daily!

Paul McCoubrie

@PMccoubrie

7 months

@drcolinm of the @gmcuk has written this in a recent blog about future education &, as a card-carrying educationalist, I disagree vehemently The last 50 yrs of educational research tells us a very clear message The single most important determinant of expertise is knowledge 1/

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