.
@MattHancock
are you suggesting if you don't pay tax, you shouldn't be entitled to free NHS care? Many migrants pay tax but many mums do not. Most homeless people cannot. What about people who have retired? Healthcare is not a commodity. It is not a privilege. It is a right.
Another day, another TB diagnosis. More patients with TB in the hospital than COVID right now.
@WHO
estimates the COVID-19 pandemic has set us back 12 years in the fight to eliminate TB & expect a 20% increase in deaths. TB can be difficult to diagnose. Here are some thoughts:
We heard from
@IndependentSage
this morning that we don't expect to have vaccinated vulnerable groups and key workers before June and not enough for herd immunity until end of 2021. Should we not be taking over football stadiums to deliver it, getting support from civil society?
Patients can't get appointments to see a GP despite GPs working their socks off (we need more GPs) and yet I heard today people completing their many years of training as GPs can't find a job. What is going on???!
1. We don't train enough doctors
2. We recruit Drs from countries that can ill afford to lose them
3. We then make those Drs feel unwelcome and charge them extortionate fees to live here
4. We consistently underfund the NHS & doctors leave in droves
#BBCQT
@bbcquestiontime
Cancer patient died after NHS demanded £30,000 for treatment
When anyone in this country dies because they cannot afford healthcare, the end of the NHS draws nearer. It is time to fight for NHS values - a health service based on need NOT ability to pay
Last day with the
@NorthMidNHS
family tomorrow. Despite a challenging past year - my 1st as a respiratory consultant, waves 2 & 3 of COVID & stepping up to lead the TB service - it's been immensely rewarding & enjoyable thanks to the wonderful staff & patients. Back in 2022!
This morning I spoke to
@GMB
because it is important everyone understands the severity of the
#COVID19
situation. It is vital people follow the guidance. Colleagues across London & members of
@EveryDoctorUK
tell us we are in a position similar to the peak of the first wave. 1/9
Men - stay at home, lounge around, save lives
Women - stay at home, care for the kids, cook, clean, save husbands from having to do anything, save lives
How in the world did this advert get approved???
Self-isolating. I am fortunate to employ a weekly cleaner but I have obviously asked her not to come here. I will be paying her anyway as I am employed and entitled to sickness cover. What measures are being taken to protect income of those who are self-employed?
#COVID2019uk
Long day at work and came home to an empty home with my family away but it was all made better after a knock on the door - a neighbour I've never chatted to before dropping by with food and a chat to share with me because it is Ramadan - this is the Islam that I know ❤️.
I continue to hear a genetic relationship between ethnicity and
#COVID19
invoked in both explicit and implicit ways among medical colleagues. In this thread I argue, in the race to understand the relationship between
#COVID
ー19 and ethnicity, we need to look beyond genetics.
I joined
@RCPhysicians
emergency general meeting online. I had no real pre-conceptions on PAs & I don't have experience working with PAs. I get the argument that we have a work force crisis and we need to get lots more people with all sorts of skills into healthcare work...BUT 1/
Last night shift as a registrar 🤞 & last shift in the place that has felt like home for the best part of 10 years
@RoyalLondonHosp
and the brilliant
@teamaccu
& resp teams. Thank you for having me to stay! Onto my new home
@NorthMidNHS
with
@zaheerzaheer
from tomorrow. Excited!
Symptoms: TB is an indolent disease & comes on over weeks to months. Often starts with fatigue. Symptoms may come & go in severity. Drenching night sweats, fevers & weight loss should be big red flags. Other symptoms relate to body site affected e.g. cough, haemoptysis, back pain
If we don't think TB then we can miss it resulting in totally avoidable harm and even death. Early diagnosis leads to better outcomes for individuals & reduced transmission. So..
FEVERS, NIGHT SWEATS, WEIGHT LOSS
CHECK A CHEST X-RAY
SEND A TB CULTURE
Chat to your friendly TB team
A fox just ran through A&E and into the hospital. I kid you not. This is everything the medical registrar trained for. Just waiting for the bleep to tell me about it.....
#JuniorDoctorsStrike
#MedEd
Investigations: CXR
- Apical changes, cavitation, unil pleural effusion should raise the TB question
- For the love of god SEND A SPUTUM for AFB smear, culture & PCR
- OK to treat for CAP if unsure or worried about sepsis but avoid fluoroquinolones AND chase up the TB question
@geordie_medic
I have to log into 5 different computer applications in order to do my ward round, none of which communicate with each other. There is rarely a free computer and almost never one where all apps work.
Another honest appraisal of PPE guidance from
@RCPLondon
plus this, "If you find yourself in the impossible situation of needing to deliver patient care with insufficient PPE & are conflicted about your own safety, we will back you, whatever you decide to do." Great leadership
Most importantly it felt that patients were often at the heart of the concerns raised by the audience yet RCP officers responses appeared to obscure, deflect or dismiss. It was rightly pointed out that this should not be an attack on PAs as either a profession or individuals.
Absolutely delighted to be joining the excellent and expanding respiratory team
@NorthMidNHS
(exam results next week pending)
I am hoping to head up the
#tuberculosis
department in the near future and continue my work tackling inequalities in healthcare access.
#TeamNorthMid
My piece in
@nytimes
As people with the coronavirus flood our corridors, hospitals will be pushed to the breaking point.
It's all hands on deck
When we are called upon to step up, there is only one answer.
#COVID19
#covid19UK
@EveryDoctorUK
This is amazing news. Congratulations to
@DOTW_UK
and others who have tirelessly campaigned to get
@NHSDigital
to
#Stopsharing
- the NHS will no longer have to share immigrants' data with Home Office!
Proud of this little guy who went off to school dressed as his choice of hero - rubbish collector. Complete with bag of recycling.
#keyworkers
❤
#Recycle
Consultants I work with who are 20 years off retirement would be financially better off working fewer hours. It's madness. We're in the midst of a massive recruitment crisis with tons of empty consultant posts and the government have failed to fix the pension issue.
1/ BREAKING: As reported overnight in
@thetimes
there is a new consultation out later today
A short 🧵 in some of the detail
TLDR: Some helpful bits, but too litttle, too late with NOTHING for AA/LTA
Everyone had to read out their list of conflicts of interest but it was not at all clear what the interests of the RCP are in expanding the PA programme - they have clearly taken a side - what's in it for them? I presume £ but is their also political pressure?
A word on healthcare access: Delayed TB diagnosis occurs due to a variety of reasons.
1. People interpret their symptoms in the context of their own lives. Sweats & wt loss experienced with drug use & homelessness. Depression => wt loss. Try to consider this in history taking.
Bloods: CRP up but often not high like in bacterial inf. Raised calcium may be seen in disseminated TB. There is almost never a good reason not to test anyone for HIV - do the test.
IGRA - NOT A DIAGNOSTIC TEST FOR ACTIVE TB. May occasionally be used as tiny piece of puzzle
I heard that while evidence was lacking in almost all arenas relating to impact of PAs, significant patient safety concerns were expressed from clinicians because of the lack of clearly defined scope of practice. It did not feel these concerns were prioritised or listened to.
Wahoo! A bit later than I'd initially planned as 7 days before being first offer in December I found out I was pregnant, then I got COVID. But here I am, 1st dose done. Thanks so much to
@RCPLondon
&
@RCObsGyn
for their excellent webinar on
#COVID19
vaccines & pregnancy.
TB themed biscuits for our
#tuberculosis
awareness day
@NorthMidNHS
today. TB continues to make people unwell and can be passed from one person to another through coughing but transmission is preventable and the illness curable with antibiotics. Early diagnosis= better outcomes.
Finally think exposure risk. Hx of TB contact, incidence in countries lived in (no matter how many years ago). Think homelessness & incarceration history. If the signs & symptoms fit- don't let lack of exposure hx distract you from including TB in your differential. SEND CULTURES
2. People prioritise their health in the context of their needs. Concerns regarding security/ safety (see for example
#hostilenvironment
& impact on healthcare access for migrants) or need to work to pay bills/ feed self/ family may be prioritised ahead of health concerns.
Today is going just Greatix.
I know these things may feel trivial to some but for me, words of appreciation go a long way.
Thanks
@NorthMidNHS
A&E team for this.
If you think someone has done a good job, do consider saying so whether formally or just by writing a note.
Therefore, it seems to me that action putting patient safety at the heart and ensuring we are considering the wellbeing and working conditions of PAs AND doctors is urgently required before any further expansion. In addition, we must solve the retention & recruitment crisis
3. Health systems may be unresponsive or even obstructive: We can dismiss young people's concerns particularly if symptoms non specific as in TB - people know their own bodies, let's trust this. Past poor experiences e.g. racism/ discrimination shape future h/care interactions
Discitis, paravertebral collections, potts disease, CSF with high protein, low glucose. Lymphocyte predominance in fluid samples. Cold abscesses. Lymphadenopathy, particularly in the neck. Uveitis (see forthcoming
@BTS
statement).
I've worked nights the last few days to support junior doctor strikes. Thursday I'll strike in solidarity with all public sector workers. For me, this is less about what we deserve in pay & more about protecting the future of public services & the communities who rely on them.
This just popped into my Facebook feed in a particularly apt response to Lawrence Fox's ridiculous dismissal of racism on
#bbcqt
The ‘playing the race card’ accusation is just a way to silence us
#InstitionalRacism
in the NHS. It exists, it harms, it must be challenged. I know the contents of the
#SewellReport
were predictable (Sewell has long declared he does not believe in institutional racism). Predictable or not, I remain incensed.
I do not take industrial action lightly. It is disruptive to everyone involved but I see no other option. Workers are leaving the NHS in droves to find better pay & conditions elsewhere. I strike today to demand a better future for the NHS & the public it serves.
#PayRestoration
I heard concerns about the scope of practice of PAs. I heard questions about what role PAs perform that doctors do not with higher pay than some junior docs. None the fault of PAs, all caused by policies & processes we have failed to design to support and govern this role safely.
Pretty glad I was fully PPE'd up at 8pm this evening because I'm pretty sure I would have found the entire thing utterly overwhelming. There is no time to indulge right now and no emotional space. The sentiment however, was not lost and will sit with me forever.
#COVID19uk
Staff are tired but, as has been reported, are being asked to come in to do additional shifts. As with the first wave, they are stepping up but at what cost? I am worried about the toll on our mental and physical health.
A few points about IGRA in
#tuberculosis
#MedEd
- IGRA tells us about the presence of an immune response to TB
- IGRA is not a diagnostic test for active TB
- IGRA does not become negative after treatment for TB and therefore is not useful in people who have had TB before
What an honour to receive this award from
@JudeKelly_
I second her introductory remarks...as a cis white woman of privilege I make no claims to understanding living aonther life but I am listening and I stand in solidarity.
“We want to see patients not passports, healthcare is a right and not a privilege”
Founder of
#WOWLDN
@JudeKelly
presents
@DrJessPotter
with the Champion Award - for her work campaigning for universal healthcare
#WOMA2019
#IWD2019
Fluid, mass, node - STICK A NEEDLE IN IT and don't put the sample in formalin. Send for smear, culture, possibly PCR. Histology - granuloma, if you're lucky necrotising. If you can't see something to stick your needle in or CXR changes consider CT to look for nodes to sample
Challenges accessing healthcare particularly prevalent this past year with fear of contracting COVID in hospital coupled with limited face to face consultations/ access to x-ray. Social conditions have also been more challenging leading to health being deprioritised.
Today our research paper showing an association between policies that restrict healthcare access for some migrants and a delay in treatment of TB - an infectious disease - was published in
@BMC_series
#BMCPublicHealth
It is open access.
I would argue, in the context of our globalised world, many census listed ethnicities obscure the diversity within each group. And for those listed as BAME, perhaps the only experience that is shared is one of structural inequities rooted in racialised colonial histories?
among the currently well-regulated, clearly defined existing roles including doctors, nurses, specialist nurses etc with better pay, better supervision and training, more continuity/ better sense of team, greater equity, less bullying etc. I don't have a vote as not a fellow but
Pretty proud to have received this lovely thank you from one of the junior doctor's I've worked with this past year, not least because their own medical practice is inspiringly patient centred & I am sure I learned as much from them as they did from me.
Absolutely delighted to be joining the excellent and expanding respiratory team
@NorthMidNHS
(exam results next week pending)
I am hoping to head up the
#tuberculosis
department in the near future and continue my work tackling inequalities in healthcare access.
#TeamNorthMid
Appointed two fantastic new colleagues colleagues today at work, and do not remember feeling this nervous all day since my own consultant interview, even though I was not on interview panel and all the candidates would have made great colleagues!
Kicking off the night with a coffee from my favourite cup (thanks pops). This is what
#PayRestoration
is about - the future of the NHS. A health service designed to deliver care based on need, not ability to pay. Healthcare workers are it's beating heart. Without them, it's over
A thread of my experience being a Dr, academic & parent for
#InternationalWomensDay
When I first decided I wanted to do a PhD, like many other doctors, I was in my early 30s and also considering having a family. Could I do both? When was the best time? What about maternity pay?
My Christmas miracle of the year:
I have not taken a single day off for childcare. Through school closures, isolation, sickness my wonderful husband
@tweeterpotter
has been juggling work, childcare, house, bills - everything. I am so lucky to have such a wonderful partner.
For too long "we've indulged in a debate over redistribution" YIKES back to trickle down economics & the poorest will suffer. Just yesterday a patient refused a necessary operation because they couldn't afford time off work & was refused universal credit. Shame on us
#Budget2023
I have a 4 year old. The last place I would take him if myself or my husband had
#COVID19
is my 60+ parents. Also if you are well enough to drive 200 miles, you are well enough to look after a child. Has
#dominiccummimgs
not heard of paw patrol? Inexcusable.
Essentially - there is no scientific basis for race, it is a socially constructed phenomenon.
Or as geneticist
@AdamRutherford
puts it
'race doesn’t exit, racism does'
@wembleystadium
This is lovely! Could you also say thanks to all the other key workers without whom NHS staff wouldn't make it through a day e.g. teachers, delivery drivers, cleaners and so many more x
Moral injury - the harm that results from exposure to situations where you know the right thing to do but do not have the means to do it was talked about a lot during COVID. But COVID was extra-ordinary. I think the current NHS experience is so much more harmful to workers.
8,900 checks on NHS ‘health tourists’ find just 50 liable to pay
“People who are most likely to be charged are the least likely [LEAST ABLE] to pay. There is no evidence it saves the NHS an appreciable amount of money.”
#PatientsNotPassports
I'm a respiratory consultant. I worked in ITU during wave 1 & on the wards & our cpap unit in wave 2. In Dec 2020 I was offered the vaccine. I was 6 weeks pregnant. I hesitated, I had questions. I then got covid.
#VaccinesWork
1/3
No new TB vaccines in 100 years! Given the millions & millions affected by TB each year, the number who have died, investment for TB is woeful and grossly unequal when compared to malaria, COVID, even HIV.
It's like the NHS doesn't need competent respiratory consultants. Despite having demonstrated my competence (and at times excellence) repeatedly over the years I still feel like it is being questioned at the final hurdle. There must be a better way. Maybe a different career? Grr
@trishgreenhalgh
It's been a long and challenging 4 year journey but now just 6 weeks off the arrival of a little brother for my 6 year old. Got to see his wriggly legs on a scan today tucked up under my ribs. Feel very very lucky.
Saturday morning therapy after a long 12 day run at work. On way to the
#SOSNHSDEMO
to join the
#PatientsNotPassports
bloc.
The NHS can be resuscitated. Values - free for all, based on need - are it's spine & NHS workers - it's beating heart 💓
We worry worse is to come. Hospitals are struggling for capacity and are having to open up areas of the hospital to care for patients which would not normally act as wards and reach out across networks of hospitals to ensure patients get the care they need.
@mikewoods8902
@microlabdoc
@WHO
You're not alone but TB never went away and has continued to kill more people each year than any other infectious disease on a global scale prior to COVID. It tends to be concentrated in countries with lower income.
Had quite a bit of backlash to our paper, published last week, which set out 10 streams of evidence supporting predominance of AIRBORNE spread of SARS-CoV-2. I respond to some criticisms in this thread.
1/
#NightingaleHospitals
were pitched as a solution during the first wave but if we don't have the staff to care for patients or the systems to manage the complexity of their needs then these hospitals will be able to provide only limited relief.
@adamfeather2
1. Pay for time worked inc compensation for increase in anti social hours
2. Ask for help, accept their right to refuse
3. Ensure work of senior colleagues also having to work longer/ harder is made visible
4. Free food, mental health support
5. Reg review & plan to step off rota
3 acute medical takes and have tried to take the bleep from the registrar 3 times to facilitate a break. Partial success once but the reg just finished seeing a patient in relative peace then came to take it back. The others refused. Must do better but how? Any tips
@DrBenLovell
Back on wards. We're missing usual illnesses with COVID dominating.
IMPORTANT
Please come to hospital if you are unwell & need us. Delayed healthcare acess when you need it can lead to more severe illness and even death.
Our job is to care for you. We'll find a way to do so.
Thanks
@hugh_montgomery
for drawing attention on
@Channel4News
to the fact general medical wards are also managing vast numbers of patients that would usually be ln intensive care. These patients need intensive respiratory support + higher nursing ratios than we have access to.
Labour to give all foreign nationals living in UK right to vote..
The motion also proposes to "close all detention centres" & "scrap all
#HostileEnvironment
measures" including restrictions on migrants' access to the NHS
#PatientsNotPassports