TheGorillaGardener @GorillaGardner Twitter profile

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@brasil_can

TheGorillaGardener

@GorillaGardner

2 months

@karimbrohi As one of the med students who helped on 7/7 I can categorically state this is a very different situation. 48 hours Vs weeks of activity for free. And tuition fees have more than tripled since then too...

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TheGorillaGardener

@GorillaGardner

2 months

@NykaraNizri @BadMedicalTakes No, it is a bad medical take. The response to 'please elaborate' should have been "filling up with water can lead to hyponatraemia and hypoglycaemia, they need milk". Not "they cannot process water".

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TheGorillaGardener

@GorillaGardner

3 months

@Ask_foradoctor @gmcuk Interview 19 is hilarious. Such an EM consultant response. Like thanks inpatient PA for your 'guidance' on how to manage this condition...

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TheGorillaGardener

@GorillaGardner

3 months

@CitizenUddin It's known as the Streisand effect.

Streisand effect - Wikipedia

en.wikipedia.org

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TheGorillaGardener

@GorillaGardner

2 months

@jabberwock951 If it was a minor injury I would be reassured that ENPs are typically amazing and typically far more skilled in their niche than rotating doctors.

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TheGorillaGardener

@GorillaGardner

2 months

@Thomo420o @speedfox_uk @david_stillwell Hi there NHS consultant here. Prove it. You say it is a fact. Prove it.

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TheGorillaGardener

@GorillaGardner

20 days

@ShaunLintern @wesstreeting If you want honesty Shaun why not approach Imperial to ask if there have been any complaints of bullying and sexism arising from Lord Darzis research unit. A higher than usual number of PhD candidates quitting part way etc.

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TheGorillaGardener

@GorillaGardner

3 months

@mlkytee @ben_hock If you were an NHS HCA for 3 years make sure you get your long serviced annual leave boost at the end of F2.

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TheGorillaGardener

@GorillaGardner

3 months

@Dr_Done_ You don't need the word trainee. Huge number of doctors desperate to join a cardiology training programme would move heaven and earth for a 'LED' role like that

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TheGorillaGardener

@GorillaGardner

1 month

@PurdieWorldwide @PassportAndPix It isn't free. We need to get away from this mindset. It still costs substantial amounts of money and absolutely no-one can afford all the 'healthcare' available. Even those with insurance find they have limits. DOI NHS doctor.

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TheGorillaGardener

@GorillaGardner

4 months

@bmj_latest @JohnLauner I would have a neck like a tree trunk after a week.

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TheGorillaGardener

@GorillaGardner

2 months

@katemasters67 Anecdotally oncology remain as resistant as ever to have the difficult discussion and so we end up having to in the ED. And how awful the conversation is to have with the 88 year old wife of the 90year old man at 3am in the morning.

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TheGorillaGardener

@GorillaGardner

2 months

@sarah_aslannnn If you are going to draw diagrams for parents to explain what balanitis is for the love of god put them deep in the bin afterwards and don't leave them on the examining couch/bedside for the next person to find.

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TheGorillaGardener

@GorillaGardner

4 months

@Dr_Done_ Flipping this around (cos you haven't thought about this) The MRSA exam is doing something very wrong when we have endless local trainees, UK graduates unable to find training jobs but doctors from abroad who have never even worked in the NHS apply, do the exam and do amazingly.

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TheGorillaGardener

@GorillaGardner

2 months

@l_seddon @ShaunLintern @NHSBartsHealth Still working EM consultant. Your assertion he would have died regardless appears bold. He may have, but he would have at least stood a chance.

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TheGorillaGardener

@GorillaGardner

2 months

@ShareCabling @nhsbourbon "the style of patient involvement" The style of patient involvement. Genuinely don't know what that is supposed to mean.

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TheGorillaGardener

@GorillaGardner

2 months

@AmarHujan @techpriest If they graduated in 2020 (assuming July/August) they cannot be a specialist/specialty doctor - they don't meet miminum requirements for the grade. They can at most be a LED working as a fellow. Defo beyond scope of practice regardless

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TheGorillaGardener

@GorillaGardner

2 months

@NykaraNizri @BadMedicalTakes In a similar way why shouldn't I look directly at a solar eclipse is answered by "because the partially covered sun is darker but still has enough dangerous rays to cause damage to your retina". Not "Because the solar ghosts will cut your eyes out"

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TheGorillaGardener

@GorillaGardner

3 months

@mlkytee In my favourite medical school clinical posting I missed pretty much every teaching session for 2 weeks because the F1 was on leave, F2 post was vacant so I ended up 'acting up' It. Was. Awesome. Proper teaching of that actual job. Feeling useful. Heck, I even did an LP...

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TheGorillaGardener

@GorillaGardner

3 months

@EM_Dr_Jacklin LOL. Absolutely do this. And sometimes when someone describes a great catch you think to yourself "frick, i dont think i would have thought of that..."

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TheGorillaGardener

@GorillaGardner

2 months

@vasconcell75240 @Ask_foradoctor GPs are specialists in general practice Psychiatrists are specialists in psychaitry and some psychiatrists subs specialise in substance misuse. This is me teaching you.

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TheGorillaGardener

@GorillaGardner

14 days

@ItsnotrightUK So in the view of that department year one covers f1 and f2 and then they jump straight to ACCS ST1 in level for their year 2..? Oooooo k

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TheGorillaGardener

@GorillaGardner

13 days

@gmcuk @iDrSunny Is Twitter GMC about to get into fisticuffs with Facebook GMC?

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TheGorillaGardener

@GorillaGardner

2 months

@fjkeats @Davidmarkpye That's such a bloody big stretch. I am saying that any argument that because they described your job title as 'alphabet soup' that they would give inferior clinical care to you as a patient is drek. If I can treat someone in a prison, I can treat someone with a job I don't like

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TheGorillaGardener

@GorillaGardner

3 months

@ritakj @DrNeenaJha Presumably not sitting in an MDT listening to the results of another patient. Having patients sit in their own MDT is a lovely idea. But if you have that much money to burn then free patient parking, better hospital food and better access to healthcare would be higher priorities

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TheGorillaGardener

@GorillaGardner

3 months

@dave_dlt Yeh a GP wrote me a shitogram about this recently. I maintain however that if the patient attended the ED for high BP (190/100) w/o any red flags. And were started on 2 weeks anti-hypertensives (as per nice guidance) the GP can kindly review and titrate to effect

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TheGorillaGardener

@GorillaGardner

19 days

@Dr_DeanS @mrjamesob You just know this guy would have been one of those paramedics bragging about how many patients he left at home that shift. It does a disservice to all the other proper paramedics out there.

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TheGorillaGardener

@GorillaGardner

4 months

@JohnLauner @bmj_latest I think its perfectly reasonable in some areas. And not in others. Personally if i was a patient I would not want someone passing me to constantly try and catch my eye so they can nod their acknowledgement...and then keep walking by.

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TheGorillaGardener

@GorillaGardner

3 months

@PaulHowarthUK I agree with 20mph limits. But I also agree that most of us *know* what 30 and 40mph feels like and can easily judge it. 20 and 50mph much harder as unfamiliar. But with 50mph (AVG speed motorway roadworks) I can set my cruise control. Can't do that W 20mph

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TheGorillaGardener

@GorillaGardner

4 months

@melissagoin @reverendofdoubt When they are taking their 10th attempt at the other arm and the antibioptics for your sepsis are delayed for several hours because of lack of IV access... That is the harm All becaue you avoid the lovely drain pipe in the 'mastectomy arm'.

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TheGorillaGardener

@GorillaGardner

4 months

@Dr_Done_ And sooner or later someone will try and claim it's racist to argue against this. It isn't. A UK trained doctor should be prioritised in training posts above a non UK trained doctor. (regardless of country of origin)

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TheGorillaGardener

@GorillaGardner

2 months

@DrHuw @Leic_hospital Isn't postgraduate medical training by definition the extra diplomas/certificates one trains for in specialties AFTER graduating with a medical certificate..?

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TheGorillaGardener

@GorillaGardner

3 months

@PaulHowarthUK But with a few years of 20mph limits we will get the hang of it

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TheGorillaGardener

@GorillaGardner

13 days

@DevanSinha @iDrSunny They are absolutely right of course. PAs study medicine just not as deep content or for as long The first aider at your local supermarket is probably trained in CPR. Which means they have studied Advanced Life Support. Just not for as deep or as long.

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TheGorillaGardener

@GorillaGardner

1 month

@DrRobgalloway He knows full well it is common place. It has been going on for years. The man in this article went missing from the A&E queue in St Marys Hospital. He is very aware of this case.

Missing man found dead in canal

Pensioner found dead in water in London.

www.guardian-series.co.uk

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TheGorillaGardener

@GorillaGardner

2 months

@Dr_DeanS Govt isn't dissolved. Parliament is. Government ministers remain in charge of their departments. The role of minister is independent of the role of MP.

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TheGorillaGardener

@GorillaGardner

1 month

@Anniedroid_ I have a feeling some people here don't get the joke...

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TheGorillaGardener

@GorillaGardner

3 months

@dr_tallpaul 17 hours later the NHS PC still hasn't shut down properly. Good luck on next adventures!

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TheGorillaGardener

@GorillaGardner

1 month

@SaraTon08500527 That's quite misleading. As far as I can tell there are 70 in the entirety of London and 236 across UK.

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TheGorillaGardener

@GorillaGardner

19 days

@ShaunLintern A female friend of mine who worked for him in the past had a panic attack from just hearing the news he is back on the political scene. Everyone knows what he is like. And back he is. Another one of the untouchables.

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TheGorillaGardener

@GorillaGardner

2 months

@mstotty88 Compared to the ED it's a fucking palace to us. Plus the majority of us we want our membership fees going on stuff for us, and not maintaining a relic and a wine cellar like the older royal colleges.

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TheGorillaGardener

@GorillaGardner

2 months

@RodricJenkin Yup. The candidates I am turning away today I would have cut my arm off to get previously

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TheGorillaGardener

@GorillaGardner

3 months

@FrankCoffey26 @Burnt2020 "Let’s move on to sort the governance & regulation & get medics involved more in multi & inter professional education." Hang on, what!? You might have a generous SPA allocation to educate the world and their dog. But most of us barely have enough to cover our juniors.

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TheGorillaGardener

@GorillaGardner

3 months

@rachelgemma90 And then you can come on twitter and hear people grumble about the idea of boarding a few of these patients on wards because such a thing would be undignified...

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TheGorillaGardener

@GorillaGardner

2 months

@karimbrohi I misspoke. The tuition fee in that year of medical school for me was £1000. So tuition fees are 9 times higher, not 3 times higher. Primarily it is the tone of the email that bothers me, not the concept of volunteering in a crisis.

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TheGorillaGardener

@GorillaGardner

2 months

@Parody_RCGP Like all of us you have slowly boiled in your lobster broth to the point you can't remember what normal was

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TheGorillaGardener

@GorillaGardner

4 months

@Dr_Done_ They then start their first GPVTS post and struggle badly to adjust to the wackiness that is the NHS. And need huge support from their supervisors (who get no extra time for this). And this is happening up and down the country. Ask any supervisor (esp GPVTS). Its an MRSA thing

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TheGorillaGardener

@GorillaGardner

3 months

@dave_dlt Apparently not though. Apparently I should be following them up in my emergency department... For the management of their long term hypertension. Of course this is a rarity, and most the GP pushback I get is warranted (usually SHOs acting on inpatient team phone advice)

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TheGorillaGardener

@GorillaGardner

2 months

@haemopoiesis @Xeon4f145d96s1 @davehartin @drokane They cannot and do not work as senior decision makers. They dont work as most senior overnight and there are RCEM guidelines about who needs a senior review and these all talk about ST4+ (so not ACPs) So really really don't understand depts that have 'consultant ACPs'

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TheGorillaGardener

@GorillaGardner

3 months

@juliaisobela Language aside, would you feel equally uncomfortable if it was say Katherine Ryan who had done a show about her 6 foot 3 male stalker, and then people had figured out who it was, and said man then went on a TV show to talk about it?

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TheGorillaGardener

@GorillaGardner

1 month

@MikeSouthWestUK @Only9built The mini was in the wrong lane to turn right and the black car could not have avoided that regardless of whether the mini was indicating they wanted to pull into their lane.

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TheGorillaGardener

@GorillaGardner

1 month

@AliJaneMoore Here is me betting you will find at least a few saying they still have not been told where they will be and what they are doing...

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TheGorillaGardener

@GorillaGardner

2 months

@ispy1990 @Thomo420o @speedfox_uk @david_stillwell Surgeons cant work in substantive posts for NHS trusts via LTD companies, the proportion who use umbrellas for NHS work when locumming is near nothing. Most those using LTD companies for their private work (because the act as a freelance, not an employee) are NHS PAYE employees

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TheGorillaGardener

@GorillaGardner

3 months

@PaulMiddleton_ @dob86 I have written responses to datixes before that point out the deficiency/knowledge gap is with the reporter not the reportee

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TheGorillaGardener

@GorillaGardner

2 months

@haemopoiesis @Xeon4f145d96s1 @davehartin @drokane The wording of that makes no sense. But then it's an NHS job advert. I can only speak as to how we utilise ACPs (credentialled and trainee) in our departments. None go onto tier 4 rota. Highest are on tier 3 alongside ST3s which in Emergency medicine used to be called junior reg

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TheGorillaGardener

@GorillaGardner

2 months

@GottaBigMouth @BethRigby Nothing wrong with admin, they are vital. But she's a trained solicitor now work in occupational health in the NHS so probably something more niche in terms of role.

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TheGorillaGardener

@GorillaGardner

3 months

@ronansetron @ben_hock It's an oversight commonly made. Usually people only have 1 year of pre F1 NHS experience but those with more will usually need to highlight it on every rotation until they hit ST3 level

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TheGorillaGardener

@GorillaGardner

4 months

@JohnLauner @bmj_latest In my context it would not be a hotel so much as a big ass line going out of heathrow passport control which the border officers are walking along constantly to get from a to b. And worse, every once in the whilst they will pluck someone out the queue and process them...

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TheGorillaGardener

@GorillaGardner

2 months

@FrankCoffey26 @clifford0584 A 15 word tweet from an Emergency Medicine trainee who by very definition has 'skin in the game' is not exactly a 'lecture'. I personally train and work with ACPs and think there is a role for them in the ED but have along with my colleagues not allowed PAs into our dept.

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TheGorillaGardener

@GorillaGardner

3 months

@DrJSherrington Have some stemetil and you'll feel better

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TheGorillaGardener

@GorillaGardner

20 days

@Breezy49 @BBCBreakfast "we also planned for retire at 60 are shattered and we are expected to work till 67" I don't understand tho as someone in their 40s why I will be any less 'shattered' aged 65. The rising pension age is because people are living longer and we need more workers to support them

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TheGorillaGardener

@GorillaGardner

2 months

@ShaunLintern @GSTTnhs Who is this letter coming from. From the letterhead and size of the block out I'm guessing it isn't Sam Thenabadu who is AFAIK the GKT MBBS medical director. Is it just from the St Thomas' DME/medical education head? There must be a named person responsible for this request.

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TheGorillaGardener

@GorillaGardner

5 months

@docmartin22 @AshleyGWinter @DissanaikeMD Yes. Same health service where no patient has ever been bankrupted by medical fees. Swings and roundabouts. Every system has positives and negatives.

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TheGorillaGardener

@GorillaGardner

2 months

@SahalQuazi @DocDoLi The average imperial student has great communication skills. They constantly use them to tell everyone how great they are.

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TheGorillaGardener

@GorillaGardner

20 days

@Mid_WifeCrisis What you are describing isn't necessarily a mistake. That's clinical course.

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TheGorillaGardener

@GorillaGardner

3 months

@mlkytee By all means show your pay which is undoubtably too low. But don't point at the basic pay for 40 hours and state you are working 50 hours. If you are working 50 hours you are getting paid for it.

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TheGorillaGardener

@GorillaGardner

4 months

@EmergMedDr @EDPractitioner Linda Dykes has had a CES poster based upon the NS and spinal ortho's own socs guidelines for probably a decade. None of this is remotely new. And still we get asked for a fricking post void bladder scan... Delaying tactics.

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TheGorillaGardener

@GorillaGardner

2 months

@doctorpallavi @JamesTitcombe @TheGreenParty HE502 On the Green Party Policy website. Last updated April 2024. How mortifying. You probably want to read through that quickly and get the website team to start deleting stuff.

Our 2024 General Election Manifesto - Green Party

Real hope.Real change. Millions of people in our country are feeling insecure and deeply worried about the future. We live in one of the richest countries on the planet, yet nurses are using food...

greenparty.org.uk

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TheGorillaGardener

@GorillaGardner

3 months

@DrMattThomas1 No call. The team you summoned away from their duties will be a hindrance not a help and it may cause harm pulling them from urgent tasks.

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TheGorillaGardener

@GorillaGardner

4 months

@DonnchadhaD Entirely possible that ED ACP is a trained paramedics ya know...

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TheGorillaGardener

@GorillaGardner

20 days

@JuwayriyyahAlam @LordWalney "As you are well aware, merely being arrested means nothing." Being arrested does not mean you are guilty. But it sure as heck means something.

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TheGorillaGardener

@GorillaGardner

2 months

@Nuke19386116 @ShaunLintern @NHSBartsHealth (beyond it forcing the patient to require a ICU bed) This I expect. And my guess there was an obstructive ITU reg or consultant who was the root of it. Too often we make do with a dodgy 'sedation' where a tube was needed. Or delay beyond pointless of no return.

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TheGorillaGardener

@GorillaGardner

15 days

@iDrSunny Fuuuuuuuuuuuuck. Like at what point does someone with a brain come along and question whether they have set the exam difficulty right. Assuming the exam is set locally and it isn't a national thing. Now you might not like the next part...

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TheGorillaGardener

@GorillaGardner

2 months

@Xeon4f145d96s1 @davehartin @drokane There is a very rigorous credential process they go through and it is extremely competitive to get into in general. Most our ACPs come from critical care outreach, hems paramedic or ENP backgrounds. Zero in common with PAs. We have and train ACPs but won't touch PAs.

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TheGorillaGardener

@GorillaGardner

3 months

@JustDean365 @Latchemall When people walk outside in Alaska in winter they can see their own breath! When people walk outside in Singapore they cannot. Why? It's not because there is more than water vapour in the exhaled breath. It's a science thing...

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TheGorillaGardener

@GorillaGardner

3 months

@DrLKVaughan My experience running rotas was that really long shifts your staff seemed far more like to go off sick and if they did the results were significantly worse. After all, if you are feeling 80% well you might try and slog it through an 8/9 hour shift. but prob not a 12.5 hour one.

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TheGorillaGardener

@GorillaGardner

2 months

@DrTweXet 1) Most EDs roster significant # of clinicians OOH. Far fecking more than the inpatients do who need to clerk those admitted. Most ED rotas have very large OOH component. 2) ACPs in most Emergency departments do lates and nights. Admittedly less than the SHOs. so do ENPs

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TheGorillaGardener

@GorillaGardner

13 days

@cml_smith @AliJaneMoore I remember that. You decided it was 'too stressful' like 4 months before your holiday was even due so cancelled it. Whereas anyone else would have simply said 'I am going away on these dates and will not be available to work' either paid or unpaid and just continued.

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TheGorillaGardener

@GorillaGardner

5 months

@Jones88bones @EffieEss64 @JhonOkurrr @amnerisuk Don't mix up seniority with AfC banding. They are not the same thing.

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TheGorillaGardener

@GorillaGardner

3 months

@bfhermann No one is crying, they are grimacing that someone who is so objectively awful is in a position of any form of authority/power. It's the sort of mentality that has parents beating the shit out of their toddlers to 'toughen them up'. Abused freq become abusers. We pity you.

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TheGorillaGardener

@GorillaGardner

2 months

@ShaunLintern @NHSBartsHealth 4mg of lorazepam is not a sedation after oxy in a big sick patient It's incompetence. Whichever intensivist who battled to not simply tube this man is culpable.

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TheGorillaGardener

@GorillaGardner

4 months

@mancunianmedic @nuwandiss @UKLabour @wesstreeting Privately he states he is playing the long game. Say the right things to get into power then change tactics and ove more left Except no-one trusts anyone who openly admits that they are just playing politics with their words and dont intend follow through.

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TheGorillaGardener

@GorillaGardner

2 months

@cruncherwax @gold103x @ShaunLintern @GSTTnhs Inefficient use of consultant time yes. But time you are paid for . But the med students are paying to get an education so this is double twatery against them.

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TheGorillaGardener

@GorillaGardner

3 months

@SaleyhaAhsan "You will know if you are doing it." I don't think that is always true. I think a great deal of us may end up occasionally as 'accidental bullies' not because we are being mean or nasty but because of a power gradient.

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TheGorillaGardener

@GorillaGardner

2 months

@EddCarlton It makes sense if you are living and working in a country where you have way more senior ED staff than spinal surgeons and the wait to be seen in Emergency Departments is low (so they have the spare time to be the spinal surgeons proforma minion). O wait...

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TheGorillaGardener

@GorillaGardner

21 days

@simondunphy2 @DrJulia_Simons £500k is quite a big number. Can you find how that number is arrived at?

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TheGorillaGardener

@GorillaGardner

4 months

@drruthmitchell @Aidan_Baron Nothing and hope the patient doesn't end up impotent, incontinent or paralysed. The point is sticking your finger up their arse is of no benefit to either party.

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TheGorillaGardener

@GorillaGardner

3 months

@mjv__1 What is this to do with royal colleges? Of the 250 applications we received for 4 fellow posts, more than 200 trained abroad and 100 had never worked in the NHS/UK. Employment law says I cannot discriminate based upon visa status etc.

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TheGorillaGardener

@GorillaGardner

2 months

@EmergMedDr @PositiveLad Really common in garden ponds and quite a lot have been put into wild ponds, lakes and streams. They are by that manner an invasive species. Often when they are dropped it's because another bird was trying to steal it fromt he one who caught it.

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TheGorillaGardener

@GorillaGardner

3 months

Reflecting on how I completely fucked up my departmental rotas a few years ago and ended up giving double the amount of SDT/EDT to trainees then required. And it made sod all difference to trainee satisfaction scores incl with amount of SDT!

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TheGorillaGardener

@GorillaGardner

2 months

@ispy1990 @Thomo420o @speedfox_uk @david_stillwell Last survey done found of all consultants less than half had any form of private practice at all. A number that has been falling year on year since 2000.

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TheGorillaGardener

@GorillaGardner

5 months

@nomad_therapist @StuartBlitz @AshleyGWinter If it was within the ED then there would be no bill at all.

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TheGorillaGardener

@GorillaGardner

2 months

@wendyburn @UKGastroDr Need to highlight this. Many do these roles for no remuneration now. Might find Inc hard to fill in years to come

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TheGorillaGardener

@GorillaGardner

3 months

@doctor_oxford @DHSCgovuk @NHSEngland @gmcuk As it is a retrospective analysis rather than a prosepctive study I am guessing this never went near an ethical committee and that it is possible the trust itself was unaware that PAs were performing surgery in this manner?

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TheGorillaGardener

@GorillaGardner

2 months

@_MarieTolan @CowdryBen The irony of course here is that by giving and outcome 5 rather than a 1 it creates a huuuuuuge genital-ache for whoever the poor buggers are who then have to re-review and change the outcome from 5 to 1 at a later panel. Literally rod for own back.

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TheGorillaGardener

@GorillaGardner

2 months

I literally have senior doctors working alongside me asking for unpaid leave or dropping hours so as to avoid tax traps.

Dan Neidle

@DanNeidle

2 months

I did not have "Tories create new 70% marginal tax rate" on my election bingo card. But they have. By accident.

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TheGorillaGardener

@GorillaGardner

2 months

@roisinamcc So I get 0.5SPA (equivalent of 84 hours per year) to supervise 4 trainees. That also includes doing ARCP panel stuff, regional recruitment, ESLEs etc. NHS benefits massively from 'goodwill' re trainer trainee relationship in terms of doing it in own time.

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TheGorillaGardener

@GorillaGardner

4 months

@DrNeilStone "How often do you round with a pharmacist? How often do you consult a pharmacist on a management plan?" I wish There are big shortages of pharmacists both in hospital and in the community.

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TheGorillaGardener

@GorillaGardner

13 days

@LiangRhea RCEM be like

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TheGorillaGardener

@GorillaGardner

8 days

@parthaskar @RCRadiologists @NHSE_WTE @gmcuk @mmamas1973 @doctor_oxford @HPIAndyCowper @DrLKVaughan @UKGastroDr @OrthopodReg @RoshanaMN @DrSelvarajah @ShrillaB @RowanHarwood Meanwhile to get through the results backlog they also employ reporting radiographers who write me an essay about a 90 year old nursing home patients chest x-ray and advise repeat in 6-8 weeks.

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