In the last week I have seen a paediatric patient with a significantly delayed diagnosis who was originally seen by a PA several months in primary care before they were diagnosed. I’ve never quite voiced my concerns on here about this before but undifferentiated patients 1/3
There is a lot of talk about junior doctors’ “final earning potential” in the NHS as a consultant. Let me tell you this. I’ve been a consultant for 4 years, and graduated 17 years ago.
Need to be taken in the context of this. It is the reason why I’ve never seen an AI app cope well with paediatric patients, having tested some myself. Having a PA see a patient, even if discussed with a GP subsequently, results in 2 adults between patient and decision-maker. 3/3
IMO should always be seen by a doctor, particularly in primary care where so much depends on pattern recognition without easy availability of test results. Paediatrics has the added layer of complexity where the historian is often not the patient themselves, and histories 2/3
So it’s only taken me one brain cyst, 2 neurosurgeries, 3 house moves, 2 children and first consultant job but I’VE PASSED MY PHD VIVA (with thanks to
@hormone_doc
and Professor Peter Clayton!)
Today is the day I can finally ask for a new photo ID without the safety harness... have been appointed as a substantive consultant
@GreatOrmondSt
! With thanks to everyone who has supported, encouraged and guided me through my career
#endofajourney
I can tell you that I have friends and peers who graduated in the same year as me, who earn professional salaries 2-3x mine in the UK in other sectors, and other consultants with the same experience working outside the UK earning at least 2x mine, not even counting cost of living
Pay is a difficult conversation to have, but if the UK government and general public fail to recognise how uncompetitive its health sector is becoming, how poor working conditions can be, then sadly the perfect storm resulting in a brain drain will happen.
For all paediatricians utterly appalled by the judgment on the
#BawaGarba
case, a motion is being passed condemning this at the
@RCPCHtweets
conference AGM 14 March 2018 1-2 pm.
ALL members are eligible to attend to vote on it so do come.
#iamhadiza
So a comparison to top % high earners in the country may seem valid at first glance, but the uncomfortable truth is that unsurprisingly the UK health professional market is financially unattractive (before the pensions issue affecting consultants is even considered)
Increasingly students I meet are privately educated, or come from affluent areas where outstanding state education also means property prices are beyond the means of the average UK wage earner. Medicine as a career is becoming less accessible. Salary is thus important.
@rachrwlnds
We will never get Level 1 evidence for this sort of thing. Sadly it is actually the anecdotes which matter - the vast majority of patients will probably be ok. It was not clear in this scenario how involved a GP was but certainly not documented if they were on my end.
One could say that we should be looking only for people who don’t see pay as an issue to do medicine but with the cost of living crises, the fallout from Covid, pay not matching inflation for decades, the fact is many no longer find medicine a financially viable career.
@Burnt2020
As far as I know there are not where I work. I haven’t because I think much of the debate is too nuanced for Twitter. But certainly one area I have always had concerns about has been in the primary care setting where it takes a lot of skill to diagnose without tests!
Hi there. Immigrant doctor here. I’ve treated thousands of kids in my 10 year career and only been an inpatient twice. I’ve also paid 10 years of taxes at the higher rate. Think I’ve paid more than my dues no?
Mass immigration is totally unsustainable and places an unacceptable burden on our public services. Now an 85-year-old man has died waiting in A&E because of 'dangerous overcrowding'.
When will politicians wake up to the human cost of our open borders?
The
#NHS
rose from the ashes of a major global catastrophe. It seems to have taken another major global catastrophe for the public to remember its worth. May we never, ever forget how important publicly funded universal healthcare is even after this is all over
#ClapForTheNHS
In the midst of all the crappy news, pleased to be looking forward to working as a locum paediatric endocrinology consultant
@GreatOrmondSt
in a few weeks! Thanks to everyone for all your support and friendship over the years (you know who you are)
#teamendo
As a paediatric endocrinologist I see children with advanced & delayed bone ages - 3 y.o’s with a bone age of 8 from precocious puberty and 16 y.o’s with a bone age of 11 from delayed puberty. We also know stress/ malnutrition affects this. Pointless.
I'm thankful this is not my department, but it is a stark reminder to those of us who are training leads that with social media the quality of training we provide is now in a free market economy.
I’ve had multiple DMs about the shipwreck that is
@GSTTnhs
ICU 🚧
This needs URGENT addressing and is wholly unacceptable - comments welcome
@icabbs
🔥 🔥 🔥
So 4 weeks into new consultant job and I think I am meant to be tweeting something emo about the experience when actually 1) I like the flexibility for childcare purposes and 2) I sadly feel it’s taken 13 career years to be fully treated like an adult at work...
(1) leaving the UK (where I have lived for >20 years) and I am extremely reluctant to do so or (2) becoming a private healthcare provider in a world without the NHS where everyone in the sector earns more and feels more appreciated.
Me? I love my job, I love my patients, I love my team. I can’t see myself doing something else. So the options for me if nothing changes (ie higher taxation and better prioritisation of NHS funding) are sadly
Today particularly proud to be working for
@GreatOrmondSt
#NHS
. Relatively sheltered from
#COVID19
vs our adult colleagues but PICU has increased its capacity; wards have opened to gen paeds patient transfers from elsewhere to offload their workload for adults.
#AllInThisTogether
Calling all paediatricians - we have been largely watching from afar re the role of PAs in other specialties.
@RCPCHtweets
now wants to know what we think - really important we fill this in:
It is a truth almost universally acknowledged when a person replies to your email with Dear <misspells your name>... despite you having your full name on an email signature... that person is white...
I should also DOI - I recognise I am one of the lucky ones coming from a socioeconomic background where I could and can “afford” to do medicine (my parents paid overseas fees). But I had the privilege of working with peers from all manner of backgrounds.
Year 5 consultant here. Not sure why I won't be having a pay rise for 4 more years. If this plan has something to do with front loading the pay scale so career earnings are increased, I hope there's a transition plan for those of us who have lost out, like the JD contract did
11/ changes to pay scale are:
- higher starting salary ~£100k
- shorter time to top of scale 14 years instead of 19
- fewer pay points -4 rather than 8
- higher top paypoint ~£132k
- a range of additional increases from 0-12.8% on top of the 6% but payable from Jan 24
What the - so everything I document in medical notes could potentially not have happened on the basis of someone saying it did not? I hope there is more to this than documented here....
Having read this MPTS report, I am struggling to see how the tribunal determined that, on the balance of probabilities, Dr Pandian did not examine the patient…🤷🏽♂️
There have been no winners here. A little boy has died, his family are bereaved, a doctor has been dragged through the mud by the gutter press, an entire profession has lost faith in
@gmcuk
, yet the
#NHS
remains underfunded and understaffed
#BawaGarba
@rodkelly50
@MattHancock
As do expats from non-EU countries via the Immigration Health Surcharge (this includes people working FOR the NHS of course 🤦♂️)
.
@RCPCHtweets
votes unanimously that criminal prosecution of dedicated doctors for gross negligence manslaughter following systemic errors impairs the advancement of safe healthcare for patients.
#IamHadiza
#BawaGarba
@rachrwlnds
Whatever it is imo the decision made is what I would have expected of someone at an F1-2 level, maybe of a GPST1 with no paediatric exposure, but certainly not from someone making decisions unsupervised.
This Christmas let us remember that:
Jesus was born in the Middle East
Jesus was Jewish
Jesus’ mum very likely wore a headscarf
Jesus was a refugee/ asylum seeker from a dictatorship
Jesus was an immigrant
Blessed
#Christmas
everyone.
BREAKING NEWS: Statement by Dr. Cusack,
#BawaGarba
’s educational supervisor disputing
@gmcuk
statement that her training records were not used against her.
An amazingly powerful message from someone who has been through it. There’s also a very good reason why modern palliative care was born in the UK - universal free healthcare allows decision-making with the patient at the centre.
"I misunderstood what palliative care was, I thought that was stopping treatment, doing nothing..."
Sacha's son died after being diagnosed with a brain tumour. She spoke to us about the Alfie Evans case and the battle parents face when they're told their child can't be cured.
Really don't get the bile being hurled at
@doctor_oxford
for writing a book. It's like any other book isn't it? If you don't like it, don't buy/ read it? All it's done is expose the amount insecurity that exists within our profession...
Very useful Grand Round
@GreatOrmondSt
about the GOSH experience with
#COVID19
- reassuring to hear that mortality 0% in children with paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS)
I’ve been thinking hard about how to tweet about this, especially having been a victim of bullying within paediatrics. It’s not something we talk about much as paediatricians (or frankly want to face) but the less we talk about it the less it is addressed.
Dear colleagues
@GreatOrmondSt
, I love you all very much but can we please stop replying all to the email about paper towels not being flushed down the toilet? 😂😂😂
A 66yr old 20/day smoker has started coughing up blood. His appetite & energy levels are reduced & he's a bit constipated...
Only the world's worst medical student, &
@MattHancock
's favourite
@babylonhealth
Chatbot, would suggest an
#ileus
as the most likely cause.🙄
As a paediatrician with expertise in stickers it slightly bemuses me that colleagues in another specialty are having a serious debate about how their stickers should be stuck.
There are side effects to leaking emails about clinical reorganisation. If you are concerned that your child is unwell get them seen, whether by a GP or in A&E. Delayed presentations were not unusual in the 1st wave. Children have been the hidden cost of this pandemic throughout.
Been told by
@GreatOrmondSt
that it will be reimbursing parking, congestion charge, ULEZ, taxi costs for all its staff who have to come in to work. Makes such a big difference to getting staff in without increased risk of transmission. Should be central decision though
@SadiqKhan
The level of reorganisation of paediatric services to make way for our adult medical colleagues and their sicker patients across London is amazing. Can’t quite discuss more here until things happen but we are all in this together. The public must
#StayAtHome
to mitigate.
#COVID19
So our nursery has said a normal temperature in a child is 36.4C and anything above this is a fever for which a child needs to be excluded from nursery for 24 hours... answers on a postcard on how I should respond.... (also list of other minor illnesses qualifying for exclusion)
Giving advice today to a trainee about OOPs and career paths etc. and have been reflecting on my own and others’ experiences. Remember that the heavenly spreadsheet “dictating” our lives can be worked around, there is always >1 path and your life is your own.
@CamillaKingdon
Absolutely. Don't even need to use surgery as an example. Every year, thousands of F1s help their consultant supervisors fill in their trainers' report forms by typing with ten rather than two fingers....
BBC News - Surgery students 'losing dexterity to stitch patients'
This is anecdotal nonsense along the lines of 'back in my day...'
This is ACTUAL BLOODY EVIDENCE to the contrary
@bota_uk
@OrthopodReg
2000 arrive in the UK to do A-Levels
2006 medical degree
@MedicineUoN
2008 start paediatric training
2018 MSc, PhD-in-writing, developed UK guidelines for paediatric craniopharyngiomas, research to improve
#cancersurvivor
QoL, trial development group
@SIOPEurope
#1DayWithoutUs
People who believe that UK junior doctor jobs should be reserved for UK graduates only vs IMGs have clearly not recently been involved in interviews/ shortlisting for jobs to fill rota gaps recently, even more so in the post-Brexit era.
As the father of ethnic minority daughters, the inspiration you will have by being the first woman and first BAME vice-president of the United States is of a far greater significance for me.
Dear
@didoharding
. We have been self isolating since Friday as our child spiked a fever. Swabs done promptly. It’s been >48h and still no results back. 119 can’t tell me if swab has been lost or not. Been told system overwhelmed due to Wembley etc. 1/
.
@TfL
are you going to waive
#CongestionCharge
fees for frontline public service staff (
#NHS
, police etc) who might have to drive in to work to avoid public transport as part of
#SocialDistancing
measures?
Today I have become aware of someone returning from maternity leave next week.
1) No corporate induction information sent despite numerous attempts at chasing HR/ dept
2) No instructions of how to get IT passwords
3) Rota out but only up to July for a 6 month rotation