Doug McKechnie @ldndoc Twitter profile

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Doug McKechnie

@ldndoc

3 years

Underrated GP skill: instant recall of the multiples of 28.

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Doug McKechnie

@ldndoc

5 months

@DrJSherrington If it makes you feel better, this is the guy that applied for a last-minute emergency locum via an agency at a GP surgery, and when the surgery found out his name, they replied "ah, never mind, we'll manage without". (I know this cos he posted it on his own twitter feed).

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Doug McKechnie

@ldndoc

6 months

@ColCurph @Parody_RCGP My favourite one of these seen recently (not mine) was Dear consultant Sorry that you felt this was an inappropriate referral to your clinic. I have reviewed the notes; the referral was made by you, as per the discharge summary from when you looked after them as an inpatient.

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Doug McKechnie

@ldndoc

10 months

@Xeon4f145d96s1 PAs are not 'medical practitioners' under the Medical Act 1983, by the way. In fact it is illegal, by the very provisions of that Act, to state that you are one without being on the GMC register.

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Doug McKechnie

@ldndoc

3 months

@DrEilidhMaria They posted a card addressed to them as 'dear doctor'? And their post is saying "I was never trying to imply I was a doctor"?!?

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Doug McKechnie

@ldndoc

11 months

@bruceppdl @wiggs1234 That's good then, we can stop training ITU consultants entirely.

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Doug McKechnie

@ldndoc

9 months

@AlkadhiO @A03580132276 @veggieequallife @RooDoherty @markr1004 @PenfoldJohanna The original post generated a lot of feeling. It certainly made me upset. Perhaps a better way forward is to acknowledge the feedback, even if delivered in a modality you don't like, rather than making veiled GMC threats - which don't really help anyone.

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Doug McKechnie

@ldndoc

3 months

@iDrSunny As a GP, most of those things are difficult to do properly (“dizziness” being the classic - is it postural hypotension? BPPV? Stroke? or many other things) and I still have to think hard about them. Easy to do badly, though (“take Stemetil and go away”).

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Doug McKechnie

@ldndoc

3 months

@Xeon4f145d96s1 @drsophiegp These references to 'med school' are causing hypertensive damage to my cerebral vasculature.

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Doug McKechnie

@ldndoc

8 months

@DrHollysMum @Learner00490431 @MichelePaduano Drilling a burr hole which is used to evacuate intracranial bleeds is the same technique used for drilling into a wall. Are we saying only neurosurgeons should drill into walls now too?

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Doug McKechnie

@ldndoc

3 months

@SecretPhysician As someone who is a recipient of discharge summaries - they should be done by the team who has cared for the patient, not a doctor on the ward who has never met the patient and is trying to piece things together from the notes.

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Doug McKechnie

@ldndoc

2 months

@AlexNevard I'm not ED but I have a personal bugbear about sending severe asymptomatic hypertension to you. This is a brilliant paper which looks at what happens if we send people to ED versus keeping them at home with severe hypertension: (nothing is achieved)

Hypertensive Urgency in the Office Setting

This cohort study investigates whether referral to the hospital is associated with better outcomes in a population of patients presenting with hypertensive urgency in the office setting.

jamanetwork.com

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Doug McKechnie

@ldndoc

10 months

@veggieequallife This is giving me end-organ hypertensive damage.

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Doug McKechnie

@ldndoc

1 year

@nhscaroline @AnjanBa91282506 @veggieequallife Perhaps the doctors should sit on the floor.

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Doug McKechnie

@ldndoc

5 months

@DrJSherrington The funniest thing is he posted it in the usual 'look at what the medical establishment does to people who speak The Truth' way, not realising it was an epic self-own.

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Doug McKechnie

@ldndoc

3 months

@quackophage The only differences between me and an airline pilot are that I don't have a pilot's license, and have never flown a plane. Otherwise, I can do everything they can.

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Doug McKechnie

@ldndoc

3 months

@medicalmodelbri Doctors do make mistakes, but a doctor who made a diagnostic error as major as that in Emily’s case would have had their practice scrutinized closely, and would probably face a fitness to practice investigation. Whereas the PA declined extra supervision, and went off to locum.

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Doug McKechnie

@ldndoc

4 months

@SecretPhysician Jesus. Is this in general practice? This is grossly unsafe. GP registrars aren’t meant to ever be the only clinician in the building, and they would have known what to do with this.

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Doug McKechnie

@ldndoc

3 months

@LittlePersonDoc @BMA_James_Steen @AliJaneMoore "I don't know, Dr Consultant, what WOULD the GMC say about you putting patients at risk by making an exhausted doctor work overtime?"

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Doug McKechnie

@ldndoc

7 months

@Xeon4f145d96s1 As a GP I feel the exact opposite. We are one of the only specialties that uses knowledge from nearly every part of medical school day-in, day-out. 90% of things one could probably deal with by 'on the job' learning. The complex 10% often requires deep thinking.

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Doug McKechnie

@ldndoc

11 months

@Xeon4f145d96s1 that's true, with the right training and education, anyone can do what a doctor does it's called 'medical school'

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Doug McKechnie

@ldndoc

6 months

@DrRichardPile Such a pathway would need to include the breadth and depth of a medical school education. Because that does actually matter for doctors. In fact, it would be 'medical school'.

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Doug McKechnie

@ldndoc

3 years

Our paper in @BJGPOpen now: Only 17% of medical school applicants had GP experience (vs 57% hospital); those that did thought more highly of GP as a future career Private/grammar school + high socioeconomic status parents more likely to have done GP...

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Doug McKechnie

@ldndoc

4 months

@DrAsifQasim The irony is that NHSE wanted to increase the use of A&G, so, somewhere, someone is looking at A&G numbers going up, and saying "look, this is a great success!".

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Doug McKechnie

@ldndoc

20 days

@Ask_foradoctor Did the consent form include "I consent to pictures of my excised breast tissue being posted on social media"?

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Doug McKechnie

@ldndoc

3 months

@sgaventa @HistoricEngland Former Barbican resident here. That's horrible. The service charge is enough surely to cover a proper repair...

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Doug McKechnie

@ldndoc

9 months

@doctor_dru_ come work in general practice, we collect these 'you have used v1.6 of our referral form, we only accept referrals on v1.7 which was released 15 minutes ago' 'you have not supplied the patient's favourite colour so the referral has been rejected'

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Doug McKechnie

@ldndoc

7 months

@Dr_Done_ This troubles me. Had I been the clinician to misdiagnose thrush, and another clinician later diagnosed vulval cancer, I would be upset at myself - not the other clinician. (And I would try to figure out why I got things wrong.)

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Doug McKechnie

@ldndoc

10 months

@Xeon4f145d96s1 Lol at the idea that doctors only start reviewing acutely unwel patients in FY2. We literally train and assess them in ABCDE-style 'assessing the critically ill patient' multiple times across the last few years of med school.

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Doug McKechnie

@ldndoc

7 months

@ExplosiveEnema I think it's very elitist of you to insist that only people who have a valid driving license should be allowed to drive.

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Doug McKechnie

@ldndoc

9 months

@DrLKVaughan @drcolinm @gmcuk Part II states the qualifications required to be considered eligible as a "medical practitioner", which are a recognised medical degree or the LRCP/LRCS (when those were still awarded). So, no, this assertion is false. Nobody can be a medical practitioner without a med degree.

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Doug McKechnie

@ldndoc

3 months

@drkeithsiau @bornw1cked Sounds like the medical director was the problem there, not you.

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Doug McKechnie

@ldndoc

11 months

@jasaunders90 @Alexsahistul “Non consultant level doctor” is a very wide group. Do ST5 doctors need the same supervision level as a PA? (Those doctors are often the most senior clinician on site, out of hours.)

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Doug McKechnie

@ldndoc

1 year

@Moham1287 @ClareGerada @iDrSunny @DeanEggitt @TheBMA @BMA_GP Wow. Is this accurate? These questions appear to be set at the level of 'someone who watches a lot of Holby City'.

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Doug McKechnie

@ldndoc

4 months

Oh! I should also point out that the FY1s will be on a lower salary than the PAs - so they are doing better whilst also being cheaper to employ. (You would have to factor in the cost of med school vs PA school too, but still.)

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Doug McKechnie

@ldndoc

11 months

@wendyburn @trentconsultant @rcpsych So, given PAs practice under supervision... who is supervising them when the physical medical needs of the patients are challenging? The psychiatrists (who apparently don't know much about it)?

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Doug McKechnie

@ldndoc

2 months

@DrAsifQasim But it's only working at 60%!!! We need to get their ejection fraction to 100%.

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Doug McKechnie

@ldndoc

1 year

@sh_abbers In my experience the bullying usually happens to women, IMGs, and BME doctors (or indeed people who are all three). Can recall one particularly 'undermining' senior nurse who didn't give me any hassle - guess why.

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Doug McKechnie

@ldndoc

11 months

@helencrimlisk I'm not sure that this clarifies the role for patients. "Working independently" and "supervised by a senior doctor" are conflicting statements.

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Doug McKechnie

@ldndoc

8 months

@DrEilidhMaria There is a common theme emerging here of "I want to do the fun bits that doctors do, but not the boring/tough bits". It's a travesty really given that this isn't something that so-called 'trainee' doctors get much leeway in.

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Doug McKechnie

@ldndoc

1 year

@allanson_j Hello ANP, it's also not good for the GP to be initating and titrating a medication with which I have no familiarity or expertise, please speak to your clinical director about how to make your service better for patients

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Doug McKechnie

@ldndoc

1 year

@jessdoe2000 @simondoyle87 @MHA_92_ you can do better than this crabs in a bucket stuff. perhaps if we pay F1s what they're worth, other HCPs can be paid their worth too?

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Doug McKechnie

@ldndoc

3 months

@Dr__Sarmy "Hello, police? I am being held against my will"

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Doug McKechnie

@ldndoc

1 year

@theCFOM @drcolinm @gmcuk @riaagarwal19 No, you can replace me with ChatGPT and Wikipedia and everything will be fine.

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Doug McKechnie

@ldndoc

4 months

@rheumipainmask @JimBethell @HelenRSalisbury Bahaha. “The free market will remove all need for doctors to be regulated and licensed”.

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Doug McKechnie

@ldndoc

4 months

So... the most junior doctors, who need the most supervision, generally don't work in most EDs anyway, and are there for a max of 4 months, do better than the PAs (in terms of LOS), even though the PAs may have been working in the ED much longer.

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Doug McKechnie

@ldndoc

3 years

Feel gutted I never got to practice in the times when the standard of GP documentation was Tonsils {illegible} Amox

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Doug McKechnie

@ldndoc

8 months

@RodricJenkin @drcolinm @GMC You'd think the expert reviewers, who are presumably doctors, are bound by the same GMC regulations about admitting mistakes and apologising for errors....

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Doug McKechnie

@ldndoc

1 year

@McCaffreyLaw The suicide risk amongst doctors under GMC investigation is 13 times higher than the general population. A third of those doctors have suicidal thoughts.

Almost one in three doctors investigated by GMC ‘have suicidal thoughts’

Exclusive: Medical Protection Society says many feel ‘guilty until proven innocent’ with the regulator

www.theguardian.com

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Doug McKechnie

@ldndoc

2 months

@Parody_RCGP @rcgp I haven't read this series, but I do agree - it annoys me a lot that the people who get the plaudits are doing GP plus something else... rather than 'just' being a very good GP, which is an end in itself.

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Doug McKechnie

@ldndoc

4 months

The primary outcome was wait time to be seen. Why? This is a strange outcome to choose. Wait time is a function of how busy the department is, and how well-staffed it is. It's not within the control of individual clinicians, unless everyone is deliberately working slowly.

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Doug McKechnie

@ldndoc

11 months

@donalmurray2002 @MetroUK @IpsoNews Awful case. If they have to write a headline about the GP, it should really be "GP correctly recognises seriously ill teenager".

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Doug McKechnie

@ldndoc

1 year

@PaulJohnson65 @Ned_Donovan warren street. is this the one where the estimated time to solve the maze is the same time as the waiting time between trains?

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Doug McKechnie

@ldndoc

3 months

@doctor_katie I wonder if the swallowing difficulties that the stroke team wants “looking in to” could be related to… a stroke?

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Doug McKechnie

@ldndoc

1 year

@DrJenGunter I do it myself and like it, but, rather like low-carb, it's been hijacked by some evangelists as the One True Diet that cures everything.

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Doug McKechnie

@ldndoc

9 months

@Dr_Done_ @JeanetteRCR @AoMRC @UKGastroDr Getting people onto the Honours List.

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Doug McKechnie

@ldndoc

6 months

@mariamichle29 @drmattuk @Xeon4f145d96s1 @potsy70 I think what makes good doctors is the extensive training of medical school, plus clinical experience. Both, not either/or. I use stuff from medical school on a daily basis. Recently a patient asked about amitriptyline pharmacology. Yesterday had to recall cranial nerve anatomy.

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Doug McKechnie

@ldndoc

1 year

@EM_Dr_Jacklin Good illustration of the craziness of the London property market, that an unremarkable-looking end-of-terrace (4 bed?) is £1 million.

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Doug McKechnie

@ldndoc

30 days

@vasconcell75240 @Ask_foradoctor Hard to know where to start with this one. GP is a specialism and training GPs should be led by, and primarily (though not exclusively) delivered by GPs. I don't think CNSs are, or should be, in charge of a medical specialty training programme (not to dispute their worth).

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Doug McKechnie

@ldndoc

7 months

@ReddicalMedge @timricketts_ It reminds me of the recent comment about "I'm signed-off as competent for history taking so now I can teach it". I'm pretty sure that, 12 years after I first started learning it, my history-taking skills are still evolving.

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Doug McKechnie

@ldndoc

9 months

@UKGastroDr Personally, I think that threatening unhappy trainees with the GMC is a GREAT way to boost trainee morale.

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Doug McKechnie

@ldndoc

6 months

@IncogAssociate @RupretS @Xeon4f145d96s1 There's no reason that someone with 5 days of diarrhoea and a positive Campylobacter PCR can't also have bowel cancer. They have a symptom of bowel cancer, and need an urgent colonoscopy to rule it out.

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Doug McKechnie

@ldndoc

9 months

@Xeon4f145d96s1 Good example of "something in the Conclusions not at all supported by the Results". Where is the evidence that there has been 'better training for the junior medical staff'? (Other evidence posted suggests the opposite.)

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Doug McKechnie

@ldndoc

8 months

@msteggy What supervision do we give final year medical students? Perhaps there's the answer.

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Doug McKechnie

@ldndoc

11 months

@Parody_RCGP Hello MS nurse. Great idea. I'll tell the patient to pop over to your clinic for that appointment then.

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Doug McKechnie

@ldndoc

1 year

@danj_h Going back to the 1917 Venereal Diseases Act there was a legal obligation for GUM clinics to keep separate records not accessible by other clinical services (to encourage people to use them without fearing confidentialty breaches).

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Doug McKechnie

@ldndoc

11 months

@GaryNosam @Parody_RCGP I've seen "Dr [x], Consultant Spinal Practitioner" before. The author was not a medical doctor.

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Doug McKechnie

@ldndoc

10 months

@Hinesh_ @DrAnimeshSingh This letter just keeps getting more and more bizarre. I almost wonder if it is deliberate parody - it’s just so absurd.

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Doug McKechnie

@ldndoc

1 year

@chriscraigCCC Did you know - Royal College fees are tax deductible, so you can get 40% (or whatever your marginal rate is) off. One weird trick is that you can actually get 100% off by not being a member at all!

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Doug McKechnie

@ldndoc

10 months

@Xeon4f145d96s1 @LittlePersonDoc @HelenRSalisbury I asked her in my response if she wished to submit a correction. Maybe we’ll see that.

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Doug McKechnie

@ldndoc

4 months

It's not really making a strong case for PAs in ED, is it?

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Doug McKechnie

@ldndoc

2 months

@Parody_RCGP To be fair, a sore throat with a fever is not (yet) scarlet fever. FeverPAIN is not entirely unreasonable given it is estimating the probability of Strep infection. But 'there is a scarlet fever outbreak at school' would affect my diagnostic probabilities.

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Doug McKechnie

@ldndoc

1 month

@anish_k_patel I genuinely don't know how these GPs have such a low opinion of their own utility. ("What I do is actually very easy and doesn't need as much training or knowledge as I have.")

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Doug McKechnie

@ldndoc

5 months

@BogodDavid Aren't they the ones that move the operating tables up and down for the surgeons?

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Doug McKechnie

@ldndoc

1 year

@Dr_Done_ I have 6 years undergrad experience (MBBS/MA), 9 years postgraduate, various postgraduate qualifications, and I still find GP work intellectually challenging (and therefore interesting). Maybe I'm just very dim.

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Doug McKechnie

@ldndoc

1 month

@peaceanddoug @BJGPjournal Imagine the cheek of salaried GPs expecting a salary commensurate to their skills, expertise, and responsibility!

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Doug McKechnie

@ldndoc

4 months

@DoctorJLam No, I wouldn't. The advice is the same regardless - 'lifestyle' (healthy diet, exercise, maintaining a healthy weight). I do appreciate the patient's concern and motivation to improve things, though. I might do a fasting glucose if they really want, but it will be normal.

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Doug McKechnie

@ldndoc

3 months

@naomi2009 @leenaV4565 You can get seen same-day for whatever you want at a private GP, but it will cost £70-£100 (NHS GP gets about £160 per patient per year to cover all care). Ironically, those private GPs are far more limited in what they do than the NHS. Fund NHS GP properly.

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Doug McKechnie

@ldndoc

7 months

@pepemac27 "Hello, police? Yes, I'm being held captive"

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Doug McKechnie

@ldndoc

1 year

@drkeithsiau Livedo reticularis, although I'll go for erythema ab igne as a differential.

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Doug McKechnie

@ldndoc

1 year

@Dr_Done_ I was going to say that PEs are tricky diagnoses and easy for even the most experienced clinicians to miss, but... to elicit breathlessness and calf pain and diagnose two unrelated conditions is... not so great.

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Doug McKechnie

@ldndoc

6 months

@Parody_RCGP @drgandalf52 most of them do this tbh, RCS(Eng I think) sends out a letter demanding return of the MRCS/FRCS diploma. MRCP(UK) is one of the few exceptions that is not membership-dependent. Anyway, us cool kids just use MRCGP(year of passing the exam) to indicate a qualification.

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Doug McKechnie

@ldndoc

3 months

@misha_saul @ctine__ So... you told your friend that they might have an aggressive brain tumour that their physicians missed, and it then took 3 further opinions to confirm that the original normal read was correct? How did your friend feel?

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Doug McKechnie

@ldndoc

2 months

@DrEilidhMaria This reads like something an American doctor would post on med twitter, along with a black-and-white photo of them crying, because they Care. So. Damn. Much.

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Doug McKechnie

@ldndoc

4 months

Choosing F1s as the comparator is interesting. Most EDs don't have F1s, who generally need close supervision (all discharges discussed). Usually the most junior doctors in EDs are F2s. The F1s are in ED for max 4 months, whereas the PAs can remain in post for years.

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Doug McKechnie

@ldndoc

3 months

@parthaskar @NHSE_WTE @PrimaryCareNHS @rcgp @DrSelvarajah @MFAminGP @sas_sobauk @trishgreenhalgh @doctor_oxford @drgandalf52 @mmamas1973 @RobJimFleming @DrAsifQasim @DrLKVaughan It is very bizzare, isn’t it. A similar dichotomy is evident in the recommendations for postgrad training: 1 “GP regs need half an hour debrief for each clinic” 2 “PAs need 10-15 mins of debrief every few weeks, if they think they need it”.

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Doug McKechnie

@ldndoc

9 months

@Dr_Done_ "from medical school" caused a reflex spike in my blood pressure.

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Doug McKechnie

@ldndoc

11 months

@Parody_RCGP Dear consultant, No. We both have much better things to do with our time. Please manage your own waiting list for your own procedures. Kind regards,

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Doug McKechnie

@ldndoc

3 years

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Doug McKechnie

@ldndoc

3 months

@JanjuaAdam Happens multiple times a day. Recently in same clinic: "I never got the biopsy results from the hospital, I assume it was OK?" (I looked it up, fortunately it was) "Can I have the results of [hospital ordered test]?" "Hospital cancelled my appointment, can you help me rebook?"

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Doug McKechnie

@ldndoc

10 months

@ExplosiveEnema are you reporting these to the GMC unregistered practice email? (good work though)

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Doug McKechnie

@ldndoc

3 months

@Ask_foradoctor So on my GP training programme there were rotations in acute med, paeds, ortho, ENT, ophthal, derm/rheum, geris, public health, pall care, gynae, psych, ED (maybe more) and of course GP. It's a shame that those GP trainees were not capable of working across that range then.

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Doug McKechnie

@ldndoc

10 months

@lucypgeridoc @bethicillin Yes, but…… the decision not to scan needs to be carefully justified, especially given that a lot of these patients lack capacity to decide, and a fatal ICB is likely to result in the decision being scrutinized in coroner’s court.

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Doug McKechnie

@ldndoc

3 months

@Cleverclog67596 First time I went to resus as a med student was to attend (as an observer) resuscitation for an out of hospital cardiac arrest, and unfortunately the patient died. I had a lot of thoughts and emotions, but none were "wow this is so cool, let's post a video on socials".

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Doug McKechnie

@ldndoc

3 months

@Ask_foradoctor The funniest thing about this story is how the responder pitched up, took two big medical bags out of her car, used trauma shears to cut off the victim's clothing, but the nurse who was attending clearly knew she didn't know what she was doing.

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Doug McKechnie

@ldndoc

1 year

A good counterpoint to the "F1s are useless" shtick the other day. There's not many jobs where, within 1 year of starting, you're speaking to people about their loved ones dying. (Nursing is one of them, too.)

SH

@stephenrhughes

1 year

@NHypService @veggieequallife I make sensitive phone calls to families about matters including DNACPR, end of life care and even to tell them their loved ones have passed away. Without a doctor's office I'm forced to do the above in the corridor or at the open nurses station 2/

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Doug McKechnie

@ldndoc

10 months

@BlackM1710 @doctor_dru_ No, they shouldn't do that, because it's misleading to patients as to what their qualifications are. They are still a highly valuable and skilled clinician.

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Doug McKechnie

@ldndoc

3 months

@DrPastry Perichondritis is fairly rare, though. I doubt pharmacists see much of it. Think I’ve seen 1 or 2 in 4 years of GP (much more in an ENT job ofc). Probably does make sense to require that to see a dr.

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Doug McKechnie

@ldndoc

11 months

@jasaunders90 @Alexsahistul In primary care, a PA is always going to need more supervision - and have a narrower scope of practice - than a GP registrar towards the end of their training. And yet, worryingly, some places seem to offer much less supervision to their PAs.

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Doug McKechnie

@ldndoc

3 years

is there a medical term for 'brain zaps' (the SSRI side effect)?

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