MKeech

@Finumus1 @NHSuk Depends on what low means…Shows the classic problem with some private providers happy to do and charge for investigations but then not actually manage the results. Doings tests is the easy bit!

Low bone density on DEXA scan (private obviously) Advised to go see @NHSuk GP who told me to "drink more milk". It's like talking to ChatGPT 2.5. 🤦

@Finumus1 If you have to do them. But those false positives are more likely to harm you than the potential benefits.

Aggressive health screening (broad spectrum cancer blood tests, full body MRI) - high rate of false (or real, but wasn't going to kill you) positives - DO NOT have them until you've bought your last slug of life insurance and then HAVE THEM ALL just before you buy your Annuity?

@Finumus1 @HaircutTungsten Interesting, I probably examine 80-90% of my non review patients in GP? One of the big barriers will be digital/general literacy along with regulation. AI is pretty dependent on how good your prompts are - many people struggle to describe their problems in a ‘medical’ way.

@HaircutTungsten Maybe. I don't really understand the difference though, the last maybe 30 times I've been to the GP, they've not touched me, just asked me to describe my symptoms, asked me questions, prescribed me something, or referred me to someone else. Which of those can an AI not do?

If we're still using human GPs for any more than 5% of patient interactions in 10 years time - we've seriously dropped the ball. AI is already better than most Doctors.

@Hrushworth Random removes autonomy and worst (by scoring matrix used) going to least desirable year after year is also bad for patient equity.

@Hrushworth Is this politically possible? Not sure but there is the fundamental tension of doctors not wanting to go equally to everywhere people need and should get equal quality care - I would rather incentives pay/perks/whatever over a demoralising random stick or just on grades etc

The NHS’s random allocation system for junior doctors has got to be one of the largest acts of self-harm an institution has ever done to itself.

@Hrushworth Yeah that would be seen as even worse many! Would be the end of the national contract which would be radical and hugely resisted for ‘race to the bottom’ concerns as is already happening in parts of the GP market which has the IC model.

@MKeech2 Ah yes, that’s fair. Apols, in my head, I had equated pricing mechanism to assigning a ‘price’ to candidates based on how good they were, along the lines of a preferential allocation system.

@Hrushworth 1) BMA don’t want it 2) Even most non-unionist doctors would think it ‘unfair’ that you get paid less for working at an ‘elite’ hospital 3) politicians and trusts also not keen I suspect for the pay increase costs it could mean alone let alone optics

@MKeech2 Reminds me of when polls come back with “yes, we should have higher taxes, oh no, not on me though, I already pay too much tax”. Why are pricing mechanisms not allowed?

@KlausRB @maxtempers But you have provisional registration as an F1. So the option is go where told or leave medicine. Which is a choice, but pretty extreme one to have to take after at least 5 years working towards the career because of a random number generator.

@maxtempers That’s not quite the whole truth. It’s bad but you can’t be sent anywhere against your will. You can say yes or no.

Spoke to some doctors and the latest batch of F1s are the worst ever, due to the new non-merit-based randomised allocation system. They're from top London hospitals that traditionally are v 'in demand', and this is a complete shock to the system. Also no one's really trying anymore beyond the bare minimum in tests as it doesn't matter, people topping their class are ending up being sent to places at the bottom of their preferences and just quitting. We've somehow made the NHS even more communist.

@Parody_RCGP ‘The service might not have time’ but obviously GPs do…

I can smell the work dumps from secondary care already....I wonder how many GPs contributed to this guidance and felt that this was appropriate?

@LukeAmos__ @Parody_RCGP I haven’t directly - Expecting individuals rather than organisations to do that is rather a high bar to set.l for participation in discourse and society.

@MKeech2 @Parody_RCGP And how long have you been lobbying the government to reflect the funding of pharmacy to that effect?

I bluntly told the consultant at the hospital that I wanted them to see me three times as often and they compromised at twice. Love how people think we are fair game and then brag about it. Hat tip to my pharmacy colleagues too.

@LukeAmos__ @Parody_RCGP I have been issuing 2 month scripts since I was a trainee? Hardly ‘new’

@MKeech2 @Parody_RCGP So any sane person would agree that if something systematic needs to change, it needs to change in tandem with for example pharmacy funding Not one before the other

@Parody_RCGP That’s a problem with the pharmacy funding model which I agree isn’t good. Generally things that make it easier for patients and reduce admin burden I am in favour of.

@MKeech2 And how would the pharmacy get paid for it's services? Would you be happy to earn half as much because someone spotted a way for things to be more convenient for them as an individual?

@Parody_RCGP Would it be much better or a waste of time? Whereas getting most people on to 2 monthly scripts for stable non control drugs they take regularly actually saves time. I agree pestering GPs about it isn’t helpful and invariably involves a monitored drug.

@MKeech2 And if the consultant sees the patient monthly their care and overall health would be much better too. They would be able to work more and provide more economic growth. Everything is so simple right?

@rcolvile @hor22189 London weighting doesn’t really vary medical pay as it has been static for well over a decade unlike salaries and is the same at each grade. The justification that while London is expensive it is still oversubscribed so doesn’t need even more incentive in higher base pay.

@hor22189 Yes but the system doesn't allow you to vary pay significantly (apart from the London weighting). Then again if every doctor was paid market rate the NHS would cost even more...

The NHS placement row is the logical culmination of being the last genuinely nationalised sector. Eternal tension between where people want to work (good hospitals in cities) and where they are needed, which can’t be solved by hiking pay for roles with less demand.

@Finumus1 Make sure you are not unnecessarily fatigued and do what they say with respect to eating/coffee beforehand.

I'm having a VO2 max test in a week. Any tips on how to smash it?

@Parody_RCGP @DrGoblin3 Maybe not but I suspect going to be net work positive to see so I don’t have to deal with the discharge summary and likely follow up appointment if I get it right first time.

@MKeech2 @DrGoblin3 Not GMS.

Triaging GPs in surgeries: 10 yr old child’s parents request F2F appt 12 hrs after head injury. No red flags in brief Hx given. Do you choose… Show your working.

@SahalQuazi @DrGoblin3 Are you not now almost guaranteeing 2 appointments rather than one here? Or are you expecting a very high rate of 'mild safety-net?' given we are pretty happy 'no red flags'

@DrGoblin3 Phone consult to get more details, what type of head injury, any loc etc etc then f2f, or send to ED or if it’s very mild safety net