Linda de Cossart

@afshineemrani Very important message. I am disappointed these days at the common lack of curiosity and searching that seems prevalent amongst our young. We are not brining them up well.

In medical school, we are taught a golden rule: "When you hear hoofbeats, think horses, not zebras." It is a reminder to look for the common explanation before the exotic one. But after decades in cardiology, I’ve learned that if a patient is still suffering after the "horses" have been ruled out, a doctor must have the courage—and the curiosity—to go hunting for the zebra. Sarah was a thirty-four-year-old marathon runner and a devoted mother who came to me after six months of being told she was "fine." She had been bounced from one specialist to another, each one pointing to her normal EKG and standard blood tests as proof that her crushing fatigue and racing heart were simply the result of "new mom stress." By the time she reached my office, she didn't just look tired; she looked invisible, as if the medical system had stopped seeing the woman and only saw the data. Instead of re-reading the normal test results that had already failed her, I asked Sarah to walk me through her life. We talked about her training and her family, eventually landing on a backpacking trip she took to the Mendoza province of rural Argentina. She described staying in a charming, rustic cottage made of sun-dried mud bricks. She mentioned waking up one morning with a strangely swollen, purple eyelid that she assumed was a simple spider bite. As she spoke, a memory surfaced from a biography I had read years ago about Charles Darwin. Most people know Darwin for his theories on evolution, but medical historians have long puzzled over the mysterious, debilitating illness that plagued him for decades after he returned from his voyage on the HMS Beagle. Darwin had written in his journals about being bitten by the "great black bug of the Pampas" while sleeping in mud-walled huts in South America. He spent the rest of his life suffering from heart palpitations and exhaustion that the Victorian doctors of his time could never explain. I realized then that Sarah wasn't suffering from stress; she was likely hosting the same "silent killer" that may have haunted Darwin: Chagas Disease. The "Kissing Bug" lives in the cracks of those mud-brick walls. It bites its victims—often near the eyes or mouth—while they sleep, passing a parasite called Trypanosoma cruzi into the blood. The danger of Chagas is that the initial symptoms disappear quickly, but the parasite can hide in the body for years, slowly weaving itself into the muscle and electrical "wiring" of the heart. To confirm this, I moved beyond the standard tests. I ordered a specialized "Strain Rate" ultrasound, which doesn't just look at whether the heart is pumping, but at how the individual muscle fibers are stretching. We saw that while her heart looked strong to the naked eye, the fibers were "stuttering," a sign of early parasite-induced scarring. A specific blood test for the parasite's antibodies confirmed the diagnosis. Treatment required a difficult, sixty-day course of anti-parasitic medication to stop the infection, paired with a protective heart regimen to keep her electrical system stable while the inflammation settled. Because we caught it before her heart was physically damaged or enlarged, the recovery was a success. Months later, Sarah returned to my office, her vibrant energy restored. She brought me a leather-bound copy of The Voyage of the Beagle with a note tucked inside. She wrote that while other doctors had looked at her charts, I had looked at her. This case remains a vital reminder for my memoir: in a world of high-tech scans and AI, the most sophisticated diagnostic tool we possess is still the human story. When we truly listen, we don't just find the disease—we find the patient. Good morning.

@MadsDavies Great question. Perhaps helpful might read…changed you thinking and your living???

REQUEST. Clergy - can you give an example of training provided by the diocese that you found really helpful? Not for an article, I'm just curious! Could be one day, or a course or programme etc.

@dr_shibley Happy new year Shibley

As we arrive in London at 2026, I should like very much to wish you a happy new year. I found that life is actually much shorter than you think, so value all your friendships; follow your dreams, but make sure you don't waste your time on unimportant stuff. Take care xxxx

‘Respair’ is a word recorded just once in the OED. It means ‘fresh hope’, a recovery from despair. I wish the world and the Church and human hearts everywhere respair in the new year. @thetimes @guardian @ChurchTimes @churchofengland

@RoyLilley Happy new year

Wishing you all a happy and healthy New Year

It is not too late to put the brakes on assisted dying, and focus on improved palliative, social and end-of-life care theguardian.com/commentisfree/…

Great opportunities for values in postgraduate medical education research #MedEd #medicaleducation @ED4MEDPRAC

Dear @David_Cameron I know you mean well, but unfortunately screening for early disease may sound logical and sensible but can also be ineffective and harmful. Recommending a bad test leads to false reassurance, and harms through unnecessary or ineffective treatment that only /

@ProfRobHoward Not rocket science but will it really stimulate action?? I hope so.

The Medical Training Review Diagnostic Report today makes 4 recommendations to improve postgraduate medical training. I’m very pleased that these all align with priorities I had already set out in my Manifesto for College President at profrobhoward.com. We can do this!

@RoyLilley A travesty and very flawed thinking. How will the NHS survive??? Or will it.

frontline staff! The people who keep the show on the road, will have to queue at the pharmacy, behind the old geezers… credit card in hand… to protect themselves, their patients and... ... the service that employs them. myemail.constantcontact.com/CQC.html?soid=…

You can now purchase three of our books via shopify r1pipy-tb.myshopify.com

How can we move from accumulation to abundance? What's the relationship between money & spirituality? We've come to the end of this week's "Daily Meditations," exploring these questions. Revisit highlights from our meditations with today's weekly summary. buff.ly/CIvDLvV

I'm inspired by my colleague @brianmclaren's words in today's "Daily Meditations." He writes: "We are free to understand Jesus as more than a prophet, but we should never understand him as less." Join us this week as we explore Jesus as a prophet. buff.ly/SYYVrAf

@parthaskar @SwearyPaed @RCPhysicians @rcgp I think we are very week at making explicit how doctors think and act. Someone see fluency and expertise and think it is matter of copying!!

Opinion: The acceleration of replacement of doctors with the philosophy of 'anyone can do that role'? Squarely down to the passivity of Royal Colleges ergo @RCPhysicians @rcgp Politicians have played it as they saw fit-the greenlight from the Colleges is what has set that train in motion. Leaders who have it all- have chosen actively to dunk their Gen Next due to their desire of prizes and access. #JustSaying

This is Trevor Fisher, an inpatient in @ArthurRankHouse in Cambridgeshire, speaking to @Channel4News this week. I am a palliative care specialist and Trevor’s interview has devastated me. His hospice has just found out that in 6 months, Cambridge University Hospitals NHS Trust will withdraw its £800k funding. This means that 9 of the hospice’s 16 beds will close, denying patients like Trevor the precious end-of-life care they need. In total, 200 people a year in Cambridgeshire will now be forced to die in an overcrowded hospital instead of the hospice environment they so longed for. Some will doubtless end up dying on trolleys in corridors - we witness this far too often, these days & I can tell you, it is barbaric. @CUH_NHS says it has made this “very difficult decision” following a “value for money assessment” - confirming what I have long known as a doctor, that too often, patients with terminal illnesses are treated as second class citizens whose lives simply don’t matter as much as other people's. Yet the real responsibility here lies not with the NHS trust but with the current government, who is forcing the NHS nationwide to cut clinical services in order to meet impossible “efficiency savings” (what weasel words those are). These cuts were necessary, say @CUH_NHS, “in order to maintain core services within a reduced budget” - that is to say, the reduced budget they are now receiving from this government. So this is on you, @wesstreeting, and on you @UKLabour. You've chosen to do this & now patients like Trevor must live - and die - with your choices. I believe that the measure of a civilised country is how well it cares for its most vulnerable members. The difference between politicians and me is that I look the palliative care patients they are failing in the eye. So I will put it to you directly, Mr Streeting. We are still a rich country capable of affording decent, humane palliative care for all. Do you really care so little for dying people that you are happy to fail them on your watch? Thank you @channel4news for covering this story. #palliativecare #hospicecare #NHS

Lucy Winkett (a priest in the ⁦@dioceseoflondon, so knows about her leadership style⁩) writes about ⁦@bishopSarahM⁩’s appointment as #ArchbishopofCanterbury. ⁦@OfficeofABC⁩

As the CNC is said to be meeting this week, here is my advice for what we need desperately from a new Archbishop: trust the people and clergy on the ground; let go of the power to control what they do and how they do it; show that they are loved. thecritic.co.uk/biscuit-crumbs…

@DrNeenaJha So so important and hard to teach in the current context of medical practice. Please don’t stop !

I have obtained the patient’s permission to share his story below… I’ve chosen to post it now, years later, as I feel it highlights the danger of taskification of medicine & how detrimental it can be for patients Some details changed for further anonymity 🧵 1/n

@Rav_Ortho @jamestoml1 Useful paper but I would question the acceptance of ‘without explicit explanation’. The whole point of deep understanding is that you can understand why this is important.

Out now…Bridging the gap: exploring the impact of bootcamp on non-technical skills and professional development in early-career orthopaedic trainees Check out link.springer.com/content/pdf/10… Great work Zaha Siddiqui @jamestoml1 Chris Lewis, Vivek Balanchandar

@jfdwolff @parthaskar @HmniDipti Be able to use discretion and think deliberately

@parthaskar @HmniDipti It does create an obligation to use our knowledge and training to do the things that others (including other HCPs) cannot do. That includes a degree of professional curiosity, being prepared to overrule daft requests/pathways, and actually leading the MDT.

It isn’t elitist to be proud to be a doctor. Don’t allow yourself to be gaslit to an extent where you aren’t proud of your hard earned degree. I am a Doctor. And very proud to be one. #WednesdayWords 😊