Person Pikin

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Person Pikin

Person Pikin

@First_Neptunian

Anonymous diary of an opinionated medic (MBBS, not MSc). Retweets are not endorsements. Tweets may contain 'spices'. ⚠️ Supporter for #PayRestoration

England, United Kingdom Katılım Ocak 2020
460 Takip Edilen274 Takipçiler
Person Pikin
Person Pikin@First_Neptunian·
If anyone risks obsolescence by virtue of evolving technologies, it’s the specialist rather than the generalist, but the nature of medicine as an art rather than pure science means obsolescence will be difficult to achieve.
Seb@SebPillon

Genuinely wonder if specialists are unaware of direction of travel in NHS and see themselves as untouchable. As GPs, we are used to having to constantly justify ourselves so aren't complacent. If expertise is simply replaced by "test and discharge"... Who needs a consultant?

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Seb
Seb@SebPillon·
Genuinely wonder if specialists are unaware of direction of travel in NHS and see themselves as untouchable. As GPs, we are used to having to constantly justify ourselves so aren't complacent. If expertise is simply replaced by "test and discharge"... Who needs a consultant?
Parody RCGP@Parody_RCGP

We get around 100 of these a month from various specialist teams who think we are their clinical dog. Can't wait till we go private. Can't wait.

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Person Pikin
Person Pikin@First_Neptunian·
There is no way that anyone would be obese if they were in a true caloric deficit, persistently. But people be deceiving themselves.
Lauren Chen@TheLaurenChen

At one point in college, I had an obese roommate. After a few weeks, she complained about how lucky I was to be thin, since I ate more than her. The thing is, however, that I absolutely did not eat more than her, in terms of calories or just amount of food. She put ranch on everything. 600 calorie drinks. Endless snacking. Maybe my plate was more full than hers at dinner, but it was obvious tp everyone but her that she was consuming more throughout the day. I'm sorry, but after multiple instances of this happening with other overweight people, I just don't trust when someone heavy insists they're in caloric deficit. Maybe some people lose weight faster than others. For sure. But it's simple science that if calories out exceed calories in, you WILL lose weight.

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ThesalariedGP
ThesalariedGP@zaynhasn·
But all of the above would have been easily avoidable had secondary care done its job. Easily, we are littered with inefficiency because getting it right first time should be about clinical efficiency and patient journey and not just diagnosis and treatment
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ThesalariedGP
ThesalariedGP@zaynhasn·
Lets talk about why you can’t see your GP. 🧵 I got a letter from specialist, patient seen f2f, doctor and prescriber. Says patient needs a drug for symptom pertaining directly to their condition seen specialist for. Vagueness in plan of “GP to consider”
Parody RCGP@Parody_RCGP

We get around 100 of these a month from various specialist teams who think we are their clinical dog. Can't wait till we go private. Can't wait.

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Seb
Seb@SebPillon·
Being a GP is now a never ending game of apologising that other services no longer offer care, explaining tests and treatments done by others, and late nights researching how to manage conditions previously handled by specialists. (Whilst being chastised for all NHS ills)
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Person Pikin
Person Pikin@First_Neptunian·
HF nurse - I’ve seen this patient for heart failure and made no changes to what the GP did. Discharge back to GP for rapid heart rate to “consider rate control” WHAT’S THE BLEEDING POINT OF YOU?! This bureaucracy is maddening. FFS!
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Person Pikin
Person Pikin@First_Neptunian·
@CarysBarton @XelenX1 I agree with different levels of knowledge for different skills. However, I’d expect anyone to seek advice at their limits before sending a letter. It does to a degree, help that is, if only to hear the experiences of others.
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Person Pikin
Person Pikin@First_Neptunian·
@CarysBarton @XelenX1 I agree. Which is why I expected more. But this is all I’m to expect from the local HF service, then time spent making a referral is inefficient.
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Person Pikin
Person Pikin@First_Neptunian·
@CarysBarton @XelenX1 On the other hand, I’d be very surprised if any GP didn’t know how to manage heart failure. Complexity is our bread and butter. A referral to the HF team isn’t in the hope that they’d manage our complexity for us but that they can coordinate holistic HF care for the pt
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Person Pikin
Person Pikin@First_Neptunian·
@CarysBarton @XelenX1 Perhaps but I’ve got so much on my plate to be telling other people how to do their jobs and my experience with ICB escalation has been pointless. If they don’t have sufficient cardiology oversight, what stops them from escalating themselves if they believe they are unsafe? /
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Person Pikin
Person Pikin@First_Neptunian·
@Eemeyrald 100%. If this sort of care is the apex of what the service is able to provide, it’s certainly a waste of time involving them and best to manage the patient in primary care
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OnlyEm
OnlyEm@Eemeyrald·
@First_Neptunian So many titles, still poor outcomes. I don't waste my time with them anymore
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LostDaze
LostDaze@LostDazes·
@partywcrypto @First_Neptunian Are they at least a gateway to more expert doctor treatment, cardiac rehab, complex meds, devices, if they are aware of their limits?
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Person Pikin
Person Pikin@First_Neptunian·
@LostDazes Completely agree. Tbf, they did assess for compromise, incompletely. However, If this was what I was foresaw happening to the patient on referral, I wouldn’t have wasted my time completing the proforma.
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LostDaze
LostDaze@LostDazes·
@First_Neptunian Send someone home with nonsinus tachy (/ sinus tachy of unclear cause)? From a hospital clinic? Contact cardiology/ sdec/ ambulatory medical unit. Do a f*g ECG, assess for compromise. Rate/ rhythm control as appropriate (DCCV if appropriate). That's an unsafe HF (causing) nurse
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Person Pikin
Person Pikin@First_Neptunian·
@2manypeople4me @CarysBarton @DrJoFranklin Should not exist then if they can’t make decisions. We can provide holistic care and refer directly to cardiac rehab, it will just take a bit more time which we are unfunded for, especially when there’s a service specifically funded for this purpose of coordinating HF care.
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Person Pikin
Person Pikin@First_Neptunian·
@CarysBarton @DrJoFranklin This certainly sounds like what I’d hope the HF service does. Exceptions to cardiology oversight would be worrying tbh, especially as complexity is the order of the day in a lot of HF patients. x.com/First_Neptunia…
Person Pikin@First_Neptunian

@XelenX1 Tweaking heart failure medication is something that every GP is comfortable with. I refer to the HF service because I’m hoping the patient will have a more holistic experience - rehab, access to cardio oversight, access to monitoring echos if needed, etc.

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Person Pikin
Person Pikin@First_Neptunian·
@DrJoFranklin @XelenX1 Very expensive business if they’re not providing the value expected and arguably dangerous if they have become a silo’d business
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Jo Franklin
Jo Franklin@DrJoFranklin·
@XelenX1 @First_Neptunian Quite convinced that HFNs used not to be like this. Is this a product of ACP courses & finding roles for people who don't actually have years of experience & clinical acumen? Why are we doing this? At best expensive busyness. At worst it's much worse than that.
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