Lucie Cocker

I hadn’t anticipated the overwhelming response & engagement to my tweet as @ASTC108 left the NHS. I’m trying to reply to everyone but I’m sure there’s some I’m missing so here are 🧵’s answering the two main themes: 1. Why are we leaving? 2.Aussie system v NHS

@clifford0584 This isn’t the ‘mic drop’ you think it is. If someone is unwell or in distress either help them or say you don’t want to. Don’t hide behind a false statement.

🆕 Hypertension Classification New AHA 2024 guidelines have omitted ❌Hypertensive urgency ❌Hypertensive crisis

*SEXUAL HARASSMENT IN SURGERY* One of these brave doctors is a friend. I know some of the turmoil they have been through Please read this and sign the open letter to insist on greater sanctions for surgeon James Gilbert @wesstreeting @gmcuk ➡️ forms.gle/bvWrjeJA82HFPR…

@EM_RESUS Abdominal compartment syndrome?!

Here’s the most impressive X-Ray of this medical emergency I’ve ever seen What’s the diagnosis?

The Emergency Department is not the out-of-hours stop gap for other Speciality’s expected workload

@caldy003 Rusty

@drokane Fittingly given its international nurses day today, I was supported by the ward matron who overheard and escalated to senior management who stepped in to reallocate other registrars to cover the on call registrar gap.

@drokane Actually Kevin I wasn’t ’up for it’ - I’ve never been afraid of hard work or challenging situations but I’m not a ‘have a go Henry’ either. I believe patients deserve better than that. (1/2)

FY2 Gen Med, reg didn’t show one am. Consultant said I should take arrest bleep for the hospital. Concerned I was too junior for that I asked could he take it -he said ‘no’, put bleep on the floor & walked off saying ‘up to you if you leave it there & let people die or not’ 1/3

@drokane @KeepGoinEoin Can I suggest you take a break and then come back. I’d be interesting in your thoughts on the consultants approach to a junior raising concerns by putting a bleep on the floor and walking off.

@drokane @KeepGoinEoin Kevin, for whatever reason you are now being deliberately obtuse & argumentative. We’ve know each other a long time through BMA committees & I’m really surprised to see you take this stance.

@drokane @RoshBoshski Is it any wonder trusts & government feel a PA can do a doctors job when medical consultants like yourself are being so reductionist about the skills and necessity of medical training that they argue tooth and nail that an FY2 should be fine to do a registrars job.

@drokane @RoshBoshski Medical training and exams exist for a reason. An FY2 is not the same as a registrar. Expecting them to perform the same role nulifies that training and education and creates an environment where people feel ashamed to ask for help or have a falsely elevated self confidence.

@Xeon4f145d96s1 @drokane @Louisdebernard Absolutely agree. A conversation like that would have turned this into a valuable learning experience.

@drokane @Lucie_Cocker @Louisdebernard But all that is a separate conversation and a significant number of other means available at the consultants disposal to at least ask about why an F2 feels unconfident + coming up with a mutually happy agreement.

@RoshBoshski @drokane

@drokane @Lucie_Cocker agree with most of your tweets but not sure about these ones. Sure, F2+ALS can carry bleep. but main point is not giving a shite about the absent SpR, apprehension of junior colleague, and placing it on the floor with emotional blackmail - all suggests s/he can't be trusted.

@telswood @XelenX1 Great start to learning, certainly not the end. There’s a journey in the middle that’s essential to form a confident evidence-based clinician who can go further than a narrow algorithm. I truly hope no one leaves their first ALS thinking they’ve reached the summit of resus care

@drokane @Louisdebernard The wards already had their own foundation doctors to do that, the med reg on call/med reg arrest bleep was their escalation. A further foundation doctor would add nothing, as the trust recognised by not allowing foundation doctors to pick up locums in that role.

@Louisdebernard @Lucie_Cocker Not every peri arrest pt gets a registrar review. Paramedics manage these daily in community. SHOs in community hospitals manage these. Registrars maybe busy elsewhere. I expect an F2 to be able to assess and make a plan and call for guidance approval if needed.

@Louisdebernard @drokane Agreed.

@drokane @Lucie_Cocker Most arrest calls are actually peri-arrest calls that need urgent senior decision making, no? Isn't that much of the point of having the med reg attend? CCOT/resus officers/anyone with ALS could run the ALS aspect of a full cardiac arrest.

@drokane I think at the stage we probably just need to accept we disagree. 9yrs on I strive to consciously ensure my juniors never feel that unsupported. That wasn’t a productive learning environment, or a patient safety focused one either. I’m fortunate to now be surrounded by better.

@Lucie_Cocker Yes well take the call and pass to consultant if unsure what to do. Just take number say u need to discuss and call back.

@drokane The brevity required for twitter may have hindered this a little - med reg cardiac arrest bleep was also the on call bleep that all, ED and external used to get advice. Far more than just ALS needed and those without PACES were not allowed to locum to cover that role as a result.

@Lucie_Cocker PAs: I have ALS I can run a cardiac arrest Paramedic: I have ALS and I can run a cardiac arrest F2: I have ALS and I can't run a cardiac arrest